51 research outputs found
Increased Carotid Thickness in Subjects with Recently-Diagnosed Diabetes from Rural Cameroon
No full textPMCID: PMC3423396This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited
L'Abbazia di Chiaravalle Milanese e la sua foresteria. Conoscere e valorizzare l'esistente, conservare la fabbrica e progettare nuovi spazi di fruizione
No full textLAUREA MAGISTRALEIl lavoro che si propone sull’Abbazia di Chiaravalle prende avvio dalla conoscenza profonda di un monumento secolare. La ricerca, partendo dalle origini dell’ordine cistercense per mano di San Bernardo, percorre le diramazioni filiari delle abbazie concentrandosi sul risvolto che tale sviluppo ebbe in territorio italiano. In particolare, quindi, ci si sofferma sull’architettura: le abbazie cistercensi hanno una peculiarità tutta loro, quella dell’organizzazione in moduli quadrati, che si ripetono e si accostano per andare a formare e organizzare i luoghi della vita del monaco. Ciò ha fornito le basi per un’idea progettuale forte: la modularità dedotta dall’Abbazia di Chiaravalle diventa una maglia regolare su cui contestualizzare il progetto del nuovo. L’oratorio progettato a servizio della parrocchia è un ambiente necessario alla vita del luogo e viene localizzato all’interno del complesso monastico nei pressi della Foresteria antica. L’oratorio è dunque basato sul modulo quadrato non solo in pianta ma anche in alzato, integrandosi nell’ambiente e fondando nuove funzionalità educative e di ritrovo. L’ambiente della Foresteria antica, manufatto spesso sottovalutato, è invece testimonianza degli usi e costumi medievali dell’abbazia: gli arconi a sesto acuto e le cornici delle aperture al primo piano tramandano l’esistenza di una Ca’ Amata da Dio, che ospitava i pellegrini e gli infermi. Tale ambiente svuotato dall’attività di oratorio pretende di essere conservato e riportato alla sua antica funzione.The work suggested for Chiaravalle Abbey starts from a deep knowledge about this centuries-old monument. The research begins from the origins of the Cistercian’s Order by San Bernardo, it goes through the develop of this saint Order by the new foundations of the Abbeys in all Europe and particularly in Italy. The Cistercian’s architecture is characterized by the use of the square module.Repeating and putting together the module it is possible to create the living places for monks.
This clear method suggested to create the new project with the same module that was already used for Chiaravalle Abbey. The new project is an oratory for the parish located near the Old Guest House and is projected with the square shape module not only in plan but also in section, it is well integrated with the ambient and creates new spaces for education and socialization. The building of the Old Guest House, usually forgotten, with its lancet arch it’s the proof of the existence of Ca’Amata where foreign and sick people founded a dear place for restore. Here without the oratory it is important to recreate that kind of function
Vertebral Lesions from AIDS-Related Kaposi's Sarcoma
No full textBackground: Kaposi’s sarcoma is commonly described in HIV/AIDS patients but usually manifests as overt
skin lesions or visceral involvement. Bone involvement, particularly vertebral, is uncommon, especially when there is no
adjacent cutaneous lesion but a small number of cases have been reported. Unlike many other diseases associated with
HIV, Kaposi’s sarcoma can occur despite a normal CD4 count.
Case Presentation: A 44 year-old HIV positive Nigerian man presented with a 20 day history of severe, worsening lumbar
back pain, nearly three years after an earlier diagnosis of a single cutaneous lesion consistent with Kaposi’s sarcoma, for
which he received chemo-radiotherapy. Despite varying previous compliance with his anti-retroviral therapy, he was
thought to be taking his medications at time of presentation and his CD4 count was 408 cells/mm3. No other organ
involvement was found but a pathological fracture was seen on magnetic resonance imaging affecting L1 vertebra. A CTguided
needle aspiration biopsy was performed and a histological diagnosis subsequently confirmed Kaposi’s sarcoma.
The patient was treated with further courses of radiotherapy but had little clinical improvement. Indeed, a follow-up MRI
four months later showed new involvement of a further four vertebrae, fortunately in the absence of progressive focal
neurology.
Conclusion: Vertebral Kaposi’s sarcoma is a rare diagnosis but can be accurately diagnosed with CT or MRI imaging in
conjunction with a histological diagnosis. An immunosuppressed patient presenting with bone pain should be thoroughly
investigated for Kaposi’s sarcoma as modern chemotherapeutic agents alongside anti-retroviral therapy may delay or
prevent further devastating complications such as spinal cord compression
Cervical pessary for preventing preterm birth in twin pregnancies with short cervical length: a systematic review and meta-analysis
No full textObjective: To evaluate the effectiveness of cervical pessary for preventing spontaneous preterm birth (SPTB) in twin pregnancies with an asymptomatic transvaginal ultrasound cervical length (TVU CL) in the second trimester.
METHODS:
We performed a meta-analysis including all randomized clinical trials (RCTs) comparing the use of cervical pessary (i.e. intervention group) with expectant management (i.e. control group). The primary outcome was incidence of SPTB <34 weeks.
RESULTS:
Three trials, including 481 twin pregnancies with short cervix, were analyzed. Two RCTs defined short cervix as TVU CL ≤25 mm and one as TVU CL ≤38 mm. Pessary was not associated with prevention of SPTB, and the mean gestational age at delivery and the mean latency were similar in the pessary group compared to the control group. Moreover, no benefits were noticed in neonatal outcomes.
CONCLUSIONS:
Use of the Arabin pessary in twin pregnancies with short TVU CL at 16-24 weeks does not prevent SPTB or improve perinatal outcome
Cervical pessary for preventing preterm birth in twin pregnancies with short cervical length: a systematic review and meta-analysis
Get PDFTo evaluate the effectiveness of cervical pessary for preventing spontaneous preterm birth (SPTB) in twin pregnancies with an asymptomatic transvaginal ultrasound cervical length (TVU CL) in the second trimester
Diagnostic accuracy and economic impact of three work-up strategies identifying risk groups in endometrial cancer, fully incorporating sentinel lymph node algorithm
No full textBackground: According to the European Society for Medical Oncology/ European Society of Gynaecological Oncology/European Society for Radiotherapy and Oncology (ESMO/ESGO/ESTRO) Consensus Conference, the role of preoperative risk groups (RGs) in endometrial cancer (EC) is to direct surgical nodal staging. We compared diagnostic accuracy and economic impact of three work-up strategies to identify RGs.
Methods: A retrospective multicentre study including patients with early-stage EC. The three different work-up strategies were as follows:-Mondovì Hospital: transvaginal ultrasonography, pelvic magnetic resonance imaging (MRI); frozen section examination of the uterus in case of imaging discordance. High-risk patients underwent abdominal computed tomography.-Gemelli Hospital: transvaginal ultrasonography, MRI, One-Step Nucleic Acid Amplification (OSNA) of sentinel lymph node (SLN); frozen section examination of the uterus in case of imaging discordance.-Negrar Hospital: positron emission tomography (PET), frozen section examination of the uterus and of SLN. For statistical purposes patients were assigned, preoperatively and postoperatively, to two groups: group A (high-risk) and group B (not high-risk).
Results: Three hundred eighty-five patients were included (93 Mondovì, 215 Gemelli, 77 Negrar). Endometrial biopsy errors led to 47.3% misclassifications. Test accuracy of Mondovì, Gemelli and Negrar strategies was 0.83 (95%CI 0.734-0.901), 0.95 (95%CI 0.909-0.975) and 0.94 (95%CI 0.866-0.985), respectively. Preoperative work-up mean cost per patient in group A was €514.5 at Mondovì, €868.5 at Gemelli, and €1212.8 at Negrar hospital (p-value < 0.001), while in group B was €378.8 at Mondovì, €941.2 at Gemelli, and €1848.4 at Negrar hospital (p-value < 0.001).
Conclusions: In our study, work-up strategies with more relevant economic impact showed a better diagnostic accuracy. Upcoming guidelines should specify recommendations about the gold standard work-up strategy, including the role of SLN
SUrgical Access and Pattern of Recurrence of Endometrial Cancer: The SUPeR Study, a Multicenter Retrospective Observational Study
No full textStudy objectiveTo evaluate recurrence rate and pattern in apparently early-stage endometrial cancer (EC) treated with minimally invasive surgery (MIS) and compare it to the "historical" populations treated by laparotomy. Secondary outcomes were to establish if, among MIS recurrent patients, intermediate-high/high-risk patients presented the same recurrence pattern compared to those at low/intermediate-risk and to evaluate time to first recurrence (TTR) of the study population.DesignMulticenter retrospective observational study.SettingFive Italian Gynecologic Oncology referral centers.PatientsAll patients with proven recurrence of apparently early-stage EC treated with MIS from January 2017 to June 2022 . The laparotomic historical cohort was obtained from Laparoscopy Compared With Laparotomy for Comprehensive Surgical Staging of Uterine Cancer: Gynecologic Oncology Group Study (LAP2) and Laparoscopic Approach to Cancer of the Endometrium trials.InterventionsEvaluation of recurrence rate and pattern.Measurements and main resultsSeventy-seven recurrences occurred on the total of 1028 patients treated with MIS for apparently early-stage EC during a median follow-up time of 36 months. The rate of recurrence in our cohort did not differ significantly from the rate of the historical cohort (7.4% vs 7.9%, odds ratio 0.9395, 95% CI 0.6901-1.2792). No significant differences were noticed for local, abdominal, nodal, and multiple site recurrence patterns; distant site recurrence appeared more likely in patients from the historical cohort. Postoperative low/intermediate risk patients had a higher likelihood of local recurrence compared to intermediate-high/high risk patients. Mean TTR was 19 months. No significant difference of TTR was observed for each pattern of recurrence compared to others.ConclusionMIS appears to be safe for the treatment of early-stage EC. We did not identify any recurrence pattern specifically associated with MIS in early-stage EC
Primary versus interval cytoreductive surgery in patients with rare epithelial or non-epithelial ovarian cancer
No full textBackground: The standard treatment for advanced epithelial ovarian cancer is primary cytoreductive surgery, with the goal of achieving no residual disease. Neoadjuvant chemotherapy and interval cytoreductive surgery can be viable treatment options for patients with extensive disease that precludes complete tumor removal during initial surgery, or when significant comorbidities increase the surgical risk without adversely impacting overall survival rates. However, published studies mostly included patients with high-grade serous ovarian cancer, with an underrepresentation of non-high-grade serous epithelial and non-epithelial cancers. This review aimed to provide an overview of the available data on the outcomes of primary cytoreductive surgery versus interval cytoreduction in patients with rare ovarian cancer histotypes. Methods: Published literature on primary versus interval cytoreductive surgery in non-high-grade serous ovarian cancers from 2004 to 2024 was searched using PubMed, EMBASE, and Google Scholar and reported for each histological subtype. The outcomes of patients with low-grade serous, endometrioid, clear-cell, and mucinous carcinomas after neoadjuvant chemotherapy were reviewed. Furthermore, the results following neoadjuvant chemotherapy in non-epithelial ovarian cancers, such as ovarian germ cell tumors, sex cord-stromal tumors, and small-cell carcinoma of the ovary, have also been reported. Most data were derived from retrospective studies, with heterogeneity in design. Results & Conclusions: Several ovarian cancer histotypes, including low-grade serous and mucinous carcinomas, may be less responsive than high-grade serous carcinomas to neoadjuvant chemotherapy. Consequently, primary cytoreduction with maximal surgical effort may confer a survival advantage. Other tumors responded well to neoadjuvant chemotherapy, allowing for interval fertility-sparing surgeries. Additional evidence is required because no prospective studies are currently available. Given the low incidence of these diseases, randomized controlled trials may not be feasible. However, national or international registries could play a pivotal role in determining the optimal approach for managing patients with these rare histotypes
Should phenotype of previous preterm birth influence management of women with short cervix in subsequent pregnancy? Comparison of vaginal progesterone and Arabin pessary
Get PDFPessari Arabin; Coll uterí curt; Progesterona vaginalPesario de Arabin; Cuello uterino corto; Progesterona vaginalArabin pessary; Short cervix; Vaginal progesteroneObjective
To investigate whether the classification of a previous spontaneous preterm birth (sPTB) as preterm labor (PTL) with intact membranes (IM) or as preterm prelabor rupture of membranes (PPROM) impacts the efficacy of cervical pessary or vaginal progesterone for prevention of sPTB in pregnant women with short cervix on transvaginal ultrasound.
Methods
This was a retrospective cohort study of asymptomatic high‐risk singleton pregnancies with a short cervix and history of sPTB, treated using Arabin pessary or vaginal progesterone for primary PTB prevention, conducted at four European hospitals. A log‐rank test on Kaplan–Meier curves was used to assess the difference in performance of pessary and progesterone, according to history of PTL‐IM or PPROM. Linear regression analysis was used to evaluate significant predictors of gestational age at delivery.
Results
Between 2008 and 2015, 170 women were treated with a pessary and 88 with vaginal progesterone. In women treated with a pessary, rate of sPTB < 34 weeks was 16% in those with a history of PTL‐IM and 55% in those with a history of PPROM. In women treated with progesterone, rate of sPTB < 34 weeks was 13% in those with a history of PTL‐IM and 21% in those with a history of PPROM. Treatment with a pessary resulted in earlier delivery in women with previous PPROM than in any other subgroup (P < 0.0001). Linear regression analysis showed a clear effect of PPROM history (P < 0.0001), combination of PPROM history and treatment (P = 0.0003) and cervical length (P = 0.0004) on gestational age at birth.
Conclusions
Cervical pessary may be a less efficacious treatment option for women with previous PPROM; however, these results require prospective validation before change in practice is recommended. Phenotype of previous preterm birth may be an important risk predictor and treatment effect modifier; this information should be reported in future clinical trials
How to Blend Concepts in Diffusion Models
Get PDFFor the last decade, there has been a push to use multi-dimensional (latent) spaces to represent concepts; and yet how to manipulate these concepts or reason with them remains largely unclear. Some recent methods exploit multiple latent representations and their connection, making this research question even more entangled. Our goal is to understand how operations in the latent space affect the underlying concepts. To that end, we explore the task of concept blending through diffusion models. Diffusion models are based on a connection between a latent representation of textual prompts and a latent space that enables image reconstruction and generation. This task allows us to try different text-based combination strategies, and evaluate easily through a visual analysis. Our conclusion is that concept blending through space manipulation is possible, although the best strategy depends on the context of the blend
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