Archivio istituzionale della ricerca - Università dell'Insubria
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Predicting splenic artery embolization outcomes in blunt trauma: results from a multicentre retrospective observational study
No full textAimTo evaluate the association of anatomical, clinical, and procedural factors with endovascular treatment failure, including both proximal and distal splenic artery embolization (SAE).Material and methodsIn 11 centers, all patients following blunt splenic injury (BSI) were retrospectively evaluated, and those who had received SAE were selected. Data collected included: patient demographics and characteristics, mechanism and grading of BSI, endovascular management, and outcomes. Technical and clinical success were defined as successful embolization of the bleeding artery and stabilization of the haemodynamic status and laboratory data in 1 or 2 sessions, respectively. Rebleeding during follow-up and subsequent splenectomy were considered as treatment failure. The rate of complications related to the endovascular procedure was evaluated.ResultsThe management of two hundred and forty-seven participants was evaluated. Technical and clinical success were 100% and 91.9% (227/247), respectively. A second embolization was performed in 5 cases. Rescue splenectomy occurred in 20 (8.1%) patients.Statistically significant associations were identified between endovascular treatment failure and GCS and the presence of other lesions at CT at patient presentation. No anatomical or procedural factors were found to be statistically significant; in the surgical group, a larger diameter of the splenic artery was observed. The complication rate was 15.2% (26/171), all relating to the vascular access, e.g., hematoma or pseudoaneurysm, and all managed conservatively.ResultsThe management of two hundred and forty-seven participants was evaluated. Technical and clinical success were 100% and 91.9% (227/247), respectively. A second embolization was performed in 5 cases. Rescue splenectomy occurred in 20 (8.1%) patients.Statistically significant associations were identified between endovascular treatment failure and GCS and the presence of other lesions at CT at patient presentation. No anatomical or procedural factors were found to be statistically significant; in the surgical group, a larger diameter of the splenic artery was observed. The complication rate was 15.2% (26/171), all relating to the vascular access, e.g., hematoma or pseudoaneurysm, and all managed conservatively.ConclusionSAE is a safe and effective procedure; unsuccessful cases resulted statistically associated with some clinical factors, but no correlation with anatomical factors was observed
Comparative microscopic analysis of plastic dispersion from 3D-printed and thermoformed orthodontic aligners
No full textAim: To compare directly printed aligners (DPA) and thermoformed aligners (TFA), evaluating the potential release and dispersion of microplastic (MP) and nanoplastic (NP) particles under simulated oral conditions. Materials and methods: DPA samples (Graphy Tera Harz TC-85-DAC resin) and TFA samples (Invisalign® SmartTrack) were subjected to rubs in an ultrapure water bath. The liquid was collected post-friction and analyzed for MPs and NPs using various techniques: optical microscopy (OM), transmission electron microscopy (TEM), and atomic force microscopy (AFM). Also, plastic residues were quantified by weighing after drying within a laminar flow hood. Microscopic image analyses comprised the quantification of the average size of MPs and NPs, their concentration by TEM, and the roughness analysis by AFM. Results: The masses of MPs and NPs separated after rubbing were 0.001 g/200 μl and 0.004 g/200 μl for TFA and DPA samples, respectively. TEM analysis confirmed that DPA samples had larger (203.08â€...±â€...2651.65 μmÂ2) and more numerous particles compared to TFA (0.23â€...±â€...27.53 μmÂ2), even though it was not possible to distinguish the MPs and NPs due to clustering of the plastic residuals. AFM analysis indicated a bigger root mean square grain size for TFA than DPA; similarly, the mean roughness was lesser in the DPA sample than TFA one. Conclusions: DPA generated larger and more numerous plastic particles compared to TFA, though grain-size characterization was challenging due to particle aggregation. This suggests that the manufacturing process and materials used in DPA could impact the creation of MPs and NPs during simulated mastication, highlighting a potential area for process optimization
Impact of ketogenic and fast-mimicking diet in gastrointestinal cancer treatment
No full textGrowing evidence suggests that both the ketogenic diet (KD) and the fast-mimicking diet (FMD) may have significant therapeutic effects in the treatment of gastrointestinal (GI) cancers. KD, characterized by a high fat intake and low carbohydrate intake, induces a state of ketosis that alters energy metabolism, reducing the availability of energy for cancer cells and slowing their growth. Similarly, FMT, which simulates the effects of fasting without requiring complete food abstention, has been studied for its potential to enhance immune response, reduce inflammation, and stimulate autophagy, contributing to the removal of damaged cells. Preclinical and clinical studies indicate that both dietary strategies may enhance the efficacy of chemotherapy while reducing the side effects associated with conventional treatments. Despite these promising findings, few studies have investigated the potential impact of these diets on anticancer treatment of gastrointestinal cancers, and further studies are necessary to better understand the biological mechanisms and to evaluate the safety and effectiveness of these strategies in broader clinical settings. With our review, we aim to analyze the available literature on KD and FMD and their role in the treatment of GI cancers
Association of plasma biomarkers of lung injury with positive end expiratory pressure and postoperative pulmonary complications in obese surgical patients A substudy of the PROBESE randomised controlled trial
No full textBACKGROUND The effect of positive end expiratory pressure (PEEP) on postoperative pulmonary complications (PPCs) in obese patients remains controversial. OBJECTIVE To test, whether intra-operative PEEP or PPCs are associated with plasma levels of biomarkers of lung injury. DESIGN A prospective substudy of a multicentre randomised controlled trial (PROBESE). SETTING Operating rooms of six tertiary care centres in the United States and Europe. PATIENTS Obese patients at risk for PPCs undergoing abdominal surgery. INTERVENTION Intra-operative low tidal volume ventilation with high PEEP (12 cmH2O) and recruitment manoeuvres, or low PEEP (4 cmH2O). MAIN OUTCOME MEASURES The primary endpoint was the association between absolute postoperative plasma levels of receptor for advanced glycation end-products (RAGE) and intra-operative PEEP; secondary endpoints included pre and postoperative plasma concentrations as well as the relative changes of interleukin-6, IL-8, tumour necrosis factor-a, surfactant protein D, mucin-1, clara cell protein-16, intercellular adhesion molecule-1 and vascular cell adhesion molecule. PPCs were assessed as a ‘collapsed composite’ of adverse pulmonary events. The predictive ability of biomarkers for PPCs was assessed with the receiver operating curve-area under the curve (ROC-AUC). RESULTS A total of 96 patients received low PEEP, and 95 patients high PEEP. Postoperative plasma concentrations of RAGE and other biomarkers did not differ between groups. The relative increase of RAGE during surgery was more pronounced with low than high PEEP; median [IQR], 1.2 [1.0 to 1.6] vs. 1.1 [0.9 to 1.3], P 1⁄4 0.012. Patients who developed PPCs showed higher postoperative plasma levels and relative increase of IL-6; 26.3 [12.6 to 139.5] vs. 15.1 [3.7 to 38.7] fold change. The ROC-AUC was less than 0.7 for all biomarkers. CONCLUSIONS In this subgroup, choice of PEEP did not affect postoperative biomarkers of lung injury. Irrespective of PEEP, PPCs were associated with an increase in plasma levels of these biomarkers, but their predictive capability was poor
Long-term sex-dependent effects of antibiotic-induced dysbiosis and Lacticaseibacillus rhamnosus GG (ATCC 53103) in juvenile mice: implications for gastrointestinal motility and behavior
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Large-scale regional assessment of surgical volumes and European Society of Gynaecological Oncology quality indicators for ovarian cancer surgery in Italy
No full textObjective: This study aimed to evaluate the adherence of ovarian cancer care in Lombardy, Italy to European Society of Gynaecological Oncology (ESGO) quality indicators and identify organizational strengths and gaps within the regional service delivery. Methods: A cross-sectional assessment was conducted and distributed to all 111 hospitals in Lombardy between January 15 and March 15, 2024. The survey, based on ESGO quality indicators, examined surgical volume, access to multi-disciplinary tumor boards, peri-operative resources, and molecular diagnostics. Surgical volumes from 2022 to 2023 were cross-validated using administrative data (International Classification of Diseases and Current Procedural Terminology codes). Institutions were categorized by annual procedure volume: <10, 10 to 24, 25 to 49, and ≥50 surgeries per year. Adherence to ESGO standards was analyzed across these strata. Results: A total of 52 hospitals reported performing ovarian cancer surgeries during the study period, totaling 1866 procedures. Only 8 centers (15.4%) met the ESGO quality criteria, yet they managed 64.4% of patients, indicating partial centralization. Although 71.2% of hospitals used dedicated gynecologic oncologists and 78.8% had functional multi-disciplinary tumor boards, BRCA and homologous recombination deficiency testing were available in only 44.2% and 38.5% of centers, respectively. A substantial number of patients were still treated in low-volume centers (<10 surgeries per year), raising concerns about surgical expertise and outcome quality. In addition, prospective documentation of surgical outcomes and complications was inconsistently implemented. Conclusions: Ovarian cancer care in Lombardy is partially centralized, with high-volume centers managing most cases and generally adhering to ESGO indicators. However, disparities persist in molecular testing, peri-operative outcome documentation, and equitable access to high-standard care. Strategic investments in diagnostics, referral networks, and data infrastructure are essential to optimize regional outcomes
