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Complex role of insurance in living donor kidney transplantation: Perspectives from the affordable care act era
No full textThe landscape of organ transplantation in the United States reflects a complex and multifaceted reality. According to the latest OPTN/UNOS statistics on kidney transplants, 20446 deceased organ donors contributed to these life-saving procedures, alongside 5798 living donor kidney transplants (LDKT). Despite these advancements, the transplant waiting list remains alarmingly long, with approx- imately 140165 individuals still awaiting a kidney. In addition, there are still inequalities in access to LDKT. As of December 31, 2022, Black adults accounted for 31.7% of the transplant waiting list, yet only 12.8% of LDKT recipients, com- pared to 34.1% of deceased donor kidney transplant (DDKT) recipients that year. Conversely, White patients represented 35.5% of those on the list, but comprised 61.4% of LDKT recipients and 35.3% of DDKT recipients. A majority of adult LDKT recipients (54.5%) had private insurance at the time of transplantation, compared to 26.9% of DDKT recipients. In addition, 62.5% of patients with a kid- ney transplant from a deceased donor were covered by Medicare, in contrast to 37.6% of living donor kidney transplant recipients. In 2022, 33.3% of adult living donor kidney transplant recipients were transplanted without prior dialysis, com- pared to 12.1% of deceased donor kidney transplant recipients. These data high- light the critical need to dismantle barriers to transplantation, particularly those rooted in insurance coverage and socioeconomic disparities
Silk Vista Baby for the treatment of distal anterior cerebral artery aneurysms
No full textPurpose: Treating small-caliber vessel aneurysms with flow diverters poses challenges due to narrow luminal diameters and tortuous vasculature, which complicate the navigation and deployment of conventional devices using standard microcatheters. The Silk Vista Baby (SVB, Balt, Montmorency, France) flow diverter was developed to treat intracranial aneurysms located in smaller vessels or more distal segments and is compatible with 0.017′′ microcatheters. We present the largest multicenter analysis to date evaluating the outcomes of SVB use in unruptured distal anterior cerebral artery (DACA) aneurysms. Methods: Retrospective data from 20 centers were reviewed for patients with unruptured DACA aneurysms treated with the SVB. Demographic information, clinical presentation, radiographic characteristics, complications, and outcomes were recorded. Results: Seventy-nine patients (79 DACA aneurysms) were treated between January 2018 and December 2022; 59 were female (74.7%), and the median age was 61 years (IQR 53–67). Most aneurysms were saccular (89.9%), and 65.8% involved a branch. The median parent vessel diameter was 1.9 mm (IQR 1.7–2.1). A single stent was implanted in 97.5% of cases; 2.5% required two stents. The median imaging follow-up duration was 12 months (IQR 9.5–24). At the last follow-up, 76% of aneurysms showed complete or near-complete occlusion (O’Kelly–Marotta scale C or D, Raymond-Roy 1 or 2). Overall, thromboembolic or hemorrhagic complications occurred in 14% of patients, with two cases being symptomatic. The mortality rate was 0%, and the retreatment rate was 1.3%. Conclusion: In this multicenter series, the SVB flow diverter represented a valuable treatment option for distal anterior cerebral artery (DACA) aneurysms
Higher Law. Rilievo storico, limiti e significato attuale del pensiero di Locke per il costituzionalismo
No full textIta
Il lavoro è dedicato alla teoria della costituzione di John Locke. Si approfondiscono le implicazioni dell’idea di costituzione come “higher law” per
il costituzionalismo contemporaneo, in un tempo nel quale le costituzioni
sembrano perdere la loro capacità di governare e plasmare la realtà politica
e sociale. Senza voler nascondere i limiti o esagerare i meriti del contributo
lockiano, il saggio si sofferma su alcuni aspetti salienti di un’impostazione
ricca di spunti in merito al concetto di costituzione (par. 2), alla forma di Stato
e al modo di intendere la tutela dei diritti inviolabili (par. 3) oltreché, infine, al
sistema istituzionale (par. 4).
En
The paper is dedicated to John Locke’s theory of constitution. The implications of the idea of constitution as “higher law” for contemporary constitutionalism are explored, in a time in which constitutions seem to lose their
ability to govern and shape political and social reality. Without wanting to
hide the limits or exaggerate the merits of Locke’s contribution, the essay
focuses on some salient aspects of an approach rich in ideas regarding the concept of constitution (par. 2), the form of State and the way of understanding
the protection of inviolable rights (par. 3) as well as, finally, the institutional
system (par. 4)
The Association between opportunistic DECT-derived bone values and vertebral fracture status
No full textIntroduction: Osteoporosis is a major cause of spinal insufficiency fractures but often remains underdiagnosed. Dual-energy CT (DECT) enables reliable assessment of bone mineral density (BMD), but its limited accessibility highlights the need for alternative metrics. This study investigates the association between vertebral fracture status, DECT-derived BMD and alternative bone quality assessments, including Hounsfield Unit (HU)-based assessment and cortical thickness ratio. Methods: A total of 180 patients who underwent non-contrast DECT of the spine between January 2016 and December 2021 were retrospectively analyzed. All imaged vertebrae were assessed for acute insufficiency fractures. DECT-based BMD was assessed using a dedicated postprocessing software that applies material decomposition and compared with HU-based assessment and cortical thickness ratio. Statistical analysis included correlation analysis, logistic regression adjusted for age and sex, ROC and PR curve analyses. Results: Among 180 patients (97 females, median age of 65 years), 126 subjects (70 %) were confirmed to have insufficiency fractures. Patients with fractures had significantly lower values for DECT-based BMD (98.3 vs. 123.7 mg/cm3, p < 0.001), trabecular HU (93.5 vs. 159.5 HU, p < 0.001), and cortical thickness ratio (1.065 vs. 1.05, p < 0.001). Cortical HU showed no significant difference between patients with and without fractures (p = 0.35). DECT-based BMD provided the highest diagnostic accuracy for detecting insufficiency fractures, yielding an AUC of 0.8 for the ROC curve and an AUC of 0.9 for the PR curve. HU-based measurements (trabecular HU: Spearman ρ = 0.17; cortical HU: ρ = 0.2) and the cortical thickness ratio (ρ = -0.01) demonstrated only weak correlations with the reference standard, DECT-derived BMD. Conclusion: DECT-based BMD demonstrated the highest diagnostic accuracy for insufficiency fractures. HU-based assessments and cortical thickness ratio showed only weak correlations with DECT-based BMD, limiting their reliability as alternatives
Rare earth elements on aquatic organisms: Toxicity, detoxification, and ecological implications
No full textRare earth elements (REEs) are widely used in various industries, such as electronics, renewable energy, and manufacturing, leading to their gradual accumulation in ecosystems, including water environments. As emerging pollutants, REEs find their way into water bodies through various channels, such as industrial discharge, mining runoff, and sewage. Despite their growing presence, the understanding of their toxicity in aquatic organisms is limited, representing a significant gap in current research. This review studies the bioaccumulation and toxicity of REEs in aquatic organisms, highlighting factors such as water chemistry, speciation, and organism characteristics that influence their uptake and effects. REEs can induce oxidative stress, ion imbalance, enzyme inhibition, and reproductive toxicity in aquatic species, leading to potential impairments in growth, survival, and reproduction. The ecological consequences of REE contamination extend beyond individual species and potentially affect community structures, disrupt food webs, and alter ecosystem functioning. This review emphasizes the urgent need for international regulatory guidelines to manage REE pollution in aquatic environments to protect biodiversity and ecosystem health. (c) 2024 The Authors. Publishing services by Elsevier B.V. on behalf of KeAi Communications Co. Ltd. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/)
Quantum phase transitions in many-dipole light-matter systems
No full textA potential phase transition between a normal ground state and a photon-condensed ground state in many-dipole light-matter systems is a topic of considerable controversy, exacerbated by conflicting no-go and counter no-go theorems and often ill-defined models. We contribute to the clarification of this long-lasting debate by analyzing two specific arrangements of atoms, including a three-dimensional cubic lattice and a cavity-embedded square lattice layer - which provides a physical model for single-mode cavity QED with coupled dipoles in the thermodynamic limit. These models are shown to significantly differ from the standard Dicke model and, in the thermodynamic limit, give rise to renormalized Hopfield models. We show that a ferroelectric phase transition can, in principle, still occur and the description of the abnormal phase beyond the critical point requires the inclusion of nonlinear terms in the Holstein-Primakoff mapping. We also demonstrate how our model agrees with recent experiments
Microscopic in vivo description of dermatoscopic pigment network under magnified dermoscopy
No full textSHEAR WAVE ELASTOGRAPHY TECHNIQUES IN DOGS AND CATS: PERSONAL FINDINGS
No full textShear wave elastography (SWE) is an innovative ultrasound technique which measures the propagation of shear waves produced in response to an ultrasound impulse in the tissue; since shear waves propagate faster in harder tissues, by measuring shear wave speed (SWS) it is possible to obtain information on tissue stiffness.
In this thesis we applied SWE techniques to evaluate testicular stiffness in dogs and the spleen of dogs and cats, using Mindray ultrasound equipment.
In the first chapter, we summarized the operating principles of elastography, the techniques currently available, the technical factors and the artifacts that can be found in performing the exams. Furthermore, we reported the current state of the art regarding the applications of SWE in dogs and cats. Finally, we described the technical characteristics and the exam procedures of a Mindray machine.
In the second chapter, we evaluated the testicular SWS associated to functional integrity and normal semen parameters of breeding dogs. Subsequently, we hypothesized that SWE techniques could help in distinguishing testicular lesions, and we explored this hypothesis by performing pSWE and 2D-SWE on a group of canine testicular abnormalities.
In the third chapter we evaluated the spleen SWS in dogs affected by leishmaniosis and in the fourth chapter we compared the performance of two different ultrasound transducers (linear and convex) in the SWE assessment of canine spleen.
In the fifth chapter, we evaluated feline spleen stiffness in cats seropositive to Leishmania infantum, feline immunodeficiency virus, and their coinfection, and we compared it to a healthy control group. Moreover, as we grouped our population into awake and anesthetized patients, we compared the spleen SWS between the two groups.
In the sixth chapter, we hypothesized that spleen stiffness could be affected by anesthetic drugs, thus we performed repeated 2D-SWE evaluation in groups of healthy dogs before any drug administration, during premedication, and during general anesthesia, to observe the effects of pharmacological agents on splenic stiffness.
This work brings new evidence to the literature on SWE in dogs and cats, with preliminary results that encourage the clinical application of this ultrasound technique in the veterinary clinical practice
