The use of fractal dimension methods in clinical epidemiology: an application for postural assessment

Background: this study considers the analysis of postural sway by comparing the use of a fractal dimension outcome (DBOX) with the usual sway ellipse area (SEA), calculated by the least squares method. Both the response variables come from centre of pressure (COP) dynamics detected by means of a force platform. Methods: recent literature regarding postural stability assessment in subjects with muscularskeletal disorders, or neuromuscular diseases affecting their motor skills, has suggested, both for practical and theoretical reasons, the use of some fractal dimension as a good outcome measurement for overall postural status. A sample group of 24 male subjects was recruited. The postural stabilogram was recorded both with eyes open (EO) and eyes closed (EC) while standing upright. A matched-pair comparison of the sway ellipse area with the COP dynamics box counting dimension was performed. A ROC analysis of the outcome variables was performed. Then, a ROC comparison of the tests, using the area under the curve (AUC) index, was conducted. Results: the comparison of paired groups showed a statistically significant difference between EO and EC status, according to the sway ellipse area and the fractal dimension (p<0.05). The ROC analysis, describing the test performance in terms of AUC difference, was statistically significant (p<0.05). The comparison of the AUCs showed an overall superior performance of the DBOX with respect to SEA (p<0.05). Conclusions: this study showed a statistically significant better overall performance of DBOX with respect to SEA, suggesting possible improvements of clinical practice, as well as theoretical insights into the response patterns

Palliation with a multimodality treatment including hypoxic pelvic perfusion for unresectable recurrent rectal cancer: outcomes based on a retrospective study

Patients with unresectable recurrent rectal cancer that progresses after systemic chemotherapy and radiotherapy are candidates for palliation with hypoxic pelvic perfusion (HPP). The aim of this observational retrospective study was to evaluate if a multimodality treatment including HPP and targeted-therapy may be useful to prolong clinical responses and survival of these patients. From a cohort of 77 patients with unresectable recurrent rectal cancer in progression after standard treatments and submitted to HPP, 21 patients underwent repeat HPP using mitomycin C (MMC) at the dose of 25 mg/m2. After the last HPP, 7 patients received a targeted-therapy with cetuximab according to overexpression of epidermal growth factor receptor in recurrence cancer cells. The median overall survival of these 21 patients from the diagnosis of unresectable recurrent rectal cancer was 23 months (iqr 18-24). After the first HPP, the median survival of the 21 patients until death or end of follow-up was 10 months (iqr 9-13). The 1-year and 2-year survival rates were 71.4%, and 4.8%, respectively. From the first HPP, age\u2009>\u200960 years, a recurrence shrinkage of at least 30% (partial response), and the addition of a post-HPP targeted-therapy with cetuximab significantly affected survival (P\u2009<\u20090.04). In conclusion, repeated MMC-HPP followed by targeted-therapy seems to be an effective palliative treatment for patients with unresectable recurrent rectal cancer in progression after systemic chemotherapy and radiation but the results of this study have to be confirmed by a larger phase III trial

Stem-Skilled Parents and Autism Spectrum Disorder in Offspring: A Case-Control Study

Autism spectrum disorder (ASD) is a neurodevelopment disorder characterised by a range of deficits in two specific domains: social communication and social interaction and repetitive patterns of behaviour. Several studies have explored the link between ASD and STEM (science, technology, engineering and mathematics, or other mathematics-grounded disciplines), but results are still uncertain. Objective of the study was to estimate the potential role of systemising abilities in parents as a risk factor for ASD in the offspring, using the achievement of a degree in STEM disciplines as a proxy characteristic of the exposure. There were 1,316 participants overall. There were 658 incident consecutive cases of definite ASD, diagnosed in a Reference Centre for ASD in Italy, from 2001 to 2020. The main exposure variable was parental education level. The risk of ASD in the offspring associated with the main exposure variable and the exposure covariates (e.g. use of neurotropic drugs during the first trimester of the mother’s pregnancy, perinatal outcomes of participants and/or preterm birth) was studied by using conditional logistic regression analysis. In addition, we carried out a mediation analysis to investigate whether and the extent to which covariates significantly associated with ASD risk mediate the relationship between parental education level and ASD in offspring. A STEM degree in parents was significantly associated with risk of ASD in offspring (OR 1.43, 95% CI 1.03-2.54). Familiarity was weakly associated with the risk of ASD (OR 1.33, 95% CI 1.00-1.66) and is the stronger mediator (PME 28%). Sensitivity analysis did not show deviations related to gender or ASD level. Our study moves in the direction of confirming the risk of occurrence of ASD in the offspring of parents with elevated systemising abilities

Expansion of permanent first molars with rapid maxillary expansion appliance anchored on primary second molars

To evaluate how the amount of expansion of the primary second molars, the patient?s age, and the skeletal maturation stage influence the amount of expansion at the level of the permanent first molars. Fifty-five patients aged between 6 and 11 years with a cervical vertebral maturation stage of CS1 or CS2 were retrospectively selected. The intermolar width was measured before and after expansion to evaluate the amount of expansion achieved at the level of the primary second molars and the permanent first molars. Stepwise multiple linear regression was used to evaluate how the amount of primary molars expansion, the patient?s age, and the cervical vertebral maturation stage predict the amount of permanent molar expansion. A significant regression equation was found, and for every 1 mm of primary molar expansion, 0.91 mm of permanent molar expansion can be expected. An age between 6 and 11 years and the CS1 or CS2 skeletal maturation stage were not significant predictors of permanent molar expansion. A rapid maxillary expansion appliance anchored on primary second molars is effective in expanding the permanent molars to correct a transverse maxillary deficiency in prepubertal patients, transferring the risks associated with the large forces used to the primary teeth

Mental health in L'Aquila after the earthquake

INTRODUCTION: In the present work we describe the mental health condition of L'Aquila population in the aftermath of the earthquake in terms of structural, process and outcome perspectives. METHOD: Literature revision of the published reports on the L'Aquila earthquake has been performed. RESULTS: Although important psychological distress has been reported by the population, capacity of resilience can be observed. However if resilient mechanisms intervened in immediate aftermath of the earthquake, important dangers are conceivable in the current medium-long-term perspective due to the long-lasting alterations of day-to-day life and the disruption of social networks that can be well associated with mental health problems. CONCLUSIONS: In a condition such as an earthquake, the immediate physical, medical, and emergency rescue needs must be addressed initially. However training first responders to identify psychological distress symptoms would be important for mental health triage in the field

Notational Analysis of the Volleyball Serve

none6noThe aim of the present study was to investigate the serving techniques in male top level volleyball, especially the tactical and spatial behavior of the servers and receiving opponents focusing on the pros and cons of the different serving techniques. An analysis was made of 4552 serves from 28 matches played during the 2008-2009 regular season of the Italian volleyball male Top League. Serving techniques were categorized into Jump Serve (JS), Float Jump Serve (FJS) and Float Serve (FS), and for each serve several parameters were recorded: role of the server (Setter - S, Hitter - H, and Middle Blocker - MB), kind of serve (JS, FJS, FS), number of players defending the serve (Defense), difficulty in receiving the serve (RS), evaluation of serve outcome (EV), and defensive court zone where the ball was directed (FZ). The results confirmed the largest use of the JS (69.9%), followed by the FJS (26.9%) and the FS (3.3%). There were significant relationships between the serve technique, the EV, the Defense and the FZ where the serves were directed (Chi-Square p = 0.000). The zone absolutely most hit was the posterior/central, followed by the left/posteriors. There were significant differences in the RS difficulty for the JS respect to FJS (p = 0.001) and FS (p = 0.000) and also for the defensive strategies performed: a defense strategy with 2 defenders showed significant and better score during the reception respect to that with 3 (p = 0.000). No statistical relationship was found between the role of the server and other parameters. These results are consistent with previous studies in which JS showed to be the most powerful technique in terms of increasing defensive difficulties but, at the same time, with a fairly high percentage of errors. This issue must be taken into consideration in crucial phases of the game, and the serving techniques must be used strategically. JS can be very useful for increasing the defensive “conflict zones” with the aim to score a direct ace or to make the offensive maneuver difficult after reception. FJS can be useful when there is the need to aim a specific FZ and prepare the team for the next defense action. Scouting or match analysis procedure of the serving statistics should be performed during the game to better indicate the serve strategy to choose.openAndrea CIUFFARELLA, Luca RUSSO, Francesco MASEDU, Marco VALENTI, Riccardo IZZO, Marco DE ANGELISCiuffarella, Andrea; Russo, Luca; Masedu, Francesco; Valenti, Marco; Izzo, Riccardo; DE ANGELIS, Marc

Physical Exercise and Quality of Life in Breast Cancer Survivors

An important goal for cancer patients is to improve the quality of life (QOL) by maximising functions affected by the disease and its therapy. Preliminary research suggests that exercise may be an effective intervention for enhancing QOL in cancer survivors. Research has provided preliminary evidence for the safety, feasibility, and efficacy of exercise training in breast cancer survivors. The aim of this study was to assess the association between physical exercise and quality of life in a population of female breast cancer survivors, followed up from diagnosis to the off-treatment time period, and investigated about their exercise habits in pre-diagnosis

Register-based cumulative prevalence of Autism Spectrum Disorders during childhood and adolescence in Central Italy

Background: Studies have evaluated the prevalence of Autism Spectrum Disorders (ASD), focusing on different ages during childhood and adolescence. How cumulative prevalence increases before adulthood remains unclear.  Methods: We used data from the Autism Register of the Regional Reference Centre for Autism in L’Aquila, Central Italy, to retrieve information on individuals born in 2001–2012 with any of the inclusion diagnoses of ASD (DSM criteria) for the period 2001 to 2018. Cumulative prevalence on L’Aquila district population data was calculated as percentages for three-year age strata.  Results: All prevalence data were estimated at December 31st, 2018. The overall crude prevalence was 0.95% (352 cases over 36938 population). Cumulative prevalence was 1.19% among those born in 2001-2003 (15 to 17 years of follow up), 1.15% among those born in 2004-2006 (12 to 14 years of follow up), 1.04% among those born in 2007-2009 (9 to 11 years of follow up), 0.80% among those born in 2010-2012 (6 to 8 years of follow up), and 0.57% among those born in 2013-2015 (3 to 5 years of follow up). The proportion of ASD diagnoses until the age of 5 years, compared to the group diagnosed 6 to 8 years of age, showed a significant increasing trend over calendar time (53.6% for those born in 2001-2003, to 77.0% for those born in 2010-2012).  Conclusions: Cumulative prevalence by time period provides a better understanding of ASD occurrence than a point prevalence. We did not find any difference in frequency of diagnosis comparing age strata and year of birth, suggesting that frequencies of ASD diagnosis remained roughly constant from 2001 to 2015. Results show that cumulative prevalence of autism diagnosis does not substantially change over time; instead, diagnosis of ASD is more likely at earliest ages over time, although new cases of ASD are also detected at later ages.&nbsp

A Prospective Study of Intraarterial Infusion Chemotherapy in Advanced WT BRAF Melanoma Patients.

ABSTRACT Background Treatment strategies for advanced cutaneous melanoma (CM) patients, resistant or not treatable with novel target and immunotherapeutic drugs, remain a significant challenge, particularly for patients with unresectable stage IIIC/D disease localized to inferior limbs and pelvis, for whom specific outcomes are rarely considered. Materials and methods This is a prospective study of multidisciplinary treatments, including locoregional melphalan chemotherapy, in 62 BRAF wild-type CM patients with locoregional metastases in the inferior limbs and pelvis, including inguinal regions. Patients were either in progression following or ineligible for, or not treatable with novel immunotherapy. For exclusively inferior limb-localised disease, patients received locoregional melphalan chemotherapy performed by hyperthermic isolated limb perfusion (n = 19) or isolated limb infusion (n = 19), and for synchronous lesions localised to inferior limbs and pelvis, received hypoxic pelvic and limb perfusion (n = 24). Additional multidisciplinary therapy included local, locoregional and systemic treatments and the primary endpoint was tumour response. Results The objective response rate following first cycle of locoregional chemotherapy was 37.1% at 3 mo and median progression-free survival was 4-mo, with 12.9% procedure-related complications, 30.6% low-grade haematological toxicity and 11.3% severe limb toxic tissue reactions. Multivariate logistic regression showed that the odds of response were significantly higher for patients ≤ 75 y of age and for patients with locoregional metastases exclusively located in the inferior limbs. Conclusion In this subgroup of CM patients with BRAF wild-type status, locoregional metastases localized to inferior limbs and pelvis, in progression following or ineligible for immunotherapy, melphalan locoregional chemotherapy demonstrated a safe and effective profile. Trial Registration ClinicalTrials.gov Identifier NCT01920516; date of trial registration: August 6, 2013