Health-related quality of life and functional changes in DMD:A 12-month longitudinal cohort study

Family caregivers of people with amyotrophic lateral sclerosis (ALS) live stressful lives in which they spend most of their time caring for their loved ones and managing difficult situations, thereby reducing the time spent in taking care of themselves. This situation may last several years. Previous literature has widely highlighted that this situation reduces caregivers' quality of life and increases their psychological distress and risk of health problems, but there is a lack of studies that focus on psychological interventions for these situations. This qualitative study examined a pilot experience of two mutual support groups for family caregivers of people with ALS. The aim was to identify caregivers' needs, the prominent aspects of their experience, and to understand whether and how this intervention strategy might help them. Six partners (four men and two women) and six adult children (five women and one man) participated in the groups, which were conducted in northern Italy. After the support groups finished, participants underwent semi-structured interviews. The authors conducted a content analysis of the transcripts of the interviews and the 20 group sessions. The thematic areas identified were "caregiving," "being the son/daughter of a person with ALS," "being the partner of a person with ALS," "group experience" and "group evaluation." The caregiving experience was profoundly different depending on whether the caregiver was a son/daughter or a partner of a patient with ALS. Moreover, comparison with peers and mutual support helped participants to better cope with ALS and its consequences, to improve their care for their relatives and to overcome typical caregiver isolation. These results suggest the usefulness of involving communities in caregiver support in order to create new networks and activate personal and social resources for well-being

Economic consequences of investing in anti-HCV antiviral treatment from the Italian NHS perspective : a real-world-based analysis of PITER data

OBJECTIVE: We estimated the cost consequence of Italian National Health System (NHS) investment in direct-acting antiviral (DAA) therapy according to hepatitis C virus (HCV) treatment access policies in Italy. METHODS: A multistate, 20-year time horizon Markov model of HCV liver disease progression was developed. Fibrosis stage, age and genotype distributions were derived from the Italian Platform for the Study of Viral Hepatitis Therapies (PITER) cohort. The treatment efficacy, disease progression probabilities and direct costs in each health state were obtained from the literature. The break-even point in time (BPT) was defined as the period of time required for the cumulative costs saved to recover the Italian NHS investment in DAA treatment. Three different PITER enrolment periods, which covered the full DAA access evolution in Italy, were considered. RESULTS: The disease stages of 2657 patients who consecutively underwent DAA therapy from January 2015 to December 2017 at 30 PITER clinical centres were standardized for 1000 patients. The investment in DAAs was considered to equal €25 million, €15 million, and €9 million in 2015, 2016, and 2017, respectively. For patients treated in 2015, the BPT was not achieved, because of the disease severity of the treated patients and high DAA prices. For 2016 and 2017, the estimated BPTs were 6.6 and 6.2 years, respectively. The total cost savings after 20 years were €50.13 and €55.50 million for 1000 patients treated in 2016 and 2017, respectively. CONCLUSIONS: This study may be a useful tool for public decision makers to understand how HCV clinical and epidemiological profiles influence the economic burden of HCV

Vertebral fractures in patients on dialysis : a clinically relevant problem with insufficient investigation

Sir, Chronic kidney disease mineral and bone disorder (CKD-MBD), previously denominated renal osteodystrophy [1], is a major clinical problem, with increasing prevalence and adverse outcomes, including high bone turnover associated with secondary hyperparathyroidism, low bone turnover or adynamic bone disease, cardiovascular calcifications and bone fractures. The impact of such outcomes on patient morbidity and mortality has not been fully elucidated. We would like to point out a poorly investigated subject, which we feel is of great clinical importance: .

Sistemi Formativi Integrati e persone con disabilit\ue0: sfide, progetti e storie per studenti in formazione

Il volume \u201cSistemi Formativi Integrati e persone con disabilit\ue0: sfide, progetti e storie per studenti in formazione\u201d rappresenta un\u2019opera collettanea realizzata con studenti in formazione che, insieme al team di ricercatori della cattedra di Pedagogia e Didattica Speciale dell\u2019Universit\ue0 degli Studi Macerata, hanno accettato di intraprendere dei percorsi di ricerca sperimentali sulle questioni fondative e centrali nel dibattito scientifico della presa in carico di persone con disabilit\ue0

Electro-Thermal Characterization And Compact Modelling of GaN HEMTs for Microwave Applications

A new modeling approach has been developed for the accurate prediction of the dynamic drain current of GaN FETs. This is accomplished by separation of the low (LF) and high (HF) frequency transistor dynamic behavior

Early results with the Revitan modular revision stem

Introduction Anatomic acetabular cup, studied in 1999 by Prof. M. D\u2019Imporzano, is born to solve the problem of acetabular revision in grade I and II mobilization (GIR), respectively, characterized by widening and deformation of cavity with eventual superior or posterior wall loss. The problem in these lesions is not such bone stock reconstruction, as correct positioning of new cup. Indeed superior wall loss can set wrong collocation of the cup tending to verticalization and superior migration of rotation centre, while posterior loss can lead to retroversion. Material and methods The hemispheric cup owns a cranial fin for iliac support with 4 holes for stabilization with spongiosa screws. In its equatorial area features 3 holes for posterior and medial screws, according to Pauwels, and circular retention cavities in order to increase the initial stability. The external shell is covered with a porous titanium layer so as to facilitate secondary osteointegration The tapered liner is in ceramic or polyethylene eventually protruded. The originality of this cup consists in having the insertion seat of the articular liner oriented by 18\ub0 in antiversion. This choice was made in order to automatically guarantee the necessary antiversion, even if the supero-posterior iliac wall is eroded, the latter being the reason why normal symmetrical revision cups lead to undesired positioning in insufficient antiversion. Considering these features, the cup can be used, as well as in revision surgery, in treatment of Coxa Profunda, Displasic Coxo-femural Osteoarthritis and acetabular fractures out-comes. In this study we present the results of 60 revisions between 2000 and 2007, with a 1\u20137 years follow-up. Results and conclusions The clinical outcome was good with an improvement from 55 to 88 considering the Harris Hip Score. As complications we observed only 1 case of sepsis, neither dislocation nor mobilization. Radiographical study of rotation centre pointed out a reduction of the superior migration from 1.2 to 0.8 cm after surgery. The shortness of follow-up period does not allow to conclude definitively about the effectiveness of this cup as the optimal solution in this surgery; however, we can state that it can be a valid solution for treatment of grade I and II contrasting the two principal problems of these revisions: superior migration of rotation centre and retroversion tendency

Shear stress influences the release of platelet-derived growth-factor and basic fibroblast growth-factor by arterial smooth-muscle cells

Objectives: To determine the correlation between haemodynamic forces and the release of two mitogens for smooth muscle cells (SMC): Platelet Derived Growth Factor (PDGF) and basic Fibroblast Growth Factor (bFGF). Methodology: Bovine aortic smooth muscle cells were seeded on fibronectin coated polystyrene cylinders and allowed to reach confluence. The cells were subjected to a laminar flow of 50 cc/min (3 dyne/cm2), 100 cc/min (6 dyne/cm2) and 150 cc/min (9 dyne/cm2) in an in vitro system. Control cells were subjected to similar incubation conditions without flow. Principal results: Shear stress increased the release of mitogens by SMC. The release of mitogens was proportional to the level of shear stress and was still evident 24 hours after flow cessation. Conditioned serum-free medium from SMC subjected to shear stress increased tritiated thymidine uptake in Swiss 3T3 fibroblasts 13-fold as compared to conditioned serum-free medium from control SMC and not subjected to shear stress (p < 0.01) and threefold as compared to standard control (p < 0.001). Addition of an excess of anti-PDGF antibody reduced the mitogenic activity of the conditioned medium by 30% (p < 0.01). Addition of an excess of anti-bFGF antibody reduced the mitogenic activity of the conditioned medium by 60% (p < 0.01). Conclusions: Increasing shear stress promotes the release of both PDGF and bFGF from arterial SMC in culture and is a possible explanation for atherosclerosis formation

Development of various forms of lung injury with increasing tidal volume in normal rats

Background: Mechanical ventilation (MV) with large tidal volumes (VT) causes lung edema, mechanical alterations, tissue lesions, and release of inflammatory markers. Objective: The aim of the present study is to explore the dependence of these events on tissue strain-stress. Methods: Sixty-three, normal, open-chest, normal rats were ventilated for 2-4 hours with VT from 7.5 (baseline ventilation) to 39.5ml\uf0d7kg-1 and PEEP ~2.5cmH2. Arterial blood gasses and mean pressure, and lung mechanics were measured during baseline ventilation before and after test ventilation, when cytokine, von Willebrand Factor (vWF), and albumin concentration in serum and broncho-alveolar lavage fluid (BALF), lung wet-to-dry ratio (W/D), and histologic injury scores were assessed. Main results: Elevation of W/D and serum vWF and cytokine concentration occurred with VT>25ml\uf0d7kg-1 and peak inflation pressure (Ppeak) >25cmH2O, whereas with VT>30ml\uf0d7kg-1 and Ppeak>30cmH2O, cytokine and albumin concentration increased also in BALF, arterial oxygen tension decreased, and lung mechanics and histology deteriorated, while W/D and serum vWF and cytokine concentration increased further. Conclusions: In normal rats, lung injury occurs once a definite volume and/or pressure threshold is overcome. Microvascular stress-strain failure leading to interstitial edema is the initial manifestation of injurious MV, as shown by elevated vWF and cytokine levels in serum only. Failure of the epithelial barrier with alveolar flooding occurs only at higher stress-strain levels, with inflammatory reaction, mechanical and histologic damage proportional to the concomitant edema formation