555 research outputs found
From acute to chronic pain: tapentadol in the progressive stages of this disease entity
No full textOBJECTIVE:
Chronic pain is now recognized as a neural disease, which results from a maladaptive functional and structural transformation process occurring over time. In its chronic phase, pain is not just a symptom but also a disease entity. Therefore, pain must be properly addressed, as many patients still report unsatisfactory pain control despite on-going treatment. The selection of the therapy - taking into account the pathophysiological mechanisms of pain - and the right timing can result in a successful analgesic outcome. This review will present the functional and structural modifications leading to chronification of pain, focusing on the role of tapentadol in this setting.
MATERIALS AND METHODS:
For inclusion in this review, research studies were retrieved via a keyword-based query of multiple databases (MEDLINE, Embase, Cochrane). The search was last updated in November 2016; no limitations were applied.
RESULTS:
Functional and structural abnormalities of the nervous system associated with pain chronification have been reported in several conditions, including osteoarthritis, chronic back pain, chronic pelvic pain and fibromyalgia. Correct identification and treatment of pain in recurrent/progressive stage is crucial to prevent chronification and related changes in neural structures. Among analgesic drugs, tapentadol, with its dual mechanism of action (opioid agonist and noradrenaline reuptake blocker), has recently resulted active in pain control at both central and spinal level.
CONCLUSIONS:
Tapentadol represents a suitable candidate for patients at early progressive stage of pain who have developed neuroplasticity with modification of pain pathways. The availability of different doses of tapentadol may help clinicians to tailor treatment based on the individual need of each patient, with the aim to enhance therapeutic appropriateness in the treatment of musculoskeletal and neuropathic pain
Ultraviolet, atomic oxygen and outgassing effect on materials for space vehicles in LEO environment
No full textSublingual sufentanil, a new opportunity for the improvement of postoperative pain management in Italy
No full textDespite the availability of national and international guidelines, adequate postoperative pain (POP) management is still a challenge in Italy. One of the potential reasons for the high incidence of surgical patients complaining moderate to severe pain is the difficult application of the currently recommended analgesic techniques in clinical practice. In particular, morphine, the most commonly used systemic opioid in the POP treatment, has some unfavorable pharmacodynamic and pharmacokinetic characteristics for POP management, suggesting a potential relevant improvement by using different opioids. Many of sufentanil properties make it particularly suitable for POP control: a high affinity for the μ opioid receptor, the highest therapeutic index compared to any other opioid used in clinical practice and the absence of clinically relevant active metabolites. The elevated potency, together with the high lipophilicity of sufentanil, allow the preparation of a nanotablet, 3 mm of diameter and 0.75 mm of thickness, containing 15 μg of active drug. The sublingual route allows a longer time of drug plasmatic permanence in comparison to IV route, overcoming the need for continuous dosing. The patient-controlled system, considered in the present review, is preprogrammed to deliver one sublingual tablet of sufentanil with a 20-minute lockout period with a radiofrequency identification thumb tag allowing only the patient to activate the on demand button. Phase II and III studies have assessed the efficacy of this system in POP management, showing that it was considered more satisfactory than the IV PCA morphine system by both patients and nurses. The introduction of this simple and innovative system of patient-controlled analgesic administration could represent an opportunity for Italy to update the current practice in POP management
PLASMA RISORSA STRATEGICA:PROGRAMMA DI PLASMAFERESI E AUTOSUFFICIENZA IN PLASMADERIVATI
No full textVI Conferenza Nazionale dei Servizi Trasfusionali Relazioni Conferenza
RE01
PLASMA RISORSA STRATEGICA:
PROGRAMMI DI PLASMAFERESI
E AUTOSUFFICIENZA IN PLASMADERIVATI
Berti P.(1), Coluzzi S.(2)
(1)SIMT Azienda USL, Aosta; (2) SIMT Policlinico "Umberto I", Roma
Premessa. La raccolta e la conservazione di plasma per la produzione di plasmaderivati hanno assunto negli ultimi anni sempre maggior rilevanza, e sono soggette a stringenti normative di matrice europea che hanno indotto il sistema trasfusionale a importanti processi di adeguamento. Nell'affrontare il problema dell'autosufficienza dei farmaci plasmaderivati non è del resto possibile ignorare che, in aggiunta a tutti i processi riguardanti l'attività di raccolta di plasma, va certamente affrontato anche il problema dell'appropriatezza del loro utilizzo, considerati i dati di consumo italiani che si pongono a livelli disallineati con quelli degli altri paesi avanzati.
Metodi. La survey con 11 domande a risposta multipla inviate a 232 Strutture Trasfusionali (ST) si è proposta di indagare alcuni aspetti critici riguardanti queste attività, con lo scopo di chiarire le interconnessioni fra la pianificazione della raccolta, l'utilizzo clinico del plasma e dei plasmaderivati e il monitoraggio dell'appropriatezza d'uso.
Risultati. Globalmente hanno risposto alla survey 179 (77,2%) ST. In 144 ST (80,4%) viene raccolto plasma mediante aferesi: le procedure eseguite in media per struttura sono lievemente diminuite dal 2015 (n=1.203) al 2017 (n=1.065), così come la produzione (kg medi: da 786 a 747 per struttura).
L'impiego del plasma per uso clinico nelle Strutture Sanitarie avviene in base a Linee Guida/Raccomandazioni condivise con il COBUS nell'88,7% dei casi, ma permane una parte non irrilevante (11,3%) di strutture rispondenti nelle quali esse non sono state definite.
La misurazione della percentuale di richieste di plasma inappropriate non viene eseguita nel 13,9% delle strutture; in quelle ove viene eseguita, l'appropriatezza è elevata (>75% delle richieste) nel 61,5% dei casi.
Riguardo alla tendenza ad assegnare plasma prescindendo da valutazioni contestuali di appropriatezza, ma secondo formule prestabilite, essa viene riferita nel 43,6% dei casi di trasfusione massiva, mentre nel 28,5% mancano protocolli definiti.
Viene segnalata dal 46% delle strutture la necessità di introdurre adeguamenti procedurali e nella selezione del donatore per rispettare i nuovi requisiti di volume della raccolta in aferesi introdotti dal DM 02/11/2015.
Nella definizione del fabbisogno dei farmaci plasmaderivati, che nel 79,9% dei casi vengono forniti dalle Farmacie Ospedaliere e non dalla ST, vi è stato un coinvolgimento dell'azienda nel 63,4% dei casi. Il monitoraggio sul loro impiego clinico (tipo, quantità, indicazioni) vede coinvolto il SIMT solo nel 30,7% dei casi, ma i risultati del monitoraggio sull'impiego clinico dei farmaci plasmaderivati sono accessibili anche alla ST nei casi in cui essa, come avviene nella maggioranza dei casi (55,1%), non ne autorizzi direttamente l'impiego.
Conclusioni. La survey ha evidenziato che la gestione sia dei programmi di plasmaferesi sia del monitoraggio dell'appropriatezza dei farmaci plasmaderivati è alquanto disomogenea. Seppur un'ampia maggioranza di ST (80,4%) effettui procedure di plasmaferesi e mostri di essere coinvolta nei programmi di autosufficienza in farmaci plasmaderivati,
meno evidente risulta il coinvolgimento nel monitoraggio dell'appropriatezza per quanto riguarda i medicinali plasmaderivati, che in larga parte vengono gestiti dalle farmacie ospedaliere.
Elaborazione statistica a cura di Ilaria Ardoino
Ivermectin against larval stages of Dirofilaria repens in dogs.
No full textThe prophylactic efficacy of ivermectin against Dirofilaria repens infections in dogs was investigated. A first trial was carried out on 15 dogs exposed to four inoculations of L3 larvae at 15-day intervals and treated, in groups of five, with 0, 6 or 12 micrograms/kg body weight of ivermectin given per os 30 and 60 days after the first inoculation. Necropsy, performed about 9 months later, revealed that worm burdens were reduced by 86.6 and 92.8% for the 6 and 12 micrograms/kg dose levels, respectively. In a second trial with an otherwise identical protocol, a dose rate of 24 micrograms/kg of ivermectin was tested in 12 dogs. Only one of the six treated dogs was found worm free at necropsy. The worm burden was reduced by 87.9% in treated animals as opposed to controls. A lengthening of the prepatent periods, which might be considered dose related, was apparent in all treated groups. Ivermectin was not completely effective in preventing establishment of experimental infections with D. repens in dogs
Writing systems for Italian regional languages*
No full textDevising a writing system, or graphisation, is a fundamental aspect of corpus planning that no language can take too lightly. This paper begins with a general introduction to graphisation and to Italian regional languages, followed by an analysis of the different orthographies in use so far or proposed for the main regional languages in Italy, with reference also to the three Romance languages already accorded official recognition as minority languages: Sardinian, Friulian and Ladin. The practical aspect and the symbolic aspect of graphisation are discussed and the problems and difficulties that are being encountered in this process are highlighted, especially with regard to two Northern varieties that are presented as case studies: Lombard and Piedmontese. The paper closes with some general considerations and recommendations, particularly on the adoption of a polynomic approach to graphisation if at all possible, and of a digraphic regime as a transitional strategy for cases where a common orthography cannot be decided upon, or to help the spread of the language among new speakers
Degradation of silicon carbide reflective surfaces in the LEO environment
No full textSpace mirrors in Low Earth Orbit (LEO) encounter a degradation problem caused by the impact of atomic oxygen (ATOX) in the space environment. This paper presents an experiment of the atomic oxygen impact degradation and UV synergic effects on ground simulation. The experiment was carried out in a dedicated ATOX simulation vacuum chamber. As target materials, a polished CVD Beta-silicon carbide (SIC) coating was investigated. The selection of silicon carbide is due to its high potential candidate as a mirror layer substrate material for its good reflectance at UV wavelengths and excellent thermal diffusivity. It has highly desirable mechanical and thermal properties and can achieve an excellent surface finish.
The deposition of the coatings were on carbon-based material substrate; i.e., silicon impregnated carbon fiber composite (C/SiC). Mechanical and thermal properties of the coatings such as hardness and Coefficient of Thermal Expansion (CTE) were achieved. Several atomic oxygen impact angles were studied tilting the target samples respect to the flux direction. The various impact angles permitted to analyze the different erosion rates and typologies which the mirrors would encounter in LEO environment.
The degradation was analyzed in various aspects. Macroscopic mass loss per unit area, surface roughness and morphology change were basically analyzed. The exposed surfaces of the materials were observed through a Scanning Electron Microscope (SEM). Secondly, optical diagnostic of the surfaces were performed in order to investigate their variation in optical properties as the evaluation of reflectance degradation. The presence of micro-cracks caused by shrinkage, grinding, polishing or thermal cycling and the porosity in the coatings, could have led to the undercutting phenomenon. Observation of uprising of undercutting was also conducted. Remarks are given regarding capabilities in short-term mission exposures to the LEO environment of this coating
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