L’utilizzo delle protesi endoscopiche nella patologia dell’apparato digerente

L’utilizzo di protesi ad introduzione per via endoscopica per patologie dell’apparato digerente sia benigne che maligne ha avuto negli ultimi anni un considerevole sviluppo. Il posizionamento delle endoprotesi è ben tollerato dai pazienti, non necessita di anestesia e comporta rischi relativamente minimi. Le nuove protesi metalliche autoespansibili permettono di risolvere stenosi anche molto serrate senza quasi mai necessità di dilatazione, con riduzione dei rischi che da questa derivano. Viene riportata una revisione dell’esperienza di protesizzazione per patologie dell’apparato digerente e vengono discussi le indicazioni, i limiti e le complicanze, sulla scorta dei dati dalla letteratura internazionale

Purdue Conference on Active Nonproliferation

One major problem with nuclear security measurements involves source identification inthe presence of low signal-to-background ratio. This scenario iscommon to several applications, ranging from radiation identification atportal monitors to radiation source search with unmanned vehicles. In this context of identification of a large variety of sources, including natural and medical sources, sensitive sources of particular interest, but also potentially new/unknown sources for which no reference measurement is available, statistical methods are particularly appealing for their ability to capture the random nature of the measurements. Among them, Bayesian methods form a generic framework allowing for uncertainty quantification and propagation, which is of prime interest for detection (of known and unknown sources), classification, and quantification of smuggled nuclear and radiological materials. We demonstratethe use of Bayesian models for the identificationof mixed gamma sources, measured with organic scintillatorswithinshort acquisition times. We alsocompare the estimation performance using two different materials: liquid EJ-309 and stilbene crystal

Satisfaction with chronic obstructive pulmonary disease treatment: results from a multicenter, observational study

Background: Understanding the level of patients\u2019 satisfaction with treatment and its determinants have the potential to impact therapeutic management and clinical outcome in chronic conditions such as chronic obstructive pulmonary disease (COPD). Methods: A national, multicenter, longitudinal, observational study of COPD from 20 Italian pulmonary centers to explore patients\u2019 satisfaction to treatment [assessed by the Treatment Satisfaction Questionnaire, 9 items (TSQM-9)] and association with clinical parameters [including dyspnea score, COPD Assessment Test (CAT) score, exacerbation rate], adherence to treatment [Morisky Medication-Taking Adherence Scale (MMAS-4)], illness perception [evaluated by Brief Illness Perception Questionnaire (B-IPQ)] in a 1-year follow up. Results: A total of 401 COPD patients were enrolled [69.4% group B Global Initiative for COPD (GOLD), considering 366 patients with available GOLD 2017 classification at enrollment]. At enrollment, satisfaction with treatment was moderate, being TSQM-9 mean scores for effectiveness 64.2 [95% confidence interval (CI) 62.5\u201365.9], for convenience 75.8 (95% CI 74.2\u201377.3), and for global satisfaction 65.7 (95% CI 64.0\u201367.4). Global satisfaction was negatively associated with disease perception (\u3b2 = 120.4709, p < 0.0001), and grade of dyspnea (\u3b2 = 124.2564, p = 0.009). Satisfaction with treatment was lower in patients with poor compared with optimal adherence to treatment (\u3b2 = 124.5608, p = 0.002). Changes in inhalation regimens during follow up did not modify the satisfaction with treatment. Conclusions: The results of this real-life study showed that the patients\u2019 satisfaction with treatments is only moderate in COPD. A high grade of patients\u2019 satisfaction is associated mainly with a low perception of the disease, high adherence to treatment and lower level of dyspnea

Association between sleep-disordered breathing and hearing disorders: Clinical observation in Sicilian patients

Introduction: To examine the putative association between Sleep-Disordered breathing and hearing disorders Material and methods: 120 Sicilian subjects ranging from 14 to 85 years of age who were divided in 46 cases suffering from tinnitus (G1 group) and 74 controls (G2 group) were evaluated through STOP BANG screening questionnaire and Four-Variable Screening Tool; after Data collecting each subject underwent Audiological assessment by multi-frequency audiometry (PTA) and Transient-evoked otoacoustic emissions (TEOAE-diagnostic) for each ear. Results: Cases showed: PTA significantly severe than the control group (58.70% vs. 16.89% hearing loss; P<0.001), such as a lower signal-to-noise ratio (SNRs) (P<0.05). Moreover Tinnitus subjects had a higher risk to develop Sleep-Disordered breathing respect to controls (P<0.001). OSA risk population - subjects positive to both screening questionnaires - had tinnitus, wore hearing threshold mean values and, lower SNRs values than total cohort (P<0.01). The relative risk of Sleep-Disordered breathing and tinnitus was 4.83 (P<0.0001). Conclusions: Our results stress a probable association between tinnitus, hearing loss and Sleep-Disordered breathing even if further studies will be needed to confirm our findings

Disease awareness in patients with COPD: measurement and extent

Background: Patient awareness of COPD refers to knowledge and acceptance of the disease and its treatment. Although it is relevant to management and outcomes, the disease awareness of patients is poorly investigated, and no validated questionnaires are currently available. We aimed to develop the novel Disease Awareness in COPD Questionnaire (DACQ), which was validated in relation to demographic and clinical features, in patients participating in the SATisfaction and Adherence to COPD Treatment (SAT) study. Methods: DACQ was developed according to a list of items regarding the patient's knowledge, acceptance, and perception of COPD as well as of treatment needs. The questionnaire was validated by assessing internal structure and consistency, correlations with other patient-reported outcomes, and stability over time. Furthermore, the extent of disease awareness of patients enrolled in the SAT study was assessed by using DACQ, and correlations with demographic and clinical features were evaluated. Results: DACQ was composed of four domains. Overall reliability and stability over time were adequate; correlations between DACQ and other tools measuring different constructs (ie, treatment satisfaction, illness perception, impact of COPD symptoms on daily life, and dyspnea severity) were, as expected, more limited. In the enrolled patient sample, a suboptimal level of disease awareness (<70%) was detected, especially in terms of disease acceptance and perception. Disease knowledge was positively associated with COPD severity, while the impact of symptoms on daily life was negatively associated with disease acceptance, awareness of treatment needs, and overall awareness. Conclusion: DACQ proved to be a reliable tool to assess awareness in COPD patients. Awareness of COPD patients need to be improved. Clinical trial registration: ClinicalTrials.gov ID# NCT02689492

Survival after Locoregional Treatments for Hepatocellular Carcinoma: A Cohort Study in Real-World Patients

Evidence of relative effectiveness of local treatments for hepatocellular carcinoma (HCC) is scanty. We investigated, in a retrospective cohort study, whether surgical resection, radiofrequency ablation (RFA), percutaneous ethanol injection (PEI), and transarterial embolization with (TACE) or without (TAE) chemotherapy resulted in different survival in clinical practice. All patients first diagnosed with HCC and treated with any locoregional therapy from 1998 to 2002 in twelve Italian hospitals were eligible. Overall survival (OS) was the unique endpoint. Three main comparisons were planned: RFA versus PEI, surgical resection versus RFA/PEI (combined), TACE/TAE versus RFA/PEI (combined). Propensity score method was used to minimize bias related to non random treatment assignment. Overall 425 subjects were analyzed, with 385 (91%) deaths after a median followup of 7.7 years. OS did not significantly differ between RFA and PEI (HR 1.11, 95% CI 0.79–1.57), between surgery and RFA/PEI (HR 0.95, 95% CI 0.64–1.41) and between TACE/TAE and RFA/PEI (HR 0.88, 95% CI 0.66–1.17). 5-year OS probabilities were 0.14 for RFA, 0.18 for PEI, 0.27 for surgery, and 0.15 for TACE/TAE. No locoregional treatment for HCC was found to be more effective than the comparator. Adequately powered randomized clinical trials are still needed to definitely assess relative effectiveness of locoregional HCC treatment

Estrogens and neuropeptides in postmenopausal women: un update

Menopause is characterized by depletion of ovarian follicles, a reduction of ovarian hormones to castrate levels and elevated levels of serum gonadotropins from the anterior pituitary gland. Although this process has significant repercussions throughout the body and affects a large proportion of our society, the neuroendocrine control mechanisms that accompany menopause are poorly understood. This review aims to examine rigorously the most accredited literature to provide an update about our current understanding of the role of the hypothalamic-pituitary axis in the onset of and transition into female reproductive senescence, focusing on the role of some specific neuropeptides in regulating the HPG axis and on their effects on several menopausal symptoms, especially referring to the cardiovascular risk, to open up new horizons for new therapeutic strategie