Achilles tendon pathologies: How to choose the best treatment

The Achilles tendon is the thickest and strongest tendon of the human body and it gets frequently injured during sports activity. The incidence of Achilles tendon pathologies has increased over the last decades, especially in the last few years, as a result of the increased sports participation among general population and for the diffusion of competitive sports at a high level. Although the increased interest and number of studies about Achilles tendon pathologies, at the moment there is not a consensual point of view on which is the best treatment for Achilles tendon injuries, and its management is still controversial. Treatment options mainly include conservative treatment and surgical repair. The decision for treatment in patients with an Achilles tendon pathology should be tailored on patient’s needs and level of activity, since patients with high activity levels may accept the risk of a higher complication rate to rapidly return to previous activity, while less active patients or those who cannot undergo surgery due to comorbidities may choose the non-operative option to decrease the risk of infection and other complications. The aim of this article is to give an insight about the most used and recent treatment options for Achilles tendon pathologies

Achilles tendon pathologies: How to choose the best treatment

The Achilles tendon is the thickest and strongest tendon of the human body and it gets frequently injured during sports activity. The incidence of Achilles tendon pathologies has increased over the last decades, especially in the last few years, as a result of the increased sports participation among general population and for the diffusion of competitive sports at a high level. Although the increased interest and number of studies about Achilles tendon pathologies, at the moment there is not a consensual point of view on which is the best treatment for Achilles tendon injuries, and its management is still controversial. Treatment options mainly include conservative treatment and surgical repair. The decision for treatment in patients with an Achilles tendon pathology should be tailored on patient’s needs and level of activity, since patients with high activity levels may accept the risk of a higher complication rate to rapidly return to previous activity, while less active patients or those who cannot undergo surgery due to comorbidities may choose the non-operative option to decrease the risk of infection and other complications. The aim of this article is to give an insight about the most used and recent treatment options for Achilles tendon pathologies

How do we treat the broad spectrum of patients with serious mental illness who have committed crimes? The Law 81/2014: limits and problems

In Italia è in corso un processo di deistituzionalizzazione che non ha precedenti al mondo. Si stanno progressivamente svuotando gli Ospedali Psichiatrici Giudiziari che non sono mai stati riformati negli ultimi 80 anni. Questo processo sta venendo attuato tramite una stratificazione di norme senza una progettualità diversa dalla rapida chiusura di queste fatiscenti strutture. Ai Dipartimenti di Salute Mentale (DSM) sono richieste una molteplicità di compiti nuovi e fortemente specialistici, e una estensione del loro potere di controllo, senza che queste strutture siano organizzate in tale senso. Alcune delle norme recentemente varate, come la Legge 81 del 2014, per risolvere alcuni problemi derivanti dalle difficoltà di deistituzionalizzazione complicano, a nostro parere, diversi aspetti gestionali di questa popolazione di gravi pazienti psichiatrici, che comunque non è assimilabile alla normale utenza dei DSM.Vi è necessità di un intervento legislativo coordinato e pensato su una prospettiva a lungo termineIn Italy an ongoing process of deinstitutionalization unprecedented in the world is been enacted.The Judicial Psychiatric Hospitals, that were never reformed in the past 80 years, are now on the edge of their closure.This process is being implemented through a layering of rules that had no purpose other than the rapid closure of these structures.The Mental Health Departments have now the responsibility of a multiplicity of new and highly specialized tasks, and an extension of their power to control.There is no previous organization for these tasks in the Mental Health System. Some of the recently enacted laws,such as the Law 81 of 2014, are intented to solve some problems, althought issues of deinstitutionalization are getting worse.In our opinion several management aspects of this population of severe psychiatric patients are unfit with the present organization of the Mental Health Services.There is need for legislative action coordinated and based on a long-term perspective

I.S.Mu.L.T - Rotator cuff tears guidelines

Despite the high level achieved in the field of shoulder surgery, a global consensus on rotator cuff tears management is lacking. This work is divided into two main sessions: in the first, we set questions about hot topics involved in the rotator cuff tears, from the etiopathogenesis to the surgical treatment. In the second, we answered these questions by mentioning Evidence Based Medicine. The aim of the present work is to provide easily accessible guidelines: they could be considered as recommendations for a good clinical practice developed through a process of systematic review of the literature and expert opinion, in order to improve the quality of care and rationalize the use of resources

I.S.Mu.L.T. Achilles Tendon Ruptures Guidelines

This work provides easily accessible guidelines for the diagnosis, treatment and rehabilitation of Achilles tendon ruptures. These guidelines could be considered as recommendations for good clinical practice developed through a process of systematic review of the literature and expert opinion, to improve the quality of care for the individual patient and rationalize the use of resources. This work is divided into two sessions: 1) questions about hot topics; 2) answers to the questions following Evidence Based Medicine principles. Despite the frequency of the pathology andthe high level of satisfaction achieved in treatment of Achilles tendon ruptures, a global consensus is lacking. In fact, there is not a uniform treatment and rehabilitation protocol used for Achilles tendon ruptures

Fatality rate and predictors of mortality in an Italian cohort of hospitalized COVID-19 patients

Clinical features and natural history of coronavirus disease 2019 (COVID-19) differ widely among different countries and during different phases of the pandemia. Here, we aimed to evaluate the case fatality rate (CFR) and to identify predictors of mortality in a cohort of COVID-19 patients admitted to three hospitals of Northern Italy between March 1 and April 28, 2020. All these patients had a confirmed diagnosis of SARS-CoV-2 infection by molecular methods. During the study period 504/1697 patients died; thus, overall CFR was 29.7%. We looked for predictors of mortality in a subgroup of 486 patients (239 males, 59%; median age 71 years) for whom sufficient clinical data were available at data cut-off. Among the demographic and clinical variables considered, age, a diagnosis of cancer, obesity and current smoking independently predicted mortality. When laboratory data were added to the model in a further subgroup of patients, age, the diagnosis of cancer, and the baseline PaO2/FiO2 ratio were identified as independent predictors of mortality. In conclusion, the CFR of hospitalized patients in Northern Italy during the ascending phase of the COVID-19 pandemic approached 30%. The identification of mortality predictors might contribute to better stratification of individual patient risk

SIMULAZIONE E CONTROLLO DI UN SISTEMA FRENANTE ANTISKID DI TIPO IDRAULICO PER VELIOVOLI DI AVIAZIONE GENERALE

Il seguente lavoro di tesi è stato condotto presso il Dipartimento di Ingegneria Aerospaziale dell’Università di Pisa come prova finale del corso di Laurea Specialistica. Scopo dell’attività è la realizzazione di un modello preliminare di impianto frenante Antiskid con attuazione idraulica per un velivolo di classe FAR 23, categoria Commuter (fascia Entry Level). L’obiettivo è quello di analizzare analiticamente, e successivamente attraverso simulazione al calcolatore, i principali aspetti fisici ed ingegneristici che caratterizzano la fase frenante di un velivolo: • Dinamica del velivolo • Controllo della stabilità del sistema • Attuazione idraulica della frenata Il lavoro parte dalla stesura dei requisiti preliminari, con la descrizione della classe del velivolo, le prestazioni e i requisiti per la certificazione. In seguito si ha una descrizione tecnologica di un tipico impianto frenante per applicazione aeronautica, con uno studio dello stato dell’arte dei componenti di controllo e di attuazione e un excursus sull’evoluzione tecnologica delle logiche Antiskid. La fase operativa del lavoro consiste nello studio della dinamica del velivolo durante la fase frenante, la realizzazione in ambiente Matlab-Simulink del corrispondente modello fisico e lo studio delle stabilità in ciclo aperto delle equazioni linearizzate. Le verifiche sono effettuate attraverso appositi tools di Matlab. Lo studio della stabilità in ciclo aperto si traduce in una analisi delle tecniche di controllo in ciclo chiuso del velivolo. Obiettivo dell’analisi è la realizzazione di un algoritmo di controllo Antiskid della frenata e il successivo modello Simulink da interfacciare al modello fisico del velivolo e a quello di attuazione idraulica. L’ultima fase riguarda la modellazione dell’impianto idro-meccanico di attuazione dei freni e la successiva modellazione Simulink. Il lavoro si è concentrato su uno studio fisico accurato dei principali aspetti che influenzano le performance della frenata e sulla realizzazione di un modello di controllo robusto da utilizzare come piattaforma per successive modifiche e complicazioni del sistema. The following paper describes the activity of research conducted in the Aerospace Engineering Department of University of Pisa as part of the final work for Aerospace Engineering Master Degree. Aim of the task is the creation of a preliminary model of a hydraulic braking system with Antiskid protection for a FAR 23 aircraft. The main objective is to assess analytically and then through software modeling and simulation the main aspects involving the braking phase of an aircraft, in particular considering: • Aircraft dynamics on the ground • System stability • Close loop control techniques • Hydraulic braking system The research starts from the study of preliminary requirements, the choice of a reference aircraft, its performance and certification requirements. Then, a study of typical aircraft braking systems is conducted, with an analysis of the main components currently adopted in aviation. The following step consists in the study of aircraft dynamics during the braking phase, a Matlab-Simulink model of it and the study of open loop stability of its equations. Stability of the system is verified with Matlab tools. Following the analysis of stability, a closed loop control system is introduced with an analysis of feasibility of Loop-shaping techniques. The last phase consists in the study of the hydraulic system and the modeling of the correspondent Matlab-Simulink model. The whole research is focused on an accurate study of the main aspects involving aircraft performance during the braking phase and on the creation of a valid model, which can be used as a robust basis for future development

Test section design for SGTR experimental investigation in CIRCE facility for HLMRS supported by SIMMER-III code

In the framework of MAXSIMA project, the design of a large-scale Test Section (TS), aiming to experimentally investigate the Steam Generator Tube Rupture (SGTR) postulated event in a relevant configuration for Gen IV MYRRHA reactor, was carried out. The TS will be implemented in the large pool CIRCE facility, at ENEA CR Brasimone. The TS is composed of four tube bundles representing a full scale portion of the Primary Heat eXchanger (PHX) of MYRRHA plant. They allow the execution of four SGTR tests, one at a time, excluding the necessity to extract the TS from the facility after each test. Water is foreseen to be injected at 16 bar and 200° C in the pool, partially filled by LBE at 350° C with a cover gas of argon at about 1 bar. The pressurization transients of CIRCE vessel and the sizing of the discharge lines and relative rupture disks were numerically predicted by SIMMER-III code on the base of a preliminary simplified configuration of the TS. The obtained results showed that the design pressure of CIRCE main vessel was not reached during more than 10 s of water injection, implementing a singular rupture disk having a diameter of 2 inch activated at 6.5 bar. It appears more than enough to notice, in a real reactor, the occurrence of the SGTR event and stop the water supply, interrupting the accidental scenario. These numerical results were adopted to support the design of the presented TS