Il comportamento termoigrometrico degli edifici in legno nel clima Mediterraneo

In Sardinia timber and particulary cross laminated timber (CLT) are starting to be used for buildings due to their excellent properties and speed of execution. But timber is not a traditional material for wall in Sardinia and the climate (very wet but also very hot in summer) brought about many questions in designers. In this work dynamic hygrothermal simulations are performed by the use of WUFI software (Wärme und Feuchte Instationär – transient heat and moisture) developed by Fraunhofer Institute for Building Physics (IBP) and demonstrated that CLT is suitable in weather conditions of Sardinia. The commercial research software (WUFI PRO 5.3) was used to calculate heat and moisture transfer through 7 different walls and 7 types of roof in Cagliari, Oristano, Nuoro and Sassari due to their climatic conditions. The results show that there are no risks of surface or interstitial condensation and hygrothermal conditions inhibit mould growth. In the second part the research shows the project of a family house and townhouses in Cagliari using ProCasaClima software. ProCasaClima 2013 software was used to calculate heating and cooling in the buildings and thermal comfort for the occupants. The buildings observe Italian regulations on energy efficiency but in order to obtain a “zero energy building” and to increase thermal comfort passive design strategies must be applied. These strategies are not the same for all the Italian climates. In Cagliari the most effective strategies to reduce the need for cooling are: shading elements to avoid summer sun, night ventilation of thermal mass, areal heat capacity and light colours for building envelope. The research shows that also in Sardinia a building in CLT can reach high thermal performance and can provide comfort to its occupants

A case series of the twiddler syndrome

Background: Twiddler syndrome (TS) is a complication of cardiac implantable electronic device (CIED) implantation, caused by the deliberate or unconscious manipulation of the device by the patient himself, which results in dislocation of the leads by retraction towards the subcutaneous pocket. Case summary: This report describes two clinical cases that occurred in our centre, for which two different solutions were successfully implemented. In the first case, a complete removal of the stimulation system was performed, and a leadless pacemaker (PM; Medtronic Micra VR) was implanted. In the second case, the patient underwent a revision procedure. The PM was disconnected, and the electrodes were debrided, a submuscular pocket for the PM was created, and at the end of the procedure, the PM was anchored to the pectoralis major. Discussion: Twiddler syndrome is a not so rare and serious complication of CIED implantation, leading to device malfunctioning and higher risk of infection of the pocket due to multiple re-interventions. In these two cases, different surgical solutions were performed, both resulting to be effective to solve the effects of TS

Does Patient Compliance Influence Wearable Cardioverter Defibrillator Effectiveness? A Single-Center Experience

The study was designed to assess patient adherence to wearable cardioverter defibrillator as an indicator of device effectiveness. The patient training is not widely properly standardized. We enrolled 25 patients with a wearable cardioverter defibrillator to prevent sudden cardiac death between June 2020 and August 2022. Among them, 84% were male with a median age of 63.6 years. The indication was an ischemic (44%) and a non-ischemic (56%) disease. The patients were followed-up until the decision to upgrade to an implantable device was taken. We trained the patients according to our suggested protocol. The median wear time was 90 days, and the median daily wear time was 23.5 h, similar throughout sex, age, and indication groups. In total, 24% of the participants underwent cardioverter defibrillator implantation. Between the device-implanted and non-implanted groups, left ventricular ejection fraction and left ventricular indexed end-diastolic volume were significantly different (EF 35.8 & PLUSMN; 12 vs. 46.4 & PLUSMN; 8.5%, p = 0.028, iEDV 108 & PLUSMN; 52 vs. 70.7 & PLUSMN; 21.1 mL/m(2), p = 0.024). We did not find any differences in cardiac magnetic resonance data, even though all patients who underwent device implantation had late gadolinium enhancement spots. Our results support standardized patient training to obtain great patient adherence to the instructions to the wearable device and therefore its effectiveness

Lack of SYT-SSX Fusion Transcripts in Malignant Peripheral Nerve Sheath Tumors on RT-PCR Analysis of 34 Archival Cases

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Numeric Rating Scale Analysis of Trigeminal Neuralgia Patients Before and After Microvascular Decompression

Background: Trigeminal Neuralgia is a common condition of facial pain and its significantly affect patients’ daily life. Microvascular decompression is one of the interventional pain management for trigeminal neuralgia. There is still a little data obtained on evaluation of facial pain after microvascular decompression in Indonesia. Objective: This research aimed to evaluate facial pain after microvascular decompression of trigeminal neuralgia patients in Dr. Soetomo General Hospital, PHC Hospital, and Bangil General Hospital, Indonesia. Methods: The research design was a pretest-posttest with total sampling. Data were obtained from medical records from January 2018 until June 2019. Researches used Numeric Rating Scale (NRS) as pain measurement. The data obtained were analyzed by descriptive statistical test, normality test, and paired t-test. Results: Trigeminal Neuralgia patients that has been treated with microvascular decompression have an average facial reduction from 7.33±2.29 to 1.89±3.41 with p = 0.001. This result showed that the microvascular decompression has significantly reduce facial pain in patients with trigeminal neuralgia. Conclusion: Microvascular decompression significantly reduce the facial pain of trigeminal neuralgia patients

Approach to residual dizziness after successfully treated benign paroxysmal positional vertigo: effect of a polyphenol compound supplementation

Purpose: To assess if a polyphenol compound supplementation (Vertigoval (R)) could improve residual dizziness earlier after benign paroxysmal positional vertigo (BPPV) and relieve patients from this disabling symptomatology.Methods: In this prospective, multicentric study, 127 patients were randomized in the treatment group (TG), who received a 60-day supplementation, while 131 patients were randomized in the control group (CG), who did not receive any medication. The dizziness handicap inventory (DHI) score, static posturography, and the visual analog scale (VAS) for both dizziness (D-VAS) and nausea/vomit (N/V-VAS) were used as measures of outcome at baseline and after 30 and 60 days. Patients were asked about efficacy and tolerance to the treatment. Side effects were examined.Results: A statistically significant greater decrease was established in the TG for DHI, DVAS, and N/V-VAS compared to the CG. On the other hand, static posturography did not show statistical differences between the two groups, though a better clinical improvement after 60-day supplementation was shown in the TG in comparison to the CG. We counted mild side effects in only 2 patients. Most patients reported an excellent or good efficacy and tolerance to the treatment.Conclusion: Residual dizziness is a frequent condition of unknown origin that manifests as persistent disabling imbalance after successful repositioning maneuvers for BPPV. The decreasing postural control can affect the quality of life, contributing to falling and psychological problems. The supplementation with the polyphenol compound used in our study is safe, manageable, and appeared to be able to reduce subjective symptoms and improve instability earlier, decreasing the risk of potential complications

Pengaruh Usia dan Jenis Kelamin pada Skala Nyeri Pasien Trigeminal Neuralgia

Pendahuluan: Trigeminal neuralgia (TN) merupakan kondisi yang digambarkan sebagai nyeri hebat seperti tersilet pada satu sisi wajah  pada distribusi area saraf ke lima. Nyeri ini dapat mengganggu aktivitas sehari-hari pasien. Rasa nyeri merupakan fenomena subjektif yang dapat dipengaruhi oleh banyak faktor, seperti usia dan jenis kelamin. Tujuan: Mengetahui pengaruh usia dan jenis kelamin terhadap skala nyeri pasien Trigeminal Neuralgia. Metode: Data diambil dari rekam medik pasien pada periode Januari 2017 hingga Juni 2019 di RSUD Dr. Soetomo Surabaya, RS PHC Surabaya, dan RSUD Bangil Pasuruan berdasarkan kriteria inklusi dan eksklusi yang telah ditetapkan. Hasil: TN banyak ditemukan pada kelompok usia  36-64 tahun (55,55%) dan jenis kelamin perempuan (66,67%). Tidak didapatkan hubungan pengaruh usia dan jenis kelamin terhadap skala nyeri pasien (p > 0.05). Kesimpulan: Usia dan jenis kelamin merupakan faktor yang tidak dapat diubah dalam mempengaruhi nyeri. Usia dan jenis kelamin mempengaruhi nyeri melalui perubahan anatomi, hormonal, dan psikologis. Tidak ada hubungan antara usia dan jenis kelamin pada skala nyeri pasien dengan TN

A randomised controlled trial of a Mediterranean Dietary Intervention for Adults with Non Alcoholic Fatty Liver Disease (MEDINA): study protocol

BACKGROUND: Non-alcoholic fatty liver disease, the most prevalent liver disease in developed countries, remains difficult to manage with no proven safe and effective pharmacotherapy available. While weight reduction is the most commonly practiced treatment strategy, this is difficult to both achieve and/or maintain in the majority. Furthermore evidence-based dietary recommendations to guide the nutritional management of these patients are lacking. Using a randomised controlled trial design, this study compares the effectiveness of the Mediterranean diet to a standard low fat diet in terms of differences in insulin sensitivity, hepatic steatosis and metabolic outcomes in participants with non-alcoholic fatty liver disease. METHODS: Ninety four eligible patients who have non-alcoholic fatty liver disease and who are insulin resistant, will be randomised into either a Mediterranean or low fat diet group for a 3 month intervention period. Insulin sensitivity will be measured on peripheral blood using Homeostatic Model Assessment and liver fat content quantified using Magnetic Resonance Spectroscopy. Both arms will consist of three face to face and three telephone call follow up consultations delivered by an Accredited Practicing Dietitian. The intervention arm focuses on recommendations from the traditional Mediterranean diet which have been tailored for use in the Australian population The standard arm uses the Australian Guide to Healthy Eating and the Australian National Heart Foundation dietary guidelines. Study recruitment will take place at four major metropolitan hospitals in Melbourne, Australia. Data collection will occur at all face to face reviews including baseline, 6, and 12 weeks. A follow up assessment to measure sustainability will take place at 6 and 12 months. The primary end point is improved insulin sensitivity scores at the 12 week time point. DISCUSSION: This trial aims to demonstrate in a large cohort of participants with NALFD that a Mediterranean diet independent of weight loss can result in significant benefits in liver fat and insulin sensitivity and that these changes are sustained at 12 months. These metabolic changes would potentially lead to reductions in the risk of chronic liver disease, heart disease, type 2 diabetes and liver cancer. TRIAL REGISTRATION: Australia and New Zealand Clinical Trials Register ACTRN: ACTRN12615001010583

Essential function for ErbB3 in breast cancer proliferation

The overexpression of the ErbB family of tyrosine kinase receptors is thought to be important in the development of many breast tumours. To date, most attention has focused on the ErbB2 receptor. Now, in a recent report, it has been shown that ErbB3 is a critical partner for the transforming activity of ErbB2 in breast cancer cells. Importantly, the proliferative signals from this transforming complex appear to act via the PI-3 kinase pathway

ECMO for COVID-19 patients in Europe and Israel

Since March 15th, 2020, 177 centres from Europe and Israel have joined the study, routinely reporting on the ECMO support they provide to COVID-19 patients. The mean annual number of cases treated with ECMO in the participating centres before the pandemic (2019) was 55. The number of COVID-19 patients has increased rapidly each week reaching 1531 treated patients as of September 14th. The greatest number of cases has been reported from France (n = 385), UK (n = 193), Germany (n = 176), Spain (n = 166), and Italy (n = 136) .The mean age of treated patients was 52.6 years (range 16–80), 79% were male. The ECMO configuration used was VV in 91% of cases, VA in 5% and other in 4%. The mean PaO2 before ECMO implantation was 65 mmHg. The mean duration of ECMO support thus far has been 18 days and the mean ICU length of stay of these patients was 33 days. As of the 14th September, overall 841 patients have been weaned from ECMO support, 601 died during ECMO support, 71 died after withdrawal of ECMO, 79 are still receiving ECMO support and for 10 patients status n.a. . Our preliminary data suggest that patients placed on ECMO with severe refractory respiratory or cardiac failure secondary to COVID-19 have a reasonable (55%) chance of survival. Further extensive data analysis is expected to provide invaluable information on the demographics, severity of illness, indications and different ECMO management strategies in these patients