Bisphosphonate-related osteonecrosis of the jaws (Bronj)

Bisphosphonate-related osteonecrosis of the jaws (BRONJ) is an extremely therapy resistant osteomyelitis-like disease exclusively involving the jaw bones of patients in treatment with bisphosphonates (BPs). Objectives: The aim of this study was to evaluate the radiological and clinical findings and management of 51 patients with BRONJ diagnosed from 2004 to 2009 in our Reference Center. Study Design: A prospective study was performed. The patients were examined every 2-6 months, depending on their clinical conditions. Outcome variables were the resolution of symptoms, persistence of bone exposure and / or fistula and the status of the lesional mucosa. Results: The higher prevalence of the disease was noted in 2006 and 2007 and at the time of diagnosis 90% of patients had been treated with iv BPs. The main precipitating event leading to BRONJ was an invasive dental procedure in 61% of patients while no traumatic event could be identified in 16% of patients. The median time of follow-up was 19 months (range: 2-57), during which 31% of patients healed and 39% succumbed. In 78% of patients the therapy was medical, in 16% it consisted in surgical deep curettage and only in 6% it was necessary to perform an osteotomy to avoid a mandibular pathological fracture. All the patients in treatment with oral BPs healed from BRONJ with a median time of conservative treatment of 19 months. Conclusions: Prevention has lead to a progressive reduction in the prevalence of BRONJ. In our experience medical treatment is often sufficient to keep the disease under control and to lead to the healing of the lesions by spontaneous loss of the sequestrum. This approach seems to be very effective in patients who were in treatment with oral Bps preparations; BRONJ seems to have a more benign clinical behaviour in these patients

Impact of multiple modes on the black-hole superradiant instability

Ultralight bosonic fields in the mass range $\sim (10^{-20}-10^{-11})\,{\rm eV}$ can trigger a superradiant instability that extracts energy and angular momentum from an astrophysical black hole with mass $M\sim(5,10^{10})M_\odot$, forming a nonspherical, rotating condensate around it. So far, most studies of the evolution and end-state of the instability have been limited to initial data containing only the fastest growing superradiant mode. By studying the evolution of multimode data in a quasi-adiabatic approximation, we show that the dynamics is much richer and depend strongly on the energy of the seed, on the relative amplitude between modes, and on the gravitational coupling. If the seed energy is a few percent of the black-hole mass, a black hole surrounded by a mixture of superradiant and nonsuperradiant modes with comparable amplitudes might not undergo a superradiant unstable phase, depending on the value of the boson mass. If the seed energy is smaller, as in the case of an instability triggered by quantum fluctuations, the effect of nonsuperradiant modes is negligible. We discuss the implications of these findings for current constraints on ultralight fields with electromagnetic and gravitational-wave observations.Comment: 21 pages, 12 figures; matches version accepted in PR

Applying Textural Features to the Classification of HEp-2 Cell Patterns in IIF images

The analysis of anti-nuclear antibodies in HEp-2 cells by indirect immunofluorescence (IIF) is fundamental for the diagnosis of important immune pathologies; in particular, classifying the staining pattern of the cell is critical for the differential diagnosis of several types of diseases. Current tests based on human evaluation are time-consuming and suffer from very high variability, which impacts on the reliability of the results. As a solution to this problem, in this work we propose a technique that performs automated classification of the staining pattern. Our method combines textural feature extraction and a two-step feature selection scheme to select a limited number of image attributes that are best suited to the classification purpose and then recognizes the staining pattern by means of a Support Vector Machine module. Experiments on IIF images showed that our method is able to identify staining patterns with average accuracy of about 87%

Classification of HEp-2 staining patterns in ImmunoFluorescence images. Comparison of Support Vector Machines and Subclass Discriminant Analysis strategies

nti-nuclear antibodies test is based on the visual evaluation of the intensity and staining pattern in HEp-2 cell slides by means of indirect immunofluorescence (IIF) imaging, revealing the presence of autoantibodies responsible for important immune pathologies. In particular, the categorization of the staining pattern is crucial for differential diagnosis, because it provides information about autoantibodies type. Their manual classification is very time-consuming and not very reliable, since it depends on the subjectivity and on the experience of the specialist. This motivates the growing demand for computer-aided solutions able to perform staining pattern classification in a fully automated way. In this work we compare two classification techniques, based respectively on Support Vector Machines and Subclass Discriminant Analysis. A set of textural features characterizing the available samples are first extracted. Then, a feature selection scheme is applied in order to produce different datasets, containing a limited number of image attributes that are best suited to the classification purpose. Experiments on IIF images showed that our computer-aided method is able to identify staining patterns with an average accuracy of about 91% and demonstrate, in this specific problem, a better performance of Subclass Discriminant Analysis with respect to Support Vector Machine

Validation of a questionnaire for young women to assess knowledge, attitudes and behaviors towards cervical screening and vaccination against HPV in Italy

Background: Despite knowledge about HPV may be an important determinant for vaccine acceptance and uptake, only few studies have assessed HPV-related knowledge in young females. The aim of this study was to assess the reliability and validity of the questionnaire, in Italian women ≥18 years old, as a tool to examine knowledge, attitudes and behaviors towards screening and vaccination against HPV and reliable source of information. Methods: The questionnaire was administered to 30 girls in anonymous, voluntary and self -administered form with close-ended type of questions, except for the socio-demographic characteristics. It was composed in 3 sections for a total of 69 items. Participation in the study was entirely voluntary and anonymous. Descriptive analyses were performed using frequencies, percentages, and frequency table for categorical variables. Reliability analysis was tested and content validity was evaluated using Cronbach's alpha to check internal consistency and avoid misinterpretation of the results. The study was conducted in 4 Italian cities: Ferrara, Rome, Cassino and Palermo, to represent the different Italian geographical areas and knowledge, attitudes and behaviors towards screening and vaccination against HPV and reliable source of information. Data were collected in October 2010. Statistical analysis was performed with the statistical software for Windows SPSS, version 19.0. Results: The highest value of Cronbach's alpha resulted on 24 items (alpha= 0,774); the addition of other items, one at a time, decreased the value. Cronbach's alpha on all the 3 sections together resulted in a value of 0, 059. Young women generally knew that HPV can cause cervical cancer (93.3%) and genital warts (16.7%) and 76.7% of them recognized Pap-test as a screening tool. The main sources of information about HPV vaccination are represented by magazines / books (33.3%), TV (26.7%), and gynecologists (23.3%). Conclusions: This pilot study demonstrated that a short version of the questionnaire has very good reliability properties in the study and this needs to be taken into account for future studies

La Valle dei Templi in epoca medioevale. Caratterizzazione antropologica e paleopatologica delle sepolture antistanti in Tempio della Concordia

Riassunto ― Il lavoro presenta i risultati delle analisi bio-archeologiche effettuate su resti scheletrici umani rinvenuti in quattordici sepolture di epoca medioevale rinvenute nel Parco Archeologico della Valle dei Templi di Agrigento (Sicilia). L’obiettivo è stato l’acquisizione delle informazioni necessarie per la ricostruzione del profilo biologico di ciascun individuo, al fine di determinarne il sesso, la stima dell’età biologica alla morte, la stima della statura e la valutazione delle patologie e degli indicatori di stress occupazionale mediante le correnti metodologie e tecniche diagnostiche di tipo antropologico. Sebbene il cattivo stato di conservazione di alcuni individui non ne abbia consentito la caratterizzazione antropologica, le indagini hanno messo in luce l’eterogeneità relativa alle classi d’età e hanno permesso di constatare la manifestazione di alterazioni di natura patologica nei soggetti di età matura, talvolta di eziologia non ancora accertata, come la DISH (Diffuse Idiopathic Skeletal Hyperostosis). La dimensione del campione non è rappresentativa dell’intera popolazione, ma approfondimenti successivi forniranno una migliore comprensione delle dinamiche popolazionistiche di Agrigento medievale

PADUA and R.E.N.A.L. nephrometry scores correlate with perioperative outcomes of robot-assisted partial nephrectomy: analysis of the Vattikuti Global Quality Initiative in Robotic Urologic Surgery (GQI-RUS) database

Objectives: To evaluate and compare the correlations between Preoperative Aspects and Dimensions Used for an Anatomical (PADUA) and R.E.N.A.L. [Radius (tumour size as maximal diameter), Exophytic/endophytic properties of the tumour, Nearness of tumour deepest portion to the collecting system or sinus, Anterior (a)/posterior (p) descriptor and the Location relative to the polar line] nephrometry scores and perioperative outcomes and postoperative complications in a multicentre, international series of patients undergoing robot-assisted partial nephrectomy (RAPN) for masses suspicious for renal cell carcinoma (RCC). Patients and Methods: We retrospectively evaluated the clinical records of patients who underwent RAPN between 2010 and 2013 for clinical N0M0 renal tumours in four international centres that completed all the data required for the Vattikuti Global Quality Initiative in Robotic Urologic Surgery (GQI-RUS) database. All patients underwent preoperative computed tomography or magnetic resonance imaging to define the clinical stage and anatomical characteristics of the tumours. PADUA and R.E.N.A.L. scores were retrospectively assessed in each centre. Univariate and multivariate analyses were used to evaluate the correlations between age, gender, Charlson comorbidity index, clinical tumour size, PADUA and R.E.N.A.L. complexity group categories and warm ischaemia time (WIT) of >20 min, urinary calyceal system closure, and grade of postoperative complications. Results: Overall, 277 patients were evaluated. The median (interquartile range) tumour size was 33.0 (22.0\u201343.0) mm. The median PADUA and R.E.N.A.L. scores were eight and seven, respectively; 112 (40.4%), 86 (31.0%) and 79 (28.5%) patients were classified in the low-, intermediate- or high-complexity group according to PADUA score, while 118 (42.5%), 139 (50.1%) and 20 (7.2%) were classified in the low-, intermediate- or high-complexity group according to R.E.N.A.L. score, respectively. Both nephrometry tools significantly correlated with perioperative outcomes at univariate and multivariate analyses. Conclusion: A precise stratification of patients before PN is recommended to consider both the potential threats and benefits of nephron-sparing surgery. In our present analysis, both PADUA and R.E.N.A.L. were significantly associated with predicting prolonged WIT and high-grade postoperative complications after RAP