7 research outputs found
Treatment of large knee osteochondral lesions with a biomimetic scaffold: Results of a multicenter study of 49 patients at 2-year follow-up
No full textBackground: Osteochondral knee lesions represent a challenging condition encountered by orthopaedic surgeons. A variety of methods have been developed to repair articular cartilage defects. However, these techniques are limited by donor site morbidity or by the requirement for a staged procedure. Purpose: To assess the effectiveness of a biomimetic osteochondral scaffold for the treatment of large osteochondral knee lesions. Study Design: Case series; Level of evidence, 4. Methods: From 2009 to 2011, a total of 49 patients affected by isolated large osteochondral knee lesions (mean [± SD] size, 4.35 ± 1.26 cm2) were treated with the biomimetic scaffold. Patients were evaluated using the International Knee Documentation Committee (IKDC), Tegner, and visual analog scale (VAS) pain scores, as well as magnetic resonance imaging (MRI) up to 3-year follow-up. The MOCART (magnetic resonance observation of cartilage repair tissue) score was performed to analyze different variables. Biopsies were carried out in 5 patients. Four of the 5 second-look arthroscopies and biopsies were performed on patients with failed results because of ethical issues. Results: The mean IKDC subjective score increased significantly from 45.45 ± 19.29 preoperatively to 70.86 ± 18.08 at 1-year followup and to 75.42 ± 19.31 at 2-year follow-up (P < .001). The IKDC objective score changed from 50% normal and nearly normal knees before treatment to 89.79% at the 2-year follow-up. There was a statistically significant improvement (P < .005) in VAS score from the preoperative level (6.69 ± 1.88) to the 2-year follow-up (1.96 ± 2.47). Tegner scores increased (P < .001) from the preoperative value (2.20 ± 0.67) to the 2-year follow-up (4.9 ± 1.73) without achieving preinjury level. A correlation was found between the IKDC subjective score and age (P < .001, r = 20.497, r = 20.502). Patients affected by osteochondritis dissecans (OCD) achieved a statistically significantly better outcome (P < .05). A subgroup of 19 competitive athletes showed a statistically significantly improvement (P < .001) in the subjective IKDC (86.5 ± 13.2) compared with the nonathletic subpopulation (69.03 ± 19.41) at the 2-year follow-up. The MRI findings of 30 patients were available at 2-year follow-up: 70% showed complete filling of the lesion, 63.3% had an intact articular surface, and 86% had mild or no effusion. In all cases, in dual T2-weighted fast spin echo sequence, the repair tissue showed a hyperintensive signal with respect to the surrounding subchondral bone; however, no edema was observed. Conclusion: The study findings indicate that the biomimetic scaffold that was investigated is an off-the-shelf, cell-free, and costeffective implant that can regenerate either cartilage or subchondral bone. The scaffold allows a 1-step surgical procedure that can be used for osteochondral lesions, OCD, and in some cases osteonecrosis. © 2014 The Author(s)
La tutela della salute e sicurezza dei volontari
No full textL’obiettivo del saggio è quello di ricostruire il quadro normativo che disciplina la prevenzione dei volontari. Dopo l’analisi delle caratteristiche del volontariato in Italia attraverso i dati Istat e FEO-FIVOL, l’autrice ha studiato le disposizioni contenute nel d.lgs. n. 81/2008 inerenti la tutela della salute e della sicurezza dei volontari. In particolare, il volontario del Corpo Nazionale dei Vigili del Fuoco e della Protezione Civile è equiparato al lavoratore in senso infortunistico e ad esso si applica la disciplina del d.lgs. n. 81/2008, tenendo conto delle particolari modalità di svolgimento delle rispettive attività individuate con Decreto del Ministero del Lavoro e delle Politiche Sociali 13 aprile 2011, mentre ai volontari di cui alla legge n. 266/1991 e ai volontari che effettuano il servizio civile si applicano le sole disposizioni relative ai lavoratori autonomi. A fronte di tale distinzione, l’autrice ha proceduto ad analizzare tali gruppi di volontari separatamente.The subject of this essay is the study of the regulatory framework concerning the prevention from injuries for volunteer workers. After the analysis of the characteristics of volunteering in Italy through the information Istat and FEO-FIVOL, the author has studied the provisions contained in legislative decre no.81/2008 concerning the protection of the health and safety of volunteer workers. In particular, injuries occurring to volunteers of the National Fire Service and Civil Defence are consideredequivalent to “common” workers injuries and the discipline of legislative decree no. 81/2008 is applied, taking into account the peculiarities of their respective activities, as identified by the Decree of the Ministry of Labour and Social Policy 13 April 2011. For what concern volunteers identified by Law no. 266/1991and volunteers of the civil service, the provisions concerning autonomous workers are applied. Given this distinction, the author proceed to analyze these volunteer groups separately
Utility of newer technologies for the diagnosis of active and latent tuberculosis
No full textIncludes bibliographical references (leaves 91-109).Since the 1800s the tuberculin skin test (TST) has been the only available test for latent tuberculosis (LTBI). Recently, interferon-gamma release assays (IGRAs) have been developed which are based upon the responses of peripheral blood effector cells to M.tb-specific antigens [early secretory antigenic target -6 (ESAT-6) and culture filtrate protein (CFP10)]. Discordance between the TST and IGRAs has been well documented but remains largely unexplained
Adam und Eva in der byzantinischen und abendländischen Kunst des Mittelalters
No full textThe pictorial art of the Church, as a spiritual product of the Christian civilisation, has continually received great influences from its ecclesiastical tradition and it was defined by its formal aesthetical standards and its iconographic preferences. A more nuanced reading of the parallels can be attained by placing the images in their visual context, which would allow a better appreciation of the meanings within. The biblical story of Adam and Eve, which is the theme of the following thesis, reflects the differentiation between the Eastern and the Western understanding of the events of the history of the holy Oikonomia, a point, which is the major ground for the development of the relative pictorial motifs. The protoplasts are the protagonists from their creation and life in paradise, the fall and expulsion until their resurrection through Christ. Their story is visualised in a number of scenes and episodes, having thus their original sin and resurrection for specific reasons centralised. This doctoral thesis attempts to collect as many parallels of the scenes is possible, trying to collate the Eastern with the Western visual approach in a deductive way, in order to reach our constructive conclusions and make available the combination of the art, theology and liturgy in the scenes of Adam and Eve in Genesis and in Resurrection (Anastasis). The reading we tried to perform was based upon the specific iconographical elements, which were worth to be commented. Our aim was to detect the direct bond between the production of art and the relevant patristic and apocryphal writings or even the theological theories, by quoting texts from the ecclesiastical literature, as well as the liturgical praxis.Die kirchliche Kunst hat als geistiges Produkt der christlichen Kultur stets unter dem Einfluss der kirchlichen Tradition gestanden und wurde durch ihre formalen ästhetischen Standards und ihre ikonographische Auswahl bestimmt. Eine genauere Bestimmung der Parallelen kann erreicht werden, indem man die Bilder in ihren visuellen Kontext stellt, was zu einem besserem Verständnis ihrer Inhalte führt. Die biblische Geschichte von Adam und Eva, welche das Thema unserer Arbeit ist, reflektiert das differenzierte Verständnis der Heilsgeschichte (Oikonomia) in Ost und West, welche die Hauptursache für die Entwicklung der entsprechenden Bildmotive ist. Die Stammeltern sind die Protagonisten dieser Geschichte seit der Schöpfung und dem Leben im Paradies, sowie Sündenfall und Vertreibung, bis zu ihrer Auferweckung durch Christus. Ihre Geschichte wird in einer Reihe von Szenen und Episoden visualisiert, wobei die Ursünde und die Auferstehung aus besonderen Gründen im Mittelpunkt stehen. Diese Dissertation versucht, so viele wie mögliche Gemeinsamkeiten der Darstellung herauszuarbeiten, um so in deduktiver Weise den visuellen Zugang des Ostens und des Westens in Beziehung zu setzen, um zu konstruktiven Ergebnissen zu kommen und eine Verbindung von Kunst, Theologie und Liturgie in den Darstellungen von Adam und Eva in der Genesis und der Anastasis, am Anfang und am Ende also, herzustellen. Unsere Untersuchung basiert auf den spezifischen ikonographischen Elementen, die wir kommentieren. Unser Ziel war es, die unmittelbare Verbindung zwischen der künstlerischen Darstellung und den entsprechenden patristischen oder apokryphen Schriften oder sogar den theologischen Theorien zu ermitteln, indem wir Texte aus der kirchlichen Literatur, aber auch aus der liturgischen Praxis heranzogen. Wir versuchten die Beteiligung der Stammeltern Adam und Eva im Genesis-Zyklus und der Anastasis-Szene in Beziehung zu setzen, deren Darstellungsnormen zur Gänze auf der Heilsverheissung Gottes basieren. So besteht unsere Dissertation aus zwei Teilen: Genesis und Anastasis (Abstieg in den Hades), sowie einem Anhang, welcher die Überschrift „Die Bildsprache der Geschichte der Stammeltern“ trägt, der Bibliographie und einer Liste der verwendeten Abbildungen
Prescription of ACE-Is/ARBs in patients with cardio-renal disease: a multicenter retrospective cohort study from the REPOSI registry.
No full textHematopoietic stem cell transplantation for CD40 ligand deficiency: Results from an EBMT/ESID-IEWP-SCETIDE-PIDTC study
No full textBACKGROUND: CD40 ligand (CD40L) deficiency, an X-linked primary immunodeficiency, causes recurrent sinopulmonary, Pneumocystis and Cryptosporidium species infections. Long-term survival with supportive therapy is poor. Currently, the only curative treatment is hematopoietic stem cell transplantation (HSCT). OBJECTIVE: We performed an international collaborative study to improve patients' management, aiming to individualize risk factors and determine optimal HSCT characteristics. METHODS: We retrospectively collected data on 130 patients who underwent HSCT for CD40L deficiency between 1993-2015. We analyzed outcome and variables' relevance with respect to survival and cure. RESULTS: Overall survival (OS), event-free survival (EFS), and disease-free survival (DFS) were 78.2%, 58.1%, and 72.3% 5 years after HSCT. Results were better in transplantations performed in 2000 or later and in children less than 10 years old at the time of HSCT. Pre-existing organ damage negatively influenced outcome. Sclerosing cholangitis was the most important risk factor. After 2000, superior OS was achieved with matched donors. Use of myeloablative regimens and HSCT at 2 years or less from diagnosis associated with higher OS and DFS. EFS was best with matched sibling donors, myeloablative conditioning (MAC), and bone marrow-derived stem cells. Most rejections occurred after reduced-intensity or nonmyeloablative conditioning, which associated with poor donor cell engraftment. Mortality occurred mainly early after HSCT, predominantly from infections. Among survivors who ceased immunoglobulin replacement, T-lymphocyte chimerism was 50% or greater donor in 85.2%. CONCLUSION: HSCT is curative in patients with CD40L deficiency, with improved outcome if performed before organ damage development. MAC is associated with better OS, EFS, and DFS. Prospective studies are required to compare the risks of HSCT with those of lifelong supportive therapy.sponsorship: F. F. received an ESID Medium Term Fellowship. M. J. Cowan, C. C. Dvorak, and K. E. Sullivan are supported by the Division of Allergy, Immunology and Transplantation, National Institute of Allergy and Infectious Diseases (NIAID), and the Office of Rare Diseases Research (ORDR), National Center for Advancing Translational Sciences (NCATS), National Institutes of Health (NIH), Bethesda, Maryland (Public Health Service grant/cooperative agreements U54-AI082973 and R13-AI094943). The SCETIDE registry is funded by CEREDIH and the French Ministry of Health. Research was supported by the National Institute for Health Research (NIHR) Newcastle Biomedical Research Centre based at Newcastle Hospitals NHS Foundation Trust and Newcastle University. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR, or the Department of Health. (ESID Medium Term Fellowship, Division of Allergy, Immunology and Transplantation, National Institute of Allergy and Infectious Diseases (NIAID), Office of Rare Diseases Research (ORDR), National Center for Advancing Translational Sciences (NCATS), National Institutes of Health (NIH), Bethesda, Maryland|U54-AI082973, Office of Rare Diseases Research (ORDR), National Center for Advancing Translational Sciences (NCATS), National Institutes of Health (NIH), Bethesda, Maryland|R13-AI094943, CEREDIH, French Ministry of Health, National Institute for Health Research (NIHR) Newcastle Biomedical Research Centre based at Newcastle Hospitals NHS Foundation Trust, Newcastle University)status: Publishe
Prescription of ACE-Is/ARBs in patients with cardio-renal disease: a multicenter retrospective cohort study from the REPOSI registry
No full textCardio-renal disease is a common clinical condition leading to increased morbidity and mortality. Angiotensin-converting enzyme inhibitors (ACE-Is) and angiotensin II receptor blockers (ARBs) are the cornerstone of treatment of chronic cardio-renal disease. Using data from the REPOSI register, we performed a multicenter, observational, retrospective study to determine which factors are associated with the non-prescription or discontinuation of ACE-Is/ARBS in a cohort of 889 cardio-renal patients hospitalized in 109 Italian internal medicine and geriatric wards. Only 55% of the patients with cardio-renal disease of the investigated cohort were on treatment with ACE-Is or ARBs at admission. The primary end point was ACE-Is/ARBs use at discharge. Patients with lower probability of receiving ACE-Is/ARBs at discharge were older and hospitalized for longer periods. Furthermore, patients with advanced chronic kidney disease (advanced CKD: eGFR ≤ 29 mL/min/1.73m2) had a much lower (54%) probability of being discharged or continuing ACE-Is/ARBs treatment than those with eGFR ≥ 60 mL/min/1.73m2. A more prominent lower probability was found comparing advanced CKD patients with G3 stage CKD patients (eGFR: 59-30 mL/min/1.73m2) in multivariate analyses (OR and 95%CI: 0.37, 0.24-0.57. multivariate p-value < 0.001). The probability of stopping treatment in patients already on treatment with ACE-Is/ARBs at hospital admission (secondary end point) almost reached a threefold increase (OR and 95%CI: 2.82, 1.69-4.71. multivariate p-value < 0.001) when the advanced CKD group was compared with G3 CKD patients. The data of our study are not in line with the recently published updated KDIGO 2024 Guidelines, which recommend patients with advanced CKD to continue treatment with ACE-Is/ARBs. (REPOSI investigators
