Cognitive thought diary in supportive psychology for people undergoing radiotherapy: a feasibility study.

BAC KGROUND: Radiation therapy (RT ) has become one of the most widely-used and efficient treatments for cancer; nevertheless, people who undergo radiotherapy suffer the physical and psychological consequences of this stressful treatment, in addition to the psychosocial distress related to cancer. However, a Radiotherapy Unit is often a place where several patients crowd in from various hospitals with restricted timetables and, for logistic reasons, it is not easy to provide regular psychological sessions for each one. It is important to find a setting that allows us the involvement of the largest number of patients referred to the unit. In this study, we aimed to evaluate the feasibility and the effect of a brief intervention of cognitive-oriented diary on the quality of life, anxiety and depressive symptoms of patients undergoing radiotherapy (RT ), compared to a control group. METH ODS: The sample was constituted of 68 experimental subjects and 78 controls, treated with RT . Both groups were assessed with the Toronto Alexithymia Scale (TAS -20), the Hamilton Anxiety and Depression Scale (HA DS) and the EORTC -QLQ at the beginning and at the end of their RT . Experimental subjects were instructed to report emotions and thoughts before attending the RT sessions in a thought diary. RES ULTS : The experimental group showed a good adherence to the diary, a reduction in mean scores of anxiety (P<0.001), depression (P<0.001), and alexithymia (P<0.001) together with an ameliorative effect on quality of life (P<0.014), compared to control group. CONCLUSI ONS: We observed a reduction in alexithymia scores in the experimental group, together with a significant reduction in anxiety and depression symptoms and an improvement in quality of life, with a moderator role of social disparity in treatment adherence. Our outcomes suggest the opportunity to consider the diary an affordable and effective device for psychologists operating in RT units, able to be extended to the majority of patients, in a simple and replicable setting

Younger age at onset and sex predict celiac disease in children and adolescents with type 1 diabetes: an Italian multicenter study

OBJECTIVE— To estimate the prevalence of biopsy-confirmed celiac disease in Italian children and adolescents with type 1 diabetes and to assess whether age at onset of type 1 diabetes is independently associated with diagnosis of celiac disease. RESEARCH DESIGNANDMETHODS— The study group was a clinic-based cohort of children and adolescents with type 1 diabetes cared for in 25 Italian centers for childhood diabetes. Yearly screening for celiac disease was performed using IgA/IgG anti-gliadin and IgA anti-endomysium antibodies. RESULTS— Of the 4,322 children and adolescents (age 11.8 4.2 years) identified with type 1 diabetes, biopsy-confirmed celiac disease was diagnosed in 292 (prevalence 6.8%, 95% confidence interval [CI] 6.0 –7.6), with a higher risk seen in girls than in boys (odds ratio [OR] 1.93, 1.51–2.47). In 89% of these, diabetes was diagnosed before celiac disease. In logistic regression analyses, being younger at onset of diabetes, being female, and having a diagnosis of a thyroid disorder were independently associated with the risk of having diabetes and celiac disease. In comparison with subjects who were older than 9 years at onset of diabetes, subjects who were younger than 4 years at onset had an OR of 3.27 (2.20–4.85). CONCLUSIONS— We have provided evidence that 1) the prevalence of biopsy-confirmed celiac disease in children and adolescents with type 1 diabetes is high (6.8%); 2) the risk of having both diseases is threefold higher in children diagnosed with type 1 diabetes at age 4 years than in those age 9 years; and 3) girls have a higher risk of having both diseases than boys

Antiinflammatory Therapy with Canakinumab for Atherosclerotic Disease

Background: Experimental and clinical data suggest that reducing inflammation without affecting lipid levels may reduce the risk of cardiovascular disease. Yet, the inflammatory hypothesis of atherothrombosis has remained unproved. Methods: We conducted a randomized, double-blind trial of canakinumab, a therapeutic monoclonal antibody targeting interleukin-1β, involving 10,061 patients with previous myocardial infarction and a high-sensitivity C-reactive protein level of 2 mg or more per liter. The trial compared three doses of canakinumab (50 mg, 150 mg, and 300 mg, administered subcutaneously every 3 months) with placebo. The primary efficacy end point was nonfatal myocardial infarction, nonfatal stroke, or cardiovascular death. RESULTS: At 48 months, the median reduction from baseline in the high-sensitivity C-reactive protein level was 26 percentage points greater in the group that received the 50-mg dose of canakinumab, 37 percentage points greater in the 150-mg group, and 41 percentage points greater in the 300-mg group than in the placebo group. Canakinumab did not reduce lipid levels from baseline. At a median follow-up of 3.7 years, the incidence rate for the primary end point was 4.50 events per 100 person-years in the placebo group, 4.11 events per 100 person-years in the 50-mg group, 3.86 events per 100 person-years in the 150-mg group, and 3.90 events per 100 person-years in the 300-mg group. The hazard ratios as compared with placebo were as follows: in the 50-mg group, 0.93 (95% confidence interval [CI], 0.80 to 1.07; P = 0.30); in the 150-mg group, 0.85 (95% CI, 0.74 to 0.98; P = 0.021); and in the 300-mg group, 0.86 (95% CI, 0.75 to 0.99; P = 0.031). The 150-mg dose, but not the other doses, met the prespecified multiplicity-adjusted threshold for statistical significance for the primary end point and the secondary end point that additionally included hospitalization for unstable angina that led to urgent revascularization (hazard ratio vs. placebo, 0.83; 95% CI, 0.73 to 0.95; P = 0.005). Canakinumab was associated with a higher incidence of fatal infection than was placebo. There was no significant difference in all-cause mortality (hazard ratio for all canakinumab doses vs. placebo, 0.94; 95% CI, 0.83 to 1.06; P = 0.31). Conclusions: Antiinflammatory therapy targeting the interleukin-1β innate immunity pathway with canakinumab at a dose of 150 mg every 3 months led to a significantly lower rate of recurrent cardiovascular events than placebo, independent of lipid-level lowering. (Funded by Novartis; CANTOS ClinicalTrials.gov number, NCT01327846.

Allergic contact dermatitis of the lip margins from para-tertiary-butylphenol in a lip liner

We describe the use of gas chromatography with mass spectrometry (GC-MS) in the investigation of a case of allergic contact dermatitis of the lip margins caused by a lip liner. Patch testing identified sensitization to para-tertiary-butylphenol-formaldehyde resin (PTBP-FR), a resin glue frequently used in leather work but rarely found in cosmetics. Investigation specified the paratertiary-butylphenol (PTBP) component of the resin as the hapten responsible for the allergic contact dermatitis, as well as for associated depigmentation

Unsupervised neural analysis of very-long-period events at Stromboli volcano using the self-organizing maps

We have implemented a method based on an unsupervised neural network to cluster the waveforms of very-long-period (VLP) events associated with explosive activity at the Stromboli volcano (southern Italy). Stromboli has several active vents in the summit area producing together more than 200 explosions/day. We applied this method to investigate the relationship between each vent and its associated VLP explosive waveform. We selected 147 VLP events recorded between November and December 2005, when digital infrared camera recordings were available. From a visual inspection of the infrared camera images, we classified the VLPs on the basis of which vent produced each explosion. We then applied the self-organizing map (SOM), an unsupervised neural technique widely applied in data exploratory analysis, to cluster the VLPs on the basis of their waveform similarity. Our analysis demonstrates that the most recurrent VLP waveforms are usually generated by the same vent. Some exceptions occurred, however, in which different waveforms are associated with the same vent, as well as different vents generating similar waveforms. This suggests that the geometry of the upper conduit-vent system plays a role in shaping the recurring VLP events, whereas occasional modest changes in the source process dynamics produce the observed exceptions

Lyell's syndrome and lymphoma

The authors present the case of a patient affected by Lyell's Syndrome and Lymphoma that was revealed in the post-mortem examination. At onset the disease showed mucosal hyperaemia, oedema and erosions. In about ten days macular lesions with vesciculation and bullae appeared on the abdomen. General conditions did not seem to be affected. Three weeks later a fever was noted. No important illness, nor drug assumption were detectable in the history of the patient. At the beginning of the fourth week a dramatic worsening occurred with erythrodermic state and high fever. Death occurred at the sixth week in spite of therapy. Bacteriological and virological examinations were always negative. Post-mortem examination showed retroperitoneal and pelvic neoplastic tissue, involving lumboaortic lymph nodes. Histopathology demonstrated a low grade malignancy non Hodgkin Lymphoma, diffused type with small lymphocytes showing plasmocytic differentiation. The lack of drug intake or infectious disease in the history, underlines the peculiar association between the tumor and the syndrome. Rare cases of TEN associated with lymphoproliferative neoplasm are reported in the literature, and the pathogenetic problem of the syndrome is reviewed

Allergic contact dermatitis of the lip margins from para-tertiary-butylphenol in a lip liner

We describe the use of gas chromatography with mass spectrometry (GC-MS) in the investigation of a case of allergic contact dermatitis of the lip margins caused by a lip liner. Patch testing identified sensitization to para-tertiary-butylphenol-formaldehyde resin (PTBP-FR), a resin glue frequently used in leather work but rarely found in cosmetics. Investigation specified the paratertiary-butylphenol (PTBP) component of the resin as the hapten responsible for the allergic contact dermatitis, as well as for associated depigmentation

Lyell's syndrome and lymphoma

The authors present the case of a patient affected by Lyell's Syndrome and Lymphoma that was revealed in the post-mortem examination. At onset the disease showed mucosal hyperaemia, oedema and erosions. In about ten days macular lesions with vesciculation and bullae appeared on the abdomen. General conditions did not seem to be affected. Three weeks later a fever was noted. No important illness, nor drug assumption were detectable in the history of the patient. At the beginning of the fourth week a dramatic worsening occurred with erythrodermic state and high fever. Death occurred at the sixth week in spite of therapy. Bacteriological and virological examinations were always negative. Post-mortem examination showed retroperitoneal and pelvic neoplastic tissue, involving lumboaortic lymph nodes. Histopathology demonstrated a low grade malignancy non Hodgkin Lymphoma, diffused type with small lymphocytes showing plasmocytic differentiation. The lack of drug intake or infectious disease in the history, underlines the peculiar association between the tumor and the syndrome. Rare cases of TEN associated with lymphoproliferative neoplasm are reported in the literature, and the pathogenetic problem of the syndrome is reviewed