Reduction of MRONJ risk after exodontia by virtue of ozone infiltration: A randomized clinical trial.

INTRODUCTION: Exodontia is commonly considered as a risk factor for the development of medication-related osteonecrosis of the jaw (MRONJ) in individuals exposed to bone modifying agents. This study was aimed at assessing the efficiency and safety of a gaseous oxygen-ozone mixture as an adjuvant to a standard exodontia to reduce the risk of MRONJ development. METHODS: A randomized, open-label, phase II, single-center clinical trial involving 117 patients at risk of MRONJ was conducted. The study protocol tested injections of an oxygen-ozone mixture in the post-extraction site. Participants were randomly assigned to two groups: oxygen-ozone therapy, and standard tooth extraction protocol. Post-extraction wound healing was assessed using the Inflammatory Proliferative Remodeling (IPR) Wound Healing Scale. RESULTS: The oxygen-ozone therapy group exhibited a significant improvement in wound healing post-extraction during the inflammatory and proliferative phases, as indicated by the IPR scale scores at 3-5 days (p = 0.006) and 14 days (p < 0.001) respectively. CONCLUSION: Oxygen-ozone therapy shows promise in improving post-extraction healing in patients at risk of MRONJ. Future studies with larger sample sizes and multicenter collaborations are recommended to confirm the validity of these findings and explore the long-term efficacy of ozone therapy.

Artificial intelligence-based, semi-automated segmentation for the extraction of ultrasound-derived radiomics features in breast cancer: a prospective multicenter study.

PURPOSE: To investigate the feasibility of an artificial intelligence (AI)-based semi-automated segmentation for the extraction of ultrasound (US)-derived radiomics features in the characterization of focal breast lesions (FBLs). MATERIAL AND METHODS: Two expert radiologists classified according to US BI-RADS criteria 352 FBLs detected in 352 patients (237 at Center A and 115 at Center B). An AI-based semi-automated segmentation was used to build a machine learning (ML) model on the basis of B-mode US of 237 images (center A) and then validated on an external cohort of B-mode US images of 115 patients (Center B). RESULTS: A total of 202 of 352 (57.4%) FBLs were benign, and 150 of 352 (42.6%) were malignant. The AI-based semi-automated segmentation achieved a success rate of 95.7% for one reviewer and 96% for the other, without significant difference (p = 0.839). A total of 15 (4.3%) and 14 (4%) of 352 semi-automated segmentations were not accepted due to posterior acoustic shadowing at B-Mode US and 13 and 10 of them corresponded to malignant lesions, respectively. In the validation cohort, the characterization made by the expert radiologist yielded values of sensitivity, specificity, PPV and NPV of 0.933, 0.9, 0.857, 0.955, respectively. The ML model obtained values of sensitivity, specificity, PPV and NPV of 0.544, 0.6, 0.416, 0.628, respectively. The combined assessment of radiologists and ML model yielded values of sensitivity, specificity, PPV and NPV of 0.756, 0.928, 0.872, 0.855, respectively. CONCLUSION: AI-based semi-automated segmentation is feasible, allowing an instantaneous and reproducible extraction of US-derived radiomics features of FBLs. The combination of radiomics and US BI-RADS classification led to a potential decrease of unnecessary biopsy but at the expense of a not negligible increase of potentially missed cancers.

Retaining Healing Hands: A Transnational Study on Job Retention Interventions for the Healthcare Workforce.

Healthcare organizations worldwide face challenges in retaining their healthcare workforce, with individual and organizational factors influencing their intentions to leave. This study conducted eight online co-creation workshops and four Delphi sessions to gain qualitative and in-depth insights into job retention interventions, involving healthcare workers, hospital managers, and policymakers. A thematic analysis was conducted, resulting in multiple interventions that were clustered in four pre-defined themes: professional and personal support, education, financial incentives, and regulatory measures. Professional and personal support interventions included regular interprofessional team meetings, leadership training programs, self-scheduling and sabbaticals, support for administrative and non-clinical work, and the provision of psychological counselling. Educational interventions encompassed facilitating development opportunities, periodic evaluations, onboarding, mentorship programs, and peer support groups. Financial incentives included the provision of competitive salaries, adequate infrastructure, extra benefits, transport possibilities, and permanent employment contracts. Regulatory measures addressed the need for complementary legislation across various levels, fixed healthcare worker-to-patient ratio, and instruments to monitor workload. To optimize retention strategies, healthcare organizations should tailor these interventions to address the unique factors influencing their workforce's intentions to leave within their specific context. The study concludes that combining personal and professional support, educational opportunities, financial incentives, and regulatory measures is necessary because there is no one-size-fits-all solution.

Multimorbidity increases the risk of dementia: a 15 year follow-up of the SHARE study.

AIMS: the literature regarding the association between multimorbidity and dementia is still unclear. Therefore, we aimed to explore the potential association between multimorbidity at the baseline and the risk of future dementia in the SHARE (Survey of Health, Ageing and Retirement in Europe) study, a large European research survey, with a follow-up of 15 years. METHODS: in this longitudinal study, multimorbidity was defined as the presence of two or more chronic medical conditions, among 14 self-reported at the baseline evaluation. Incident dementia was ascertained using self-reported information. Cox regression analysis, adjusted for potential confounders, was run and hazard ratios (HRs), with their 95% confidence intervals (CIs), that were estimated in the whole sample and by 5 year groups. RESULTS: among 30,419 participants initially considered in wave 1, the 23,196 included participants had a mean age of 64.3 years. The prevalence of multimorbidity at baseline was 36.1%. Multimorbidity at baseline significantly increased the risk of dementia in the overall sample (HR = 1.14; 95% CI: 1.03-1.27) and in participants younger than 55 years (HR = 2.06; 95% CI: 1.12-3.79), in those between 60 and 65 years (HR = 1.66; 95% CI: 1.16-2.37) and in those between 65 and 70 years (HR = 1.54; 95% CI: 1.19-2.00). In the overall sample, high cholesterol levels, stroke, diabetes and osteoporosis increased the risk of dementia, particularly if present among participants between 60 and 70 years of age. CONCLUSIONS: multimorbidity significantly increases the risk of dementia, particularly in younger people, indicating the need for early detection of multimorbidity for preventing cognitive worsening.

The long-term effect of job mobility on workers' mental health: a propensity score analysis.

OBJECTIVES: The main purpose of this longitudinal study was to elucidate the impact of external job mobility, due to a change of employer, on mental health. METHODS: A cohort of Belgian employees from the IDEWE occupational medicine registry was followed-up for twenty-seven years, from 1993 to 2019. The use of drugs for neuropsychological diseases was considered as an objective indicator of mental health. The covariates were related to demographic, physical, behavioural characteristics, occupational and work-related risks. Propensity scores were calculated with a Cox regression model with time-varying covariates. The PS matching was used to eliminate the systematic differences in subjects' characteristics and to balance the covariates' distribution at every time point. RESULTS: The unmatched sample included 11,246 subjects, with 368 (3.3%) that changed their job during the baseline year and 922 (8.2%) workers that left their employer during the follow-up. More than half of the matched sample were males, were aged less than 38 years old, did not smoke, were physically active, and normal weighted, were not exposed to shift-work, noise, job strain or physical load. A strong association between job mobility and neuropsychological treatment was found in the matched analysis (HR = 2.065, 95%CI = 1.397-3.052, P-value < 0.001) and confirmed in the sensitivity analysis (HR of 2.012, 95%CI = 1.359-2.979, P-value < 0.001). Furthermore, it was found a protective role of physical activity and a harmful role of job strain on neuropsychological treatment. CONCLUSIONS: Our study found that workers with external job mobility have a doubled risk of treatment with neuropsychological medication, compared to workers without job mobility.

Diagnostic performance of 2D-shear wave elastography in the diagnosis of breast cancer: a clinical appraisal of cutoff values.

PURPOSE: To assess the role of 2D-shear wave elastography (2D-SWE) in differentiating benign from malignant focal breast lesions (FBLs), providing new vendor-specific cutoff values. METHODS: 158 FBLs (size: 3.5-50 mm) detected in 151 women (age: 21-87 years) were prospectively evaluated by means 2D-SWE. For each lesion, an expert radiologist assessed US BI-RADS category and calculated the following four 2D-SWE parameters: (1) elasticity maximum (Emax); (2) mean elasticity (Emean); (3) minimum elasticity (Emin); (4) elasticity ratio (Eratio). US-guided core-biopsy was considered as standard of reference for all the FBLs classified as BI-RADS 4 or 5. For each 2D-SWE parameter, the optimal cutoff value for a diagnostic test was calculated using the Youden method. Diagnostic performance of the US BI-RADS and 2D-SWE parameters was calculated accordingly. RESULTS: 83/158 (52.5%) FBLs were benign and 75/158 (47.5%) were malignant. Statistically significant higher stiffness values were observed in malignant FBLs for all 2D-SWE parameters than in benign ones (p < 0.001). 2D-SWE cutoff values were 82.6 kPa, 66.0 kPa and 53.6 kPa, respectively, for Emax, Emean, Emin and 330.8% for Eratio. The 2D-SWE parameter showing the best diagnostic accuracy was Emax (85.44%). Considering US BI-RADS 3 (n = 60) and 4a (n = 32) FBLs, Emax and Emean showed the best diagnostic accuracy (85.87% for both), without a statistically significant decrease in sensitivity (p = 0.7003 and p = 1, respectively). CONCLUSION: Our study provides new vendor-specific cutoff values for 2D-SWE, suggesting its possible clinical use in the adjunctive assessment of category US-BI-RADS 3 and 4a breast masses.

Biomarkers Related to Synaptic Dysfunction to Discriminate Alzheimer's Disease from Other Neurological Disorders.

Recently, the synaptic proteins neurogranin (Ng) and α-synuclein (α-Syn) have attracted scientific interest as potential biomarkers for synaptic dysfunction in neurodegenerative diseases. In this study, we measured the CSF Ng and α-Syn concentrations in patients affected by AD (n = 69), non-AD neurodegenerative disorders (n-AD = 50) and non-degenerative disorders (n-ND, n = 98). The concentrations of CSF Ng and α-Syn were significantly higher in AD than in n-AD and n-ND. Moreover, the Aß42/Ng and Aß42/α-Syn ratios showed statistically significant differences between groups and discriminated AD patients from n-AD patients, better than Ng or α-Syn alone. Regression analyses showed an association of higher Ng concentrations with MMSE < 24, pathological Aß 42/40 ratios, pTau, tTau and the ApoEε4 genotype. Aß 42/Ng was associated with MMSE < 24, an AD-related FDG-PET pattern, the ApoEε4 genotype, pathological Aß 42 levels and Aß 42/40 ratios, pTau, and tTau. Moreover, APO-Eε4 carriers showed higher Ng concentrations than non-carriers. Our results support the idea that the Aß 42/Ng ratio is a reliable index of synaptic dysfunction/degeneration able to discriminate AD from other neurological conditions.

Ultrasonographic Detection of Vascularity of Focal Breast Lesions: Microvascular Imaging Versus Conventional Color and Power Doppler Imaging.

To compare microvascular flow imaging (MVFI) to conventional Color-Doppler (CDI) and Power-Doppler (PDI) imaging in the detection of vascularity of Focal Breast Lesions (FBLs). A total of 180 solid FBLs (size: 3.5-45.2 mm) detected in 180 women (age: 21-87 years) were evaluated by means of CDI, PDI, and MVFI. Two blinded reviewers categorized lesion vascularity in absent or present, and vascularity pattern as (a) internal; (b) vessels in rim; (c) combined. The presence of a "penetrating vessel" was assessed separately. Differences in vascularization patterns (chi2 test) and intra- and inter-observer agreement (Fleiss method) were calculated. ROC analysis was performed to assess performance of each technique in differentiating benign from malignant lesions. About 103/180 (57.2%) FBLs were benign and 77/180 (42.8%) were malignant. A statistically significant (p < .001) increase in blood flow detection was observed for both readers with MVFI in comparison to either CDI or PDI. Benign FBLs showed mainly absence of vascularity (p = .02 and p = .01 for each reader, respectively), rim pattern (p < .001 for both readers) or combined pattern (p = .01 and p = .04). Malignant lesions showed a statistically significant higher prevalence of internal flow pattern (p < .001 for both readers). The prevalence of penetrating vessels was significantly higher with MVFI in comparison to either CDI or PDI (p < .001 for both readers) and in the malignant FBLs (p < .001). ROC analysis showed MVFI (AUC = 0.70, 95%CI = [0.64-0.77]) more accurate than CDI (AUC = 0.67, 95%CI = [0.60-0.74]) and PDI (AUC = 0.67, 95%CI = [0.60-0.74]) though not significantly (p = .5436). Sensitivity/Specificity values for MVFI, PDI, and CDI were 76.6%/64.1%, 59.7%/73.8% and 58.4%/74.8%, respectively. Inter-reader agreement with MVFI was always very good (k-score 0.85-0.96), whereas with CDI and PDI evaluation ranged from good to very good. No differences in intra-observer agreement were noted. MVFI showed a statistically significant increase in the detection of the vascularization of FBLs in comparison to Color and Power-Doppler.

Socioeconomic inequality in non-communicable diseases in Europe between 2004 and 2015: evidence from the SHARE survey.

Background: The scope of this work was to investigate socioeconomic inequalities among European adults aged 50 or older in chronic diseases and behavioural risk factors for these diseases, namely, smoking habits, obesity and physical inactivity, between 2004 and 2015. Methods: Data for this study were drawn from the Survey of Health, Ageing and Retirement (SHARE) in Europe, which is a panel database of microdata on health, socioeconomic status and social and family networks of people aged 50 years or older, covering most of the European Union. The predicted number of non-communicable diseases (NCDs) was used to estimate the concentration index and to find the contributions of determinants to socioeconomic inequalities in chronic diseases. Results: The inequality disfavoured the poor in both years, but the effect was stable from 2004 (C = -0.071) to 2015 (C = -0.081). Inequality was shown to be attributed mostly to physical inactivity and obesity and this contribution increased during the study period. Among socioeconomic status (SES) determinants, education and marital status were the most concentrated in both years, while physical inactivity and obesity were the most concentrated behavioural risk factors in both years. Conclusions: To prevent chronic diseases, health policy should aim not only to improve individual health behaviours in the population, but also to reduce socioeconomic inequality. Our study suggests promoting a healthy lifestyle in the most disadvantaged socioeconomic classes as a strategy to improve the health conditions of the whole population.

DNA fragmentation index, pAKT and pERK1/2 in cumulus cells are related to oocyte competence in patients undergoing in vitro fertilization programme.

Activated pERK1/2 and pAKT are key players in supporting cell survival and proliferation pathways. Translocation of pERK1/2 into the nucleus, where it interacts with transcription factors and DNA itself, is instrumental in exerting an anti-apoptotic effect. In this study, pAKT levels, pERK1/2 nuclear localization and DNA fragmentation index (DFI) in cumulus cells of single cumulus-oocyte complexes of patients undergoing in vitro fertilization programmes were evaluated and correlated with the clinical outcome of the related embryos. For a positive clinical outcome of blastocyst development, pERK1/2 nuclear localization and DFI value had a significant inverse relationship, whereas the former and the intracellular accumulation of pAKT had a significant direct relationship. This relationship was not observed for the negative clinical outcome of the arrested embryos. Moreover, intracellular accumulation of pAKT and DFI value had a significant inverse relationship in all samples examined. The obtained data suggest that the intranuclear relocation of pERK1/2, along with an enhanced intracellular accumulation of pAKT, may exert a survival effect and increase cell viability, therefore providing a novel marker tool to choose the best oocyte to be fertilized and submitted to an intracytoplasmic sperm injection cycle.

Determinants of inappropriate hospitalization in cataract surgery in the south of Italy: a retrospective study.

PURPOSE: To analyze the frequency of inappropriate hospitalization in cataract surgery and the type of related determinants. METHODS: A nested retrospective case-control study was carried out on 2708 consecutive cataract surgery patients operated between January 2013 and December 2015. All cases with inappropriate hospitalization (day surgery or ordinary hospitalization) were compared with a control group of cases treated in an appropriate (day service) regimen. The predictive value for inappropriate admissions to the hospital was assessed using a logistic regression model. Significant variables from the univariate analysis were included in a multivariate model. RESULTS: Forty-five cases (< 2%) of inappropriate hospital admissions were recorded. Residence, heart disease, tremors, anticoagulants, intraoperative floppy iris syndrome were not related to appropriateness, while psychotic disorder (OR 12.571, p = 0.018), anxiety-depressive syndrome (OR 7.818, p = 0.010) and use of antipsychotropic drugs (OR 7.724, p = 0.002) were related to the inappropriateness of admission by univariate and multivariate analysis. Previous systemic surgeries were predictors of ordinary hospitalization by logistic regression analysis. A greater presence of hypertension, diabetes mellitus and fellow eye pseudophakia was noticed in appropriate hospitalization cases. CONCLUSIONS: This study detects the predictive role of psychiatric disorders as determinants of hospitalization inappropriateness in cataract surgery. The negative correlation between inappropriate hospitalization and conditions such as hypertension and diabetes points out that in the elderly population common diseases are effectively addressed, in contrast to the difficult management of psychiatric patients. Prior systemic interventions represent factors inducing transfer from day service to ordinary hospitalization, highlighting communication problems related to difficult coping with an outpatient surgery setting.

Sedentariness and weight status related to SES and family characteristics in Italian adults: exploring geographic variability through multilevel models.

AIM: In this study, our aim was to assess the prevalence of sedentariness and overweight/obesity, two modifiable risk factors for non-communicable diseases (NCDs), and to investigate the geographic variability in their association with socio-economic status (SES) and family characteristics in Italian adults. METHODS: The Multipurpose Survey on Health Conditions and the Recourse to Health Services (MSHC), 2012/2013 edition, conducted by the National Institute of Statistics was used as data source. The sample for this study included 99,479 interviewed people aged 18 and over, which are representative of about 50 million persons. For the scope of this analysis, data were considered as individuals nested within families within regions and analysed through multilevel models. RESULTS: It was estimated that 39.8% of Italian adults are sedentary, 38.1% are partially active and 22.1% are physically active; 11.3% of Italian adults are obese and the 34.5% are overweight. There was evidence of inverse socio-economic gradient for both sedentariness and body mass index (BMI). There was higher risk of sedentariness for one-parent (odds ratio (OR) = 1.10; 95% confidence interval (CI) = (1.02; 1.20)) and other family types (OR = 1.34; 95% CI = (1.20; 1.48 )) compared with couples with children. Also, the relative variation of BMI was statistically significant for one-parent, one-person and other families ( p < 0.05). An increasing north-south gradient was suggested for BMI, but not for sedentariness. CONCLUSIONS: Policy interventions could be addressed to reduce BMI levels in the southern area and to encourage physical activity in regions with high sedentariness. The Italian family is the key driver to promote virtuous healthy behaviours.

Gingival displacement using diode laser or retraction cords: A comparative clinical study.

PURPOSE: To compare two systems used for conditioning the gingival sulcus and exposing the finish line before the final impression for a fixed denture: retraction cords and diode laser. METHODS: All subjects participating in the study had healthy gingival and periodontal status before intervention for fixed prosthesis. 74 abutments for complete crown restoration were randomly divided into two groups for displacing the gingival sulcus before the final impression: gingival retraction cords (RC) and diode laser (DL). The height of the clinical crowns was measured by a blinded examiner in three points of the buccal surface (mesial, midline and distal) at four different times: after tooth preparation (T0), 15 days after tooth preparation, before exposing the finish line with RC or with DL (T1), 10 minutes after exposing the finish line (T2), and 15 days after the final impression was taken (T3). The amount of gingival retraction produced (ΔT2-T1) and restoration to baseline (ΔT3-T1) were calculated. Ease of technique and patient comfort were evaluated through the Visual Analog Scale. The time required to carry out the technique and bleeding during and after the conditioning procedure were also evaluated. RESULTS: There was no difference between the two techniques with regard to the height differences: ΔT2-T1 was 0.65±0.33 for RC and 0.66#177;0.43 for the DL (P= 0.966), while ΔT3-T1 was 0.03#177;0.27 for RC and 0.02#177;0.46 for DL (P= 0.286). DL required less time, was easier for the operator and more comfortable than RC for the patient (all P<0.001). CLINICAL SIGNIFICANCE: The amount of gingival retraction and restoration to baseline resulting from use of gingival retraction cords or diode laser technique is similar, but diode laser required less time, was simpler for the operator and was more comfortable to the patient than retraction cords.

Evolution of indeterminate hepatocellular nodules at Gd-EOB-DPTA-enhanced MRI in cirrhotic patients.

PURPOSE: To retrospectively analyze the evolution of indeterminate hepatocellular nodules in cirrhotic patients on serial Gd-EOB-DPTA-enhanced MRI, and to identify predictors of HCC development. MATERIALS AND METHODS: This IRB approved study included 33 cirrhotic patients with 69 indeterminate hepatocellular nodules (mean diameter 1.1 cm) at baseline Gd-EOB-DPTA-enhanced MRI and a Gd-EOB-DPTA-enhanced-MRI follow-up of at least 2 years. Two radiologists evaluated size and signal intensity of each nodule at baseline and follow-up. Age, cirrhosis etiology, and HCC history were recorded. Data were compared between nodules that became HCCs at follow-up (HCC) and those that did not (no-HCC). RESULTS: On follow-up, 5/69 nodules became HCCs and 64/69 showed indeterminate characteristics. HCC history was more frequently found in HCCs than in no-HCCs. Age, sex, and cirrhosis etiology were not significantly different between HCCs and no-HCCs. HCCs had a significantly greater baseline diameter and increase in size than no-HCCs. Hepatobiliary phase hypointensity was significantly more common in HCCs than in no-HCCs. Multivariate regression analysis showed that increase in size (OR 10.48; sensitivity, 100%; specificity, 81.2%; p < 0.001) and hepatobiliary phase hypointensity (OR 1.02; sensitivity, 100%; specificity, 78.1%; p < 0.001) was associated with HCC development. CONCLUSION: Indeterminate hepatocellular nodules at Gd-EOB-DPTA-enhanced MRI in cirrhotic patients rarely became HCCs. Hepatobiliary phase hypointensity had a weak association with HCC development.

Complete written/oral information about dose exposure in CT: is it really useful to guarantee the patients' awareness about radiation risks?

AIMS AND OBJECTIVES: According to the European directive 2013/59/Euratom, starting from February 2018, the information relating to patient exposure will be part of computed tomography (CT) reports, but the impact of this information on patients has not been deeply evaluated. Aim of our study was to evaluate patients' perception of radiation exposure related to routine CT and their understanding after communication of their dose exposure. MATERIALS AND METHODS: A survey, investigating patient's knowledge of radiation dose, was given to all adult patients (> 18 years) undergoing a CT examination both before and after CT scan. The first survey was the same for all patients. After CT scan, a second questionnaire was administered (after receiving the CT dose bill report and medical written and/or explanation about ionizing radiation risk). Results of the pre- and post-CT questionnaires responses were compared according to demographics characteristics and among the four post-CT groups. RESULTS: For some questions, statistically significant differences were found between the two centres. Seventy per cent of the patients answered that the presence of CT parameters in the report is considered useful. Even if not always statistically significant there was a slight increase in awareness of ionizing radiation risk comparing the pre- and post-CT surveys. The group that had both written and oral explanations had a better comprehension of CT dose bill (group III vs. I, p = 0.002). CONCLUSION: The way of communication of ionizing radiation risks did not affect the results of the post-CT survey. Indeed, the interest in the topic did not rise in the post-CT survey in any of the group. Adequate information about ionizing radiation risks provided together with dose exposure information may be useful. However, there is not a standardized better way of communicating information on ionizing radiation risks due to CT.

Hypo-fractionated stereotactic radiation therapy for lung malignancies by means of helical tomotherapy: report of feasibility by a single-center experience.

BACKGROUND: Several experiences in the literature report SBRT as an effective treatment option for medically inoperable early stage non-small cell lung cancer (NSCLC) and oligometastatic disease. The optimal fractionation schedules and total dose remain controversial. In this study, we evaluated the safety in terms of toxicity and efficacy of using of 8-10 fractions schedules with Helical Tomotherapy (HT) for primary and metastatic lung lesions. METHODS: Between March 2014 and May 2016, a total of 39 patients (median age 72 years, range 26-91) were treated with HT-SBRT for malignant lung lesions: 22 patients with early stage NSCLC, 17 with oligometastases. Patients received 8-10 fractions with lower daily dose for central and ultracentral lesions. Treatment-related toxicity was evaluated using CTCAE v 4.0 scale. Local control (LC), overall survival (OS) and toxicity rates were prospectively collected. RESULTS: Median duration of RT was 15 days (range 10-26 days) and no interruption occurred. With a median follow-up of 13 months (range 3-29), we reported one G2 pneumonitis (2.6%) and one G2 chest pain (2.6%); no ≥ G2 esophagitis was registered. Actuarial local control rate was 95.5% both at 12 and 24 months for early stage NSCLC and 92.9% both at 12 and 24 months for metastatic patients. OS rate was 94.4 and 92.3% at 1 year, and 94.4 and 83.9% at 2 years in primary and metastatic group, respectively. CONCLUSIONS: The use of 8-10 fractions schedule HT-SBRT for lung malignancies results in high LC and OS rates with minimal toxicities reported.

Relationship between apoptosis and survival molecules in human cumulus cells as markers of oocyte competence.

To select from a single patient the best oocytes able to reach the blastocyst stage, we searched for valuable markers for oocytes competence. We evaluated the DNA fragmentation index (DFI) and the level of some survival molecules, such as AKT, pAKT and pERK1/2, in individual cumulus cell-oocyte complexes (COC). The study included normo-responder women. The average age of the patients was 34.3. DFI in cumulus cells was evaluated using the terminal deoxynucleotidyl transferase (TdT) dUTP nick-end labelling (TUNEL) assay in situ. AKT, pAKT and pERK1/2 were measured by immunological assay and densitometric analysis of fluorescent signals using NIS-Elements BR 3.10 image software. Statistical analysis was performed using STATA SE/14.1. The study focused on 53 patients involved after informed consent. Out of 255 MII oocytes, 197 were fertilized and the derived embryos had the following evolution: 117 completed the development to blastocyst and were transferred to uterus; 57 were vitrified at the blastocyst stage; and 23 were arrested during in vitro culture at different stages of cleavage. We found a significant statistical difference between the DFI of cumulus cells of the arrested embryos and the transferred blastocysts (P = 0.004), confirming that DFI could be considered as a valuable marker of oocyte competence. In addition, the pAKT/DFI ratio was higher in cumulus cells of oocytes able to produce blastocysts, indicating that DFI is significantly lower when pAKT is higher (P = 0.043). This study demonstrates for the first time that the relationship between apoptosis and survival molecules can be used as a marker to select the best oocytes.

Umbilical venous catheters placement evaluation on frontal radiogram: application of a simplified flow-chart for radiology residents.

BACKGROUND: Umbilical Venous Catheter (UVC) are commonly used in neonatal period; they can be not correctly positioned and could be associated with complications. The purpose of this article is to suggest a flow-chart to evaluate the placement of UVC, testing it in young radiologists-in-training. METHOD: We developed a simple flow-chart to asses, steps by step, UVC placement considering its course and tip location (ideally placed in the atriocaval junction). We tested the flow-chart impact asking to 20 residents to evaluate the placement of 10 UVC before and after they familiarized with the flow-chart and the anatomical findings of a newborn. The agreement among the 20 students was evaluated too. RESULTS: The number of correct characterizations was different due to the administration of the flow-chart. One hundred and six correct UVC assessments at the beginning switched to 196 after the administration of the flow-chart (p = 0.0001). The observed agreement among the twenty radiology residents was statistically significant, both before (kappa = 0.41, p < 0.001) and after (kappa = 0.37, p < 0.001) the flow-chart administration. CONCLUSION: The developed flow-chart demonstrated to be useful in increasing residents performance in UVC placement assessment.

The burnout phenomenon among student radiographers: a single centre experience.

OBJECTIVES: Burnout syndrome is a condition that may occur not only for staff in human service sectors/jobs, involving intensive interactions with others, but also people that are engaged in activities psychologically similar to work, such as students. Radiographers in training suffer double stress, first linked to the status of being a university student and secondly as early career workers who have relations with the public of the health system. Aim of our study was to investigate the prevalence and levels of burnout syndrome among radiographers in training in an University Hospital. METHODS: In order to gain a better understanding of nature of the burnout syndrome a modified version of Maslach's questionnaire (investigating three areas: emotional exhaustion, depersonalization and reduced personal accomplishment), was administered to two groups selected from a cohort of radiographers University students (from the 1st and 3rd year of course). RESULTS: 62/62 questionnaires were completed, returned and analysed. The research outcomes highlighted a clear difference between group I and group II in relation to one of the three areas of the Maslach's model: "depersonalization" (p<0.001). Moreover, the third year students group presented a significantly higher risk to develop burnout. On the other hand, the third area examined, the reduced personal accomplishment domain, was surprisingly high even among first-year students. CONCLUSIONS: The research outcomes seem to suggest that the presence of emotional burnout, or risk of burnout, among third year students is statistically significant, compared to the first year students, being a significant aspect to investigate further in this class of students. It is also assumed that the high degree of "past failures, feeling of self failure" observed among all student, is related to a feeling of poor efficacy and poor self worth that appear to grow from the beginning of the course. This topic needs further investigation in the light of the result of this study.

A randomized trial of intravitreal bevacizumab vs. ranibizumab for myopic CNV.

AIMS: The aim was to compare the efficacy of intravitreal therapy with bevacizumab and ranibizumab for choroidal neovascularization (CNV) in pathologic myopia (PM). METHODS: This was a prospective multicenter randomized nonblinded trial. RESULTS: In seven centers, 78 eyes were randomized 1:1 to treatment with bevacizumab (group B, 40 eyes) or ranibizumab (group R, 38 eyes) given with an "on demand" regimen (PRN). The mean follow-up was 19 months (SD 2, range 12-24). The mean BCVA at baseline was 0.60 logMAR (20/80 Snellen equivalent, Seq) and 50 letter score (ls). Mean final BCVA was 0.51 LogMAR (20/63 Seq) and 57 ls (p = 0.0009 and p = 0.0002, respectively). In group B, mean basal BCVA was 0.52 logMAR (20/63 Seq) and 54 ls, and final BCVA was 0.51 logMar (20/63 Seq) and 57 ls. In group R, mean basal BCVA was 0.62 logMAR (20/80 Seq) and 45 ls, and the final values were 0.50 logMAR (20/63 Seq) and 58 ls. Statistical comparison of the two groups showed no significant difference (logMAR p = 0.90 and letters p = 0.78). Multivariate analysis showed no influence of age or previous photodynamic treatment (PDT) on final visual changes. The mean number of treatments in the first year was 2.7 in group B and 2.3 in group R (p = 0.09). CONCLUSION: Myopic CNV equally benefits from on-demand intravitreal injection of either bevacizumab or ranibizumab; the therapeutic effect is independent of previous PDT and age.