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

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

Fracture of a polyethylene post in a 9-year-old posterior-stabilized knee prosthesis: light microscopy and SEM evaluation

Objective Aim of this study is to evaluate the surface of the TKA polyethylene liner, harvested after the breakage of the post nine years after the implant in a 63 years old female (BMI 39) after an hyperextension trauma. Methods During the revision we harvested sample of the periprosthetic tissue which was prepared for the light microscopy evaluation. The samples were stained using both haematoxylineosin and Von Kossa. The PE liner was prepared for the Scanning Electron Microscopy. Results The SEM evaluation revealed two different damage patterns considering the medial part and the lateral aspect of the sample. The medial part presented a fracture line laminated in front and smooth behind and with the tear lines with a medio-lateral and anterior posterior orientation. The lateral part presented a sharp fracture line that ends anteriorly with a laminated tear paralleled to the anterior edge of the polyethylene insert, and which implies that this area could be the terminal failure area of the fractured post. The medial part of the fracture edge appears to be smooth and with a different orientation of the fracture lines. Conclusions These features could be explained with a \u2018\u2018two stage\u2019\u2019 rupture of the polyethylene post. This could have been caused by a non-optimal ligamentous balance that weakened the post, which was finally broken by a postero-anterior stress

Peritalar release according to Simons for treatment of congenital clubfoot: medium-term clinical and X-ray results

Introduction The objective of the present study is to evaluate medium-term results of the Simons procedure for the treatment of congenital clubfoot. Material and methods Fifteen patients affected by III degree congenital talipes equinovarus (TEV) were treated surgically. TEV was bilateral in seven cases, thus the total number of operated feet were 22. The patients underwent peritalar release according to Simons, and were evaluated postoperatively with antero-posterior and lateral view X-rays. Clinical and radiological follow-up was at mean 6.7 years (range 2\u201313 years). Clinical and morpho-functional evaluations were performed in agreement with Manes and Laaveg/Ponseti. Also, all patients were evaluated at standard X-ray two-projection stress views, photopodogram and baropodometric exam. Results Of the 15 operated patients, two were not available for followup. Therefore, a total of 20 feet were evaluated. Two patients underwent another surgical intervention for deformity recurrence. At follow-up no patient presented with pain at rest. According to Manes 13 cases had good results, five cases had satisfactory results, and two cases had bad results. Results at Laaeveg and Ponseti evaluation were excellent in 16 cases, good in two cases, and unsatisfactory in two cases. Anteroposterior radiographic exam revealed an alteration of the astragalo-calcanear divergence in seven feet and a reduction of Kite angle in three patients. At lateral view, X-rays revealed a reduction of the astragalo-calcanear angle, compared to normal values, in 12 cases. The scaphoid was dorsally subdislocated in eight cases. Photopodogram evaluation showed accentuation of the plantar vault in five cases, Static baropodometric examination showed a backward shift of the body baricenter, which determined an overload at the normal hindfoot. Discussion In the present study, we perform a complete peritalar release as described by Simons, which seems to guarantee better chances of restoring correct astragalo-calcanear anatomy. In terms of deformity correction, the clinical and morphological results were satisfactory in 90% of cases. However, a data analysis of long-term follow-up studies reported in the literature over the last years demonstrates that less invasive treatment is better than the surgical approach. In fact, the latter is more likely to determine development of pain, functional limitation, and beginning and progression of foot osteoarthritis. Despite the good results obtained with the peritalar release technique in short-term and mid-term studies, the therapeutic choice for treating TEV is unanimously shifting from extensive releases to less aggressive treatments

Body knowledge in brain-damaged children: a double-dissociation in self and other's body processing.

Bodies are important element for self-recognition. In this respect, in adults it has been recently shown a self vs other advantage when small parts of the subjects\u2019 body are visible. This advantage is lost following a right brain lesion underlying a role of the right hemisphere in self body-parts processing. In order to investigate the bodily-self processing in children and the development of its neuronal bases, 57 typically developing healthy subjects and 17 subjects with unilateral brain damage (5 right and 12 left sided), aged 4\u201317 years, were submitted to a matching-to-sample task. In this task, three stimuli vertically aligned were simultaneously presented at the centre of the computer screen. Subjects were required which of two stimuli (the upper or the lower one) matched the central target stimulus, half stimuli representing self and half stimuli representing other people\u2019s body-parts and face-parts. The results showed that corporeal self recognition is present since at least 4 years of age and that self and others\u2019 body parts processing are different and sustained by separate cerebral substrates. Indeed, a double dissociation was found: right brain damaged patients were impaired in self but not in other people\u2019s body parts, showing a self-disadvantage, whereas left brain damaged patients were impaired in others\u2019 but not in self body parts processing. Finally, since the double dissociation self/other was found for body-parts but not for face parts, the corporal self seems to be dissociated for body and face-parts. This opens the possibility of independent and lateralized functional modules for the processing of self and other body parts during development

The origin of nephrocalcinosis, Randall\u2019s plaque and renal stones: a cell biology viewpoint

Medullary nephrocalcinosis is a rare condition typically observed in metabolic conditions prone to renal calcium stones. Randall's plaques are very frequently observed in the common idiopathic calcium-oxalate nephrolithiasis. These plaques are apatite mineral structures, and we propose they also are an example of nephrocalcinosis. While these calcium deposits are generally considered to be the consequence of purely physico-chemical phenomena, we advance the hypothesis that they form because of a true ectopic biomineralization in the renal tissue. Henle's loop epithelial cells, or pericyte-like interstitial cells, or papillary stem-cells differentiating along a bone lineage could be involved