Clinical outcomes for sexual and gender minority adolescents in a dialectical behaviour therapy programme.

BACKGROUND: Sexuality and gender minoritised (SGM) adolescents are at increased risk of self-injury and suicide, and experience barriers to accessing mental health support. Dialectical behaviour therapy (DBT) is an effective treatment for self-injury and emotion dysregulation in adolescent populations, but few studies have published outcomes of DBT for SGM young people. AIMS: This study aimed to investigate treatment outcomes and completion for SGM adolescents and their cisgender and heterosexual peers, in the National & Specialist CAMHS, DBT service (UK). METHOD: Treatment completion, and opting out before and during treatment were examined for sexual and gender identity groups, as well as changes by the end of treatment in emotion dysregulation, self-injury, in-patient bed-days, emergency department attendances, and borderline personality disorder, depression and anxiety symptoms. RESULTS: SGM adolescents were over-represented in this service, even after considering their increased risk for self-injury. No statistically significant differences were found for treatment completion between the sexual orientation and gender identity groups, although there were patterns indicating possible lower treatment uptake and completion that warrant further investigation. Clinical outcomes for treatment-completers showed improvement by the end of DBT for each group, with few exceptions. DISCUSSION: These results are from relatively small subsamples, and it was not possible to separate by sex assigned at birth. Findings should be treated tentatively and as early indications of effect sizes to inform future studies. This study suggests that DBT could be a useful treatment for SGM adolescents in a highly specialist treatment setting.

First Report of Botryosphaeria dothidea, Diplodia seriata, and Neofusicoccum luteum Associated with Canker and Dieback of Grapevines in Tunisia.

In 2011, common symptoms of grapevine dieback were frequently observed in 2- to 5-year-old table grape (Vitis vinifera L.) cvs. in four vineyards located in northern Tunisia. The symptoms included dead spur and cordons, shoot dieback, and sunken necrotic bark lesions, which progressed into the trunk resulting in the death of large sections of the vine. Longitudinal and transversal sections of cordons and spurs from symptomatic vines revealed brown wedge-shaped cankers of hard consistency. Twelve symptomatic samples from spur and cordons were collected, surface disinfected by dipping into 5% (v/v) sodium hypochlorite for 2 min, and small pieces from the edge of necrotic and healthy tissue were removed and plated onto potato dextrose agar (PDA) at 25°C in the dark. Based on colony and conidia morphological characteristics, isolates were divided in three species, named Diplodia seriata, Botryosphaeria dothidea, and Neofusicoccum luteum. D. seriata colonies were gray-brown with dense aerial mycelium producing brown cylindric to ellipsoid conidia rounded at both ends and averaged 22.4 × 11.7 µm (n = 50). B. dothidea colonies were initially white with abundant aerial mycelium, gradually becoming dark green olivaceous. Conidia were fusiform to fusiform elliptical with a subobtuse apex and averaged 24.8 × 4.7 µm (n = 50). N. luteum colonies were initially pale to colorless, gradually darkening with age and becoming gray to dark gray producing a yellow pigment that diffuses into the agar. Conidia were hyaline, thin-walled, aseptate, fusiform to fusiform elliptical, and averaged 19.8 × 5.5 µm (n = 50). Identity of the different taxa was confirmed by sequence analyses of the internal transcribed spacer (ITS1-5.8S-ITS2) region of the rDNA and part of the elongation factor 1-alpha (EF1-α) gene. BLAST analysis of sequences indicated that six isolates were identified as D. seriata (GenBank: AY259094, AY343353), one isolate as B. dothidea (AY236949, AY786319) and one isolate as N. luteum (AY259091, AY573217). Sequences were deposited in GenBank under accessions from KC178817 to KC178824 and from KF546829 to KF546836 for ITS region and EF1-α gene, respectively. A pathogenicity test was conducted on detached green shoots cv. Italia for the eight Botryosphaeriaceae isolates. Shoots were inoculated by placing a colonized agar plug (5 mm diameter) from the margin of a 7-day-old colony on fresh wound sites made with a sterilized scalpel. Each wound was covered with moisturized cotton and sealed with Parafilm. Control shoots were inoculated using non-colonized PDA plugs. After 6 weeks, discoloration of xylem and phloem and necrosis with average length of 38.8, 17.6, and 11.2 mm were observed from inoculated shoots with D. seriata, N. luteum, and B. dothidea, respectively, and all three fungi were re-isolated from necrotic tissue, satisfying Koch's postulates. Control shoots showed no symptoms of the disease and no fungus was re-isolated. In Tunisia, Botryosphaeria-related dieback was reported only on citrus tree caused by B. ribis (2), on Pinus spp. caused by D. pinea (4), on Quercus spp. caused by D. corticola (3), and on olive tree (Olea europea) caused by D. seriata (1). To our knowledge, this is the first report of D. seriata, B. dothidea, and N. luteum associated with grapevine dieback in Tunisia. References: (1) M. Chattaoui et al. Plant Dis. 96:905, 2012. (2) H. S. Fawcett. Calif. Citrogr. 16:208, 1931. (3) B. T. Linaldeddu et al. J. Plant Pathol. 91:234. 2009. (4) B. T. Linaldeddu et al. Phytopathol. Mediterr. 47:258, 2008.

First Report of Agrobacterium vitis as Causal Agent of Crown Gall Disease of Grapevine in Tunisia.

Since October 2011, a serious outbreak of crown gall disease was observed on 1- and 2-year-old grapevines (Vitis vinifera L.) cv. Superior Seedless in several vineyards located in the region of Regueb in the center of Tunisia. Fifty isolates of Agrobacterium were isolated on a tartrate medium from galls of affected plants. To prepare template DNA, cell suspensions were lysed in 0.25% sodium-azide (NaN3) buffer prepared in 1% Triton X-100 by heating the samples at 95°C for 10 to 15 min (1). The strains were differentiated using a multiplex PCR assay with a combination of VIRFF1/VIRFR2 and VIRD2S4F716/VIRD2S4R1036 primers (2), which detect regions of virF and virD2 genes, respectively, in A. vitis strains carrying octopine or nopaline Ti plasmids and A. vitis vitopine strains. In order to differentiate A. vitis strains from A. tumefaciens strains, PGF/PGR (4), a polygalacturonase specific primer set, was added to the mixture in multiplex PCR. The isolates segregated into three main groups. The first group carries octopine type Ti plasmids, the second carries vitopine type Ti plasmids, and the third group carries both octopine and vitopine type Ti plasmids. The polygalacturonase gene sequence from 10 isolates showed 94 to 97% identity to the sequences of A. vitis previously deposited in the NCBI GenBank database (Accession No. CP000633.1gb). The biochemical test results corresponded to the results of genetic analysis. The ability to aerobically convert lactose to 3-ketolactose was tested by spotting bacteria onto medium containing lactose and flooding plates with a layer of Benedict's reagents after incubation at 28°C for 48 h. Acid production from glucose was tested by spotting bacterial strains onto potato dextrose agar (PDA) medium supplemented with CaCO3. Alkali production from L-tartrate was tested by streaking bacteria on AB minimal medium supplemented with L-tartrate and growth in salt medium was tested by streaking on nutrient broth supplemented with 2% NaCl. All isolates except one were negative in 3-ketolactose. They were negative in acid clearing on PDA-CaCO3, grew in 2% NaCl, and produced alkali from tartarate. Pathogenicity of all 50 strains was tested on 1-month-old tomato plants (Lycopersicum esculentum cv. Riograndi). Plants were inoculated on the stem by pricking one to three times through a drop of inoculum (108 CFU/ml) at three inoculation sites. Sterile distilled water was used as control treatment. Plants were grown for 4 weeks at 23 ± 3°C and symptoms were recorded. Typical tumors developed at the inoculation sites and no symptoms were observed on the control plants. In Tunisia, crown gall disease was observed only on stone fruit trees and only A. tumefaciens Biovar 1 have been reported and assigned to four genomic species G4, G6 G7, and G8 basically on the recA sequencing (3). To our knowledge, this is the first report of A. vitis determined as the causal agent of grapevine crown gall in Tunisia. References: (1) A. Abolmaaty et al. Microbios 101:181, 2000. (2) F. Bini et al. Vitis 47:181, 2008. (3) D. Costechareyre et al. Microb. Ecol. 60:862, 2010. (4) E. Szegedi and S. Bottka. Vitis 41:37, 2002.

Atrial natriuretic factor inhibits norepinephrine biosynthesis and turnover in the rat hypothalamus.

We have previously reported that atrial natriuretic factor (ANF) increased neuronal norepinephrine (NE) uptake and reduced basal and evoked neuronal NE release. Changes in NE uptake and release are generally associated to modifications in the synthesis and/or turnover of the amine. On this basis, the aim of the present work was to study ANF effects in the rat hypothalamus on the following processes: endogenous content, utilization and turn-over of NE; tyrosine hydroxylase (TH) activity; cAMP and cGMP accumulation and phosphatidylinositol hydrolysis. Results showed that centrally applied ANF (100 ng/microl/min) increased the endogenous content of NE (45%) and diminished NE utilization. Ten nM ANF reduced the turnover of NE (53%). In addition, ANF (10 nM) inhibited basal and evoked (with 25 mM KCl) TH activity (30 and 64%, respectively). Cyclic GMP levels were increased by 10 nM ANF (100%). However, neither cAMP accumulation nor phosphatidylinositol breakdown were affected in the presence of 10 nM ANF. The results further support the role of ANF in the regulation of NE metabolism in the rat hypothalamus. ANF is likely to act as a negative putative neuromodulator inhibiting noradrenergic neurotransmission by signaling through the activation of guanylate cyclase. Thus, ANF may be involved in the regulation of several central as well as peripheral physiological processes such as cardiovascular function, electrolyte and fluid homeostasis, endocrine and neuroendocrine synthesis and secretion, behavior, thirst, appetite and anxiety that are mediated by central noradrenergic activity.

[Medical or surgical treatment of the elderly bleeding ulcer patient]. / Trattamento medico o chirurgico nell'ammalato ulceroso sanguinante anziano.

In recent years there has been a distinct decline in the total number of operations for ulcers while the number performed for ulcerous complications has remained more or less constant. Hesitation between medical and surgical treatment most frequently arises in the case of bleeding especially when the patient is elderly. A retrospective study is conducted on 526 ulcer patients encountered in 1976-84 and a comparison is made with the literature as a means of identifying the limitations of conservative treatment. Certain parameters of possible use in the treatment of bleeding ulcers in the elderly are identified.

[A case of ectopic vas deferens opening into the bladder]. / Un caso di sbocco ectopico del dotto deferente in vescica.

A case of epididymitis in a two years old boy owing to an ectopic vas deferens opening into the bladder is reported. Only a very few similar cases have been recorded in the world literature.

[Conservative treatment of esophageal perforation in the newborn infant. Description of a case]. / Trattamento conservativo delle perforazioni esofagee nel neonato. Descrizione di un caso.

A case of oesophageal perforation in a newborn is reported. Authors describe the different clinical pictures due to the various sites of perforation. Authors believe that conservative treatment is satisfactory when applied to most oesophageal perforations and operative approach should be employed only in selected cases and after failure of a trial of non-operative treatment.

[Scaphoid megalourethra. Description of a case and review of the literature]. / Megalouretra scafoide. Descrizione di un caso e revisione della letteratura.

Authors describe a case of scaphoid megalourethra in a newborn. The child underwent a successful urethroplasty in neonatal period, as described by Nesbitt. In a careful review of the Literature only 47 such cases were found (included the one herein described). Authors discuss etiology, diagnosis and management of this rare malformation and stress the feasibility of an early reconstructive procedure.

[Acute epididymitis in children]. / Le epididimiti acute in età pediatrica.

Fifteen cases of epididymitis in children are reviewed, six of these occurring in children under twelve months of age, and nine in older children. In five of the six cases occurring in infants a U.T.I. and a malformation of the urinary tract were found, while in children over one year only three infections and two urinary malformations were discovered. Authors recommend that in infants under 1 year presenting with epididymitis a thorough investigation of the urinary tract is performed.

[Stable ventricular tachycardia in arrhythmogenic dysplasia of the right ventricle in sportsmen]. / Stabil'naia zheludochkovaia takhikardiia pri aritmogennoi displazii pravogo zheludochka u sportsmenov.

Right ventricular arrhythmogenic dysplasia (RVAD) is a typical asymptomatic arrhythmogenic cardiopathy in athletes, which is occasionally concurrent with normal ventricular function and life-threatening arrhythmias. A total of 32 athletes (28 males and 4 females, mean age, 23 years, mean follow-up, 6.7 years) were examined for severe cardiac arrhythmias with left bundle branch block. The conclusive diagnosis of RVAD was established from clinical, echocardio-, and angiographic evidence. The protocol of the examination involved Holter monitoring, loading tests, electrophysiological study, two-dimensional echocardiography, cardiac angiography of the right and left ventricles, coronary angiography. The most severe arrhythmias were observed in athletes whose mean age was 23.4 years, 20 patients had sustained ventricular tachycardia (it occurred only in 19 who were indulging in sports), 6 presented with transient ventricular tachycardia, and 1 had ventricular fibrillation. They all had been considered fit for sports. The disease proceeded severely in 16 of 32 athletes (in 13 of 16 while indulging in sports), the conditions close to syncope were seen in 9 patients (8 had sustained ventricular tachycardias and 1 had transient ventricular tachycardias), syncopes were observed in 5 patients (sustained ventricular tachycardias).

Macular edema induced by phacoemulsification.

PURPOSE: To characterise the association between lens phacoemulsification and the development of macular edema. METHODS: We studied 15 patients who underwent lens phacoemulsification in our clinic between January and April 1998 performed by the same surgeon. Ultrasound power and cumulative time was noted. Follow-up was performed at 1 day, 1 week, 1, 3 and 6 months after operation. On each visit corneal thickness, best corrected visual acuity, biomicroscopy and fluorescein angiography were performed. Patients with systemic diseases and/or retinal diseases were not included. RESULTS: Visual acuity was inversely related to the amount of energy delivered during phacoemulsification. In patients who had received more than 1 Joule of energy, fluorescein angiography revealed a higher incidence of blood retinal barrier breakdown. Corneal thickness was not correlated with the ultrasound energy used. CONCLUSIONS: Excessive use of power during phacoemulsification may hamper the postoperative evolution of cataract surgery.

Pars plana vitrectomy in diabetic macular edema.

PURPOSE: To ascertain the association between the improvement of diabetic macular edema and increased visual acuity after pars plana vitrectomy. METHODS: From January 1994 to December 1996 we prospectively studied 18 patients (18 eyes, 7 women and 11 men, mean age 52 years, range 37-68) with type II diabetes and clinically significant macular edema. One group was composed of 9 patients presenting diffuse macular edema (DME); a second group with 9 patients presented cystoid macular edema (CME). All patients underwent pars plana vitrectomy. RESULTS: Preoperative Snellen visual acuity was 20/143 in DME and 20/441 in CME. In both groups vision increased to 20/136 and 20/205, respectively, postoperatively. For the DME this difference was statistically significant (p<0.05) at 1 month after the surgery, but vision decreased again after 10 months reaching preoperative values. CONCLUSIONS: Our results suggest that pars plana vitrectomy for diabetic macular edema may increase visual acuity in diffuse macular edema, although this increase is only short lived.

[Clinico-electrophysiologic relations in isolated complete atrioventricular block, congenital or idiopathic]. / Correlazioni clinico-elettrofisiolgiche nel blocco atrioventricolare completo isolato, congenito o idiopatico.

Congenital or idiopathic complete A-V block with no detectable heart disease may be complicated by near syncope, syncope or sudden death. The proposed predictive "risk factors" of these events have not proved sufficiently reliable so far. This study was undertaken in order to re-evaluate the correlation between symptoms and clinical and electrophysiological data with particular regard to the junctional recovery time in 10 patients (4 M; 6 F; mean age 24.4 +/- 9.6 at our first observation) with congenital or idiopathic complete A-V block. Patients were divided into 2 groups: group A (3 M; 3 F; mean age 27.8 +/- 10.6 at our first observation) with patients who complained of vertigo, near syncope or syncope before our study; group B (1 M; 3 F; mean age 19.2 +/- 4.1 at first observation) without cardiovascular symptoms before our study. In group A, Holter monitoring revealed periods of asystole longer than 3000 ms in 2, and ectopic ventricular arrhythmias mainly during effort in 2; ergometric stress test performed in 3 patients demonstrated ectopic ventricular arrhythmias in 2 (those who had ectopic ventricular arrhythmias at rest). In all patients the site of the block was suprahisian (demonstrated by electrophysiologic endocavitary study) with a normal H-V interval; mean junctional recovery time was 4.600 +/- 1.620 ms and corrected junctional recovery time was 3.088 +/- 1.500. Four patients had vertigo during the electrophysiologic endocavitary study. After Atropine 0.02 mg/Kg i.v. junctional recovery time and corrected junctional recovery time decreased respectively to 1052 +/- 238 and 166 +/- 38 ms (the measurement was made in 5 patients). In group B Holter monitoring revealed periods of asystole longer than 3000 ms in 1 case. All patients had ectopic ventricular arrhythmias, confirmed by the stress test. In this group too, the block was suprahisian (electrophysiologic endocavitary study) with normal H-V. Mean junctional recovery time was 5162 +/- 2408 ms; and corrected junctional recovery time 3687 +/- 2202. Two patients complained of dizziness during the electrophysiologic endocavitary study. After Atropine 0.02 mg/Kg i.v., junctional recovery time and corrected junctional recovery time decreased respectively to 1300 +/- 356 and 260 +/- 145 ms. Four group A and 1 group B patients received a permanent pacemaker and have remained asymptomatic since.(ABSTRACT TRUNCATED AT 400 WORDS)

[Sustained ventricular tachycardia: induced polymorphism. Clinical and electrophysiological aspects; therapeutic implications]. / Tachicardia ventricolare sostenuta: polimorfismo indotto. Aspetti clinici ed elettrofisiologici, implicazioni terapeutiche.

By induced polymorphism (I.P.) we mean the electrical induction during endocavitary electrophysiologic study (E.E.S.) either of two or more morphologically distinct types of Sustained Ventricular Tachycardia (S.V.T.) (i.e. different bundle branch block patterns or with shifting of QRS by greater than or equal to 90 degrees) or of one type of sustained ventricular tachycardia other than the spontaneous one. Twenty-two patients with clinical sustained ventricular tachycardia, in whom at least one episode of sustained ventricular tachycardia was induced during endocavitary electrophysiologic study, were divided into 2 groups depending on the presence or not of induced polymorphism: Group I consisted of 13 patients with induced polymorphism; Group II consisted of 9 patients without induced polymorphism. All the patients of the Group I had chronic ischemic heart disease (C.I.H.D.); 12/13 previously had myocardial infarction. Only 1 patient of the Group II had chronic ischemic heart disease. Intraventricular conduction defect was present in 9 patients of the Group I and in 2 of the Group II. An overall of 26 sustained ventricular tachycardia episodes were induced in patients of the Group I: 9 with RBBB, 10 with LBBB and 7 with "bizarre" QRS morphology. Sustained ventricular tachycardia reinduction was attempted in 10 patients of the Group I after acute drug testing (Ajmaline, Propafenone, Amiodarone): sustained ventricular tachycardia was no longer inducible in 6, but in 3 of those 4 in whom it was, a marked increase in polymorphism was observed as compared to pre-test pattern. Of the 11 alive patients of Group I, 10 are on Amiodarone alone or in combination with other antiarrhythmic drugs. We conclude as follows: different morphological types of sustained ventricular tachycardia can be quite commonly induced during endocavitary electrophysiologic study; according to our cases induced polymorphism is observed only in patients with chronic ischemic heart disease; patients with induced polymorphism often have intraventricular conduction defect; induced polymorphism furtherly accounts for reentry as the mechanism of sustained ventricular tachycardia in patients with chronic ischemic heart disease; a prevalent morphology of the endocavitary electrophysiologic study induced sustained ventricular tachycardia in patients with chronic ischemic heart disease was not observed at least in our patients; Amiodarone is the drug of choice for the treatment of induced polymorphic sustained ventricular tachycardia patients.

Fibrosarcoma in pediatric patients: results of the Italian Cooperative Group studies (1979-1995).

BACKGROUND AND OBJECTIVES: Fibrosarcoma is a rare soft tissue sarcoma (STS) that has two peaks of incidence in pediatric patients: one in infants and young children (infantile fibrosarcoma), another in older children ("adult type" fibrosarcoma). The purpose of this study was to describe the clinical features and the treatment results in patients affected by fibrosarcoma enrolled in two consecutive studies run by the STS-Italian Cooperative Group (ICG) between 1979 and 1995. PATIENTS AND METHODS: Twenty-five evaluable patients were grouped according the intergroup rhabdomyosarcoma staging (IRS) system: 12 Gr I, 5 Gr II, 8 Gr III. The cut-off point between the two forms was considered the age of 2 years: 14 patients were affected by infantile and 11 by adult type of fibrosarcoma. The therapeutic guidelines were not strict and not different for the two forms: patients with initial macroscopic excision (Gr I-II) were given IVA or VAC; Gr III had VAC or VAIA and subsequent excision, if feasible. Radiation therapy (RT) was delivered in patients > 3 years with microscopic (42 Gy) and macroscopic (54 Gy) residuals. RESULTS: Thirteen patients are alive without evidence of disease: 10 in first complete remission (CR), 7 Gr I, 1 Gr II, 2 Gr III, 3 in second CR after local relapse (LR) (2 Gr I, 1 Gr II). Two Gr I patients are alive with metastatic relapse. Nine patients died: six of progressive disease (PD) (three Gr II, three Gr III), two because of a second tumor (one Gr I, one Gr III) and one because of other causes (Gr III). One Gr III patient was lost at follow up, 2 years from diagnosis. The 10 years overall survival (OS) is 67.4% and the progression-free survival (PFS) is 52.2%. The OS for patients < 2 years is 78.6% (11 of 14), versus 51% for patients > 2 years (5 of 11). CONCLUSIONS: The complete excision at diagnosis was the treatment of choice and was related to the best outcome. Microscopical residuals were difficult to treat with chemo-radiotherapy in both forms of fibrosarcoma. Neoadjuvant chemotherapy (CT) obtained a partial remission (PR) only in three of eight cases, while no conclusions concerning the efficacy of CT for infantile forms are possible. Patients < 2 years had a better outcome than the older ones: most of them had a tumor on extremities which was excised at diagnosis.