Morphometry And Histology Of Gonads From 13 Children With Dysgenetic Male Pseudohermaphroditism

Background. - Dysgenetic male pseudohermaphroditism (DMP) is a sexual differentiation disorder characterized by bilateral dysgenetic testes, persistent müllerian structures, and cryptorchidism in individuals with a 46,XY karyotype. However, the histologic criteria for the diagnosis of DMP are poorly established. Objective. - To determine gonadal histology in children with DMP. Patients and Methods. - Between 1996 and 1998, 13 patients with DMP were evaluated on our service. The clinical diagnosis of DMP was based on a 46,XY karyotype, sex ambiguity, high levels of follicle-stimulating hormone and low levels Of antimüllerian hormone, a decreased testosterone response to human chorionic gonadotropin stimulation without accumulation of testosterone precursors, and the presence of müllerian structures. Molecular sequencing the HMGbox region of the SRY gene did not reveal any mutations. Biopsies were performed for 22 of 26 gonads (patient age at the time of biopsy, 16 months to 10 years). Conventional microscopy was used to evaluate mean tubular diameter, tubular fertility index, and number of Sertoli cells per tubular profile. Results. - All 26 gonads were located outside of the labioscrotal folds. Their histologic features varied from only a reduction in tubular size to features of a streak gonad. Five of the 22 gonads grossly resembled a streak gonad. The mean tubular diameter was severely reduced (>30% reduction relative to the normal tubular diameter for the patient's age) in 4 gonads, markedly reduced (10%-30%) in 11 gonads, slightly reduced (<10%) in one gonad, and normal in one gonad. The tubular fertililty index, expressed as the percentage of tubular profiles containing germ cells, was severely reduced (<30% of normal values) in 9 gonads, markedly reduced (50%-30%) in 2 gonads, and normal in 6 gonads. The number of Sertoli cells per tubular profile was elevated in 16 gonads and normal in one gonad. Thin tubules surrounded by fibrous tissue were occasionally observed. Conclusion. - The histologic findings confirmed the clinical diagnosis of DMP in every patient in the present series. However, gonadal histology was variable, and careful morphometric evaluation may be necessary to establish the diagnosis.1255652656Robboy, S.J., Miller, T., Donahoe, P.K., Dysgenesis of testicular and streak gonads in the syndrome of mixed gonadal dysgenesis: Perspective derived from clinicopathologic analysis of twenty-one cases (1982) Hum Pathol, 13, pp. 700-716Troche, V., Hernandez, E., Neoplasia arising in dysgenetic gonads (1986) Obstet Gynecol Surv, 41, pp. 74-79Krasna, I.H., Lee, M.L., Smilow, P., Sciorra, L., Eierman, L., Risk of malignancy in bilateral streak gonads: The role of the Y chromosome (1992) J Pediatr Surg, 27, pp. 1376-1380Rohatgi, M., Gupta, D.K., Menon, P.S., Verma, I.C., Mathur, M., Mixed gonadal dysgenesis and dysgenetic male pseudohermaphroditism - A critical analysis (1992) Indian J Pediatr, 59, pp. 487-500Rey, R.A., Belville, C., Nhou-Fékété, C., Evaluation of gonadal function in 107 intersex patients by means of serum antimüllerian hormone measurement (1999) J Clin Endocrinol Metab, 84, pp. 627-631Stuchi-Perez, E.G., Lukas-Croisier, C., Castro, M., Evaluation of the tubular and interstitial functions of the testis in 46,XY patients with ambiguous genitalia (2000) J Pediatr Endocrinol Metab, 13, pp. 605-612Chang, H.J., Clark, R.D., Bachman, H., The phenotype of 45,X/46,XY mosaicism: An analysis of 92 prenatally diagnosed cases (1990) Am J Hum Genet, 46, pp. 156-167Rajfer, J., Walsh, P.C., Mixed gonadal dysgenesis: Dysgenetic male pseudoher-maphroditism (1981) The Intersex Child: Pediatric and Adolescent Endocrinology, pp. 103-115. , Josso N, ed. Basel, Switzerland: S. KargerBorer, J.G., Nitti, V.W., Glassberg, K.I., Mixed gonadal dysgenesis and dysgenetic male pseudohermaphroditism (1995) J Urol, 153, pp. 1267-1273Donahoe, P.K., Crawford, J.D., Hendren, W.H., Mixed gonadal dysgenesis: Pathogenesis and management (1979) J Pediatr Surg, 14, pp. 287-300Pelletier, J., Bruening, W., Kashtan, C.E., Germline mutations in the Wilms' tumor supressor gene are associated with abnormal urogenital development in Denys-Drash syndrome (1991) Cell, 67, pp. 437-1147Carré-Éusebe, D., Imbeaud, S., Harbison, M., New, M.I., Josso, N., Picard, J.Y., Variants of the anti-Müllerian hormone gene in a compound heterozygote with the persistent Müllerian duct syndrome and his family (1992) Hum Genet, 90, pp. 389-394Nistal, M., Paniagua, R., Non-neoplastic diseases of the testis (1996) Urologic Surgical Pathology, pp. 458-565. , Bostiwick DG, Eble JN, eds. St Louis, Mo: MosbyLennox, B., Ahmad, K.M., Mack, W.S., A method for determining the relative total length of the tubules in the testis (1970) J Pathol, 102, pp. 229-238Jimenez, R., Sanchez, A., Burgos, M., Dias De La Guardia, R.C., Puzzling out the genetics of mammalian sex determination (1996) Trends Genet, 12, pp. 164-166Müller, J., Skakkebaek, N.F., Quantification of germ cells and seminiferous tubules by stereological examination of testicles from 50 boys who suffered from sudden death (1983) Int J Androl, 6, pp. 143-156Cortes, D., Müller, J., Skakkebaek, N.E., Proliferation of Sertoli cells during development of the human testis assessed by stereological methods (1987) Int J Androl, 10, pp. 589-596Nistal, M., Abaurrea, M.A., Paniagua, R., Morphological and histometric study on the human Sertoli cell from birth to the onset of puberty (1982) J Anat, 14, pp. 351-363Van Niekerk, W.A., Retief, A.E., The gonads of human true hermaphrodites (1981) Hum Genet, 58, pp. 117-122Guerra Jr., G., De Mello, M.P., Assumpção, J.G., True hermaphrodites in the southeastern region of Brazil: A different cytogenetic and gonadal profile (1998) J Pediatr Endocrinol Metab, 11, pp. 519-524Quigley, C.A., De Bellis, A., Marschke, K.B., El-Awady, M.K., Wilson, E.M., French, F.S., Androgen receptor defects: Historical, clinical and molecular perspectives (1995) Endocr Rev, 16, pp. 271-32

Charge and matter distributions and form factors of light, medium and heavy neutron-rich nuclei

Results of charge form factors calculations for several unstable neutron-rich isotopes of light, medium and heavy nuclei (He, Li, Ni, Kr, Sn) are presented and compared to those of stable isotopes in the same isotopic chain. For the lighter isotopes (He and Li) the proton and neutron densities are obtained within a microscopic large-scale shell-model, while for heavier ones Ni, Kr and Sn the densities are calculated in deformed self-consistent mean-field Skyrme HF+BCS method. We also compare proton densities to matter densities together with their rms radii and diffuseness parameter values. Whenever possible comparison of form factors, densities and rms radii with available experimental data is also performed. Calculations of form factors are carried out both in plane wave Born approximation (PWBA) and in distorted wave Born approximation (DWBA). These form factors are suggested as predictions for the future experiments on the electron-radioactive beam colliders where the effect of the neutron halo or skin on the proton distributions in exotic nuclei is planned to be studied and thereby the various theoretical models of exotic nuclei will be tested.Comment: 26 pages, 11 figures, 3 tables, accepted for publication in Phys. Rev.

Detection Of Metabolic Syndrome Features Among Childhood Cancer Survivors: A Target To Prevent Disease

Along with the growing epidemic of obesity, the risk of atherosclerosis, cardiovascular disease morbidity, and mortality are increasing markedly. Several risk factors for cardiovascular disease, such as visceral obesity, glucose intolerance, arterial hypertension, and dyslipidemia commonly cluster together as a condition currently known as metabolic syndrome. Thus far, insulin resistance, and endothelial dysfunction are the primary events of the metabolic syndrome. Several groups have recommended clinical criteria for the diagnosis of metabolic syndrome in adults. Nonetheless, in what concerns children and adolescents, there are no unified definitions, and modified adult criteria have been suggested by many authors, despite major problems. Some pediatric disease states are at risk for premature cardiovascular disease, with clinical coronary events occurring very early in adult life. Survivors of specific pediatric cancer groups, particularly acute lymphocytic leukemia, central nervous system tumors, sarcomas, lymphomas, testicular cancer, and following bone marrow transplantation, may develop metabolic syndrome traits due to: hormonal deficiencies (growth hormone deficiency, thyroid dysfunction, and gonadal failure), drug or radiotherapy damage, endothelial impairment, physical inactivity, adipose tissue dysfunction, and/or drug-induced magnesium deficiency. In conclusion, some primary and secondary prevention remarks are propose in order to reduce premature cardiovascular disease risk in this particular group of patients. © 2008 Siviero-Miachon et al, publisher and licensee Dove Medical Press Ltd.44825836Adan, L., Trivin, C., Sainte-Rose, C., GH deficiency caused by cranial irradiation during childhood: Factors and mukers in young adults (2001) J Clin Endocrinol Metab, 86, pp. 5245-5251Ahmet, A., Blaser, S., Stephens, D., Weight gain in craniopharyngioma -a model for hypothalamic obesity (2006) J Pediatr Endocrinol Metab, 19, pp. 121-128Alberti, K.G.M.M., Zimmet, P.Z., World Health Organisation (WHO)-Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: Diagnosis and classification of diabetes mellitus provisional report of a WHO consultation (1998) Diabet Med, 15, pp. 539-553National Cholesterol Education Program: Report of the Expert Panel on Blood Cholesterol Levels in Children and Adolescents (1992) Pediatrics, 89 (PART 2), pp. 525-584. , American Academy of PediatricsType 2 diabetes in children and adolescents (2000) Diabetes Care, 23, pp. 381-389. , American Diabetes AssociationArgüelles, B., Barrios, V., Buño, M., Anthropometric parameters and their relationship to serum growth hormone-binding protein and leptin levels in children with acute lymphoblastic leukemia: A prospective study (2000) Eur J Endocrinol, 143, pp. 243-250Baker, K.S., Ness, K.K., Steinberger, J., Diabetes, hypertension, and cardiovascular events in survivors of hematopoietic cell transplantation: A report from the Bone Marrow Transplantation Survivor Study (2007) Blood, 109, pp. 1765-1772Balkau, B., Charles, M.A., European Group for the Study of Insulin Resistance (EGIR) - Comment on the provisional report from the WHO consultation. European Group for the Study of Insulin Resistance (1999) Diabet Med, 16, pp. 442-443Barker, D.J., Fetal origins of coronary heart disease (1995) BMJ, 311, pp. 171-174Brydøy, M., Fosså, S.D., Dahl, O., Gonadal dysfunction and fertility problems in cancer survivors (2007) Acta Oncol, 46, pp. 480-489Bülow, B., Link, Y., Ahren, B., Survivors of childhood acute lymphoblastic leukaemia, with radiation-induced GH deficiency, exhibit hyperleptinaemia and impaired insulin sensitivity, unaffected by 12 months of GH treatment (2004) Clin Endocrinol (Oxf), 61, pp. 683-691Chatterjee, R., Palla, K., MeGarrigle, H.H., Syndrome "X" in adult female recipients of bone marrow transplantation for haematological malignancies (2005) Bone Marrow Transplant, 35, pp. 209-210Colao, A., Di Somma, C., Rota, F., Common carotid intima-media thickness in growth hormone (GH)-deficient adolescents: A prospective study after GH withdrawal and restarting GH replacement (2005) J Clin Endocrinol Metab, 90, pp. 2659-2665Cook, S., Weitzman, M., Auinger, P., Prevalence of a metabolic syndrome phenotype in adolescents: Findings from the third National Health and Nutrition Examination Survey, 1988-1994 (2003) Arch Pediatr Adolesc Med, 157, pp. 821-827Cruz, M.L., Weigensberg, M.J., Huang, T.T., The metabolic syndrome in overweight Hispanic youth and the role of insulin sensitivity (2004) J Clin Endocrinol Metab, 89, pp. 108-113Dalton, V.K., Rue, M., Silverman, L.B., Height and weight in children treated for acute lymphoblastic leukemia: Relationship to CNS treatment (2003) J Clin Oncol, 21, pp. 2953-2960DeFerranti, S.D., Gauvreau, K., Ludwig, D.S., Prevalence of the metabolic syndrome in American adolescents (2004) Circulation, 110, pp. 2494-2497Einhom, D., Reaven, G.M., Cobin, R.H., The American College of Endocrinology - American College of Endocrinology position statement on the insulin resistance syndrome (2003) Endocr Pract, 9, pp. 237-252Florin, T.A., Fryer, G.E., Miyoshi, T., Physical inactivity in adult survivors of childhood acute lymphoblastic leukemia: A report from the Childhood Cancer Survivor Study (2007) Cancer Epidenziol Biomarkers Prev, 16, pp. 1356-1363Genuth, S., Alberti, K.G., Bennett, P., Follow-up report on the diagnosis of diabetes mellitus. The Expert Committee on the Diagnosis and Classification of Diabetes Mellitus (2003) Diabetes Care, 26, pp. 3160-3167Gleeson, H.K., Shalet, S.M., The impact of cancer therapy on the endocrine system in survivors of childhood brain tumors (2004) Endocr Relat Cancer, 11, pp. 589-602Grundy SM, Brewer Jr HB, Cleeman JI, et al. 2004. Definition of metabolic syndrome. Report of the National Heart, Lung, and Blood Institute/American Heart Association Conference on Scientific Issues Related to Definition. Circulation, 109:433-8Guo, C.Y., Halton, J.M., Barr, R.D., Hypomagnesemia associated with chemotherapy in patients treated for acute lymphoblastic leukemia: Possible mechanisms (2004) Oncol Rep, 11, pp. 185-189Gurney, J.G., Ness, K.K., Sibley, S.D., Metabolic syndrome and growth hormone deficiency in adult survivors of childhood acute lymphoblastic leukemia (2006) Cancer, 107, pp. 1303-1312Harish, K., Dharmalingam, M., Himanshu, M., Study protocol: Insulin and its role in cancer (2007) BMC Endocr Disord, 7, p. 10Harz, K.J., Müller, H.L., Waldeck, E., Obesity in patients with craniopharyngioma: Assessment of food intake and movement counts indicating physical activity (2003) J Clin Endocrinol Metab, 88, pp. 5227-5231Heikens, J., Ubbink, M.C., Van der Pal, H.P.J., Long term survivors of childhood brain cancer have an increased risk for cardiovascular disease (2000) Cancer, 88, pp. 2116-2121Hickman, T.B., Briefel, R.R., Carroll, M.D., Distributions and trends of serum lipid levels among United States children and adolescents ages 4-19 years: Data from the Third National Health and Nutrition Examination Survey (1998) Prev Med, 27, pp. 879-890Higgins, K., Noon, C., Cartwright, V., Features of the metabolic syndrome present in bone marrow transplantation in adulthood (2004) Bone Marrow Transplant, 33 (SUPPL. 1), pp. S216-S217Hodgkinson, E., Neville-Webbe, H.L., Coleman, R.E., Magnesium depletion in patients receiving cisplatin-based chemotherapy (2006) Clin Oncol (R Coll Radiol), 18, pp. 710-718Hoffman, K.E., Derdak, J., Bernstein, D., Metabolic syndrome traits in long-term survivors of pediatric sarcoma (2008) Pediatr Blood Cancer, 50, pp. 341-346Hsu, I.R., Kim, S.P., Kabir, M., Metabolic syndrome, hyperinsulinemia, and cancer (2007) Am J Clin Nutr, 86, pp. S867-S871Hu, G., Qiao, Q., Tuomilehto, J., Prevalence of the metabolic syndrome and its relation to all-cause and cardiovascular mortality in nondiabetic European men and women (2004) Arch Intern Med, 164, pp. 1066-1076. , for the DECODE Study Group(2006) The IDF consensus worldwide definition of the metabolic syndrome, , http://www.idf.org/webdata/docs/IDF_Meta_def_final.pdf, online, Accessed on January 10, 2008. URLJaniszewski, P.M., Oeffinger, K.C., Church, T.S., Abdominal obesity, liver fat, and muscle composition in survivors of childhood acute lymphoblastic leukemia (2007) J Clin Endocrinol Metab, 92, pp. 3816-3821Jarfelt, M., Lannering, B., Bosaeus, I., Body composition in young adult survivors of childhood acute lymphoblastic leukaemia (2005) Eur J Endocrinol, 153, pp. 81-89Jones, K.L., The dilemma of the metabolic syndrome in children and adolescents: Disease or distraction? (2006) Pediatr Diabetes, 7, pp. 311-321Kavey RE, Allada V, Daniels SR, et al. 2006. Cardiovascular risk reduction in high-risk pediatric patients: a scientific statement from the American Heart Association Expert Panel on Population and Prevention Sciencethe Councils on Cardiovascular Disease in the Young, Epidemiology and Prevention, Nutrition, Physical Activity and Metabolism, High Blood Pressure Research, Cardiovascular Nursing, and the Kidney in Heart Diseaseand the Interdisciplinary Working Group on Quality of Care and Outcomes Research: endorsed by the American Academy of Pediatrics. Circulation, 114:2710-38Kourti, M., Tragiannidis, A., Makedou, A., Metabolic syndrome in children and adolescents with acute lymphoblastic leukemia after the completion of chemotherapy (2005) J Pediatr Hematol/Oncol, 27, pp. 499-501Link, K., Moëll, C., Garwicz, S., Growth hormone deficiency predicts cardiovascular risk in young adults treated for acute lymphoblastic leukemia in childhood (2004) J Clin Endocrinol Metab, 89, pp. 5003-5012Lustig, R.H., Autonomic dysfunction of the β-Cell and the pathogenesis of obesity (2003) Rev Endocr Metab Disord, 4, pp. 23-32Lustig, R.H., Post, S.R., Srivannaboon, K., Risk factors for the development of obesity in children surviving brain tumors (2003) J Clin Endocrinol Metab, 88, pp. 611-616Mertens, A.C., Yasui, Y., Neglia, J.P., Late mortality experience in five-year survivors of childhood and adolescent cancer: The Childhood Cancer Survivor Study (2001) J Clin Oncol, 19, pp. 3163-3172Mohamed-Ali, V., Pinkney, J.H., Coppack, S.W., Adipose tissue as an endocrine and paracrine organ (1998) Int J Obes, 22, pp. 1145-1158Moser, E.C., Noordijk, E.M., Carde, P., Late non-neoplastic events in patients with aggressive non-Hodgkin's lymphoma in four randomized European Organisation for Research and Treatment of Cancer trials (2005) Clin Lymphoma Myeloma, 6, pp. 122-130National Center for Health Statistics. 2000 CDC Growth Charts: United States [updated 2007 February 12cited 2007 November 08] [online]. Accessed on January 10, 2008. URL: http://www.cdc.gov/ growthcharts[NCEP-ATP III] National Cholesterol Education Program Adult Treatment Panel III - Expert panel on the detection, evaluation, and treatment of high blood cholesterol in adults. 2001. Executive summary of the Third Report of the National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). JAMA, 285:2486-97National High Blood Pressure Education Program Working Group on Hypertension Control in Children and Adolescents. 1996. Update on the 1987 Task Force Report on High Blood Pressure in Children and Adolescents: a working group report from the National High Blood Pressure Education Program. Pediatrics, 98:649-58National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents. 2004. Fourth report of the Task Force on the Diagnosis, Evaluation and Treatment of High Blood Pressure in Children. Pediatrics, 114:555-76Neville, K.A., Cohn, R.J., Steinbeck, K.S., Hyperinsulinemia, impaired glucose tolerance, and diabetes mellitus in survivors of childhood cancer: Prevalence and risk factors (2006) J Clin Endocrinol Metab, 91, pp. 4401-4407Nuver, J., Smit, A.J., Postma, A., The metabolic syndrome in long-term cancer survivors, an important target for secondary preventive measures (2002) Cancer Treat Ver, 28, pp. 195-214Nuver, J., Smit, A.J., Wolffenbuttel, B.H., The metabolic syndrome and disturbances in hormone levels in long-term survivors of disseminated testicular cancer (2005) J Clin Oncol, 23, pp. 3718-3725Oeffinger, K.C., Buchanan, G.R., Eshelman, D.A., Cardiovascular risk factors in young adult survivors of childhood acute lymphoblastic leukemia (2001) J Pediatr Hematol/Oncol, 23, pp. 424-430Oeffinger, K.C., Mertens, A.C., Sklar, C.A., Obesity in adult survivors of childhood acute lymphoblastic leukemia: A report from the Childhood Cancer Survivor Study (2003) J Clin Oncol, 21, pp. 1359-1365Oeffinger, K.C., Are survivors of acute lymphoblastic leukemia (ALL) at increased risk of cardiovascular disease? (2008) Pediatr Blood Cancer, 50, pp. 462-467Pollak, M.N., Insulin, insulin-like growth factors, insulin resistance, and neoplasia (2007) Am J Clin Nutr, 86, pp. S820-S821Razzouk, B.I., Rose, S.R., Hongeng, S., Obesity in survivors of childhood acute lymphoblastic leukemia and lymphoma (2007) J Clin Oncol, 25, pp. 1183-1189Reaven, G.M., Banting lecture 1988: Role of insulin resistance in human disease (1988) Diabetes, 37, pp. 1595-1607Reilly, J.J., Kelly, A., Ness, P., Premature adiposity rebound in children treated for acute lymphoblastic leukemia (2001) J Clin Endocrinol Metab, 86, pp. 2775-2778Ross, J.A., Oeffinger, K.C., Davies, S.M., Genetic variation in the leptin receptor gene and obesity in survivors of childhood acute lymphoblastic leukemia: A report from the Childhood Cancer Survivor Study (2004) J Clin Oncol, 22, pp. 3558-3562Roth C, Wilken B, Hanefeld F, et al. 1998. Hyperphagia in children with craniopharyngioma is associated with hyperleptinaemia and a failure in the downregulation of appetite. Eur J Endocrinol, 138-89-91Rutter, M.M., Rose, R.S., Long-term endocrine sequelae of childhood cancer (2007) Curr Opin Pediatr, 19, pp. 480-487Saini, A., Al-Shanti, N., Stewart, C.E., Waste management - cytokines, growth factors and cachexia (2006) Cytokine Growth Factor Rev, 17, pp. 475-486Sarti, C., Gallagher, J., The metabolic syndrome: Prevalence, CHD risk, and treatment (2006) J Diabetes Compl, 20, pp. 121-132Shalitin, S., Phillip, M., Stein, J., Endocrine dysfunction and parameters of the metabolic syndrome after bone marrow transplantation during childhood and adolescence (2006) Bone Marrow Transplant, 37, pp. 1109-1117Shoelson, S.E., Lee, J., Goldfine, A.B., Inflammation and insulin resistance (2006) J Clin Invest, 116, pp. 1793-1801Siviero-Miachon, A.A., Spinola-Castro, A.M., Tosta-Hernandez, P.D.C., Leptin assessment in acute lymphocytic leukemia survivors: Role of cranial radiotherapy? (2007) J Ped Hematol/Oncol, 29, pp. 776-782Sklar, C.A., Mertens, A.C., Walter, A., Changes in body mass index and prevalence of overweight in survivors of childhood acute lymphoblastic leukemia: Role of cranial irradiation (2000) Med Pediatr Oncol, 35, pp. 91-95Sklar, C.A., Mertens, A.C., Mitby, P., Premature menopause in survivors of childhood cancer: A report from the Childhood Cancer Survivor Study (2006) J Natl Cancer Inst, 98, pp. 890-896Soares, D.V., Spina, L.D., de Lima, Oliveira Brasil, R.R., Carotid artery intima-media thickness and lipid profile in adults with growth hormone deficiency after long-term growth hormone replacement (2005) Metabolism, 54, pp. 321-329Srinivasan, S., Ogle, G.D., Garnett, S.P., Features of the metabolic syndrome after childhood craniopharyngioma (2004) J Clin Endocrinol Metab, 89, pp. 81-86Szczepaniska-Kostro, J., Tolwinska, J., Urban, M., Cardiac mass and function, carotid artery intima media thickness, homocysteine and lipoprotein levels in children and adolescents with growth hormone deficiency (2004) J Pediatr Endocrinol Metab, 17, pp. 1405-1413Talvensaari, K.K., Lanning, M., Tapanainen, P., Long-term survivors of childhood cancer have an increased risk of manifesting the metabolic syndrome (1996) J Clin Endocrinol Metab, 81, pp. 3051-3055Taskinen, M., Lipsanen-Nyman, M., Tiitinen, A., Insufficient growth hormone secretion is associated with metabolic syndrome after allogeneic stem cell transplantation in childhood (2007) J Pediatr Hematol/ Oncol, 29, pp. 529-534Trimis, G., Moschovi, M., Papassotiriou, I., Early indicators of dysmetabolic syndrome in young survivors of acute lymphoblastic leukemia in childhood as a target for preventing disease (2007) J Ped Hematol/ Oncol, 29, pp. 309-314Waychenberg, B.L., Subcutaneous and visceral adipose tissue: Their relation to the metabolic syndrome (2000) Endocr Rev, 21, pp. 697-738Weiss, R., Dziura, J., Burgett, T.S., Obesity and the metabolic syndrome in children and adolescents (2004) N Engl J Med, 350, pp. 2362-2374Zimmet P, Alberti G, Kaufinan F, et al. on behalf of the International Diabetes Federation Task Force on Epidemiology and Prevention of Diabetes. 2007. The metabolic syndrome in children and adolescents. Lancet, 369:2059-61Zhou JR, Blackburn GL, Walker WA. 2007. Symposium introduction: metabolic syndrome and the onset of cancer. Am J Clin Nutr, 86: S817-S81

Lean Six Sigma Approach to Implement a Femur Fracture Care Pathway at “San Giovanni di Dio e Ruggi d’Aragona” University Hospital

Timeliness in the treatment of fracture of the femur, through surgery, is crucial in the elderly patient as it reduces the risk of mortality and disability. Here we propose a Lean Six Sigma (LSS) approach to reduce the preoperative length of stay for patients with femur fracture. Through the LSS, a tailored Diagnostic Therapeutic Assistance Path (DTAP) for these has been implemented and monitored over time. In particular, through the analysis, based on the application of the DMAIC cycle conducted on data extrapolated from the information system of the “San Giovanni di Dio e Ruggi d’Aragona” University Hospital of Salerno, the new DTAP was designed and implemented. After the introduction of the DTAP, a significant reduction in the average length of hospital stay was observed, with a preoperative length of stay within 48 h in 65% cases (compared to the previous 9%). In particular, the most significant reduction (over 55%) is obtained for patients aged over 65 years old. Such a result reflects not only the improvement in the care process but it is also compliant with the guidelines of the Italian Ministry of Health, as reported in the New Guarantee System for monitoring the quality of care. © 2021, Springer Nature Switzerland AG

Anomalous Spreading of Power-Law Quantum Wave Packets

We introduce power-law tail quantum wave packets. We show that they can be seen as eigenfunctions of a Hamiltonian with a physical potential. We prove that the free evolution of these packets presents an asymptotic decay of the maximum of the wave packets which is anomalous for an interval of the characterizing power-law exponent. We also prove that the number of finite moments of the wave packets is a conserved quantity during the evolution of the wave packet in the free space.Comment: 5 pages, 3 figures, to appear in Phys. Rev. Let

Subcritical Fluctuations at the Electroweak Phase Transition

We study the importance of thermal fluctuations during the electroweak phase transition. We evaluate in detail the equilibrium number density of large amplitude subcritical fluctuations and discuss the importance of phase mixing to the dynamics of the phase transition. Our results show that, for realistic Higgs masses, the phase transition can be completed by the percolation of the true vacuum, induced by the presence of subcritical fluctuations.Comment: RevTeX, 4 eps figs (uses epsf.sty), 26 pages, to be published in Phys. Rev.