Diagnostic work-up and management of young patients with ulcer-like dyspepsia: A cost-minimisation study

Objective: We initiated a cost-minimisation modelling study to compare the costs of strategies based on initial endoscopy or initial non-invasive tests for the detection of Helicobacter (C13 UBT or serology) from the perspective of the Italian National Health Service. The secondary outcomes were the number of patients undergoing unnecessary Helicobacter pylori (HP) eradication treatment and the number of endoscopic examinations spared.Methods: The study was based on a decision analysis model referring to patients aged less than 45 years with ulcer-like dyspepsia and no alarming symptoms. The probabilities entered in the model were weighted means from published studies, and the costs were derived from the Italian NHS reimbursement schedule. Sensitivity analyses were conducted over a wide range of probability and cost estimates in order to test the robustness of the model.Results: Non-invasive tests (such as the preliminary work-up of patients with ulcer-like dyspepsia aged less than 45 years) were cheaper ..

Rationale and design of an independent randomised controlled trial evaluating the effectiveness of aripiprazole or haloperidol in combination with clozapine for treatment-resistant schizophrenia

<p>Abstract</p> <p>Background</p> <p>One third to two thirds of people with schizophrenia have persistent psychotic symptoms despite clozapine treatment. Under real-world circumstances, the need to provide effective therapeutic interventions to patients who do not have an optimal response to clozapine has been cited as the most common reason for simultaneously prescribing a second antipsychotic drug in combination treatment strategies. In a clinical area where the pressing need of providing therapeutic answers has progressively increased the occurrence of antipsychotic polypharmacy, despite the lack of robust evidence of its efficacy, we sought to implement a pre-planned protocol where two alternative therapeutic answers are systematically provided and evaluated within the context of a pragmatic, multicentre, independent randomised study.</p> <p>Methods/Design</p> <p>The principal clinical question to be answered by the present project is the relative efficacy and tolerability of combination treatment with clozapine plus aripiprazole compared with combination treatment with clozapine plus haloperidol in patients with an incomplete response to treatment with clozapine over an appropriate period of time. This project is a prospective, multicentre, randomized, parallel-group, superiority trial that follow patients over a period of 12 months. Withdrawal from allocated treatment within 3 months is the primary outcome.</p> <p>Discussion</p> <p>The implementation of the protocol presented here shows that it is possible to create a network of community psychiatric services that accept the idea of using their everyday clinical practice to produce randomised knowledge. The employed pragmatic attitude allowed to randomly allocate more than 100 individuals, which means that this study is the largest antipsychotic combination trial conducted so far in Western countries. We expect that the current project, by generating evidence on whether it is clinically useful to combine clozapine with aripiprazole rather than with haloperidol, provides physicians with a solid evidence base to be directly applied in the routine care of patients with schizophrenia.</p> <p>Trial Registration</p> <p><b>Clincaltrials.gov Identifier</b>: NCT00395915</p

Laser induced forward and reverse transfer for additive manufacturing of multimaterial micro components

Pulsed laser can be used to eject materials from transparent donors through an ablation based expulsion mechanism. The material ejection can be controlled through the correct design of the donor materials and the laser optical setup. The ejected material in the form of sub-micrometric droplets can be stacked in order to achieve freestanding 3D components in the micrometric scale. This work depicts the use of a femtosecond pulsed UV laser to deposit material from solid donors in forward and reverse transfer modes in a flexible manner. The system architecture and the process development were carried out as a collaboration between Technoprobe and Politecnico di Milano. In the laser induced forward transfer (LIFT) mode, PVD produced pure titanium layers deposited on transparent glass is deposited in a drop-by-drop fashion to produce free- standing 3D micro metal objects. In the laser induced reverse transfer (LIRT) mode solid metals are transferred to transparent media to produce 2D layers with in-situ material mixing capabilities

Allogeneic Lethally Irradiated Cord Blood Mononuclear Cells in No-Option Critical Limb Ischemia: A “Box of Rain”

stem cell treatment for critical limb ischemi

Sex-Related Differences and Factors Associated with Peri-Procedural and 1 Year Mortality in Chronic Limb-Threatening Ischemia Patients from the CLIMATE Italian Registry

Background: Identifying sex-related differences/variables associated with 30 day/1 year mortality in patients with chronic limb-threatening ischemia (CLTI). Methods: Multicenter/retrospective/observational study. A database was sent to all the Italian vascular surgeries to collect all the patients operated on for CLTI in 2019. Acute lower-limb ischemia and neuropathic-diabetic foot are not included. Follow-up: One year. Data on demographics/comorbidities, treatments/outcomes, and 30 day/1 year mortality were investigated. Results: Information on 2399 cases (69.8% men) from 36/143 (25.2%) centers. Median (IQR) age: 73 (66-80) and 79 (71-85) years for men/women, respectively (p &lt; 0.0001). Women were more likely to be over 75 (63.2% vs. 40.1%, p = 0.0001). More men smokers (73.7% vs. 42.2%, p &lt; 0.0001), are on hemodialysis (10.1% vs. 6.7%, p = 0.006), affected by diabetes (61.9% vs. 52.8%, p &lt; 0.0001), dyslipidemia (69.3% vs. 61.3%, p &lt; 0.0001), hypertension (91.8% vs. 88.5%, p = 0.011), coronaropathy (43.9% vs. 29.4%, p &lt; 0.0001), bronchopneumopathy (37.1% vs. 25.6%, p &lt; 0.0001), underwent more open/hybrid surgeries (37.9% vs. 28.8%, p &lt; 0.0001), and minor amputations (22% vs. 13.7%, p &lt; 0.0001). More women underwent endovascular revascularizations (61.6% vs. 55.2%, p = 0.004), major amputations (9.6% vs. 6.9%, p = 0.024), and obtained limb-salvage if with limited gangrene (50.8% vs. 44.9%, p = 0.017). Age &gt; 75 (HR = 3.63, p = 0.003) is associated with 30 day mortality. Age &gt; 75 (HR = 2.14, p &lt; 0.0001), nephropathy (HR = 1.54, p &lt; 0.0001), coronaropathy (HR = 1.26, p = 0.036), and infection/necrosis of the foot (dry, HR = 1.42, p = 0.040; wet, HR = 2.04, p &lt; 0.0001) are associated with 1 year mortality. No sex-linked difference in mortality statistics. Conclusion: Women exhibit fewer comorbidities but are struck by CLTI when over 75, a factor associated with short- and mid-term mortality, explaining why mortality does not statistically differ between the sexes