Medical Malpractice: The Italian Experience

Beginning with an investigation into the problematic nature of medical liability, the Article overviews the most significant approaches taken by courts and scholars in order to establish whether the physician\u27s position before the patient is comparable with that of either a tortfeasor or a contractor. Having explained that the most recent approaches in this regard tend toward the recognition of the contractual nature of medical liability, the Author discusses the implications of such a solution, making specific reference to the following issues: 1) the assignment of the burden of proof (along with the distinction between obligations of means and obligations of result); 2) proof of causation (along with further reference to the difference between civil and criminal standards of proof regarding causation-in-fact); 3) the role of informed consent; 4) the prescription regime. The final part of the Article investigates the rapid increase in medical malpractice litigation as a side-effect of the contractualization of medical liability, focusing on the strategies to follow in order to minimize expense claims

Epidermal Langerhans Cells-A Target for HTLV-III/LAV Infection

Langerhans cells (LC) are bone marrow-derived, la+, CD1+, CD4+, ATPase+ dendritic antigen-presenting cells within the human epidermis. Since the CD4 molecule has been implicated as a receptor structure for HTLV-III/LAV (human T-cell leukemia virus/lymphadenopathy-associated virus), we asked whether LC from HTLV-III/LAV-seropositive individuals display signs of HTLV-III/LAV infection. In skin biopsies from 7/40 HTLV-III/LAV-infected persons (1 asymptomatic carrier, 2 patients with acquired immunodeficiency syndrome (AIDS)-related complex and 4 patients with AIDS), LC were the only epidermal cells to react with a monoclonal antibody specific for the HTLV-III core protein p17. A varying percentage of p17+ LC were morphologically altered with blunt dendrites and poorly demarcated cellular contours. In one of these biopsies, the presence of LC-associated viral particles characteristic of HTLV-III/LAV as well as cytopathic changes in approximately one-third of the LC population were demonstrated by electron microscopy. These results strongly suggest that LC may harbor HTLV-III/LAV. The infection of LC with this retrovirus may have deleterious consequences for the immunologic functions of this cell system and may thus contribute to both the acquisition of immunodeficiency and the infectious and neoplastic complications of AIDS

Automated Motile Cell Capture and Analysis with Optical Traps

Laser trapping in the near infrared regime is a noninvasive and microfluidic-compatible biomedical tool. This chapter examines the use of optical trapping as a quantitative measure of sperm motility. The single point gradient trap is used to directly measure the swimming forces of sperm from several different species. These forces could provide useful information about the overall sperm motility and semen quality. The swimming force is measured by trapping sperm and subsequently decreasing laser power until the sperm is capable of escaping the trap. Swimming trajectories were calculated by custom built software, an automatic sperm tracking algorithm called the single sperm tracking algorithm or SSTA. A real-time automated tracking and trapping system, or RATTS, which operates at video rate, was developed to perform experiments with minimal human involvement. After the experimenter initially identifies and clicks the computer mouse on the sperm-of-interest, RATTS performs all further tracking and trapping functions without human intervention. Additionally, an annular laser trap which is potentially useful for high-throughput sperm sorting based on motility and chemotaxis was developed. This low power trap offers a more gentle way for studying the effects of laser radiation, optical force, and external obstacles on sperm swimming pattern

Effects of Cannabinoids on Caffeine Contractures in Slow and Fast Skeletal Muscle Fibers of the Frog

The effect of cannabinoids on caffeine contractures was investigated in slow and fast skeletal muscle fibers using isometric tension recording. In slow muscle fibers, WIN 55,212-2 (10 and 5 μM) caused a decrease in tension. These doses reduced maximum tension to 67.43 ± 8.07% (P = 0.02, n = 5) and 79.4 ± 14.11% (P = 0.007, n = 5) compared to control, respectively. Tension-time integral was reduced to 58.37 ± 7.17% and 75.10 ± 3.60% (P = 0.002, n = 5), respectively. Using the CB1 cannabinoid receptor agonist ACPA (1 μM) reduced the maximum tension of caffeine contractures by 68.70 ± 11.63% (P = 0.01, n = 5); tension-time integral was reduced by 66.82 ± 6.89% (P = 0.02, n = 5) compared to controls. When the CB1 receptor antagonist AM281 was coapplied with ACPA, it reversed the effect of ACPA on caffeine-evoked tension. In slow and fast muscle fibers incubated with the pertussis toxin, ACPA had no effect on tension evoked by caffeine. In fast muscle fibers, ACPA (1 μM) also decreased tension; the maximum tension was reduced by 56.48 ± 3.4% (P = 0.001, n = 4), and tension-time integral was reduced by 57.81 ± 2.6% (P = 0.006, n = 4). This ACPA effect was not statistically significant with respect to the reduction in tension in slow muscle fibers. Moreover, we detected the presence of mRNA for the cannabinoid CB1 receptor on fast and slow skeletal muscle fibers, which was significantly higher in fast compared to slow muscle fiber expression. In conclusion, our results suggest that in the slow and fast muscle fibers of the frog cannabinoids diminish caffeine-evoked tension through a receptor-mediated mechanism

Ovarian stimulation protocols (anti-oestrogens, gonadotrophins with and without GnRH agonists/antagonists) for intrauterine insemination (IUI) in women with subfertility

Background Intrauterine insemination (IUI) combined with ovarian hyperstimulation (OH) has been demonstrated to be an effective form of treatment for subfertile couples. Several ovarian stimulation protocols combined with IUI have been proposed, but it is still not clear which stimulation protocol and which dose is the most cost-effective. Objectives To evaluate ovarian stimulation protocols for intrauterine insemination for all indications. Search strategy We searched for all publications which described randomised controlled trials comparing different ovarian stimulation protocols followed by IUI. We searched the Menstrual Disorders and Subfertility Group's Central register of Controlled Trials (CENTRAL). We searched the electronic databases of MEDLINE (January 1966 to present) and EMBASE (1980 to present). Selection criteria Randomised controlled trials only were considered for inclusion in this review. Trials comparing different ovarian stimulation protocols combined with IUI were selected and reviewed in detail. Data collection and analysis Two independent review authors independently assess trial quality and extracted data. Main results Forty three trials involving 3957 women were included. There were 11 comparisons in this review. Pregnancy rates are reported here since results of live birth rates were lacking. Seven studies (n = 556) were pooled comparing gonadotrophins with anti-oestrogens showing significant higher pregnancy rates with gonadotrophins (OR 1.8, 95% CI 1.2 to 2.7). Five studies (n = 313) compared anti-oestrogens with aromatase inhibitors reporting no significant difference (OR 1.2 95% CI 0.64 to 2.1). The same could be concluded comparing different types of gonadotrophins (9 studies included, n = 576). Four studies (n = 391) reported the effect of adding a GnRH agonist which did not improve pregnancy rates (OR 0.98 95% CI 0.6 to 1.6), although it resulted in significant higher multiple pregnancy rates (OR 2.9 95% CI 1.0 to 8). Data of three studies (n = 299) showed no convincing evidence of adding a GnRH antagonist to gonadotrophins (OR 1.5 95% CI 0.83 to 2.8). The results of two studies (n = 297) reported no evidence of benefit in doubling the dose of gonadotrophins (OR 1.2 95% 0.67 to 1.9) although the multiple pregnancy rates and OHSS rates were increased. For the remaining five comparisons only one or none studies were included. Authors' conclusions Robust evidence is lacking but based on the available results gonadotrophins might be the most effective drugs when IUI is combined with ovarian hyperstimulation. When gonadotrophins are applied it might be done on a daily basis. When gonadotrophins are used for ovarian stimulation low dose protocols are advised since pregnancy rates do not differ from pregnancy rates which result from high dose regimen, whereas the chances to encounter negative effects from ovarian stimulation such as multiples and OHSS are limited with low dose gonadotrophins. Further research is needed for each comparison made

Intérêt du "Dry Cupping" dans la gestion de la douleur chez des patients souffrant de lombalgies communes

Background/objective: Non specific low back pain is a very common condition linked to a degenerative cause (discogenic or facet or mixed, ligamentary, muscular, linked to a regional or global disorder of the spinal statics) or without any relation to an anatomical lesion. Recently, the practice of dry cupping has been revived, especially in sports physiotherapy. The objective of this review is to evaluate, based on existing data in the literature, if dry cupping can improve pain in patients suffering from non specific low back pain.Method: 3 databases were searched (PubMed, Cochrane and PEDro) until 20 March 2021, to assess the effectiveness of dry cupping in the management of pain in patients with common low back pain. The outcome in each study was the assessment of pain at different times. Each study was assessed using the PEDro scaleResults/analysis: 4 studies (n=298) were included. 3 were RCTs and one was classified as a placebo-controlled experimental clinical trial. 2 studies involved a control group treated with paracetamol and 2 studies proposed a placebo (sham cupping). No meta-analysis was conducted. There were differences in the modalities of the interventions in each study as well as in the assessment of the pain (different scales). The methodological analysis of each study shows significant bias in most of them. The results were obtained by calculating the effect size with the 95% CI between the groups for each study at the different time. There was heterogeneity in the results, with fairly wide confidence intervals. The estimated effects suggesting an effectiveness of dry cupping are given by the most biased studies. On the other hand, the study with the best methodological quality presented only estimated effects which showed that dry cupping was not superior to sham cupping. Mild to moderate adverse effects were found in 5.6% of the total population included.Discussion/conclusion: With the heterogeneity of the results and the various biases inherent to the included studies, we can’t conclude on the interest of dry cupping in the management of pain in patients suffering from non specific low back pain. RCTs with better methodological quality, with much larger population samples, are needed. Targeting dry cupping as a complement to other interventions recommended by clinical guidelines would also be more consistent.Introduction/objectif : la lombalgie commune est une affection très courante et liée à une cause dégénérative (discogénique ou facettaire ou mixte, ligamentaire, musculaire, liée à un trouble régional ou global de la statique rachidienne) ou sans relation tenue avec une lésion anatomique. Depuis peu, la pratique du « dry cupping » est remise au goût du jour, notamment en kinésithérapie du sport. L’objectif de cette revue est d’évaluer, à partir des données existantes de la littérature, si le « dry cupping » présente un intérêt pour améliorer la douleur des patients souffrant de lombalgies communes.Méthode : 3 bases de données ont été consultées (PubMed, Cochrane et PEDro) jusqu'au 20 mars 2021, afin d’évaluer l’efficacité du « dry cupping » dans la gestion de la douleur chez des patients souffrant de lombalgies communes. Le critère de jugement retenu dans chaque étude est l’évaluation de la douleur. L’évaluation de chaque étude a été réalisée avec l’échelle PEDro.Résultats/analyse : 4 études (n=298) ont été incluses. 3 sont des ECR et une est un clinique expérimental placebo. 2 études impliquaient un groupe contrôle traité au paracétamol et 2 études proposaient un placebo (cupping factice). Aucune méta-analyse n’a été menée. On constate des différences dans les modalités des interventions de chaque étude ainsi que dans l’évaluation du critère de jugement (différentes échelles). L’analyse méthodologique de chaque étude montre des biais importants pour la plupart d’entre-elles. Les résultats ont été obtenus en calculant la taille d’effet avec l’IC 95% entre les groupes, pour chaque étude, aux différents temps. On remarque une hétérogénéité des résultats, avec des intervalles de confiance assez larges. Les effets estimés suggérant une efficacité du « dry cupping » sont donnés par les études les plus biaisées. L’étude présentant la meilleure qualité méthodologique présente que des effets estimés qui témoignant de la non supériorité du « dry cupping » par rapport au placebo. On retrouve 5,6% d’effets indésirables légers à modérés sur l’ensemble de la population incluse.Discussion/conclusion : avec l’hétérogénéité des résultats et les différents biais inhérents aux études incluses, on ne peut pas conclure sur l’intérêt du « dry cupping » dans la gestion des douleurs chez des patients souffrant de lombalgies communes. Des ECR de meilleure qualité méthodologique, sur des échantillons de population plus importants sont nécessaires. Cibler l’action du « dry cupping » en complément d’autres interventions recommandées par les directives cliniques serait aussi plus cohérent

Software defined networks for data center optimization

The constantly increasing amount of data generated from our everyday life requires Data Centers to store data. Data Centers need a lot of resources to operate, and Companies are working to find new solutions to improve efficiency and as well as effectiveness. After using sea water to cool off servers and studying alternative ways of generating power, the attention is now moving on alternative ways to manage data. Optimizing data management has two goals: power saving and efficiency increase. In this paper, we will discuss how Software-Defined procedures could be applied on Data Centers to optimize their operating modes, also reviewing some recent patents. Finally, we will discuss the importance of this technology along with future developments, highlighting pro and cons