Allograft Reconstruction of the Extensor Mechanism after Resection of Soft Tissue Sarcoma

Soft tissue tumors around the knee joint still pose problems for the excision and subsequent reconstruction. Methods. In the 6 included patients the soft tissue sarcoma has its base on the anterior surface of the extensor mechanism and expands towards the skin. The entire extensor apparatus (quadriceps tendon, patella, and patellar tendon) was resected and replaced by a fresh-frozen allograft. Results. The mean follow-up was 6.7 years (range: 2-12.4 years). In two patients a local recurrence occurred, resulting in a 5-year local recurrence-free rale of 66.7% (95% CI: 19.5%-90.4%). Distant metastases were found in 4 patients resulting in a 5-year metastasis-free rate of 33.3% (95% CI: 4.6%-67.5%). Two patients underwent at least one revision surgery, including one patient in whom the allograft had to be removed. According to the ISOLS function score 24.7 points (range: 19-28 points) were achieved at the last follow-up. The mean active flexion of the knee joint was 82.5 degrees (range: 25-120 degrees) and a mean extension lag of 10 degrees (range: 0-30 degrees) was observed. Conclusions. Ihe replacement of the extensor mechanism by an allograft is a reasonable option, allowing wide margins and restoration of active extension in most patients. Trial Registration. The presented study is listed on the ISRCTN registry with trial number ISRCTN63060594

Myomectomy in infertile women: More harm than good?

Adhesion formation following gynecological surgery remains a challenge. The adoption of minimally invasive surgical approaches, such as conventional or robotic-assisted laparoscopy combined with meticulous microsurgical principles and the application of adhesion–reducing substances, is able to reduce the risk of de novo adhesion formation but do not eliminate it entirely. Myomectomy is the most adhesiogenic surgical procedure and postoperative adhesions can have a significant impact on the ability to conceive. Therefore, when surgery is performed as infertility treatment, attention should be paid to whether the benefits outweigh the risks. Among several factors, the size and the location of fibroids are the most accountable factors in terms of adhesion development and post surgical infertility; therefore, the search for effective strategies against adhesion formation in this setting is of paramount importance. The purpose of this review is to evaluate the incidence and factors of adhesion formation and the best preventive measures current available

Randomised clinical trial: mucosal protection combined with acid suppression in the treatment of non-erosive reflux disease - efficacy of Esoxx, a hyaluronic acid-chondroitin sulphate based bioadhesive formulation

BACKGROUND: Several studies have shown that patients with non-erosive reflux disease (NERD) are less responsive to proton pump inhibitors (PPIs) than those with erosive disease as they belong to different subgroups, in whom factors other than acid can trigger symptoms. AIM: To evaluate whether combined therapy (mucosal protection plus acid suppression) would improve symptom relief compared to PPI treatment alone. METHODS: In a multicenter, randomised, double-blind trial, 154 patients with NERD were randomised to receive Esoxx (Alfa Wassermann, Bologna, Italy), a hyaluronic acid-chondroitin sulphate based bioadhesive formulation, or placebo, in addition to acid suppression with standard dose PPIs for 2 weeks. Symptoms (heartburn, acid regurgitation, retrosternal pain and acid taste in the mouth) and health-related quality of life (HRQL) were evaluated before and after treatment. The primary endpoint was the proportion of patients with at least a 3-point reduction in the total symptom score. RESULTS: At the end of treatment, the primary endpoint was reached by 52.6% of patients taking Esoxx compared to 32.1% of those given placebo (P < 0.01). The same was true also for HRQL, evaluated by means of the Short Form-36 questionnaire, which improved with both treatments, but some items were significantly better after Esoxx plus PPI therapy. CONCLUSION: The synergistic effect of Essox with PPI treatment suggests that mucosal protection added to acid suppression could improve symptoms and HRQL in NERD patients

Does social cognition change? Evidence after 4 years from the Italian Network for Research on Psychoses

Background Deficits in social cognition (SC) are significantly related to community functioning in schizophrenia (SZ). Few studies investigated longitudinal changes in SC and its impact on recovery. In the present study, we aimed: (a) to estimate the magnitude and clinical significance of SC change in outpatients with stable SZ who were assessed at baseline and after 4 years, (b) to identify predictors of reliable and clinically significant change (RCSC), and (c) to determine whether changes in SC over 4 years predicted patient recovery at follow-up. Methods The reliable change index was used to estimate the proportion of true change in SC, not attributable to measurement error. Stepwise multiple logistic regression models were used to identify the predictors of RCSC in a SC domain (The Awareness of Social Inference Test [TASIT]) and the effect of change in TASIT on recovery at follow-up. Results In 548 participants, statistically significant improvements were found for the simple and paradoxical sarcasm of TASIT scale, and for the total score of section 2. The reliable change index was 9.8. A cut-off of 45 identified patients showing clinically significant change. Reliable change was achieved by 12.6% and RCSC by 8% of participants. Lower baseline TASIT sect. 2 score predicted reliable improvement on TASIT sect. 2. Improvement in TASIT sect. 2 scores predicted functional recovery, with a 10-point change predicting 40% increase in the probability of recovery. Conclusions The RCSC index provides a conservative way to assess the improvement in the ability to grasp sarcasm in SZ, and is associated with recovery

Biomechanics of Double Bundle Anterior Cruciate Ligament Reconstruction

The scope of this thesis was to verify whether anatomic reconstruction of the anterior cruciate ligament (ACL) with close replication of its two main bundles ensures better knee kinematics and improved clinical outcomes. The thesis articulates into three parts. In the first part the current anatomic knowledge is reviewed with regard to the double bundle ACL structure and an anatomic study is presented: its results will serve as a basis for the following kinematics and clinical studies. In the second part, a method to investigate cadaveric knee laxities is presented and employed to test intact and ACL deficient knees and to explore the function of the anteromedial and posterolateral ACL bundles. The ACL was found to be a primary restrain to anterior tibial translation mainly because of the action of the anteromedial bundle, with the posterolateral acting as a secondary restrain. Both bundles then were found to equally contribute to control the limit of internal rotation. Finally the reconstruction of both ACL bundles was demonstrated to be superior to traditional single bundle reconstruction in restoring intact knee anterior and rotational laxity. The third part focused on double bundle surgical technique with the development of surgical instruments that were validated on cadaver knees and found to be extremely accurate on the tibial side, less on the femur. Surgical technique was then improved and introduced into clinical practice. Two clinical studies were conducted and demonstrated the superiority of double bundle anatomic reconstruction in improving subjective and objective results as well as instrumented knee laxity measurements. In conclusion the main finding of this thesis was that, after a deep understanding of ACL anatomy and biomechanics, the replication at surgery of its native structure improves knee stability and patients’ satisfaction

Hijacking Downlink Path Selection in LoRaWAN

With the rise of the IoT, many protocols have been developed in order to fulfill the need for a wireless connectivity that assures energy efficiency and low-data rates. LoRaWAN is certainly one of the most widely used protocols. The LoRaWAN 1.1 specification aims to fix some serious security vulnerabilities in the 1.0 specification, however there still exist critical points to address. In this paper, we identify an attack that can affect LoRaWAN 1.0 and 1.1 networks, which hijacks the downlink path from the Network Server to an End Device. The attack exploits the deduplication procedure and the gateway selection during a downlink scheduling by the Network Server, which is in general implementation-dependent. The attack scheme has been proven to be easy to implement, not requiring physical layer-specific operations such as signal jamming, and could target many LoRaWAN devices at once. We discuss the implications of this attack and identify the possible mitigations that could be adopted by network providers to address this vulnerability

BLENDER - Bluetooth Low Energy discovery and fingerprinting in IoT

Bluetooth Low Energy (BLE) is a pervasive wireless technology all around us today. It is included in most commercial consumer electronic devices manufactured in last years, and billions of BLE-enabled devices are produced every year, including wearable or portable ones like smartphones, smart-watches and smartbands. The success of BLE as a cornerstone in IoT and consumer electronics is both an advantage, giving wireless communication potential in the short range at low cost and consumption, and a disadvantage, from a security and privacy standpoint. BLE exposes packets that enable a potential attacker to detect, enquire and fingerprint actual devices despite manufacturers attempts to avoid detection and tracking. MAC address randomization was introduced in the BLE standard to solve some of these issues. In this paper we discuss how to detect and fingerprint BLE devices, basing our analysis and data collection on GAP (Generic Access Profile) and GATT (Generic Attribute Profile) protocols and data that can be recovered from devices by interactions allowed by the standard. In our study we focus on the possibility of enumerating and creating fingerprints of discovered devices, for crowd monitoring and recognition purposes, associating BLE randomized MAC addresses to actual devices using computed fingerprints when GATT is exploitable. We describe how large scale data collection can be obtained using automatic scanning devices with long range communication hardware, to uplink collected data in cloud-based applications and to a data store

Biomechanics of double bundle anterior cruciate ligament reconstruction

The scope of this thesis was to verify whether anatomic reconstruction of the anterior cruciate ligament (ACL) with close replication of its two main bundles ensures better knee kinematics and improved clinical outcomes. The thesis articulates into three parts. In the first part the current anatomic knowledge is reviewed with regard to the double bundle ACL structure and an anatomic study is presented: its results will serve as a basis for the following kinematics and clinical studies. In the second part, a method to investigate cadaveric knee laxities is presented and employed to test intact and ACL deficient knees and to explore the function of the anteromedial and posterolateral ACL bundles. The ACL was found to be a primary restrain to anterior tibial translation mainly because of the action of the anteromedial bundle, with the posterolateral acting as a secondary restrain. Both bundles then were found to equally contribute to control the limit of internal rotation. Finally the reconstruction of both ACL bundles was demonstrated to be superior to traditional single bundle reconstruction in restoring intact knee anterior and rotational laxity. The third part focused on double bundle surgical technique with the development of surgical instruments that were validated on cadaver knees and found to be extremely accurate on the tibial side, less on the femur. Surgical technique was then improved and introduced into clinical practice. Two clinical studies were conducted and demonstrated the superiority of double bundle anatomic reconstruction in improving subjective and objective results as well as instrumented knee laxity measurements. In conclusion the main finding of this thesis was that, after a deep understanding of ACL anatomy and biomechanics, the replication at surgery of its native structure improves knee stability and patients’ satisfaction.EThOS - Electronic Theses Online ServiceGBUnited Kingdo

Ruling Out IoT Devices in LoRaWAN

LoRaWAN is certainly one of the most widely used LPWAN protocol. The LoRaWAN 1.1 specification aims at fixing some serious security vulnerabilities in the 1.0 specification, however there still exist critical points that may affect the IoT security. In this demo, we show an attack that can affect LoRaWAN 1.0 and 1.1 networks, which hijacks the downlink path from the Network Server to an End Device, ruling out the target device from the network. The attack exploits the deduplication procedure and the gateway selection during a downlink scheduling by the Network Server, which is in general implementation-dependent. The attack scheme has been proven to be easy to implement, not requiring physical layer-specific operations such as signal jamming, and could target many LoRaWAN devices at once. We demonstrate this attack and its effects by blocking a device under our control by receiving any downlink communication