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To verify the main advantages and drawbacks of mechanical suturing for pharyngeal closure after total laryngectomy versus a manual suturing technique.
A retrospective review was carried out of 126 total laryngectomies performed between 2008 and 2018. Manual closure was performed in 80 cases (63.5 per cent) and mechanical suturing was performed in 46 cases (36.5 per cent).
Mechanical suturing was used significantly more frequently in patients with: glottic tumours (p = 0.008), less local tumour extension (p = 0.017) and less pre-operative morbidity (p = 0.014). There were no significant differences in the incidence of pharyngocutaneous fistula between the manual suture group (16.3 per cent) and the mechanical suture group (13.0 per cent) (p = 0.628). None of the patients treated with mechanical suturing had positive surgical margins. Cancer-specific survival for the mechanical suture group was higher than that for the manual suture group (p = 0.009).
Mechanical suturing of the pharynx after total laryngectomy is an oncologically safe technique if used in suitable cases.
Nimodipine was administered at the daily dose of 90 mg po, for 30 days, to ten chronic undifferentiated schizophrenics, eight men and two women, aged 31-35 years, maintained on previously longlasting neuroleptic treatments. In five patients, a placebo period of 15 days preceded the administration of the drug. Monitoring of psychiatric symptomatology by the Brief Psychiatric Rating Scale (BPRS) revealed significant nimodipine-induced improvement. However, the Andreasen Rating Scale for Positive Symptoms (SAPS) showed favourable effects only in the five patients who had not received placebo, while in the others both SAPS and the Andreasen Rating Scale for Negative Symptoms (SANS) showed no significant effect of therapy. The Tardive Dyskinesia Scale revealed no improvements of neurological symptoms after either placebo or drug treatment. Measurement of plasma MHPG concentrations revealed no significant changes induced by either placebo or nimodipine, while HVA plasma levels showed a trend toward decrease, and prolactin a trend toward increase, after nimodipine.
A recent meta-analyses by our team found baseline respiratory abnormalities in subjects with Panic Disorder (PD) compared to subjects without PD. However, it is still open the question whether these abnormalities are intrinsic to pathophysiology of PD or may be shared with other psychiatric populations with high trait and state anxiety levels, such as subjects suffering from other anxiety disorders.
To meta-analyze the results from all of the studies that compared baseline respiratory parameters between subjects with PD and subjects with other anxiety disorders.
A literature research in bibliographic databases was performed. Only fixed-effects models were applied due to the small number of studies available for each parameter. Several moderator analyses and publication bias diagnostics were performed.
Subjects with PD showed a lower end-tidal CO2 pressure and a higher mean respiration rate at baseline compared to patients with both Generalized Anxiety Disorders and Social Phobia. Furthermore, also a significantly lower venous CO2 pressure and a higher venous HCO3- (bicarbonate ion) concentrations in PD than Social Phobia was found. Moderator analyses suggested that these differences between groups are not explained by differences in the state anxiety levels experienced during the assessment procedure. No evidence of publication bias was found.
Results suggest that peculiar baseline respiratory abnormalities and particularly a chronic hyperventilation may be specific of PD pathophysiology also when compared to other anxiety disorders.
A connection between balance system dysfunction and Agoraphobia (AG) in Panic Disorder (PD) has been found. Balance control of many patients with PD and AG rely mainly on visual cues (visual dependence) and moving visual stimuli in their peripheral visual field induce postural instability and anxiety. These features may maintain agoraphobic symptoms after standard treatments.
To study whether balance rehabilitation with moving peripheral visual stimuli would benefit patients with PD and AG not fully responders to standard treatments.
Six patients with PD and AG were included. Inclusion criteria: 1) panic-phobic symptoms despite adequate treatments (SSRIs for at least 3 months; cognitive behavioral therapy) and 2) balance dysfunction with instability during peripheral visual stimuli (posturography with and without peripheral visual stimulation).
The patients went through 10 sessions (3 sessions/week) of balance rehabilitation: static and dynamic exercises, with movements of eyes and head, during projection of peripheral visual stimuli (video-films, 32 times-accelerated, on large lateral screens). Descriptive and non-parametric analyses were applied.
After rehabilitation, the patients showed significant improvement both in panic-phobic symptoms (specific psychometric scale scores) (p < 0.05) and in balance performance (post-rehabilitation posturography with and without peripheral visual stimulation) (p < 0.05).
Balance rehabilitation with peripheral visual stimuli may increase the efficacy of standard treatments in patients with PD and AG and visual-balance dysfunction. Mechanisms of physical and emotional habituation to environmental destabilizing stimuli may be involved. Further larger and controlled studies are warranted.
In patients with Schizophrenia an association between smoking and improvement in cognitive deficits was found. Patients with Major Depressive Disorder (MDD) and Bipolar Disorder (BD) have shown a high prevalence of smoking habit and cognitive deficits but only a few studies have investigated the effect of smoking on their cognitive functions.
To study the effect of nicotine assumption on cognitive function in MDD and BD.
50 inpatients with MDD and 50 with BD (Major Depressive Episode) underwent a neuropsychological test battery (Anna Pesenti test, Attentive Matrices, Rey-Osterrieth Complex Figure, Phonemic/Semantic Fluency tests, Token test) at the beginning of their hospitalization. Smoking habit (current, lifetime) was investigated by specific questionnaires. Factorial ANOVA models were applied, with cognitive test scores as dependent variables and smoking (smoker/non-smoker) and diagnosis (MDD/BD) as factors.
Smokers showed significantly better performance in verbal memory (p < 0.001) and fluency tests (phonemic p = 0.012; semantic p = 0.023) than non-smokers. Significant and positive correlations were found between the scores of these tests and the number of cigarettes smoked in the 24 hours before, while no associations with the years of smoking habit were found. No effects of diagnosis or interaction between smoking and diagnosis on the cognitive performance were found.
Animal models show that nicotine can increase the monoamine levels in brain areas involved in memory and language functions. Our results suggest that the positive effect of smoking on cognitive functions may contribute to increase the smoking habit in patients with Mood Disorders as a self-medication strategy.
Previous studies suggested that cognitive enhancement associated with nicotine may be a form of “selfmedication” explaining high rates of smokers among patients with Schizophrenia or Mood Disorders. On the contrary, patients with Obsessive-Compulsive Disorder (OCD), though are characterized by cognitive impairment, do not show a higher tendency to smoking than general population and show a lower tendency to smoking than other psychiatric patients.
Our pilot study aims to investigate the effect of cigarette smoking on cognitive performance in patients with OCD. No published studies investigated this issue.
Fifty-nine inpatients suffering from OCD (22 smokers and 37 non-smokers) were recruited. At the beginning of the hospitalization, we assessed different cognitive domains using a standard non-computerized neuropsychological battery (memory, attention and verbal fluency). In addition, 28 patients out of the 59 (12 smokers and 16 non-smokers) underwent a computerized neuropsychological evaluation specific for executive functions (CANTAB software). OCD-clinical symptoms were evaluated by Y-BOCS.
Smokers and non-smokers did not differ for demographic (age, schooling) and clinical variables (Y-BOCS scores). Compared to non-smokers, smokers showed worse performances on the phonemic fluency test (non-computerized battery) and a tendency to risk higher amount of money on a decision making task (CANTAB).
Smoking does not seem to improve cognitive performances of patients with OCD, whereas it seems to affect impulsivity, thus worsening decision making ability and flexibility, possibly by an effect of nicotine on dopaminergic neurotransmission in orbito-frontal cortex. This may explain the low rate of smokers in patients with OCD.
Emergency situations related to mental disorders represent a significant proportion of all medical emergencies. Over the last years we have been witness to an upturn in the incidence of psychiatry emergency service because to change of mood.
To determine the profile of the patient who requires psychiatric attention with changing of mood in our area in different seasons.
This is a prevalence and prospective study in which the dependent variable is taken as change of mood and we also use three more independent variables that are age sex and seasonality. The seasonality (spring period and summer period) will be at the same time the form of divided the population in two groups to compare.
Out of all the consultations for changing of mood in the emergency service during the first period (113 patients), 34% were men and 66% were women. The age range of 36–50 years was more frequent for women and the age range of 51–65 years was more frequent for men. in the second period (with 162 patients), 137 women (86%) and 25 men (14%). in this case, the most common age range was 36–50 years, both for women and for men.
The epidemiological and clinical characteristics of patients with changing of mood assessed by the emergency service are described from a naturalistic approach.
Which Chi2 we will discover if the population who has been taken between woman and man is significant and with the median, we will also determine if the age ranges are enough significant to confirm our hypothesis.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Personalized medicine (PM) aims to establish a new approach in clinical decision-making, based upon a patient's individual profile in order to tailor treatment to each patient's characteristics. Although this has become a focus of the discussion also in the psychiatric field, with evidence of its high potential coming from several proof-of-concept studies, nearly no tools have been developed by now that are ready to be applied in clinical practice. In this paper, we discuss recent technological advances that can make a shift toward a clinical application of the PM paradigm. We focus specifically on those technologies that allow both the collection of massive as much as real-time data, i.e., electronic medical records and smart wearable devices, and to achieve relevant predictions using these data, i.e. the application of machine learning techniques.
The current study characterizes associations between physical and social contexts of self-reported primary episodes of eating/drinking and sociodemographic and obesity-related variables in US adults.
Multinomial logistic regression was used to analyse a nationally representative sample of adults from the 2006–2008 American Time Use Survey. Models identifying physical (where) and social (whom) contexts of primary eating/drinking episodes at the population level, controlling for demographic characteristics, weight status and time of eating, were conducted.
A nationally representative sample of US adults (n 21 315).
Eating/drinking with immediate family was positively associated with age (OR = 1·15 (95 % CI 1·04, 1·27) to 1·23 (95 % CI 1·09, 1·39)), education level (OR = 1·16 (95 % CI 1·03, 1·30) to 1·36 (95 % CI 1·21, 1·54)), obesity (OR = 1·13 (95 % CI 1·04, 1·22)), children in the household (OR = 3·39 (95 % CI 3·14, 3·66)) and time of day (OR = 1·70 (95 % CI 1·39, 2·07) to 5·73 (95 % CI 4·70, 6·99)). Eating in the workplace was negatively associated with female gender (OR = 0·65 (95 % CI 0·60, 0·70)) and children in the household (OR = 0·90 (95 % CI 0·83, 0·98)), while positively associated with non-white status (OR = 1·14 (95 % CI 1·01, 1·29) to 1·47 (95 % CI 1·32, 1·65)) and time of day (OR = 0·25 (95 % CI 0·28, 0·30) to 5·65 (95 % CI 4·66, 6·85)). Women (OR = 0·80 (95 % CI 0·74, 0·86)), those aged >34 years (OR = 0·48 (95 % CI 0·43, 0·54) to 0·83 (95 % CI 0·74, 0·93)) and respondents with children (OR = 0·69 (95 % CI 0·63, 0·75)) were less likely to eat in a restaurant/bar/retail than at home. Overweight and obese respondents had a greater odds of reporting an episode of eating in social situations v. alone (e.g. immediate family and extended family; OR = 1·13 (95 % CI 1·04, 1·22)) and episodes occurring in restaurant/bar/retail locations (OR = 1·12 (95 % CI 1·03, 1·23) to 1·14 (95 % CI 1·05, 1·24)).
Findings underscore the multidimensional nature of describing eating/drinking episodes. Social and physical contexts for eating/drinking and their demographic correlates suggest opportunities for tailoring interventions related to diet and may inform intervention targeting and scope.
The current research examined the association between state disfavoured tax on soda (i.e. the difference between soda sales tax and the tax on food products generally) and a summary score representing the strength of state laws governing competitive beverages (beverages that compete with the beverages in the federally funded school lunch programme) in US schools.
The Classification of Laws Associated with School Students (CLASS) summary score reflected the strength of a state's laws restricting competitive beverages sold in school stores, vending machines, school fundraisers and à la carte cafeteria items. Bridging the Gap (BTG) is a nationally recognized research initiative that provided state-level soda tax data. The main study outcome was the states’ competitive beverage summary scores for elementary, middle and high school grade levels, as predicted by the states’ disfavoured soda tax. Univariate and multivariate analyses were conducted, adjusting for year and state.
Data from BTG and CLASS were used.
BTG and CLASS data from all fifty states and the District of Columbia from 2003 to 2010 were used.
A higher disfavoured soda sales tax was generally associated with an increased likelihood of having strong school beverage laws across grade levels, and especially when disfavoured soda sales tax was >5 %.
These data suggest a concordance between states’ soda taxes and laws governing beverages sold in schools. States with high disfavoured sales tax on soda had stronger competitive beverage laws, indicating that the state sales tax environment may be associated with laws governing beverage policy in schools.
Many studies of various stress reactive phenotypes suggest that 5-HTTLPR short allele carriers (S-carriers) are characterised by the stable trait of negative affectivity that is converted to psychopathology only under conditions of stress. In this study, we examined the moderating role of the 5-HTTLPR on the relationship between two objective chronic risk factors, i.e. socioeconomic status (SES) and family structure, and internalising symptoms across adolescence.
A multigroup path analysis was employed in a general adolescent population sample of a 5-year follow-up study.
Internalising problems were significantly more stable in the S-carriers. The focus on the main dimensions of internalising problems, i.e. anxiety and depression, revealed two different developmental patterns. In the S-carriers Anxiety problems seemed to be more stable and to predict a possible evolution towards the development of Depressive problems. In the long allele homozygotes (LL-subjects) the anxiety trait was significantly less stable, and, in late-adolescence, seemed to be significantly predicted by SES, suggesting a possible gene–environment interaction (G × E). Family structure seemed to play a role in a G × E perspective only until early-adolescence, while during late-adolescence SES seemed to play a pivotal role in interaction with 5-HTTLPR, with the S-allele playing a protective role.
Future models of the developmental link between environmental adversities and internalising behaviour therefore need to consider that the effect of G × E interaction, may be associated with internalising behaviour via different mechanisms during different time frames and that shifts in the strength of this effect should be expected across development.
This study sought to establish the prevalence of vestibular disorders, migraine and definite migrainous vertigo in patients with psychiatric disorders who were referred for treatment of dizziness, without a lifetime history of vertigo.
Out-patients in a university hospital.
Materials and methods:
Fifty-two dizzy patients with panic disorders and agoraphobia, 30 with panic disorders without agoraphobia, and 20 with depressive disorders underwent otoneurological screening with bithermal caloric stimulation. The prevalence of migraine and migrainous vertigo was assessed. The level of dizziness was evaluated using the Dizziness Handicap Inventory.
Dizzy patients with panic disorders and agoraphobia had a significantly p = 0.05 regarding the prevalence of peripheral vestibular abnormalities in the group of subjects with PD and agoraphobia and in those with depressive disorders. Migraine was equally represented in the three groups, but panic disorder patients had a higher prevalence of migrainous vertigo definite migrainous vertigo. Almost all patients with a peripheral vestibular disorder had a final diagnosis of definite migrainous vertigo according to Neuhauser criteria. These patients had higher Dizziness Handicap Inventory scores. The Dizziness Handicap Inventory total score was higher in the subgroup of patients with panic disorders with agoraphobia also presenting unilateral reduced caloric responses or definite migrainous vertigo, compared with the subgroup of remaining subjects with panic disorders with agoraphobia (p < 0.001).
Our data support the hypothesis that, in patients with panic disorders (and especially those with additional agoraphobia), dizziness may be linked to malfunction of the vestibular system. However, the data are not inconsistent with the hypothesis that migrainous vertigo is the most common pathophysiological mechanism for vestibular disorders.
We present a detailed study of the angular dependence of the magnetization reversal at room temperature of well characterized epitaxial La0.7Sr0.3MnO3 (001) thin films grown onto SrTiO3 (001) vicinal substrates. The step edges at the substrate surface promote a topological modulation of the films along the step direction, breaking the four-fold magneto crystalline symmetry and favoring a two-fold magnetic anisotropy term. The competition between the biaxial and uniaxial anisotropy is depicted within the framework of the current theory, resulting in a vanishing biaxial contribution. The films hence show the magnetization easy (hard) direction parallel (perpendicular) to the steps direction. The thickness-dependent of both anisotropy and magnetization reversal are discussed in terms of topographic changes.
We report photoluminescence spectra of C60 single crystals grown by vapor phase transport method using either the sealed ampoule technique or the open tube technique. The spectra for both types of samples show similar features, but different line resolution related to the two different
growth techniques. An analysis of temperature and excitation intensity dependencies of the
luminescence spectra is reported. The main structures of the spectra have been interpreted according to a model involving intramolecular polaron-exciton recombinations. In particular, emissions due to
purely electronic transitions of singlet and triplet or the exciton and related vibronic recombinations have been resolved. At low temperature, emission bands due to X-traps have been observed on the high-energy side of the excitonic singlet purely electronic transition.