Heterogeneity in regional changes in body composition induced by androgen deprivation therapy in prostate cancer patients: potential impact on bone health-the BLADE study.

BACKGROUND: It is not clear whether changes in body composition induced by androgen deprivation therapy (ADT) in prostate cancer (PC) patients are uniform or vary in the different body districts and whether regional lean body mass (LBM) and fat body mass (FBM) could have an impact on bone health. OBJECTIVE: To prospectively evaluate the regional changes in LBM and FBM in PC patients submitted to degarelix; to explore the relationship of regional body composition and bone mineral density (BMD) and bone turnover markers. DESIGN, SETTING, AND PARTICIPANTS: 29 consecutive non metastatic PC patients enrolled from 2017 to 2019. FBM, LBM and bone mineral density (BMD) evaluated by dual-energy x-ray absorptiometry (DXA) at baseline and after 12-month of ADT. Alkaline phosphate (ALP) and C-terminal telopeptide of type I collagen (CTX) assessed at baseline, 6 and 12 months. INTERVENTION: All patients underwent degarelix administration. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: T-test or sign test and Pearson or Spearman test for continuous variables were used when indicated. RESULTS AND LIMITATIONS: Median percent increase in FBM ranged from + 14.5% in trunk to + 25.4% in the left leg after degarelix. LBM changes varied from + 2% in the trunk to - 4.9% in the right arm. LBM in both arms and legs and their variations after degarelix directly correlated with ALP and inversely correlated with CTX. Lean mass of limbs, trunk and legs significantly correlated with BMD of the hip, lean mass of the trunk significantly correlated with spine BMD. These are post-hoc analysis of a prospective study and this is the main limitation. CONCLUSIONS: an heterogeneous change in body composition among body district is observed after ADT and bone turnover is influenced by lean mass and its variation. A supervised physical activity is crucial to maintain general physical performance and preserving bone health.

Difficulties and practices regarding information provision among Korean and Italian nurses.

AIM: To investigate nurses' opinions and practices of providing information in a global context through cultural comparison. BACKGROUND AND INTRODUCTION: Providing sufficient information to patients about nursing interventions and plans is essential for patient-centred care. While many countries have specific legislation making information delivery to patients a legal duty of nurses, no such legislation exists in both the Republic of Korea and Italy; nurses' only guidance is the deontological code. METHODS: This was a cross-sectional survey study involving a convenience sample of 174 Korean nurses and 121 Italian nurses working in internal medicine and surgery at university hospitals. Data were collected using a self-administered questionnaire between February and November 2014. The questionnaire assessed demographic and professional characteristics, and difficulties and practices regarding information provision. RESULTS: Korean and Italian nurses significantly differed in all demographic and professional characteristics. More Korean than Italian participants reported that their role in providing information was well explained within their teams, but both groups reported the same level and type of difficulties in delivering information. Nurses in both countries regularly informed patients about medications and nursing procedures, but provided information about nursing care plans less frequently. Few nurses frequently provided information to relatives instead of patients. CONCLUSIONS: Despite cultural, demographic and professional differences between Korean and Italian nurses, their difficulties and practices in information delivery to patient were similar. IMPLICATIONS FOR NURSING AND HEALTH POLICY: Hospital managers and policymakers should be aware that nurse-patient communication can be impaired by organizational factors, patient characteristics or the interaction among providers. Educational interventions and strategies are needed to increase information provision to patients about nursing care plans.

Use of contrast-enhanced ultrasonography in chronic pathologic canine testes.

Contrast-enhanced ultrasound with sulphur hexafluoride microbubbles was performed in seven healthy dogs without a history of reproductive pathology and with histologically confirmed normal testes and in 42 dogs with chronic scrotal anomalies. All dogs underwent orchiectomy and histological examination. Enhancement patterns and perfusion parameters (peak intensity and regional blood flow) of testes of healthy dogs and testes with chronic lesions were compared. Fourteen non-pathologic and 60 pathologic testes were considered. Forty testes were neoplastic (24 interstitial cell tumours, 9 seminomas, 7 Sertoli cell tumours), 20 were non-neoplastic (16 testicular degenerations, 2 chronic orchitis, 1 testicular atrophy, 1 interstitial cell hyperplasia). In healthy dogs, the contrast medium flow had a rapid homogeneous wash-in and wash-out, with a short peak phase. With contrast ultrasound, testes that were inhomogeneous with a hyperenhancing pattern were associated with neoplasia (sensitivity: 87.5%, specificity: 100%). Lesions with persistent inner vessels and a hypo-to-isoechoic background were significantly associated with seminomas (sensitivity: 77.8%, specificity: 100%). Testes with non-neoplastic lesions were characterized by a scant/moderate homogeneous enhancement. Perfusion parameters were higher in neoplastic lesions. Contrast ultrasound was a feasible diagnostic tool in the assessment of testicular lesions, with hyperenhancement being an important feature in the diagnosis of malignancy.

Effect of pelvic inclination and torsional deformity on canine acetabular morphology with computed tomography. A phantom study.

OBJECTIVES: To evaluate how the inclination and torsional deformity of the hemipelvis using extra-rotation as a model affect acetabular angle (AA) and dorsal acetabular rim angle (DARA) assessment with computed tomography (CT). METHODS: A normal canine hemipelvis positioned in dorsal recumbency was scanned with a 16-slice multidetector CT scanner, with different degrees of torsional deformity, using extra-rotation around the long axis (0-5-10-15°) of the hemipelvis. Each degree of extra-rotation was acquired at 0°, +20° and -20° of gantry tilt, to mimic different pelvic inclinations on its transverse axis. Cranial and central individual acetabular angles (IAA) and central DARA were calculated and correlated with inclination and torsional deformity. RESULTS: A very strong negative correlation was found between cranial and central IAA, pelvic inclination, and torsional deformity. A very strong positive correlation was found between DARA, pelvic inclination, and torsional deformity. CLINICAL SIGNIFICANCE: Pelvic inclination and torsional deformity affect acetabular angles assessment with CT. The greater the inclination (ilia far from the tabletop in dorsal recumbency) and torsional deformity of the pelvis, the worse the acetabulum appeared. A standardized scanning protocol for acetabular morphology assessment is needed and it should consider pelvic inclination. The actual relevance of pelvic torsional deformity is not well known and it should be investigated more thoroughly.

Relaxation dynamics of a polymer network modeled by a multihierarchical structure.

We numerically analyze the scaling behavior of experimentally accessible dynamical relaxation forms for polymer networks modeled by a finite multihierarchical structure. In the framework of generalized Gaussian structures, by making use of the eigenvalue spectrum of the connectivity matrix, we determine the averaged monomer displacement under local external forces as well as the mechanical relaxation quantities (storage and loss moduli). Hence we generalize the known analysis for both classes of fractals to the case of multihierarchical structure, for which even though we have a mixed growth algorithm, the above cited observables still give information about the two different underlying topologies. For very large lattices, reached via an algebraic procedure that avoids the numerical diagonalizations of the corresponding connectivity matrices, we depict the scaling of both component fractals in the intermediate time (frequency) domain, which manifests two different slopes.

Disseminated histoplasmosis in a cat in Europe.

A cat was presented with a history of vomiting, decreased appetite and weight loss. Abnormal findings were poor body condition, pale mucous membranes, dehydration and a palpable abdominal mass. Abdominal ultrasound showed lymph node enlargement, a mass of uncertain origin, thickening of the muscularis layer of the small bowel, focal thickening of the ileum with loss of layering and free peritoneal fluid. Cytology revealed a piogranulomatous infiltrate and numerous macrophages containing oval or round yeast-like cells 2 to 5 microm diameter with a central, spherical, lightly basophilic body surrounded by a clear halo, compatible with Histoplasma capsulatum, within the cytoplasm. Post-mortem examination revealed cavity effusions, granulomatous nodules in lungs, intestine and omentum, thickened intestinal walls and intestinal perforation. Staining with Grocott and immunohistochemistry (IHC) revealed numerous organisms within the granulomatous reaction. H. capsulatum has a worldwide distribution in temperate and subtropical climates. To the author's knowledge, this is the first report of feline histoplasmosis in Europe.

Radiographic features of pelvis and hip joint development of English Bulldogs.

OBJECTIVES: To evaluate distinctive features of pelvis and hip joint development of English Bulldogs throughout the first year of life. METHODS: The pelves of 20 English Bulldogs were radiographed at three different ages (<4, 6-8, and 12-14 months). At each time point, the dogs were clinically evaluated and the abnormal hip joints were classified as mild, moderate, or severely deformed. The pelves were compared to a phantom study in which external rotation of a normal hemipelvis around its long axis was artificially created at different degrees, with different pelvic inclinations, and classified as either normal and without deformity, or as mild, moderate, or severely deformed. Hip joints and pelvic scores were statistically compared. RESULTS: Although none of the dogs were considered lame at the end of the study, none of the hips showed normal development; 77.5% were moderately to severely deformed at 12-14 months of age. At this age, 75% of the hemipelves had moderate to severe torsional deformity (>5.2 degrees of external rotation), with retroversion of the acetabulum confirmed by the presence of the crossover sign. An external rotation of the hemipelvis on its long axis >5 degrees was likely associated with a moderate to severely altered hip joint conformation. CLINICAL SIGNIFICANCE: Abnormal hip conformation was common in this series of English Bulldogs. Torsional deformity of the pelves with acetabular retroversion was a common and distinctive feature, which has not yet been thoroughly studied in dogs. These findings need further evaluation in English Bulldogs as well as in other breeds.

Incomplete humeral condylar fracture in two English Pointer dogs.

Incomplete humeral condylar fracture was diagnosed by means of radiology, CT, scintigraphy, arthroscopy and bone biopsy in two English Pointer dogs. In both cases an acute thoracic limb lameness, unrelated to a known episode of major trauma, was observed. Incomplete humeral condylar fracture, mainly described in the Spaniel breeds, has been recently diagnosed in Labrador retrievers, Rottweiler, German Wachtel and other breeds. The pathogenesis of the condition is still unknown, but incomplete ossification of the humeral condyle and mechanical stress, alone or associated, have to be considered. However, our clinical and histopathological data lead us to believe that in Pointers, high performance dogs, the mechanical stress can assume a critical ethiopathogenetic role.

[High frequency oscillatory ventilation (HFOV) in the newborn. Study of 10 cases]. / Ventilazione meccanica ad alta frequenza oscillatoria (HFOV) nel neonato. Studio di dieci casi.

OBJECTIVE: To evaluate clinical effectiveness of high frequency oscillatory ventilation (HFOV) with a high-volume strategy in severe neonatal respiratory failure from different causes. PATIENTS AND METHODS: Infants with respiratory failure with oxygenation index (O.I.) > 10, independently from weight, gestation age, kind of respiratory disease, previous treatment with conventional mechanical ventilation (IPPV). Patients were treated with respirator Sensormedics 3100 A. Values of O.I. were recorded at start of HFOV and after 1/2, 6 and 24 hours. Also blood gases, arterial blood pressure and vital data were monitored. If HFOV failed infants were allowed to be shifted to IPPV. RESULTS: 10 infants were selected whose gestation age was comprised between 25-38 weeks and birth weight between 640-2620 grams. Mean value of O.I. at the beginning of HFOV was 31.5 +/- 25.1. In all cases but one O.I. decreased rapidly after HFOV and improvement was significant after 6 hours (10.7 +/- 6.3; p < 0.003) still improving after 24 hours (9.5 +/- 5; p < 0.002). The neonate that did not respond to HFOV had severe congenital valvular aortic stenosis and weighted 930 grams. Four infants died: 3 after response of respiratory failure to HFOV and 1 for cardiopathy. Side-effects were: i) edema in all infants that was treated with furosemide, and ii) transient decrease of sistemic blood pressure after start of HFOV in 6 infants that was treated easily with low-dosage dopamine infusion. No significant increase of the rate of complicating disease was observed in survived patients. CONCLUSION: HFOV with high-volume strategy was able to improve rapidly and significantly O.I. in severe neonatal respiratory failure without increasing complications in survivors. Edema was present in all infants and this might depend on the relatively tardy use of HFOV that required higher mean airway pressures. A more precocious intervention has to be considered in clinical practice.