Association of kidney disease measures with risk of renal function worsening in patients with type 1 diabetes

Background: Albuminuria has been classically considered a marker of kidney damage progression in diabetic patients and it is routinely assessed to monitor kidney function. However, the role of a mild GFR reduction on the development of stage 653 CKD has been less explored in type 1 diabetes mellitus (T1DM) patients. Aim of the present study was to evaluate the prognostic role of kidney disease measures, namely albuminuria and reduced GFR, on the development of stage 653 CKD in a large cohort of patients affected by T1DM. Methods: A total of 4284 patients affected by T1DM followed-up at 76 diabetes centers participating to the Italian Association of Clinical Diabetologists (Associazione Medici Diabetologi, AMD) initiative constitutes the study population. Urinary albumin excretion (ACR) and estimated GFR (eGFR) were retrieved and analyzed. The incidence of stage 653 CKD (eGFR < 60 mL/min/1.73 m2) or eGFR reduction > 30% from baseline was evaluated. Results: The mean estimated GFR was 98 \ub1 17 mL/min/1.73m2 and the proportion of patients with albuminuria was 15.3% (n = 654) at baseline. About 8% (n = 337) of patients developed one of the two renal endpoints during the 4-year follow-up period. Age, albuminuria (micro or macro) and baseline eGFR < 90 ml/min/m2 were independent risk factors for stage 653 CKD and renal function worsening. When compared to patients with eGFR > 90 ml/min/1.73m2 and normoalbuminuria, those with albuminuria at baseline had a 1.69 greater risk of reaching stage 3 CKD, while patients with mild eGFR reduction (i.e. eGFR between 90 and 60 mL/min/1.73 m2) show a 3.81 greater risk that rose to 8.24 for those patients with albuminuria and mild eGFR reduction at baseline. Conclusions: Albuminuria and eGFR reduction represent independent risk factors for incident stage 653 CKD in T1DM patients. The simultaneous occurrence of reduced eGFR and albuminuria have a synergistic effect on renal function worsening

Elliptic fourier analysis of cell and nuclear shapes.

The elliptic Fourier analysis (EFA) is proposed to characterize the cell and nuclear shape. The principal feature of this method is that it decomposes shapes with a closed contour into subshapes each of which maintains a closed contour. A set of homogeneous, nonredundant descriptors, independent of the contour rotation and translation, is computed from the elliptic Fourier coefficients. These descriptors also account for the contour size and resolution. The paired analysis of the cell and nuclear shape provides an exhaustive and accurate definition of the nucleoplasmic configuration

Social Preferences and Perceived Intentions. An experiment with Normally Developing and Autistic Spectrum Disorders Subjects

Models of social preferences explain departures from pure self-interest as a consequence of either outcome-based or intention-based other-regarding motives. Various experimental studies lend support to the conclusion that subjects behave as if they conditioned their behaviour on the perceived intentions of others. We present a new experiment that explores this as if clause by making the ability to detect intentions a treatment variable. We compare normally developing children with autistic children – typically unable to perceive intentions – and find differences consistent with the hypothesis that behaviour responds to intentions, especially if unkind.social preferences, theory of mind, intentionality, autism

Clinical features and management of Luc's abscess: Case report and systematic review of the literature

Objectives: Luc's abscess is a rare complication of acute otitis media, with a challenging diagnosis and a controversial surgical treatment. The aim of the present study was to review the published literature in order to clarify the clinical features and the surgical management of those patients. Methods: A systematic review of the literature was carried out for published reports or case series in English language, describing a temporo-zygomatic (or Luc's) abscess which complicated an acute or chronic otitis media and/or mastoiditis, confirmed through CT scan or MRI of the petrous bone. The collected clinical and radiological data were merged and critically appraised. Results: Eighteen reports of Luc's abscess were included. Adding our case report, a total of 21 cases were included in the analysis. Abscess drainage plus myringotomy alone vs. abscess drainage plus myringotomy and mastoidectomy were the two surgical management approaches described in the literature. Patients undergoing first line mastoidectomy were successfully treated in all cases, while among those undergoing a more conservative approach, one failure required subsequent mastoidectomy. Conclusions: The clinical features of Luc's abscess are rather constant and help in rising the suspicion before the radiological diagnosis. Although cases with associated intra-cranic complications have been reported, the limited existing data do not permit to advocate the mastoidectomy over a more conservative surgical approach. However, the decision to avoid mastoidectomy as the first line surgical treatment should be based on the clinical and radiologic assessment, after an accurate counseling, particularly in the case of a pediatric patient

Il nodulo tiroideo in et\ue0 pediatrica:problemi di interesse chirurgico

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Relationship between cephalometric parameters and the apnoea-hypopnoea index in OSA patients: a retrospective cohort study

OBJECTIVE: The purpose of this study was to assess the relationship between cephalometric parameters and apnoea-hypopnoea index (AHI) controlling for the effect of gender, age, and body mass index (BMI) on a large sample of patients with obstructive sleep apnoea (OSA). METHODS: This retrospective cohort study was conducted on the lateral cephalograms of 253 Caucasian adult OSA patients. Cephalometric analyses were performed using 14 parameters for skeletal and soft tissue morphology, including antero-posterior and vertical jaw relationships, hyoid bone position, soft palate length and thickness, airway space, and tongue length and height. A hierarchical regression was run to examine the amount of variability in AHI that cephalometric variables explained after controlling for patients' general characteristics (gender, age, and BMI). RESULTS: After controlling for gender, age, and BMI, the increase in AHI variance accounted for by cephalometric parameters was equal to 0.103. Among the cephalometric variables, only MP-H and PNS-P were statistically significant (P < 0.05). LIMITATIONS: Given the retrospective nature of the study, it is difficult to assess whether other confounding variables not considered in the present study could have influenced the relationship between cephalometric parameters and AHI. CONCLUSIONS: This study revealed the existence of a relationship between OSA severity and some cephalometric parameters. Indeed soft palate length and vertical position of the hyoid bone were significant predictors of AHI in adult Caucasian OSA patients

Maximum voluntary retrusion or habitual bite position for mandibular advancement assessment in the treatment of obstructive sleep apnoea patients

Background: There is no consensus on whether the range of mandibular advancement for the construction of mandibular advancement devices in obstructive sleep apnoea (OSA) patients should be measured from a starting position of maximum voluntary retrusion or habitual bite position. Objective: The purposes of this study were to investigate the differences in mandibular advancement registrations starting from maximum voluntary retrusion or from habitual bite position and to evaluate the reliability of these assessments. Methods: A retrospective cohort analysis of 126 patients with OSA was performed. All patients had their mandibular range of motion evaluated twice (starting from maximum voluntary retrusion and from habitual bite position) through the George Gauge before undergoing drug-induced sleep endoscopy. The Dahlberg formula and paired t test were used to calculate random and systematic errors of dental positions assessment. Test-retest reliability was quantified using the intra-class correlation coefficient (ICC). Results: The mean mandibular range starting from maximum voluntary retrusion and from habitual bite position were 12.49 \ub1 2.19 mm and 7.68 \ub1 2.29 mm, respectively, with a mean distance between the two starting positions of 4.81 \ub1 1.75 mm. No systematic error was found (P >.05), and random errors ranged from 0.30 to 0.95 mm. ICC values were excellent for maximum voluntary protrusion (ICC = 0.986) and maximum voluntary retrusion (ICC = 0.956), whereas habitual bite position showed a good value (ICC = 0.818). Conclusion: The difference between maximum voluntary retrusion and habitual bite position is potentially relevant. Maximum retrusion is advisable as starting point of the mandibular advancement registration since it provides a more reliable measure

Pseudomembranous cystitis: An uncommon ultrasound appearance of cystitis in cats and dogs

In veterinary medicine, pseudomembranous cystitis (PC) is a rare condition described only in cats. The purposes of this retrospective study were to describe ultrasound features of PC in cats and dogs, predisposing factors, comorbidities and outcomes. Cats and dogs with an ultrasonographic diagnosis of PC were included in the study. The bladder ultrasound findings that were recorded were: pseudomembranes’ characteristics, abnormalities of the bladder’s wall and content and anomalies of the pericystic peritoneal space. Ten cats and four dogs met the inclusion criteria. Four pseudomembrane adhesion patterns were described. The presence of pseudomembrane acoustic shadowing was observed in the 60% of cats. A total of 80% of the cats included were presented for urethral obstruction (UO) and/or had at least one episode of UO in the previous 2 months. Thirteen patients out of fourteen received only medical therapy, and all of them survived. PC is a rare disorder in cats and dogs and there are some ultrasonographic differences between the two species, suggesting a greater severity of the pathology in cats. Chronic cystitis and UO may have a potential role in the development of feline PC. Finally, the medical approach can be a non-invasive and effective approach for PC

Early insulin secretion is a determinant of glucose tolerance in diabetic and non-diabetic subjects

none7noneDEL PRATO S; COSSU E; A. MARAN; MOTZO C; GUAITA G; PELLIGRA I; CIRILLO RDEL PRATO, S; Cossu, E; Maran, Alberto; Motzo, C; Guaita, G; Pelligra, I; Cirillo, R