Prevenzione e management odontoiatrico dei pazienti oncologici a rischio di osteonecrosi delle ossa mascellari da farmaci

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L\u2019odontoiatria a misura del paziente con patologia osteometabolica a rischio di osteonecrosi delle ossa mascellari da farmaci.

L\u2019osteonecrosi delle ossa mascellari (ONJ) da farmaci \ue8 una severa patologia odontoiatrica, recentemente defi nita come \uabuna reazione avversa farmacocorrelata, caratterizzata dalla progressiva distruzione e necrosi dell\u2019osso mandibolare e/o mascellare di soggetti esposti al trattamento con farmaci per cui sia accertato un aumentato rischio di malattia, in assenza di un pregresso trattamento radiante\ubb1-3. I pazienti osteometabolici a rischio di sviluppare l\u2019ONJ sono quelli sottoposti a terapia con bisfosfonati (in particolare aminobisfosfonati o Nitrogen-containing BisPhosphonate/NBP) e, pi\uf9 recentemente, con denosumab (anticorpo monoclonale anti-RANKL)4. Tali farmaci antiriassorbitivi caratterizzati da una prevalente azione inibitoria sul metabolismo dell\u2019osso, sono ampiamente prescritti per la cura di patologie osteometaboliche, prevalentemente osteoporosi primaria o secondaria, oltre che per la prevenzione e il trattamento di lesioni scheletriche in pazienti con patologia onco-ematologica1,5-7

ANDIL experience for building process optimization through an efficient data management / L’esperienza di ANDIL per l’ottimizzazione del processo edilizio attraverso una gestione efficiente delle informazioni

A building process optimization needs a systemic approach in order to correctly manage its complexity. Despite many important contributions have been provided in the last few years, both from a procedural point of view and from a normative one, building process management is often fragmented. This may cause repercussions on building quality and inefficiency in cost and time management. That is why, the research project INNOVance has developed an unambiguous classification system for every object and informative attribute for construction, creating a unique database to smartly store and share information. This through a proper definition of the content of data sheets which can be collected and easily shared together with their complementary attributes by different stakeholders. Unambiguous language and standardized information, in and of themselves, increase building process efficiency. If we then consider that data exchange is possible through the exploitation of a user friendly web portal and some interoperable web services, efficiency and economic savings in the entire construction chain could be extremely relevant. The present paper describes the results achieved during the last year of the research project, in terms of information standardization and data collection

Correction to: Long-term results after stapled hemorrhoidopexy: a survey study with mean follow-up of 12 years

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Risk Management in Magnetic Resonance: Failure Mode, Effects, and Criticality Analysis

The aim of the study was to perform a risk management procedure in "Magnetic Resonance Examination" process in order to identify the critical phases and sources of radiological errors and to identify potential improvement projects including procedures, tests, and checks to reduce the error occurrence risk. In this study we used the proactive analysis "Failure Mode Effects Criticality Analysis," a qualitative and quantitative risk management procedure; has calculated Priority Risk Index (PRI) for each activity of the process; have identified, on the PRI basis, the most critical activities and, for them, have defined improvement projects; and have recalculated the PRI after implementation of improvement projects for each activity. Time stop and audits are performed in order to control the new procedures. The results showed that the most critical tasks of "Magnetic Resonance Examination" process were the reception of the patient, the patient schedule drafting, the closing examination, and the organization of activities. Four improvement projects have been defined and executed. PRI evaluation after improvement projects implementation has shown that the risk decreased significantly following the implementation of procedures and controls defined in improvement projects, resulting in a reduction of the PRI between 43% and 100%

Radiofrequency Ablation and Microwave Ablation in Liver Tumors: An Update

This article provides an overview of radiofrequency ablation (RFA) and microwave ablation (MWA) for treatment of primary liver tumors and hepatic metastasis. Only studies reporting RFA and MWA safety and efficacy on liver were retained. We found 40 clinical studies that satisfied the inclusion criteria. RFA has become an established treatment modality because of its efficacy, reproducibility, low complication rates, and availability. MWA has several advantages over RFA, which may make it more attractive to treat hepatic tumors. According to the literature, the overall survival, local recurrence, complication rates, disease-free survival, and mortality in patients with hepatocellular carcinoma (HCC) treated with RFA vary between 53.2 \ub1 3.0 months and 66 months, between 59.8% and 63.1%, between 2% and 10.5%, between 22.0 \ub1 2.6 months and 39 months, and between 0% and 1.2%, respectively. According to the literature, overall survival, local recurrence, complication rates, disease-free survival, and mortality in patients with HCC treated with MWA (compared with RFA) vary between 22 months for focal lesion >3 cm (vs. 21 months) and 50 months for focal lesion 643 cm (vs. 27 months), between 5% (vs. 46.6%) and 17.8% (vs. 18.2%), between 2.2% (vs. 0%) and 61.5% (vs. 45.4%), between 14 months (vs. 10.5 months) and 22 months (vs. no data reported), and between 0% (vs. 0%) and 15% (vs. 36%), respectively. According to the literature, the overall survival, local recurrence, complication rates, and mortality in liver metastases patients treated with RFA (vs. MWA) are not statistically different for both the survival times from primary tumor diagnosis and survival times from ablation, between 10% (vs. 6%) and 35.7% (vs. 39.6), between 1.1% (vs. 3.1%) and 24% (vs. 27%), and between 0% (vs. 0%) and 2% (vs. 0.3%). MWA should be considered the technique of choice in selected patients, when the tumor is 653 cm in diameter or is close to large vessels, independent of its size. Implications for Practice: Although technical features of the radiofrequency ablation (RFA) and microwave ablation (MWA) are similar, the differences arise from the physical phenomenon used to generate heat. RFA has become an established treatment modality because of its efficacy, reproducibility, low complication rates, and availability. MWA has several advantages over RFA, which may make it more attractive than RFA to treat hepatic tumors. The benefits of MWA are an improved convection profile, higher constant intratumoral temperatures, faster ablation times, and the ability to use multiple probes to treat multiple lesions simultaneously. MWA should be considered the technique of choice when the tumor is 653 cm in diameter or is close to large vessels, independent of its size

The treatment of medication-related osteonecrosis of the jaw (Mronj): A systematic review with a pooled analysis of only surgery versus combined protocols

Medication-related osteonecrosis of the jaw (MRONJ) is a serious adverse reaction of antiresorptive and antiangiogenic agents, and it is also a potentially painful and debilitating condition. To date, no specific studies have prospectively evaluated the efficacy of its treatment and no robust standard of care has been established. Therefore, a systematic review (2007–2020) with a pooled analysis was performed in order to compare MRONJ surgical techniques (conservative or aggressive) versus combined surgical procedures (surgery plus a non-invasive procedure), where 1137 patients were included in the pooled analysis. A statistically significant difference in the 6-month improvement rate, comparing combined conservative surgery versus only aggressive (91% versus 72%, p = 0.05), was observed. No significant difference regarding any group with respect to the 6-month total resolution rate (82% versus 72%) was demonstrated. Of note, conservative surgery combined with various, adjuvant, non-invasive procedures (ozone, LLLT or blood component + Nd:YAG) was found to achieve partial or full healing in all stages, with improved results and the amelioration of many variables. In conclusion, specific adjuvant treatments associated with minimally conservative surgery can be considered effective and safe in the treatment of MRONJ, although well-controlled studies are a requisite in arriving at definitive statements

Design and characterization of a minimally invasive bipolar electrode for electroporation

Objective: To test a new bipolar electrode for electroporation consisting of a single minimally invasive needle. Methods: A theoretical study was performed by using Comsol Multiphysics® software. The prototypes of electrode have been tested on potatoes and pigs, adopting an irreversible electroporation protocol. Different applied voltages and different geometries of bipolar electrode prototype have been evaluated. Results: Simulations and pre-clinical tests have shown that the volume of ablated area is mainly influenced by applied voltage, while the diameter of the electrode had a lesser impact, making the goal of minimal-invasiveness possible. The conductive pole’s length determined an increase of electroporated volume, while the insulated pole length inversely affects the electroporated volume size and shape; when the insulated pole length decreases, a more regular shape of the electric field is obtained. Moreover, the geometry of the electrode determined a different shape of the electroporated volume. A parenchymal damage in the liver of pigs due to irreversible electroporation protocol was observed. Conclusion: The minimally invasive bipolar electrode is able to treat an electroporated volume of about 10 mm in diameter by using a single-needle electrode. Moreover, the geometry and the electric characteristics can be selected to produce ellipsoidal ablation volumes

Human Cryptic Host Defence Peptide GVF27 Exhibits Anti-Infective Properties against Biofilm Forming Members of the Burkholderia cepacia Complex

Therapeutic solutions to counter Burkholderia cepacia complex (Bcc) bacteria are challenging due to their intrinsically high level of antibiotic resistance. Bcc organisms display a variety of potential virulence factors, have a distinct lipopolysaccharide naturally implicated in antimicrobial resistance. and are able to form biofilms, which may further protect them from both host defence peptides (HDPs) and antibiotics. Here, we report the promising anti-biofilm and immunomodulatory activities of human HDP GVF27 on two of the most clinically relevant Bcc members, Burkholderia multivorans and Burkholderia cenocepacia. The effects of synthetic and labelled GVF27 were tested on B. cenocepacia and B. multivorans biofilms, at three different stages of formation, by confocal laser scanning microscopy (CLSM). Assays on bacterial cultures and on human monocytes challenged with B. cenocepacia LPS were also performed. GVF27 exerts, at different stages of formation, anti-biofilm effects towards both Bcc strains, a significant propensity to function in combination with ciprofloxacin, a relevant affinity for LPSs isolated from B. cenocepacia as well as a good propensity to mitigate the release of pro-inflammatory cytokines in human cells pre-treated with the same endotoxin. Overall, all these findings contribute to the elucidation of the main features that a good therapeutic agent directed against these extremely leathery biofilm-forming bacteria should possess