80936 research outputs found
Sort by
Procedure for Reconstruction, Modeling, and Fabrication Using Additive and Rapid Tooling Methods of a Training Model for Transsphenoidal Surgery
Get PDFThe endoscopic transsphenoidal approach (ETA) is a novel approach used by neurosurgeons and otolaryngologists to treat pituitary adenoma, and it has a long learning curve. Training is mostly performed using cadaver heads, but their low availability and cost can limit their use. ETA training models can be used to overcome these limitations. In this panorama, additive manufacturing (AM) technologies represent a more flexible and cost-effective solution to fabricate custom-made training models. Their development involves computed tomography (CT) segmentation, STL file elaboration, direct 3D printing, and rapid parts tooling. This work presents and discusses the entire procedure applied to a modular ETA training model. The procedure starts with selecting the material and AM processes based on a literature review. Accordingly, the parts of the model were designed, 3D printed, or rapid cast. In particular, fused filament fabrication (FFF) was adopted for those tissues whose materials could be directly printed (bones and cartilage), while the rapid casting of silicone was adopted for soft tissues (skin and mucosa) together with FFF to fabricate mold patterns and cores. After fabrication and assembly, the model was finally tested by an experienced neurosurgeon who provided feedback. Moreover, the cost and time of the prototype fabrication were assessed. Results validated the proposed solution from both the surgical and commercial points of view. Moreover, general procedures for designing and rapidly fabricating ETA models were generalized to make them exploitable to more general case studies
Efficacy and safety of conventional disease-modifying antirheumatic drugs in VEXAS syndrome: real-world data from the international AIDA network
No full textBackground: VEXAS (vacuoles, E1 enzyme, X-linked, autoinflammatory, somatic) syndrome is an adult-onset autoinflammatory condition resulting in severe, often treatment-refractory inflammation. Currently, there are no established treatment guidelines for VEXAS syndrome.
Objectives: To assess the efficacy and safety of conventional disease-modifying antirheumatic drugs (cDMARDs) in a cohort of VEXAS patients.
Methods: Data from VEXAS patients were obtained from the International AIDA Network VEXAS registry.
Results: Data from 36 VEXAS patients were evaluated, with 28 (77.8%) treated with cDMARDs as monotherapy - and concomitant glucocorticoids (GC) - and 8 (22.2%) receiving a combination of different cDMARDs plus GC. Complete response (CR), partial response (PR), and failure to cDMARDs monotherapy were reported in 4/22 (18.2%), 11/22 (50%), and 7/22 (31.8%) courses, respectively. All patients were treated with GCs at the start of cDMARD monotherapy, and no GC discontinuation was observed later. No significant differences were observed in the GC dosage from the start of cDMARDs to the 3-month (p = 0.43), 6-month (p = 0.31), and 12-month (p = 0.21) visits. Conversely, the GC sparing resulted to be statistically significant when using methotrexate (p = 0.02). As for cDMARDs combinations, no cases achieved CR, while PR was observed in 5/9 (55.6%). Seventeen adverse events were reported, seven of which led to discontinuation.
Conclusion: Many VEXAS patients report a partial benefit from cDMARDs, while a smaller yet not negligible number of patients exhibit a CR; cDMARDs remain a viable option for this disorder, especially when the initial GC dosage is low and the need for a steroid-sparing effect is not immediately urgent
On Symmetry Properties of Tensors for Electromagnetic Deformable Solids
Get PDFAs a generalization of the symmetry of the stress tensor of continuum mechanics, the paper investigates symmetry properties arising in models of magneto- and electro-mechanical interaction. First, the balance of angular momentum is considered, thus obtaining a symmetry condition that is applied as a mathematical constraint on admissible constitutive equations. Next, thermodynamic restrictions are also investigated and, among others, a further symmetry condition is determined. The joint validity of the two symmetry conditions implies that the dependence on electromagnetic fields has to be through variables involving deformation gradients. These variables constitute two classes that prove to be Euclidean invariants. The simplest selection of the variables is just that of Lagrangian fields in the literature. Furthermore, the variables of one class allow a positive magnetostriction and of the other one allow a negative magnetostriction. Some applications to (NO) Fe-Si are outlined. The use of entropy production as a constitutive function allows generalization to dissipative and heat-conducting electromagnetic solids
Right heart failure and mortality in patients undergoing transcatheter tricuspid valve interventions
No full textAims: To assess the association between right heart failure (RHF) and mortality in patients with severe tricuspid regurgitation (TR) undergoing transcatheter tricuspid valve intervention (TTVI), and to determine whether clinical RHF status reduces the survival benefit of successful versus failed TTVI. Methods and results: The TriValve International Registry (Transcatheter Tricuspid Valve Therapies) is a multicenter registry collecting data of patients with symptomatic, severe or greater TR undergoing TTVI. The population was stratified according to RHF status defined by the following clinical criteria: history of previous hospitalization for RHF (<1 year) OR presence of signs of RHF (jugular venous distension, ascites, peripheral oedema) OR high dose diuretic (≥125 mg/day of furosemide or equivalent). The outcome of interest was 1-year all-cause death. Among 639 patients included in the TriValve registry, 498 had complete data regarding RHF status. Overall, 54 (10.8 %) patients had no criteria for RHF, 133 (26.7 %) patients fulfilled 1 criterion, 240 (48.2 %) 2 criteria and 71 (14.3 %) 3 criteria. At a median follow-up of 216 days (IQR 49-372 days), cumulative incidence of all-cause death was higher in patients with 2 or 3 RHF criteria versus those with no or 1 RHF criterion (adjusted HR 2.91-95 % CI 1.46-5.83, P = 0.002). However, RHF status did not influence the association between procedural success and all-cause death at 1-year follow-up (p for interaction 0.857). Conclusions: In a large real-world population undergoing TTVI for severe TR, the presence of at least 2 RHF clinical criteria was independently associated with an increased risk of 1-year mortality. Procedural success was associated with a lower risk of mortality regardless of RHF status
Clinical Presentation and Outcomes of Antineutrophil Cytoplasmic Autoantibody–Negative Pauci-Immune Glomerulonephritis
No full text
Next Generation Sequencing Analysis in Patients Affected by Parkinson's Disease and Correlation Between Genotype and Phenotype in Selected Clinical Cases
Get PDFParkinson's Disease (PD) is the most frequent movement disorder and is second only to Alzheimer's Disease as the most frequent neurodegenerative pathology. Early onset Parkinson's disease (EOPD) is less common and may be characterized by genetic predisposition. NGS testing might be useful in the diagnostic assessment of these patients. A panel of eight genes (SNCA, PRKN, PINK1, DJ1, LRRK2, FBXO7, GBA1 and HFE) was validated and used as a diagnostic tool. A total of 38 in sequence EOPD patients of the Parkinson's Disease Unit of our Hospital Institution were tested. In addition, the number of the hexanucleotide repeats of the C9ORF72 gene and the frequency of main HFE mutations were evaluated. Six patients were carriers of likely pathogenic mutations in heterozygosity in the analyzed genes, one of them presented mutations in association and another had a complex genetic background. Their clinical symptoms were correlated with their genotypes. In the cohort of patients, only the p.Cys282Tyr of HFE was significantly decreased in the dominant model and allele contrast comparison. Only one patient with one allele of C9ORF72 containing 10 repeats was identified and clinically described. The clinical signs of sporadic and monogenic PD are often very similar; for this reason, it is fundamental to correlate genotypes and phenotypes, as we tried to describe here, to better classify PD patients with the aim to deepen our knowledge in the molecular mechanisms involved and collaborate in reaching a personalized management and treatment
La due diligence e le caratteristiche degli strumenti di analisi e gestione dei rischi. Note a margine della direttiva (UE) 2024/1760
No full textObiettivi: il saggio ha l’obiettivo di analizzare la human rights due diligence quale strumento basato sull’analisi e la gestione dei rischi. L’analisi viene svolta con particolare riferimento alle situazioni in cui le imprese conducono procedure di due diligence in relazione a diritti fondamentali del lavoro. Metodologia: la metodologia utilizzata si basa su un’analisi giuridico-normativa delle legislazioni che introducono obblighi di due diligence nonché su un’analisi della letteratura relativa alla risk-based regulation. Risultati: l’analisi condotta porta a ritenere che vi sia il pericolo che la sostanziale unilateralità delle procedure di due diligence comporti uno slittamento dell’attenzione dai rischi primari (l’impatto delle imprese sui diritti dei terzi) ai rischi secondari (le conseguenze reputazionali e legali per le imprese stesse). Limiti e implicazioni: l’analisi è di natura prettamente teorica e, pertanto, le conclusioni raggiunte potrebbero essere verificate in futuro attraverso indagini di carattere empirico. Originalità: il saggio evidenzia i rischi delle procedure di due diligence e suggerisce alcuni possibili controbilanciamenti mettendo in relazione due diversi filoni di letteratura, quello sulla risk-based regulation e quello sul diritto transnazionale privato del lavoro
Off-label drugs in laryngology- what should the doctor and the patient know about such therapies? A consensus statement of the European Laryngological Society
No full textPurpose: Off-label drugs are being used in laryngology. Prescribing of a medicinal product is a decision taken within the relationship between a patient and his/her treating health care provider (HCP). The purpose of this article is to discuss the medicolegal aspects of off-label drug use, to provide recommendations for obtaining informed patient consent for off-label treatment and to propose the place and role of scientific societies and specialist boards in shaping good practices in this area. The final aim is to present recommendations concerning off-label usage and propose special clauses in informed patients consent. Methods: The literature was reviewed regarding off-label applications in laryngology. Practical information on off-label use in various EU countries was collected. Results: Registration data and pharmacokinetics of cidofovir, bevacizumab, Gardasil®, hyaluronic acid and mitomycin are provided. Off-label prescribing is not prohibited by EU law. Informed consent to treatment with an off-label drug exists in all EU countries. The risk that a court will accept liability of a HCP in case of off-label prescribing is higher than in case of on-label prescribing. If a HCP is held liable for the outcome of a medical treatment, the approval by the competent authorities and professional guideline is a strong defense. Conclusion: A patient’s precise, explicit consent for the procedures including off-label drugs administration is mandatory. The second prerequisite is defining a need for creating based on recommendations by national or international scientific societies
Intermediate Care, Clinical and Economic Outcomes. Systematic Review
No full textIntroduction Intermediate care is a healthcare model designed to bridge the gap between hospital care and home, focusing on the efficient treatment and rehabilitation of patients after hospitalization. Its primary goals include facilitating early discharge, promoting patient independence, and preventing hospital readmissions. While previous studies have shown promise regarding the effectiveness of intermediate care, they often report mixed results, underscoring the necessity for further investigation. This review aims to evaluate the efficacy of bed-based intermediate care services in enhancing patient outcomes during the post-hospital discharge process.
Methods A systematic search was conducted across major scientific databases to identify relevant literature. The inclusion criteria focused on primary experimental studies that reported outcomes related to mortality, post-discharge care settings, functional status, length of hospitalization, rates of hospital readmission, and both physical and psychological well-being, as well as cost-effectiveness.
Results A total of six articles met the inclusion criteria. The findings generally suggest a favorable impact of intermediate care facilities on patient outcomes. However, it is important to note that the data exhibited low statistical significance. The evidence indicates that intermediate care facilities are at least as effective as traditional hospital care, which carries a significantly higher financial burden.ConclusionsAlthough the statistical significance of the results is limited, the trends indicate that intermediate care facilities may serve as suitable and economically viable alternatives for post-hospital care. Further research with larger sample sizes and more robust methodologies is necessary to confirm these findings and fully understand the role of intermediate care in enhancing patient outcomes