Acta Bio Medica Atenei Parmensis <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> en-US (Editor Acta) (Valeria Ceci) Fri, 29 Jun 2018 14:11:24 +0000 OJS 60 Preparing  for the Decade of Healthy Aging (2020-2030): prevention plus therapy? <p>Not available</p> Domenico Cucinotta ##submission.copyrightStatement## Thu, 07 Jun 2018 00:00:00 +0000 Lung function tests to monitor respiratory disease in preschool children <p>Pulmonary function tests are routinely used in the diagnosis and follow-up of respiratory diseases. In preschool children assessment and evaluation of lung function has always been challenging but improved techniques that require only minimal collaboration allowed obtaining reliable and useful results even in this group of patients. In this review we will describe the different techniques used in clinical practice to measure lung function in preschool children.</p> <p>&nbsp;</p> Valentina Fainardi, Enrico Lombardi ##submission.copyrightStatement## Thu, 14 Jun 2018 00:00:00 +0000 Project design for surgical department reorganization at hospital-university of Parma <p>The article explains the main technical and methodological references of the reorganization of the main surgical activities (for production volumes and case mixes) of the Parma University Hospital. In defining the organizational design we considered the compliance with national laws and regional guidelines, the vision of the Public Enterprise Strategic Management, the attempt to bring the continuity of care through hospital paths, the valorization of the high technical specialty of a hub university center, the recognition of the ability and vocations of Professionals and the search for efficiency of a complex public production system. The project has also responded to the need to pursue greater production efficiency by the entire local health system of Parma, optimizing, at the same time, training courses for Medical Students and Health Professions of the University of Parma transversely with respect to surgical clinical pathways and clinical research.</p> <p>&nbsp;</p> Antonio Ferrari, Pietro Manotti, Paolo Del Rio, Antonio Balestrino, Massimo Fabi ##submission.copyrightStatement## Thu, 07 Jun 2018 00:00:00 +0000 The “Canone Inverso”: when tobacco was not so bad. A Look Back at the Primordial Debate on the tobacco effects in the Occupational Medicine <p><em>Aim:</em> The article provides an overview on the beginning and evolutions of medical observations on tobacco induced diseases between Eighteenth and Nineteenth century. <em>Methods:</em> By searching for historical medical literature, first studies on tobacco-induced diseases focused on production risks rather than on adverse effects that the use of tobacco has for the human health. <em>Results:</em> The approach induced first eighteenth-century authors to define this substance as a non-pathogenic and, consequently, not to consider tobacco factories dangerous for health workers. In those years, tobacco was employed in therapy as a stimulant treatment and it was considered harmless and even healthy and preventive of several acute diseases. <em>Conclusions:</em> Authors will show that studies on pathogenic effects of smoking will only start around late nineteenth century, when the idea of the healthiness of tobacco industry was already supported.</p> <p>&nbsp;</p> Silvia Marinozzi, Silvia Iorio, Marta Licata, Matteo Gulino ##submission.copyrightStatement## Fri, 15 Jun 2018 00:00:00 +0000 Scrambler therapy in the management of somatosensory signs and symptoms related to neuropathic pain: an exploratory and prospective analysis <p><em>Objectives:</em> Neuropathic pain is a severe and disabling health problem, often difficult to treat and characterized by specific somatosensory signs and symptoms. The goal of this study is to detect the effect of Scrambler therapy (ST) on the reset of Neuropathic Pain Diagnostic Questionnaire (DN4), in a cohort of patients affected by intense drug-resistant neuropathic pain. <em>Methods:</em> Patients with chronic neuropathic pain were consecutively enrolled to receive 45-minute daily ST for an average of 10 consecutive days. Evaluation of pain intensity by Numerical Rating Scale (NRS) score and DN4 questionnaire was performed at the beginning and at the end of the treatment. Primary endpoint was to achieve a significant negativization of DN4 (DN4 &lt;4) in the study population after 10 ST sessions. Secondary endpoints were to detect a correlation between DN4 negativization and pain intensity reduction ≥50% (patient responders), finally to analyse the impact of ST on each item of DN4 survey. <em>Results: </em>We prospectively treated 45 patients. Mean baseline DN4 score was 5.67 [±1.43] and fell by 50.3%, with a mean DN4 score of 2.82 [±2.18] at the end of treatment (OR 2.84; 95%CI: 2.07-3.62; p&lt;0.0001). In 28 out of 45 (62.2%) patients we reported a negativisation of DN4 (p&lt;0.0001). Correlation between the percentage of patient responders and patients with negativization of DN4 was statistically significant (p&lt;0.0062). Analysing each DN4 item pre- and post-ST, we reported a significant negativization in 6 out of 10 DN4 items. <em>Discussion:</em> Our prospective exploratory analysis met the primary endpoint and ST seems to resolve relevant somatosensory signs and symptoms related to neuropathic pain. Based on these encouraging results, the next step will be to evaluate these neuropathic pain features with dedicated tools.</p> <p>&nbsp;</p> Domenico Russo, Federica Zoratto, Gastone Tirocchi, Michela Guarda ##submission.copyrightStatement## Thu, 07 Jun 2018 00:00:00 +0000 Investigation of the efficacy of generic and brand-name salmeterol/fluticasone combination in the management of asthma: a randomized comparative trial <p><em>Background: </em>Asthma is the most chronic inflammatory disease of the airways worldwide. Combination therapy with inhaled fluticasone and salmeterol is a common practice for the long-term management of asthma. Seretide® and Fluticort plus® are two available generic and brand name products of salmeterol/fluticasone. This study aimed to compare the efficacy and safety of these two drugs. <em>Materials and Methods: </em>In this randomized comparative, clinical trial, 80 asthmatic patients were allocated to Fluticort plus® (n=40) or Seretide® (n=40) for a period of 4 weeks. Patients with mild asthma were instructed to inhale one puff each 12 hours and those with moderate asthma two puffs every 12 hours. Respiratory volumes (assessed using spirometry), quality of life (assessed using St. George’s Respiratory Questionnaire [SGRQ]) and control of asthmatic symptoms (assessed using asthma control test [ACT]) were evaluated at baseline and at the end of the study. <em>Results:</em> ACT score improved only in the Fluticort plus® group (<em>p</em>=0.012) while it was not significantly changed in the Seretide® group (<em>p</em>=0.178). In both treatment groups, FEV1, FEV1/FVC, and total as well as subscale SGRQ scores were significantly improved by the end of the study (<em>p</em>&lt;0.05). Seretide® more efficiently improved respiratory volumes and SGRQ score in comparison with Fluticort plus® (<em>p</em>&lt;0.05). <em>Conclusion: </em>Our comparative trial indicated that generic fluticasone/salmeterol product could improve respiratory volumes, quality of life but its efficacy is lower than the brand-name product. However, Fluticort plus® improved asthma control more efficiently compared with Seretide®.</p> <p>&nbsp;</p> Yunes Panahi, Mostafa Ghanei, Hooshyar Maghsoudi, Sara Saffar Soflaei, Amirhossein Sahebkar ##submission.copyrightStatement## Thu, 07 Jun 2018 00:00:00 +0000 Prevalence of candidemia and associated candida subtypes following severe sepsis in non-neutropenic critically ill patients <p><em>Background:</em> Invasive candidiasis management through the rapid initiation of appropriate antifungal therapy has been shown to be associated with the better prognosis, improved clinical outcome and reduced mortality in critically ill patients. Therefore, selection of&nbsp; an appropriate antifungal therapy should be based on the distribution of candida species and the pattern of antifungal resistance. This study aimed to assess the prevalence of candidemia and associated subtypes following severe sepsis in non-neutropenic critically ill patients. <em>Methods:</em> This study was a cross-sectional study that was conducted on severe sepsis patients stayed at least seven days in intensive care unit. Patients less than 18 years old, pregnant and breastfeeding patients, immunocompromised patients, neutropenic patients, patients with concurrent use of antifungal medicines and cytotoxic agents were excluded.To asses the candidemia, one mililiter of patients’ blood sample was collected. Sample analysis was performed by Real-Time PCR and high resolution melting curve analysis method<strong>. </strong><em>Results:</em> Thirty-one critically ill patients were recruited in this study over 12-month period. Candidemia with a detection limit of 100 pg per 0.2 ml blood sample was not recognized in any of the included patients<strong>. </strong><em>Conclusion:</em> The present result indicates low incidence of candidemia in the targeted intensive care units, but other factors such as small sample size, exclusion of patients with compromised immune system and the low fungal load at the time of sampling may also account for our observation.</p> <p>&nbsp;</p> Arefeh Kashiha, Neda Setayesh, Yunes Panahi, Arezoo Ahmadi, Mohammad Soltany-Rezaee-Rad, Atabak Najafi, Mohammad Reza Rouini, Atefeh Namipashaki, Amirhossein Sahebkar, Mojtaba Mojtahedzadeh ##submission.copyrightStatement## Thu, 07 Jun 2018 00:00:00 +0000 Evaluation of serum Asymmetric Dimethyl Arginine concentrations in coronary artery disease patients without traditional cardiovascular risk factors <p><em>Background:</em> Previous studies have shown that Asymmetric Dimethyl Arginine (ADMA) is increased significantly during coronary artery diseases (CAD). However it is not clear either this increase is due to cardiovascular disease (CVD) risk factors or ADMA is increased independently in CAD. The aim of this study is to evaluate ADMA’s plasma level as an independent biomarker in CADs. <em>Patients and methods:</em> In current study a total of 165 subjects with no traditional CVD’s RFs, who fulfilled the inclusion and exclusion criteria, were recruited; 55 CAD+ patients which had more than 50% stenosis (CAD+); 55 CAD- patients which had less than 50% stenosis in their coronary arteries (CAD-), based on their angiography record and 55 healthy individuals as controls. CAD+ patients were divided into three groups: single (SVD), double (2VD), and triple vessel (3VD) disease. Plasma level of soluble ADMA was measured with an enzyme-linked immono sorbent assay (ELISA) kit. <em>Results:</em> No significant difference between ADMA’s plasma levels was found between CAD+, CAD- and healthy groups. In addition ADMA’s plasma levels was not significantly different between CAD+’s subgroups. <em>Conclusions:</em> The result of this study indicates no significant relation between ADMA’s plasma levels and either presence or severity of coronary artery stenosis. Therefore, it is presumed that ADMA may not be an independent biomarker for CADs.&nbsp;</p> <p>&nbsp;</p> Majid Ghayour-Mobarhan, Nayyereh Ayati, Amirhossein Sahebkar, Mohsen Moohebati, Narjes Ayati, Sepideh Elyasi, Amir Houshang Mohammadpour ##submission.copyrightStatement## Thu, 07 Jun 2018 00:00:00 +0000 Cystatin C may not be a precious predictor for coronary artery disease and its severity: an area of uncertainty <p><strong>Background and Aim:</strong> Cystatin C, an endogenous indicator for kidney function, may be also an original indicator for coron</p> <p><em>Background and Aim:</em> Cystatin C, an endogenous indicator for kidney function, may be also an original indicator for coronary atherosclerosis. In the current study, we intended to assess its role in establishing the existence of coronary artery disease. We also attempted to present the best cut off point for Cystatin C to discriminate coronary disease from normal coronary condition. <em>Methods:</em> 147 consecutive patients who were candidate for coronary angiography were included into the study. Cystatin C was measured using Auto-analyzer system and by Gentian kit with enzyme calorimetric method. <em>Results:</em> The mean level of Cystatin C in the patients with and without coronary artery disease was 0.97±0.51 mg/l and 1.02±0.40 mg/l with no significant difference (p=0.564). In multivariate logistic regression model, the serum level of Cystatin C could not predict coronary artery disease (OR=1.199, 95% CI: 0.531 to 1.706, p=0.662). According to the area under the ROC curve, Cystatin C was not a good indicator to discriminate coronary artery disease from normal coronary condition (AUC=0.465, 95% CI: 0.372 to 0.559, p=0.470). Considering cut of points of 0.85 and 0.94 for Cystatin C, the sensitivity of this test for predicting coronary artery disease in comparison with coronary angiography was 65% and 51%, respectively. In assessing relationship between serum level of Cystatin C and other chemical biomarkers, Cystatin C was only correlated with serum triglyceride level (r=0.207, p=0.012). <em>Conclusions:</em> Cystatin C measurement may not be a suitable predictor for coronary artery disease and severity of the coronary involvement. Future studies with large sample size are necessitated to demarcate distinct role of Cystatin C in coronary artery disease.&nbsp;</p> <p>&nbsp;</p> <p>ary atherosclerosis. In the current study, we intended to assess its role in establishing the existence of coronary artery disease. We also attempted to present the best cut off point for Cystatin C to discriminate coronary disease from normal coronary condition.</p> <p><strong>Methods:</strong> 147 consecutive patients who were candidate for coronary angiography were included into the study. Cystatin C was measured using Auto-analyzer system and by Gentian kit with enzyme calorimetric method.&nbsp;</p> <p><strong>Results:</strong> The mean level of Cystatin C in the patients with and without coronary artery disease was 0.97 ± 0.51 mg/l and 1.02 ± 0.40 mg/l with no significant difference (p = 0.564). In multivariate logistic regression model, the serum level of Cystatin C could not predict coronary artery disease (OR = 1.199, 95% CI: 0.531 to 1.706, p = 0.662). According to the area under the ROC curve, Cystatin C was not a good indicator to discriminate coronary artery disease from normal coronary condition (AUC = 0.465, 95%CI: 0.372 to 0.559, p = 0.470). Considering cut of points of 0.85 and 0.94 for Cystatin C, the sensitivity of this test for predicting coronary artery disease in comparison with coronary angiography was 65% and 51%, respectively. In assessing relationship between serum level of Cystatin C and other chemical biomarkers, Cystatin C was only correlated with serum triglyceride level (r = 0.207, p = 0.012).</p> <p><strong>Conclusions:</strong> Cystatin C measurement may not be a suitable predictor for coronary artery disease and severity of the coronary involvement. Future studies with large sample size are necessitated to demarcate distinct role of Cystatin C in coronary artery disease.</p> Hossein Vakili, Abdollah Mohamadian, Mohammadreza Naderian, Isa Khaheshi ##submission.copyrightStatement## Thu, 07 Jun 2018 00:00:00 +0000 Beneficial effects of the treatment of iron deficiency on clinical condition, left ventricular function, and quality of life in patients with chronic heart failure <p><em>Background:</em> Anemia is now considered as an important contributing factor to the deterioration of chronic heart failure. The present study aimed to assess the effects of intravenous iron therapy on clinical condition, left ventricular function and also quality of life in patients who suffered of chronic heart failure and concomitant iron deficiency. <em>Methods:</em> In this clinical trial, 25 consecutive patients with concomitant chronic heart failure and iron deficiency referred to Shariati hospital&nbsp; in Isfahan, Iran in 2013. After initial clinical, laboratory, and echocardiography assessments, the patients administered 200 mg intravenous Iron per week until compensating iron deficit. Then, all study parameters were assessed again and compared to parameters before the therapeutic intervention. <em>Results:</em> The NYHA class showed a significant improvement after the therapeutic approach. The prevalence of heart failure-related edema was also significantly reduced from 60% before treatment to 48% after that (p = 0.036). The rate of hospitalization was considerably reduced from 42% to 16% (P &lt; 0.001). Moreover, mean 6 minute walk test (6MWT) was increased from 155.18 m to 187.40 m (P &lt; 0.001). Comparing Left Ventricular Ejection Fraction (LVEF) after treatment to figures before the test indicated a significant improvement in this parameter (27.5% versus 33.0%, P = 0.007). The treatment of iron deficiency in this group of subjects got a significant improvement in SF36 total score. <em>Conclusion: </em>In patients with chronic heart failure, the treatment of iron deficiency results in a marked improvement in functional status, ejection fraction, and also quality of life as well as a reduction in need to re-hospitalization, however renal function was deteriorated and thus more pay attention to renal function is necessary.</p> <p>&nbsp;</p> Ahmad Mirdamadi, Asadolahi Arefeh, Mohammad Garakyaraghi, Ali Pourmoghadas ##submission.copyrightStatement## Thu, 07 Jun 2018 00:00:00 +0000 Recurrence of prostate cancer after HIFU. Proposal of a novel predictive index <p><em>Background and aim of the work:</em> Prostate cancer is one of the most common cancers in men over 50 years of age. Surgery, radiotherapy and hormonal manipulation represent its typical treatment. High-Intensity Focused Ultrasound (HIFU) is an alternative choice in localized prostate cancer. To date, an index for prediction of recurrence in patients treated with HIFU is not availabe. Our study proposes a novel index for the predition of recurrence able to determine if a candidate is fit for this tratment. <em>methods:</em> 107 patients underwent HIFU fram 2010 to 2015. A total of 12 variables were considered for the analysis. The final predictive model was obtained through a stepwise forward selection method. <em>Results:</em> The final model used a total of 6 variables, all correlated to the response variable. The Index is able to predict the recurrence after HIFU tratment in the most majority of candidates to treatment.&nbsp; The index may be used to make a more scientific decision with regard to choosing optimal candidates for HIFU.</p> <p>&nbsp;</p> Umberto Maestroni, Francesco Morandin, Stefania Ferretti, Francesco Dinale, Francesco Ziglioli ##submission.copyrightStatement## Thu, 07 Jun 2018 00:00:00 +0000 Is it necessary to discontinue metformin in diabetic patients with GFR > 60 ml/min per 1.73 m2 undergoing coronary angiography: A controversy still exists? <p><em>Background:</em> Although metformin is not directly nephrotoxic, it has been postulated that it can impair gluconeogenesis from lactate, which may lead lactate to be accumulated under circumstances such as contrast-induced nephropathy. The present study aims to assess the role of metformin in lactate production in a group of diabetic patients with GFR &gt; 60 ml/min per 1.73 m<sup>2</sup>undergoing coronary angiography. <em>Methods:</em> In the present randomized clinical trial, 162 metformin-treated diabetic patients were enrolled. The enlisted patients were scheduled to undergo coronary angiography at Modarres Hospital from Feb 2012 to Nov 2012. Patients were randomly allocated to continue metformin during peri-angiography period (M (+) group) or to stop the medication 24 hours prior the procedure (M (-) group). All the patients had glomerular filtration rate of &gt;60 mL/min per 1.73 m<sup>2</sup>. Iodixanol was the only contrast media which in all patients. Metformin-associated lactic acidosis (MALA) was defined as an arterial pH &lt;7.35 and plasma lactate concentration &gt;5 mmol⁄L. <em>Results:</em> 162 patients, including79 (48.7%) male and 83 (51.3%) female patients were enrolled in the study. The average of GFR was comparable in both groups (76 ml/min per 1.73 m<sup>2 </sup>in the M (+) group versus 79 ml/min per 1.73 m<sup>2 </sup>in the M (-) group, p=0.53). No significant difference was observed in the mean dose of metformin before the study between the 2 groups (2.18 tablets per day in M (+) group vs. 2.21 tablets per day in M(-) group, p=0.62).No lactic acidosis was observed in the studied groups. <em>Conclusion:</em> In conclusion, the results of the present study indicate that metformin continuation in diabetic patients with a GFR of more than 60 ml/min per 1.73 m<sup>2</sup> undergoing coronary angiography does not enhance the risk of MALA development.</p> <p>&nbsp;</p> Mohammad Hasan Namazi, Saeed AlipourParsa, Kobra Roohigilani, Morteza Safi, Hossein Vakili, Isa Khaheshi, Fatemeh Abdi, Adel Zare, Shooka Esmaeeli ##submission.copyrightStatement## Thu, 07 Jun 2018 00:00:00 +0000 Could infantile interactive drawing technique be useful to promote the communication between children with Type-1 diabetes and pediatric team? <p><em>Aim:</em> to finding what young patients with type-1 diabetes (T1D) knows about their body and also on their illness in perspective to tailor educational interventions to their real ability to understand. <em>Methods</em>: the present study involved 68 children with T1D , 5 to 14 years old with a duration of diabetes ranging from 2 to 6 years and a total HbA1c mean value of 7.96±0.87%. The sample was divided into two age Groups: 28 children 5 to 10 years old were gathered in the Group 1 and 40 teenagers aged from 11 to 14 years in the Group 2. These patients were invited to draw over a white paper using a black pencil “The human body as it is made inside”. Subsequently they were asked to explain: “what is diabetes?” and “where does insulin go?”. According to the methodology of the “interactive drawing”, the interviewer interacted with the children while drawing, forcing them to verbalize the reasons for their choices, to justify their proceeding, to explain their plan and then to explicit their theories. Drawings and replies were classified as Correct, Correct-but-Incomplete and Incorrect. <em>Results</em>: the overall production of correct/correct-but-incomplete drawings was 83.82% vs 16.20% of the incorrect ones. One-hundred of the children who have produced a correct drawing supplied also a correct verbal reply, whereas 100% of the children who have produced an incorrect drawing was unable to supply any information on diabetes or about insulin. Both younger and older subjects who produced a complete-but-incorrect drawing appeared to have misunderstood the action of insulin therapy (only 23% and 17% of correct replies). Children who produced incomplete drawings and provided incorrect replies to the questions about their disease showed also a HbA1c mean value higher (8.36±0.97%) compared to the children who drew and answered correctly (p=0.0023). <em>Conclusions</em>: the operative epistemic approach could represent a promising tool for a health professional team to verify the real understanding acquired by a child about T1D, and to provide pediatrician a guideline to directly communicate with his patient.&nbsp;</p> <p>&nbsp;</p> Maurizio Vanelli, Alberto Munari, Donata Fabbri, Brunella Iovane, Chiara Scarabello, Icilio Dodi, Carla Mastrorilli, Valentina Fainardi, Dora Di Mauro, Carlo Caffarelli ##submission.copyrightStatement## Fri, 15 Jun 2018 00:00:00 +0000 Surgical therapy of cutaneous squamous cell carcinoma: our experience <p><em>Introduction:</em> Cutaneous squamous cell carcinoma (cSCC) is the second most common skin cancer, with an excellent prognosis after surgical removal. However, nodal metastasis are present in about 5% of cases and the death rate is about 2%. <em>Presentation of case:</em> The aim of this study is to report our experience about the surgical treatment of cSCC at the Cutaneous, Regenerative, Mininvasive and Plastic Surgery Unit, University of Parma, Italy, between January 2014 and February 2016. We statistically analyzed the group of patients regarding the average age, gender, localization and size of the lesions. The surgical margins of the excisions are studied and we report the results obtained after a follow up of 3 to 25 months. <em>Discussion: </em>Between January 2014 and February 2016 in our Cutaneous, Regenerative, Mininvasive and Plastic Surgery Unit, we removed 36 squamous cell carcinomas, including 11 cSCCs in situ. The average annual incidence of squamous cell carcinoma in northeast of Italy is about 28,9&nbsp; cases per 100,000 individuals.The number of cSCCs that we removed is lower than the Italian average. In our opinion, this is due to an increase in the early diagnosis of precancerous lesions and their medical or surgical treatment. This reduces the incidence of squamous cell carcinomas developing from precancerous lesions. <em>Conclusion:</em> The excision of cutaneous squamous cell carcinoma should be undertaken with a safety margin of at least 0.9 mm to minimize recurrence and metastasis.&nbsp;</p> <p>&nbsp;</p> Francesco Simonacci, Nicolò Bertozzi, Michele Pio Grieco, Eugenio Grignaffini, Edoardo Raposio ##submission.copyrightStatement## Thu, 07 Jun 2018 00:00:00 +0000 Preliminary report of the characteristics of the upper thigh spur area of the femoral neck in Garden I and II subcapital fractures <p>The “heart” of the calcar is the internal cortical septum called “femoral thigh spur”. Nevertheless, the integrity of the femoral thigh spur and its extensions in Garden I and II&nbsp; femoral neck fractures has not been examined in depth, in CT scan-based studies. The aim of this retrospective study is to analyze characteristics as integrity of upper thigh spur area of the intra-capsular femoral neck using precise CT scans, as well as features of the medial cortical bone interruption of orthopedic calcar, in femoral fractures that are radiographically defined as Garden type I-II.A total number of 23 patients was finally included in our study. We called it the “upper thigh spur area” the area around a 360 degree perimeter of the upper thigh spur. The above-mentioned area is a cylindrical intracapsular structure oriented parallel to the intertrocanteric line of the proximal femur . We analyzed the modification of the cortical bone in this specific intra-capsular area of the femoral neck. In all the cases the upper thigh spur area (the internal cortical septum) was intact. The medial cortical (the known “orthopedic calcar”) was evaluated by CT scans in coronal views; it was found to be interrupted in 14 patients and intact in 9; among patients of the first group, 50% were classified as Garden I and 50% as Garden II. The cortical integrity on 360° of the upper thigh spur area was evaluated by CT scans in axial views through different cuts, and it was found to be intact in all cases. More extended studies including CT scans of Garden I-II-III and IV fractures are needed so as to obtain more complete results. In conclusion, it seems that the integrity of the upper thigh spur zone is associated with stable fractures.&nbsp;</p> <p>&nbsp;</p> Georgios Touloupakis, Alessio Maione, Maria Gabriella Lettera, Wilfried Stuflesser, Fabrizio Ferrara, Guido Antonini, Cornelio Crippa ##submission.copyrightStatement## Fri, 15 Jun 2018 00:00:00 +0000 Delayed, diffuse acute peritonitis secondary to misplacement of a cystogastrostomic “pigtail” drain in an outpatient after discharge <p><em>Background and aim of the work:</em> Pancreatic pseudocyst endoscopic drainage by pancreatogastrostomy “pigtail” drain placement is spreading worldwide, with high success-rate and low morbidity, and is increasingly performed as outpatient procedure. The paper reports an unusual very early complication of this procedure and discusses the peculiar aspects of this event in an outpatient setting. <em>Methods: </em>The first case of a 56-year-old outpatient developing a postoperative diffused acute peritonitis by gastric juice spilling caused by the&nbsp; misplacement of the distal end of two transgastric drains not reaching the pseudocyst is reported. As the case was programmed as outpatient and acute peritonitis symptoms occurred eight hours postoperatively, the patient was discharged and rehospitalized. A review of the literature of rare perforative complications of pancreatogastrostomy is performed. <em>Results: </em>CT scan allowed the prompt diagnosis, as it showed massive pneumoperitoneum, free fluid collection, and pigtail drain misplacement. Emergency laparoscopy allowed the removal of the two misplaced drains and gastric reparation. The procedure lasted 65 minutes, mostly needed for lavage. The patient was discharged 5 days later and outcomes are unremarkable 7 months after the procedure. <em>Conclusion: </em>The indication to endoscopic pancreatogastrostomy and its outpatient management should be carefully pondered. Pancreogastrostomy drain misplacement may cause a life-threatening acute peritonitis associated with early aspecific symptoms, resulting in a challenging situation, especially in an outpatient setting. CT-scan may allow prompt diagnosis and effective management by minimally invasive surgery.</p> <p>&nbsp;</p> Renato Costi, Alban Zarzavadjian Le Bian, Maria Teresa Mita, Assamoi Brou Fulgence Kassi, Leopoldo Sarli, Vincenzo Violi ##submission.copyrightStatement## Fri, 15 Jun 2018 00:00:00 +0000 Spot the trachea! A wide paratracheal air cyst of not easy definition <p>We report a case of a 68-year-old woman with an occasional image of a wide paratracheal oval air cyst of not easy definition. Patient had never received a chest X-ray and she had never suffered from symptoms that needed to investigate the trachea or the neck. The diagnostic hypothesis was a wide tracheal diverticulum or a bronchogenic cyst.  </p> Ernesto Crisafulli, Chiara Lazzari, Chiara Longo, Nicol Bernardinello, Veronica Alfieri, Alfredo Chetta ##submission.copyrightStatement## Thu, 07 Jun 2018 00:00:00 +0000 Charles Bonnet syndrome versus Occipital Epilepsy, a diagnostic challenge <p>Charles Bonnet Syndrome (CBS) is a disorder with visual deficit and complex recurrent visual hallucination in conscious patients, described for the first time by Charles Bonnet. It has been found in association with variable pathologic conditions of the eyes, central visual pathways and occipital lobe. Occipital lobe lesion is an important cause of visual field deficit associated with elementary simple hallucinations, whereas complex hallucinations are related to occipitotemporal and occipitoparietal visual association neocortex damage.</p> <p>&nbsp;</p> Holta Zhuzhuni, Andrea Nazaret, Lanfranco Iodice, Saverio Celletti, Sabrina Anticoli, Luigi Di Cioccio, Francesco Cipolla ##submission.copyrightStatement## Fri, 15 Jun 2018 00:00:00 +0000 FNA Cytology in pediatric small cell glioblastoma <p>Small cell glioblastoma is a high anaplastic variant of GBM characterized by a monomorphic proliferation of small or medium cells with oval nuclei and scanty cytoplasm. <em>Case study:</em> The cytologic findings of a small cell glioblastoma in 11-year-old male and histologic features of the tumor using immunocytohistochemistry are reported. <em>Conclusion: </em>The accurate preoperative diagnosis of a small cell glioblastoma is crucial to developing a curative surgical plan. Cytology- confirmed by histology- provides a convenient, safe and effective approach to solving a challenging differential diagnosis.&nbsp;</p> <p>&nbsp;</p> Alexandrai Kalogerak, Dimitrios Tamiolakis, Iris Zoi, Iliana Karvela-Kalogeraki, Mihailos Karvelas-Kalogerakis, John Segredakis, Galateia Datseri ##submission.copyrightStatement## Thu, 07 Jun 2018 00:00:00 +0000 Periosteal osteoblastoma of the distal fibula with atypical radiological features: a case report. <p>We reported the case of a 22 year-old boy who suffered a periosteal osteoblastoma of the distal fibula. The radiographic features of our case did not correlate with the majority of periosteal osteoblastomas of the long bones reported in the literature and were identical to a periosteal aneurysmal bone cyst. Periosteal osteoblastoma is a very rare tumor with a wide range of clinical and radiological features, showing in 15% of cases association with secondary aneurysmal bone cyst. Radiologist and orthopaedic surgeon should be aware of the atypical behavior of this rare entity in order to avoid mistakes with other more common tumors arising on the surface of the long bones.</p> <p>&nbsp;</p> Alessio Biazzo, Elisabetta Armiraglio, Antonina Parafioriti, Norberto Confalonieri ##submission.copyrightStatement## Thu, 07 Jun 2018 00:00:00 +0000 Sexual dysfunction in Neurological disorders: do we see just the tip of the iceberg? - Rocco Salvatore Calabrò ##submission.copyrightStatement## Thu, 07 Jun 2018 00:00:00 +0000 The Italian Code of Medical Deontology. Historical, ethical and legal issues <p><em>Background and aim: </em>Medical deontology is increasingly important, owing to the interests and rights which the medical profession involves. This paper focuses on the relationships of the Italian Code of Medical Deontology (CMD) with both the ethical and legal dimensions, in order to clarify the role of medical ethics within the medical profession, society and the overall system of the sources of law. <em>Methods:</em> The authors analyze the CMD from an ethical perspective and through the new doctrinal guidelines and current trends in the Italian law courts. <em>Results:</em> From an ethical point of view,&nbsp; moral philosophical analysis scarcely seems to&nbsp; address professional medical ethics. Nonetheless, the CMD needs to undergo careful ethical analysis. From a legal perspective, the Italian CMD contains provisions which do not have&nbsp; an official legal nature. However, they are directly binding for medical practitioners, and therefore could be understood as a supplement to the general rules of the legal system. <em>Conclusions: </em>At an ethical level, rigorous debate on the CMD is indispensable, in order to update its specific principles and to make it a real moral normative document. At a legislative level, there is a possible contradiction between a legal system that does not take into account the CMD, but which then attributes significant importance to the violation of its rules.</p> <p>&nbsp;</p> Sara Patuzzo, Francesco De Stefano, Rosagemma Ciliberti ##submission.copyrightStatement## Fri, 15 Jun 2018 00:00:00 +0000 Nutritional prevention of cognitive decline and dementia <p>Cognitive impairment results from a complex interplay of many factors. The most important independent predictor of cognitive decline is age but other contributing factors include demographic, genetic, socio-economic, and environmental parameters, including nutrition. The number of persons with cognitive decline and dementia will increase in the next decades in parallel with aging of the world population. Effective pharmaceutical treatments for age-related cognitive decline are lacking, emphasizing the importance of prevention strategies. There is extensive evidence supporting a relationship between diet and cognitive functions. Thus, nutritional approaches to prevent or slow cognitive decline could have a remarkable public health impact. Several dietary components and supplements have been examined in relation to their association with the development of cognitive decline. A number of studies have examined the role of dietary patterns on late-life cognition, with accumulating evidence that combinations of foods and nutrients may act synergistically to provide stronger benefit than those conferred by individual dietary components. Higher adherence to the Mediterranean dietary pattern has been associated with decreased cognitive decline and incident AD. Another dietary pattern with neuroprotective actions is the Dietary Approach to Stop Hypertension (DASH). The combination of these two dietary patterns has been associated with slower rates of cognitive decline and significant reduction in incident AD. This review evaluates the evidence for the effects of some dietary components, supplements, and dietary patterns as neuroprotective, with potential to delay cognitive decline and the onset of dementia.</p> <p>&nbsp;</p> Ligia J. Dominguez, Mario Barbagallo ##submission.copyrightStatement## Thu, 07 Jun 2018 00:00:00 +0000 Biogerontology: research status, challenges and opportunities <p>Biogerontology is the study of the biological basis of ageing and age-related diseases. The phenomenon and the process of ageing are well understood in evolutionary and biological terms; and a conceptual framework has been established within which general principles of ageing and longevity can be formulated. The phenotype of ageing in terms of progressive loss of physical function and fitness is best seen during the period of survival after the evolution-determined essential lifespan (ELS) of a species. However, the ageing phenotype is highly heterogenous and individualistic at all levels from the whole body to the molecular one. Most significantly, the process and the progression of ageing are not determined by any specific gerontogenes. Ageing is the result of imperfect maintenance and repair systems that allow a progressive shrinkage of the homeodynamic space of an individual. The challenge is to develop and apply wholistic approaches to the complex trait of ageing for maintaining and/or improving health. One such approach is that of mild stress-induced physiological hormesis by physical, mental and nutritional hormetins. Biogerontological research offers numerous opportunities for developing evidence-based novel biomedical technologies for maintaining and improving health, for preventing the onset of age-related diseases, and for extending the health-span.</p> Suresh I.S. Rattan ##submission.copyrightStatement## Thu, 07 Jun 2018 00:00:00 +0000 The complexity of loneliness <p>Loneliness is a prevalent and global problem for adult populations, and a number of different studies have linked it to multiple chronic conditions, including: heart disease, lung disease, cardiovascular disease, hypertension, atherosclerosis, stroke, and metabolic disorders, such as obesity and metabolic disease. Is a major predictor of psychological problems, such as depression, psychological stress, and anxiety. Loneliness is linked to overall morbidity and mortality in adult populations. But limited interventions have demonstrated long-term effectiveness in reducing loneliness in adults with these same chronic conditions. Our research of the extant literature addresses the following question: What evidence exists regarding the relationships between loneliness and health? We focus on recent findings with respect to the links between loneliness and health.</p> <p>&nbsp;</p> Javier Yanguas, Sacramento Pinazo-Henandis, Francisco José Tarazona-Santabalbina ##submission.copyrightStatement## Thu, 07 Jun 2018 00:00:00 +0000