Dose-Response Effects on LBP, Sleep, and Depression of Online Pre-Partum and Post-Partum Pilates-Based Programs.

Purpose: Pilates-based programs can help pregnant women deal with the physical and psychological burden derived by major changes in their body. This study was designed to primarily test, in pregnant women, the dose-response and health effects of both pre-partum and post-partum, online Pilates-based program on weight control, low back pain (LBP) severity, sleep disturbances, mood and depression levels. Methods: A total of 136 pregnant women were screened for eligibility (low-risk pregnancy; aged 18-45 years; single pregnancy; 20-28-week gestational age, normal BMI). Participants completed an online Pilates-based program during pregnancy and after delivery, through an online platform guided by a Pilates, Yoga and Lagree certified instructor. Main outcomes (weight control, LBP disability, sleep quality, mood, and mental health) were assessed at baseline and at the completion of pre- and post-partum programs. Results: Regarding pre-partum, significant gains in weight were observed only in low- and intermediate-amount exercisers. Only high-amount exercisers did not display significant increase in LBP-related disability (+42.7%; p = .21) unlike low (+12.2%; p < .0001) and intermediate exercisers (+9.6%; p < .0001). Sleep disturbances increased significantly in low- (+24.3%; p = .005) but not in intermediate- (+4.6%; p = .50) and high-amount exercisers (-0.1%; p = .91). Regardless of the amount of exercise, depression scores improved in all groups. Following post-partum intervention (n = 40), only intermediate-amount exercisers showed significant reductions in sleep disturbances (-24.1%; p = .003) and depression (15.9%; p = .04). Conclusions: Approximately 270 min/week of an online Pilates-based program were needed to prevent LBP worsening, and sleep deterioration in pregnant women. A different pattern was outlined for those women resuming the Pilates-based intervention at post-partum, with 150 min/week emerging as the "dose" of exercise capable of inducing the largest improvements in LBP, sleep, and mood disturbances.

Multidisciplinary clinical guidelines in proactive monitoring, early diagnosis, and effective management of trastuzumab deruxtecan (T-DXd)-induced interstitial lung disease (ILD) in breast cancer patients.

Trastuzumab deruxtecan (T-DXd), a human epidermal growth factor receptor 2 (HER2)-directed antibody-drug conjugate (ADC), has altered the treatment landscape in breast cancer (BC), irrespective of the HR-receptor status. The use of the agent is increasing, despite the finding that exposure to T-DXd increases the risk of interstitial lung disease (ILD), particularly in BC patients. Although T-DXd-related ILD can be potentially severe and life-threatening, most low-grade cases can be treated safely using a multidisciplinary approach comprising early and accurate diagnosis, effective management, close monitoring, and the prompt administration of steroids. Additionally, increasing patients' education on ILD symptoms ensures close attention and enables prompt reporting, enhancing patient outcomes. It is recommended that predictive biomarkers are assessed in patients with risk factors for developing ILD. Currently, diagnostic criteria comprise newly identified pulmonary opacities, the relation of symptom onset to medication initiation, and the exclusion of other causes of ILD. The general condition of patients is weakened during the management of ILD (BC progression and corticosteroid treatment). Consequently, BC chemotherapy might be attenuated. This highlights the importance of preventing (high-grade) ILD, especially since its use is expanded. Identifying high-risk patients, diagnosing, and customizing treatment is, however, challenging and additional information on patient selection is often not fully clarified. In this paper, we provide updated multidisciplinary clinical guidance for patient selection, proactive monitoring, early diagnosis, and effectively management of T-DXd-induced ILD in HER2-positive BC patients. We describe the risk factors for developing ILD, patients' characteristics of ILD, and the histopathological and radiographic characteristics of ILD, including real-world clinical practice reports. These recommendations provide a structured step-by-step approach for managing each suspected BC-related ILD grade.

Psychiatric symptoms and quality of life in systemic sclerosis.

INTRODUCTION: Systemic sclerosis (SSc) is a rare conjunctive tissue disorder characterized by fibrosis of the skin and internal organs, and vascular obliteration phenomena. Patients with SSc often experience elevated symptoms of psychological distress, determined by the disfiguration, the pain, the fatigue sensation, and the difficult in daily life occupations. The characteristics of the disease may influence the perceived quality of life (QoL) in people with SSc. METHODS: This is a narrative review aiming to define the amount of impairment of Quality of Life in patients with Systemic Sclerosis and the component of this impairment due to depressive or other psychiatric symptoms. The search of the significant articles was carried out in PubMed for the key words "Psychiatric symptoms and Systemic Sclerosis"; "Quality of life and Systemic Sclerosis"; "Depressive Disorders and Systemic Sclerosis". RESULTS: Psychiatric symptoms are frequents in patients with SSc, but pain, fatigue, disability, body changes don't appear to explain the high prevalence of psychiatric comorbidity in SSc. Many studies founded a significant impairment in SSc patients' QoL, and despite the undeniable correlation between physical symptoms and SSc patients' QoL, mental health was found significantly impaired. DISCUSSION: The high rate of depression seems to strictly correlate with poor quality of life, and this finding needs more research to establish the cause of such a correlation. Patients' point of view regarding their health-related QoL could help physicians to enlarge the knowledge about physical and mental correlates of the disease, and to fit therapies as patient required. Particular attention must be given to provide the patient with correct information, in order to mitigate the anxious state on disease course, and to enhance coping skills of the patients.

Quality of Life and Psychiatric Symptoms in Wilson's Disease: the Relevance of Bipolar Disorders.

INTRODUCTION: Wilson's disease is an inherited disorder caused by a gene located on chromosome 13, which involved copper transportation across cell membranes. The disease can cause a reduced incorporation of copper into ceruloplasmin resulting in accumulation of this metal in the liver, central nervous system, kidneys and other organs. The objective is to define the frequencies of psychiatric disorders in WD, the amount of impairment of Quality of Life [QoL] in patients with WD and the relevance of the psychiatric disorders in the QoL of people suffering by WD. METHODS: This is a systematic review. The search of the significant articles was carried out in PubMed using specific key words. RESULTS: Such other neurological diseases, WD is characterized by chronic course and need of treatments, impairment of functional outcomes and high frequency of psychiatric symptoms, although a specific association between Bipolar Disorders and WD was recently found. Despite this, since today few studies are carried on WD patients' quality of life related to psychiatric symptoms. Some new reports showed a link between presence of Bipolar Disorders diagnosis, cerebral damage and low Qol. CONCLUSION: Prospective studies on large cohorts are required to establish the effective impact of psychiatric disorders comorbidity, particularly Bipolar Disorders, on quality of life in WD and to clarify the causal link between brain damage, psychiatric disorders and worsening of QoL.

Counseling in primary care improves depression and quality of life.

INTRODUCTION: To measure the effectiveness on Quality of Life of adjunctive cognitive behavioral counseling in the setting of General Practitioners (GPs) along with the treatment as usual (TAU;) for the treatment of depression. METHODS: Six month-controlled trial of patients who were referred to randomly assigned GPs (four for experimental group of patients and ten for the control) was done. Experimental sample had 34 patients with DSM-IV diagnosis of Depression (Depressed Episode, Dysthymia, or Adjustment Disorder with Depressed Mood) receiving the TAU supplemented with counseling. Control group had 30 patients with diagnosis of Depression receiving only the TAU. RESULTS: The Beck Depression Inventory (BDI) score improved in both groups. Patients in the experimental group showed greater improvement compared to the control group at T2. The World Health Organization Quality OF Life Questionnaire (WHOQOL) score also improved in the experimental group but not in the control group. The improvement in the experimental group was statistically significant in terms of both BDI and WHOQOL scores. CONCLUSIONS: Adding counseling to TAU in general medical practice settings is more effective in controlling the symptoms of depression and improving the quality of life as measured over a period of six months, than TAU alone. These results while encouraging, also calls for a larger study involving a largersample size and a longer period of time.

Investigating the Nature of Late-Time High-Energy GRB Emission Through Joint Fermi /Swift Observations.

We use joint observations by the Neil Gehrels Swift X-ray Telescope (XRT) and the Fermi Large Area Telescope (LAT) of gamma-ray burst (GRB) afterglows to investigate the nature of the long-lived high-energy emission observed by Fermi LAT. Joint broadband spectral modeling of XRT and LAT data reveal that LAT non-detections of bright X-ray afterglows are consistent with a cooling break in the inferred electron synchrotron spectrum below the LAT and/or XRT energy ranges. Such a break is sufficient to suppress the high-energy emission so as to be below the LAT detection threshold. By contrast, LAT-detected bursts are best fit by a synchrotron spectrum with a cooling break that lies either between or above the XRT and LAT energy ranges. We speculate that the primary difference between GRBs with LAT afterglow detections and the non-detected population may be in the type of circumstellar environment in which these bursts occur, with late-time LAT detections preferentially selecting GRBs that occur in low wind-like circumburst density profiles. Furthermore, we find no evidence of high-energy emission in the LAT-detected population significantly in excess of the flux expected from the electron synchrotron spectrum fit to the observed X-ray emission. The lack of excess emission at high energies could be due to a shocked external medium in which the energy density in the magnetic field is stronger than or comparable to that of the relativistic electrons behind the shock, precluding the production of a dominant synchrotron self-Compton (SSC) component in the LAT energy range. Alternatively, the peak of the SSC emission could be beyond the 0.1-100 GeV energy range considered for this analysis.

Photodegradation of organic waste coupling hydrogenase and titanium dioxide.

In this work the results of the study on the degradation of dairy waste and lactose with use of titanium dioxide (TiO2), as photocatalyst, are presented. The ability of TiO2 to degrade dairy waste is compared either in the presence of molecular oxygen or of a bacterial hydrogenase as electron acceptor. The enzyme-mediated H2 production rates or the O2 consumption rates are used to measure electron donor degradation. The results obtained clearly indicate that dairy waste can be degraded by the TiO2 photocatalyst. Proteins present in the dairy waste have a strong inhibitory effect on the degradation process. Indeed lactose alone can easily be degraded. When the protein extract obtained from the dairy waste was added to the lactose solution, the reaction for both electron acceptors, hydrogenase and oxygen, was inhibited. When the dairy waste solutions were diluted, there was a positive effect on the reaction rate. This was particularly true in the case of hydrogenase, and to a lesser extent in the case of oxygen acceptor. The reduction of the pH from 8 to 6 also increased H2 production when the enzyme was used.

Modulation of chemosensitivity by alpha interferon in multiple myeloma and non-Hodgkin's lymphoma.

Low-grade non-Hodgkin's lymphoma and multiple myeloma are chemosensitive malignancies, but are rarely curable because of primary or acquired drug resistance. Interferon has been shown to modulate the multidrug resistance phenotype and to reinduce chemosensitivity in patients with chemoresistant tumors. Fifteen patients with multiple myeloma and 64 patients with low/intermediate grade non-Hodgkin's lymphoma unresponsive to initial chemotherapy were treated with alpha 2b interferon for 2 months. In case of an objective response, treatment was continued until disease progression; non-responding patients received the same chemotherapy to which they were resistant, preceded by a 5 day course of interferon. Interferon salvage monotherapy induced an objective response in 1/15 patients with multiple myeloma and in 7/64 patients with non-Hodgkin's lymphoma. An objective response was achieved after retreatment with first-line chemotherapy preceded by interferon in 4/14 patients (28.6%) with multiple myeloma and in 20/56 evaluable patients (35.7%) with non-Hodgkin's lymphoma. Toxicity was moderate, predictable, manageable, and never caused interruption of the treatment. Interferon appears to be able to modulate chemosensitivity of tumors refractory to chemotherapy with several potential mechanisms, including an effect on drug accumulation; its utilization in this setting warrants further evaluation.

A real-time classification system of thalassemic pathologies based on artificial neural networks.

Thalassemias are pathologies that derive from genetic defects of the globin genes. The most common defects among the population affect the genes that are involved in the synthesis of alpha and beta chains. The main aspects of these pathologies are well explained from a biochemical and genetic point of view. The diagnosis is fundamentally based on hematologic and genetic tests. A genetic analysis is particularly important to determine the carriers of alpha-thalassemia, whose identification by means of the hematologic parameters is more difficult in comparison with heterozygotes for alpha-thalassemia. This work investigates the use of artificial neural networks (ANNs) for the classification of thalassemic pathologies using the hematologic parameters resulting from hemochromocytometric analysis only. Different combinations of ANNs are reported, which allow thalassemia carriers to be discriminated from normals with 94% classification accuracy, 92% sensitivity, and 95% specificity. On the basis of these results, an automated system that allows real-time support for diagnoses is proposed. The automated system interfaces a hemochromo analyzer to a simple PC.

The effects of certain antibiotics on biogas production in the anaerobic digestion of pig waste slurry.

Antibiotics commonly used in the treatment of pigs - amoxicillin trihydrate, oxytetracycline hydrochloride and thiamphenicol were added at different concentrations to aliquots of pig waste slurry plus anaerobic sludge in serum bottles. The biogas production and methane concentration in the headspace were monitored to determine the effect of the antibiotics on the anaerobic process. With thiamphenicol significant differences in methane production were found for concentrations of 80 and 160 mg l(-1) slurry. Compared to the control, only minor differences in methane production were noted in the bottles to which amoxicillin (60 and 120 mg l(-1)) had been added. Methane production was about the same for the bottles with different oxytetracycline concentrations (125 and 250 mg l(-1)) and for the control.

Short-term treatment of reflux oesophagitis with ranitidine 300 mg nocte. Italian multicentre study.

A multicentre study involving 9 Italian institutions was carried out to compare the efficacy and safety of ranitidine 150 mg b.i.d. and ranitidine 300 mg nocte in the treatment of reflux oesophagitis. 117 patients with histologically proven oesophagitis were randomly allocated to two comparable treatment groups. Efficacy and reliability were evaluated by clinical and laboratory tests at the beginning of the study, and at 3 and 6 weeks; endoscopy and biopsies were performed at the beginning and at 6 weeks. Treatment with ranitidine for 6 weeks led to total disappearance of gastro-oesophageal reflux symptoms in 60% of patients, with percentages of partial improvement varying between 85% and 95% of cases. Improvement in the results of endoscopic examination was 85%, of which 55% were cured. Microscopic examination revealed an improvement of 36% and 44%, with a cure rate of 18% and 26% respectively. With regard neither to the regression of symptoms nor to the macroscopic and microscopic inflammation of the oesophageal mucosa did statistical examination show significant differences in the therapeutic efficacy of ranitidine 150 mg b.i.d. or 300 mg nocte for treatment of reflux oesophagitis.

The Role of Chirocephalus diaphanus in the Early Recognition of Environmental Pollution by Trace Elements

A study was undertaken to evaluate whether the fairy shrimp Chirocephalus diaphanus (Crustacea: Anostraca) could be considered as a species capable of biomonitoring environmental contamination by accumulating trace elements. This preliminary investigation aimed at assessing the levels of As, Cd, Cu, Hg, Pb, Se, and Zn in natural waters as well as in adults and cysts of fairy shrimps sampled from five different sites in central Italy. Trace elements were determined by inductively coupled plasma (ICP)-based spectrometry. In particular, ICP-mass spectrometry (ICP-MS) was resorted to in most cases due to its high detection power. Pretreatment of samples (adults and cysts) consisted basically in the HNO3-assisted microwave digestion of the material. The highest levels of trace elements were found in the anostracan cysts, with concentration ranges (µg/g) of 0.464-3.11 for As, up to 0.820 for Cd, 2.62-13.0 for Cu, 0.011-0.213 for Hg, 0.966-8.46 for Pb, 0.295-2.45 for Se, and 16.4-50.4 for Zn. On the other hand, the lowest concentrations were found in natural waters, with values close to the ICP-MS detection power for some elements. These data are probative of a bioconcentration process, the extent of which is proportional to the environmental level of each element. This may turn out to be useful in planning biological monitoring and assessing ecotoxicological consequences which might ensue from the diffusion of the exploitation of such organisms in aquaculture.

The electrocardiographic T wave changes in highly trained athletes during training. An old problem revisited.

OBJECTIVE: To evaluate the T-wave pattern alterations during vigorous training in elite athletes. SETTING: Institute of Sport Science in Rome and National Rowing Center in Piediluco, Italy. STUDY POPULATION: Nine male and 7 female rowers of the national team were examined prospectively at different times of their conditioning period. METHODS: All athletes underwent electrocardiography and echocardiography; the ecg was analyzed for QRS voltages and axis, T-wave pattern and QTc interval; from echocardiography the left ventricular (LV) cavity dimension, wall thickness and mass were calculated. From Doppler-echocardiography the transmitral diastolic LV filling pattern was evaluated. RESULTS: Variation of T-wave voltages was seen in all the athletes. Specifically, during the low-intensity training period the T-wave pattern was positive and increased in voltage (T-wave max amplitude in V6 increased to 130% in male and 100% in female than pretraining values). During the peak training a variety of patterns was observed, and a transient flattening was present in 50% of subjects. No concomitant alteration of heart rate, QRS and T-wave axis and QTc duration were observed. No significant changes of cavity dimension, wall thickness, LV mass index and Doppler-derived diastolic peak flow velocities were detected during the study period. CONCLUSIONS: Transient changes of T-wave pattern may occur in athletes as an effect of athletic conditioning, without changes of cardiac dimension or alteration of indexes of LV function. This finding supports the role of ecg monitoring to follow-up the individual athletes response to training exercise load.

[Jeiuno-ileal diverticula complicated by perforation. Clinical case]. / Diverticolosi digiuno-ileale complicata da perforazione. Caso clinico.

The diverticular disease is rarely located in the small intestine (0.1-1.4%). The most important feature is due to the lack of a typical symptomatology which may appear only on the occasion of the complications it may incur (perforation, haemorrhage and so on). It isn't also infrequent that the surgeon may observe intestinal diverticula accidentally, on the occasion of laparotomies carried out in emergency or for other pathologies. The literature on intestinal diverticula is reviewed and personal experience in a clinical case presenting as acute abdomen is described.

[Day Surgery. Five years of experience and activity]. / Day Surgery. Nostra esperienza dopo 5 anni di attività

BACKGROUND: The aim of this paper is to evaluate the management of an integrated unit of Day Surgery in a General Surgery Department. METHODS: An outline of the first 5 years of activity is presented. Setting of investigation: little provincial hospital. Patients have been selected on a basis of Day Surgery specific features: a total of 1,294 patients. Pathologies treated: inguinal hernias, phlebectasias, phimosis, borsitis, arthritic cysts, tendon cysts, carpal tunnel, Dupuytren's disease ("crispatura tendinum"), lymphadenitis, mammary nodules, hemorrhoids, hydroceles, varicoceles, adipomas. Patients' selection parameters, surgical operation type and modalities, postoperative course, protected discharges from hospital, follow-up and complications have all been carefully recorded. RESULTS: The most numerous operations were related to hernial pathology (54.32%) and to adipomas (10.81%). The form of anesthesia was mainly loco-regional. Only 4 cases (0.3%) had to be hospitalized for the night after operation. COMPLICATIONS: 1 serious wound infection, needing removal of the hernial prosthesis; 1 painful "tumefaction" on the inguinal wound for hernioplastic operation; 3 "seromas" in inguinal hernioplastics. CONCLUSIONS: Advantages of Day-Surgery: cut in health costs due to the reduction of admissions to hospital; reduction in hospital infections and in surgical wounds; reduction in drug use; thinning of waiting lists; increase of available beds for other pathologies; reduction of disability days; high appreciation index.

[Prevention of periodontopathy and oral mucositis during antineoplastic chemotherapy. Clinical study]. / Prevenzione delle parodontopatie e delle stomatomucositi in corso di chemioterapia antineoplastica. Studio clinico.

BACKGROUND: Oral mucositis is a common side effect of chemotherapy, with a multifactorial etiology: the direct toxicity of cancer therapy on the normal cells, reduced immunitary defences, presence of bacteria in the oral cavity. The aim of this study is to assess the clinical effectiveness of a preventive protocol of oral mucositis and periodontopathy during antineoplastic chemotherapy. METHODS: The design of the study was a longitudinal evaluation of 30 patients undergoing antineoplastic chemotherapy at the out-patients Department of Oncology of the University of Sassari. The study lasted one year and was carried out at the Dentistry Department of the University of Sassari. The patients were motivated to home oral hygiene, underwent professional oral hygiene and clorexidine rinses were prescribed. Visible plaque index (VPI) and gingival bleeding index (GBI) were taken from each patient as periodontal indices, and the state of the mucosa was evaluated according to the WHO recommendations (1975). The control group was composed by 33 patients. RESULTS: The values of the bleeding and plaque indices were considerably diminished between the first and the last visit, in nearly all the patients; the incidence of oral mucositis in the treated group was 20%, while in the control group it was 66%. 5-fluoruracil was always involved. CONCLUSIONS: According to the results observed, the conclusion is drawn that the professional and home oral hygiene and the use of clorexidine, can reduce the incidence of oral mucositis as a side effect of antineoplastic chemotherapy.

[Characterization of the difference between filtered back projection and ordered subsets expectation maximization in spect images using the Wavelet Transform]. / Caracterización de la diferencia entre retroproyección filtrada y Ordered Subsets Expectation Maximization, en imágenes SPECT, utilizando la transformada Wavelet.

Efficiency of reconstruction algorithms is important to guarantee quality of Nuclear Medicine tomographic images. The algorithms belong to one of two types: analytical or statistical. The Filtered Back Projection (BP) algorithm belongs to the first group and the Ordered Subsets Expectation Maximization (OSEM) algorithm belongs to the second group. The aim of the present paper was to compare both algorithms by means of the Wavelet Transform (WT). This tool was selected because of its capability to divide the image into different frequency levels without losing information about their spatial position. The WT was applied on the Haar basis without decimation in order to compare matrixes of the same size. Attention was drawn to the relative presence of three typical perturbations: Poisson noise, annular artifacts that express a deficient correction to the planar uniformity and attenuation phenomenon. With these purposes, we studied homologue transversal slices of images of homogeneous distribution of activity. The OSEM algorithm not only greatly improves the filtering of the Poisson noise, but also diminishes the annular artifacts, mainly at the image zone that coincides with the rotation center. The intensity of the attenuation phenomenon was the same with both algorithms, except in the peripheral zone where OSEM showed a slightly higher activity than BP. These observations encourage our interest to continue applying the WT not only to identify the artifacts, but also to try to decrease their deleterious influence on Nuclear Medicine images.