A randomized controlled trial comparing behavioral, educational, and pharmacological treatments in youths with chronic tic disorder or Tourette syndrome

Context: The existing literature on the treatment of pediatric chronic tic disorder (CTD) and Tourette syndrome (TS) indicates that both behavioral therapy (BT) and pharmacotherapy (PT) are effective for reducing symptoms. Objective: To evaluate the efficacy of BT compared to psychoeducation (PE) or PT for reducing tics and co-occurring symptoms and for improving quality of life (QoL) in a sample of youths with CTD and TS. Design: A 10 weeks, 2 sites (Catania, Rome) randomized controlled trial. Participants were randomized to receive one of the following treatments: BT, PE, or PT. Participants: 110 outpatients aged between 8 and 17 years affected by CTD or TS. Results: Patients in the BT and PT groups showed a significant reduction in the severity of tic symptoms, while the PE group did not show any improvement. PT was more effective for reducing obsessive compulsive symptoms than BT, while PE group did not show any improvement. Both BT and PT groups showed an improvement in most QoL domains, whereas no differences were found in the PE group. Conclusions: BT is as effective as pharmacological therapy in the treatment of tic disorders in children and adolescents, thus offering an alternative to medications for CTD and TS

Ataxia in children: early recognition and clinical evaluation

Background: Ataxia is a sign of different disorders involving any level of the nervous system and consisting of impaired coordination of movement and balance. It is mainly caused by dysfunction of the complex circuitry connecting the basal ganglia, cerebellum and cerebral cortex. A careful history, physical examination and some characteristic maneuvers are useful for the diagnosis of ataxia. Some of the causes of ataxia point toward a benign course, but some cases of ataxia can be severe and particularly frightening. Methods: Here, we describe the primary clinical ways of detecting ataxia, a sign not easily recognizable in children. We also report on the main disorders that cause ataxia in children. Results: The causal events are distinguished and reported according to the course of the disorder: acute, intermittent, chronic-non-progressive and chronic-progressive. Conclusions: Molecular research in the field of ataxia in children is rapidly expanding; on the contrary no similar results have been attained in the field of the treatment since most of the congenital forms remain fully untreatable. Rapid recognition and clinical evaluation of ataxia in children remains of great relevance for therapeutic results and prognostic counseling

A comparative evaluation of 3 different free-form deformable image registration and contour propagation methods for head and neck MRI : the case of parotid changes radiotherapy

Purpose: To validate and compare the deformable image registration and parotid contour propagation process for head and neck magnetic resonance imaging in patients treated with radiotherapy using 3 different approachesthe commercial MIM, the open-source Elastix software, and an optimized version of it. Materials and Methods: Twelve patients with head and neck cancer previously treated with radiotherapy were considered. Deformable image registration and parotid contour propagation were evaluated by considering the magnetic resonance images acquired before and after the end of the treatment. Deformable image registration, based on free-form deformation method, and contour propagation available on MIM were compared to Elastix. Two different contour propagation approaches were implemented for Elastix software, a conventional one (DIR_Trx) and an optimized homemade version, based on mesh deformation (DIR_Mesh). The accuracy of these 3 approaches was estimated by comparing propagated to manual contours in terms of average symmetric distance, maximum symmetric distance, Dice similarity coefficient, sensitivity, and inclusiveness. Results: A good agreement was generally found between the manual contours and the propagated ones, without differences among the 3 methods; in few critical cases with complex deformations, DIR_Mesh proved to be more accurate, having the lowest values of average symmetric distance and maximum symmetric distance and the highest value of Dice similarity coefficient, although nonsignificant. The average propagation errors with respect to the reference contours are lower than the voxel diagonal (2 mm), and Dice similarity coefficient is around 0.8 for all 3 methods. Conclusion: The 3 free-form deformation approaches were not significantly different in terms of deformable image registration accuracy and can be safely adopted for the registration and parotid contour propagation during radiotherapy on magnetic resonance imaging. More optimized approaches (as DIR_Mesh) could be preferable for critical deformations

Enhancement of titanate nanotubes dispersion for reinforcement of nylon-II nanocomposites

The purpose of the present study was to investigate the effect of titanate nanotubes (TINTs) dispersion in the mechanical properties of Nylon 11 (polyamide 11) polymer. According ,to the existing literature small amounts of TTNTs used as reinforcement in polymer matrix improve properties such as tensile strength and stiffness. However, the addition of these nanoparticles may also lead to a decrease of strength of the composite if the nanotubes are not well dispersed in the polymer matrix. In this work two different routes were investigated to enhance the disl?ersion of TTNTs used as a reinforcement of nylon matrix nanocomposites: (1) chemical functionalization with 3-arninopropyltriethoxysilane; and (2) treatment with 2 kinds of surfactant - a cationic (CTAB) and an anionic (SDS). Characterization of the nanotubes was done by infrared spectroscopy, CHN elemental analysis, measurement of the specific surface area, thermogravimetric analysis, scanning electron microscopy and transmission electron microscopy. Nylon-II matrix nanocomposites were manufactured by microextrusion-microinjection and reinforced with 0.5 to 2.0 wt.-% of functionalized and surfactant treated nanotubes. Finally, mechanical and thermal properties as well as the microstructure of the nanocomposites were evaluated. The presentation will discuss the results and potential applications of these materials

Enhancement of titanate nanotubes dispersion for reinforcement of nylon-II nanocomposites

The purpose of the present study was to investigate the effect of titanate nanotubes (TINTs) dispersion in the mechanical properties of Nylon 11 (polyamide 11) polymer. According ,to the existing literature small amounts of TTNTs used as reinforcement in polymer matrix improve properties such as tensile strength and stiffness. However, the addition of these nanoparticles may also lead to a decrease of strength of the composite if the nanotubes are not well dispersed in the polymer matrix. In this work two different routes were investigated to enhance the disl?ersion of TTNTs used as a reinforcement of nylon matrix nanocomposites: (1) chemical functionalization with 3-arninopropyltriethoxysilane; and (2) treatment with 2 kinds of surfactant - a cationic (CTAB) and an anionic (SDS). Characterization of the nanotubes was done by infrared spectroscopy, CHN elemental analysis, measurement of the specific surface area, thermogravimetric analysis, scanning electron microscopy and transmission electron microscopy. Nylon-II matrix nanocomposites were manufactured by microextrusion-microinjection and reinforced with 0.5 to 2.0 wt.-% of functionalized and surfactant treated nanotubes. Finally, mechanical and thermal properties as well as the microstructure of the nanocomposites were evaluated. The presentation will discuss the results and potential applications of these materials

Primary headaches in children: clinical findings on the association with other conditions.

The aim of the present study is to report on the frequency of some comorbidities in primary headaches in childhood. Two hundred and eighty children (175 males and 105 females; ratio 1.7:1), aged 4 to 14 years, affected by primary headaches were consecutively enrolled in this study. In direct interviews, parents and children gave information about the association of their headaches with different conditions including asthma and allergic disorders, convulsive episodes, sleep disorders and increased body weight, affections some time associated in the literature to headache as comorbidities. In addition, anxiety and depression, attention deficit/hyperactivity disorder, tics, learning disabilities and obsessive-compulsive disorders, using psycho-diagnostic scales were evaluated. Two hundred and eighty children matched for age, sex, race and socio-economic status, were used as controls. No significant association of primary headaches was found with asthma and allergic disorders, convulsive episodes, sleep disorders and increased body weight. Overall behavioral disorders were more common in children who experienced headache than in controls. A significant association of primary headache was found with anxiety and depression (p value <0.001), but not with the other psychiatric disorders. Primary headaches in children are not associated with most of the psychiatric and systemic conditions herein investigated. On the contrary, there was a significant association with anxiety and depression, as frequently reported in adults

Placental and Umbilical Cord Anomalies Diagnosed by Two- and Three-Dimensional Ultrasound

The aim of this review is to present a wide spectrum of placental and umbilical cord pathologies affecting the pregnancy. Placental and umbilical cord anomalies are highly associated with high-risk pregnancies and may jeopardize fetal well-being in utero as well as causing a predisposition towards poor perinatal outcome with increased fetal and neonatal mortality and morbidity. The permanent, computerized perinatology databases of different international centers have been searched and investigated to fulfil the aim of this manuscript. An extended gallery of prenatal imaging with autopsy correlation in specific cases will help to provide readers with a useful iconographic tool and will assist with the understanding and definition of this critical obstetrical and perinatological issue

Educação social e brincadeiras de crianças de uma escola das águas do Pantanal sul mato-grossense

O brincar e as brincadeiras fazem parte do contexto da criança e esta ação, no Brasil, é um direito que vem sendo garantido em diferentes contextos, sendo as práticas educativas sociais um exemplo. Neste sentido, esta pesquisa busca apresentar e analisar o brincar e as brincadeiras de crianças de uma escola das águas do Pantanal sul mato-grossense a partir de uma ação educativa de educação social. A estrutura metodológica deste trabalho foi pautada em uma abordagem qualitativa e em procedimentos metodológicos de campo, utilizando os desenhos feitos pelas crianças em uma roda de conversa como estratégia de coleta de dados. Constatamos que a ação de educação social na escola contribuiu para a garantia do acesso ao brincar como direito e que as brincadeiras das crianças na escola refletem o processo de ensino-aprendizagem do contexto escolar e da intervenção da ação de educação social do projeto de extensão. Destaca-se a falta de maior representação da cultura pantaneira, uma vez que as brincadeiras apresentadas pela maioria são realizadas em grupo

POUSADA RECANTO DA NATUREZA: EMPREENDEDORISMO VERDE PARA UM FUTURO SUSTENTÁVEL

O presente caso relata a implantação de uma pousada localizada no Município de Bombinhas, na Praia de Bombas, litoral catarinense. Foi idealizada a partir de um sonho de dois irmãos visionários, Manoel e Joaquim, que se preocuparam com o meio ambiente. Realizaram ações sustentáveis desde a escolha dos materiais utilizados na construção até a implementação de práticas rotineiras de sustentabilidade nas dimensões ambiental, social e econômica. No caso, foram apresentadas as fontes das informações, as quais os proprietários tiveram como base para implantar suas ações, bem como as difi culdades encontradas, indicadores de resultado, iniciativas sem sucesso e soluções aplicadas. Os proprietários planejam e investem em melhorias constantes e procuram novas ações sustentáveis que possam contribuir com a gestão já existente. Pretendem reforçar a imagem da empresa com ações de consciência ambiental com certifi cação de empresa parceira do meio ambiente. O caso demonstra que pequenas empresas também podem ser sustentáveis, apresentando como realizar algumas ações e quais os benefícios e as difi culdades ao realizá-las