12 research outputs found
Investigation of the interaction phenomena between foot and insole by means of a numerical approach
No full textThe biomechanical response of foot with regard to interaction phenomena occurring at interface with insole inserted in
the shoe is investigated by using a numerical approach. At this purpose, a complex three-dimensional model of the foot
is defined from biomedical images, while insole conformation is acquired by laser scanner technique, leading to the finite
element discretization. Foot tissues are characterized by means of specific constitutive visco-hyperelastic anisotropic formulations,
recalling previous research activity. The mechanical behavior of insole material is analyzed by means of experimental
compression tests that highlight the geometric and material non-linear response, represented by a hyperelastic
formulation, while a hyperfoam formulation is assumed for the sole. Numerical analysis considers the mid-stance phase
of the gait and allows to interpret the response of overall foot, insole and sole system. The investigation represents a
preliminary step of a parametric analysis addressed to support footwear design considering different configurations of
components. As matter of example, the influence of variation in insole material properties is reported
A singular case of cavernous internal carotid artery aneurysm in patient with cavernous sinus syndrome and bacterial meningitis
No full textAbstractWe report the uncommon case of an acute cavernous sinus syndrome in a patient who was consequently discovered to have both a cavernous internal carotid artery aneurysm and bacterial meningitis. Which came first, the chicken or the egg? Which of the two, the aneurysm or the meningitis, gave rise to the patient’s symptoms? We briefly reviewed the literature of similar cases and tried to analyze the possible pathophysiological relationship between these findings. Moreover, this case highlights the importance of a multidisciplinary management of these patients to better decide between a medical and a surgical and/or endovascular treatment
Which Are the Best Regimens of Broad-Spectrum Beta-Lactam Antibiotics in Burn Patients? A Systematic Review of Evidence from Pharmacology Studies
No full textBackground: Burn injury causes profound pathophysiological changes in the pharmacokinetic/pharmacodynamic (PK/PD) properties of antibiotics. Infections are among the principal complications after burn injuries, and broad-spectrum beta-lactams are the cornerstone of treatment. The aim of this study was to review the evidence for the best regimens of these antibiotics in the burn patient population. Methods: We performed a systematic review of evidence available on MEDLINE (from its inception to 2023) of pharmacology studies that focused on the use of 13 broad-spectrum beta-lactams in burn patients. We extracted and synthetized data on drug regimens and their ability to attain adequate PK/PD targets. Results: We selected 35 studies for analysis. Overall, studies showed that both high doses and the continuous infusion (CI) of broad-spectrum beta-lactams were needed to achieve internationally-recognized PK/PD targets, ideally with therapeutic drug monitoring guidance. The most extensive evidence concerned meropenem, but similar conclusions could be drawn about piperacillin-tazobactam, ceftazidime, cefepime, imipenem-clinastatin and aztreonam. Insufficient data were available about new beta-lactam-beta-lactamase inhibitor combinations, ceftaroline, ceftobiprole and cefiderocol. Conclusions: Both high doses and CI of broad-spectrum beta-lactams are needed when treating burn patients due to the peculiar changes in the PK/PD of antibiotics in this population. Further studies are needed, particularly about newer antibiotics
Differences in the rate of carbapenem-resistant Enterobacteriaceae colonisation or Clostridium difficile infection following frontline treatment with tigecycline vs. meropenem for intra-abdominal infections
No full textObjectives: We hypothesised that treatment with a tigecycline-based antimicrobial regimen for intra–abdominal infection (IAI) could be associated with lower rates of subsequent carbapenem-resistant Enterobacteriaceae (CRE) colonisation or Clostridium difficile infection (CDI) compared with a meropenem-based regimen. Methods: We performed a retrospective, single-centre, matched (1:1) cohort analysis of all patients who received at least 5 days of empirical or targeted tigecycline (TIG)- or meropenem (MER)-based treatment regimens for IAI over a 50-month period. Patients with previous CRE colonisation and CDI were excluded. Risk factors for CRE and CDI were assessed with a Cox regression model that included treatment duration as a time-dependent variable. Thirty-day mortality was assessed with Kaplan-Meier curves. Results: We identified 168 TIG-treated and 168 MER-treated patients. The cumulative incidence rate ratio of CDI was 10-fold lower in TIG-treated vs. MER-treated patients (incidence rate ratio [IRR] 0.10/1000 patient-days, 95%CI 0.002–0.72, P = 0.007), but similar incidence rates were found for CRE colonisation (IRR 1.39/1000 patient-days, 95%CI 0.68–2.78, P = 0.36). In a multivariate Cox regression model, the receipt of a TIG- vs. MER-based regimen was associated with significantly lower rates of CDI (HR 0.07, 95%CI 0.03–0.71, P = 0.02), but not CRE (HR 1.12, 95% CI 0.45–2.83, P = 0.80). All-cause 30-day mortality was similar in the two groups (P = 0.46). Conclusion: TIG-based regimens for IAI were associated with a 10-fold lower incidence of CDI compared with MER-based regimens, but there was no difference in the incidence of CRE colonisation
Combined computed tomography and fluorodeoxyglucose positron emission tomography in the diagnosis of prosthetic valve endocarditis: a case series
No full textBackground: The diagnosis of prosthetic valve endocarditis is challenging. The gold standard for prosthetic valve endocarditis diagnosis is trans-esophageal echocardiography. However, trans-esophageal echocardiography may result in negative findings or yield images difficult to differentiate from thrombus in patients with prosthetic valve endocarditis. Combined computed tomography and fluorodeoxyglucose positron emission tomography is a potentially promising diagnostic tool for several infectious conditions and it has also been employed in patients with prosthetic valve endocarditis but data are still scant. Case presentations. We reviewed the charts of 6 patients with prosthetic aortic valves evaluated for suspicion of prosthetic valve endocarditis, at two different hospital, over a 3-year period. We found 3 patients with early-onset PVE cases and blood cultures yielding Pseudomonas aeruginosa, Staphylococcus epidermidis and Staphylococcus lugdunensis, respectively; and 3 late-onset cases in the remaining 3 patients with isolation in the blood of Streptococcus bovis, Candida albicans and P. aeruginosa, respectively. Initial trans-esophageal echocardiography was negative in all the patients, while fluorodeoxyglucose positron emission tomography showed images suspicious for prosthetic valve endocarditis. In 4 out of 6 patients valve replacement was done with histology confirming the prosthetic valve endocarditis diagnosis. After an adequate course of antibiotic therapy fluorodeoxyglucose positron emission tomography showed resolution of prosthetic valve endocarditis in all the patients. Conclusion: Our experience confirms the potential role of fluoroseoxyglucose positron emission tomography in the diagnosis and follow-up of prosthetic valve endocarditis. © 2014 Bartoletti et al.; licensee BioMed Central Ltd
Alarming correlation between multidrug-resistant bacteriobilia and morbidity after pancreatic surgery
No full textBackground: Pancreatic surgery is characterized by high morbidity and mortality. Biliary colonization may affect clinical outcomes in these patients. Aims: This study aimed to verify whether bacteriobilia and multidrug resistance (MDR) detected during and after pancreatic surgery may have an impact on post-operative outcomes. Methods: Data from patients undergoing pancreatic surgery involving bile duct transection (2016-2022) in two high-volume centers were analyzed in relationship to overall morbidity, major morbidity and mortality after pancreato-duodenectomy (PD) or total pancreatectomy (TP). Simple and multivariable regressions were used. Results: 227 patients submitted to PD (n=129) or TP (n=98) were included. Of them, 133 had preoperative biliary drainage (BD; 56.6%), mostly with the employment of endoscopic stents (91.7%). Bacteriobilia was detected in 111 patients (48.9%), and remarkably, observed in patients with BD (p=0.001). In addition, 25 MDR pathogens were identified (22.5%), with a significant prevalence in patients with BD. Multivariable regression analysis showed BD was strongly related to MDR isolation (odds ratio [OR]: 5.61; p=0.010). MDR isolation was the main factor linked to a higher number of major complications (OR: 2.75; p=0.041), including major infection complications (OR: 2.94; p=0.031). Conclusions: Isolation of MDR from biliary swab during PD or TP significantly increases the risk of a worse post-operative outcome. Pre-operative precautions could improve patient safety
The impact of public acceptance on cost efficiency and environmental sustainability in decentralized energy systems
No full textFunding Information: The authors would like to thank H.G. Schwarz-von Raumer as well as the German Federal Agency for Nature Conservation for providing the scenicness data. Large parts of the methodology of this study were developed during the first author's three-and-a-half year PhD study period. The first author would therefore like to thank the three funding bodies during this period: the German Federal Ministry of Education and Research (BMBF) within the Kopernikus Project ENSURE “New ENergy grid StructURes for the German Energiewende” (funding reference: FKZ 03SFK1N0 ), the PhD College “Energy and Resource Efficiency” ( ENRES ) from the Federal State of Baden-Wuerttemberg, as well as the German Federal Ministry for Economic Affairs and Energy (BMWi) within the TrafoKommune project (funding reference: 03EN3008F ).Peer reviewe
Geological cartography in Poland in the 19th century
No full textThe history of modern geological mapping in Poland began with the Carta Geologica totius Poloniae, Moldaviae, Transylvaniae, Hungariae et Valachiae by S. Staszic, often called the “father of Polish geology”. Before Staszic, a general map of Poland had been published by J.-E. Guettard (1764a); ones of the Sudety Mts. by J. Jirasek (1791), L. von Buch (1797), and Raumer (1813); and that of the Tatra Mts. by Hacquet (1796). In times of the partition of Poland (1772 to 1918), areas annexed by Prussia were covered by systematic geological surveys. These cartographic projects resulted in the compilation of two geological atlases comprising maps of the standard sheet type, in the period from 1826 to 1836. These atlases were compiled by teams of outstanding geologists, under the leadership of L. von Buch and F. Hoffmann. Another outstanding contribution to the geology of Poland was made by G.G. Pusch, the author of the excellent Geognostische Beschreibung von Polen (1833–1836), subsequently supplemented by Geognostyscher Atlas von Polen. One of the greatest achievements of L. Zejszner was the geological map of the Tatra Mts., Carte de la chaine du Tatra, published anonymously in Berlin in 1844, and a series of geological maps prepared as drafts of Geognostic maps of the Eastern District of the Polish Kingdom. Special attention should be also paid to two extensive studies which covered areas of Upper and Lower Silesia. The first of these, Geognostische Karte von Oberschlesien und den Angrenzenden Gebieten, was completed by a team led by F. Roemer, and published in 1870. The second, Geologische Karte von dem Niederschlesischen Gebirge und den angrezenden gegenden, was compiled by a team led by R. von Carnall, and published in the same year. Out of all the studies carried out by Austrian geologists, it is necessary to mention those of E. Tietze, as they produced excellent geological maps of the Carpathians and vicinities of Kraków and Lviv. It is also worth mentioning the contributions made by the Physiographic Commission, active from 1866 until the beginning of the First World War. Its members decided to prepare the Geological Atlas of Galicia. The final product of works of this commission was a set of 25 booklets, with over a hundred geological maps at a scale 1:75000, issued in the years 1885–1912. From 1881, the commission was also publishing its famous Physiographic Diaries, which include papers on the geology of areas annexed by Russia, written by famous Polish geologists such as J. Siemiradzki, A. Michalski, and E. Habdank-Dunikowski, illustrated with relevant geological maps prepared by them
Infection-Related Ventilator-Associated Complications in Critically Ill Patients with Trauma: A Retrospective Analysis
No full textBackground: Trauma is a leading cause of death and disability. Patients with trauma undergoing invasive mechanical ventilation (IMV) are at risk for ventilator-associated events (VAEs) potentially associated with a longer duration of IMV and increased stay in the intensive care unit (ICU). Methods: We conducted a retrospective cohort study aimed to evaluate the incidence of infection-related ventilator-associated complications (IVACs), possible ventilator-associated pneumonia (PVAP), and their characteristics among patients experiencing severe trauma that required ICU admission and IMV for at least four days. We also determined pathogens implicated in PVAP episodes and characterized the use of antimicrobial therapy. Results: In total, 88 adult patients were included in the main analysis. In this study, we observed that 29.5% of patients developed a respiratory infection during ICU stay. Among them, five patients (19.2%) suffered from respiratory infections due to multi-drug resistant bacteria. Patients who developed IVAC/PVAP presented lower total GCS (median value, 7; (IQR, 9) vs. 12.5, (IQR, 8); p = 0.068) than those who did not develop IVAC/PVAP. Conclusions: We observed that less than one-third of trauma patients fulfilling criteria for ventilator associated events developed a respiratory infection during the ICU stay
John Stuart Mill’s projected science of society: 1827-1848
No full textThe purpose of the thesis is to examine John Stuart Mill’s political thought from
about 1827 to 1848 as an exercise in intellectual history. It focuses, first, on Mill’s view,
formulated by the late 1830s, that contemporary society was ‘civilized’, and second, on
his project of a science of society, which he aspired to develop in the late 1830s and
early 1840s.
By the late 1830s, Mill came to the view that his contemporary society was a
‘commercial society or civilization’, dominated by the middle, commercial class. The
first part of my thesis, constituted by Chapters 2-4, discusses the way in which Mill
formed his notion of civilization, and what he meant by the term ‘civilization’. Mill paid
attention to the implications of the rise of the middle class, and regarded such
phenomena of contemporary society as the corruption of the commercial spirit and
excessive social conformity as an inevitable consequence of the rise of the middle class.
The second part of the thesis, constituted by Chapters 5-9, examines Mill’s
projected science of society. In the late 1830s and early 1840s, Mill attempted to
develop a new science of society whose subject-matter was the nature and prospects of
commercial, civilized society. This aspiration culminated in A System of Logic,
published in 1843. In examining Mill’s projected science, I pay particular attention to
the fact that he conceived new sciences of history and of the formation of character,
both of which were indispensable in his project, although he failed to give a complete
account of these sciences. My thesis shows that the implications of his interest both in
history and in the formation of character are more significant than Mill scholars have
assumed
