Day case parathyroidectomy: is this the right way for the patients?

Minimally-invasive video-assisted parathyroidectomy (MIVAP) can be considered as the primary treatment of choice for single parathyroid adenoma. Often, this technique is performed in a day surgery setting and is associated with regional anaesthesia (RA). Many studies have already reported the feasibility and safety of MIVAP in day surgery. Here our focus has been on the patient's personal experience with these procedures through an assessment of their recovery at home

Empirical characterisation of agents’ spatial behaviour in pedestrian movement simulation

Route choice behaviour is a key factor in determining pedestrian movement flows throughout the urban space. Agent-based modelling, a simulation paradigm that allows modelling individual behaviour mechanisms to observe the emergence of macro-level patterns, has not employed empirical data regarding route choice behaviour in cities or accommodated heterogeneity. The aim of this paper is to present an empirically based Agent-Based Model (ABM) that accounts for behavioural heterogeneity in pedestrian route choice strategies, to simulate the movement of pedestrians in cities. We designed a questionnaire to observe to what degree people employ salient urban elements (local and global landmarks, regions, and barriers) and road costs (road distance, cumulative angular change) and to empirically characterise the agent behaviour in our ABM. We hypothesised that a heterogeneous ABM configuration based on the construction of agent typologies from empirical data would portray a more plausible picture of pedestrian movement flows than a homogeneous configuration, based on the same data, or a random configuration. The city of Münster (DE) was used as a case study. From a sample of 301 subjects, we obtained six clusters that differed in relation to the role of global elements (distant landmarks, barriers, and regions) and meaningful local elements along the route. The random configuration directed the agents towards natural elements and the streets of the historical centre. The empirically based configurations resulted in lower pedestrian volumes along roads designed for cars (25% decrease) but higher concentrations along the city Promenade and the lake (40% increase); based on our knowledge, we deem these results more plausible. Minor differences were identified between the heterogeneous and homogeneous configurations. These findings indicate that the inclusion of heterogeneity does not make a difference in terms of global patterns. Yet, we demonstrated that simulation models of pedestrian movement in cities should be at least based on empirical data at the average sample-level to inform urban planners about areas prone to high volumes of pedestrians

Mutational and large deletion study of genes implicated in hereditary forms of primary hyperparathyroidism and correlation with clinical features

The aim of this study was to carry out genetic screening of the MEN1, CDKN1B and AIP genes, both by direct sequencing of the coding region and multiplex ligation-dependent probe amplification (MLPA) assay in the largest monocentric series of Italian patients with Multiple Endocrine Neoplasia type 1 syndrome (MEN1) and Familial Isolated Hyperparathyroidism (FIHP). The study also aimed to describe and compare the clinical features of MEN1 mutation-negative and mutation-positive patients during long-term follow-up and to correlate the specific types and locations of MEN1 gene mutations with onset and aggressiveness of the main MEN1 manifestations. A total of 69 index cases followed at the Endocrinology Unit in Pisa over a period of 19 years, including 54 MEN1 and 15 FIHP kindreds were enrolled. Seven index cases with MEN1 but MEN1 mutation-negative, followed at the University Hospital of Cagliari, were also investigated. FIHP were also tested for CDC73 and CaSR gene alterations. MEN1 germline mutations were identified in 90% of the index cases of familial MEN1 (F-MEN1) and in 23% of sporadic cases (S-MEN1). MEN1 and CDC73 mutations accounted for 13% and 7% of the FIHP cohort, respectively. A CDKN1B mutation was identified in one F-MEN1. Two AIP variants of unknown significance were detected in two MEN1-negative S-MEN1. A MEN1 positive test best predicted the onset of all three major MEN1-related manifestations or parathyroid and gastro-entero-pancreatic tumors during follow-up. A comparison between the clinical characteristics of F and S-MEN1 showed a higher prevalence of a single parathyroid disease and pituitary tumors in sporadic compared to familial MEN1 patients. No significant correlation was found between the type and location of MEN1 mutations and the clinical phenotype. Since all MEN1 mutation-positive sporadic patients had a phenotype resembling that of familial MEN1 (multiglandular parathyroid hyperplasia, a prevalence of gastro-entero-pancreatic tumors and/or the classic triad) we might hypothesize that a subset of the sporadic MEN1 mutation-negative patients could represent an incidental coexistence of sporadic primary hyperparathyroidism and pituitary tumors or a MEN1 phenocopy, in our cohort, as in most cases described in the literature

Novel insights in health-promoting properties of sweet cherries

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Microwave-Assisted Extraction of Bioactive Compounds from Lentil Wastes: Antioxidant Activity Evaluation and Metabolomic Characterization

The recovery of industrial by-products is part of the zero-waste circular economy. Lentil seed coats are generally considered to be a waste by-product. However, this low-value by-product is rich in bioactive compounds and may be considered an eco-friendly source of health-promoting phytochemicals. For the first time, a sustainable microwave-assisted extraction technique was applied, and a solvent screening was carried out to enhance the bioactive compound content and the antioxidant activity of green and red lentil hull extracts. With respect to green lentil hull extracts that were obtained with different solvents, the aqueous extract of the red lentil seed coats showed the highest total phenolic and total flavonoid content (TPC = 28.3 ± 0.1 mg GAE/g dry weight, TFC = 1.89 ± 0.01 mg CE/100 mg dry weight, respectively), as well as the highest antioxidant activity, both in terms of the free radical scavenging activity (ABTS, 39.06 ± 0.73 mg TE/g dry weight; DPPH, IC50 = 0.39 μg/mL) and the protection of the neuroblastoma cell line (SH-SY5Y, IC50 = 10.1 ± 0.6 μg/mL), the latter of which has never been investigated so far. Furthermore, a metabolite discovery analysis was for the first time performed on the aqueous extracts of both cultivars using an HPLC separation which was coupled with an Orbitrap-based high-Resolution Mass Spectrometry technique

Incidence of toxoplasmosis in pregnancy in Campania: A population-based study on screening, treatment, and outcome

INTRODUCTION: The aim of this study was to evaluate the incidence of toxoplasmosis infection during pregnancy and to describe the characteristics of the serological status, management, follow-up and treatment. MATERIAL AND METHODS: This is a population-based cohort study of women referred for suspected toxoplasmosis during pregnancy from January, 2001 to December, 2012. Suspected toxoplasmosis was defined as positive IgM antibody during pregnancy. Women with suspected toxoplasmosis during pregnancy were classified into three groups: seroconversion, suspected infection, or no infection in pregnancy. Women in the first and second group were treated according to local protocol, and amniocentesis with toxoplasmosis PCR detection and serial detailed ultrasound scans were offered. Neonates were investigated for congenital toxoplasmosis at birth and were monitored for at least one year after birth. RESULTS: During the study period, there were 738,588 deliveries in Campania. Of them 1159 (0.2%) were referred to our Institution for suspected toxoplasmosis during pregnancy: 183 (15.8%) women were classified as seroconversion, 381 (32.9%) were suspected infection, and 595 (51.3%) were not infected in pregnancy. Neonatal outcome was available for 476 pregnancies, including 479 neonates (3 twins, 473 singletons), out of the 564 pregnancies with seroconversion or suspected infection. 384 (80.2%) babies were not infected at birth and at follow-up, 67 (14.0%) had congenital toxoplasmosis, 10 (2.1%) were voluntary induced termination of pregnancy, 15 (3.1%) were spontaneous miscarriage, and 4 (0.8%) were stillbirth (of which one counted already in the infected cohort). Considering cases of congenital toxoplasmosis, the transmission rate in women with seroconversion was 32.9% (52/158), and in women with suspected infection was 4.7% (15/321). CONCLUSIONS: Toxoplasmosis is uncommon in pregnancy with overall incidence of seroconversion and suspected infection in pregnancy of 0.8 per 1000 live births and incidence of congenital toxoplasmosis 0.1 per 1000 live births when applying a strict protocol of screening, follow-up, and treatment. 51.3% (595/1159) of women referred to our center for suspected infection were actually considered not infected

O monitoramento das inclusões residenciais em Psiquiatria: resultados preliminares da atividade da unidade de monitoramento e planejamento clínico

Introduction: Planning and Monitoring Unit Clinical (UMPC) has clinical epidemiological purposes, but mainly for evaluating and improving the quality of service. Objective: To describe the journeys of patients to residential care for mental health services. Method: The routes were analyzed from twopoints of view: based on the management structure and the type of intervention (these two criteria were intertwined) and based on the type of structure. 213 patients were followed. The first analysis of pathways was performed considering the residential subdivision of the Department offer residentialbased management and intervention. Results: A significant number of these patients remains inserted for several years, it can be stated that the rehabilitative program running inside the supporting structures, allow improving or at least maintaining the autonomy acquired. Conclusion: The fact thatthere are numerous passages of protected structures, administered by the Department, the support structures, such as groups of Apartment, the Accommodation Support, indicates a good capacity of rehabilitation programs, working in the community, to prepare patients to new projects characterized bygreater autonomy and personal independence.Descriptors: Psychosocial rehabilitation; Autonomy; Health Services

NIED E CRR ESTRATÉGIAS DE SENSIBILIZAÇÃO E EDUCAÇÃO CONTINUADA DE ESTUDANTES E PROFISSIONAIS PARA O ENFRENTAMENTO DA DROGADIÇÃO

O Núcleo de Enfrentamento da Drogadição da UFPR (NIED), surgiu em resposta a demanda da própria comunidade em torno da instituição, que através da Associação de Moradores e Comerciantes do entorno da UFPR procurou-a em virtude do aumento do consumo de drogas no centro de Curitiba. Provocado por essa demanda, o NIED, desde 2016 contribui para a educação continuada de profissionais e gestores de políticas públicas que atuam neste campo, ofertando cursos de extensão com essa temática e através do ciclo de debates, envolve a comunidade na problematização e compreensão desse fenômeno. Em conjunto com o Centro Regional de Referência Para Formação em Políticas Sobre Drogas (CRR) vem catalisando as ações em ensino, pesquisa e extensão voltadas para o campo do uso e abuso de álcool e outras drogas, envolvendo professores de diferentes cursos e setores, configurando-se como um projeto de extensão interdisciplinar, multiprofissional e articulador dos diferente gestores de políticas públicas que atuam nesse campo. Os ciclos de debates ocorrem 1x ao mês, e os cursos de extensão ofertam capacitação para discentes, egressos e técnicos da UFPR, bem como comunidade e gestores. Neste período, em função da avaliação favorável e demandas da comunidade interna e externa da UFPR, o NIED promoveu 25 ciclos de debates e 2 edições do CRR (2016 e 2018), em cada edição ofertou 8 módulos formativos, com carga horária de 50 a 60 horas cada, a 360 cursistas em cada edição

Effects of Sweet Cherry Polyphenols on Enhanced Osteoclastogenesis Associated With Childhood Obesity

Childhood obesity is associated with the development of severe comorbidities, such as diabetes, cardiovascular diseases, and increased risk of osteopenia/osteoporosis and fractures. The status of low-grade inflammation associated to obesity can be reversed through an enhanced physical activity and by consumption of food enrich of anti-inflammatory compounds, such as omega-3 fatty acids and polyphenols. The aim of this study was to deepen the mechanisms of bone impairment in obese children and adolescents through the evaluation of the osteoclastogenic potential of peripheral blood mononuclear cells (PBMCs), and the assessment of the serum levels of RANKL and osteoprotegerin (OPG). Furthermore, we aimed to evaluate the in vitro effects of polyphenol cherry extracts on osteoclastogenesis, as possible dietary treatment to improve bone health in obese subjects. High RANKL levels were measured in obese with respect to controls (115.48 ± 35.20 pg/ml vs. 87.18 ± 17.82 pg/ml; p < 0.01), while OPG levels were significantly reduced in obese than controls (378.02 ± 61.15 pg/ml vs. 436.75 ± 95.53 pg/ml, respectively, p < 0.01). Lower Ad-SoS- and BTT Z-scores were measured in obese compared to controls (p < 0.05). A significant elevated number of multinucleated TRAP+ osteoclasts (OCs) were observed in the un-stimulated cultures of obese subjects compared to the controls. Interestingly, obese subjects displayed a higher percentage of CD14+/CD16+ than controls. Furthermore, in the mRNA extracts of obese subjects we detected a 2.5- and 2-fold increase of TNFα and RANKL transcripts compared to controls, respectively. Each extract of sweet cherries determined a dose-dependent reduction in the formation of multinucleated TRAP+ OCs. Consistently, 24 h treatment of obese PBMCs with sweet cherry extracts from the three cultivars resulted in a significant reduction of the expression of TNFα. In conclusion, the bone impairment in obese children and adolescents is sustained by a spontaneous osteoclastogenesis that can be inhibited in vitro by the polyphenol content of sweet cherries. Thus, our study opens future perspectives for the use of sweet cherry extracts, appropriately formulated as nutraceutical food, as preventive in healthy children and therapeutic in obese ones