Acta Bio Medica Atenei Parmensis 2018-10-15T14:44:09+00:00 Editor Acta Open Journal Systems <p>Expression of the Society of Medicine and Natural Sciences of Parma and Centre on Health System's Organization, Quality and Sustainability, Parma. Acta Bio Medica is now one of the few Italian generals reviewed publications on major international databases. Divided into sections on research, case studies and updated monograph, is a training tool for broad spectrum close to the most recent advances of modern medical science.</p> Sofosbuvir/Velpatasvir for the treatment of Hepatitis C Virus infection 2018-10-15T10:33:54+00:00 Anna Linda Zignego Monica Monti Laura Gragnani <p class="p1">Hepatitis C Virus (HCV) infection is major health problem worldwide, with 150 million infected people according to recent epidemiologic estimations. The introduction of direct-acting antivirals made a revolutionary change in the management of HCV infected patients with surprisingly high rates of antiviral response, improved tolerability and reduced time of treatment. Sofosbuvir, in combination with different partner drugs, has been the molecule that led this incredible change. The last generation of SOF-based regimens, namely Sofosbuvir/Velpatasvir, represents a single tablet, once a day, pangenotypic and pan-fibrotic combination, demonstrated to be safe and effective in almost all type of HCV infected individuals. This review overviews the main clinical data of SOF/VEL registration trials, underlying the key features of this combination in terms of efficacy, safety and Patients Reported Outcomes obtained in more than 1800 HCV chronically infected subjects.</p> 2018-10-08T00:00:00+00:00 ##submission.copyrightStatement## Flow and volume response to bronchodilator in patients with COPD 2018-10-15T10:33:55+00:00 Matteo Vigna Marina Aiello Giuseppina Bertorelli Ernesto Crisafulli Alfredo Chetta <p class="p1"><span class="s1">The response to a bronchodilator is considered as crucial to diagnose COPD and to distinguish COPD from asthma. COPD is characterized by progressive airflow obstruction that is only partly reversible, whereas asthma is associated with airflow obstruction that is often reversible either spontaneously or with treatment. In spite of the partly reversible airflow obstruction, patients with COPD may show a significant bronchodilator response both in terms of an increase in forced expiratory volume in 1 second (FEV1) or in forced vital capacity (FVC) after an adequate dose of an inhaled bronchodilator. Changes in FEV1 or FVC characterize, respectively, flow or volume response after bronchodilator administration. This overview will deal with the reversibility testing characteristics and its clinical significance in COPD patients.</span></p> 2018-10-08T00:00:00+00:00 ##submission.copyrightStatement## Anesthesia protocols in laboratory animals used for scientific purposes 2018-10-15T10:33:54+00:00 Luca Cicero Salvatore Fazzotta Vincenzo Davide Palumbo Giovanni Cassata Attilio Ignazio Lo Monte <p class="p1"><em>Background: </em>A suitable, effective and free of complications anesthetic protocol is very important in experimental studies on animal models since it could bias the outcome of a trial. To date there is no universally accepted protocol for induction, maintenance and recovery from anesthesia. The endotracheal intubation with the use of inhalation anesthesia is used very especially in the from of large size laboratory animals, because it is a secure and easy control mode. However, it is not common for small laboratory animals because of the high technical skills required. <em>Aim: </em>The aim of this paper is a review of the main methods of induction of anesthesia in laboratory animals. <em>Materials and methods:</em> We performed an electronic search of MEDLINE (PubMed interface), ISI Web of Science and Scopus using the keywords “anesthesia” and “animal (s)” or “protocol (s)” or “surgery”, without the data or the language restriction. We consider only the most common laboratory animals (rats, mice, rabbits, pigs). We identify all the scientific articles that refer to the use of anesthetics for studies on laboratory animals in all areas: experimental surgery, CT, MRI, PET. All documents identified the search criteria are subject to review only by identifying relevant studies. <em>Conclusions:</em> There is a strong need for application of existing guidelines for research on experimental animals; specific guidelines for anesthesia and euthanasia should be considered and reported in future studies to ensure comparability and quality of animal experiments.</p> 2018-10-08T00:00:00+00:00 ##submission.copyrightStatement## Thomas Percival. Discussing the foundation of Medical Ethics 2018-10-15T10:33:54+00:00 Sara Patuzzo Giada Goracci Rosagemma Ciliberti <p class="p1"><em>Background and aim of the work: </em>In 1803, the English physician Thomas Percival published <em>Medical Ethics</em>, a work destined to become a milestone in the development of modern codes of medical ethics, starting from the first edition of the American Medical Association’s ethical code. Notwithstanding the undeniable influence that this book has exerted upon the codification of the principles of medical ethics, researchers and experts foster different and opposing points of views on its real nature. They question whether <em>Medical Ethics </em>truly belongs to the literary genre of codes of medical ethics or, better yet, to that of medical etiquettes. <em>Methods:</em> This debate is crucial in the field both of medical history and of medical ethics, with regard not only to Percival’s work, but also to the ethical value of the current codes of medical ethics and deontology. <em>Results:</em> The lack of a rigorous philosophical-moral analysis of the current medical codification is reflected in its mere loyalty to the legal regulation, in substantial continuity with the past. However, the constant challenges proposed by the biomedical development, require the need to rethink the traditional conceptual tools of the current codes of medical ethics, with the purpose to achieve new schemes and innovative solutions. <em>Conclusions:</em> On this perspective, when the codes of medical ethics are worked out by physicians, they could be considered as wrongly titled medical etiquettes. This consideration could regard current codes of medical ethics, that remain faithful to tradition and that would more probably be codes of medical etiquette with a wrong title.</p> 2018-10-08T00:00:00+00:00 ##submission.copyrightStatement## Novel approach for quality assessment and improving diagnostic accuracy in cell-based infection imaging using 99mTc-HMPAO labeled leukocytes 2018-10-15T10:33:54+00:00 Silvia Migliari Antonino Sammartano Carla Cidda Giorgio Baldari Maura Scarlattei Giulio Serreli Caterina Ghetti Silvia Pipitone Giuseppe Lippi Livia Ruffini <p class="p1"><em>Background and aim:</em> Labeled leukocytes with <sup>99m</sup>Tc-HMPAO are routinely used for infection imaging. Although cell labeling with <sup>99m</sup>Tc-HMPAO represents an imaging probe to detect infection sites, the diagnostic efficiency of the probe is largely influenced by cell manipulation, multidisciplinary interventions (i.e., biologist, technicians) and available technology (i.e., SPECT, SPECT/CT). The aim of the study was to assess in vitro and in vivo accuracy of a comprehensive approach for quality assessment (QA) of all steps of the procedure. <em>Methods:</em> Radiochemical purity (RCP), pH, labeling efficiency (LE) were measured in 320 procedures. White Cell Viability Factor (WVF) was determined in consecutive blood samples. Images (490 studies) were scored using a 5-point scale. Training program was evaluated using a Learning Questionnaire and a score system. <em>Results:</em> Pre/post-labelling WVF was 0.99% (max value 1%) in all blood samples. LE (mean value 72%) and RCP (&gt;80% until 55 minutes) yielded considerably high values. The vast majority of images were scored as diagnostic by three independent observer (90% with score ≥4). <em>Conclusions:</em> This method appears highly reproducible and easy to use in clinical routine for leukocyte labeling, especially when standardized training and total QA system are implemented.</p> 2018-10-08T00:00:00+00:00 ##submission.copyrightStatement## Could decorin be a biomarker of coronary artery disease? A pilot study in human beings 2018-10-15T10:33:54+00:00 Saeed Nazemi Atefeh Rezapour Seyed Mohammad Hassan Moallem Mohammad Afshar Sepideh Elyasi Hamid Reza Mashreghi Moghadam Mahmoud Dargahi Zaboli Amir Hooshang Mohammadpour <p class="p1"><em>Background and aim: </em>Nowadays there is a strong necessity in identifying patients who may be exposed to the risk for future cardiovascular events like progressive atherosclerotic disease. Biomarkers are valuable tools for this purpose. Coronary artery calcification (CAC) is utilized as an important tool for the global risk assessment of cardiovascular events in individuals with intermediate risk. Decorin (DCN) is a small leucine-rich proteoglycan that induces calcification of arterial smooth muscle cell and localizes to mineral deposition in human atherosclerotic plaque. The main purpose of this clinical study was to find out the correlation between Decorin serum concentration and CAC in human for the first time. <em>Methods:</em> In this study 84 patients with coronary artery disease who fulfilled inclusion and exclusion criteria, entered the study. For all patients a questionnaire consisting demographic data and traditional cardiovascular risk factors were completed. CT-Angiography was carried out to determine coronary artery calcium score and ELISA method was used for measuring DCN serum concentrations. <em>Results:</em> No significant correlation between DCN serum concentration and total CAC score and also CAC of left anterior descending, right coronary artery, left main coronary artery and circumflex was found in the study population (P&gt;0.05). <em>Conclusions:</em> On the basis of our results DCN serum concentration is not a suitable biomarker of coronary artery disease. However, more studies with higher sample size are necessary for its confirmation.</p> 2018-10-08T00:00:00+00:00 ##submission.copyrightStatement## Relation of the frequency and mortality of pulmonary thromboembolism with meteorological parameters 2018-10-15T10:33:54+00:00 Gökhan Perincek Osman Nuri Hatipoğlu Erhan Tabakoğlu Sema Avcı <p class="p1"><em>Objective:</em> The objective of this study is to find the relationship between incidence rate and mortality of acute pulmonary thromboembolism (PTE), and seasonal and meteorological factors. <em>Materials and methods:</em> The data from 234 patients who were hospitalized due to acute PTE in the emergency service or policlinics between 2001 and 2008 were investigated retrospectively. Cases that developed APE (acute pulmonary embolism) in the hospital were excluded. Seasons and months in which acute PTE was diagnosed were recorded. Mortality rates by months and seasons were evaluated. The mean pressure, temperature and humidity values were evaluated for periods of three days, seven days and one month before the day of presentation. The effects of meteorological factors on the severity (massive or non-massive) and mortality of APE were investigated. <em>Results: </em>The incidence rate of acute APE showed a significant difference according to seasons (p=0.000). APE was diagnosed most commonly in spring and winter. The mean pressure values for three days, seven days and one month and the mean humidity values for three days for the dead patients were found to be significantly lower than those of the survived ones (p&lt;0.05). The mortality rate for patients admitted in summer was significantly higher than the rates for other seasons (p=0.02). There were no seasonal differences among the massive APE incidences. Mortality rates were higher in summer because of the nonmassive APE patients rather than the massive patients. <em>Conclusion: </em>Acute PE is a disease whose incidence and mortality rates are affected by meteorological factors.</p> 2018-10-08T00:00:00+00:00 ##submission.copyrightStatement## The role of FFR in clinical decision making in patients with moderate coronary lesions: a pilot study 2018-10-15T10:33:55+00:00 Morteza Safi Mohammad Ali Mehrabi Saeed Alipour Parsa Isa Khaheshi Mohammadreza Naderian <p class="p1"><em>Background and Aim:</em> Applying fractional flow reserve (FFR) recently helped to assess borderline coronary defects and also facilitates assessment of these lesions. The present study aimed to assess cost-effectiveness of FFR in detection of these borderline lesions. <em>Methods:</em> This cross-sectional study was conducted on140 consecutive patients with 219 diseased arteries who underwent coronary angiography and suffered intermediate coronary lesions. <em>Results:</em> Of 18 patients who candidate for CABG before FFR, only one patient underwent CABG after determining FFR (P-value&lt;0.05), while 15 patients were scheduled for PCI and 2 patients for medical treatment. Of 122 patients who candidate for PCI, 59 were programmed to underwent PCI after FFR determination(P-value&lt;0.05), while the strategy in 63 patients (47 with one-vessel disease, 15 with two vessel diseases, and 1 with three vessel diseases) was modified to medical treatment. Considering strategy modifying from PCI to medical treatment, 101 stents were saved (P-value&lt;0.05). Also, in change of strategy from CABG to PCI, spending has decreased as much as 77.3% (P-value&lt;0.05). Furthermore, the change of treatment approach from PCI on much number of coronary vessels to PCI on less number of coronary lesions led to saving of 52.2% of costs(P-value&lt;0.05). <em>Conclusions:</em> In patients with an intermediate coronary lesion, measuring FFR to guide the decision to determine treatment strategy may lead to significant cost savings.</p> 2018-10-08T00:00:00+00:00 ##submission.copyrightStatement## Surgical management of middle ear cholesteatoma in children with Turner syndrome: a multicenter experience 2018-10-15T10:33:55+00:00 Diego Zanetti Filippo Di Lella Maurizio Negri Vincenzo Vincenti <p class="p1"><em>Background and aim:</em> As in other syndromes characterized by craniofacial anomalies, middle ear cholesteatoma is known to have a high prevalence in Turner syndrome. The aim of this study was to review a multicenter experience with the surgical management of middle ear cholesteatoma in children with Turner syndrome. <em>Methods</em>: We retrospectively analyzed sixteen girls with Turner syndrome who underwent otologic surgery for middle ear cholesteatoma between January 2000 and December 2012. Surgery was performed in 3 tertiary care otologic centers. Four patients had bilateral disease, resulting in a total of 20 ears treated. The following data were recorded: age, history of ventilation tube insertion, status of the controlateral ear, cholesteatoma location and extension, and surgical technique involved. Cholesteatoma recidivism, stable mastoid cavity and hearing levels were the main outcomes measured. <em>Results:</em> Follow-up ranged from 3 to 15 years (mean 7 years). Fourteen ears underwent canal wall down mastoidectomy: no cases of recurrent cholesteatoma were observed in these cases; revision mastoidectomy with cavity obliteration was needed in 2 ears (14.3%) for recurrent otorrhea. In the remaining 6 ears a staged canal wall up mastoidectomy was performed: 1 child showed a recurrent cholesteatoma and required conversion to canal wall down mastoidectomy. A postoperative air-bone gap result of 0 to 20 dB was achieved in 6 ears (30%); in 9 ears (45%) postoperative air-bone gap was between 21 and 30 dB, while in 5 (25%) was &gt;30 dB. Bone conduction thresholds remained unaffected in all cases. <em>Conclusions:</em> Cholesteatoma in children with Turner syndrome is a challenging entity for the otologic surgeon. Although not mandatory, canal wall down mastoidectomy should be regarded as the technique of choice to achieve a safe and dry ear in TS children with middle ear cholesteatoma. Intact canal wall mastoidectomy should be adopted only in appropriately selected patients such as those with limited attic cholesteatoma that can be regularly followed-up.</p> 2018-10-08T00:00:00+00:00 ##submission.copyrightStatement## A three-year experience with medial-pedicle-based breast reduction for different mammary hypertrophy 2018-10-15T10:33:54+00:00 Michele Pio Grieco Nicolò Bertozzi Eugenio Grignaffini Edoardo Raposio <p class="p1"><em>Background and aim:</em> The aim of breast reduction is to reduce excessive breast volume, ensuring an adequate vascular supply and sensitivity of the nipple-areola complex, as well as to produce an aesthetically pleasing final shape. The authors report on their experience with medial-pedicle-based breast reduction combined with both vertical and inverted-T skin resection patterns for different types of breast hypertrophy. <em>Methods:</em> From January 2012 to June 2015, 27 female patients (mean age: 49 years) underwent reduction mammoplasty with the medial pedicle technique. The choices of medial pedicle base widths were: 6 cm for low-grade mammary hypertrophy (350-500 gr per breast), 6-8 cm for medium-grade hypertrophy (500-1000 gr per breast), or 8-10 cm for severe mammary hypertrophy (&gt;1000 gr per breast). The authors chose the model of vertical skin resection for low-grade breast hypertrophy. The vertical model was used for medium-grade breast hypertrophy, and Wise skin resection was chosen on a case-by-case basis; only the Wise model was applied to severe breast hypertrophy.<span class="Apple-converted-space">&nbsp; </span><em>Results:</em> The mean weight of breast excised was 540 g on the left (range, 207 to 1160 g) and 564.8 g on the right (range, 215 to 1150 g). The complications were minor and self-limiting. All patients reported relief of neck pain, back pain, and bra strap indentations after 6 months of follow-up. <em>Conclusions:</em> Breast reduction surgery must address both functional and aesthetic issue by restoring an aesthetically pleasing shape to ptotic or hypertrophic breasts, repositioning the NAC in a physiological position. Various breast reduction techniques have been attempted to combine the safety of the pedicle with aesthetic and functional results. Surgeons should tailor the best technique to each patient. We found that medial-pedicle-based reduction mammoplasty is effective and reliable because it can be applied to a wide range of breast hypertrophy, with reproducible breast weight reduction and results that are aesthetically satisfactory for both patients and surgeons.</p> 2018-10-08T00:00:00+00:00 ##submission.copyrightStatement## A clinical efficacy experience of Lacosamide on sleep quality in patients with Nocturnal Frontal Lobe Epilepsy (NFLE) 2018-10-15T14:44:09+00:00 Marilena Mangiardi Guido Alfano <p class="p1"><em>Background:</em> Nocturnal frontal lobe epilepsy (NFLE) is a focal epilepsy with seizures arising mainly during sleep and characterized by complex motor behavior or sustained dystonic posturing. First described in 1981, it was considered a motor disorder of sleep and was indicated as nocturnal paroxysmal dystonia (NPD). The debated on epileptic origin of this condition was demonstrated in 1990 and the term NFLE was introduced. Since then it has been demonstrated that the heterogeneous aspects of morpheic seizures were responsive to antiepileptic drugs (AED’s) with sodium blocking action mechanism, especially the carbamazepine (CBZ). <em>Aim of Work and Methods: </em>We report a clinical experience of NFLE patients associated with sleep disorders treated with Lacosamide, AED’s with a novel mechanism of action. In vitro electrophysiology studies have shown that lacosamide selectively boosts the slow inactivation of the sodium-voltage-dependent channels, resulting in a stabilization of the hypersensitive neuronal membranes. <em>Results and Conclusion:</em> On the treated patients we observed a positive clinical response to lacosamide therapy without significant side effects. In particular, the effective clinical response to the pharmacological treatment was obtained at a dose of 200 mg/day.</p> 2018-10-08T00:00:00+00:00 ##submission.copyrightStatement## Face Rejuvenation: a new combinated protocol for biorevitalization 2018-10-15T10:33:54+00:00 Cesare Brandi Roberto Cuomo Giuseppe Nisi Luca Grimaldi Carlo D'Aniello <p class="p1"><em>Introduction:</em> The slowing of the aging process is subject of great research and attention in modern society, particularly aging of face. Processes involved are very complex. Mesotherapy. hyaluronic acid and carbon dioxide injection can be used for biorevitalization and skin rejuvenation. <em>Methods:</em> Three groups were made and 62 patients were enrolled. Patients with superficial wrinkles of the face, neck and/or décolleté, without presence of nasolabial folds and marionette wrinkles were included in group 1. Patients with superficial/medium depth wrinkles of the face, neck and/or décolleté, with moderate nasolabial folds but no marionette wrinkles were included in group 2. Patients with deep wrinkles of the face, with deep nasolabial folds and marionette wrinkles were included in group 3. Patients were treated with three different protocols that included injections of amino acids, vitamins and hyaluronic acid in association with carbon dioxide injection. We submitted the PAIS and GAIS scales and we analyzed the scores obtained with Wilcoxon’s and Kolmogorov-Smirnov’s tests. Statistical Product and Service Solutions (SPSS) softare was used. The p-value was considered acceptable if inferior to 0,05 (p&gt;0,05). <em>Results:</em> In according with these tests, the differences of values at one week and at the end of the study are significant (p&lt;0,05) for both PAIS and GAIS. No side effects were reported. <em>Conclusions:</em> Protocol treatment used in this study gave statistically valid results in the rejuvenation of face for mild, moderate and severe aging.</p> 2018-10-08T00:00:00+00:00 ##submission.copyrightStatement## Traumatic deep neck infection due to pulling a tooth with pliers 2018-10-15T10:33:54+00:00 Sema Avcı <p class="p1">Deep neck infection is life-threatening and mortal condition that requires immediate treatment. This infection is generally polymicrobial and frequently seen after upper respiratory infections, poor dental hygiene, trauma and surgery to the head and neck region. The symptoms of deep neck infections are swelling, dysphagia, pain, trismus, dysphonia and otalgia. Deep neck infections can be seen at any age and its mortality is about 20-50%. Initial management of the deep neck infection is intravenous antibiotic, protection of airway and drainage of abscess. Deep neck infections can cause severe complications even dead can be seen, so physicians should be aware of these complication. Herein, we reported a 71-year-old-woman suffering from traumatic deep neck infection due to pulling a tooth with pliers.</p> 2018-10-08T00:00:00+00:00 ##submission.copyrightStatement## Linezolid-induced black hairy tongue 2018-10-15T10:33:54+00:00 Cesare Braggio Giovanni Bocchialini Luigi Ventura Paolo Carbognani Michele Rusca Luca Ampollini <p class="p1"><span class="s1">Black hairy tongue (BHT) is a self-limiting disorder characterized by abnormal hypertrophy and elongation of filiform papillae on the surface of the tongue. The exact mechanism of drug-induced BHT is unknown. Several factors have been implicated and included smoking or chewing tobacco, drinking alcohol, poor oral hygiene and antibiotics such as tetracyclines and penicillins. We report a quite uncommon case of Linezolid-induced BHT in a patient with a long-lasting history of chest wall infection</span></p> 2018-10-08T00:00:00+00:00 ##submission.copyrightStatement## Schwannoma of right cerebellopontine angle. A cytologic diagnosis 2018-10-15T10:33:55+00:00 Alexandra Kalogeraki Dimitrios Tamiolakis Iris Zoi John Segredakis Maria Kafousi Antonios Vakis <p class="p1">Schwannomas affect mainly head and neck peripheral nerves, are benign tumors and derive from Schwann cells. Schwannoma of right cerebellopontine angle is extremely rare to diagnose by cytology. We report one such rare case presenting the cytological features in material obtained during the resection of the tumor. <em>Case report:</em> A 47-year-old female was diagnosed by MRI with a tumor of right cerebellopontine angle.. Cytologic material from the tumor was obtained intraoperatively and diagnosed cytologically as a neurilemoma. <em>Conclusion:</em> This case is presented here to focus the ability of cytology in diagnosis of schwannoma in intraoperative material of the tumor, using immunohistochemistry and confirmed by histology- immunohistochemistry.</p> 2018-10-08T00:00:00+00:00 ##submission.copyrightStatement## Scapular reconstructions after resection for bone tumors: a single-institution experience and review of the literature 2018-10-15T10:33:54+00:00 Alessio Biazzo Massimiliano De Paolis Davide Maria Donati <p class="p1"><span class="s1">Scapulectomy and limb-salvage surgery are indicated for low and high-grade tumors of the scapula and soft-tissue sarcomas that secondary invade the bone. After total or partial scapulectomy there are 3 options of reconstruction: humeral suspension (flail shoulder), total endoprosthesis and massive bone allograft. Nowadays prosthesis and allograft reconstructions are the most used and humeral suspension is reserved only as salvage technique when no other surgery is possible. Several studies reported dislocations and wound infections as the most frequent complications of scapular prosthesis, account for 10-20%. Recently, in the attempt to prevent these complications, some authors have used homologous allografts to replace shoulder girdle after scapulectomy for bone tumors, avoiding common complications of scapular prosthesis. Scapular reconstruction following tumor resection is a safe procedure and can be performed with good functional, oncological and cosmetic results but in reference centres and by skill surgeons. In this paper we present three cases of scapular reconstructions following resections for scapular tumors (chondrosarcoma in all cases) performed in our Institute and we analyse the different options of reconstruction described in the current literature. The final message is to send these rare tumors to reference centres where a multidisciplinary team is able to treat these rare entities and where a group of skill oncology surgeons are able to plan this complex surgery.</span></p> 2018-10-08T00:00:00+00:00 ##submission.copyrightStatement## Unilateral twin tubal pregnancy: a case report and review of the literature 2018-10-15T10:33:54+00:00 Marta Betti Patrizia Vergani Gianluca Raffaello Damiani Antonio Pellegrino Edoardo Di Naro Giuseppe Trojano Cecilia Pirovano Massimo Stomati Matteo Loverro <p class="p1"><em>Background:</em> Unilateral twin tubal pregnancy is an extremely rare condition, occurring in 1/20.000-250.000 pregnancies and represents a major health risk for reproductive-aged women, leading to even life-threatening complications. <em>Aim:</em> We present a case of a 31-year-old woman with unilateral twin tubal pregnancy, treated with methotrexate and then surgically because of failure, followed by review of the literature. <em>Methods:</em> Researches for relevant data were conducted utilizing multiple databases, including PubMed and Ovid. <em>Results:</em> The most common type of twin ectopic pregnancy is the heterotopic (1/7000 pregnancies) in which in which both ectopic and intrauterine pregnancy occur simultaneously. Expectant, medical and surgical therapy have similar success rates in correctly selected patients. Two prospective randomized trials did not identify any statistically significant differences between groups receiving MTX as a single dose or in multiple doses. Among the 106 cases reported in literature, methotrexate was tried just in 4 patients (3 unilateral and 1 bilateral) before ours. Details are reported in the table 1. <em>Conclusion:</em> The recent shift in the treatment of singleton ectopic pregnancies to the less invasive medical therapy might apply even in the case of twin implants.</p> 2018-10-08T00:00:00+00:00 ##submission.copyrightStatement## Hypersensitivity to metallic implants: pathophysiologic and diagnostic considerations 2018-10-15T10:33:54+00:00 Nicholas G Kounis Ioanna Koniari <p>Metals are ubiquitous in the surrounding environment and constitute an important class of substances that can act as allergens. Consumer products such as earings, zip, jewellery, cosmetics, paints, dental and body implants as well as endovascular, intracardiac and orthopedic devices are made from metals. Metal anions eluted from various metals&nbsp; are common allergic sensitizers. In Europe nickel, chromium and cobalt induce allergic skin reactions in about 20%, 4%, and 7% while in the United States14%, 4%, and 9% respectively</p> 2018-10-08T00:00:00+00:00 ##submission.copyrightStatement## Some observations on the signs of certain death in the 18th century 2018-10-15T10:33:54+00:00 Ilaria Gorini Mariano Martini Marta Licata <p class="p1">In 1783, the work of Ferdinand de la Boissiere, <em>Letters above the certainty of death signs with various observations and experiences over the drowned</em>, was published in Rome. Manuscript is a translation of the French work of Antoine Louis, <em>Lettres sur la certitude des signes de la mort</em>, printed in France in 1752 and in which the surgeon discussed on the certain diagnosis of death. The Louis’s work represented an important contribute of medicine especially because in the 18<sup>th</sup> century only the appearance of the first putrefactive processes was recognized as the indisputable sign of death. In the debate of the time, the treaty of Antoine Louis (1723-1792) overtaken the believed that the only indisputable sign of death was the appearance the first putrefaction processes. Our paper is limit to offering some author’s account around the characteristic signs of death, which dispense from putrefaction of the bodies or the rigidity of the limbs and the collapse and softness of the eye. The book boasted a great meaning in the medical association of the time, especially because it discussed with contemporary criteria the signs of certain death.</p> 2018-10-08T00:00:00+00:00 ##submission.copyrightStatement## Historical evolution of the concept of health in Western medicine 2018-10-15T10:33:54+00:00 Andrea Alberto Conti <p class="p1">“Health” is a positive multi-dimensional concept involving a variety of features, ranging from ability to integrity, from fitness to well-being. According to the first principle of the constitution of the World Health Organization “Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”. This constitution was adopted by the International Health Conference held in New York in June-July 1946 and became operative in April 1948. This classical, seventy-year old definition of the World Health Organization is nowadays considered a historical one and it stands as a fundamental milestone of a diachronic track beginning, in Western medicine, with the definition of health proposed by Hippocrates and his School. For Hippocrates health was the state of equilibrium of four humours. This philosophical-naturalistic definition has been flanked in the history of Western medicine by various concepts of health and disease, alternatively based, according to different scientists and in different medical contexts and periods, on epidemiological, anatomical, physiological, functional, social and molecular perspectives. Since biomedical definitions are always prone to integration and updating, depending on the continuous achievements of medical science and bioethics, the fascinating journey through the concepts of health and disease, the fundamental milestones of which are here briefly proposed, is still in progress.</p> 2018-10-08T00:00:00+00:00 ##submission.copyrightStatement## “Should I stay or Should I go”: patient who leave Emergency Department of an Italian Third-Level Teaching Hospital 2018-10-15T10:33:54+00:00 Alberto Carli Francesca Moretti Giulia Giovanazzi Valentina Niero Valeria Perilli Giovanna Ghirlanda Chiara Bovo Stefano Tardivo <p class="p1"><em>Background and Aim:</em> Patients could leave ED not receiving the desired care either Without Being Seen by a doctor (LWBS) or Against Medical Advice (DAMA). In term of care quality, LWBS may be related to inappropriate access and process of care, while DAMA may lead to increased risk of mortality and re-admissions. This study aims to identify frequency of patients who leave ED, determine their characteristics and identify associated factor. <em>Methods: </em>This was a retrospective observational study of patients that attended EDs of University Hospital Trust of Verona in 2017. Demographic and ED access associated variables were collected for LWBS, DAMA and completed-ED-treatment patients. Univariate and multivariate data analyses was based on EMUR-PS administrative data.<em> Results:</em> 5,901 of 127,180 ED accesses were uncompleted treatment (4.64%); LWBS were 4,664 (79.04%) and DAMA 1,237 (20.96%). Those who leave ED tended to be younger (39.35 vs. 45.56, p&lt;0.01). Independent factors associated with ED leaving resulted: i) non-urgent triage category (OR: 2.941, 95%CI: 2.405-3.596) ii) non-Italian-nationality (OR: 1.695, 95%CI: 1.493-1.924) and requiring psychiatric consult (OR:6.16 95%IC 4.82-7.87); while protective factors resulted: i) female gender (OR: 0.713, 95%CI: 0.633-0.803); i) Paediatric ED (OR: 0.593, 95%CI: 0.437-0.805); ii) Obstetrics-Gynaecology ED (OR: 0.284, 95%CI: 0.193-0.416) iii) inclusion in fast track pathways (OR: 0.747, 95%CI: 0.602-0.927). Higher ED leaving rate were observed during night-time and Sunday, either overcrowding resulted not associated.<em>Conclusion:</em> Results show the necessity to implement primary care-ED integrated pathway, mainly in frail sub-population, improve awareness on healthcare service use and refine communication skills in ED-team.</p> 2018-10-08T00:00:00+00:00 ##submission.copyrightStatement## Rotavirus gastroenteritis hospitalization rates and correlation with rotavirus vaccination coverage in Sicily 2018-10-15T10:33:54+00:00 Vincenzo Restivo Francesca Caracci Claudia Emilia Sannasardo Francesco Scarpitta Carlotta Vella Gianmarco Ventura Fabio Tramuto Claudio Costantino <p class="p1"><em>Background and aim of the works:</em> Rotavirus (RV) is considered the main cause of gastroenteritis in children from 0 to 59 months and vaccination represents the only strategy to prevent hospitalizations due to RV. In 2013 Sicilian Region introduced universal RV vaccination for all newborns. The present study aims to estimate the reduction rotavirus gastroenteritis (RVGE) hospitalization rates among Sicilian children and their relations with vaccination coverages of the nine Sicilian Local Health Units (LHUs). <em>Methods: </em>Were analyzed hospital discharge records including a diagnosis of RVGE occurred from January 2009 to December 2017 in hospitalized children aged 0 to 59 months, residents in Sicily. Were reported data on complete RV vaccination cycles among Sicilian children under 12 months of age (vaccination coverage). <em>Results: </em>A 49.2% overall reduction of RVGE hospitalization rates was reported after RV vaccination introduction. A more considerable reduction of hospitalization rates was observed among children aged 0 to 11 months (-61.4%), followed by children aged 12-23 months (-51.2%) and 24-35 months (-48.8%). In all the nine Sicilian Local Health Units (LHUs), a reduction of RVGE hospitalization rates was observed after RV vaccine implementation. <em>Conclusions: </em>This study demonstrated the significant impact of RV vaccination on RVGE hospitalization rates in Sicily, especially among children aged 0 to 23 months. The reduction in RVGE hospitalization rates observed in the Sicilian LHUs after universal vaccination program implementation, were generally higher or consistent with average vaccination coverage reported from 2013 to 2017.</p> 2018-10-08T00:00:00+00:00 ##submission.copyrightStatement## Prevalence of the bullying phenomenon in a schools sample of Palermo, Sicily: a pre-post intervention observational study among teachers 2018-10-15T10:33:54+00:00 Claudio Costantino Gianmarco Ventura Claudia Marotta Stefania Enza Bono Evelina Arcidiacono Carlo Roberto Gambino Maurizio Gentile Sara Palmeri Giovanna Ripoli Claudia Emilia Sannasardo Pierfrancesco Sannasardo Francesco Scarpitta Carlotta Vella Walter Mazzucco Alessandra Casuccio Vincenzo Restivo <p class="p1"><em>Background and aim of the work: </em>Bullying involves a significant percentage of school-age children. According to the latest available surveillance data, in Sicily, the estimated prevalence among 11-15 years old children is 14%. This study aimed to estimate a prevalence of the bullying phenomenon, observed by teachers, in a sample of secondary schools of Palermo, Sicily. Moreover, after the conduction of preventive interventions among teachers, aimed to evaluate any modification in bullying prevalence. <em>Methods:</em> A cluster sampling selection according to socio-economic level of the school neighborhood was carried out. Two anonymous online questionnaires, pre and post-intervention, were administered to the 63 teaching staff, belonging to second and third year classes of ten secondary schools enrolled. Preventive interventions were conducted among teachers by experienced researchers. <em>Results:</em> Prevalence of bullying reported decreased significantly from 44.4% to 19.0% (p-value 0.001), comparing pre and post-intervention questionnaires. A reduction in the prevalence of verbal and physical bullying and a concomitant slight increase of indirect bullying were also observed. All the characteristics, reported by the teaching staff, for describing bullies, victims and observers of bullying have been categorized under three different content domains (affective-relational discomfort, socio-cultural context, and character/natural disposition). <em>Conclusions: </em>The present study estimated the prevalence and the characteristics of bullying phenomenon in a sample of secondary schools of Palermo, evaluating the reduction of bullying episodes among students, after a preventive interventions conducted among teaching staff. Data obtained confirmed the effectiveness of this approach and suggested an extension of the project at Regional Level.</p> 2018-10-08T00:00:00+00:00 ##submission.copyrightStatement##