Role of centers with different patient volumes in the management of rhabdomyosarcoma. An analysis by the Italian Pediatric Soft Tissue Sarcoma Committee.

PROCEDURE: The survival of children with rhabdomyosarcoma (RMS) has gradually improved as a result of the adoption of multidisciplinary treatments. Dedicated skills and facilities are indispensable and more readily available at reference centers. In this study, we examined the role of centers' experience (based on the number of patients treated) in their management of patients with RMS. METHODS: We analyzed 342 patients with localized RMS enrolled in the European RMS 2005 protocol from October 2005 to December 2016 at 31 Italian centers that are part of the Soft Tissue Sarcoma Committee (STSC). We grouped the centers by the number of patients each one enrolled (Group 1: >40; Group 2: <40 and >10; and Group 3: <10), and compared a number of indicators to assess the appropriateness of patients' diagnostic workup and treatment and their survival. RESULTS: Overall, 74.6% of patients were treated at 10 centers, and only three of them classifiable as high-volume centers. Only minor differences emerged between the three patient groups in terms of diagnostic investigations and treatment modalities. Survival was similar in the three groups. Approximately, one in four children treated at the centers in Groups 2 and 3 traveled to another center for surgery or radiotherapy. CONCLUSION: Patients treated at STSC centers with different amounts of experience had similar results in terms of survival. This is attributable to all centers in the network adhering to protocol recommendations and receiving the STSC's support on diagnostics and multidisciplinary treatments for RMS.

Are distinctive risk indicators associated with different stages of caries in children? A cross-sectional study.

BACKGROUND: Actual caries figures emphasize the need to identify the risk indicators involved in the disease's development. The hypothesis that certain risk indicators might affect the dynamic evolution of the caries process was assessed; to clarify this premise, a cross-sectional survey was performed in school children. METHODS: A total of 390 subjects aged 6-8 years old were randomly selected. Caries was assessed, and the subjects were stratified as follows: i) highest caries score; ii) most prevalent caries score; and iii) number of affected teeth. Parents/guardians completed a questionnaire regarding vital statistics, socio-economic indicators, dietary habits, oral hygiene habits and oral health behaviours. RESULTS: Caries was detected in 42.31% of the subjects. Maternal nationality, parental education level, use of a sweetened pacifier at night, intake of lactose-free milk and toothbrushing frequency were statistically significant associated (p < 0.05) with subjects stratified according to the highest caries score. Parental educational level, maternal occupational status and use of a sweetened pacifier at night were associated (p < 0.05) with affected children stratified according to the most prevalent caries score. Maternal educational level and intake of lactose-free milk were associated with subjects with moderate caries stages compared to being caries-free (p = 0.01 and p = 0.02, respectively). Maternal nationality (p < 0.01) and toothbrushing frequency (p = 0.01) were associated with subjects affected by extensive lesions compared to caries-free children. In subjects affected by initial lesions as the most prevalent figure, gender (male) and paternal occupation status (unemployed) were statistically significant associated (p = 0.03 and p = 0.04, respectively) compared to those affected by highest prevalence of extensive caries lesions. In children with the highest prevalence of moderate caries lesions, maternal education level (p < 0.01), paternal occupational status (p = 0.03) and use of a sweetened pacifier at night (p < 0.01) were statistically significantly associated. CONCLUSIONS: Maternal nationality, maternal low level of education, intake of lactose-free milk and low toothbrushing frequency were involved in the change from caries-free status to different caries stages. Gender, paternal unemployment, maternal low educational level and use of a sweetened pacifier were correlated with caries progression, showing how distinctive risk indicators were associated with different caries stages.

Fluoride content in breast milk after the use of fluoridated food supplement. A randomized clinical trial.

PURPOSE: To evaluate if the intake of a fluoridated food supplement in breastfeeding mothers increases the fluoride concentration in breast milk. METHODS: A double-blind randomized placebo-controlled study was designed. Two groups of women were formed: a fluoride group (n = 112), using a non-sucrose food supplement containing fluoride (1,500 µg/l for each dose) and a control group (n = 116), using a non-sucrose food supplement without fluoride content. The women were followed for 6 weeks. Samples of breast milk were collected and analyzed using an ion-specific electrode. RESULTS: 85 women in the fluoride group and 83 in the control group concluded the trial. Fluoride concentrations in the two groups were statistically significantly different (515 µg/l in the fluoride and 476 µg/l in the control group P= 0.04) at the end of the experimental period. In the fluoride group, a statistically significant increment in fluoride concentration during the experimental period was also observed (from 468 ± 104 µg/l to 515 ± 105 µg/l). The use of a non-sucrose food supplement containing fluoride resulted in a significant increment in fluoride concentration in breast milk.

Early Childhood Caries (ECC) Prevalence and Background Factors: A Review.

PURPOSE: To describe the prevalence of early childhood caries (ECC) by reviewing published reports and to assess the role of background factors in ECC prevalence. MATERIALS AND METHODS: The studies included here consisted of reviews, meta-analyses and randomised clinical trials (RCT) which assessed the prevalence of ECC and included more than 100 subjects and subjects without any stated medical condition. These were in vivo studies published between January 1, 2000 to May 31, 2011. The patients' age range for inclusion was zero (0) to five (5) years of age. RESULTS: Database searching showed 411 findings as potentially eligible. After abstract review, eight (8) papers were retrieved as full text and assessed for eligibility: three using ECC as mesh word, four using the term early childhood caries and one using severe-ECC (S-ECC) as mesh word. CONCLUSION: The main risk factor for ECC is the low socioeconomic status of the parents. ECC is a public health problem and it requires the involvement of all health professionals that provide care to children together with efforts from family members.

Natural history of hepatitis C in thalassemia major: a long-term prospective study.

BACKGROUND: Transfusion-acquired hepatitis C virus (HCV) remains an important problem among patients with thalassemia. In this study, we evaluated the natural history of post-transfusional hepatitis C in thalassemia major, paying special attention to spontaneous viral clearance, to factors influencing the chronicity rate and fibrosis progression. DESIGN AND METHODS: A prospective study to evaluate the incidence and etiology of transfusion-related hepatitis was started in 1980. In patients who developed hepatitis C, HCV RNA, ALT, and ferritin were measured over time. The correlation between interleukin-28B gene polymorphisms and viral clearance was also analyzed. RESULTS: Seventy-three of 135 patients (62.2%) acquired HCV. An extended follow-up (22 to 30 yr) with HCV RNA assessment was available in 52 patients. Of them, 23 (44.2%) cleared the virus. The proportion of IL-28B genotypes was different between the subjects who cleared the virus and the subjects who did not. Fibrosis progression was similar in HCV RNA-positive and HCV RNA-negative patients. Liver iron was the only factor associated with the fibrosis. CONCLUSIONS: In thalassemia patients with HCV infection, liver iron does not play a major role in influencing the chronicity rate, whereas it is significantly associated with the fibrosis.

Early childhood caries and associated determinants: a cross-sectional study on Italian preschool children.

OBJECTIVES: This study evaluates the influence of several determinants on the presence of early childhood caries (ECC) in preschool children living in northern Sardinia, Italy. These determinants include the educational level and occupational status of the parents as a proxy for the socioeconomical level (SES) and behavioral factors (dietary and oral hygiene). METHODS: An observational cross-sectional study was designed with a dental examination and a standardized questionnaire. Five hundred forty-four subjects (260 girls and 284 boys) were enrolled and categorized into two age groups: 359 children were aged 18-47 months and 185 children were aged 48-60 months. RESULTS: The total caries prevalence was 15.99%. Caries risk increased with lower parents' educational level (P = 0.01), increased number of siblings (P < 0.01), the use of bottle feeding (P = 0.02), and the use of a sweetened baby's pacifier at night (P = 0.01). In robust multivariate analysis, a high parental educational level played a protective role on the presence of caries lesion [odds ratio (OR) = 0.51, 95% confidence interval (CI) 0.34-0.78]; the mother's being employed had a positive statistically significant association with the child having decayed, missing, filled tooth surfaces = 0 (OR = 0.64, 95% CI 0.23-0.97). The presence of more than one sibling in the family was associated with caries (OR = 1.70, 95% CI 1.20-2.40). CONCLUSION: ECC prevalence evaluated was similar to other western countries, and SES and behavioral habits influence the development of ECC.