41 research outputs found
Prevalence of orthorexic traits in type 2 diabetes mellitus: at the crossroads between nutritional counseling and eating disorders.
Acinic cell carcinoma of the parotid gland: Timeo Danaos et dona ferentes? A multicenter retrospective analysis focusing on survival outcome
Objectives: To analyze the demographic data, surgical and adjuvant treatment data and the survival outcomes in adult patients affected by acinic cell carcinoma of the parotid gland (AciCC). Methods: A retrospective multicenter analysis of patients treated for AciCC of the parotid gland from 2000 to 2021 was performed. Exclusion criteria were pediatric (0â18 years) patients, the absence of follow-up and patients with secondary metastatic disease to the parotid gland. Multivariable logistic regression was used to determine factors associated with survival. Results: The study included 81 adult patients with AciCC of the parotid gland. The median age was 46.3 years (SD 15.81, range 19â84 years), with a gender female prevalence (F = 48, M = 33). The mean follow-up was 77.7 months (min 4âmax 361, SD 72.46). The 5 years overall survival (OS) was 97.5%. The 5 years disease-free survival (DFS) was 60%. No statistical differences have been found in prognosis for age (< 65 or â„ 65 years), sex, surgery type (superficial vs profound parotid surgery), radicality (R0 vs R1 + Rclose), neck dissection, early pathologic T and N stages and adjuvant therapy (p > 0.05). Conclusion: This study did not find prognostic factor for poorest outcome. In contrast with the existing literature, our results showed how also high-grade tumours cannot be considered predictive of recurrence or aggressive behaviour
A comprehensive overview of radioguided surgery using gamma detection probe technology
The concept of radioguided surgery, which was first developed some 60 years ago, involves the use of a radiation detection probe system for the intraoperative detection of radionuclides. The use of gamma detection probe technology in radioguided surgery has tremendously expanded and has evolved into what is now considered an established discipline within the practice of surgery, revolutionizing the surgical management of many malignancies, including breast cancer, melanoma, and colorectal cancer, as well as the surgical management of parathyroid disease. The impact of radioguided surgery on the surgical management of cancer patients includes providing vital and real-time information to the surgeon regarding the location and extent of disease, as well as regarding the assessment of surgical resection margins. Additionally, it has allowed the surgeon to minimize the surgical invasiveness of many diagnostic and therapeutic procedures, while still maintaining maximum benefit to the cancer patient. In the current review, we have attempted to comprehensively evaluate the history, technical aspects, and clinical applications of radioguided surgery using gamma detection probe technology
Un modello per intensitĂ di cura basato sulla stratificazione del rischio di instabilitĂ clinica dei pazienti consente lâerogazione di cure piĂč appropriate e migliora gli esiti clinici ed organizzativi in Medicina Interna.
Introduzione: Gli aggravamenti clinici durante la degenza ospedaliera in area medica possono determinare il decesso precoce del paziente o il trasferimento non programmato in reparti intensivi1. Una adeguata stratificazione del grado di instabilitĂ clinica dei pazienti puĂČ consentire lâerogazione di cure differenziate e di diversa intensitĂ basate sulle necessitĂ dei pazienti. Presso il reparto di Medicina Interna dellâOspedale S. Chiara di Trento Ăš stato implementato un nuovo modello organizzativo per IntensitĂ di Cura (IC). A tale scopo sono stati introdotti specifici strumenti di monitoraggio e uno score di valutazione standardizzato e internazionalmente validato: il National Early Warning Score (NEWS).
Obiettivo: Dimostrare come la riorganizzazione di un reparto di Medicina Interna basata su un modello per IC, utilizzando uno score di stratificazione del rischio di deterioramento clinico, migliori outcome clinici ed organizzativi del reparto.
Metodologia: Il processo di cambiamento Ăš stato effettuato in due step: una prima fase di validazione del potere prognostico del NEWS nel contesto locale2, una seconda di implementazione di un reparto per IC sulla base della stratificazione del rischio clinico dei pazienti. Sono stati analizzati gli accessi effettuati nel reparto di Medicina Interna dellâOspedale Santa Chiara di Trento durante sei anni: 2012 e 2013 (non-IC), 2014, 2015, 2016 e 2017 (IC). Sono stati comparati 1453 e 1393 accessi consecutivi con il modello non-IC e 1437, 1622, 1498 e 1435 con il modello IC. Ă stata quindi effettuata una trend analisi su tutti gli anni. Gli outcome valutati sono stati: mortalitĂ , mortalitĂ precoce (<72 ore), trasferimenti per aggravamento verso i reparti intensivi, accettazione dai reparti intensivi e dagli altri ospedali della rete.
Risultati: Le mortalitĂ intraospedaliere totale e precoce sono passate rispettivamente dal 8,7% nel 2012 al 7,0% nel 2017 (p di trend=0,02) e dal 3,5% nel 2012 al 2,2% nel 2017 (p di trend <0,01). I trasferimenti per aggravamento sono diminuiti partendo da un 4,2% nel 2012 ad un 1,6% nel 2017 (p di trend<0,01). Contemporaneamente le accettazioni dai reparti intensivi e dagli altri ospedali della rete sono aumentate passando rispettivamente da 1,9% nel 2012 a 5,2% nel 2017 (p di trend<0,01) e da 4,0% nel 2012 al 9,6% nel 2017 (p di trend<0,01).
Conclusioni: Lâimplementazione del modello IC basato sul NEWS, ha portato un miglioramento continuo degli esiti clinici e della gestione dei flussi intra ed inter ospedalieri. Tale approccio, basato su un utilizzo appropriato delle tecnologie disponibili, consente il superamento di unâorganizzazione indifferenziata che assegna a tutti i pazienti uno standard âmedioâ di cura, calibrando lâintensitĂ di assistenza sulla base del rischio di instabilitĂ clinica del paziente, fornendo un setting di cura piĂč appropriato
Effects of reversal of hypotension on cerebral microcirculation and metabolism in experimental sepsis
Reduced endothelial progenitor cells and brachial artery flow-mediated dilation as evidence of endothelial dysfunction in ocular hypertension and primary open-angle glaucoma
PURPOSE:
This study aimed to assess vascular endothelial function in patients with ocular hypertension (OHT) or primary open-angle glaucoma (POAG) by measuring: (a) endothelium-dependent flow-mediated vasodilation (FMD) of the brachial artery, and (b) circulating endothelial progenitor cells, which are believed to support the integrity of the vascular endothelium.
METHODS:
We enrolled 25 patients with OHT, 23 with POAG and 26 control subjects, all of whom were aged < 65 years and had no medical history of cardiovascular disease or cardiovascular risk factors. All subjects underwent a complete ophthalmological examination, biochemistry study, assessment of cardiovascular parameters, brachial artery ultrasound assessment of endothelium-dependent FMD, generic circulating progenitor cell (CPC) and circulating endothelial progenitor cell (EPC) count with the use of flow cytometry.
RESULTS:
Flow-mediated vasodilation values differed significantly in OHT (4.5 +/- 1.1%; p = 0.021) and POAG (4.0 +/- 0.9%; p = 0.003) patients compared with controls (7.7 +/- 0.8%). The CD34(+) KDR(+) EPC count was markedly lower in OHT (28.0 +/- 5.0; p < 0.001) and POAG (24.3 +/- 3.4; p < 0.001) patients compared with controls (73.1 +/- 8.1). Neither FMD not EPCs differed significantly between OHT and POAG patients. No significant differences in CPC count or cardiovascular parameters were found among OHT or POAG patients and controls. The levels of CD34(+) KDR(+) EPCs were directly correlated (p = 0.043) with FMD, and inversely correlated (p = 0.032) with baseline intraocular pressure in OHT and POAG patients.
CONCLUSIONS:
Both OHT and POAG patients without cardiovascular risk factors have previously unreported severely reduced circulating EPCs and reduced FMD, both of which are indicators of endothelial dysfunction and increased risk of cardiovascular events
Vitamin D status and non-alcoholic fatty liver disease in patients with type 1 diabetes
In patients with type 1 diabetes (T1D), the prevalence of non-alcoholic fatty liver disease (NAFLD) ranges from 10 to 53% and contrasting evidence suggests that vitamin D deficiency may favor liver fat accumulation. Here, we investigated the association between vitamin D status and NAFLD in adults with T1D