SummaryBackground The rationale for combining anticancer drugs has not been applied consistently to use of intravesical agents for treatment of superficial bladder cancer, for which immunotherapeutic BCG and chemotherapeutic mitomycin seem to be a potentially effective combination. We aimed to do a prospective, randomised comparison of BCG alone with that of sequential BCG and electromotive mitomycin in patients with stage pT1 bladder cancer.Methods After transurethral resection and multiple biopsies, 212 patients with stage pT1 bladder cancer were randomly assigned to: 81 mg BCG infused over 120 min once a week for 6 weeks (n=105); or to 81 mg BCG infused over 120 min once a week for 2 weeks, followed by 40 mg electromotive mitomycin (intravesical electric current 20 mA for 30 min) once a week as one cycle for three cycles (n=107). Complete responders underwent maintenance treatment: those assigned BCG alone had one infusion of 81 mg BCG once a month for 10 months, and those assigned BCG and mitomycin had 40 mg electromotive mitomycin once a month for 2 months, followed by 81 mg BCG once a month as one cycle for three cycles. The primary endpoint was disease-free interval; secondary endpoints were time to progression; overall survival; and disease-specific survival. Analyses were done by intention to treat. This trial has been submitted for registration at the US National Cancer Institute website http://clinicaltrials.gov. Findings

The broad construct of empathy incorporates both cognitive and affective dimensions. Recent evidence suggests that the subjects with autistic spectrum disorder (ASD) show a significant impairment in empathic ability. The aim of this study was to evaluate the cognitive and affective components of empathy in adolescents with ASD compared to controls. Fifteen adolescents with ASD and 15 controls underwent paper and pencil measures and a computerized Multifaceted Empathy Test. All measures were divided into mentalizing and experience sharing abilities. Adolescents with ASD compared to controls showed deficits in all mentalizing measures: they were incapable of interpreting and understanding the mental and emotional states of other people. Instead, in the sharing experience measures, the adolescents with ASD were able to empathize with the emotional experience of other people when they express emotions with positive valence, but were not able to do so when the emotional valence is negative. These results were confirmed by the computerized task. In conclusion, our results suggest that adolescents with ASD show a difficulty in cognitive empathy, whereas the deficit in affective empathy is specific for the negative emotional valence.

Abstract-Upregulation of endothelial adhesion molecules is the earliest step of atherogenesis. Whether obesity induces endothelial adhesin upregulation is unknown. To address this topic, circulating vascular cell adhesion molecule-1 (VCAM-1), intercellular adhesion molecule-1 (ICAM-1), E-selectin, and von Willebrand factor (vWF) Obesity and central body fat disposition have been correlated with a higher prevalence of cardiovascular death in low-risk subjects. 4 The relative risk of cardiovascular death associated with an increment of 1 kg/m 2 in body mass index (BMI) is 1.10 and 1.08 for adult men and women, respectively. 1 Thus, although the influence of other risk factors such as low physical activity and excess alcohol intake 2 cannot be excluded, obesity acts as an independent cardiovascular risk factor.Upregulation of endothelial adhesins of the selectin family 5 (E-selectin and P-selectin) and of the immunoglobulin superfamily 6 [intercellular adhesion molecule-1 (ICAM-1) and vascular cell adhesion molecule-1 (VCAM-1)] allows the attachment of circulating cells to the endothelium and represents the initiating event in atherogenesis. 7,8 Upregulation of adhesin genes leads to the expression of membraneassociated adhesins and release of their soluble forms. Thus, circulating soluble adhesin levels act as markers of in vivo adhesin expression. 8 -11 Accordingly, plasma soluble E-selectin concentrations were found to be elevated in conditions associated with increased risk for developing atherosclerosis, ie, type 2 diabetes 12,13 and hypertension. 14 Similarly, plasma soluble VCAM-1, ICAM-1, and E-selectin concentrations were found to be elevated in glucoseintolerant hypertensives. 15 Augmented levels of circulating von Willebrand factor (vWF), a marker of in vivo endothelial damage, 16 were found in nonatherosclerotic obese persons. 17 Furthermore, circulating levels of endothelin-1 18 and tissue plasminogen activator-1 19 were increased while endotheliumdependent vasodilation 20 was reduced in normotensive obese individuals.Taken together, the above data support the concept that obesity per se might induce early endothelial activation in humans. In view of the possible relationship between such endothelial activation and obesity, we evaluated circulating

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BackgroundAdult-onset Still’s disease (AOSD) is rare inflammatory disease of unknown etiology that usually affects young adults. The more common clinical manifestations are spiking fevers, arthritis, evanescent rash, elevated liver enzymes, lymphadenopathy, hepatosplenomegaly, and serositis. The multi-visceral involvement of the disease and the different complications, such as macrophage activation syndrome, may strongly decrease the life expectancy of AOSD patients.MethodsThis study aimed to identify the positive and negative features correlated with the outcome of patients. A retrospective analysis of AOSD patients prospectively admitted to three rheumatologic centers was performed to identify the clinical features present at the time of diagnosis and to predict the possible outcome. Furthermore, we investigated the as yet to be validated prognostic value of the systemic score previously proposed.ResultsOne hundred consecutive AOSD patients were enrolled. The mean systemic score showed that the majority of patients had a multi-organ involvement. Sixteen patients showed different complications, mainly the macrophage activation syndrome. A strong increase of inflammatory markers was observed. All patients received steroids at different dosages, 55 patients in association with immunosuppressive drugs and 32 in association with biologic agents. Sixteen patients died during the follow-up. Regression analysis showed that the higher values of the systemic score and the presence of AOSD-related complications, assessed at the time of diagnosis, were significantly correlated with patient mortality. A prognostic impact of the systemic score of ≥ 7.0 was reported.ConclusionsOur study showed that a higher systemic score and the presence of AOSD-related complications at the time of diagnosis were significantly associated with mortality. Of note, a cut-off at 7.0 of the systemic score showed a strong prognostic impact in identifying patients at risk of AOSD-related death.

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Individuals with autism spectrum disorders (ASD) show significant impairments in social skills and theory of mind (ToM). The aim of this study was to evaluate ToM and social information processing abilities in 52 children with ASD compared to 55 typically developing (TD) children. A mediation analysis evaluated whether social information processing abilities can be mediated by ToM competences. In our results, children with autism showed a deficit in social skills and ToM components. The innovative results of our study applying mediation analysis demonstrate that ToM plays a key role in the development of social abilities, and the lack of ToM competences in children with autism impairs their competent social behavior.

In advanced cancer patients, a range of oral problems significantly may impact on the physical, social, and psychological well-being of advanced cancer patients to varying degrees. These symptoms should be carefully assessed early but become imperative in the palliative care setting when they produce relevant consequences that may be life-threatening other than limiting the daily activities, particularly eating and drinking.