IRIS Università degli Studi dell'Aquila
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Management of Cutaneous Squamous Cell Carcinoma of the Scalp in Kidney Transplant Recipients
Get PDFBackground: Organ transplant recipients are at a significantly higher risk of developing skin cancer compared to the general population, particularly cutaneous squamous cell carcinoma. Approximately 3-8% of these carcinomas are located on the scalp. Scalp reconstruction is particularly challenging, especially for large excisions, due to the thickness of the scalp, the inelastic aponeurosis of the galea, and the integrity of the hair-bearing scalp. Additionally, in organ transplant recipients, the presence of numerous comorbidities and the increased risk of infection due to immunosuppressive therapy make management more complex. Based on our experience and the existing literature, we aim to describe possible reconstruction methods and discuss the combined management of medical and immunosuppressive therapy. Method: We present our experience with seven kidney transplant patients who underwent excision of cutaneous squamous cell carcinoma with a diameter larger than 3 cm. The crane technique involves three key steps. First, the tumor is excised with wide margins of disease-free tissue. Next, a pericranial flap is rotated and positioned to cover the exposed cranial bone. Finally, a bilayer dermal substitute is applied to create a microenvironment that supports skin graft implantation. Results: The crane technique was used for six patients. In one case, an O-Z rotation flap was used. All patients modified their immunosuppressive therapy, with those receiving antiproliferative therapy switching everolimus after surgery. Conclusions: When combined with a post-operative modification of the immunosuppressive regimen, the crane technique could be considered a feasible, safe, and effective approach to managing large cSCC of the scalp in fragile patients
Digital output feedback event-based stabilization of nonlinear systems with state delays
Get PDFIn this paper, the stabilization problem of nonlinear time-delay systems by means of digital dynamic output feedback event-triggered controllers is addressed. In particular, for the class of control-affine nonlinear systems with state delays, a methodology for the design of quantized sampled-data observer-based event-triggered (QSOE) stabilizers is provided. As a first step, the notion of Dynamic Output Steepest Descent Feedback (DOSDF), induced by a class of Lyapunov–Krasovskii functionals, is suitably revised in order to cope with the design of QSOE stabilizers. Then, the stabilization in the sample-and-hold sense theory is used as a tool to prove the existence of a suitably fast sampling and of an accurate quantization of the input/output channels such that: the digital implementation of DOSDFs, updated through a proposed event-based mechanism, ensures the semi-global practical stability property of the related closed-loop system with arbitrarily small final target ball of the origin. In the theory here developed, aperiodic sampling and the non-uniform quantization of the input/output channels are taken into account. Possible discontinuities in the functions describing the DOSDF at hand are also managed enlarging the possibilities to successfully designing QSOE stabilizers. Moreover, the proposed QSOE stabilizer is described by easily implementable difference equations avoiding the necessity to solve differential equations for the correct application of the controller at hand. Nonlinear delay-free systems are addressed as a special case. The proposed results are validated through practical examples concerning a Glucose-Insulin system and a Continuous Stirred Tank Reactor system
La materia dell’intangibile o sul disegno dei beni culturali
No full textRappresentare il patrimonio culturale pone questioni in merito alla natura dello stesso, alle finalità della rappresentazione, al ruolo del disegnatore. Prendendo le mosse dal rapporto tra le correlate dimensioni tangibili ed intangibili dei beni culturali, il disegno si offre come metodo e strumento per comprendere e comunicare pubblicamente i valori del patrimonio e per sviluppare un discorso partecipativo di significazione sociale e culturale, dove la storia, incarnata dal bene, e la memoria individuale e collettiva svolgono un ruolo di primo piano. In questo contesto diversi sono gli attori:
il disegnatore, il bene, il disegno, la sua immagine, la collettività. Un caso specifico è offerto dalla rappresentazione di ruderi archeologici per i quali si è scelto di utilizzare il disegno dal vero
D-chiro-inositol effectively counteracts endometriosis in a mouse model
Get PDFBackground: Endometriosis, a common condition affecting 5–10% of women of reproductive age, is the growth of endometrial-like tissue outside the uterus, leading to pain and infertility. Current treatments, such as surgery and hormonal therapy, offer limited long-term benefits. This study investigated the potential of D-chiro inositol (DCI), a natural compound that influences ovarian steroidogenesis, to treat endometriosis and compared its efficacy with a progestin drug such as Dienogest (DG). Methods: We established a non-surgical mouse model of endometriosis in CD1 mice. Uterine horns were removed from donor mice, cut into fragments and inoculated in recipient mice by intraperitoneal injection. Endometriosis progression was assessed at 15, 21 and 28 days after transplantation, with the 28-day window being the most effective. The mice were then randomly assigned to four experimental groups, which received for 28 days: water (EMS); DCI 0.4 mg/die (DCI); DCI 0.2 mg/die and Dienogest 0.33 ng/die (DCI + DG); DG 0.67 ng/die (DG). At the end of the treatments, endometriotic lesions, ovaries and circulating estradiol levels were analyzed. Results: The results showed that treatment with DCI, both alone and in combination with DG, significantly reduced the number, size and vascularization of endometriotic lesions compared to the EMS control group. Histological analysis confirmed a decrease in endometriotic foci across all treatment groups, with the most pronounced effects in the DCI group. To investigate the underlying molecular mechanisms, we found that DCI led to a significant reduction in the expression of Sirt1 and an increase in E-Cadherin, indicating a reduction in EMT transition relevant for lesion development. In addition, DCI decreased cell proliferation and,blood vessel formation, as evaluated by PCNA and CD34, respectively. Futhermore, in the ovary, DCI treatment downregulated the expression of aromatase (Cyp19a1), the enzyme critical for estrogen biosynthesis, and increased the number of primordial to antral follicles, suggesting a beneficial effect on ovarian folliculogenesis. Conclusions: By modulating proliferation, EMT transition and aromatase activity, DCI emerges as a promising compound for endometriosis treatment
La rigenerazione urbana dei borghi del Gran Sasso: qualità urbana e dimensione atmosferica
No full textLa rigenerazione urbana dei centri storici minori rappresenta una sfida cruciale per l’urbanistica e l’architettura contemporanea, in un contesto di crescenti trasformazioni sociali, economiche e ambientali. Tale processo richiede un approccio integrato, capace di coniugare il recupero fisico del patrimonio storico con interventi che promuovano inclusione sociale, sostenibilità ambientale e sviluppo economico. Questa tesi si propone di contribuire al dibattito teorico e operativo, sviluppando un approccio innovativo e integrato per affrontare il tema, ovvero introducendo un nuovo indicatore quali-quantitativo, il Credenziale di Recuperabilità Qualitativa (CRQ), concepito per valutare la qualità urbana dei borghi nelle aree interne montane. L’indicatore combina dati quantitativi relativi alla conservazione fisica e funzionale del tessuto urbano con valutazioni qualitative della dimensione affettiva e percettiva degli spazi.
La ricerca è stata condotta su una selezione di borghi situati nel Parco Nazionale del Gran Sasso e Monti della Laga, sono caratterizzati da una forte rilevanza culturale e paesaggistica, ma segnati da fenomeni di spopolamento, declino economico e degrado edilizio. Attraverso la formulazione e successiva applicazione dell’indicatore CRQ, supportata da strumenti fenomenografici come i parcours commentés, le descrizioni e le fotografie atmosferiche, è stata indagata non solo la struttura fisica dei borghi, ma anche l' esperienza affettiva degli spazi e le emozioni, percezioni e risonanze che generano nei soggetti percipienti. Questo approccio consente di catturare quella “eccedenza” trascurata dagli strumenti tradizionali, ma determinante per comprendere il significato profondo e l’identità dei luoghi.
L’analisi ha permesso di individuare criticità e potenzialità specifiche per ciascun borgo, evidenziando come il valore di un territorio non risieda unicamente nella sua integrità fisica, ma anche nella sua capacità di mantenere vivo il legame con la comunità. In particolare, è emerso come borghi apparentemente compromessi dal punto di vista strutturale possano, grazie a comunità resilienti e consapevoli, offrire opportunità significative per interventi di rigenerazione mirati e sostenibili. Al contrario, borghi architettonicamente integri ma privi di vitalità possono essere percepiti come “paesi fantasma” incapaci di creare legami emotivi duraturi.
Questa tesi propone, quindi, un approccio metodologico innovativo e transdisciplinare che unisce urbanistica, antropologia, filosofia e ingegneria degli indicatori. Tale approccio è pensato non solo per supportare le decisioni strategiche degli amministratori locali, ma anche per stimolare un dibattito critico sulle modalità di valorizzazione e conservazione del patrimonio culturale nei centri storici minori. Le conclusioni della ricerca sottolineano l’importanza di un equilibrio tra interventi materiali e strategie volte a preservare la dimensione affettiva e identitaria dei luoghi, suggerendo la necessità di una visione olistica e sostenibile per il futuro della rigenerazione urbana
Inappropriate Sinus Tachycardia in Athletes: Could Nutraceuticals Play a Role?
Get PDFIntroduction: Inappropriate sinus tachycardia (IST) is a syndrome characterized by unexpectedly fast and prolonged sinus rates at rest or with minimal physical activity. Epidemiologic characteristics are uncertain, but most patients are young and female. When IST occurs in athletes, its management (controlling symptoms and reducing heart rate) can present additional challenges. We designed an observational pilot study to investigate whether a food supplement can be useful in the treatment of IST when standard therapy is refused. Methods: We enrolled 50 consecutive recreational athletes affected by frequent recurrences of IST. Twelve-lead ECG and Holter ECG parameters were recorded at enrollment (T0) and after a 6-month treatment (T1) with the food supplement. Symptoms and quality of life were also evaluated through specific questionnaires. The study population was compared to a historical control group of 25 patients receiving ivabradine as treatment for the same clinical condition. Results: The resting ECG heart rate was 88.7 ± 12.4 bpm (T0) and 73.6 ± 6.6 bpm (T1) (p < 0.00001); Holter average heart rate was 88.4 ± 3.3 bpm and 74.9 ± 4.8 bpm (p < 0.0001). Holter ECG maximum heart rate was 147.1 ± 16.7 bpm and 139.2 ± 16.8 bpm (p = 0.06); Holter minimum heart rate was 49.9 ± 6.5 bpm and 50.5 ± 6.9 bpm (p = 0.33). Finally, the number of sustained episodes decreased from 3.3 ± 1.7 to 0.8 ± 0.8 (p < 0.00001). The following variations in ASTA scores were observed: ASTA symptom scale (range: 0–27) decreased from 14.9 ± 2.1 to 5.8 ± 1.4 (p < 0.00001), while ASTA HR QoL (range: 0–39) decreased from 24.1 ± 2.1 to 10.8 ± 2.3 (p < 0.00001). Conclusions: The findings of our pilot study suggest that this food supplement could play a beneficial role in managing symptoms and improving quality of life in recreational athletes affected by IST who refuse standard medical therapy. These clinical effects appear to correlate with significant improvements in resting ECG parameters and some Holter ECG parameters
A Systematic Mapping Study on Automated Negotiation for Autonomous Intelligent Systems
Get PDFAutonomous intelligent systems are known as artificial intelligence software entities that can act on their own and can take decisions without any human intervention. The communication between such systems to reach an agreement for problem-solving is known as automated negotiation. This study aims to systematically identify and analyze the literature on automated negotiation from four distinct viewpoints: (i) the existing literature on negotiation with focus on automation, (ii) the specific purpose and application domain of the studies published in the domain of automated negotiation, (iii) the input, and techniques used to model the negotiation process, ad (iv) the limitations of the state of the art and future research directions. For this purpose, we performed a systematic mapping study (SMS) starting from 73,760 potentially relevant studies belonging to 24 conference proceedings and 22 journal issues.
Through a precise selection procedure, we identified 50 primary studies, published from the year 2000 onward, which were analyzed by applying a classification framework. As a result, we provide: (a) a classification framework to analyze the automated negotiation literature according to several parameters (e.g., focus of the paper, inputs required to carry on the negotiation process, techniques applied, and type of agents involved in the negotiation), (b) an up-to-date map of the literature specifying the purpose and application domain of each study, (c) a list of techniques used to automate the negotiation process and the list of input to carry out the negotiation, and (d) a discussion about promising challenges and their consequences for future research. We also provide a replication package to help researchers replicate and verify our systematic mapping study. The results and findings will benefit researchers and practitioners in identifying the research gap and conducting further research to bring dedicated solutions for automated negotiation
Enlightening Nursing Care: A Protocol for a Multicenter Observational Study Measuring Nursing Work in Hospital Settings
Get PDFBackground: Rising costs and demands for improved quality of care present complex challenges for existing healthcare systems. The strain on healthcare resources is exacerbated by the increasing complexity of patient conditions. The Diagnosis-Related Group (DRG) system classifies inpatients according to clinical and treatment criteria, controls healthcare expenditures, and ensures the sustainability of procedures. The cost of nursing care is included in the DRG system in the same way as other fixed costs of hospital care, but the amount of nursing care provided for the same DRG can vary widely. This study, which is based on this protocol, will aim to assess the variability of nursing costs within and across DRGs and to measure how much variability in nursing care is explained by DRGs by comparing nursing care delivery in acute care hospitals with the DRG reimbursement system in Italy. It is necessary to develop a specific protocol to ensure systematic and consistent data collection at the national level. Methods: A multicenter retrospective cross-sectional study will be conducted. A random sample of five public Italian hospitals will be enrolled. Patients included in medical or surgical DRGs, hospitalized and discharged in 2022 will be included. Data will be collected retrospectively from two sources: hospital discharge records and nursing records. Inferential statistics will be used to assess the variability of nursing time and costs across hospitals and DRGs. Nursing costs will be determined by several factors, including time spent on nursing activities and the hourly wages of nursing staff. The time needed to complete each activity will be estimated by a convenience sample of nurses from the hospitals included in this study. The annual salary of nurses will be used to calculate the nursing cost per minute, multipled by the amount of time spent per each nursing activity. The cost per patient per day of hospitalization will be calculated. Conclusions: The results of this study will shed light on the variation in nursing care across different DRGs. This understanding will guide recommendations for optimizing healthcare resource allocation and enhancing the efficiency of the DRG system in Italy