Archivio Istituzionale della Ricerca - Università degli Studi della Campania "Luigi Vanvitelli"
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Innovazioni terapeutiche nella proctite attinica cronica: valutazione della radiofrequenza endoscopica come alternativa alle tecniche tradizionali
No full textAbstract
Chronic actinic proctitis is a late complication of pelvic radiotherapy, caused by ischemic microvascular lesions that lead to chronic rectal bleeding, anemia, and a reduction in quality of life. Traditional therapies, including argon plasma coagulation (APC), although effective, are burdened by ulceration and stenosis. Radiofrequency ablation (RFA), already successfully used for esophageal lesions, provides controlled and superficial necrosis, promoting mucosal re-epithelialization. The aim of the study was to evaluate the efficacy and safety of RFA in the treatment of refractory chronic actinic proctitis, comparing it with conventional endoscopic techniques. Selected patients were treated with a BarrxTM through-the-scope catheter, applying an energy of 10 J/cm2 (300 W). Endoscopic follow-up, using white light and narrow-band imaging (NBI), monitored re-epithelialization and the onset of complications. Hemostasis was achieved after 1–2 sessions in all cases, with complete resolution of rectal bleeding and no strictures or ulcerations. No major complications were observed. Endoscopic radiofrequency therapy has been confirmed as an effective, safe, and minimally invasive treatment for chronic actinic proctitis, capable of ensuring long-lasting bleeding control and excellent mucosal healing
Biology Meets Design: From Observation to Computational Design Through Interdisciplinary Approaches in Bio-Inspired Design
No full textThe growing interest in bio-inspired design has fostered interdisciplinary collaborations between biology, design, and technology, aiming to address sustainability challenges in innovative ways. This paper explores three case studies where biological observation, computational modeling, and digital fabrication are integrated to translate natural principles into cutting-edge design solutions.
At Arizona State University, spaces such as NatureSpace and The Biomimicry Center provide support for transforming biological insights into design concepts. NatureSpace offers inspiration through its collection of natural history specimens and visualization tools, enabling exploration, sketching, and creative support for research projects. The Biomimicry Center provides foundational training in biomimicry, teaching approaches to integrate nature into design while promoting cross-sector collaboration. The computational and digital fabrication phase takes place at the University of Camerino, where the SaadLab Prototype, a digital fabrication laboratory, translates natural concepts into digital models and physical prototypes using technologies such as 3D printing.
This research highlights how the synergy between biologists and designers fosters a holistic approach to bio-inspired design, advancing sustainable innovation across various sectors. By converging biology and design, these collaborations offer solutions to environmental challenges and contribute to the development of resource-efficient materials and products. This interdisciplinary research integrates theory and practice to highlight how bio-inspired design acts as a driver of innovation by identifying sustainable strategies and developing nature-inspired solutions
Point-of-care tests for biomarkers to improve the Quality and Safety of surgery actions.
No full textEthical Issues Affecting Underage Players in the E-sports System Between Problems of Integrity and Gender-based Discrimination: possible solutions from an International Law Perspective
No full textThe vast majority of e-sports players, whether professional or amateur, are
underage teenagers. Given the very young age of the players, the ethical issues affecting the e-sports system pose a series of additional risks, as e-sports players could be more vulnerable and susceptible to corruption attempts and discriminatory treatment. This paper will first seek to identify the main issues affecting underage players and, then, to suggest possible solutions under International Law. In particular, the first part will discuss the problems of integrity that undermine the legitimacy and the growth of the e-sports sector, such as illegal betting, match-fixing and doping. After a brief explanation of the phenomena, the work will analyse the sanctions provided in the e-sports system in order to suggest some guidelines for uniform rules. The second part of the paper, in turn, will focus on gender-related challenges faced by young female players, notably equal participation and professional opportunities, the toxic patriarchal culture
of objectification and hyper sexualization both of the players themselves and of female characters, as well as online violence and harassment. Suggested approaches will comprise the analysis of legal protections to female minors in the realm of International Law, as well as progressive initiatives by international actors such as the “Game Changers Coalition” by UNICEF
Regional anesthesia in breast surgery: An Italian expert consensus – Part 1: Methodology and Delphi strategy
No full textBackground: Despite being considered routine, breast surgery is associated with a high incidence of acute and chronic postoperative pain, which can significantly impact recovery and quality of life. Regional anesthesia techniques have become increasingly relevant within multimodal analgesic strategies, yet clinical practice remains heterogeneous and lacks clear guidance. To address this, we aimed to develop a multidisciplinary, evidence-based consensus on the role of regional anesthesia in breast surgery. Methods: An expert panel was appointed by the Italian Chapter of the European Society of Regional Anaesthesia, including anesthesiologists and breast surgeons (in partnership with the Italian National Association of Breast Surgeons). A four-round Delphi method was applied to refine an initial set of 24 PICO-formulated questions. Each question was evaluated for relevance and clarity using a 9-point Likert scale (1 = not relevant/clear, 9 = extremely relevant/clear). Finalized questions underwent systematic review or network meta-analysis depending on data availability. Results: Eleven clinically relevant and clearly formulated PICO questions were identified after four Delphi rounds. These questions encompass acute and chronic pain control, block safety in anticoagulated patients, awake surgery, and the comparative efficacy of single-shot versus continuous blocks, among others. Each question will guide a systematic review and support the development of graded consensus statements. Conclusion: This consensus project establishes a transparent, multidisciplinary framework for guiding the use of regional anesthesia in breast surgery. The ultimate objective is to formulate a set of consensus statements, graded according to evidence strength, which will serve as a foundation for future guidelines and standardized clinical decision-making
Immagini perdute, memorie ritrovate. Su alcuni ritratti di Maria Sofia di Borbone Wittelsbach
No full text
Correlates of embolic complications and vegetation size in a contemporary cohort of infective endocarditis: performance of a diagnostic score model
No full textBackground
Infective endocarditis (IE) is a heterogeneous disease undergoing epidemiological changes. Whether those changes have an impact on the correlates of embolic events (EE) and vegetation size (VS) remains unclear. I analyzed the correlates of EE and VS and the performance of a diagnostic score model for the detection of clinically significant EE in a large contemporary IE cohort.
Methods
This is a retrospective observational study including patients with definite valve IE according to existing criteria overtime and admitted between 2000 and 2023. EE were defined as acute complications causing overt clinical manifestations. The study primary aim was to identify independent correlates of EE and VS.
Results
715 valve-IE cases were included. A vegetation was found in 395 cases (55%) with a median size of 14 mm. EE occurred in 41.4% (n=296) of patients. According to the 14 mm cut-off, EE were significantly more likely to occur in patients with larger vegetations (48% vs 33%; p=0.015). S. aureus etiology (OR 2.708[1.268–5.786];p=0.010), C-reactive protein>6.7 mg/dL (OR 2.415[1.371–4.252];p=0.002), and splenomegaly (OR 2.858[1.620–5.403];p<0.001) were independently associated with EE. VS≥14 mm (OR 1.575[0.925–2.682];p=0.061) and D-dimers >747 ng/mL (OR 1.677[0.976–2.881];p=0.061) showed a trend for independent association. These variables were included in a diagnostic score model. A stepwise increase of EE occurrence was found stratifying patients into 3 categories (score 0-2–22%; score 3-5–53%; score 6-8–78%;p<0.001). A cut-off of 2 showed a sensitivity of 83% and a specificity of 50% (AUROC 0.732; p<0.001).
Conclusion
EE were independently associated to S. aureus, C-reactive protein and splenomegaly and less strongly linked to vegetation size in our cohort. These results may be explained by a change in embolic complications correlates linked to the epidemiological shift. The discriminative ability of our score was only fair. At present, clinicians should rely upon clinical and imaging data to diagnose EE.Introduzione
L’endocardite infettiva (EI) è un complesso ed eterogeneo gruppo di infezioni cardiovascolari che sta subendo importanti cambiamenti epidemiologici. E’ ancora da chiarire se questi cambiamenti epidemiologici abbiano avuto un impatto sui fattori determinanti la dimensione della vegetazione e le complicanze emboliche. In questo studio ho analizzato i correlati delle complicanze emboliche e della dimensione della vegetazione e sviluppato un modello di score diagnostico delle complicanze emboliche in un’ampia coorte contemporanea di pazienti affetti da endocardite infettiva.
Metodi
Studio osservazionale retrospettivo monocentrico che ha arruolato pazienti con endocardite infettiva certa (basati sui criteri esistenti al momento dell’arruolamento) ed ospedalizzati fra il 2000 ed il 2023. Le complicanze emboliche sono state definite come complicanze che determinavano una manifestazione clinica significativa. L’obiettivo primario dello studio è stato identificare i fattori indipendentemente correlati alle complicanze emboliche ed alla dimensione della vegetazione.
Risultati
Sono stati arruolati 715 pazienti con EI valvolare. La vegetazione era presente in 395 pazienti (55%) con una dimensione mediana di 14 mm. Le embolie si sono manifestate nel 41.4% (n=296) dei pazienti. Sfruttando il cut-off di 14 mm, le embolie era più frequenti nei pazienti con vegetazioni al di sopra del cut-off (48% vs 33%; p=0.015). Lo Staphylococcus aureus come agente eziologico (OR OR 2.708[1.268–5.786];p=0.010), la proteina C-reattiva > 6.7 mg/dL (OR 2.415[1.371–4.252];p=0.002) e la splenomegalia (OR 2.858[1.620–5.403];p<0.001) sono stati associati in modo indipendente all’embolia. La vegetazione > 14 mm (OR 1.575[0.925–2.682];p=0.061) ed il D-dimero > 747 ng/mL (OR 1.677[0.976–2.881];p=0.061) hanno mostrato un trend per una associazione indipendente. Queste variabili sono state incluse in un modello di score diagnostico. Stratificando i pazienti in tre categorie di rischio sulla base del punteggio ottenuto, ho trovato un progressivo incremento della probabilità di complicanze emboliche (score 0-2: 22%; score 3-5: 53%; score 6-8: 78%; p<0.001). Il cut-off di 2 ha mostrato una sensibilità dell’83% ed una specificità del 50% (AUROC 0.732; p<0.001).
Conclusioni
Nella mia coorte, ho dimostrato una forte correlazione indipendente fra le complicanze emboliche e l’eziologia di S. aureus, la proteina C-reattiva e la splenomegalia, ed un minor impatto della dimensione della vegetazione. Questi risultati potrebbero essere spiegati dai cambiamenti epidemiologici che stiamo osservando nell’EI e che potrebbero aver avuto un impatto sui fattori determinanti le complicanze emboliche. Il moderato potere discriminante del mio modello di score sottolinea come i clinici debbano sempre basarsi sull’utilizzo combinato di fattori clinici e radiologici per la diagnosi delle complicanze emboliche
Unveiling the role of peak load in the stability and growth of interlaminar fatigue damage in composite structures
No full textUnderstanding the stability of delamination growth is essential for ensuring the reliability of composite structures under compressive fatigue loading. In post-buckling regimes, where crack propagation can become highly unstable and nonlinear, even small variations in the applied load may drastically alter damage evolution and residual strength. Despite its critical role, the stability of interlaminar crack growth under cyclic compression remains poorly understood, demanding refined numerical strategies to capture its complex behaviour. This work addresses this gap by investigating how the peak compressive load influences the stability and progression of delamination in composite structures. A dedicated numerical approach has been developed to study these effects. The methodology, named SMART LOOP, couples the Virtual Crack Closure Technique (VCCT) with the Paris Law-based damage accumulation model. Such method employs an adaptive timestep strategy to ensure precise load control and mesh-independent predictions. SMART LOOP transforms force-controlled fatigue simulations into a sequence of displacement-controlled static analyses, where the displacement input is automatically adjusted to reach the target load level. This produces delamination length results that are independent of element size, eliminating the need for mesh refinement strategies. A series of simulations has been carried out on an Omega-stiffened composite panel subjected to three different compressive peak loads (25.2, 27.1, and 29.1 kN). The numerical results have been compared with experimental data from the literature to enhance the understanding of the unstable delamination growth phenomenon. This provides additional insights into failure mechanisms and complements the experimental observations