ALTERAZIONI ELETTROCARDIOGRAFICHE ASSOCIATE A PATOLOGIE CEREBROVASCOLARI ACUTE: MECCANISMI PATOGENETICI E IMPLICAZIONI CLINICHE

- ABSTRACT - Background: le patologie cerebrovascolari acute, ischemiche ed emorragiche, determinano frequentemente effetti patologici cardiaci: aritmie, cardiomiopatie ischemiche, scompenso. L’origine di tali complicanze è dovuta ad uno squilibrio del sistema nervoso autonomo indotto dalle lesioni cerebrali. Tuttavia affinché si verifichino complicanze clinicamente rilevanti è necessaria una predisposizione individuale. Obiettivi: lo studio si propone di valutare quali fattori individuali siano maggiormente implicati nell’insorgenza di complicanze cardiache clinicamente rilevanti. In particolar modo valuta l’importanza della comorbidità cardiovascolare mettendo a confronto pazienti con ictus e con patologie cardiovascolari concomitanti (vasculopatie, cardiopatie, aritmie, danno cardiaco subclinico) e pazienti con ictus ma privi di patologie concomitanti. Lo studio inoltre si propone di inquadrare i pazienti in classi di rischio per eventi cardiaci durante la fase iperacuta e acuta dell’evento ictale. Metodi: attraverso la valutazione retrospettiva dei 336 pazienti con evento cerebrovascolare acuto che hanno beneficiato di cure nell’anno 2007 presso l’unità stroke – Osp. Santa Chiara, sono stati messi a confronto i differenti quadri clinici, le rilevazioni anamnestiche, l’evoluzione durante la degenza, l’insorgenza di complicanze cardiache e il loro decorso. Risultati: il 50% dei pazienti ha presentato aritmie di grado variabile durante la degenza, il 30% alterazioni di ripolarizzazione, il 18% alterazioni ecocardiografiche di cinetica, il 10% elevazione dei markers di necrosi miocardia, il 3% elevazione del BNP. Pazienti senza comorbidità cardiovascolare hanno sviluppato esclusivamente aritmie di grado lieve; pazienti cardiopatici, aritmici, vasculopatici e con danno d’organo subclinico hanno manifestato invece oltre a disturbi aritmici (di gravità maggiore) anche disturbi ischemici e di insufficienza cardiaca. Conclusioni: nell’evento ictale durante la fase iperacuta e acuta sono di frequente riscontro complicanze cardiache. Queste possono condizionare l’evoluzione clinica e, talvolta, portare ad exitus. Tuttavia solo in pazienti con patologie cardiovascolari concomitanti hanno un’incidenza statisticamente significativa. Si consiglia di inquadrare i pazienti già al momento del ricovero in classi di rischio per complicanze cardiache e di procedere con protocolli di monitoraggio differenti e adeguati per ciascuna classe

Effetti “inibitori” della interdittiva antimafia e bilanciamento fra principi costituzionali: alcune questioni di legittimità dedotte in una recente ordinanza di rimessione alla Consulta

Moving from a very recent order of submission to the Italian Constitutional Court, the paper analyses some of the critical profiles that – in the last years – are related to the institute if the s.c. “interdittiva antimafia” (i.e. “anti-mafia interdictive), among the wider discipline provided against the organized crime. Regarding the parameters evoked by the Administrative Judge, it is intended to reflect on the delicate balancing procedure between rights and liberties that – equally guaranteed by the Constitution – inevitably collide as the aforementioned institute is enforced and that require, then, a particular care by the proceeding Public Administration: the private economic initiative freedom, the right to work, the guarantee of a fair trial for the defense of own rights and the guarantee of public order, security and socio-economical legality. This, in order to focus on the normative and jurisprudential addresses that may be followed to safeguard the human dignity – as a primary interest – even in the matter of constraining the phenomenon of “mafia”

Static Crow’s Feet Treated with Voltaic Arc Dermabrasion (Atmospheric Plasma): Post-Operative Pain Assessment by Thermal Infrared Imaging

Background: In the literature, several strategies have been described for the treatment of unaesthetic marks on the face resulting from the aging processes. The atmospheric plasma procedure is a non-invasive, inexpensive technique proposed for the rejuvenation of facial tissues. The aim of this study was to evaluate the performance of voltaic arc dermabrasion (VAD) for the treatment of static crow’s feet of the periorbital area. Methods: The crow’s feet of 135 patients (127 female and 8 male) were treated using the VAD technique. The perioperative skin temperature measurement was assessed using an Infrared Temperature sensor. The pain was measured using the Visual Analogic Score (VAS) at 1 week, 1 month and 1 year. The patient’s and surgeon’s satisfaction were assessed using the Global Aesthetic Improvement Scale (GAIS) at 1 month and 1 year from the procedure. The severity of the crow’s feet was rated using the Crow’s Feet Grading Scale (CFGS). Results: A complete epidermal healing of all the subjects treated was evident at 7 days. The atmospheric plasma technique showed an efficient treatment for the removal of the crow’s feet, with a good aesthetic outcome, high surgeon and patient satisfaction, without clinical complications. Conclusions: The atmospheric plasma technique can be a useful modality in the cosmetic as well as therapeutic treatment of crow’s feet

Avaliação da contração de polimerização de três resinas compactáveis, medida por picnômetro a gás

Modern restorative dentistry has been playing an outstanding role lately since composite resins, allied to adhesive systems, have been widely applied on anterior and posterior teeth restorations. The evolution of composite resins has mostly been verified due to the improvement of their aesthetic behavior and the increase in their compressive and abrasive strengths. In spite of these developments, the polymerization shrinkage inherent to the material has been a major deficiency that, so far, has been impossible to avoid. Using a gas pycnometry, this research investigated the polymerization shrinkage of three packable composite resins: Filtek P60 (3M), Prodigy Condensable (Kerr), and SureFil (Dentsply/Caulk), varying the distance from the light source to the surface of the resins (2 mm or 10 mm). The pycnometer Accupyc 1330 (Micromeritics, USA) precisely records helium displacement, allowing fast and reliable measurements of the volume of composite resin immediately before and after polymerization, without interference of temperature or humidity. Results were not found to be statistically different for the three tested resins, either for 2 mm or 10 mm-distance from the light source to the composite surface.A Odontologia Restauradora moderna tem se destacado nos últimos anos e as resinas compostas, aliadas aos sistemas adesivos, têm sido muito empregadas para restaurações de dentes anteriores e posteriores. A evolução das resinas compostas tem sido constatada na melhoria do seu comportamento estético e no aumento da sua resistência à compressão e à abrasão. Apesar dos avanços mencionados, a contração de polimerização, inerente a esse material, continua sendo uma grande deficiência e, por enquanto, impossível de ser evitada. Nesta pesquisa a contração de polimerização de três resinas compostas compactáveis, Filtek P60 (3M), Prodigy Condensável (Kerr) e SureFil (Dentsply/Caulk), variando-se a distância entre a fonte de luz e a superfície das resinas em 2 mm e 10 mm, foi avaliada pelo método da picnometria a gás. O aparelho picnômetro Accupyc 1330 (Micromeritics, EUA) mede o deslocamento de gás hélio com grande precisão, permitindo medições rápidas e fiéis do volume das resinas compostas antes e após a polimerização, sem interferência da temperatura e da umidade. Os resultados mostraram que não houve diferenças estatisticamente significantes entre as três resinas avaliadas. Independentemente do tipo de resina composta, também não houve diferenças significantes para as distâncias de polimerização de 2 mm e 10 mm

Finite elements study of the Flexi Post and Flexi Flange post systems in a maxillary central incisor

A utilização de pinos intra-radiculares tem se mostrado uma excelente alternativa para dentes endodonticamente tratados. Este trabalho teve como objetivo avaliar, utilizando o Método dos Elementos Finitos (MEF), como pinos intra-radiculares pré-fabricados metálicos podem alterar o padrão das tensões geradas de von Mises e de máxima tração e compressão na raiz dental. A comparação foi realizada entre os pinos pré-fabricados Flexi Post/Flexi Flange de aço inoxidável e titânio com preenchimento coronário em resina composta. Os pinos intra-radiculares foram fixados com um cimento resinoso e recobertos por uma coroa total cerâmica. A partir de fotografias da peça anatômica e dos pinos estudados, foram criados modelos matemáticos bidimensionais no programa MSC/Nastran 4.5 e, após aplicação de uma força de 100 N a 45 graus na superfície palatina dos modelos, foi avaliada a distribuição das tensões geradas. Com base nos resultados obtidos, pode-se concluir que os pinos intra-radiculares alteram o padrão das tensões geradas dependendo do desenho do pino intra-radicular e do tipo de material constituinte.The use of post and core systems has become an excellent alternative for restoring endodontically treated teeth. The aim of this study was to evaluate the von Mises, maximal compressive and tensile stresses distribution using the Finite Element Method (FEM) on human teeth restored with different post and core systems. The analysis was made on endodontically treated maxillary central incisors. The post systems used in this investigation were the stainless steel or titanium Flexi Post/Flexi Flange. Composite resin was used as core material and resin cement was the cement material of choice to seat a full porcelain crown. The bi-dimensional mathematical model was created from pictures taken from an intact human maxillary central incisor and prefabricated posts. This image was transferred to a personal computer in the MSC/Nastran 4.5 software. A static and linear analysis treatment was performed when a 45º load of 100 N was applied on the lingual surface of the tooth. Based on the results obtained, it can be concluded that the post design and its material can alter the stress pattern distribution

Economic Aspects in the Management of Diabetic Macular Edema in Italy

BackgroundDiabetic Macular Edema (DME) is the most common cause of vision loss in diabetic patients. Currently, the Vascular Endothelial Growth Factor inhibitors (anti-VEGFs) are used as the first line of DME treatment and corticosteroid implants are usually used as a second-line treatment. These implants are a safe and effective therapeutic option that can improve the quality of life of DME patients by reducing the intravitreal injections number. We determined the economic impact related to DME, also from the social perspective, and the consequences of the increased use of the dexamethasone implant. MethodsThe analysis compares two scenarios: the first based on the current rate of recourse to the therapeutic alternatives available in the Italian healthcare setting (as is) and the second based on the assumption of an increased recourse to dexamethasone implants (to be). The results are expressed both in terms of the resource absorption associated with the two scenarios and in terms of the cost differential yielded by their comparison. ResultsThe increased use of the dexamethasone implant allows considerable savings in terms of healthcare professionals' time, follow-up and productivity lost by patients/caregivers. These savings would reduce healthcare costs for the management of DME patients in Italy by euro2,058,238 in 5 years. ConclusionsTo optimize the healthcare resources allocation, it is necessary to implement treatments that yield not only cost reductions but also a clinical benefit for patients. The dexamethasone implant use is an example of DME management that generates value for patients, health system and society

A real world analysis of COVID-19 impact on hospitalizations in older adults with chronic conditions from an Italian region

Healthcare delivery reorganization during the COVID-19 emergency may have had a significant impact on access to care for older adults with chronic conditions. We investigated such impact among all adults with chronic conditions aged >= 65 years, identified through the electronic health databases of two local health agencies-ATS Brianza and ATS Bergamo-from the Lombardy region, Italy. We considered hospitalizations for 2020 compared to the average 2017-2019 and quantified differences using rate ratios (RRs). Overall, in 2017-2019 there were a mean of 374,855 older adults with >= 1 chronic condition per year in the two ATS and 405,371 in 2020. Hospitalizations significantly decreased from 84,624 (225.8/1000) in 2017-2019 to 78,345 (193.3/1000) in 2020 (RR 0.86). Declines were reported in individuals with many chronic conditions and for most Major Diagnostic Categories, except for diseases of the respiratory system. The strongest reductions were observed in hospitalizations for individuals with active tumours, particularly for surgical ones. Hospitalization rates increased in individuals with diabetes, likely due to COVID-19-related diseases. Although determinants of the decrease in demand and supply for care among chronic older adults are to be further explored, this raises awareness on their impacts on chronic patients' health in the medium and long run

Erratum to nodal management and upstaging of disease. Initial results from the Italian VATS Lobectomy Registry

[This corrects the article DOI: 10.21037/jtd.2017.06.12.]

International Expert Opinions and Recommendations on the Use of Melatonin in the Treatment of Insomnia and Circadian Sleep Disturbances in Adult Neuropsychiatric Disorders

Introduction: Insomnia and circadian rhythm disorders, such as the delayed sleep phase syndrome, are frequent in psychiatric disorders and their evaluation and management in early stages should be a priority. The aim of this paper was to express recommendations on the use of exogenous melatonin, which exhibits both chronobiotic and sleep-promoting actions, for the treatment of these sleep disturbances in psychiatric disorders.Methods: To this aim, we conducted a systematic review according to PRISMA on the use of melatonin for the treatment of insomnia and circadian sleep disorders in neuropsychiatry. We expressed recommendations for the use of melatonin in psychiatric clinical practice for each disorder using the RAND/UCLA appropriateness method.Results: We selected 41 studies, which included mood disorders, schizophrenia, substance use disorders, attention deficit hyperactivity disorders, autism spectrum disorders, neurocognitive disorders, and delirium; no studies were found for both anxiety and eating disorders.Conclusion: The administration of prolonged release melatonin at 2–10 mg, 1–2 h before bedtime, might be used in the treatment of insomnia symptoms or comorbid insomnia in mood disorders, schizophrenia, in adults with autism spectrum disorders, neurocognitive disorders and during sedative-hypnotics discontinuation. Immediate release melatonin at <1 mg might be useful in the treatment of circadian sleep disturbances of neuropsychiatric disorders

The interplay among psychopathology, personal resources, context-related factors and real-life functioning in schizophrenia: stability in relationships after 4 years and differences in network structure between recovered and non-recovered patients

Improving real-life functioning is the main goal of the most advanced integrated treatment programs in people with schizophrenia. The Italian Network for Research on Psychoses previously explored, by using network analysis, the interplay among illness-related variables, personal resources, context-related factors and real-life functioning in a large sample of patients with schizophrenia. The same research network has now completed a 4-year follow-up of the original sample. In the present study, we used network analysis to test whether the pattern of relationships among all variables investigated at baseline was similar at follow-up. In addition, we compared the network structure of patients who were classified as recovered at follow-up versus those who did not recover. Six hundred eighteen subjects recruited at baseline could be assessed in the follow-up study. The network structure did not change significantly from baseline to follow-up, and the overall strength of the connections among variables increased slightly, but not significantly. Functional capacity and everyday life skills had a high betweenness and closeness in the network at follow-up, as they had at baseline, while psychopathological variables remained more peripheral. The network structure and connectivity of non-recovered patients were similar to those observed in the whole sample, but very different from those in recovered subjects, in which we found few connections only. These data strongly suggest that tightly coupled symptoms/dysfunctions tend to maintain each other's activation, contributing to poor outcome in schizophrenia. Early and integrated treatment plans, targeting variables with high centrality, might prevent the emergence of self-reinforcing networks of symptoms and dysfunctions in people with schizophrenia