68994 research outputs found
Sort by
Paediatric Robotic Transperitoneal Heminephroureterectomy in Complete Duplicated Systems: Early and Long-Term Outcomes
No full textBackground: We present outcomes for paediatric robotic heminephroureterectomy from a prospective single-surgeon series. Methods: Children who underwent this operation between July 2007 and March 2017 were reviewed from a prospective database. Results: There were 32 heminephroureterectomy (28 upper, 4 lower) for ureterocele (13), reflux (7), ectopic ureter (11), ureteric atresia (1). Co-morbidities (urological anomalies, recurrent infection, previous abdominal scarring) were common. Concomitant non-robotic procedures took place in 50%. Mean console time was 101 ± 30.2 min, hospital stay 29.5 ± 10.3 h. There were no conversions, intraoperative complications, and no remnant moiety function loss. Excision of diseased moiety calyces was complete in 30 (94%), incomplete in 2 (6%) who subsequently developed asymptomatic small marginal cysts. Eleven (34%) had total-ureterectomy, the remaining 21 (66%) were left with a ureteric stump. Postoperatively 3 (9%) females with residual stump (2 ureterocele, 1 bladder neck ectopia) and other urological anomalies underwent surgery (stump excision + reimplant refluxing remnant moiety ureter) for recurrent infection. Conclusion: In children, heminephroureterectomy is well suited to a robotic approach with favourable outcomes in our experience
Comparing MVS and Gaussian Splatting for the 3D Reconstruction of Reflective and Texture-less Cultural Heritage Artifacts
Get PDFThis study presents a comparative analysis of Multi-View Stereo (MVS) and 3D Gaussian Splatting (GS) for the threedimensional reconstruction of cultural heritage artifacts characterized by reflective and texture-less surfaces, conditions that traditionally challenge image-based modeling techniques. Two case studies, a ceramic and a bronze head, were documented through controlled photographic acquisition and processed using both methods. Laser scanning served as a geometric benchmark for quantitative evaluation. Results demonstrate that GS provides more spatially homogeneous reconstructions and enhanced visual coherence, particularly in regions affected by specular highlights and low surface texture. Visual comparisons further highlight the potential of GS to deliver smooth, photorealistic renderings through its volumetric, viewdependent representation
Redefining the blanking period after pulsed field ablation in patients with atrial fibrillation
No full textBackground: Recurrence during the 3-month blanking period after radiofrequency ablation of atrial fibrillation (AF) is typically not considered as a predictor for late recurrence. Objective: We investigated the significance of early recurrence as a risk factor for late recurrence in patients with AF receiving pulsed-field ablation (PFA). Methods: Consecutive patients undergoing PFA were prospectively followed up for 1 year. All patients received isolation of pulmonary veins. Additional ablation procedures were performed per operator's discretion. After the procedure, all remained on their previously ineffective antiarrhythmic drugs (AADs) during the 2-month blanking period after which the AADs were discontinued. Early recurrence was defined as atrial arrhythmia of >30-second duration during the 3-month blanking period, and any recurrence beyond 3 months was considered as late recurrence. Results: A total of 337 patients undergoing PFA for AF were included. Early recurrence was recorded in 53 patients (15.7%): 10 in the first month, 12 in the second month, and 31 in the third month. Of the 10 patients having recurrence during the first month, 7 (70%) remained in sinus rhythm after cardioversion whereas 3 (30%) underwent a redo procedure because of late recurrence. At 1 year, all patients with recurrence in the second and third months experienced late recurrence; among these patients, 10 (83.3%) of 12 and 27 (87%) of 31 underwent a redo procedure and the remaining 6 patients were in sinus rhythm on AADs. Conclusion: In this consecutive series of patients with AF, early recurrence in the second or third month after the PFA procedure was associated with a high risk of late recurrence. Thus, blanking period could be redefined as 1 month after PFA
A scoring model integrating CXCL9, GDF15, FGF21, and NfL, predicts long-term mortality in type 2 diabetes: a retrospective study
Get PDFBackground: Type 2 diabetes (T2D) is a chronic metabolic disorder associated with aging, systemic inflammation, and increased long-term mortality. Identifying prognostic biomarkers may improve risk stratification and guide personalized interventions. This study aimed to evaluate the long-term prognostic value of circulating biomarkers related to inflammation, metabolic stress, and organ damage in individuals with T2D. Methods: A retrospective study was conducted on a cohort of 478 individuals with T2D, followed for a median of 16.1 years. Ten circulating biomarkers (IL-6, IL-10, CD163, CXCL9, CCL22, GDF15, IL-33, FGF21, Follistatin, and neurofilament light chain [NfL]) were quantified using an automated immunoassay platform. Kaplan-Meier survival analysis and Cox proportional hazards models were used to assess their prognostic significance for all-cause mortality. A biomarker-based scoring model was developed by integrating independent predictors of mortality. Predictive performance was evaluated in comparison with the RECODe equation, a validated risk model for diabetes complications and mortality. Results: Deceased individuals exhibited significantly higher levels of IL-6, IL-10, CXCL9, FGF21, NfL, and GDF15. Biomarker levels correlated with both microvascular and macrovascular complications, particularly neuropathy, nephropathy, retinopathy, and major adverse cardiovascular events (MACE). In multivariable Cox regression analysis, four biomarkers emerged as independent predictors of mortality: CXCL9 (HR per 1 SD increase 1.19, 95% CI 1.05-1.36, p = 0.006), GDF15 (HR 1.16, 95% CI 1.02-1.33, p = 0.032), NfL (HR 1.25, 95% CI 1.09-1.43, p = 0.001), and FGF21 (HR 1.20, 95% CI 1.04-1.37, p = 0.009). A composite biomarker score (range: 4-12) stratified individuals into distinct risk categories, with each 1-point increase in the score associated with a 55% higher mortality risk (HR 1.53, 95% CI 1.35-1.74, p < 0.001). The biomarker score remained independently predictive after adjusting for clinical covariates and significantly improved individual-level risk classification beyond the RECODe model, as demonstrated by net reclassification and discrimination improvement metrics. Conclusions: These findings suggest that inflammatory and metabolic stress-related biomarkers independently predict long-term mortality in T2D. The biomarker-based scoring model enhances risk stratification and improves the prognostic performance of existing clinical tools, such as the RECODe equation, potentially informing targeted clinical interventions
Development and Characterization of Lignin-Based Hydrogels for Efficient Adsorption of Diclofenac From Aqueous Environment
Get PDFHydrogels are interesting materials with potential applications in the treatment of water contaminated by organic and inorganic toxic compounds. Among the different monomers/polymers commonly used, the natural polymer lignin is undoubtedly an attractive candidate due to its biocompatibility, biodegradability, low toxicity, and availability in high quantities as the main by-product of the pulp industry. In the present work, the synthesis and characterization of a lignin-based hydrogel are described and tested in the adsorption of the nonsteroidal anti-inflammatory drug, diclofenac, one of the so-called emerging contaminants. Due to the anionic nature of diclofenac currently used in pharmaceutical preparations, a cationic functionality is included in the polymeric backbone. The obtained hydrogel is characterized by a porous structure, thermal stability, and an elastic behavior more pronounced than the viscous one. It has a high swelling capacity and is able to efficiently remove diclofenac in batch mode, following a pseudo-second order kinetic, and adsorption could be well described by Langmuir and Sips isothermal models. For the first time, diclofenac removal by a lignin-based hydrogel is also carried out in a packed-bed column with a maximum capacity of ca. 50 mg/g, and different theoretical models are used to fit the experimental data
Effective Inventory Control Under Very Large Unknown Deterioration Rate and Volatile, Almost Unpredictable Customer Demand
Get PDFWe consider a periodically reviewed perishable Supply Chain (SC) whose dynamics shows the following elements of complexity: the goods are affected by a very large, uncertain deterioration factor (DF), the customer demand is highly unpredictable and volatile. The problem we face is to define an effective Inventory Replenishment Policy (IRP) conciliating the conflicting requirements of maximizing the satisfied customer demand and containing the Bullwhip Effect (BE). The method we propose is situated in the general framework of min-max Model Predictive Control (MPC) applied to SC management. We exploit the flexibility and generality of min-max MPC to define a specifically tailored method to address the peculiarity of the current, extremely complex issue. Especially, we demonstrate the advantages of using a short prediction horizon and point-wise constraints on the IR
Advances in Cardiovascular Multimodality Imaging in Patients with Marfan Syndrome
Get PDFMarfan syndrome (MFS) is a genetic disorder affecting connective tissue, often leading to cardiovascular complications such as aortic aneurysms and mitral valve prolapse. Cardiovascular multimodality imaging plays a crucial role in the diagnosis, monitoring, and management of MFS patients. This review explores the advancements in echocardiography, cardiovascular magnetic resonance (CMR), cardiac computed tomography (CCT), and nuclear medicine techniques in MFS. Echocardiography remains the first-line tool, essential for assessing aortic root, mitral valve abnormalities, and cardiac function. CMR provides detailed anatomical and functional assessments without radiation exposure, making it ideal for long-term follow-up. CT offers high-resolution imaging of the aorta, crucial for surgical planning, despite its ionizing radiation. Emerging nuclear medicine techniques, though less common, show promise in evaluating myocardial involvement and inflammatory conditions. This review underscores the importance of a comprehensive imaging approach to improve outcomes and guide interventions in MFS patients. It also introduces novel aspects of multimodality approaches, emphasizing their impact on early detection and management of cardiovascular complications in MFS
Sicurezza sociale e crisi del modello contributivo: le contraddizioni tra sostenibilità finanziaria ed esigenze di riforma
No full textIl saggio analizza in chiave sistemica la crisi strutturale del modello previdenziale contributivo italiano, mettendo in luce il progressivo squilibrio tra retribuzione, obbligo contributivo e prestazione pensionistica. Muovendo da una lettura costituzionalmente orientata dell’art. 38 Cost. e dal confronto con l’evoluzione normativa e giurisprudenziale più recente, il contributo evidenzia l’indebolimento del principio di corrispettività e la conseguente attenuazione della tradizionale dicotomia tra previdenza e assistenza. In tale contesto, si sottolinea come la crescente precarizzazione del lavoro e la frammentazione delle carriere contributive abbiano accentuato le disuguaglianze nell’accesso e nell’adeguatezza delle prestazioni. Il saggio propone, infine, una riflessione di iure condendo volta al ripensamento complessivo dell’impianto previdenziale, prospettando soluzioni di lungo periodo orientate a un modello più integrato e universalistico delle tutele, fondato sull’equilibrio tra responsabilità individuale e solidarietà collettiva
Non-Holonomic Mobile Manipulator Obstacle Avoidance with Adaptive Prioritization
Get PDFThis paper presents an obstacle avoidance strategy for mobile manipulators consisting of a robotic arm and a base with a non-holonomic differential wheel system. The algorithm makes it possible to avoid obstacles in a dynamic environment, without planning the path a priori. A series of examples are proposed in simulation using Matlab and analyzed to show how the algorithm works if the obstacle interferes with the manipulator or the base. In addition, the possibility of prioritizing the movement of certain parts of the system using the weighted pseudo-inverse matrix is introduced. In this way, it is possible to give movement priority to the base if it is necessary to move the robot over long distances while keeping the manipulator as still as possible. The use of null space to keep the end-effector stationary while it avoids obstacles is also explored, exploiting the system’s redundancy and allowing the rest of the kinematic chain and the mobile base to move accordingly. Finally, current standards are analyzed and a solution is shown that allows the robot to vary its behavior to avoid obstacles depending on the distance to the target point
Imaging Features of Prostate Sarcoma: A Case Report
Get PDFA 54-year-old man presented to our clinic complaining of painful ejaculation. The patient underwent various imaging modalities, including ultrasound, transrectal ultrasound, prostate magnetic resonance imaging and positron emission tomography/computed tomography that detected a voluminous mass originating from the prostate. Histological examination diagnosed a prostate sarcoma, a rare mesenchymal tumour. This case offers an opportunity to evaluate a rare subtype of prostate cancer and to describe its main imaging features with an educational approach