Impact of direct acting antivirals (DAAs) on cardiovascular events in HCV cohort with pre-diabetes

Background and aimsBeyond type 2 diabetes, even a condition of prediabetes is associated with an increased cardiovascular (CV) risk, and HCV infection coexistence represents an exacerbating factor. CV prognosis improvement in prediabetes represents a challenge, due to the increasing prevalence of this metabolic condition worldwide. Hence, we aimed to prospectively assess how direct acting antivirals (DAAs) could affect major cardiovascular events (MACE) in a prediabetic HCV positive cohort.Methods and resultsIn this prospective multicenter study, we enrolled HCV patients with overt prediabetes. We compared a subgroup of patients treated with DAAs with untreated prediabetic controls. We recorded all CV events occurred during an overall median follow-up of 24 months (IQR 19–34). 770 HCV positive prediabetic patients were enrolled, 398 untreated controls and 372 DAAs treated patients. Overall, the CV events annual incidence was much higher among prediabetic treated patients (1.77 vs. 0.62, p < 0.001), and HCV clearance demonstrated to significantly reduce CV events (RR: 0.411, 95%CI 0.148–1.143; p < 0.001), with an estimated NNT for one additional patient to benefit of 52.1. Moreover, an independent association between a lower rate of CV events and HCV clearance after DAAs was observed (OR 4.67; 95%CI 0.44–53.95; p = 0.016).ConclusionsHCV eradication by DAAs allows a significant reduction of MACEs in the prediabetic population, and therefore represents a primary objective, regardless of the severity of liver disease and CV risk factors.     

Reconstruction of a complex pelvic perineal defect with pedicled anterolateral thigh flap combined with bilateral lotus petal flap: A case report

Reconstructing extensive perineal defects represents a challenge, and reconstructive choice requires a careful physical assessment of previous radiotherapy, pre‐existing scars, the presence of stomas, and the availability of donor sites. We report a case of a patient affected by an anal carcinoma who underwent a pelvic exenteration and bilateral inguinal iliac obturator lymph node dissection. We performed a pedicled anterolateral thigh flap (ALT) combined with bilateral lotus petal flaps (LPF) to reconstruct the pelvic–perineal area. The result was good, and no major post‐operative complications were reported. Bilateral LPF, combined with a pedicled ALT, may represent a valid option in pelvic–perineal reconstruction following a wide oncological resection. © 2014 Wiley Periodicals, Inc. Microsurgery 35:154–157, 2015.     

Prevalence and distribution by gender of occlusal characteristics in a sample of Italian secondary school students: a cross-sectional study

The aim of this study was to describe the prevalence and distribution, by gender, of occlusal traits in a sample of Italian students aged 11-14 years (mean 13 +/- 1 years). Using standardized and validated recording criteria, a single operator measured the overjet, overbite, open bite, anterior and posterior crossbites, crowding, coincidence of the upper and lower midlines, and diastema, in 810 secondary school students (53.6 per cent males). Chi-square, t-test statistics, and odds ratios (ORs) with 95 per cent confidence intervals (CI) were used to investigate the relationship between gender and malocclusion characteristic. Logistic regression was used to further analyse the independent association between gender and each outcome measure. Ninety-three per cent of the subjects showed at least one occlusal trait, with one or two anomalies recorded in 63 per cent of children. The prevalence of occlusal traits ranged from 1.1 (negative overjet) to 54 per cent (upper and lower midlines not coincident). Males were more likely than females to show both an increased overbite and an increased overjet, although the latter result was not confirmed by logistic regression (P = 0.05). Multivariate analysis showed a negative association between overbite and misalignment of the lower incisors and lack of coincidence of the upper and lower midlines, whereas subjects with an increased overbite were more likely to have an increased overjet (all P < 0.01). Further studies are required in order to further clarify these findings and to provide accurate estimates of the orthodontic treatment need in Italian adolescents.     

Second cycle of intralesional Collagenase Clostridium histolyticum for Peyronie's disease using the modified shortened protocol: Results from a retrospective analysis

The purpose of this study was to evaluate the effectiveness and safety of the second cycle of Collagenase Clostridium histolyticum injections using the modified shortened protocol. We performed a retrospective analysis on patients who had already undergone the first cycle of injections using the modified shortened protocol and requested more injections to improve the remaining curvature. The International Index of Erectile Function, the Peyronie's Disease Questionnaire and the Global Assessment of Peyronie's Disease questionnaire were self-administered to all patients. All the parameters were recorded at baseline, after the first cycle and after the second cycle of injections. All adverse events were recorded. Seventeen patients completed two cycles of injections. All patients had a reduction of the initial curvature after the first cycle, with a mean improvement of 17.4° (27.4%). After the second cycle, the reduction of the curvature was 7.9° (17.1%), and 29.4% of patients had no further improvement. No severe side effect was recorded. The results of the present study confirm the effectiveness and safety of the modified shortened protocol of Collagenase C. histolyticum injections for Peyronie's disease. However, the second cycle of three injections may be less effective, and patients may not be completely satisfied.     

Explicit and incidental facial expression processing: an fMRI study

Considerable evidence indicates that processing facial expression involves both subcortical (amygdala and basal ganglia) and cortical (occipito-temporal, orbitofrontal, and prefrontal cortex) structures. However, the specificity of these regions for single types of emotions and for the cognitive demands of expression processing, is still unclear. This functional magnetic resonance imaging (fMRI) study investigated the neural correlates of incidental and explicit processing of the emotional content of faces expressing either disgust or happiness. Subjects were examined while they were viewing neutral, disgusted, or happy faces. The incidental task required subjects to decide about face gender, the explicit task to decide about face expression. In the control task subjects were requested to detect a white square in a greyscale mosaic stimulus. Results showed that the left inferior frontal cortex and the bilateral occipito-temporal junction responded equally to all face conditions. Several cortical and subcortical regions were modulated by task type, and by facial expression. Right neostriatum and left amygdala were activated when subjects made explicit judgements of disgust, bilateral orbitofrontal cortex when they made judgement of happiness, and right frontal and insular cortex when they made judgements about any emotion.     

Recurrent Glioma and Crossed Cerebellar Diaschisis in a Patient Examined With 18F-DOPA and 18F-FDG PET/CT

ABSTRACT: Two years after resection of a left parietal glioma, a 46-year-old woman underwent F-FDG and F-DOPA brain PET/CT. FDG showed left parietal hypometabolism with crossed cerebellar diaschisis. No abnormally increased FDG activity was seen. F-DOPA PET/CT scan demonstrated focal left parietal uptake. Recurrent glioma was confirmed by surgical biopsy. F-DOPA may demonstrate abnormal amino acid metabolism in evaluation of recurrence of glioma.