STUDIO NUMERICO DELL'EMODINAMICA IN PAZIENTI CON DISSECAZIONE AORTICA DI TIPO B

The development of type B aortic dissection (AoD) is caused by altered haemodynamic forces exerted on false and true lumina of dissected aorta. This work aims to study haemodynamic and morphological proprieties, which influence the progression or stability of type B AoD. Computational fluid-dynamic analyses were performed on three patients with type B AoD, whose two presented an aneurysm evolution and one presented no further complication connected with dissection. Blood flow features showed that the true lumen flow was laminar and uniform while false lumen flow lost the laminar characteristic with consequent vorticity formation. The entry point zone proximal to the aortic arch showed both high blood velocity and pressure connected with peaks of maximum WSS value. A negative pressure gradient between the false lumen entry and re-entry points was observed. This promotes the blood to flow towards the abdominal aorta reducing the risk of retrograde flow during systole. We concluded that fluid dynamics study of patients with type B AoD is a valid tool to identify the risk of aortic dissection progression as well as the formation of aortic dissection connected pathology

Sipunculus nudus: particulate components of the coelomic fluid and its relationship with brown bodies

Corpuscular components of the coelomic fluid were observed in Sipunculus nudus using cytochemical and cytoenzymatic methods. In particular, granulocytes were studied and two different types, based on morphology, chemical composition, and function were distinguished. Cell aggregates, identified as stem cells of type II granulocytes, were also evidenced. Besides, empty vesicles, vesicle fragments, laminar structures and brown bodies were observed. Based on the observation of their structure and ultrastructure, brown bodies were attributed with the function of accumulating foreign material, as well as aged components typical of the coelomic fluid

Spermiogenesis in the vermetid gastropod Dendropoma petraeum (Gastropoda, Prosobranchia)

The structure and maturation of the male gonad of the Mediterranean vermetid gastropod Dendropoma petraeum are described. Histological sections of the gonads were made throughout development and gonad activity was monitored at regular monthly intervals. During tha autumn monts the gonad is very small and is surrounded by a large quantity of connective tissue; it becomes more voluminous from December to August, with the highest growth peak in springtime. The stages of spermatogenesis were also observed and described

Ethical, philosophical, and practical considerations in adherence to therapy in sleep medicine

This is the author accepted manuscript. The final version is available from Lippincott, Williams & Wilkins via the DOI in this recordPurpose of review We consider a series of linked philosophical issues created by non-adherence to therapy in sleep medicine. Recent findings First, the difficulty of measuring rates of adherence creates an epistemic problem regarding the efficacy of prescribed treatments. Secondly, as diseases are often classified as refractory based on apparent failure of standard medicines, the validity of this classification faces a similar epistemic crisis. This in turn produces ethical issues when therapies are restricted to cases deemed refractory. It also calls into question, if the patient does not take the medicines as prescribed, what they do with them; and the prospect of potential drug diversion arises. Education of patients seems to be of limited help in addressing these issues; what may be needed is a revision of the patient–prescriber relationship to move away from blame when nonadherence occurs. We close by revisiting an ancient debate in the philosophy of action, which may shed light on what such a revised relationship would require. Summary More honest and trusting patient–physician relationships, and a much more accurate sense of when nonadherence is occurring and why, may result from a better practical and philosophical understanding of the patient's decision-making

Engagement of the periesophageal ring during Holothuria polii response to erythrocyte injection.

In Holothuria polii, the periesophageal ring is an important organ supplying spherule cells after stimulation with foreign material. In animals injected with formalinized sheep erythrocytes, in fact, a depletion of spherule cells is observed in the periesophageal ring, whereas in the connective tissue, in the external epithelium and around the antigen- injected site, small, transparent cells can be visualized. It is supposed that the latter are stem cells of spherule cells

Burden of acute otitis media in primary care pediatrics in Italy: A secondary data analysis from the Pedianet database

Background: The incidence of acute otitis media (AOM) vary from country to country. Geographical variations together with differences in study designs, reporting and settings play a role. We assessed the incidence of AOM in Italian children seen by primary care paediatricians (PCPs), and described the methods used to diagnose the disease.Methods: This secondary data analysis from the Pedianet database considered children aged 0 - 6 years between 01/2003 and 12/2007. The AOM episodes were identified and validated by means of patient diaries. Incidence rates/100 person-years (PY) were calculated for total AOM and for single or recurrent AOM.Results: The 92,373 children (52.1% males) were followed up for a total of 227,361 PY: 23,039 (24.9%) presented 38,241 episodes of AOM (94.6% single episodes and 5.4% recurrent episodes). The total incidence rate of AOM in the 5-year period was 16.8 episodes per 100 PY (95% CI: 16.7-16.9), including single AOM (15.9 episodes per 100 PY; 95% CI: 15.7-16.1) and recurrent AOM (0.9 episodes per 100 PY; 95% CI: 0.9-0.9). There was a slight and continuously negative trend decrease over time (annual percent change -4.6%; 95%CI: -5.3, -3.9%). The AOM incidence rate varied with age, peaking in children aged 3 to 4 years (22.2 episodes per 100 PY; 95% CI 21.8-22.7). The vast majority of the AOM episodes (36,842/38,241, 96.3%) were diagnosed using a static otoscope; a pneumatic otoscope was used in only 3.7%.Conclusions: Our data fill a gap in our knowledge of the incidence of AOM in Italy, and indicate that AOM represents a considerable burden for the Italian PCP system. Educational programmes concerning the diagnosis of AOM are needed, as are further studies to monitor the incidence in relation to the introduction of wider pneumococcal conjugate vaccines

Adverse Events in Italian Nursing Homes During the COVID-19 Epidemic. A National Survey

Older people living in nursing homes (NHs) are particularly vulnerable in the ongoing COVID-19 pandemic, due to the high prevalence of chronic diseases and disabilities (e.g., dementia). The phenomenon of adverse events (AEs), intended as any harm or injury resulting from medical care or to the failure to provide care, has not yet been investigated in NHs during the pandemic. We performed a national survey on 3,292 NHs, either public or providing services both privately and within the national health system, out of the 3,417 NHs covering the whole Italian territory. An online questionnaire was addressed to the directors of each facility between March 24 and April 27, 2020. The list of NHs was provided by the Dementia Observatory, an online map of Italian services for people with dementia, which was one of the objectives of the implementation of the Italian National Dementia Plan. About 26% of residents in the Italian NHs for older people listed within the Dementia Observatory site had dementia. The objective of our study was to report the frequency of AEs that occurred during the months when SARS-CoV-2 spreading rate was at its highest in the Italian NHs and to identify which conditions and attributes were most associated with the occurrence of AEs by means of multivariate regression logistic analysis. Data are referred to 1,356 NHs that participated in the survey. The overall response rate was 41.2% over a time-period of six weeks (from March 24 to May 5). About one third of the facilities (444 out of 1,334) (33.3%) reported at least 1 adverse event, with a total of 2,000 events. Among the included NHs, having a bed capacity higher than the median of 60 beds (OR=1.57, CI95% 1.17–2.09; p=0.002), an observed increased in the use of psychiatric drugs (OR=1.80, CI95% 1.05–3.07; p=0.032), adopting physical restraint measures (OR=1.97, CI95% 1.47–2.64; p<0.001), residents hospitalized due to flu-like symptoms (OR =1.73, CI95% 1.28–2.32; p<0.001), and being located in specific geographic areas (OR=3.59, CI95% 1.81–7.08; OR = 2.90, CI95% 1.45–5.81 and OR = 4.02, CI05% 2.01–8.04 for, respectively, North-West, North-East and Centre vs South, p<0.001) were all factors positively associated to the occurrence of adverse events in the facility. Future recommendations for the management and care of residents in NHs during the COVID-19 pandemic should include specific statements for the most vulnerable populations, such as people with dementia

The intertwining of healthcare-associated infections and COVID-19 in Italian intensive care units: an analysis of the SPIN-UTI project from 2006 to 2021

Background: Although healthcare-associated infections (HAIs) pose an extraordinary burden on public health, the impact of coronavirus disease 2019 (COVID-19) is still a matter of debate. Aim: To describe trends of HAIs in Italian intensive care units (ICUs) from 2006 to 2021, and to compare characteristics and outcomes of patients with or without COVID-19. Methods: We evaluated patients participating in the 'Italian Nosocomial Infections Surveillance in Intensive Care Units' (SPIN-UTI) project, who were admitted to ICUs for more than 48 h. Data regarding diagnosis, clinical conditions, therapies, treatments and outcomes of COVID-19 patients were also collected. Findings: From a total of 21,523 patients from 2006 to 2021, 3485 (16.2%) presented at least one HAI. We observed an increasing trend for both the incidence of patients with HAI and the incidence density of HAIs (P-trend <0.001). Compared with the pre-pandemic period, the incidence density of HAIs increased by about 15% in 2020-2021, with pneumoniae being the greatest contributors to this increase (P-trend <0.001). Moreover, incidence of HAIs was higher in ICUs dedicated to COVID-19 patients (P<0.001), who showed a greater risk of HAIs and death than patients without COVID-19 (P-values <0.001). Accordingly, the mortality in ICUs increased over the years and doubled during the pandemic (P-trend <0.001). Notably, co-infected patients had higher mortality (75.2%) than those with COVID-19 (66.2%) or HAI (39.9%) alone, and those without any infection (23.2%). Conclusions: Our analysis provides useful insight into whether and how the COVID-19 pandemic influenced HAI incidence and death in Italian ICUs, highlighting the need for evaluation of the long-term effects of the pandemic. (c) 2023 The Authors. Published by Elsevier Ltd on behalf of The Healthcare Infection Society. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/)