University of Verona
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Il governo del territorio transfrontaliero: istituzioni, policies e funzioni
Get PDFIntroduzione al numero monografico "Il governo del territorio transfromntaliero"
FDA Adverse Event Reporting System Essentials: A Reflection on Study Conception
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61st EASD Annual Meeting of the European Association for the Study of Diabetes SO 077 Hi Hypo :) I would like to know you better 854 - Detecting hypoglycaemia with glycaemia risk index in adults with type 1 diabetes using continuous glucose monitoring and multiple daily injection therapy: a multicentric real-world study
No full textBackground and aims: The glycemia risk index (GRI) is a novel composite score to evaluate the quality of glucose monitoring profiles, weighted according to the risk of both hypo- and hyperglycemia. Aim of this multicentric, retrospective study was to investigate the relationship between GRI and the most common sensor-derived glucose metrics in a population in multiple daily injection (MDI) therapy and with 2nd generation intermittently-scanned continuous glucose monitoring (isCGM) sensors in a real-world setting.
Materials and methods: The analysis included 90-day intervals from 539 routine visits of 367 patients (M/F=203/164; mean±SD: age 42±16 years, diabetes duration 21±14 years, HbA1c 7.5±1.0%) with type 1 diabetes (T1D), in MDI therapy and with isCGM sensors, who attended the outpatient diabetes clinics at the Hospitals of Verona (from January 2023 to December 2023) and Bergamo (from January 2023 to April 2023). Patients’ 90-day-long isCGM tracings were stratified into three groups based on time in range (TIR) (groups 1 to 3: >70%, 70 to 50% and ≤50%, respectively) and then in subgroups according to clinical guideline-based thresholds for time below range (TBR) (<4% vs ≥4%). GRI was computed for each subgroup and correlation and regression analyses were performed to assess the relationship between GRI and the main metrics.
Results: Pairwise comparisons between TIR-based groups showed significantly higher GRI as TIR decreased among groups (all p<0.001); after further stratifications based on TBR thresholds within TIR groups 1 and 2, the subgroups with TBR≥4% vs <4% displayed significantly higher GRI (31.0±8.4 vs 19.8±6.9 and 51.7±9.7 vs 43.7±8.4 for groups 1 and 2, respectively, both p<0.001), although without any significant differences in TIR (79.0±5.8% vs 80.4±7.0%, p 0.289, and 60.6±5.6% vs 59.6±5.8%, p 0.221, for groups 1 and 2, respectively). Pearson’s correlations and unadjusted linear regression analyses showed negative relationships between GRI and TIR and positive ones with time above range (TAR) and the coefficient of variation (CV) (all p<0.001), but none with TBR; however, when adjusted for TIR and CV, regression analyses unveiled significant opposite associations of GRI with TAR and TBR (coeff. -1.28 and 1.28, respectively, both p<0.001).
Conclusion: This real-world, retrospective analysis suggested that GRI may be useful for identifying patients at higher risk of hypoglycemia within groups with similar TIR. Further studies are needed, particularly in patients with different
combinations of sensors and insulin administration methods
Exercise ventilatory inefficiency may be a specific feature of patients with acromegaly
Get PDFPurpose: Reduction in exercise capacity and peak oxygen uptake (V̇O2) are common in acromegaly, but ventilatory alterations during exercise remain unstudied. We evaluated the exercise ventilatory response in terms of efficiency in patients with acromegaly. Methods: We prospectively evaluated 10 patients with acromegaly in a phase of disease control. To minimise confounders related to ventilatory response and anthropometric differences, acromegalic patients were matched with 10 control subjects according to age, body mass index, and body surface area. Chronic diseases, any cardio-respiratory condition likely to alter ventilatory response, and evidence of cardiac dysfunction were excluded. Pulmonary function tests and maximal cardiopulmonary exercise testing were performed. Ventilatory response was assessed via minute ventilation (V̇E)/carbon dioxide(CO2) output slope (V̇E/V̇CO2slope) and end-tidal carbon dioxide pressure (PETCO2). Exercise ventilatory inefficiency (EVin) was defined according to reference values for healthy individuals. Results: No alterations in lung function were observed in either group. Compared with controls, patients with acromegaly showed lower power output and V̇O2 at peak (1.38 ± 0.20 vs. 1.90 ± 0.64 L·min-1; p = 0.033). Breathing patterns were similar to those of controls, but acromegalic patients exhibited higher values of V̇E/V̇CO2slope (31.8 ± 3.7 vs. 28.0 ± 2.7; p = 0.018), lower PETCO2 at peak (31.1 ± 5.3 vs. 36.9 ± 3.0 mmHg; p = 0.008), and a greater prevalence of EVin (60% vs. 10%; p = 0.019). No correlations emerged between ventilatory inefficiency and biochemical or clinical variables. Conclusion: Patients with acromegaly display ventilatory inefficiency during exercise. These findings suggest subclinical alveolar-capillary impairment or altered CO2 chemosensitivity. Exercise testing may help unmask these abnormalities, supporting its role in risk stratification and rehabilitation planning
Polyelectromyography Under Propofol to Differentiate Functional from Idiopathic Dystonia: A Pilot Study
No full textBackground: Functional dystonia (FD) is one of the most diagnostically challenging functional movement disorders. Phenomenological features often lack specificity, as many are also observed in idiopathic dystonia (ID) and validated biomarkers to distinguish FD from ID are currently unavailable OBJECTIVE: To investigate potential differences in muscle activity between ID and FD patients using polyelectromyography (PEMG) under anesthesia. Methods: We consecutively enrolled 10 patients with FD and 17 with ID according to the current diagnostic criteria who underwent continuous PEMG before, during, and after propofol infusion. Sedation levels were monitored by electroencephalography and bispectral index and stratified via the Observer's Assessment of Alertness/Sedation Scale (OASS). PEMG recordings were performed under five definite scenarios: alert, mild and deep sedation, and partial and full recovery of consciousness status. Presence/absence of EMG activity was evaluated across these stages, and changes from baseline patterns were analyzed. Results: During mild sedation, EMG activity persisted in all ID (100%) and in 9 (90%) FD patients. During deep sedation, EMG activity persisted in 9 (53%) ID patients and was absent in all FD patients (100%) (P = 0.01). During partial recovery of consciousness, EMG activity was present in all (100%) ID and only in 1 (10%) FD patients (P < 0.001). At full recovery, a different muscular activation pattern from baseline was observed in 7 (70%) FD and only in 1 (6%) ID patients (P = 0.001) CONCLUSIONS: EMG silence during deep sedation and partial recovery may serve as a neurophysiological marker of FD. A muscular activation pattern differing from baseline may represent a neurophysiological clue for incongruence © 2025 The Author(s). Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society
Hyaluronic Acid in Dentistry: A Narrative Review
No full textBiocompatibility, anti-inflammatory properties, and regenerative potential. It plays a crucial role in enhancing wound healing, reducing inflammation, and supporting tissue repair. This review aims to evaluate the clinical efficacy of HA in various dental applications, including periodontal therapy, oral surgery, implantology, and the management of oral mucosal lesions
L’unità incrinata. Heisenberg tra Goethe, pensiero greco e Weltformel
No full textLe scienze nascono dalla filosofia, dalla quale trovano autonomia epistemologica man mano che definiscono i loro ambiti, i loro metodi e i loro linguaggi. Il terreno comune sul quale si dispiegano sia la scienza sia la filosofia è quello della storia. Solo chiarendo e ricostruendo sul piano storico i rapporti tra scienza, filosofia e contesto culturale e sociale è possibile comprendere in modo approfondito autori, teorie e correnti di pensiero. La prospettiva storica interagisce inoltre con la consapevolezza teorica della scienza e della filosofia e può essere considerata parte integrante della riflessione di queste discipline.
Silvia Caianiello, Dario Generali, Fabio Minazzi (a cura di).
Contributi di: Ugo Baldini, Maria Teresa Costa, Stefano Furlan, Rocco Gaudenzi, Laurent Loison, Cesare Maffioli, Roberto Marcuccio, Renato G. Mazzolini, Pietro Daniel Omodeo, Barbara Orland e Hans-Jörg Rheinberge
A Composite Endpoint of Liver Surgery (CELS): Development and Validation of a Clinically Relevant Endpoint Requiring a Smaller Sample Size
No full textBackground. The feasibility of trials in liver surgery using a single-component clinical endpoint is low because single endpoints require large samples due to their low incidence. The current study sought to develop and validate a novel composite endpoint of liver surgery (CELS) to facilitate the generation of more feasible and robust high-level evidence in the field of liver surgery. Methods. Patients who underwent curative-intent hepatectomy for hepatocellular carcinoma, intrahepatic cholangiocarcinoma, or colorectal liver metastasis were identified using a multi-institutional database. Components of CELS were selected based on perioperative liver surgery-specific complications using univariable logistic regression models. The association of CELS with prolonged length of stay (LOS) and surgery-related death was evaluated and externally validated. Sample sizes were calculated for both individual outcomes and CELS. Results. Among 1958 patients, 377 (19.3%) met CELS criteria based on postoperative bile leak (n = 221, 11.3%), post-hepatectomy liver failure (n = 71, 3.6%), post-hepatectomy hemorrhage (n = 38, 1.9%), or intraoperative blood loss of 2000 ml or greater (n = 101, 5.2%). CELS demonstrated favorable discriminative accuracy of surgery-related death (analytic cohort: area under the curve [AUC], 0.79 vs external validation cohort: AUC, 0.85). In addition LOS was longer among the patients with a positive CELS (analytic cohort: 14 vs. 9 days [p < 0.001] vs. the validation cohort: 10 vs. 6 days [p < 0.001]). Relative to individual endpoints, CELS allowed a 45.8-91.6% reduction in sample size. Conclusion. CELS effectively predicted surgery-related death and can be used as a standardized, clinically relevant endpoint in prospective trials, facilitating smaller sample sizes and enhancing feasibility compared with single quality outcome metrics
Globalizzazione economica e caporalato
No full textLa deregolamentazione del mercato del lavoro e la crescente esternalizzazione dei processi produttivi hanno fatto emergere nel nostro Paese nuove forme di caporalato e di sfruttamento del lavoro. Repressione e aumento dei controlli ispettivi non bastano ad arginare fenomeni criminosi così complessi, lesivi della dignità e dei diritti dei lavoratori e delle lavoratrici. Occorrono interventi coordinati e strategie multilivello, atte ad incidere sui molteplici fattori che agevolano le condotte di intermediazione illecita di manodopera e lo sfruttament
ASO Authors Reflections: Could Robotics, 3D Imaging, and Liver Venous Deprivation Potentially Redefine Surgical Standards for Perihilar Cholangiocarcinoma?
Get PDF: Peri-hilar cholangiocarcinoma remains a major challenge in hepatobiliary surgery, where safety of surgical operation and oncological radicality (R0 resection) are primary goals. Traditional open surgery, including major hepatectomy with caudate lobe and bile duct resection plus lymphadenectomy, remains the standard. Recent advances-robotic platforms, 3D imaging, and liver venous deprivation-offer new possibilities: liver venous deprivation ensures sufficient future liver remnant, and robotics provide precise dissection and enhanced visualization. Although costs and the learning curve remain limiting factors, these strategies could safely expand the use of minimally invasive surgery in peri-hilar cholangiocarcinoma. Validation in larger cohorts is required to assess their true potential