47 research outputs found
Conservative management of complicated colonic diverticulitis: long-term results
No full textBACKGROUND: The management of recurrent diverticulitis after
initial non-operative treatment remains controversial.
Recurrences after medical treatment have been described up to
36\% but only 3 to 5\% develop complicated disease. AIM: To
investigate the effectiveness of conservative treatment during a
prolonged follow-up after first episode of complicated
diverticulitis. METHODS: This retrospective single-center study
describes the conservative management and outcomes of 207 with
complicated acute colonic diverticulitis treated at Parma
University Hospital from 1 January 2012 until 31 December 2019.
The follow-up was performed until December 2020. Diverticulitis
severity was staged according to WSES CT driven classification
for acute diverticulitis. RESULTS: We enrolled 207 patients (118
males, 89 females). The mean age was 59 14.5 years. CT
scan of the abdomen was always performed. Almost all patients
were treated with bowel rest and antibiotics (98.5\%).
Percutaneous drainage of abscessed diverticulitis was performed
12 times (5.7\%). Average follow-up was 48 28.8 months. 79
patients had new episodes of diverticulitis (38.1\%) and 23
patients had high severity new episodes (11.1\%). 11 patients
underwent surgery (7.7\%). Lower CT-Stages showed a higher
recurrence rate (P = 0.002). Grade III diverticulitis showed a
lower recurrence rate (P = 0.007). Patients with chronic NSAID
use showed a higher incidence of high severity new episodes (P =
0.039). No recurrence rate differences were noted among patients
with or without home therapy (P > 0.05). CONCLUSIONS:
Non-operative treatment is an effective and safe option in
selected patients with complicated diverticulitis. The
recurrence's severity is generally lower than the previous
episodes and this can justify the conservative management
Superiumentarius (Suet. Claud. 2,2). L’imperatore Claudio autore di epigrammi?
No full textAccording to Suet., Claud. 2, 2 in a "libellus" Claudius complained about his master who had been a "superiumentarius". This ironic hyperbole, which refers to the brutal use of whip, seems an allusion to Horace's "plagosus Orbilius", and so suggests the possibility that Claudius'words were part of an epigram. Starting from some recognizable jambic sequences, the author of this article attempts to reconstruct it
Intraoperative Neuromonitoring, Nerves at Risk and Staged Thyroidectomy, our Experience on 377 Consecutive Cases
No full textPURPOSE: The aim of this study was firstly to report the experience of intermittent intraoperative neuromonitoring (I-IONM) and evaluate the impact of loss of signal (LOS) in staged thyroidectomy management. METHODS: We retrospectively reviewed patients who underwent total thyroidectomy, performed by a single surgeon in two years. All patients have been subjected to I-IONM. In case of intraoperative loss of signal (LOS), planned total thyroidectomy was always aborted. Six-month follow-up was performed. Postoperative dysphonia was evaluated with VHI-10 score in 3 time settings T1, during hospital stay, T2 after 30 days, T3 after 6 months. Dysphonia has been compared to IONM results to evaluate sensitivity and specificity. RESULTS: 377 patients were included. Incidence of dysphonia was calculated based on the number of nerves at risk (NAR). We evaluated a total of 724 NAR. LOS encountered were 43 cases (5.9% of total NAR), of these 14 were LOS 1 while 29 were LOS 2. 27 patients (3.7% of NAR) presented early post-operative dysphonia with VHI-10 score > 13 (T1), among these 16 had presented LOS at IONM (true positives) while11 had no LOS (false negatives). In T2 and T3 we reported a decrease in true positive cases increasing false positives. Sensitivity at T3 reached 85.7% while specificity and odds ratio were respectively 94.8% and 110. CONCLUSIONS: Given the high sensitivity and specificity, IONM should be considered a useful tool for thyroid surgery and its use should be suggested for patients undergoing planned total thyroidectomy. Its right application may cancel the risk of bilateral paralysis. (www.actabiomedica.it
State of the Art of Immune Checkpoint Inhibitors in Unresectable Pancreatic Cancer: A Comprehensive Systematic Review
No full textImmune checkpoint inhibitors (ICIs) have transformed the therapeutic landscape for several malignancies, but their efficacy in unresectable pancreatic adenocarcinoma remains uncertain. This systematic review aimed to evaluate the effectiveness and safety of ICIs in this context, focusing on overall survival (OS), progression-free survival (PFS), objective response rate (ORR), disease control rate (DCR), and toxicity. A comprehensive search of MEDLINE, EMBASE, CENTRAL, and Scopus identified 34 eligible studies, including randomized controlled trials and observational cohorts. Quantitative synthesis involved 21 studies comprising 937 patients, with additional qualitative analyses on biomarker-driven subgroups and early-phase trials. The median OS across studies was 8.65 months, while the median PFS was 2.55 months. The ORR and DCR were 16.2% and 50.3%, respectively, with grade ≥3 treatment-related adverse events occurring in 22% of patients. Promising outcomes were observed in MSI-H/dMMR populations, although these represented only 1–2% of cases. Combination strategies with chemotherapy demonstrated synergistic potential but lacked definitive evidence due to heterogeneity and the absence of phase III trials. ICIs showed a manageable toxicity profile, highlighting their feasibility in selected patients. Future research should focus on overcoming tumor microenvironment barriers and identifying biomarkers to optimize responsiveness and expand the applicability of ICIs in pancreatic cancer
Neurochemical changes in the striatum of dyskinetic rats after administration of the cannabinoid agonist WIN55,212-2
No full textChronic use of levodopa, the most effective treatment for Parkinson's disease, causes abnormal involuntary movements named dyskinesias, which are linked to maladaptive changes in plasticity and disturbances of dopamine and glutamate neurotransmission in the basal ganglia. Dyskinesias can be modeled in rats with unilateral 6-hydroxydopamine lesions by repeated administration of low doses of levodopa (6 mg/kg, s.c.). Previous studies from our lab showed that sub-chronic treatment with the cannabinoid agonist WIN55,212-2 attenuates levodopa-induced dyskinesias at doses that do not interfere with physiological motor function. To investigate the neurochemical changes underlying WIN55,212-2 anti-dyskinetic effects, we used in vivo microdialysis to monitor extracellular dopamine and glutamate in the dorsal striatum of both the hemispheres of freely moving 6-hydroxydopamine-treated, SHAM-operated and intact rats receiving levodopa acutely or chronically (11 days), and studied how sub-chronic WIN55,212-2 (1 injection x 3 days, 20 min before levodopa) affected these neurochemical outputs. Our data indicate that: (1) the 6-hydroxydopamine lesion decreases dopamine turnover in the denervated striatum; (2) levodopa injection reduces extracellular glutamate in the side ipsilateral to the lesion of dyskinetic rats; (3) sub-chronic WIN55,212-2 prevents levodopa-induced glutamate volume transmission unbalances across the two hemispheres; and (4) levodopa-induced dyskinesias are inversely correlated with glutamate levels in the denervated striatum. These data indicate that the anti-dyskinetic properties of WIN55,212-2 are accompanied by changes of dopamine and glutamate outputs in the two brain hemispheres of 6-hydroxydopamine-treated rats
Identification of 6,9-dihydro-5H-pyrrolo[3,2-h]quinazolines as a new class of F508del-CFTR correctors for the treatment of cystic fibrosis
No full text: Although substantial advances have been obtained in the pharmacological treatment of cystic fibrosis (CF) with the approval of Kaftrio, a combination of two correctors (VX-661, VX-445) and one potentiator (VX-770), new modulators are still needed to rescue F508del and other CFTR mutants with trafficking defects. We have previously identified PP compounds based on a tricyclic core as correctors with high efficacy in the rescue of F508del-CFTR on native epithelial cells of CF patients, particularly in combination with class 1 correctors (VX-809, VX-661). Compound PP028 was found as a lead candidate for the high rescue of F508del-CFTR and used for mechanistic insight indicating that PP028 behaves as a class 3 corrector, similarly to VX-445. From the exploration of the chemical space around the hit structure, based on iterative cycles of chemical synthesis and functional testing, the class of 6,9-dihydro-5H-pyrrolo [3,2-h]quinazolines with corrector activity was discovered. Within a series of 38 analogues, two derivatives emerged as promising candidates and used for further insight to assess the mechanism of action. Both compounds, decorated with a benzensulfonylamino group at the pyrimidine moiety, were able to generate a dose-dependent increase in CFTR function, particularly in the presence of VX-809. Half-effective concentrations (EC50) were in the single digit micromolar range and decreased in the presence of VX-809 thus indicating a synergistic interaction with class 1 correctors. Synergy was also observed with corr-4a (class 2 corrector) but not with VX-445 and PP028 (class 3 correctors) indicating that the new compounds behave as class 3 correctors. These results suggest that tricyclic pyrrolo-quinazolines interact with CFTR at a site different from that of VX-809 and represent a novel class of CFTR correctors suitable for combinatorial pharmacological treatments for the basic defect in CF
Spinocerebellar Ataxia Type 2
No full text1. Introduction: The autosomal dominant cerebellar ataxias (ADCA) are a clinically, pathologically and genetically heterogeneous group of neurodegenerative disorders caused by degeneration of cerebellum and its afferent and efferent connections. The degenerative process may additionally involves the ponto- medullar systems, pyramidal tracts, basal ganglia, cerebral cortex, peripheral nerves (ADCA I) and the retina (ADCA II), or can be limited to the cerebellum (ADCA III) (Harding et al., 1993). The most common of these dominantly inherited autosomal ataxias, ADCA I, includes many Spinocerebellar Ataxias (SCA) subtypes, some of which are caused by pathological CAG trinucleotide repeat expansion in the coding region on the mutated gene. Such is the case for SCA1, SCA2, SCA3/MJD, SCA6, SCA7, SCA17 and Dentatorubral-pallidoluysian atrophy (DRPLA) (Matilla et al., 2006). Among the almost 30 SCAs, the variant SCA2 is the second most prevalent subtype worldwide, only surpassed by SCA3 (Schöls et al., 2004; Matilla et al., 2006; Auburger, 2011)..
The Economic Impact of Medical Migration: a Receiving CountryÕs Perspective
No full textThis paper seeks to determine the macro-economic impacts of migration of skilled medical personnel from a receiving countryÕs perspective, taking the UK as an archetype OECD economy that imports medical services. The resource allocation issues have been explored in theory, by further developing the Rybczynski theorem and empirically, using a Computable General Equilibrium (CGE) model with an extended health component. The main finding is that importing foreign doctors and nurses into the UK yields higher overall welfare gains compared to a generic increase in the NHS budget. Welfare gains rise in the case of wage protection.medical migration, immigrant health care workers, migrant nurses, migrant doctors
Characterization of seismic signals recorded in Tethys Bay, Victoria Land (Antarctica): data from atmosphere-cryosphere-hydrosphere interaction
No full textIn this paper, we analysed 3-component seismic signals recorded during 27 November 2016 - 10 January 2017 by two stations installed in Tethys Bay (Victoria Land, Antarctica), close to Mario Zucchelli Station. Due to the low noise levels, it was possible to identify three different kinds of signals: teleseismic earthquakes, microseisms, and icequakes.We focus on the latter two. A statistically significant relationship was found between microseism amplitude and both wind speed and sea swell. Thus, we suggest that the recorded microseism data are caused by waves at the shore close to the seismic stations rather than in the deep ocean during storms. In addition, we detected three icequakes, with dominant low frequencies (below 2 Hz), located in the David Glacier area with local magnitude of 2.4-2.6. These events were likely to have been generated at the rock–ice interface under the glacier. This work shows how seismic signals recorded in Antarctica provide insights on the interactions between the atmosphere-cryosphere-hydrosphere. Since climate patterns drive these interactions, investigations on Antarctic seismic signals could serve as a proxy indicator for estimating climate changes
Cahiers de documentation europeenne = Papers on European documentation. 12th year, No. 3, July-September 1970
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