Publications by authors named "Giuseppe Migliaretti"

64 Publications

Percutaneous Kidney Puncture with Three-dimensional Mixed-reality Hologram Guidance: From Preoperative Planning to Intraoperative Navigation.

Eur Urol 2021 Nov 16. Epub 2021 Nov 16.

Division of Urology, Department Of Oncology, School of Medicine, University of Turin, San Luigi Hospital, Orbassano, Turin, Italy.

Background: Despite technical and technological innovations, percutaneous puncture still represents the most challenging step when performing percutaneous nephrolithotomy. This maneuver is characterized by the steepest learning curve and a risk of injuring surrounding organs and kidney damage.

Objective: To evaluate the feasibility of three-dimensional mixed reality (3D MR) holograms in establishing the access point and guiding the needle during percutaneous kidney puncture.

Design, Setting, And Participants: This prospective study included ten patients who underwent 3D MR endoscopic combined intrarenal surgery (ECIRS) for kidney stones from July 2019 to January 2020. A retrospective series of patients who underwent a standard procedure were selected for matched pair analysis.

Surgical Procedure: For patients who underwent 3D MR ECIRS, holograms were overlapped on the real anatomy to guide the surgeon during percutaneous puncture. In the standard group, the procedures were only guided by ultrasound and fluoroscopy.

Measurements: Differences in preoperative and postoperative patient characteristics between the groups were tested using a χ test and a Kruskal-Wallis test for categorical and continuous variables, respectively. Results are reported as the median and interquartile range for continuous variables and as the frequency and percentage for categorical variables.

Results And Limitations: Ten patients underwent 3D MR ECIRS. In all cases, the inferior calyx was punctured correctly, as planned using the overlapping hologram. The median puncture and radiation exposure times were 27 min and 120 s, respectively. No intraoperative or major postoperative complications occurred. Matched pair analysis with the standard ECIRS group revealed a significantly shorter radiation exposure time for the 3D MR group (p < 0.001) even though the puncture time was longer in comparison to the standard group (p < 0.001). Finally, use of 3D MR led to a higher success rate for renal puncture at the first attempt (100% vs 50%; p = 0.032). The main limitations of the study are the small sample size and manual overlapping of the rigid hologram models.

Conclusions: Our experience demonstrates that 3D MR guidance for renal puncture is feasible and safe. The procedure proved to be effective, with the inferior calyx correctly punctured in all cases, and was associated with a low intraoperative radiation exposure time because of the MR guidance.

Patient Summary: Three-dimensional virtual models visualized as holograms and intraoperatively overlapped on the patient's real anatomy seem to be a valid new tool for guiding puncture of the kidney through the skin for minimally invasive treatment.
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http://dx.doi.org/10.1016/j.eururo.2021.10.023DOI Listing
November 2021

Migraine in Chiari 1 Malformation: a cross-sectional, single centre study.

Acta Neurol Belg 2021 May 28. Epub 2021 May 28.

Centro Regionale Esperto Siringomielia e Sindrome di Chiari (CRESSC), Department of Neuroscience, AOU Città della Salute e della Scienza di Torino, Presidio CTO, Via Zuretti, 29, 10126, Turin, Italy.

In Chiari 1 Malformation (CM1) the most frequent symptom is exertional headache, but other headache types have been reported, such as migraine. This cross-sectional study is aimed to examine the prevalence of migraine in a group of CM1 headache patients and to compare clinical-demographic characteristics between migraine and non-migraine patients. 427 adults were enrolled at the multidisciplinary Chiari Center in Torino. 230 headache patients were classified, based on radiological criteria. Frequencies (absolute/percentage values) were calculated in the whole sample for: migraine presence (with and without aura), gender, age, radiologic phenotypes and headache clinical characteristics. The association between CM1 diagnosis and headache characteristics (independent variables) and migraine diagnosis (dependent variable) was estimated by logistic regression models. Seventy-eight patients (67 females) out of 230 presenting headache had a migraine (34%), 44/78 (56%) with aura; in 58/78 (74%) migraine was comorbid with secondary headache attributable to CM1. Migraine prevalence in patients with isolated CM1 (52/120, 43.3%) was higher (p = 0.0016) than in all the other patients (26/110, 23.6%). Although migraine was prevalent in females (86%; 6:1 female:male ratio), age classes and gender were not risk factors for migraine at multivariate analysis, while migraine was associated with isolated CM1 phenotype (OR = 2.6). This study shows a high prevalence of migraine in CM1 patients and a significant association between migraine and isolated CM1. In patients with radiological evidence of CM1, particularly in the absence of neurological signs, a careful headache clinical characterization, according to the International Headache Society criteria, may be advised.
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http://dx.doi.org/10.1007/s13760-021-01716-zDOI Listing
May 2021

Trends in admissions to a child and adolescent neuropsychiatric inpatient unit in the 2007-2017 decade: how contemporary neuropsychiatry is changing in Northwestern Italy.

Eur Child Adolesc Psychiatry 2021 Apr 29. Epub 2021 Apr 29.

Department of Public Health and Pediatric Sciences, Section of Child and Adolescent Neuropsychiatry, University of Turin, Turin, Italy.

Purpose: Rising levels of psychopathology in the adolescent population have been evidenced in the last few years throughout the Western world. We aim to examine how contemporary neuropsychiatry is changing in Northwestern Italy and how this impacts inpatient services.

Methods: The present research considered the 1177 admissions to a public neuropsychiatric inpatient service in the 2007-2017 decade. The annual percentual change (APC) was analysed for the total admissions, the number of the neurological vs psychiatric admissions, the length of inpatient stay, and the mean age at admission, also accounting for sex differences. The annual trend was also calculated for each diagnosis.

Results: The overall number of inpatient admissions decreased significantly (APC = - 5.91), in particular for children under 12 years of age (APC = - 7.23). The rate of neurologic diagnoses significantly decreased (APC = - 26.44), while the length of the inpatient stay (APC = 6.98) and the mean age at admission (APC = 6.69) increased. Among the psychiatric diagnoses, depression significantly rose (APC = 41.89), in particular among female adolescents (APC = 40.30).

Conclusions: These data document a substantial change in the utilization of inpatient neuropsychiatric services for children and adolescents, with a major increase in psychiatric hospitalizations and a parallel decrease in neurological ones. These trends call for greater attention to early preventive intervention in mental healthcare system.
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http://dx.doi.org/10.1007/s00787-021-01794-7DOI Listing
April 2021

Prevalence of musculoskeletal disorders among perioperative nurses: a systematic review and META-analysis.

BMC Musculoskelet Disord 2021 Feb 26;22(1):226. Epub 2021 Feb 26.

Department of Public Health and Pediatrics, University of Torino, Via Zuretti 29, 10126, Turin, Italy.

Background: To evaluate the prevalence of work-related musculoskeletal disorders (WRMSDs) in perioperative nurses and to explore their association with personal characteristics.

Methods: Medline, Cumulative Index to Nursing and Allied Health Literature, Scopus, Web of Science, Cochrane Library and Joanna Briggs Institute Database were systematically searched. A meta-analysis calculating event rates, and relative 95% Confidence Intervals (CI) was performed for each musculoskeletal body region. The contribution of perioperative nurses' sex, age, and BMI was assessed through a meta-regression.

Results: Twenty-two studies, considering 3590 perioperative nurses, were included in the systematic review. The highest prevalence of WRMSDs was found for the lower-back (62%; 95% CI 0.54-0.70), followed by knee (47%; 95% CI 0.36-0.59), shoulder (44%; 95% CI 0.37-0.51), waist (42%; 95% CI 0.31-0.53), neck (39%; 95% CI 0.29-0.51), ankle-feet (35%; 95% CI 0.22-0.51), upper-back (34%; 95% CI 0.25-0.44), hand-wrist (29%; 95% CI 0.20-0.40), and elbow (18%; 95% CI 0.12-0.26). Meta-regression showed that sex, age, and BMI were not significant predictors of low-back disorders (p = 0.69; R = 0).

Conclusions: WRMSDs represent a high prevalence issue among perioperative nurses. Perioperative nurses, in general, are steadily exposed to both physical and temporal risk factors. Further studies should be addressed to identify specific interventions aimed at reducing the burden of WRMSDs including ergonomic education and physical rehabilitation. Our data could be used in future studies as a reference to assess the risk of WRMSDs in other health-care professionals' population.
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http://dx.doi.org/10.1186/s12891-021-04057-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7908783PMC
February 2021

Evaluation of Extrauterine Head Growth From 14-21 days to Discharge With Longitudinal Intergrowth-21st Charts: A New Approach to Identify Very Preterm Infants at Risk of Long-Term Neurodevelopmental Impairment.

Front Pediatr 2020 19;8:572930. Epub 2020 Nov 19.

Neonatal Care Unit, Department of Public Health and Pediatric Sciences, University of Turin, Turin, Italy.

ExtraUterine Growth Restriction (EUGR) is a common definition for in-hospital growth failure of very preterm infants. Wide heterogeneity is found in definitions and anthropometric charts used to describe EUGR. We aim to compare two traditional definitions of EUGR with a newly proposed one, based on a longitudinal evaluation, that takes into account the physiological period of fluid loss after birth. We also wish to detect which definition could better predict neurodevelopmental impairment at 24 months of corrected age (CA). A total of 195 infants with GA < 30 were included. EUGR was calculated both for weight and head circumference (HC). Cross-sectional EUGR was defined as measurements < 10th percentile at discharge; longitudinal EUGR was defined as Δscore < -1 between birth and discharge measurements. The new longitudinal "post-loss" EUGR definition was proposed as Δscore < -1 between measurements taken at 14-21 days of life and at discharge. Longitudinal postnatal Intergrowth-21st charts specifically built on preterm infants were used. Association with major and minor neurodevelopmental impairment at 24-month CA was assessed for each definition. coefficient and ROC curve were evaluated. Longitudinal "post-loss" definition of EUGR for HC is the one predicting minor neurodevelopmental impairment at the multivariate analysis (OR = 3.94), and it is also associated with a worse General Quotient. The chosen cut-off (Δscore < -1) is the proper one. HC in-hospital growth could be a more accurate tool than weight to predict neurodevelopmental outcomes and especially minor neurological impairment. Longitudinal "post-loss" definition of EUGR assessed on longitudinal charts for preterm infants could be the most appropriate definition from the methodological, clinical, and prognostic point of view.
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http://dx.doi.org/10.3389/fped.2020.572930DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7711073PMC
November 2020

The relationship between alexithymia, sensory phenotype and neurophysiological parameters in patients with chronic upper limb neuropathy.

J Neural Transm (Vienna) 2021 01 14;128(1):61-71. Epub 2020 Dec 14.

Department of Psychology, University of Turin, Turin, Italy.

In this study, we investigated the relationship between sensory abnormalities evaluated by quantitative sensory testing (QST) and alexithymia, depression and anxiety in patients with neuropathic pain involving the upper limbs. We enrolled 62 patients (34 with carpal tunnel syndrome, 7 with brachial plexopathy, 3 with cervical painful radiculopathy, 5 with ulnar entrapment neuropathy at elbow and 13 with post-burn hypertrophic scars) and 48 healthy controls. All underwent nerve conduction studies (NCS), evaluation of cold, heat pain and vibration detection threshold (VDT) by QST and evaluation of alexithymia by Toronto Alexithymia Scale (TAS-20), depression by Beck Depression Inventory II (BDI-II), anxiety by State-Trait Anxiety Inventory (STAI-Y), level of psychological distress by 12-item General Health Questionnaire (GHQ-12) and perceived social support by the Multidimensional Scale of Perceived Social Support (MSPSS). The general linear model analysis revealed a significant relationship between TAS-20 overall and TAS-20 sub-score for difficulty identifying feelings and VDT z-scores in the left index with no interaction by year of education and sensory NCS results. Our results demonstrated the association between impairment of vibratory sensation of the left hand, reflecting cutaneous mechanoceptor dysfunction, and alexithymia, particularly the difficulty to identify feelings. The importance of delivering to patients with neuropathic pain personalized care that takes into account not only the neurophysiological aspects but also the aspects of mental functioning is discussed.
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http://dx.doi.org/10.1007/s00702-020-02282-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7815565PMC
January 2021

Manual push technique, an alternative route of subcutaneous immunoglobulin administration in chronic inflammatory demyelinating polyradiculoneuropathy: A proof-of-concept study.

Clin Neurol Neurosurg 2020 11 16;198:106240. Epub 2020 Sep 16.

Divisione di Riabilitazione Neuromotoria, Istituti Clinici Scientifici Maugeri, Presidio Sanitario Major, Via Santa Giulia, 60, 10124, Torino, Italy. Electronic address:

Objective: Subcutaneous immunoglobulin (SCIg) administered through infusion pump has been reported as effective in chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) patients. In this study we evaluate an alternative technique of SCIg administration, based on the delivery of lower volumes administered daily using manual push technique (MPT) in 10 CIDP patients.

Methods: In this randomized, controlled, two-arm, crossover clinical trial, CIDP patients were randomly assigned 1:1 to receive SCIg either by MPT or pumps for 4 consecutive months with crossover to the other. The primary objective was to assess whether MPT had the same effectiveness as pumps. The secondary objectives were to assess whether MPT resulted in greater plasma IgG levels and improved quality of life (QoL).

Results: Ten patients (mean age = 48.3) were enrolled. No significant changes were observed in the efficacy parameters (INCAT, MRC, R-ODS, and GS scales). A positive mean variation of 5.4 % in plasma IgG levels in the group treated with MPT was observed at the end of MPT periods. Treatment interference, which is one of the dimensions of the Life Quality Index, showed a significant improvement in the MPT periods.

Conclusion: In CIDP patients, the MPT technique was as effective as pump infusion, allowed comparable, slightly increases plasma IgG levels, and also improved the QoL.
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http://dx.doi.org/10.1016/j.clineuro.2020.106240DOI Listing
November 2020

Syringomyelia and Chiari Syndrome Registry: advances in epidemiology, clinical phenotypes and natural history based on a North Western Italy cohort.

Ann Ist Super Sanita 2020 Jan-Mar;56(1):48-58

Centro Nazionale Malattie Rare, Istituto Superiore di Sanità, Rome, Italy.

Background: Syringomyelia and Chiari Syndrome are classified as rare diseases, but current known occurrence in Europe is missing. The increased ability to diagnose these pathologies by magnetic resonance imaging and its widespread availability has led to an increase of reported cases, often asymptomatic, with the need to standardize definitions, diagnostic criteria and treatments.

Aims: We present shared Interregional Recommendations developed with the primary aim to estimate Syringomyelia and Chiari Syndrome prevalence and incidence in North Western Italy, with special reference to symptomatic forms.

Methods: An agreement for the standardization of definitions, classifications, diagnostic criteria and surgical Recommendations was reached by the multidisciplinary Interregional Piemonte and Valle d'Aosta Chiari-Syringomyelia Consortium (Delphi method); next, in 2011 a census for Syringomyelia and Chiari Malformation was performed through the Interregional Piemonte and Valle d'Aosta Rare Disease Registry, integrated by a dedicated form in order to estimate prevalence and incidence.

Results: 436 patients, 292 females, met shared interregional diagnostic criteria. Syringomyelia prevalence was estimated in 4.84:100 000; Chiari Malformation prevalence was 7.74:100 000; incidence was 0.82:100 000 and 3.08:100 000 respectively. Demographics, neuroradiological parameters and aetiology were reported (in symptomatic and asymptomatic forms). Finally, symptoms and signs, familiar and natural history were analyzed.

Conclusions: First Italian epidemiological data (prevalence, incidence) on Chiari and syringomyelia was collected, according to shared diagnostic Recommendations. Future perspectives include the adoption of these Recommendations at national level to standardize the access to diagnosis and care process and promote multicenter clinical trials.
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http://dx.doi.org/10.4415/ANN_20_01_08DOI Listing
January 2021

miR-130a and Tgfβ Content in Extracellular Vesicles Derived from the Serum of Subjects at High Cardiovascular Risk Predicts their In-Vivo Angiogenic Potential.

Sci Rep 2020 01 20;10(1):706. Epub 2020 Jan 20.

2i3T Scarl, University of Turin, Turin, Italy.

Serum-derived extracellular vesicles (sEV) from healthy donors display in-vivo pro-angiogenic properties. To identify patients that may benefit from autologous sEV administration for pro-angiogenic purposes, sEV angiogenic capability has been evaluated in type 2 diabetic (T2DM) subjects (D), in obese individuals with (OD) and without (O) T2DM, and in subjects with ischemic disease (IC) (9 patients/group). sEV display different angiogenic properties in such cluster of individuals. miRNomic profile and TGFβ content in sEV were evaluated. We found that miR-130a and TGFβ content correlates with sEV in-vitro and in-vivo angiogenic properties, particularly in T2DM patients. Ingenuity Pathway Analysis (IPA) identified a number of genes as among the most significant miR-130a interactors. Gain-of-function experiments recognized homeoboxA5 (HOXA5) as a miR-130a specific target. Finally, ROC curve analyses revealed that sEV ineffectiveness could be predicted (Likelihood Ratio+ (LH+) = 3.3 IC 95% from 2.6 to 3.9) by comparing miR-130a and TGFβ content 'in Series'. We demonstrate that sEV from high cardiovascular risk patients have different angiogenic properties and that miR-130a and TGFβ sEV content predicts 'true ineffective sEVs'. These results provide the rationale for the use of these assays to identify patients that may benefit from autologous sEV administration to boost the angiogenetic process.
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http://dx.doi.org/10.1038/s41598-019-55783-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6971269PMC
January 2020

Integration of Ki-67 index into AJCC 2018 staging provides additional prognostic information in breast tumours candidate for genomic profiling.

Br J Cancer 2020 02 29;122(3):382-387. Epub 2019 Nov 29.

Department of Medical Sciences, University of Turin, Via Santena 7, 10126, Turin, Italy.

Background: The Eighth edition of the American Joint Committee on Cancer (AJCC) staging system (2018) for breast cancer (BC) introduced the prognostic stage. Moreover, multigene assessment has been indicated to tailor staging in T1/T2/N0, ER-positive/HER2-negative BC. However, many National Health Systems do not provide reimbursement for routine testing. The aim of this study was to assess whether Ki67 proliferation index is prognostically relevant for patients' candidacy for molecular testing.

Methods: A retrospective series of 686 ER+/HER2- BC were reclassified using AJCC 2018, and in the group of 521 patients for which AJCC 2018 recommends molecular evaluation, we assessed the prognostic efficacy of a prognostic stage enriched by Ki67 (Ki67-PS), considering Ki67 <20% an alternative to recurrence score <11 provided by Oncotype DX.

Results: We found that a group of BCs (35.6%, 58/163) assigned to IB stage by prognostic score were down classified to IA with Ki67-PS. The outcome of these 58 cases overlapped with that of lesions classified as stage IA using prognostic stage, showing a significantly better prognosis compared to IB tumours (HR = 2.79, p = 0.003).

Conclusions: These data suggest that Ki67 may be a reliable marker to enrich the 2018 AJCC prognostic score in BC patients' candidacy for genomic profiling.
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http://dx.doi.org/10.1038/s41416-019-0656-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7000715PMC
February 2020

Three-dimensional virtual imaging of renal tumours: a new tool to improve the accuracy of nephrometry scores.

BJU Int 2019 12 27;124(6):945-954. Epub 2019 Sep 27.

Division of Urology, Department of Oncology, School of Medicine, San Luigi Hospital, University of Turin, Orbassano (Turin), Italy.

Objectives: To apply the standard PADUA and RENAL nephrometry score variables to three-dimensional (3D) virtual models (VMs) produced from standard bi-dimensional imaging, thereby creating three-dimensional (3D)-based (PADUA and RENAL) nephrometry scores/categories for the reclassification of the surgical complexity of renal masses, and to compare the new 3D nephrometry score/category with the standard 2D-based nephrometry score/category, in order to evaluate their predictive role for postoperative complications.

Materials And Methods: All patients with localized renal tumours scheduled for minimally invasive partial nephrectomy (PN) between September 2016 and September 2018 underwent 3D and 2D nephrometry score/category assessments preoperatively. After nephrometry score/category evaluation, all the patients underwent surgery. Chi-squared tests were used to evaluate the individual patients' grouping on the basis of the imaging tool (3D VMs and 2D imaging) used to assess the nephrometry score/category, while Cohen's κ coefficient was used to test the concordance between classifications. Receiver-operating characteristic curves were produced to evaluate the sensitivity and specificity of the 3D nephrometry score/category vs the 2D nephrometry score/category in predicting the occurrence of postoperative complications. A general linear model was used to perform multivariable analyses to identify predictors of overall and major postoperative complications.

Results: A total of 101 patients were included in the study. The evaluation of PADUA and RENAL nephrometry scores via 3D VMs showed a downgrading in comparison with the same scores evaluated with 2D imaging in 48.5% and 52.4% of the cases. Similar results were obtained for nephrometry categories (29.7% and 30.7% for PADUA risk and RENAL complexity categories, respectively). The 3D nephrometry score/category demonstrated better accuracy than the 2D nephrometry score/category in predicting overall and major postoperative complications (differences in areas under the curve for each nephrometry score/category were statistically significant comparing the 3D VMs with 2D imaging assessment). Multivariable analyses confirmed 3D PADUA/RENAL nephrometry category as the only independent predictors of overall (P = 0.007; P = 0.003) and major postoperative complications (P = 0.03; P = 0.003).

Conclusions: In the present study, we showed that 3D VMs were more precise than 2D standard imaging in evaluating the surgical complexity of renal masses according to nephrometry score/category. This was attributable to a better perception of tumour depth and its relationships with intrarenal structures using the 3D VM, as confirmed by the higher accuracy of the 3D VM in predicting postoperative complications.
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http://dx.doi.org/10.1111/bju.14894DOI Listing
December 2019

Final results of the SENECA (SEcond line NintEdanib in non-small cell lung CAncer) trial.

Lung Cancer 2019 08 27;134:210-217. Epub 2019 Jun 27.

Department of Oncology, University of Turin, AOU San Luigi, Orbassano, Italy.

Objectives: Despite the scant docetaxel's tolerability, second-line association with nintedanib still represents a standard-of-care for non-squamous non-small cell lung cancer (nsNSCLC), giving to rapidly-progressing patients the greatest survival advantage. The SENECA trial is a phase IIb, open-label, study evaluating whether nintedanib/docetaxel can be equally effective and safe regardless docetaxel schedule.

Materials And Methods: Recurrent nsNSCLC patients were stratified into cohort 1 and 2, according to relapse-time (within or over 3 months) from end of first-line chemotherapy. They were treated with docetaxel (T1: 33 mg/mq on days 1 and 8 in a 21-days cycle; T2: 75 mg/mq q3wks) plus nintedanib, allowing maintenance in case of disease-control. Primary endpoint was progression-free survival (PFS) by investigator's assessment; secondary endpoints: overall survival (OS), safety and quality-of-life.

Results: Between January 2016-April 2018, 212 patients were evaluated: 30 resulted screening-failures, 12 were excluded for lack of compliance. According to investigator's choice, 85 patients received T1 docetaxel and 85 T2; 138 (81.2%) were stratified in C1, 32 (18.8%) in C2, with a median relapse-time of 0.54 and 9.29 months, respectively. Baseline characteristics were balanced between groups. After 35.5 months follow-up, no survival differences appear between cohorts and treatments; toxicity seems to be slightly higher in T2, especially for chemotherapy-related events. Perception of quality-of-life remains stable and docetaxel schedule doesn't modify patients' load.

Conclusion: The SENECA trial confirms efficacy of second-line nintedanib/docetaxel for nsNSCLC, regardless time of recurrence and docetaxel schedule; higher toxicities for q3wks docetaxel, without alterations in quality-of-life, have been described, underling the possibility, adopting the weekly schedule, to maintain efficacy with better tolerability.
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http://dx.doi.org/10.1016/j.lungcan.2019.06.028DOI Listing
August 2019

Development and validation of the Premorbid Childhood Traits Questionnaire (PCT-Q) in eating disorders.

Eat Weight Disord 2019 Oct 16;24(5):815-823. Epub 2019 Jul 16.

Department of Psychiatry, University of California, San Diego, CA, USA.

Purpose: Some features of eating disorders (EDs) are often present in childhood before the onset of the ED. We developed a novel questionnaire to retrospectively capture such childhood traits.

Methods: Focus groups were conducted at the University of California-San Diego, USA, and at the University of Turin, Italy. Three focus groups were conducted at each site, interviewing patients and parents to identify those traits that most commonly characterize childhood of patients with EDs. A preliminary version of the Premorbid Childhood Traits Questionnaire (PCT-Q) derived from these focus groups was then administered to 94 consecutive inpatients with an ED and to 286 healthy controls (HCs) at the Turin site. Also, 208 participants' parents were enrolled as well; in fact, the PCT-Q was developed with both a proband and an informant version.

Results: A 37-item final version of the PCT-Q was generated. Reliability analyses suggested acceptability for harm avoidance (HA), social phobia, alexithymia, interoceptive awareness (IA), and food obsessions. Inter-rater reliability ranged from fair to moderate. ED sufferers scored significantly higher than HCs on HA, social phobia, alexithymia, IA, and food obsessions.

Conclusions: These findings support the possibility that premorbid traits contribute to a risk to develop an ED in some individuals.

Level Of Evidence: III: case-control analytic study.
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http://dx.doi.org/10.1007/s40519-019-00748-yDOI Listing
October 2019

Resolvin D1 Attenuates the Organ Injury Associated With Experimental Hemorrhagic Shock.

Ann Surg 2021 05;273(5):1012-1021

Queen Mary University of London, William Harvey Research Institute, Barts and The London School of Medicine & Dentistry, London, UK.

Objective: To evaluate the potential changes in the plasma levels of resolvin D1 (RvD1) in patients with trauma and hemorrhage. Having found that trauma results in a profound reduction in plasma RvD1 in patients, we have then investigated the effects of RvD1 on the organ injury and dysfunction associated with hemorrhagic shock (HS) in the rat.

Background: HS is a common cause of death in trauma due to excessive systemic inflammation and multiple organ failure. RvD1 is a member of the resolvin family of pro-resolution mediators.

Methods: Blood samples were drawn from critically injured patients (n = 27, ACITII-prospective observational cohort study) within 2 hours of injury for targeted liquid chromatography tandem mass spectrometry. HS rats (removal of blood to reduce arterial pressure to 30 ± 2 mm Hg, 90 minutes, followed by resuscitation) were treated with RvD1 (0.3 or 1 μg/kg intravenous (i.v.)) or vehicle (n = 7). Parameters of organ injury and dysfunction were determined.

Results: Plasma levels of RvD1 (mg/dL) were reduced in patients with trauma+HS (0.17 ± 0.08) when compared with healthy volunteers (0.76 ± 0.25) and trauma patients (0.62 ± 0.20). In rats with HS, RvD1 attenuated the kidney dysfunction, liver injury, and tissue ischemia. RvD1 also reduced activation of the nuclear factor (NF)-κB pathway and reduced the expression of pro-inflammatory proteins such as inducible nitric oxide synthase, tumor necrosis factor-α, interleukin-1β, and interleukin-6.

Conclusion: Plasma RvD1 is reduced in patients with trauma-HS. In rats with HS, administration of synthetic RvD1 on resuscitation attenuated the multiple organ failure associated with HS by a mechanism that involves inhibition of the activation of NF-κB.
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http://dx.doi.org/10.1097/SLA.0000000000003407DOI Listing
May 2021

Total anatomical reconstruction during robot-assisted radical prostatectomy: focus on urinary continence recovery and related complications after 1000 procedures.

BJU Int 2019 09 15;124(3):477-486. Epub 2019 Mar 15.

Division of Urology, Department of Oncology, San Luigi Gonzaga Hospital, Orbassano, Turin, Italy.

Objectives: To present the functional and oncological outcomes after ≥1 year of follow-up, following an experience of >1000 robot-assisted radical prostatectomies (RARPs) with our standardised total anatomical reconstruction (TAR) technique. To evaluate which factors influence postoperative continence recovery in order to obtain a nomogram to predict the risk of postoperative urinary incontinence (UI).

Patients And Methods: The enrolment phase began in June 2013 and ended in May 2017. Patients were prospectively included in the study with the following inclusion criteria: (i) localised prostate cancer (clinical stages cT1-3, cN0, cM0); (ii) indication for RP; and (iii) preoperative multiparametric prostate magnetic resonance imaging. All patients underwent RARP with the TAR technique done at the end of the demolitive phase. The continence rates were assessed at 24 h, and 1, 4, 12, 24 and 48 weeks after catheter removal. Patients were defined as continent if they answered 'zero pad' or 'one safety pad' per day. A logistic regression model was used to evaluate the potential impact of some pre- and intraoperative factors on postoperative urinary continence recovery. Model discrimination was assessed using an area under (AUC) the receiver operating characteristic (ROC) curve. A nomogram to predict the risk of postoperative UI after RARP with the TAR technique was generated based on the logistic model.

Results: In all, 1008 patients were enrolled in our study. At 24 h, and 1, 4, 12, 24 and 48 weeks after catheter removal, 621 (61.61%), 594 (58.93%), 803 (79.66%), 912 (90.48%), 950 (94.25%) and 956 (94.84%) patients were continent, respectively. In the logistic regression model, the variables analysed had a higher impact on continence recovery at 4 and 12 weeks. At 4 weeks, the postoperative odds of urinary continence recovery increased with the absence of diabetes [odds ratio (OR) 2.76, 95% confidence interval (CI) 1.41-5.41] and D'Amico low vs high risk (OR 2.01, 95% CI 1.01-3.99). At 12 weeks, urinary continence increased with the absence of diabetes (OR 3.01, 95% CI 1.23-7.35), D'Amico low vs high risk (OR 4.04, 95% CI 1.56-10.47), and D'Amico intermediate vs high risk (OR 3.33, 95% CI 1.66-6.70). ROC curves were drawn and an AUC value of 61.9% (95% CI 57.49-66.36) at 4 weeks and 63.8% (95% CI 58.03-69.65) at 12 weeks were computed. Based on these parameters, two nomograms (at 4 and 12 weeks postoperatively) were generated.

Conclusion: The TAR technique conferred excellent results in the early recovery of urinary continence. Two nomograms were created, to predict preoperatively the postoperative odds of urinary continence recovery at 4 and 12 weeks after RARP by integrating the presence of diabetes and D'Amico risk classification.
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http://dx.doi.org/10.1111/bju.14716DOI Listing
September 2019

Use of chitosan membranes after nerve-sparing radical prostatectomy improves early recovery of sexual potency: results of a comparative study.

BJU Int 2019 03 1;123(3):465-473. Epub 2018 Nov 1.

Division of Urology, Department of Oncology, San Luigi Gonzaga Hospital, Orbassano (Turin), Italy.

Objectives: To evaluate the 1-year efficacy of chitosan membrane (ChiMe) application on the neurovascular bundles (NVBs) after nerve-sparing (NS) robot-assisted radical prostatectomy (RARP) in potency recovery rate. To compare the results with those of a contemporary cohort of patients who did not benefit from chitosan use.

Patients And Methods: Patients in the ChiMe group were enrolled at our institution from July 2015 to September 2016 in a preliminary phase II study. All of them underwent NS-RARP with ChiMe applied on the NVBs and were followed over time to complete a 1-year follow-up. The control group was composed of patients who underwent NS-RARP at our institution without the application of ChiMe from January 2015. The patients were further classified into two groups based on the amount of nerves spared: Group A, comprised patients who underwent a monolateral or bilateral full NS; Group B, comprised patients in which a full NS was not performed. The demographics, peri- and postoperative data, and complications were recorded and compared. Potency recovery was recorded for Group A vs Group B in both the ChiMe and the control groups.

Results: In all, 136 patients were enrolled in the ChiMe group and 334 patients in the control group. There were no differences between groups in terms of baseline variables. Based on the amount of nerves preserved, 183 patients were included in Group A and 287 in Group B. Odds ratios at different time points showed that the only two factors influencing potency recovery were the amount of nerves preserved (Group A vs Group B) and the application or not of ChiMe on the NVBs spared. Comparing the ChiMe vs control groups at different time points, we found a statistically significant improvement in the potency recovery rate in the ChiMe group at 1 month (36.76% vs 25.88%; P = 0.02) and 2 months (52.2% vs 39.22%; P = 0.01) after surgery, showing a favourable trend at every time point of the entire follow-up period, even if not significant after the second postoperative month. In Group A, the log-rank test showed a statistically significant difference between the ChiMe vs control groups (P = 0.02), in particular at 1 and 2 months after surgery (P = 0.02 and P = 0.01, respectively).

Conclusion: The application of ChiMe on the NVBs resulted in a higher potency recovery rate at 1 and 2 months after a bilateral or monolateral full NS-RARP. A trend of a higher and shorter potency recovery rate showed it to be favourable to use ChiMe, even in the cohort of patients who did not undergo a full NS procedure.
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http://dx.doi.org/10.1111/bju.14583DOI Listing
March 2019

Comparison of Eye Movement Desensitization Reprocessing and Cognitive Behavioral Therapy as Adjunctive Treatments for Recurrent Depression: The European Depression EMDR Network (EDEN) Randomized Controlled Trial.

Front Psychol 2018 13;9:74. Epub 2018 Feb 13.

EMDR Institut Deutschland, Bergisch Gladbach, Germany.

Treatment of recurrent depressive disorders is currently only moderately successful. Increasing evidence suggests a significant relationship between adverse childhood experiences and recurrent depressive disorders, suggesting that trauma-based interventions could be useful for these patients. To investigate the efficacy of Eye Movement Desensitization and Reprocessing therapy (EMDR) in addition to antidepressant medication (ADM) in treating recurrent depression. A non-inferiority, single-blind, randomized clinical controlled trial comparing EMDR or CBT as adjunctive treatments to ADM. Randomization was carried out by a central computer system. Allocation was carried out by a study coordinator in each center. Two psychiatric services, one in Italy and one in Spain. Eighty-two patients were randomized with a 1:1 ratio to the EMDR group ( = 40) or CBT group ( = 42). Sixty-six patients, 31 in the EMDR group and 35 in the CBT group, were included in the completers analysis. 15 ± 3 individual sessions of EMDR or CBT, both in addition to ADM. Participants were followed up at 6-months. : Rate of depressive symptoms remission in both groups, as measured by a BDI-II score <13. Sixty-six patients were analyzed as completers (31 EMDR vs. 35 CBT). No significant difference between the two groups was found either at the end of the interventions (71% EMDR vs. 48.7% CBT) or at the 6-month follow-up (54.8% EMDR vs. 42.9% CBT). A RM-ANOVA on BDI-II scores showed similar reductions over time in both groups [(6,59) = 22.501, < 0.001] and a significant interaction effect between time and group [(6,59) = 3.357, = 0.006], with lower BDI-II scores in the EMDR group at T1 [mean difference = -7.309 (95% CI [-12.811, -1.806]), 0.010]. The RM-ANOVA on secondary outcome measures showed similar improvement over time in both groups [(14,51) = 8.202, < 0.001], with no significant differences between groups [(614,51) = 0.642, = 0.817]. Although these results can be considered preliminary only, this study suggests that EMDR could be a viable and effective treatment for reducing depressive symptoms and improving the quality of life of patients with recurrent depression.

Trial Registration: ISRCTN09958202.
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http://dx.doi.org/10.3389/fpsyg.2018.00074DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5816922PMC
February 2018

Is the admission test for a course in medicine a good predictor of academic performance? A case-control experience at the school of medicine of Turin.

BMJ Open 2017 Dec 1;7(11):e017417. Epub 2017 Dec 1.

Department of Public Health and Pediatric Sciences, School of Medicine, University of Turin, Turin, Italy.

Objectives: The usefulness of university admission tests to medical schools has been discussed in recent years. In the academic year 2014-15 in Italy, several students who failed the admission test appealed to the regional administrative court ('Tribunale Amministrativo Regionale'-TAR) requesting to be included, despite their test results, and all were admitted to their respective courses. The existence of this population of students generated a control group, in order to evaluate the predictive capacity of the admission test. The aim of the present work is to discuss the ability of university admission tests to predict subsequent academic success.

Setting And Participants: The study involved 683 students who enrolled onto the first year of the degree course in medicine in the academic year 2014-15 at the University of Turin (Molinette and San Luigi Gonzaga colleges). The students were separated into two categories: those who passed the admission test (n1=531) and those who did not pass the admission test but won their appeal in the TAR (n2=152).

Outcomes: The validity of the admission test was analysed using specificity, sensitivity, positive and negative likelihood ratios (LH+, LH-), receiver operating characteristic (ROC) curves, area under the ROC curve (AUC), and relative (95% CI).

Results: The results showed that the admission test appeared to be a good tool for predicting the academic performances in the first year of the course (AUC=0.70, 95% CI 0.64 to 0.76). Moreover, some subject areas seemed to have a greater discriminating capacity than others. In general, students who obtained a high score in scientific questions were more likely to obtain the required standards during the first year (LH+ 1.22, 95% CI 1.14 to 1.25).

Conclusions: Based on a consistent statistical approach, our study seems to confirm the ability of the admission test to predict academic success in the first year at the school of medicine of Turin.
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http://dx.doi.org/10.1136/bmjopen-2017-017417DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5719312PMC
December 2017

[Admission test to the degree course in Medicine and Surgery and university career: the experience in the campuses of Piedmont Region (Northern Italy)].

Epidemiol Prev 2017 Sep-Dec;41(5-6):250-255

Dipartimento di sanità pubblica e scienze pediatriche, Università degli Studi di Torino.

Objectives: to consider the admission test to the degree course in Medicine and Surgery in the three campus of Piedmont Region (Northern Italy) in order to discuss the ability of this test to predict the academic outcome of the students.

Design: cohort study considering all the students enrolled in the first year of medicine during the academic year 2014-2015. Their academic career is monitored during the period January 2015-February 2016.

Setting And Participants: a total of 781 students is considered and divided into two groups: regular (registered after passing the admission test; n. 605) and TAR (registered after court decision and having won the case in tribunal; n. 176).

Main Outcome Measures: the study is based on three indicators of performance: A1. at least one of the required exams in the first year passed; A2. at least half of the required exams in the first year passed; A3. all the exams required in the first year passed. Statistical analyses are based on: positive predictive value and relative 95% confidence interval; odds ratio and relative 95% confidence intervals, adjusted by sex, age, high school type, and vote estimated by logistic regression models.

Results: the results highlight the good prediction of the admission test that remains significant even after adjustment for the confounding factors considered.

Conclusions: the major limits are the short period of observation and the restricted number of campus considered. However, this analysis confirms the importance of the admission test. In fact, students with low scores in the test could show serious disadvantages in passing the exams (in the appointed time) in the first year.
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http://dx.doi.org/10.19191/EP17.5-6.P250.085DOI Listing
July 2018

Assessing the prognostic impact of the International Association for the Study of Lung Cancer proposed definitions of complete, uncertain, and incomplete resection in non-small cell lung cancer surgery.

Lung Cancer 2017 09 20;111:124-130. Epub 2017 Jul 20.

University of Torino, Department of Oncology, Thoracic Surgery Unit, San Luigi Hospital, Regione Gonzole 10, 10043 Orbassano, Torino, Italy. Electronic address:

Objective: The aim of this study was to assess the prognostic impact of the definitions of complete, uncertain, and incomplete resection in non-small cell lung cancer (NSCLC) surgery, as proposed by the International Association for the Study of Lung Cancer (IASLC).

Patients And Methods: Single institution retrospective study of consecutive patients undergoing surgery for NSCLC between 1998 and 2007. Complete resection was defined by absence of gross and microscopic residual disease; systematic nodal dissection; no extracapsular extension in distal lymph nodes; and negativity of the highest mediastinal node removed. An uncertain resection was defined by free resection margins, but one of the following applied: lymph node evaluation less rigorous than systematic nodal dissection; positivity of the highest mediastinal node removed; presence of carcinoma in situ at the bronchial margin; positive pleural lavage cytology. A resection was defined incomplete by presence of residual disease; extracapsular extension in distal lymph nodes; positive cytology of pleural or pericardial effusions. Follow-up was complete and all patients were followed up until death or for a minimum period of 5 years. Overall survival (OS) was analyzed using Kaplan-Meier method, log rank test, and Cox proportional hazards model.

Results: A total of 1277 patients were identified. One thousand and three patients (78.5%) underwent complete resection, 185 (14.5%) underwent uncertain resection, and 89 (7.0%) underwent incomplete resection. Both uncertain and incomplete resection were associated with significantly worse OS when compared with complete resection (hazard ratio: 1.69 and 3.18, respectively; both p=0.0001). Median OS and 5-year survival rate were 80.1, 39.9, 17.3 months and 58.8%, 37.3%, 15.7% in patients undergoing complete, uncertain, and incomplete resection, respectively.

Conclusion: The present analysis suggests that in patients undergoing surgery for NSCLC, the IASLC definitions of complete, uncertain, and incomplete resection are associated with statistically significant differences in survival.
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http://dx.doi.org/10.1016/j.lungcan.2017.07.013DOI Listing
September 2017

Electrophysiological Predictors of Clinical Outcome in Traumatic Neuropathies: A Multicenter Prospective Study.

Neurol Res Int 2016 28;2016:4619631. Epub 2016 Jul 28.

GdS Neuropatie Traumatiche e Iatrogene, SINC (Società Italiana di Neurofisiologia Clinica), Via Nizza 45, 00198 Roma, Italy.

Objectives. This prospective, observational, multicentre study aims to identify electrodiagnostic (EDX) markers of clinical recovery in patients with traumatic neuropathy (TN) receiving surgical (S) and nonsurgical (NS) treatments. Methods. Subjects referred to the Italian Traumatic Neuropathy Network between 2010 and 2011 (307 patients, for a total of 444 TN) were evaluated with serial clinical/EDX evaluations at 6, 12, 24, and 36 months of follow-up. Results. Primary surgery was performed in 21 subjects with open lesions and evidence of neurotmesis, while closed lesions were treated with either conservative medical approach (216 patients) or secondary surgery (70 patients), according to the clinical spontaneous recovery at 4-6 months. Clinical improvement correlated with the increase of the compound muscle action potential amplitude (OR 3.76; CI 1.61-8.76), particularly in the S group (OR 7.25; CI 1.2-43.87), and with sensory nerve action potential amplitude in the NS group (OR 4.35; CI 1.14-16.69). No correlations were found with needle electromyography qualitative evaluations, changes in maximal voluntary recruitment, age, and gender. Conclusions. Nerve conduction studies (NCS) represent the more accurate neurophysiological markers of clinical outcome in patients with TN. Significance. Serial NCS assessments predict the functional recovery in TN, increasing the accuracy of peripheral nerves surgical decision-making process.
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http://dx.doi.org/10.1155/2016/4619631DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4980505PMC
August 2016

Influence of multi-step etch-and-rinse versus self-etch adhesive systems on the post-operative sensitivity in medium-depth carious lesions: An in vivo study.

Am J Dent 2015 Aug;28(4):214-8

Purpose: To evaluate the influence of a three-step etch-and-rinse versus a two-step self-etch adhesive system on immediate post-operative sensitivity.

Methods: In total, 204 subjects with one posterior tooth affected by a primary carious lesion were recruited. The subjects were randomly divided into two groups, based on the two multi-step adhesive systems used: Group A (All Bond 3) and Group B (Clearfil Protect Bond). The same skilled operator carried out the restorations using a nano-hybrid composite (Venus Diamond) in oblique stratification. Each increment was light-cured for 20 seconds with a LED lamp (Translux Power Blue). Subjects received a three-level thermal sensitivity questionnaire for post-operative sensitivity ratings. The evaluations were recorded daily for 7 days. Scores were analyzed using the McNemar test and postoperative trends were analyzed with the Friedman test (P < 0.05). All (100%) enrolled subjects completed the follow-up visits. There was no statistically significant difference between the two groups in post-operative sensitivity trends. In both groups, increased post-operative sensitivity was found at D1, which then decreased significantly during the observation period.

Results: The results of this in vivo study showed that both of the tested adhesives, etch-and-rinse or self-etch, provided effective dentin sealing, preventing subjects from experiencing post-operative sensitivity in the treatment of medium-depth cavities.
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August 2015

Day Hospital Treatment for Anorexia Nervosa: A 12-Month Follow-up Study.

Eur Eat Disord Rev 2015 Sep 14;23(5):390-8. Epub 2015 May 14.

Eating Disorders Center, Department of Neuroscience, University of Turin, Turin, Italy.

Day hospitals (DHs) represent a treatment option for anorexia nervosa (AN), a mental disorder that is difficult to treat and has no evidence-based treatments available. We aimed to determine the effectiveness of a DH treatment that was specifically focused on the emotions of severe AN patients. Body mass index and eating psychopathology were the primary outcome measures. Fifty-six adult patients with AN were assessed upon admission, at the end of treatment (EOT) and at a 12-month follow-up evaluation (T18) using Eating Disorders Inventory-2, Beck Depression Inventory, Hamilton Rating Scale for Anxiety and Brief Social Phobia Scale. All participants received a multidisciplinary treatment programme that focused on psychodynamic psychotherapy. Seventy-eight per cent of participants reported positive outcomes at EOT and 68% at T18. Moreover, 82.1% and 65.4% of long-standing patients showed positive outcomes at EOT and T18, respectively. All measures of psychopathology were significantly improved at EOT and were maintained at follow-up. Our DH was effective at treating severe AN patients; however, further investigations of the processes of change are warranted.
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http://dx.doi.org/10.1002/erv.2369DOI Listing
September 2015

Teleconsulting for minor head injury: the Piedmont experience.

J Telemed Telecare 2013 Jan 1;19(1):33-5. Epub 2013 Mar 1.

Department of Public Health and Microbiology, University of Turin, Turin, Italy.

We evaluated the benefits of teleconsulting for patients hospitalised with minor head injuries in centres without neurosurgery. In the Piedmont region, 1462 consultation requests were received at specialist centres in 2009, relating to 519 patients with a minor head injury diagnosis (ICD 850-854). These were compared with the details of 1895 patients admitted with the same diagnosis during 2009, but for whom no consultations were requested. The mortality risk in the two groups was estimated using logistic regression, after adjusting for the principal confounding factors (sex, age, seriousness of the patient's injury at diagnosis, referral centre). The estimated risk of death for patients for whom no consultation was requested was an odds ratio of 1.32 (95% CI 1.08 to 1.74) compared to those who received a teleconsultation. However, after adjusting for the confounding factors, the risk was not significant (odds ratio = 1.25, 95% CI 0.83 to 1.91). A stratified analysis identified a significant effect for elderly people, aged over 70 years, in whom the odds ratio was 1.14 (95% CI 1.04 to 1.82). The results confirm the benefits of telemedicine, in particular for elderly patients, when teleconsultation is requested in the case of minor head injury.
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http://dx.doi.org/10.1177/1357633X12474738DOI Listing
January 2013

Observational approaches in the study of the effects of Total Suspended Particulates (TSP) exposure.

Int J Environ Health Res 2013 23;23(5):392-9. Epub 2012 Nov 23.

a Department of Public Health and Microbiology , University of Turin , Turin , Italy.

Literature contains mainly reports of observations based on time-series, or those of a case-crossover analysis design or, although less frequently, case control studies. However, data obtained by different approaches are difficult to compare based on different and non-homogenous population. The principal aim of this research was to compare the estimated risks obtained by differing approaches based on the same population study in the period 2006-2009. The data were based on a total of 44,200 residents in the city of Turin, hospitalised for respiratory diseases (ICD 460-519) in the period 2006-2009. Total suspended particulates (TSP), measured in µg/m(3), are the most commonly used predictors of urban pollution. The association between hospital admission for respiratory diseases and TSP exposure was investigated using at the same time the time-series, case-crossover and case-control approaches. The analyses show a general comparability of the case-crossover design stratified for time and the time-series approach, and the case control approach provided a more unstable estimation of risks. In conclusion, our results seem to indicate that the different approaches studied seem to offer comparable results.
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http://dx.doi.org/10.1080/09603123.2012.743113DOI Listing
June 2014

Association among oral health, apical periodontitis, CD14 polymorphisms, and coronary heart disease in middle-aged adults.

J Endod 2012 Dec 12;38(12):1570-7. Epub 2012 Oct 12.

Department of Surgical Sciences, University of Turin, Turin, Italy.

Introduction: There is evidence to suggest that an association exists between oral infections and coronary heart disease (CHD). Subjects presenting lesions of endodontic origin (LEOs) or pulpal inflammation had an increased risk of developing CHD. However, findings concerning systemic manifestations of apical periodontitis (AP) remain controversial. An association between CD14 gene polymorphisms and atherosclerosis-associated diseases has been shown, but there are no data regarding an association between CD14 polymorphism and AP. This study evaluated associations between clinical oral health status, CD14 polymorphisms, and CHD.

Methods: A case-controlled clinical trial was designed to compare middle-aged adults with acute myocardial infarction or unstable angina (n = 51) within 12 months of the acute event defined as first manifestation with healthy controls (n = 49). Participants were matched for age, sex, and socioeconomic status. Indicators of oral disease and compliance were evaluated. CD14 polymorphisms were analyzed by restriction fragment length polymorphism-polymerase chain reaction.

Results: CHD subjects had a higher prevalence of oral diseases and lower compliance to oral preventive strategies than healthy controls. Multivariate analysis showed a positive association between missing teeth (odds ratio [OR] = 1.37; 95% confidence interval [CI], 1.02-1.85), the number of LEOs (OR = 4.37; 95% CI, 1.69-11.28), chronic periodontitis (OR = 5.87; 95% CI, 1.17-29.4), and CHD. No statistically significant association emerged between the CD14 C(-260)T and the CD14 C(-159)T polymorphism, endodontic or periodontal disease, and CHD.

Conclusions: Chronic oral diseases may increase the risk of CHD and may be an unconventional risk factor for CHD.
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http://dx.doi.org/10.1016/j.joen.2012.08.013DOI Listing
December 2012

Amyotrophic lateral sclerosis in Piedmont (Italy): a Bayesian spatial analysis of the incident cases.

Amyotroph Lateral Scler Frontotemporal Degener 2013 Jan 22;14(1):58-65. Epub 2012 Oct 22.

Department of Public Health and Microbiology, University of Turin, Turin, Italy.

In the analysis of risk factors in amyotrophic lateral sclerosis (ALS), few ecological studies, based on the relationship between the distribution of the patients in a given area and the environmental exposures, have been performed. The aim of our study was to depict the spatial risk distribution of ALS in Piedmont's resident population during the period 1995-2004. Data were collected from the Piedmont and Aosta Valley Register for ALS, which is a prospective epidemiological archive for gathering all the ALS incident cases in north-western Italy. Only cases from Piedmont were considered. The Besag, York and Molliè model was used to estimate smoothed standardized incidence ratios (SIR) by municipalities either overall or stratified by gender and age class. Results demonstrated that excess of risk was particularly evident in the area of Cuneo, Alessandria and Vercelli (SIR > 1.2). The results were evident for both genders, but in particular for males aged 35-60 years. Given the geographic distribution of rural areas, our results suggest that the environmental exposure to agricultural chemicals could be possibly linked to this pattern. Despite some limits of the spatial analysis in the study of rare diseases, results appear coherent with literature data, stimulating other in-depth analysis in this field of research.
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http://dx.doi.org/10.3109/21678421.2012.733401DOI Listing
January 2013

Comparison of primary stability of straight-walled and tapered implants using an insertion torque device.

Int J Prosthodont 2012 Sep-Oct;25(5):465-71

Department of Biomedical Sciences and Human Oncology, Universita di Torino, Torino, Italy.

Purpose: Implant geometry has a major impact on insertion torque values and primary stability, and bone engagement during implant insertion differs according to implant morphology. Primary stability of straight-walled and tapered implants was compared using insertion torque monitoring.

Materials And Methods: A total of 57 implants (36 straight-walled OSSEOTITE and 21 tapered OSSEOTITE NT) were inserted in 20 patients. Implant torque values and insertion times were recorded, and the data were processed and interpolated to determine torque as a function of time.

Results: Tapered implants required less insertion time and a higher insertion torque than straight-walled implants; this provided better primary stability, although the success rate was 86% for tapered and 100% for straight-walled implants.

Conclusions: Tapered implants showed better primary stability than straight-walled implants but had a lower success rate. The authors suggest that in low-density bone, in which only a thin dense cortical layer can contribute to primary stability, a higher insertion torque can lead to the destruction of peri-implant bone, compromising osseointegration.
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November 2012

Fiber post adhesion to radicular dentin: The use of acid etching prior to a one-step self-etching adhesive.

Quintessence Int 2012 Jul-Aug;43(7):615-23

Department of Cariology and Operative Dentistry, University of Turin, Italy.

The aim of this study was to evaluate the bond strength of fiber posts luted with a one-step self-etching adhesive with the push-out test after phosphoric acid conditioning of the root dentin. Thirty-six single-rooted teeth were endodontically treated. Teeth were sectioned perpendicularly to the cementoenamel junction, and a 10-mm post space was prepared with a calibrated bur. Specimens were then divided into three groups according to the adhesive protocol: A, total-etch three steps; B, self-etch one step; and C, 32% phosphoric acid conditioning and self-etch one step. Fiber posts were luted with self-curing resin-based cement. Teeth were cut in 1-mm slices and pushed until failure with an Instron machine. Results were statistically analyzed with the ANOVA and Bonferroni tests (P < .05). Two additional specimens from each group were examined under the scanning electron microscope (SEM). The 32% phosphoric acid significantly influenced the push-out bond strength of fiber posts luted with self-etch adhesives (P < .05). SEM analysis showed a continuous hybrid layer with resin tags and lateral branches in groups A and C, while group B showed smear layer dissolution with poor infiltration of the tubules.
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November 2012

BClI polymorphism of the glucocorticoid receptor gene is associated with increased obesity, impaired glucose metabolism and dyslipidaemia in patients with Addison's disease.

Clin Endocrinol (Oxf) 2012 Dec;77(6):863-70

Department of Clinical and Biological Sciences, University of Turin, Turin, Italy.

Object: Although glucocorticoids are essential for health, several studies have shown that glucocorticoids replacement in Addison's disease might be involved in anthropometric and metabolic impairment, with increased cardiovascular risk, namely if conventional doses are used. As the effects of glucocorticoids are mediated by the glucocorticoid receptor, encoded by NR3C1 gene, different polymorphisms in the NR3C1 gene have been linked to altered glucocorticoid sensitivity in general population as well as in patients with obesity or metabolic syndrome.

Design: We investigated the impact of glucocorticoid receptor gene polymorphisms, including the BclI, N363S and ER22/23EK variants, on anthropometric parameters (BMI and waist circumference), metabolic profile (HOMA, OGTT and serum lipids) and ACTH levels in 50 patients with Addison's disease (34 women and 16 men, age 20-82 year) under glucocorticoids replacement.

Results: Neither N363S nor ER22/23EK variants were significantly associated with anthropometric, metabolic or hormonal parameters, while patients carrying the homozygous BclI polymorphism GG (n = 4) showed higher (P < 0·05) BMI, waist circumference, HOMA and 2-h glucose levels after OGTT, as well as total cholesterol and triglycerides than those with wild-type genotype CC (n = 28) or heterozygous CG (n = 18). The totality of GG patients was connoted by abdominal adiposity, impaired glucose tolerance/diabetes mellitus or dyslipidaemia, while a lower percentage of CC or CG patients showed some anthropometric and metabolic alterations.

Conclusion: These results suggest that BclI polymorphism may influence the sensitivity to glucocorticoids in patients with Addison's disease and may contribute, along with other factors, to the increase in central adiposity, impaired glucose metabolism and dyslipidaemia.
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http://dx.doi.org/10.1111/j.1365-2265.2012.04439.xDOI Listing
December 2012
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