A multi-element psychosocial intervention for early psychosis (GET UP PIANO TRIAL) conducted in a catchment area of 10 million inhabitants: study protocol for a pragmatic cluster randomized controlled trial

Multi-element interventions for first-episode psychosis (FEP) are promising, but have mostly been conducted in non-epidemiologically representative samples, thereby raising the risk of underestimating the complexities involved in treating FEP in 'real-world' services

Imaging of osteonecrosis of the femoral head

Osteonecrosis of the femoral head is a common disease affecting both children and adults causing acute hip pain and functional impairment. Among the various techniques allowing a correct diagnosis, MRI represents the gold standard for an early detection, the latter being useful for a positive outcome. The purpose of this review is to describe the imaging findings of the osteonecrosis of the femoral head

CT-guided fine-needle aspiration of abdominal and retroperitoneal small lesions with the coaxial technique using MPR images

Purpose: To demonstrate the advantages of CT-guided fine-needle aspiration (FNA) of abdominal and retroperitoneal small lesions with the coaxial technique using MPR images. Materials and methods: The study included retrospectively 50 patients who underwent CT-guided FNA of abdominal and/or retroperitoneal small lesion (<30 mm). Patients with suspected lymphomas or sarcomas were excluded. Cytology reports were the reference standard. Results: The cytology was diagnostic in 48/50 biopsies (96%): out of 41 neoplastic lesions (85%), 37 were malignant (90.2%) and 4 were benign (9.8%); 7 out of 48 were non-neoplastic (14.6%). No procedural complications were observed (0%). Conclusion: By using MPR images there is an effective improvement in coaxial CT-guided FNA of abdominal and retroperitoneal small lesions

MRI in acute ligamentous injuries of the ankle

Ankle sprains are the most common lower limb injuries and affect more frequently young athletes; imaging is needed for an accurate diagnosis of such traumatic injuries. The purpose of this review is to analyse the magnetic resonance (MR) findings of both normal and pathological ankle’s ligaments; indeed, MRI is the gold standard for the diagnosis of acute traumatic injuries and is useful for differentiation of the causes of ankle instability as well as for pre-operative planning

CT arthrography for evaluation of autologous chondrocyte and chondral-inductor scaffold implantation in the osteochondral lesions of the talus

Purpose: to analyse the findings of CT arthrography of the ankle, one year after the transplant of autologous chondrocytes in solution (ACI technique) and the covering with the only scaffold implantation of the osteochondral lesions of the talus, in comparison with the clinical evaluation of the ankle. Methods: This retrospective study includes 10 patients (6 male, 4 female, mean age 49.4, range 25-74 years) with an osteochondral lesion of the medial side of the talus, 4 pure chondrals, 6 osteochondrals, painful and limiting the articulation, who underwent ACI using autologous chondrocyte (5 cases) and a covering with the only scaffold implantation (5 cases), in patients who underwent multi-detector CT arthrography between April 2006 and December 2013, at least 12 months after the surgery. Results: Grade 0 was presented in 5 cases (50%), grade 1 in 2 cases (20%), grade 3 in 2 cases (20%) and grade 4 in 1 case (10%). Among the 5 cases even to 0 according to ICRS classification, the patient presented no symptoms in 4 out of 5 cases (80%); in 1 case, the patient presented post-operation pain of moderate entity due to the onset of adhesive capsulitis (20%). The 2 grade 1 patients, according to the ICRS classification, did not report any post-operation pain (0%). The 2 grade 3 patients, according to the ICRS classification, reported a light pain in 1 case (50%). The grade 4 patient, according to the ICRS classification, reported moderate pain (100%). Conclusions: The CT arthrography, for the elevate spatial and contrast resolution, is a very accurate exam in detecting irregularities in the chondral-inductor scaffold implantation, and in correlating the clinical presentation

A multi-element psychosocial intervention for early psychosis (GET UP PIANO TRIAL) conducted in a catchment area of 10 million inhabitants: study protocol for a pragmatic cluster randomized controlled trial

Multi-element interventions for first-episode psychosis (FEP) are promising, but have mostly been conducted in non-epidemiologically representative samples, thereby raising the risk of underestimating the complexities involved in treating FEP in 'real-world' services

A multi-element psychosocial intervention for early psychosis (GET UP PIANO TRIAL) conducted in a catchment area of 10 million inhabitants: study protocol for a pragmatic cluster randomized controlled trial

BACKGROUND: Multi-element interventions for first-episode psychosis (FEP) are promising, but have mostly been conducted in non-epidemiologically representative samples, thereby raising the risk of underestimating the complexities involved in treating FEP in 'real-world' services. METHODS/DESIGN: The Psychosis early Intervention and Assessment of Needs and Outcome (PIANO) trial is part of a larger research program (Genetics, Endophenotypes and Treatment: Understanding early Psychosis - GET UP) which aims to compare, at 9 months, the effectiveness of a multi-component psychosocial intervention versus treatment as usual (TAU) in a large epidemiologically based cohort of patients with FEP and their family members recruited from all public community mental health centers (CMHCs) located in two entire regions of Italy (Veneto and Emilia Romagna), and in the cities of Florence, Milan and Bolzano. The GET UP PIANO trial has a pragmatic cluster randomized controlled design. The randomized units (clusters) are the CMHCs, and the units of observation are the centers' patients and their family members. Patients in the experimental group will receive TAU plus: 1) cognitive behavioral therapy sessions, 2) psycho-educational sessions for family members, and 3) case management. Patient enrollment will take place over a 1-year period. Several psychopathological, psychological, functioning, and service use variables will be assessed at baseline and follow-up. The primary outcomes are: 1) change from baseline to follow-up in positive and negative symptoms' severity and subjective appraisal; 2) relapse occurrences between baseline and follow-up, that is, episodes resulting in admission and/or any case-note records of re-emergence of positive psychotic symptoms. The expected number of recruited patients is about 400, and that of relatives about 300. Owing to the implementation of the intervention at the CMHC level, the blinding of patients, clinicians, and raters is not possible, but every effort will be made to preserve the independency of the raters. We expect that this study will generate evidence on the best treatments for FEP, and will identify barriers that may hinder its feasibility in 'real-world' clinical settings, patient/family conditions that may render this intervention ineffective or inappropriate, and clinical, psychological, environmental, and service organization predictors of treatment effectiveness, compliance, and service satisfaction