[Maternal Satisfaction and Birth: a web-based survey]. / Soddisfazione materna ed evento nascita: una web-based survey.

INTRODUCTION: Maternal satisfaction regarding care during delivery is an indicator of maternity service's quality. METHODS: We conducted an observational study between May and August 2018, using an online questionnaire for women who have delivered in the last 3 years. Data was processed using descriptive and bivariate analysis, considering satisfaction as outcome. RESULTS: Sample includes 1229 women. About 73% had a spontaneous vaginal delivery, of which 29.3% received a Kristeller manoeuvre and 34,4% episiotomy. Three women out of 10 complaint about lack of involving in the decision-making process, 13.9% of women believe that their delivery's experience can negatively influence their decision to have another child, and 19.8% would like not to give birth again in the same hospital. Four women out of 10 are only partially satisfied with the care received and 6.4% is not satisfied at all. Satisfaction is significantly associated to the following variables: age more than 25 years old, positive environment during labour, gentle attitude of healthcare provider, respect of needs, respect of dignity, woman's inclusion in the decision making process, presence of a trustworthy person during the labour/delivery, vaginal delivery, positive delivery's experience, episiotomy, Kristeller manoeuvre, skin-to-skin contact, support during breastfeeding and postpartum period, choice to come back in the hospital for another delivery. CONCLUSION: We should implement strategies to promote the mother-partner-child triad as a central focus during delivery and allocate human resources in more efficient ways.

Contribution of TMS and TMS-EEG to the Understanding of Mechanisms Underlying Physiological Brain Aging.

In the human brain, aging is characterized by progressive neuronal loss, leading to disruption of synapses and to a degree of failure in neurotransmission. However, there is increasing evidence to support the notion that the aged brain has a remarkable ability to reorganize itself, with the aim of preserving its physiological activity. It is important to develop objective markers able to characterize the biological processes underlying brain aging in the intact human, and to distinguish them from brain degeneration associated with many neurological diseases. Transcranial magnetic stimulation (TMS), coupled with electromyography or electroencephalography (EEG), is particularly suited to this aim, due to the functional nature of the information provided, and thanks to the ease with which it can be integrated with behavioral manipulation. In this review, we aimed to provide up to date information about the role of TMS and TMS-EEG in the investigation of brain aging. In particular, we focused on data about cortical excitability, connectivity and plasticity, obtained by using readouts such as motor evoked potentials and transcranial evoked potentials. Overall, findings in the literature support an important potential contribution of TMS to the understanding of the mechanisms underlying normal brain aging. Further studies are needed to expand the current body of information and to assess the applicability of TMS findings in the clinical setting.

Primary cutaneous lymphoma: local control and survival in patients treated with radiotherapy.

BACKGROUND: The treatment of primary cutaneous lymphoma is still ongoing and the role of radiotherapy, as exclusive or combined modality, is not yet clear. MATERIALS AND METHODS: From 1994 to June 2004, 29 patients with cutaneous B-cell lymphoma and 9 patients with cutaneous T-cell lymphoma were treated by radiotherapy (median dose of 3900 cGy, range 600-4600 cGy). Eight patients had previously received chemotherapy. RESULTS: The complete response rate was 94.7% with progressive disease in two patients (5%). Sixteen (42.1%) patients relapsed, with the relapse occurring only in the skin site as single episode (9 patients) and more than two episodes (7 patients). The 5-year overall survival and event-free survival were 94% and 53%, respectively. CONCLUSION: Radiotherapy offers a substantial local control of primary cutaneous lymphoma, both as exclusive or combined approach. The patients with wide-spread or multiple lesions, usually candidates for radiotherapy and chemotherapy, are amenable to radiotherapy alone.

Adjuvant radiotherapy and radiochemotherapy in the management of esophageal cancer: a review of the literature.

Surgical resection remains the mainstay treatment for esophageal cancer and the failure of surgery alone is attributed to the systemic nature of the disease at the time of presentation. In an effort to improve local control of the disease that should correspond to a benefit in survival, postoperative adjuvant schemes of treatment have been explored. Current standard treatment, and future implications in light of the new knowledge are analyzed, based on the present literature. The possibility of different treatments in relation to different histology findings, is stressed.

MACOP-B and involved-field radiotherapy is an effective and safe therapy for primary mediastinal large B cell lymphoma.

PURPOSE: To report the clinical findings and long-term results of front-line, third-generation MACOP-B (methotrexate, doxorubicin, cyclophosphamide, vincristine, prednisone, and bleomycin) chemotherapy and mediastinal involved-field radiotherapy (IFRT) in 85 consecutive, previously untreated patients with primary mediastinal large B cell lymphoma (PMLBCL) diagnosed and managed at a single institution. METHODS AND MATERIALS: Between 1991 and April 2004, 92 consecutive, untreated patients with PMLBCL were treated at our institution. The median age was 33 years (range, 15-61 years), 46 patients (50%) showed a mediastinal syndrome at onset; 52 patients (57%) showed a low/low-intermediate (0 to 1) and 40 patients (43%) an intermediate-high/high (2 to 3) International Prognostic Index (IPI) score. Eighty-five patients were treated with standard chemotherapy (MACOP-B), and 80 underwent mediastinal IFRT at a dose of 30-36 Gy. RESULTS: After a MACOP-B regimen, the overall response rate was 87% and the partial response rate 9%. After chemotherapy, (67)Ga scintigraphy/positron emission tomography results were positive in 43 of 52 patients (83%), whereas after IFRT 11 of 52 patients (21%) remained positive (p < 0.0001). After a median follow-up of 81 months (range, 2-196 months), progression or relapse was observed in 15 of 84 patients (18%). The projected 5-year overall survival and progression-free survival rates were 87% and 81%, respectively. The 5-year overall survival and progression-free survival rates were better for patients with an IPI of 0 to 1 than for those with an IPI of 2 to 3 (96% vs. 73% [p = 0.002] and 90% vs. 67% [p = 0.007], respectively). CONCLUSIONS: Combined-modality treatment with intensive chemotherapy plus mediastinal IFRT induces high response and lymphoma-free survival rates. Involved-field RT plays an important role in inducing negative results on (67)Ga scintigraphy/positron emission tomography in patients responsive to chemotherapy.