Can platelet-rich plasma be an alternative to surgery for resistant chronic patellar tendinopathy in sportive people? Poor clinical results at 1-year follow-up

Introduction and purpose: Patellar tendinopathy is a disease affecting particularly athletes. Platelet-rich plasma (PRP) injections have gained increasing interest for their potential benefits. Anyway, a tendon disease longer than 6 months should be considered as an indication for surgery. The aim of our study was to evaluate the efficacy of PRP in athletes with a severe chronic patellar tendinopathy longer than 6 months when surgery should be chosen. Methods: We enrolled 17 sport practitioners (19 patellar tendons) who did not want to undergo surgery and who are nonresponders to other conservative treatments. We treated them with PRP and calculated the results using the visual analog scale (VAS), the Victorian Institute of Sport Assessment-Patellar (VISA-P) score, and Tegner Activity Scale. Every test has been conducted at T0, T1 (4 months), and T2 (12 months). Results: We found a poor improvement at T1 and a clinical worsening at T2 through VAS. VISA-P showed a medium improvement both at T1 and T2. Tegner scale did not show improvements. Conclusions: Our study was not able to remove the doubts about the benefits of PRP in patellar tendinopathy, confirming ambiguous certainties. Further investigations are needed to assess its effectiveness

Absences from work among healthcare workers: are they related to influenza shot adherence?

BACKGROUND: The coverage for influenza vaccination among healthcare workers (HCWs) is inadequate in many countries despite strong recommendations; is there evidence that influenza vaccination is effective in preventing absenteeism? Aim of the study is to evaluate the influenza vaccination coverage and its effects on absences from work among HCWs of an Italian academic healthcare trust during the 2017-2018 influenza season. METHODS: We performed a retrospective study to identify predictive characteristics for vaccination, and a retrospective cohort study to establish the effect of vaccination on absences among the vaccinated and non-vaccinated cohorts between December 2017 and May 2018. Overall absence rates over the whole observation period and sub-rates over 14-days intervals were calculated; then comparison between the two groups were conducted applying Chi-square test. RESULTS: Influenza vaccination coverage among 4419 HCWs was 14.5%. Age, university degree, medical care area and physician profile were positively associated with vaccine uptake. Globally during influenza season non-vaccinated HCWs lost 2.47/100 person-days of work compared to 1.92/100 person-days of work among vaccinated HCWs (p\u2009<\u20090.001); significant differences in absences rates resulted when focusing on the influenza epidemic peak. CONCLUSIONS: Factors predicting influenza uptake among HCWs were male sex, working within medical care area and being a physician. Absenteeism among HCWs resulted to be negatively correlated with vaccination against influenza. These findings add evidence to the urgent need to implement better influenza vaccination strategies towards HCWs to tackle vaccine hesitancy among professionals

Executive dysfunction in children affected by obstructive sleep apnea syndrome: an observational study

Introduction: The role of sleep in cognitive processes can be considered clear and well established. Different reports have disclosed the association between sleep and cognition in adults and in children, as well as the impact of disturbed sleep on various aspects of neuropsychological functioning and behavior in children and adolescents. Behavioral and cognitive dysfunctions can also be considered as related to alterations in the executive functions (EF) system. In particular, the EF concept refers to self-regulatory cognitive processes that are associated with monitoring and controlling both thought and goal directed behaviors. The aim of the present study is to assess the impact of the obstructive sleep apnea syndrome (OSAS) on EF in a large sample of school aged children. Materials and methods: The study population comprised 79 children (51 males and 28 females) aged 7–12 years (mean 9.14 ± 2.36 years) with OSAS and 92 healthy children (63 males and 29 females, mean age 9.08 ± 2.44 years). To identify the severity of OSAS, an overnight respiratory evaluation was performed. All subjects filled out the Italian version of the Modified Card Sorting Test to screen EFs. Moreover, to check the degree of subjective perceived daytime sleepiness, all subjects were administered the Pediatric Daytime Sleepiness Scale (PDSS). Results: No significant differences between the two study groups were found for age (P = 0.871), gender (P = 0.704), z-score of body mass index (P = 0.656), total intelligence quotient (P = 0.358), and PDSS scores (P = 0.232). The OSAS children showed a significantly higher rate of total errors (P , 0.001), perseverative errors (P , 0.001), nonperseverative errors (P , 0.001), percentage of total errors (P , 0.001), percentage of perseverative errors (P , 0.001), and percentage of nonperseverative errors (P , 0.001). On the other hand, OSAS children showed a significant reduction in the number of completed categories (P = 0.036), total correct sorts (P = 0.001), and categorizing efficiency (P , 0.001). The Pearson’s correlation analysis revealed a significant positive relationship between all error parameters and apnea-hypopnea index, oxygen desaturation index, and percentage of mean desaturation of O2 with a specular negative relationship between the error parameters and the mean oxygen saturation values, such as a significant negative relationship between apnea-hypopnea index, oxygen desaturation index, percent of mean desaturation of O2, and the number of completed categories. Conclusion: Our study identified differences in the executive functioning of children affected by OSAS and is the first to identify a correlation between alteration in respiratory nocturnal parameters and EF that has not yet been reported in developmental age. These findings can be considered as the strength and novelty of the present report in a large pediatric population

ASTHMA AND MAST CELL BIOLOGY

Asthma is a chronic inflammatory disease of the lung and its pathophysiology is initiated by mast cell activation in response to the antigen binding to IgE receptor as well as by TH2 cell activation. Mast cells are well established effector cells in asthma where they exacerbate the inflammatory response, playing a key role in early phase, degranulating and increasing histamine. Human mast cells possess high affinity IgE receptors and are ubiquitous but predominantly localized in mucosal and connective tissue and are distributed along blood vessels. There are two types of mast cells: connective tissue mast cells (TC) and mucosal mast cells (T mast cells). TC mast cells contain more heparin, whereas T mast cells contain more chondroitin sulfate. In asthma, mast cell activation can trigger degranulation, releasing secretory granule complex and preformed mediators, such as histamine and proteases, along with the synthesis of leukotrines and prostaglandins, and induction of cytokines and chemokines. Leukotrine inhibitors and omalizumab, which inhibits IgE, both relieve the asthma exacerbation when administered to humans and permit to reduce the use of other drugs. The release of cytokines by mast cells, such as TNF-alpha, IL-1, IL-6 and IL-33, participate in the pathogenesis of asthma. Stress worsens asthma, and this effect is also mediated by mast cell activation through the release of cytokines. Administration of IL-33 in experimental animals provokes pathological effects in the mucosal tissues and augments antibody IgE and IgA in blood vessels. Here, we report the impact of mast cell biology in asthma pathogenesis

La malattia ossea metastatica. Strategia della diagnostica per immagini

Le metastasi scheletriche rappresentano la maggior parte dei tumori maligni dell'osso. Esse si manifestano soprattutto negli adulti, specie in età avanzata. Nell'uomo, le metastasi più comuni sono quelle del cancro prostatico (60%), nella donna quello della mammella (70%). Altri istotipi primitivi sono: polmone, rene, tiroide, tubo digerente, vescica, cute. La colonna vertebrale e la pelvi sono le sedi più colpite, perché ricche di midollo osseo. L'aspetto radiografico è in prevalenza osteolitico; seguono la forma addensante, quella mista, le forme litiche ad evoluzione mista e quelle eburnee ad evoluzione litica. Il sintomo principale è il dolore; tuttavia molte metastasi sono asintomatiche. Le complicanze più gravi sono le fratture patologiche e le compromissioni nervose. Il trattamento clinico dei pazienti con metastasi scheletriche necessita di modalità di imaging capaci di rilevarne la lesione, descriverne la sede anatomica e facilitarne la biopsia (eco- o TC-guidata) per la tipizzazione istologica. Queste tecniche sono differenziabili tra loro sulla base della propria sensibilità e specificità; tuttavia nessuna di esse ‹ quando impiegata da sola ‹ possiede la capacità di una diagnosi onnicomprensiva. Pertanto è indispensabile la cooperazione multidisciplinare per lo screening, l'impostazione terapeutica ed il follow-up. In altre parole, qual è l'efficacia dei nuovi test diagnostici rispetto a «quelli vecchi»? Di frequente le «nuove» procedure non sostituiscono quelle «vecchie», ma aggravano il lavoro diagnostico ed aumentano i costi di gestione, senza un effettivo miglioramento della «condizione» del paziente. Pertanto, scopo del presente lavoro è la proposta di un «algoritmo» procedurale diagnostico, ragionevole ed efficace, applicabile in maniera differenziata a pazienti oncologici asintomatici e sintomatici per metastasi scheletriche. La scintigrafia ossea total body è l'esame di prima scelta nei pazienti asintomatici, in cui si suppone fondatamente la presenza di metastasi scheletriche. Tuttavia la scintigrafia, anche se molto sensibile, è poco specifica. Di fronte ad una sua risposta negativa, i pazienti dovranno essere «rivalutati»: se la clinica permane negativa, l'iter diagnostico può fermarsi. Al contrario, nei pazienti con scintigrafia positiva o in quelli con sintomi locali e/o dolore l'esame successivo è quello radiologico convenzionale (radiografia e TC): il risultato può essere negativo (per la sensibilità decisamente bassa della radiologia convenzionale), dubbio (in questo caso è necessaria la biopsia ossea) oppure la causa della sintomatologia non è da riferirsi a lesioni replicative (artrosi ed altre malattie degenerative). La TC rappresenta una metodica eccellente per valutare l'estensione della lesione, soprattutto in sedi difficili da studiare con le tecniche tradizionali (colonna vertebrale, bacino). Prima della biopsia ossea s'inserisce la RM, che è oggi l'unica metodica che consenta lo studio diretto del midollo osseo. Essa è stata impiegata soprattutto nello studio dei tumori secondari del rachide. I limiti della RM sono legati alla non specificità del segnale ed al fatto che non tutto lo scheletro può essere studiato

The crowned dens sindrome. Evaluation with CT imaging. La sindrome del "dente incoronato". Valutazione diagnostica mediante TC

Purpose. The purpose of this study was to verify the value of computed tomography (CT) in the diagnosis of the "crowned dens" syndrome, not only in crystal deposition diseases, but also in other rheumatic or nonrheumatic conditions. Materials and methods. Thirty-eight patients (15 men and 23 women; mean age 55 years; age range 35–79) with neck pain were examined and divided into two groups: (1) patients already identified as rheumatic and referred for further investigation of the atlantoaxial region; (2) patients with symptoms confined to the cervical spine, with inconclusive radiographic findings. Unenhanced CT of the cervical spine (Tomoscan SR 7000 Philips, Eindhoven, Netherlands) was performed in all patients. There were 11 cases of rheumatoid arthritis (ten women and one man), two calcium pyrophosphate dihydrate crystal deposition disease (both women), one of systemic sclerosis (a woman), one of osteoarthritis (a man), one of seronegative arthritis (a man), four of neoplasm (one woman and three men) with suspected cervical involvement, one (a man) of haematological disease (lymphoma), one (a woman) of menopausal osteoporosis, ten (five men and five women) of recent or previous trauma with suspected involvement of the skull base and first cervical vertebrae and six of unknown painful cervical dysfunction (three men and three women). Results. CT demonstrated calcific deposits around the dens in 12 patients (three men and nine women), in the transverse and alar ligaments, and in the anterior atlantooccipital membrane. CT revealed horseshoe- or crown-like calcification surrounding the odontoid process. In our series, other rheumatic diseases, especially rheumatoid arthritis, showed similar irregular calcifications of the atlantoaxial joint. Discussion. In calcium pyrophosphate dihydrate (CPPD) crystal deposition disease, the spine may be the only site of involvement, generally asymptomatic. Crystals located in the transverse ligament of the atlas give rise to the crowned dens syndrome, usually in patients affected by severe degenerative lesions of the atlantoaxial joint and peripheral chondrocalcinosis. Symptoms may be absent, or a neurological compressive syndrome may develop. Symptoms tend to worsen with age. The diagnosis is not always easy, as the symptoms are similar to those of other diseases, such as meningitis, cervicobrachial pain, occipitotemporal headache, calcific tendinitis of the longus colli muscle, spondylodiscitis and retropharyngeal abscess. Conclusion. CT is the gold standard in identifying crowned dens syndrome, as it is able to depict the shape and site of calcification and any bone erosions. Radiography of other joints (wrist, knee, pubic symphysis) may help to ascertain whether the disease is due to calcium pyrophosphate dihydrate or hydroxyapatite crystals, and is therefore recommended for routine patient management. Magnetic resonance imaging (MRI) is indicated for the study of neurological complications