Archivio Istituzionale della Ricerca - Università degli Studi della Campania "Luigi Vanvitelli"
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Mechanical heart valves between myths and new evidence: a systematic review and meta-analysis
No full textAimsThe use of mechanical valve prostheses in cardiac surgery remains a necessary and indicated intervention in a large number of patients. However, predicted results associated with their use, on which current guideline recommendations have been developed, are based on dated studies at risk of bias (e.g. use of old generation models, very high international normalized ratio regimes).MethodsA comprehensive search in multiple electronic databases was conducted from January 1995 to January 2024 using predefined criteria. The primary outcomes included all-cause death, bleeding events and thromboembolic events (i.e. stroke) at follow-up.ResultsOverall, 38 studies were included in the meta-analysis. Cumulative meta-analysis results for mortality, thromboembolic events and bleeding events were initially extremely variable and tended to become more consistent over time. A meta-regression for the impact of age and sex on mortality showed no difference, whereas a meta-regression for the impact of age and sex on thromboembolic events and on bleeding events showed a higher risk in the elderly and in female patients, respectively.ConclusionThe lack of fundamental information on the type of anticoagulant treatment (e.g. dosage, monitoring method) in the studies published to date does not allow us to draw any definitive conclusions on the outcomes of mechanical valve prostheses. The most recent studies have provided more consistent results, which in the past were highly variable, probably due to overcoming the bias in the use of prosthetic models of different generations
Young Workers and Lifestyles in a Mediterranean Cultural Context: What Is the Contribution of Occupational Health Promotion?
No full textCFD Prediction of Tandem Water Columns Aerobreakup Using Open-Source Codes
No full textThe present study addresses the comparison of two different novel open-source computational fluid dynamics (CFD) codes for the numerical simulation of the deformation and breakup of tandem water columns subjected to high-speed air flow. The computations are conducted using the code ECOGEN and a customized version of OpenFOAM. Both codes employ a volume-of-fluid interface-tracking method coupled with a higher-order finite-volume approach. Unlike some similar studies, viscous and capillary effects are taken into account. As to the computational setup, a virtual shock tube environment is arranged to accurately replicate the experimental conditions. The well-defined post-shock air flow conditions allow to model the post-impact dynamics, capturing key phenomena such as interface deformation, leading edge drift, and incipient breakup. A comparative analysis of the results highlights the strengths and limitations of each solver. Comparison of results with experimental observations indicates that while both codes capture the primary mechanism of aerobreakup, differences arise in the formation of early-stage instabilities and ligament stripping dynamics. By validating open-source codes against experimental observations, this study aims to contribute to the ongoing refinement of multiphase flow modeling tools
Management of Local Skin Reactions Caused by 5-FU 4% Cream for the Treatment of Actinic Keratosis: A Delphi Consensus
No full textIntroduction: Treatments such as 4% 5-fluorouracil (5-FU) cream have demonstrated strong efficacy in lesion clearance of actinic keratosis; however, local skin reactions (LSR) during treatment remain a significant challenge, potentially affecting patient adherence. Objective: We sought to build consensus on management of LSR associated with 4% 5-FU using the Delphi methodology. Methods: Twenty-eight expert dermatologists participated in a 3-round Delphi process. Experts evaluated LSR management strategies, including emollients, antibiotics, steroids, and treatment discontinuation. Agreement levels were measured using a 7-point Likert scale. Consensus was categorized as high if >80% of votes were within the 5–7 rating range and low when >25% were in the 1–3 rating range, with <25% of the votes in the 6–7 rating range. Other combinations of votes were considered as having moderate agreement. Results: High agreement was achieved for the following statements: the approved daily schedule (once daily for 4 weeks) is the most appropriate (92.9%); mild LSR generally do not require intervention and do not impact treatment adherence (96.4%); severe LSR may benefit from temporary treatment interruption and emollient use, ensuring adherence without compromising efficacy (92.9%). The use of emollients (in parallel with the treatment with 5-FU) was considered not needed by most (moderate consensus, 64.3%). Experts emphasized the importance of clear communication about LSR during baseline consultation to enhance patient compliance. Conclusion: This consensus provides practical guidance for managing LSR induced by 4% 5-FU, ensuring high adherence and optimizing treatment outcomes. Further research is needed to validate these findings and explore alternative management approaches
The Influence of Teaching Strategies on Biomechanical Control and Athletic Performance in Adolescents: A Comparison Between Internal and External Focus
No full text
Multicentre retrospective detection of nailfold videocapillaroscopy abnormalities in long covid patients
No full textBackground
SARS-CoV-2 induces acute non-specific endothelial/microvascular alterations that have been identified by nailfold videocapillaroscopy (NVC). Details on NVC abnormalities in long covid (LC) patients (pts) are unknown.
Methods
LC pts without and with systemic sclerosis (non-SSc-LC and SSc-LC), recovered COVID-19 (RC) pts that did not develop LC and healthy matched control subjects (CNT) that underwent NVC examinations were evaluated in a multicentre national study from the Capillaroscopy and Microcirculation in Rheumatic Diseases Study Group of the Italian Society of Rheumatology. Retrospective collection was performed for demographic data, course of SARS-CoV-2 infection, comorbidities, concomitant drugs. NVC alterations were quantified by validated scores. Pre-COVID-19 and post-COVID-19 microvascular status was analysed by NVC.
Results
62 non-SSc-LC pts (49 female/13 male, 51±16 years old), 24 SSc-LC pts (21 female/3 male, 59±17 years old), 23 RC pts (18 female/5 male, 51±18 years old) and 84 CNT (68 female/16 male, 52±12 years old) were analysed. Non-SSc-LC pts showed significantly more dilated capillaries (p<0.01, p multivariate<0.01), microhaemorrhages (p=0.01, p multivariate<0.05), abnormal shapes (p<0.05, p multivariate<0.05) than CNT and of note, lower mean capillary number per linear millimetre (p<0.01, p multivariate<0.01) than both RC pts and CTN (p<0.01, p multivariate<0.05).
Of highest interest, 16 non-SSc-LC pts showed statistically significantly more dilated capillaries (p<0.05) and microhaemorrhages (p<0.05) in NVC examinations after COVID-19, compared with pre-COVID-19 status.
Similarly, SSc-LC pts (24) showed significantly lower capillary density (p=0.01) and more dilated capillaries (p<0.01) in NVC examinations after COVID-19, compared with pre-COVID-19 status.
Conclusions
LC pts show more microvascular alterations at NVC as compared with RC patients and CNT, which may contribute to the pathogenesis of persistent organ/systems dysfunction
Assessing Surgical Approaches and Postoperative Complications for Thoracic Schwannomas: A Multicenter Retrospective Observational Analysis of 106 Cases
No full textThoracic schwannomas are benign tumors arising from spinal nerve sheaths with potential neurological and respiratory implications depending on their location. The optimal surgical strategy remains debated, particularly regarding the balance between the extent of resection; complication rates; and postoperative morbidity. This retrospective multicenter study analyzed 106 cases classified according to the Eden system to evaluate surgical outcomes and complications associated with different techniques. Our findings suggest that minimally invasive approaches, such as video-assisted thoracoscopic surgery for extraforaminal lesions and combined neurosurgical–thoracic approaches for dumbbell tumors, improve resection rates while reducing surgical morbidity. Conversely, isolated neurosurgical approaches and open thoracotomy may be associated with increased complication risks. These results support a tailored, multidisciplinary approach based on tumor extension and anatomical constraints to optimize patient outcomes
Philosophy and Medicine: an Aristotelian Reflection
No full textThe debate on the relationship between philosophy and medicine raised by both philosophers and physicians concerns the possibility of elaborating a practical philosophy of medicine as an autonomous discipline distinct from both philosophy and medicine as separate entities. Analysis reveals the close link between philosophy and medicine since its inception in ancient Greece as well as the difficulty of defining the epistemological status of medicine, which presents a dual character of science and practice. The impossibility of defining medicine as pure science, on a par with physics and mathematics, generates tensions between explanatory theories and therapeutic aims and between universal knowledge and understanding of the specific where medical science is confronted with the values that come into play in a clinical encounter. The doctor-patient relationship is the core of clinical medicine. The significant contribution that philosophical reflection (1) can offer to medical science is to be found in the practice of the therapeutic encounter and the analysis of the ethical dimensions involved in it. A practical philosophy, in the Aristotelian sense of the term, is understood as the expression of a form of rationality that differs from the scientific one, which does not seek knowledge as an end in itself but is directed towards an understanding that aims to guide actions. This reference is to that practical logic that allows the physician to deliberate on the most suitable means to achieve his end and the greatest good for the patient