L’Isteroscopia nel percorso diagnostico della coppia infertile: tra falsi miti e realtà

STUDY DESIGN: More than 72 million couple in the world are sterile and over half of them are looking for a cure for infertility. Nowadays the literature available is almost exclusively based on a population that has already started  a MAP path rather than in the early stages of diagnosis. Infertility evaluation and treatment is challenging both physically and psychologically for the couple and often suggesting an hysteroscopic exam affects negatively patients, especially for the incomplete or inadequate information received by the medical staff. RESULTS: We conducted a study on the population of the hysteroscopic office of the Gynecological Obstetrics Clinic of Sassari with the aim of improving information channels. There were 196 subjects between 25 and 45 years. 16% of patients reported lack of information received, but overall we observed a prejudice in almost all subjects about the pain during the examination. In the 41% of the patients, even if with a normal US, we found endometrial, cervical or, myometrial anomalies locally treated. CONCLUSION: Our data, albeit partial, show the technical feasibility and good compliance during the exam. Furthermore we observed that a a good agreement between the report and the histological examination, due to the continuous updating of the endoscopic staff, improve the patients-doctor relationship and the compliance to any treatment

Relazioni fra Mental Imagery e fattori di intelligenza: una verifica sperimentale

Il legame fra funzioni cognitive e Mental Imagery, evidenziato in letteratura, richiede uno studio approfondito delle componenti intellettive maggiormente correlate con i processi immaginativi, che implicano la capacità di riprodurre ed elaborare stimoli non immediatamente presenti nel campo percettivo. Scopo di questo studio è esaminare le relazioni tra capacità di Mental Imagery e fattori dell’intelligenza. Come strumenti per la misurazione di queste variabili sono stati usati il Mental Imagery Test (MIT), basato su prove di performance piuttosto che sulla valutazione soggettiva di vividezza delle immagini, e la scala di intelligenza WAIS-IV. Il campione della ricerca è costituito da 35 adulti, 17 maschi e 18 femmine, età 19- 51 anni. I risultati confermano l’ipotesi di correlazione tra MIT e intelligenza generale: a un più elevato QI corrisponde una maggiore capacità immaginativa. In particolare, le abilità di Mental Imagery risultano maggiormente connesse con il ragionamento visuo-percettivo e la comprensione verbale (e quindi con l’indice WAIS composito di Abilità Generale), piuttosto che con l’efficienza cognitiva (memoria di lavoro e velocità di elaborazione). L’analisi di scaling multidimensionale conferma la maggiore prossimità delle prove del MIT alle componenti visuo-percettive e verbali dell’intelligenza. All’interno delle prove di memoria quelle di riordinamento di cifre o lettere e numeri sono connesse al Mental Imagery più del tradizionale span di cifre. I risultati inducono a considerare con maggiore attenzione le specifiche componenti immaginative nella valutazione e nella riabilitazione delle funzioni cognitive, ad esempio nei casi di deficit o di deterioramento mentale. The link between cognitive functions and Mental Imagery, highlighted in literature, requires an in-depth study of the intellective components that are more closely related to the imaginative processes, which imply the ability to reproduce and process stimuli not immediately present in the perceptual field. The aim of this study was to examine the relationship between the ability of Mental Imagery and intelligence factors. Instruments for measuring these variables were the Mental Imagery Test (MIT), based on performance tasks rather than on subjective evaluation of image vividness, and the WAIS-IV scale. The research sample consisted of 35 adults, 17 males and 18 females, age range 19-51. The results confirmed the main hypothesis of correlation between MIT and general intelligence: a higher QI corresponds to greater imaginative capacity. In particular, the Mental Imagery skills are more closely related to visual-perceptual reasoning and verbal comprehension (and hence the composite index of General Ability) rather than cognitive efficiency (work memory and processing speed). Multidimensional scaling analysis confirmed the proximity of MIT tests to visual perceptual and verbal components of intelligence. Within the memory tasks, reordering of digits, letters and numbers correlated with MIT scores more than traditional digit span. The results induce more attention to specific imaginative components in the assessment and planning rehabilitative interventions, regarding cognitive functions e.g., in cases of deficit or mental deterioration

Advances in paediatrics in 2019: current practices and challenges in allergy, endocrinology, gastroenterology, public health, neonatology, nutrition, nephrology, neurology, respiratory diseases and rheumatic diseases

We highlight the main developments that have been published during the first semester of the last year in the Italian Journal of Pediatrics. We have carefully chosen information from numerous exciting progresses issued in the Journal in the field of allergy, endocrinology, gastroenterology, neonatology, nutrition, nephrology, neurology, public health, respiratory diseases and rheumatic diseases. The impact on the care of patients has been placed in the broader context of studies that appeared in other journals. We think that many observations can be used directly to upgrade management of patients

Best practices, challenges and innovations in pediatrics in 2019

This paper runs through key progresses in epidemiology, pathomechanisms and therapy of various diseases in children that were issued in the Italian Journal of Pediatrics at the end of last year. Novel research and documents that explore areas such as allergy, critical care, endocrinology, gastroenterology, infectious diseases, neonatology, neurology, nutrition, and respiratory tract illnesses in children have been reported. These observations will help to control childhood illnesses

Use of Sublingual Immunotherapy for Aeroallergens in Children with Asthma

Asthma is a heterogeneous disease that in children is often allergen-driven with a type 2 inflammation. Sublingual immunotherapy represents an important progress in the use of personalized medicine in children with allergic asthma. It is a viable option for house dust mite-driven asthma and in subjects with the asthma associated with allergic rhinitis. The use and indications for isolated asthma caused by other allergens are still controversial owing to heterogeneity of commercially available products and methodological limitations of studies in children. Nevertheless, most studies and meta-analyses found the efficacy of sublingual immunotherapy. Sublingual immunotherapy is safe but cannot be recommended in children with uncontrolled asthma

Intelligence and Mental Imagery in Intellectual Disability

After a presentation of the main model for conceptualizing and measuring intelligence, the importance of Mental Imagery in determining the cognitive performances in Intellectual Disability is underlined. The study aims at investigating if mental imagery can moderate the effect of cognitive components (i.e., Factor IQ) on the degree of mental deterioration in adults diagnosed with ID. The WAIS-IV, MoCA, and MIT (Mental Imagery Test) were administered in a sample composed of 40 adults, age range 16-64 years, diagnosed with Mild or Moderate ID. The results show that the WAIS-IV, MoCA, and MIT scores are significantly correlated. Imagery improves the effect of Verbal Comprehension, Visual Perceptual Reasoning and Working Memory factors in predicting the MoCA results. A discussion about the use of mental imagery for planning rehabilitative interventions in persons with ID is presented

Component-Resolved Diagnosis of Hazelnut Allergy in Children

Hazelnuts commonly elicit allergic reactions starting from childhood and adolescence, with a rare resolution over time. The definite diagnosis of a hazelnut allergy relies on an oral food challenge. The role of component resolved diagnostics in reducing the need for oral food challenges in the diagnosis of hazelnut allergies is still debated. Therefore, three electronic databases were systematically searched for studies on the diagnostic accuracy of specific-IgE (sIgE) on hazelnut proteins for identifying children with a hazelnut allergy. Studies regarding IgE testing on at least one hazelnut allergen component in children whose final diagnosis was determined by oral food challenges or a suggestive history of serious symptoms due to a hazelnut allergy were included. Study quality was assessed by the Quality Assessment of Diagnostic Accuracy Studies-2 tool. Eight studies enrolling 757 children, were identified. Overall, sensitivity, specificity, area under the curve and diagnostic odd ratio of Cor a 1 sIgE were lower than those of Cor a 9 and Cor a 14 sIge. When the test results were positive, the post-test probability of a hazelnut allergy was 34% for Cor a 1 sIgE, 60% for Cor a9 sIgE and 73% for Cor a 14 sIgE. When the test results were negative, the post-test probability of a hazelnut allergy was 55% for Cor a 1 sIgE, 16% for Cor a9 sIgE and 14% for Cor a 14 sIgE. Measurement of IgE levels to Cor a 9 and Cor a 14 might have the potential to improve specificity in detecting clinically tolerant children among hazelnut-sensitized ones, reducing the need to perform oral food challenges

Allergic reactions to cow's milk proteins in medications in childhood

Cow's milk is a frequent trigger of allergic reactions in childhood. Cow's milk proteins can be present in pharmaceutical excipients. METHODS: We have analyzed paediatric literature on allergic reactions to cow's milk proteins in medication, focusing on the different routes of administration (inhaled, parental and oral). RESULTS: Dry-powder inhalers may contain lactose as excipient. Lactose can be rarely contaminated with milk proteins and it may induce allergic reactions in patients with cow's milk allergy. Case reports have described immediate hypersensitivity reactions to methylprednisolone sodium succinate 40 mg injection, a formulation that contains lactose as excipient. Some cases of anaphylaxis after receiving diphteria-tetanus-pertussis vaccine injection in children allergic to milk have been reported. Cow's milk proteins can be detected also in oral polio vaccine, certain probiotics and lactulose syrup. CONCLUSIONS: We suggest caution in administration of pharmaceuticals containing milk allergens in children allergic to milk

Glycan-Lectin Interactions as Novel Immunosuppression Drivers in Glioblastoma

Despite diagnostic and therapeutic improvements, glioblastoma (GB) remains one of the most threatening brain tumor in adults, underlining the urgent need of new therapeutic targets. Lectins are glycan-binding proteins that regulate several biological processes through the recognition of specific sugar motifs. Lectins and their ligands are found on immune cells, endothelial cells and, also, tumor cells, pointing out a strong correlation among immunity, tumor microenvironment and vascularization. In GB, altered glycans and lectins contribute to tumor progression and immune evasion, shaping the tumor-immune landscape promoting immunosuppressive cell subsets, such as myeloid-derived suppressor cells (MDSCs) and M2-macrophages, and affecting immunoeffector populations, such as CD8+ T cells and dendritic cells (DCs). Here, we discuss the latest knowledge on the immune cells, immune related lectin receptors (C-type lectins, Siglecs, galectins) and changes in glycosylation that are involved in immunosuppressive mechanisms in GB, highlighting their interest as possible novel therapeutical targets

Liquid Biopsy in Pediatric Renal Cancer: Stage I and Stage IV Cases Compared

Pediatric renal cancer is rare, and robust evidence for treatment recommendations is lacking. In the perspective of personalized medicine, clinicians need new biomarkers to improve risk stratification and patients’ follow-up. Herein, we analyzed some liquid biopsy tools, which have been never tested in pediatric renal cancer: namely, circulating tumor cells (CTCs); the expression of M30, an apoptosis marker, to test CTC metastatic potential; and c-MET expression in CTCs, because of its role in renal cancer progression and drug-resistance. Furthermore, we evaluated the Circulating Endothelial Cells (CECs), whose utility we previously demonstrated in adult metastatic renal cancer treated with anti-angiogenic therapy. We compared two renal cell carcinomas of clear-cell type, stage I and IV, which underwent surgery and surgery plus Sunitinib, respectively. Baseline CTC level and its changes during follow-up were consistent with patients’ outcome. In case 2, stage IV, the analysis of CECs performed during Sunitinib revealed a late response to treatment consistent with poor outcome, as the finding of M30-negative, viable cells. Noteworthily, few CTCs were MET-positive in both cases. Our study highlights the feasibility for a change in the prognostic approach and follow-up of childhood renal cancer, with a view to guide a better treatment design