Sagittal and vertical craniofacial growth and attainment of circumpubertal middle phalanx maturation (MPM) stages: A multiple regression study

Introduction: Orthodontic treatment for most of the skeletal malocclusions have specific optimal timing according to the skeletal maturation phases. The knowledge of whether attainment of a specific maturation phase is associated with the different sagittal and vertical craniofacial growth pattern then becomes of clinical relevance. Aim: This cross-sectional study evaluated whether sagittal and vertical craniofacial growth pattern, has an association with the age of attainment of the circumpubertal skeletal maturation phases. Materials and methods: A total of 300 subjects (170 females and 130 males) were included in the study (mean age, 12.0 ±1.5 years; range, 8.3-15.6 years). These subjects were equally distributed in the circumpubertal middle phalanx maturation (MPM) stages 2, 3 and 4. Subsequently,multiple regression models were run for each MPM stage group to assess the significance of the association of cephalometric parameters(SNA, SNB, ANB, PP/MP, CoGoMe, SN/MP and NSBa angles) with age of attainment of the corresponding MPM stage (in months). Results: Only sex yielded significant associations, with females having anticipated attainment of each of the circumpubertal MPM stage. Conclusion: These results show no significant correlations of the different sagittal and vertical cephalometric parameters with the age of attainment of the circumpubertal skeletal maturation phases

Clinical features and outcomes of elderly hospitalised patients with chronic obstructive pulmonary disease, heart failure or both

Background and objective: Chronic obstructive pulmonary disease (COPD) and heart failure (HF) mutually increase the risk of being present in the same patient, especially if older. Whether or not this coexistence may be associated with a worse prognosis is debated. Therefore, employing data derived from the REPOSI register, we evaluated the clinical features and outcomes in a population of elderly patients admitted to internal medicine wards and having COPD, HF or COPD + HF. Methods: We measured socio-demographic and anthropometric characteristics, severity and prevalence of comorbidities, clinical and laboratory features during hospitalization, mood disorders, functional independence, drug prescriptions and discharge destination. The primary study outcome was the risk of death. Results: We considered 2,343 elderly hospitalized patients (median age 81 years), of whom 1,154 (49%) had COPD, 813 (35%) HF, and 376 (16%) COPD + HF. Patients with COPD + HF had different characteristics than those with COPD or HF, such as a higher prevalence of previous hospitalizations, comorbidities (especially chronic kidney disease), higher respiratory rate at admission and number of prescribed drugs. Patients with COPD + HF (hazard ratio HR 1.74, 95% confidence intervals CI 1.16-2.61) and patients with dementia (HR 1.75, 95% CI 1.06-2.90) had a higher risk of death at one year. The Kaplan-Meier curves showed a higher mortality risk in the group of patients with COPD + HF for all causes (p = 0.010), respiratory causes (p = 0.006), cardiovascular causes (p = 0.046) and respiratory plus cardiovascular causes (p = 0.009). Conclusion: In this real-life cohort of hospitalized elderly patients, the coexistence of COPD and HF significantly worsened prognosis at one year. This finding may help to better define the care needs of this population

Measurement of exhaled nitric oxide in healthy adults.

BACKGROUND AND AIM: Measurement of exhaled nitric oxide (NO) is useful in the diagnosis and management of asthma. The aims of this study were to investigate the effects of physiologic confounders on levels of fractional exhaled NO (FE(NO)) in healthy adults and to establish reference values of FE(NO) measured according to American Thoracic Society (ATS) guidelines. METHODS: FE(NO) was measured in 122 healthy nonsmoking subjects of 20 to 65 years with a chemiluminescence analyser using the single breath online technique and an exhalation flow of 50 mL/s. RESULTS: The geometric mean [SE] FE(NO) was 21.6[1.06] ppb in males and 16.3[1.07] ppb in females (p < 0.01). FE(NO) increased significantly with body size and spirometric indices. In a stepwise regression analysis, body weight was the only variable included in the model (r = 0.36, p < 0.0001) and explained gender differences in FE(NO). When weight-related variables, including BMI, BSA and dead space volume, were analysed in a stepwise regression model, dead space volume gave the best correlation with FE(NO) (R = 0.39; p < 0.0001). CONCLUSION: The present study estimated that mean FE(NO) in healthy Caucasian subjects of 20 to 65 years, measured according to ATS guidelines with the online single breath technique, ranges from 15 to 24 ppb depending on the body weight. We suggest that the volume of dead space may explain the effect of weight on exhaled NO. However, a substantial part of FE(NO) variability in normal subjects remains unexplained

Adjuvant chemotherapy is associated with improved postoperative survival in specific subtypes of invasive intraductal papillary mucinous neoplasms (IPMN) of the pancreas: it is time for randomized controlled data

Background: Very little is known about adjuvant chemotherapy for invasive Intraductal Papillary Mucinous Neoplasms (IPMNs) of the pancreas. The aim was to assess whether adjuvant chemotherapy affects survival.Methods: Retrospective evaluation of invasive IPMNs. Patients treated with surgery alone or followed by adjuvant chemotherapy were compared in terms of survival.Results: A total of 102 invasive IPMNs were analyzed. Median follow-up was 72 (5-318) months and 18.6% received adjuvant chemotherapy. Overall, recurrence rate was 40.2%, while 5-year overall survival and disease specific survival (DSS) were 65.3% and 69.4%, respectively. N1 disease (HR5.58, CI95% 2.49-12.51, p &lt; 0.01), tubular type (HR2.35, CI95% 1.71-4.82, p = 0.05) and G3 tumors (HR4.54, CI95% 2.12-15.49, &lt; 0.01) were predictors of reduced DSS. Overall, there was no difference in the 5-year DSS comparing patients treated with adjuvant chemotherapy to surgery alone (61.8 vs. 69.4%, p = 0.8). Adjuvant chemotherapy significantly improved DSS only in N1 (5-years-DSS 76 vs. 35.8%, p = 0.01) and tubular carcinomas (5-years-DSS 88.9 vs. 53%, p = 0.03).Conclusions: Adjuvant therapy improves survival only in invasive IPMNs with nodal disease or tubular differentiation. Future trials are needed to improve the level of evidence about adjuvant chemotherapy