Luca Bastiani

Optimizing the Balance Between Radiation Dose and Image Quality in Pediatric Head CT: Findings Before and After Intensive Radiologic Staff Training

OBJECTIVEnThe purpose of this study was to assess the radiation dose and image quality of pediatric head CT examinations before and after radiologic staff training.nnnMATERIALS AND METHODSnOutpatients 1 month to 14 years old underwent 215 unenhanced head CT examinations before and after intensive training of staff radiologists and technologists in optimization of CT technique. Patients were divided into three age groups (0-4, 5-9, and 10-14 years), and CT dose index, dose-length product, tube voltage, and tube current-rotation time product values before and after training were retrieved from the hospital PACS. Gray matter conspicuity and contrast-to-noise ratio before and after training were calculated, and subjective image quality in terms of artifacts, gray-white matter differentiation, noise, visualization of posterior fossa structures, and need for repeat CT examination was visually evaluated by three neuroradiologists.nnnRESULTSnThe median CT dose index and dose-length product values were significantly lower after than before training in all age groups (27 mGy and 338 mGy ∙ cm vs 107 mGy and 1444 mGy ∙ cm in the 0- to 4-year-old group, 41 mGy and 483 mGy ∙ cm vs 68 mGy and 976 mGy ∙ cm in the 5- to 9-year-old group, and 51 mGy and 679 mGy ∙ cm vs 107 mGy and 1480 mGy ∙ cm in the 10- to 14-year-old group; p < 0.001). The tube voltage and tube current-time values after training were significantly lower than the levels before training (p < 0.001). Subjective posttraining image quality was not inferior to pretraining levels for any item except noise (p < 0.05), which, however, was never diagnostically unacceptable.nnnCONCLUSIONnRadiologic staff training can be effective in reducing radiation dose while preserving diagnostic image quality in pediatric head CT examinations.

Relationship Between Gambling Severity and Attitudes in Adolescents: Findings from a Population-Based Study

This study used a nationally representative sample of 14,910 high school adolescents, aged 15–19xa0years. The large sample size presents a unique opportunity to evaluate firstly the geographical distribution of gambling prevalence, secondly, on a subsample of 5,920 adolescents, we studied the association of “no-problem-gambling”, “at-risk gambling” and a relatively rare condition, “problem gambling”, with demographic, environmental and behavioral variables. It differs from other studies due to the broad sample, thus enabling the combined analysis of the above variables that typically have only been studied separately. This integrated analysis, involving multiple variables, individual and environmental, allows the control of important covariates. Multivariate analysis showed that at-risk/problem gamblers were more likely to be engaged in behaviors contrary to social rules/law including heavy episodic drinking, tranquillizer/sedatives use as well as to approve gambling and have friends who gamble. It’s important to emphasize that risk-perception is not related to gambling. Furthermore, the great geographical variability of at-risk and problem-gambling rates suggest that social aspects have to be considered. Currently universal prevention specifically targeting gambling is lacking, thus an associative model such as social analysis have been implemented in this study, in order to construct the basis for the design of a future prevention program based on scientific results and thus having important implications for implementation within community based activities. Prevention is fundamental: 53.5xa0% of underage individuals have engaged in gambling even though legislation attempts to restrict access.

Association of Problem Gambling with Type of Gambling Among Italian General Population.

The origin of gambling disorders is uncertain; however, research has shown a tendency to focus on specific types of games as a potential important risk factor. The principal aim of this study is to examine the relationships between types of gambling practices and gambling disorder. The data were extracted from IPSAD-Italia® 2010–2011 (Italian Population Survey on Alcohol and other Drugs), a survey among the Italian general population which collects socio-cultural information, information about the use of drugs, legal substances and gambling habits. In order to identify the “problem gambler” we used the Problem Gambling Severity Index. Three groups are considered in this analysis: no-risk gamblers, low-risk gamblers, moderate-risk/problem gamblers. Type of gambling practice was considered among two types of gambler: one-game players and multi-games players. 1.9xa0% of multi-game players were considered problem gamblers, only 0.6xa0% of one-game players were problem gamblers (pxa0<xa00.001). The percentage of players who were low and moderate-risk gamblers was approximately double among multi-game players, with 14.4xa0% low-risk and 5.8xa0% moderate-risk; compared with 7.7xa0% low-risk and 2.5xa0% moderate risk among one-game players. Results of ordinal logistic regression analysis confirmed that higher level of gambling severity was associated with multi-game players (ORxa0=xa02.23, pxa0<xa00.0001). Video-poker/slot-machines show the highest association with gambling severity among both one-game players and multi-game players, with scores of OR equal to 4.3 and 4.5 respectively. These findings suggest a popular perception of risk associated with this type of gambling for the development of gambling problems.

Anatomical localization of deep infiltrating endometriosis: 3D MRI reconstructions

PurposeThe goal of this study was to determine the accuracy of three-dimensional (3D) MRI reconstructions obtained with segmentation technique in the preoperative assessment of deep infiltrating endometriosis (DIE) and in particular to evaluate rectosigmoid and bladder wall involvement.Materials and methodsInstitutional review board approval for this study was obtained, and each patient gave written informed consent. Fifty-seven consecutive patients with diagnosis of DIE who had undergone pelvic MRI at 1.5 T before surgery between 2007 and 2011, were retrospectively evaluated and 3D post-processed in order to obtain a detailed mapping of DIE. A blinded reader interpreted images. MRI results were compared with surgical findings and were scored by using a four-point scale (0_3 score).Results36/57 patients with symptomatic DIE underwent surgery: 18/36 had endometriotic nodules infiltrating the rectouterine pouch, 12/36 the vesicouterine pouch, and 6/36 the rectovaginal pouch. The sensitivity of MRI and 3D MRI vs. surgery was, respectively, 64% vs. 83%; diagnostic accuracy of 3D MRI respect to MRI alone was 86% vs. 67% for localization; 86% vs. 67% for dimension; 79% vs. 58% for rectosigmoid infiltration; 92% vs. 75% for bladder infiltration.ConclusionsIn this preliminary study, 3D MRI reconstructions obtained with semi-automatic method of segmentation provided encouraging results for staging DIE preoperatively. In fact, the addition of 3D MRI reconstructions improved diagnostic accuracy and staging of DIE providing the exact volume of the lesions and enabling a precise mapping of these before surgery.

Energy Drink and Alcohol mixed Energy Drink use among high school adolescents: Association with risk taking behavior, social characteristics

PURPOSEnThe aims of the study were to: a) examine the prevalence of energy drink (ED) and alcohol mixed with energy drink (AmED) consumption; b) investigate the relationships between ED and AmED with alcohol, binge drinking and drugs accounting for at risk behaviors among a representative sample of Italian adolescents.nnnMETHODSnA representative sample of 30,588 Italian high school students, aged 15-19years, was studied. Binary and multivariate logistic regression analyses were performed to determine the independent association of the potential predictors characteristics with the ED and AmED drinking during the last year.nnnRESULTSnRespectively 41.4% and 23.2% of respondents reported drinking EDs and AmEDs in the last year. Multivariate analysis revealed that consumption of EDs and AmEDs during the last year were significantly associated with daily smoking, binge drinking, use of cannabis and other psychotropic drugs. Among life habits and risky behaviors the following were positively associated: going out with friends for fun, participating in sports, experiencing physical fights/accidents or injury, engaging in sexual intercourse without protection and being involved in accidents while driving.nnnCONCLUSIONSnThis study demonstrates the popularity of ED and AmED consumption among the Italian school population aged 15-19years old: 4 out of 10 students consumed EDs in the last year and 2 out of 10 AmED. Multivariate analysis highlighted the association with illicit drug consumption and harming behaviors, confirming that consumption of EDs and AmEDs is a compelling issue especially during adolescence, as it can effect health as well as risk taking behaviors.

Links between Psychotropic Substance Use and Sensation Seeking in a Prevalence Study: The Role of Some Features of Parenting Style in a Large Sample of Adolescents.

Aims. The objectives of the study were to (a) investigate the prevalence risk of current drug users and (b) explore the association between parental monitoring, adolescent-parent relationship, family structure, financial status, and sensation-seeking and psychotropic substance use. Methods. Data were drawn from the 2002 Italian student population survey of the European School Survey Project on Alcohol and Other Drugs. The sample size was 10,790 adolescents, aged 15–19 years. Multivariate logistic analyses were performed. Findings. The prevalence of users was 27.3% (34.2% males; 21.6% females). Single-parent and reconstructed families were related to the greatest likelihood of substance use. A medium financial status and, for females, a satisfying relationship with father were protective factors. Probability of engaging in risk-taking behavior increased when parental knowledge decreased. Exploring deeper how parental monitoring could modify the relation between different traits of sensation seeking and substances use revealed the following: “thrill and adventure seeking,” within the case of a good monitoring, can help against the use of substances; “boredom susceptibility” is not associated with drug use, except when parental monitoring is weak. Conclusions. Specific subdimensions, associated with substance use, may be more amenable to prevention than general interventions on sensation-seeking personality. Family is the context that could promote health education.

Robotic assisted versus pure laparoscopic surgery of the adrenal glands: a case-control study comparing surgical techniques

PurposeThe role of the da Vinci Robotic System® in adrenal gland surgery is not yet well defined. The goal of this study was to compare robotic-assisted surgery with pure laparoscopic surgery in a single center.MethodsOne hundred and 16 patients underwent minimally invasive adrenalectomies in our department between June 1994 and December 2014, 41 of whom were treated with a robotic-assisted approach (robotic adrenalectomy, RA). Patients who underwent RA were matched according to BMI, age, gender, and nodule dimensions, and compared with 41 patients who had undergone laparoscopic adrenalectomies (LA). Statistical analysis was performed using the Student’s t test for independent samples, and the relationship between the operative time and other covariates were evaluated with a multivariable linear regression model. Pxa0<xa00.05 was considered significant.ResultsMean operative time was significantly shorter in the RA group compared to the LA group. The subgroup analysis showed a shorter mean operative time in the RA group in patients with nodules ≥6xa0cm, BMIxa0≥xa030xa0kg/m2 and in those who had previous abdominal surgery (pxa0<xa00.05). Results from the multiple regression model confirmed a shorter mean operative time with RA with nodules ≥6xa0cm (pxa0=xa00.010). Conversion rate and postoperative complications were 2.4 and 4.8xa0% in the LA group and 0 and 4.8xa0% in the RA group.ConclusionsIn our experience, RA shows potential benefits compared to classic LA, in particular on patients with nodules ≥6xa0cm, BMIxa0≥xa030xa0kg/m2, and with previous abdominal surgery.

A prospective, single-arm study on the use of the da Vinci® Table Motion with the Trumpf TS7000dV operating table

BackgroundThe da Vinci® Table Motion (dVTM) comprises a combination of a unique operating table (Trumpf Medical™ TruSystem® 7000dV) capable of isocenter motion connected wirelessly with the da Vinci Xi® robotic platform, thereby enabling patients to be repositioned without removal of instruments and or undocking the robot.Materials and methodsBetween May 2015 to October 2015, the first human use of dVTM was carried out in this prospective, single-arm, post-market study in the EU, for which 40 patients from general surgery (GS), urology (U), or gynecology (G) were enrolled prospectively. Primary endpoints of the study were dVTM feasibility, efficacy, and safety.ResultsSurgeons from the three specialties obtained targeting success and the required table positioning in all cases. Table movement/repositioning was necessary to gain exposure of the operating field in 106/116 table moves (91.3%), change target in 2/116 table moves (1.7%), achieve hemodynamic relief in 4/116 table moves (3.5%), and improve external access for tumor removal in 4/116 table moves (3.5%). There was a significantly higher use of tilt and tilt plus Trendelenburg in GS group (GS vs. U pu2009=u20090.055 and GS vs. G pu2009=u20090.054). There were no dVTM safety-related or adverse events.ConclusionsThe dVTM with TruSystem 7000dV operating table in wireless communication with the da Vinci Xi is a perfectly safe and effective synergistic combination, which allows repositioning of the patient whenever needed without imposing any delay in the execution of the operation. Moreover, it is helpful in avoiding extreme positions and enables the anesthesiologist to provide immediate and effective hemodynamic relief to the patient when needed.

Italian Adult Gambling Behavior: At Risk and Problem Gambler Profiles

The present study examined adult gambling behaviours from a local perspective in order to assess the adult at risk and problem gambler’s profile stratified by genre and by different forms of game. 4773 Italian adults from 18 to 94xa0years old were administered a survey to assess socio-cultural information related to gambling behaviour and the SOGS to evaluate gambling behaviour severity. Logistic regression evidenced that both at risk and problem gamblers are associated with male gender, players that use to play to more than one game, gambling with strategy-based games. People with a gambler father or both parents who used to gamble were significantly more associated with problem gambling behaviour than participants with non-gambler parents. These results present adult profiles of at risk and problem providing a more clear understanding about the relationships between gambling behavior severity and type of gambling.