Diritto penale dell'igiene e della sicurezza sul lavoro. Tecniche di incriminazione e paternalismo giuridico

Il lavoro approfondisce i temi complessi della colpa e del nesso di causa nei settori specifici dell'infortunistica e dell'igiene del lavoro. L'articolazione argomentativa si diffonde poi sugli istituti della prescrizione e dell'oblazione, per procedere con lo studio delle tecniche di incriminazione che, informandosi alle proteiformi finalità della pena, tendono alla tutela più ampia del "Rechtsgut". La disamina approfondisce quindi le fattispecie specifiche del diritto penale del lavoro, soffermandosi sulle figure giuridiche-centri d'imputazione del datore di lavoro, del dirigente e del preposto. La delega di funzioni e lo scalettamento di responsabilità completano l'orizzonte problematico dell'opera

16,16-Dimethyl Prostaglandin E-2 Efficacy on Prevention and Protection from Bleomycin-Induced Lung Injury and Fibrosis

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Accuracy of ChatGPT-Generated Information on Head and Neck and Oromaxillofacial Surgery: A Multicenter Collaborative Analysis

Objective: To investigate the accuracy of Chat-Based Generative Pre-trained Transformer (ChatGPT) in answering questions and solving clinical scenarios of head and neck surgery. Study design: Observational and valuative study. Setting: Eighteen surgeons from 14 Italian head and neck surgery units. Methods: A total of 144 clinical questions encompassing different subspecialities of head and neck surgery and 15 comprehensive clinical scenarios were developed. Questions and scenarios were inputted into ChatGPT4, and the resulting answers were evaluated by the researchers using accuracy (range 1-6), completeness (range 1-3), and references' quality Likert scales. Results: The overall median score of open-ended questions was 6 (interquartile range[IQR]: 5-6) for accuracy and 3 (IQR: 2-3) for completeness. Overall, the reviewers rated the answer as entirely or nearly entirely correct in 87.2% of cases and as comprehensive and covering all aspects of the question in 73% of cases. The artificial intelligence (AI) model achieved a correct response in 84.7% of the closed-ended questions (11 wrong answers). As for the clinical scenarios, ChatGPT provided a fully or nearly fully correct diagnosis in 81.7% of cases. The proposed diagnostic or therapeutic procedure was judged to be complete in 56.7% of cases. The overall quality of the bibliographic references was poor, and sources were nonexistent in 46.4% of the cases. Conclusion: The results generally demonstrate a good level of accuracy in the AI's answers. The AI's ability to resolve complex clinical scenarios is promising, but it still falls short of being considered a reliable support for the decision-making process of specialists in head-neck surgery

Cellular and molecular effects of protons: apoptosis induction and potential implications for cancer therapy.

Due to their ballistic precision, apoptosis induction by protons could be a strategy to specifically eliminate neoplastic cells. To characterize the cellular and molecular effects of these hadrons, we performed dose-response and time-course experiments by exposing different cell lines (PC3, Ca301D, MCF7) to increasing doses of protons and examining them with FACS, RT-PCR, and electron spin resonance (ESR). Irradiation with a dose of 10 Gy of a 26,7 Mev proton beam altered cell structures such as membranes, caused DNA double strand breaks, and significantly increased intracellular levels of hydroxyl ions, are active oxygen species (ROS). This modified the transcriptome of irradiated cells, activated the mitochondrial (intrinsic) pathway of apoptosis, and resulted in cycle arrest at the G2/M boundary. The number of necrotic cells within the irradiated cell population did not significantly increase with respect to the controls. The effects of irradiation with 20 Gy were qualitatively as well as quantitatively similar, but exposure to 40 Gy caused massive necrosis. Similar experiments with photons demonstrated that they induce apoptosis in a significantly lower number of cells and in a temporally delayed manner. These data advance our knowledge on the cellular and molecular effects of proton irradiation and could be useful for improving current hadrontherapy protocols

Is a computer-assisted design and computer-assisted manufacturing method for mandibular reconstruction economically viable?

The design and manufacture of patient-specific mandibular reconstruction plates, particularly in combination with cutting guides, has created many new opportunities for the planning and implementation of mandibular reconstruction. Although this surgical method is being used more widely and the outcomes appear to be improved, the question of the additional cost has to be discussed. To evaluate the cost generated by the management of this technology, we studied a cohort of patients treated for mandibular neoplasms. The population was divided into two groups of 20 patients each who were undergoing a 'traditional' freehand mandibular reconstruction or a computer-aided design/computer-aided manufacturing (CAD-CAM) mandibular reconstruction. Data concerning operation time, complications, and days of hospitalisation were used to evaluate costs related to the management of these patients. The mean operating time for the CAD-CAM group was 435 min, whereas that for the freehand group was 550.5 min. The total difference in terms of average time gain was 115.5 min. No microvascular complication occurred in the CAD-CAM group; two complications (10%) were observed in patients undergoing freehand reconstructions. The mean overall lengths of hospital stay were 13.8 days for the CAD-CAM group and 17 days for the freehand group. Finally, considering that the institutional cost per minute of theatre time is \u20ac30, the money saved as a result of the time gained was \u20ac3,450. This cost corresponds approximately to the total price of the CAD-CAM surgery. In conclusion, we believe that CAD-CAM technology for mandibular reconstruction will become a widely used reconstructive method and that its cost will be covered by gains in terms of surgical time, quality of reconstruction, and reduced complications

Intraparotid Osteolipoma: Treatment Option and Surgical View

Osteolipoma is a benign neoplasm originating from the mesenchymal fat tissue cells and characterized by the presence of bone formation. In the head and neck district osteolipoma has been described as parapharyngeal, nasopharinx, submandibular gland, eyelid, floor of the mouth, and skull base lesion. Only 1 case of osteolipoma was reported as a neoplasm of the parotid region. Considering the rarity of the osteolipoma, our purpose was to describe the first case of totally intraparotid gland localization of osteolipoma and summarize and review the actual literature concerning the presence of this tumor in the region of major salivary glands. A 56-years-old male patient was treated for intraparotid osteolipoma. Surgical removal of tumor was done with a standard preauricular/cervical incision and blunt dissection. The facial nerve was identified and preserved completely. In the reviewed series, all cases were reported in adult patients with a relative long history of slow progression. According to our paper and the review of the literature, we can assess that Osteolipoma is an extremely rare lesion affecting the major salivary glands, which should be considered along with common salivary gland tumors in the differential diagnosis

Predictability and Effectiveness of Jaws Reconstructive Prosthesis after Tumor Removal: A Systematic Review and Meta-Analysis

Vascular-free flaps are the most frequently employed method in cases of jaws reconstruction after large tumor removal. This therapeutic choice is due to its intrinsic blood supply, which speeds up recovery and enables healing apart from the injured recipient site. This method is most commonly used in secondary reconstructions brought on by radiation, infection, or prior surgical intervention. In fact, with the help of 3d technology, guides can be designed to perform the grafting very smoothly. The purpose of this review with meta-analysis is to compare the two methods: the one using 3d and the freehand one. Methods: In accordance with the entered keywords, a literature search was conducted on PubMed, Lilacs, and Web of Science. Articles published between 2000 and 4 January 2023 were taken into consideration. Using the Boolean connective AND, the terms “jaw reconstruction”, “cad-cam”, and “cancer” have been joined. Results: After searching the three search motors, 148 articles were selected, and only 7 were chosen for this review. Conclusions: The pre-operative morphological position looks to be accurately restored using the CAD/CAM reconstructive methodology. Reconstruction using CAD-CAM and 3d technology allows for greater accuracy, less operative time, and improved aesthetics

Mandibular Reconstruction with Bridging Customized Plate after Ablative Surgery for ONJ: A Multi-Centric Case Series

Purpose: Computer-aided methods for mandibular reconstruction have improved both functional and morphological results in patients who underwent segmental mandibular resection. The purpose of this study is to evaluate the overlaying of virtual planning in terms of measures of the Computer Assisted Design/Computer Assisted Manufacturing CAD/CAM plate for mandibular reconstruction in patients who are ineligible for the insertion of reconstructing the titanium plate supported by fibular free flap, due to their poor health status, or in the presence of specific contraindications to autologous bone flap harvest. Materials and methods: The retrospective study performed analyzed the results of nine patients. The patients were treated at the Maxillofacial Surgery Unit of Policlinico S. Orsola of Bologna, Italy, and Policlinico San Marco, Catania, Italy, from April 2016 to June 2021. Superimposition between planning and post operative Computed Tomography CT scan was performed to assess the accuracy. Results: All reconstructive procedures were carried out successfully. No microsurgery-related complications occurred. In two cases, we had plate misplacement, and in one case, plate exposure that led to plate removal. The average accuracy of the series assessed after CT superimposition, as previously described, was 0.95 mm. Conclusions: Considering that microvascular bone transfer is a high-risk procedure in BRONJ patients, we can conclude that the positioning of a customized bridging mandibular prosthesis (CBMP), whether or not it is associated with a microvascular soft tissue transfer, is a safe technique in terms of surgical outcome and feasibility

Morphology of palatally displaced canines and adjacent teeth, a 3-D evaluation from cone-beam computed tomographic images

Abstract Background The goal of this study was to investigate in patients with unilateral palatally displaced canine (PDC) the morphology of maxillary teeth from cone-beam computed tomography (CBCT) scans both on the PDC side and non-PDC side using a “surface matching” technique. Methods CBCT images from 28 patients (mean age 16.04 ± 1.77 years) with unilateral PDC were selected. Each tooth in this study was segmented and then rendered into a 3D model using Mimics Research software and the root length was measured. Afterwards, 3D deviation analysis between the PDC and non-PDC side was carried out using Geomagic Control X software. Results Statistically significant differences (p ≤ 0.001) were obtained when comparing the root lengths and volumes of lateral incisors from the PDC side, non-PDC side and control group. In accordance with the findings of 3D deviation analysis, statistically significant differences between the patients and control group were obtained for the lateral incisors and canines (p ≤ 0.0001) and greater differences were found for the tooth crowns and root tips. Conclusions Lateral incisors adjacent to PDCs have shorter roots than contra-lateral lateral incisors. Furthermore, there were morphological differences between lateral incisors and canines in subjects with unilateral PDCs