Influences of Age and Comorbidities on Indication for Partial Nephrectomy: A Systematic Review

BACKGROUND: The influence of age and comorbidities during decision-making for patients with renal cell carcinoma remains controversial. OBJECTIVE: To comprehensively review the available evidence regarding the impacts of age and comorbidities on the decision to perform partial nephrectomy (PN). EVIDENCE ACQUISITION: A systematic review was conducted in accordance with PRISMA and registered with PROSPERO (CRD42022344759). Only randomized control trials, prospective cohort studies, registry-based studies, or single/multi-institutional retrospective cohort studies comparing PN to other therapeutic options for cT1N0M0 renal masses were considered. The primary outcome was to assess differences in patients' baseline characteristics between different treatments in order to investigate how those aspects have influenced clinical decision-making. Finally, perioperative outcomes were compared across the different options. EVIDENCE SYNTHESIS: Overall, patients who underwent PN were 3 to 11 years younger than those who underwent other treatments. Baseline renal function was slightly better in patients who underwent PN than in those who underwent radical nephrectomy (RN), active surveillance (AS), or tumor ablation. Patients undergoing PN had an average pre-treatment eGFR 4 to 6 points (mL/min/1.73 m2) higher than patients undergoing RN or tumor ablation. Likewise, the proportion of baseline chronic kidney disease (CKD) before treatment was higher in patients undergoing other treatments, with a rate of CKD between 6% and 56% higher compared with that for PN. A slightly higher proportion of baseline diabetes mellitus (DM) and cardiovascular comorbidities (CVD) were found in patients who underwent PN than in those who underwent RN (20% vs. 21% for DM and 37% vs. 41% for CVD). On average, patients who underwent AS and tumor ablation had more comorbidities, in terms of Charlson comorbidity index (CCI), DM, and CVD (50% vs. 38% for CCI ≥2; 25% vs. 20% for DM; and 43% vs. 37% for CVD). In terms of Eastern Cooperative Oncology Group (ECOG) Performance Status and American Society of Anesthesiologists (ASA) classification, no major differences were found between PN and other treatments, but a trend emerged whereby more fit patients underwent PN compared with RN (16% of ECOG >1 for PN vs. 18% for RN and 15% of ASA grade ≥3 for PN vs. 26% for RN). Again, tumor ablation was preferred for less fit patients (31% of ASA grade ≥3). No study included in our systematic review reported the baseline frailty status of patients treated for cT1 renal masses. The rates of perioperative complications and length of hospital stay (LOS) were similar between different techniques. CONCLUSIONS: Patients who underwent PN tended to be younger and fitter than those who underwent other available treatments for cT1 renal masses. Since this technique aims at reducing renal function impairment after surgery, a greater effort should be made to optimize patient selection to include more comorbid patients for whom PN might be useful

Influence of parental employment status on Dutch and Slovak adolescents' health

BACKGROUND: Recent research shows the possibility that the link between parental employment status and children's health can be affected by different cultural or societal settings. The aim of this study was to explore whether the effect of father's and mother's employment status on several aspects of adolescents' health differs between Slovakia and the Netherlands. METHODS: Two data sets were used: 2616 Slovak adolescents (mean age 14.9) and 2054 Dutch adolescents (mean age 16.3). Self-rated health, GHQ-12, long-term well-being and Rosenberg self-esteem scale were used to assess the health of adolescents. Parental employment status was classified into the following categories: employed, unemployed, disabled, housewife (among mothers only). Logistic regression analyses were done separately for males and females. RESULTS: Results indicate that having an unemployed father negatively influences self-rated health and long-term well-being of Slovak male adolescents, but has no effect on the health of Dutch adolescents. Secondly, having a disabled father has a negative effect on the psychological well-being of Dutch males and the self-rated health of females, but does not influence the health of Slovak adolescents. Thirdly, having a mother who is disabled, unemployed or a housewife has a negative effect on the self-esteem of Slovak adolescents. Fourthly, Dutch males whose mother was a housewife had worse long-term well-being than those with an unemployed mother, whereas Dutch females whose mother was a housewife reported better psychological well-being than those with an employed mother. CONCLUSION: To conclude briefly our results, father's unemployment seems to be a better predictor of health for Slovak adolescents, father's disablement of health for Dutch ones. Mother's employment status seemed to be important for the self-esteem of Slovak adolescents and mother as a housewife for the health of Dutch ones. This suggests that the link between parental employment status and the health of their children may vary between countries, and therefore further studies involving various cultures are needed

PROGETTAZIONE, SVILUPPO E INTEGRAZIONE DI UNA PELLE SENSORIZZATA NEL POLLICE DI UNA PROTESI DI MANO

L'obiettivo principale della progettazione delle protesi di mano è quello di creare un dispositivo che possa replicare il più possibile le funzioni e le caratteristiche della mano umana. Una protesi di mano dovrebbe essere in grado di replicare la capacità di movimento delle dita, di afferrare oggetti con diverse forme e dimensioni, e di fornire un senso di tatto e di posizione degli oggetti. Questa tesi ha lo scopo di illustrare l’intera fase di progettazione e integrazione meccanica di una pelle sensorizzata (e-Skin) implementata sul dito pollice di una mano robotica artificiale a scopo protesico: Mia Hand. L’arto protesico su cui verrà effettuata l’ingegnerizzazione è prodotto da Prensilia s.r.l., azienda spin-off della Scuola Superiore Sant’Anna di Pisa. Le pelli sensorizzate (chiamate anche pelli artificiali) sono un dispositivo elettronico flessibile che comprende un array di trasduttori che traducono uno stimolo meccanico (ad esempio, forza) in un segnale analogico (tensione o corrente) e rappresentano uno sviluppo relativamente recente nel campo delle protesi di mano. Sono progettate per fornire un feedback tattile ai pazienti migliorando la loro sensazione di controllo sulla protesi e la loro interazione con l'ambiente circostante. La pelle artificiale che si andrà ad integrare sul dito utilizzerà trasduttori nano-generatori triboelettrici (TENG) a base di idrogel. La tesi è stata svolta all’interno del progetto europeo B-CRATOS (Wireless Brain-Connect inteRfAce TO machineS) che mira alla realizzazione di un'interfaccia wireless tra il cervello umano e le macchine (denominata BCI, Brain – Computer Interface) in grado di leggere e decodificare i segnali elettrici prodotti dal cervello, e di utilizzarli per controllare dispositivi esterni, come protesi e robot. Dopo uno studio preliminare riguardo l’analisi delle aree di contatto che si vengono a creare fra mano protesica (con particolare riguardo al pollice) ed oggetti in diverse prese che possono essere eseguite quotidianamente, si è passato allo sviluppo (modellazione teorica, progettazione e produzione) degli elementi necessari alla realizzazione della e-Skin e, quindi, alla valutazione dell'effettiva integrazione meccanica. The main goal of prosthetic hand design is to create a device that can replicate the functions and characteristics of the human hand as closely as possible. A prosthetic hand should be able to replicate the movement ability of fingers, to grasp objects with different shapes and sizes, and to provide a sense of touch and the location of objects. This thesis aims to illustrate the entire mechanical design and integration phase of a sensorized skin (e-Skin) implemented on the thumb of an artificial robotic hand for prosthetic purposes: Mia Hand. The prosthetic limb on which the engineering will be carried out is produced by Prensilia s.r.l., a spin-off company of the Scuola Superiore Sant'Anna in Pisa. Sensored skins (also called artificial skins) are a flexible electronic device comprising an array of transducers that translate a mechanical stimulus (for example, force) into an analog signal (voltage or current) and represent a relatively recent development in the field of prosthetics by hand. They are designed to provide tactile feedback to patients improving their sense of control over the prosthesis and their interaction with their surroundings. The artificial skin that will be integrated onto the finger will use hydrogel-based triboelectric nano-generator (TENG) transducers. The thesis was carried out within the European project B-CRATOS (Wireless Brain-Connect inteRfAce TO machineS) which aims at the creation of a wireless interface between the human brain and machines (called BCI, Brain – Computer Interface) able to read and decode the electrical signals produced by the brain, and to use them to control external devices, such as prostheses and robots. After a preliminary study regarding the analysis of the contact areas that are created between the prosthetic hand (with particular regard to the thumb) and objects in different grips that can be performed daily, we moved on to the development (theoretical modeling, design and production ) of the elements necessary for the creation of the e-Skin and, therefore, for the evaluation of the effective mechanical integration

The Role of Buildings in Rural Areas: Trends, Challenges, and Innovations for Sustainable Development

Rural buildings represent the functional relationship between rural communities and agricultural land. Therefore, research on rural buildings has practical repercussions on environmental and socio-economic sustainability. Comprehensive state-of-the-art research on rural buildings may address research activities. We present a systematic review of the scientific research between 2000 and 2022 based on the PRISMA protocol. Five main topics were identified. The results showed that the primary research focus was production (25.1%) and environmental management issues (23.2%). However, construction and efficiency are rapidly taking centre stage (20.6%). Regarding sustainability (20.8%), life cycle assessment, green buildings, recycling and global warming should be the future research focus. Energy efficiency will benefit from studies on thermal energy. More research on engineering and technologies (10.3%), specifically remote and automatic detection and transport in rural areas, will increase cost efficiency. The results may help improve the global efficiency of rural buildings in a modern farming system

Prevention and treatment of venous thromboembolism in patients with solid brain neoplasms: results of a survey among Italian physicians

The decision concerning the introduction of primary and secondary prophylaxis of venous thromboembolism (VTE) in patients with solid brain neoplasms and brain metastases is often challenging due to the concomitant increased risk of intracranial hemorrhage and to limited evidence from available literature. A standardized questionnaire composed of nine multiple-choice questions regarding primary VTE prevention in non-surgical patients during high-risk conditions and VTE secondary prevention in patients with a solid brain neoplasm or cerebral metastases was sent via electronic mail to all the members (n = 2420) of the Italian Federation of the Internal Medicine Hospital Executives\u2019 Associations (FADOI) in June 2015. Three hundred and fifty two physicians (14.5%) returned it (participants' median age 51 years; females 46.9%). The majority of respondents prescribe primary thromboprophylaxis (usually with heparin) in non-surgical patients with solid brain neoplasms and brain metastases in concomitance with high-risk conditions. Full-dose anticoagulation with either low-molecular-weight heparin or fondaparinux is the preferred option for acute VTE (69.6%), while a reduced dose is chosen by 21.0% of physicians. The presence of a highly vascular brain neoplasm histotype mandates the prescription of a reduced-dose antithrombotic regimen in a minority of respondents. Vena cava filter placement is an option for the treatment of acute VTE in more than 6% of respondents. Anticoagulants are often prescribed for both VTE primary prevention and treatment. In conclusion, physicians\u2019 managements are partially in contrast to recent guidelines, reinforcing the need for educational programs and other studies in this setting

The Learning Curve for Radical Nephrectomy for Kidney Cancer: Implications for Surgical Training

Although radical nephrectomy (RN) is the most common treatment for kidney cancer, no data on the learning curve for RN are available. In this study we investigated the effect of surgical experience (EXP) on RN outcomes using data for 1184 patients treated with RN for a cT1–3a cN0 cM0 renal mass. EXP was defined as the total number of RNs performed by each surgeon before the patient’s operation. The primary study outcomes were all-cause mortality, clinical progression, Clavien-Dindo grade ≥2 postoperative complications (CD ≥2), and the estimated glomerular filtration rate (eGFR). Secondary outcomes were operative time, estimated blood loss, and length of stay. Multivariable analyses adjusted for case mix revealed no evidence of association between EXP and all-cause mortality (p = 0.7), clinical progression (p = 0.2), CD ≥2 (p = 0.6), or 12-mo eGFR (p = 0.9). Conversely, EXP was associated with shorter operative time (estimate −0.9; p < 0.01). Mortality, cancer control, morbidity, and renal function might not be affected by EXP. The very large cohort examined and the extensive follow-up support the validity of these negative findings. Patient summary: For patients with kidney cancer undergoing surgical removal of a kidney, those treated by novice surgeons have similar clinical outcomes to those treated by experienced surgeons. Thus, this procedure represents a convenient scenario for surgical training if longer operating theatre time can be planned

Un anno di Leggere:forte! L'esperienza di una ricerca-azione

Leggere: Forte! Ad alta voce fa crescere l’intelligenza è un intervento pluriennale, una politica educativa che mira a far diventare l’ascolto della lettura ad alta voce una pratica quotidiana, intensiva, sistematica nell’intero sistema di educazione e istruzione della Toscana, con l’obiettivo di ridurre, nel tempo, la dispersione scolastica e di garantire a tutti una reale possibilità di successo formativo. Il libro racconta, documenta e spiega le intenzioni, le azioni e i risultati del primo anno di attività di questa straordinaria apertura al futuro, e con- sente di accedere alle informazioni e agli argomenti scientifici necessari a valutare l’opportunità di diffonderne e replicarne gli intenti e gli strumenti, anche al di fuori del territorio toscano

Ad alta voce. La lettura che fa bene a tutti

Le motivazioni di questo libro sono ambiziose: si vuole invitare a utilizzare la lettura ad alta voce come pratica didattica partendo da un'esperienza di rilievo nazionale che è, al contempo, un progetto e una ricerca; si vuole inoltre dare conto degli importan-ti esiti di una ricerca quasi sperimentale che ha raccolto dati rilevanti in ordine agli effetti cognitivi e di comprensione del testo dell'esposizione alla lettura. Una precisazione, per cominciare: qui si parla della lettura di narrativa, fatta in classe per i propri studenti, dall'insegnante, secondo un approccio e un metodo precisi. Altri approcci prediligono, per esempio, il contesto familiare (Aram et al., 2017; Curtis, Zhou, Tao, 2020; Schapira, Aram, 2019). Qui, invece, il metodo è improntato sulla funzione del sistema di istruzione, che è essenziale perché l'opportunità sia estesa a tutti e non contribuisca ad approfondire le differenze legate alla diversità delle pro-venienze socio-economico-culturali. Non si può ignorare, infatti, che la provenienza socio-economico-culturale condi-ziona, di fatto, anche in presenza di un'informazione adeguata sulla rilevanza della lettura, il modo e la continuità con cui si pratica la lettura ad alta voce nel contesto familiare (Chiu, McBride-Chang, 2006). Il metodo proposto poggia sul ruolo, decisivo, degli insegnanti-lettori, sul concetto di progressività dei tempi, sulla lunghezza e complessità dei testi e sulla varietà delle proposte, sull'attenzione posta alla libertà di espressione, commento e interpretazione di tutti i bambini e le bambine, le ragaz-ze e i ragazzi coinvolti. Il tutto con gli studenti al centro. Come ogni azione tesa, realmente, all'empower-ment dei soggetti coinvolti, gli studenti sono infatti punto di partenza e di arrivo di questo approccio: • sono il punto di partenza, perché si avvia l'esposizione alla lettura ad alta voce dai loro tempi di attenzione, dai loro gusti e da storie che rispondano ai loro bisogni; • sono il punto di arrivo, perché le pratiche di lettura ad alta voce in classe sono spazi di condivisione, di co-costruzione di significati, costituiscono materiale "vi-vo" per costruire e valorizzare, al tempo, la loro esperienza, la loro visione del mondo, il loro futuro. Le storie diventano così uno spazio di dialogo con i pari, uno spazio in cui la propria opinione, l'opinione di tutti, assume valore e dignità, nel quale non esiste la "risposta giusta" e tantomeno quella "sbagliata", ma i significati vengono negoziati (Langer, 1986; Tanner et al., 2017)