EQ-5D in Central and Eastern Europe : 2000-2015

Objective: Cost per quality-adjusted life year data are required for reimbursement decisions in many Central and Eastern European (CEE) countries. EQ-5D is by far the most commonly used instrument to generate utility values in CEE. This study aims to systematically review the literature on EQ-5D from eight CEE countries. Methods: An electronic database search was performed up to July 1, 2015 to identify original EQ-5D studies from the countries of interest. We analysed the use of EQ-5D with respect to clinical areas, methodological rigor, population norms and value sets. Results: We identified 143 studies providing 152 country-specific results with a total sample size of 81,619: Austria (n=11), Bulgaria (n=6), Czech Republic (n=18), Hungary (n=47), Poland (n=51), Romania (n=2), Slovakia (n=3) and Slovenia (n=14). Cardiovascular (20%), neurologic (16%), musculoskeletal (15%) and endocrine/nutritional/metabolic diseases (14%) were the most frequently studied clinical areas. Overall 112 (78%) of the studies reported EQ VAS results and 86 (60%) EQ-5D index scores, of which 27 (31%) did not specify the applied tariff. Hungary, Poland and Slovenia have population norms. Poland and Slovenia also have a national value set. Conclusions: Increasing use of EQ-5D is observed throughout CEE. The spread of health technology assessment activities in countries seems to be reflected in the number of EQ-5D studies. However, improvement in informed use and methodological quality of reporting is needed. In jurisdictions where no national value set is available, in order to ensure comparability we recommend to apply the most frequently used UK tariff. Regional collaboration between CEE countries should be strengthened

Corpo estraneo nel seno mascellare

No abstract available

Evaluation of Skin-Core Adhesion Bond of Out-Of-Autoclave Honeycomb Sandwich Structures

Composite sandwich structures offer several advantages over conventional structural materials such as lightweight, high bending and torsional stiffness, superior thermal insulation and excellent acoustic damping. One failure mechanism in a composite sandwich structure is the debonding of the composite facesheets from the core structure. A well-formed adhesive fillet at the interface of the honeycomb core cell walls and the laminate is a significant factor in preventing bond failure. In the present work, honeycomb composite sandwich panels are manufactured using a low-cost vacuum-bag-pressure-only out-of-autoclave manufacturing process. CYCOM®5320 out-of autoclave prepreg is used for the facesheet laminates and FM® 300-2U film adhesive is used for the facesheet-to-core bond. The manufactured composite sandwich panels are of aerospace quality with a facesheet laminate void content of around 1%. In this study, adhesive fillet formation and adhesive mechanical strength are evaluated as a function of several different sandwich construction design variables. Both aluminum and aramid Nomex® honeycomb core materials are considered to study the effect of core cell size and core material. The effect of film adhesive thickness is studied. A process for reticulation of the adhesive is applied and studied. A quantitative investigation of the adhesive fillet geometry is carried out for all the panels. Manufactured panels are evaluated for flatwise tensile strength in accordance with test method ASTM C297. Optimized combinations of core material, core density, cell size and adhesive thickness are identified. Results show that the reticulation process improves fillet formation and increases flatwise tensile properties

Rhabdomyosarcoma of the oral cavity in a 24-year-old male patient.

Rhabdomyosarcoma (RMS) is the most common malignant soft tissue tumor. RMS derives from primitive mesenchymal tissues that exhibit a tendency toward myogenic differentiation and probably originate from satellite cells associated with the embryogenesis of skeletal muscle. There are reports of cases arising in oral tissues, which correspond to 10 to 12% of all head and neck RMS. Here we report a case of challenging diagnose of a pleomorphic spindle-cell RMS of the oral cavity. In June 2012, a 24-year-old male patient was referred to the Department of Oral Medicine and Pathology by his dentist to extract tooth 2.8. On history taking, the patient described a persistent left cheek abscess caused by malposition of 2.8 and non-responsive to 2-month amoxicillin (2 g/die) therapy. He also referred absence of pain, pyretic state and pus/blood discharge during this period. Objective examination revealed slight extraoral asymmetry and intraoral exophityc, hard, immovable cheek proliferation, swelling and redness, associated to ecstasy of Stenone duct. No lymphoadenopathy was recognized. No signs of disease were detected on x-rays. An incisional biopsy was immediately performed. The pathologist diagnosed a \u201cfibromatous lesion\u201d although she stated the small dimension of the specimen could be misleading. An excisional biopsy was scheduled 15 days later and revealed the extension of the lesion deep in the muscular tissue and its pedunculated nature. The pathologist reported a \u201cmyofibroblastic inflammatory tumor\u201d, positive for desmin, vimentin, CD65 and ki67 but urged on further consultation with another pathologist. Conclusive diagnose after consultation was \u201cspindle-cells/sclerosant multifocal rhabdomyosarcoma\u201d. Seven days after, PET, TC and MRI denied the presence of residual tumor cells or of metastasis. Although the patient was recommended to perform adiuvant RT/CT, he refused further interventions. Presently, patient is still free of disease

Unusual solid tumors metastasis to the oral cavity.

Metastatic tumors to the oral cavity account for less than 1.5% of malignant oral neoplasms. They usually occur in patients aged 40\u201370 years both as bone and soft tissues\u2019 lesions, above all in the lower molar area. Metastatic tumors usually derive from lung, breast, kidney, bone, colorectal and thyroid cancer. Diagnosing a metastatic lesion in the oral cavity is challenging although of great clinical significance since it can be the first manifestation of an unknown neoplasia. We present two case reports of metastasis from solid tumors to the oral cavity. A 66-year-old male patient, complained about chewing pain in February 2013. He had been operated for prostate (2010), lung (2011) and thyroid cancer (2012). Tumor and swelling in the lower right alveolar ridge and omolateral lymphoadenopathy were found. X-rays revealed a wide osteolytic area in the lower right mandible as well as smaller spread ones controlaterally. Bone biopsy was taken on the right side and revealed metastatic follicular thyroid cancer whereas contralateral lesions were free of disease. Hemimandibulectomy and reconstruction through microvascular fibula flap were performed. Neither mucosal/bone lesions nor symptoms were evidenced after 5-month reevaluation. A 69-year-old patient was referred to the EDU for oral pain of unknown origin, non-responsive to 2-week amoxicillin and NSAIDs therapy. Intraoral examination revealed tooth 1.7 mobility and fistula. After tooth extraction and continuation of medical therapy, no amelioration was obtained. The patient was referred to the Oral Medicine and Pathology Department. Swelling, redness and purulent exudate coming from a large, exophytic and thick mass located in the post-extractive site were present. Immediately, a mucosa and bone biopsy was taken. Pathologist\u2019s report revealed metastasis from colon cancer. Afterwards, patient was diagnosed with advanced pleomorphic indifferentiated colon adenocarcinoma. He died one month after palliative hemicolectomy

Grave atrofia del mascellare superiore: Soluzione chirurgica con implantologia iuxta-ossea

Obiettivi La riabilitazione fissa di arcate mascellari edentule con grave atrofia ossea rappresenta una sfida per il clinico. Negli ultimi anni, nonostante l\u2019aumento delle terapie rigenerative e delle tecniche d\u2019incremento osseo abbia notevolmente superato il ricorso all\u2019utilizzo di impianti subperiostei (o iuxta-ossei), questa metodica appare tutt\u2019altro che obsoleta. Infatti, l\u2019avvento della tecnologia digitale cone beam, la creazione del modello stereolitografico, l\u2019uso di griglie in titanio lavorate con tecniche di addizione e, conseguentemente, l\u2019aumento di precisione e resistenza del manufatto possono valorizzare l\u2019utilizzo degli impianti sottoperiostei e mettere in luce i numerosi vantaggi che essi concedono, quali la riabilitazione fissa del paziente in un\u2019unica seduta e la riduzione dei costi. Materiali e metodi Il caso clinico che presentiamo propone una riabilitazione complessa di un mascellare edentulo atrofico tramite l\u2019impiego di un impianto sottoperiosteo. Risultati A tre anni, il caso appare stabile. Conclusioni Al momento, la scelta del paziente, il disegno e la costruzione del manufatto, la fissazione rigida con viti e impianti, la presenza di adeguati tessuti molli a ricoprire il manufatto e i monconi su cui avvitare la protesi sembrano essere criteri imprescindibili per la riuscita del trattamento

Analgesic effect of Photobiomodulation Therapy: An in vitro and in vivo study

Laser therapy, also known as Photobiomodulation (PBM) is indicated to reduce pain associated with different pathologies and applied using protocols that vary in wavelength, irradiance and fluence. Its mechanisms of action are still unclear and possibly able to directly impact on pain transmission, reducing nociceptor response. In our study, we examined the effect of two specific laser wavelengths, 800 and 970 nm, extensively applied in the clinical context and known to exert important analgesic effects. Our results point to mitochondria as the primary target of laser light in isolated dorsal root ganglion (DRG) neurons, reducing adenosine triphosphate content and increasing reactive oxygen species levels. Specifically, the 800 nm laser wavelength induced mitochondrial dysregulation, that is, increased superoxide generation and mitochondrial membrane potential. When DRG neurons were firstly illuminated by the different laser protocols and then stimulated with the natural transient receptor potential cation channel subfamily V member 1 (TRPV1) ligand capsaicin, only the 970 nm wavelength reduced the calcium response, in both amplitude and frequency. Consistent results were obtained in vivo in mice, by subcutaneous injection of capsaicin. Our findings demonstrate that the effect of PBM depends on the wavelength used, with 800 nm light mainly acting on mitochondrial metabolism and 970 nm light on nociceptive signal transmission