Point-of-care Ultrasound Diagnosis of Bilateral Patellar Tendon Rupture

Musculoskeletal complaints are one cornerstone of urgent issues for which orthopedic and emergency physicians provide care. Ultrasound can be a useful diagnostic tool to help identify musculoskeletal injuries. We describe a case of bilateral patellar tendon rupture that presented after minor trauma, and had the diagnosis confirmed at the bedside by point-of-care ultrasound.Physicians caring for patients with orthopedic injuries should be familiar with the use of ultrasound to diagnose tendon ruptures

Governo e governance dei servizi di pubblica utilità per lo sviluppo umano:un'introduzione

Le presenti note introducono l’approfondimento monografico di questo numero della Rivista. Vanno quindi delineati i presupposti e il campo di indagine dell’attività di ricerca che ha favorito la realizzazione dei lavori presentati. A tale scopo, questa introduzione si concentrerà su quattro passaggi principali. Inizialmente, nel paragrafo 1 tratteggio i fattori di complessità e le idee chiave funzionali ad una governance innovativa che rendono necessaria l’adozione di modello più articolato per l’analisi dell’organizzazione della conoscenza all’interno ed all’esterno delle imprese. Successivamente, nel paragrafo 2, suggerisco un possibile metodo con cui sviluppare riflessioni periodiche ad ampio raggio all’interno delle imprese su questo ed altri temi. Nel paragrafo 3 mi concentro su alcuni fatti stilizzati che vengono evidenziati nella letteratura sull’interazione tra government e governance nella fornitura di servizi pubblici locali. Infine, nel paragrafo 4 cercherò di delineare i contorni di una relazione complessa, ma essenziale, tra government e governance, funzionale allo sviluppo umano. Il consolidamento del principio di sussidiarietà orizzontale e la crisi del modello basato sul government hanno favorito l’af-fermarsi di una nuova filosofia dell’esercizio dell’autorità: la governance, intesa come «[...] sistema multicentrico costituito da molti attori, per lo più organizzazioni sociali, [...] che va emergendo ora come fonte rivale di autorità, ora come risorsa cooperativa, altre volte ancora come competitor e infine come interlocutore» (Iannone, 2005, p. 78) nei confronti del modello basato sul government. La governance si fonda sull’efficacia della regolazione, piuttosto che sulle competenze, generando un insieme di regole di condotta nell’ambito delle quali è concesso un ampio margine di libertà ai privati. Tuttavia, nel nuovo contesto determinato dalla crisi globale, decollata nel 2007 e tuttora in atto, si sta manifestando una nuova contraddizione, acuita dalla crisi europea, tra government e governance, che contribuisce a sfumare e rivedere i confini e gli ambiti di competenza tra queste due forme di esercizio dell’autorità. L’auspicio è che questo approfondimento si presti alla realizzazione di un confronto tra cultura accademica e cultura d’impresa, continuativo nel tempo e produttivo di risultati, anche operativi, sullo sviluppo locale

Biochemical relapse predictive factors in patients with lymph node metastases during radical prostatectomy

Introduction: There are no clear recommendations for the management of patients with lymph node invasion discovered during radical prostatectomy for prostate cancer (PCa). Adequate risk stratification could personalize post-surgical adjuvant treatment. Our objective was to identify predictive factors for biochemical relapse (BCR) in patients with lymph node (LN) invasion at the time of radical prostatectomy(RP). Materials and methods: Patients who underwent RP for high-risk PCa with LN invasion in two academic centres between 2008 and 2019 were included. Patients with metastatic disease or extrapelvic LN involvement were excluded. Following data were collected retrospectively: age, preoperative prostate-specific antigen level, Gleason score, clinical and pathological stage, number of metastatic LN and LN density. Outcome was BCR during follow-up. BCR-free survival was assessed by Kaplan-Meier method and its association with relevant variables was determined with log-rank test. Results: Twenty-six patients were included. Median (IQR) age, PSA and follow-up were 64.5 years (55-78), 9.2ng/mL (4.4-20) and 16.1 months (6-27.5), respectively. Twenty patients (77%) had BCR after surgery, accounting for 24-month BCR-free survival of 65%. Patients with LN density &gt; 15% had better survival rates than those with ≤ 15% (40% vs. 0%, respectively, at 24 months; P=0.06) without reaching significance. Cox proportional Hazards analysis could not evidence predictive factors of BCR free-survival. Conclusions: LN density seemed associated with BCR-free survival within patients with high-risk PCa and positive LN at RP. However, extraprostatic extension, number of positive LN and positive surgical margins were not independent risk factors for BCR. Larger prospective studies with centralized pathological reviews are needed. Level of proof: 3.</p

Salvage Versus Adjuvant Radiation Therapy Following Radical Prostatectomy in Localised Prostate Cancer: A War Without a Winner

ObjectiveTo review current literature regarding the efficacy of adjuvant radiation therapy (ART) and salvage radiation therapy (SRT) following radical prostatectomy (RP) in patients with undetectable postoperative prostate-specific antigen (PSA) levels and high-risk features of prostate cancer (PCa) recurrence.MethodsSeven randomized controlled trials focused on the use of ART compared with either observation or SRT after RP that had been published in PubMed up to May 2022 were reviewed.ResultsThe use of ART following RP has been the treatment of choice over the past decade. Three RCTs comparing ART with early SRT show that SRT given as soon as biochemical recurrence (BCR) is detected is not inferior to ART while it offers the opportunity to avoid overtreatment and potential RT-related side effects. A meta-analysis summarizing the results from these trials supports these findings.ConclusionsEarly SRT may be suggested as the standard of care for patients with PCa and high-risk features for disease recurrence following RP. Nevertheless, further investigations are needed to identify those patients who will benefit from ART, particularly, in case of lymph node involvement. Moreover, some patients might avoid SRT despite reaching detectable postoperative serum PSA levels

Virtual Reality Hypnosis in the Electrophysiology Lab: When Human Treatments Are Better than Virtual Ones

International audienceAims: Virtual reality hypnosis (VRH) has been used successfully in various clinical settings to decrease anxiety and the sensation of pain. We aimed to investigate the feasibility and safety of VRH in patients undergoing electrophysiology and pacing procedures under conscious sedation. Methods: During a two-month period, VRH support was proposed and accepted by 25 patients undergoing electrophysiological procedures. Data were compared with a control group (n = 61) enrolled during the following three-month period. Both groups underwent the measurement of the duration of intervention, the consumption of analgesics and hypnotics, and their pain and comfort using a validated visual analogue scale (VAS 0−10). Results: The baseline characteristics were comparable in both groups, including age. There were no differences in procedure duration (46 (±29) vs. 56 (±32) min, p = 0.18) or in hypnotic/antalgic consumption (midazolam 1.95 (±1.44) vs. 2.00 (±1.22) mg, p = 0.83; sufentanyl 3.78 (±2.87) vs. 3.58 (±2.48) μg, p = 0.9) between the control and VRH groups. In a multivariate analysis, the use of VRH was independently associated with lower comfort during the procedure assessed by postoperative visual analogue scale (OR 15.00 [95% CI 4.77−47.16], p < 0.01). There was no influence of VRH use on pain or drug consumption. Conclusions: In our experience, compared with VRH, human care is preferable during procedures in electrophysiology lab to improve the comfort of the patient. VRH has no influence on pain or drug consumption

A Comparison of Intubation and Airway Complications Between COVID-19 and Non-COVID-19 Critically Ill Subjects

Introduction The number of subjects infected with the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) throughout the western hemisphere increased exponentially in the later months of 2020.&nbsp;With this increase in infection, the number of subjects requiring advanced ventilatory support increased concomitantly.&nbsp;We decided to compare the survival rates between coronavirus disease 2019 (COVID-19) subjects versus non-COVID-19 subjects undergoing intubation in the intensive care unit (ICU).&nbsp;We hypothesized that COVID-19 subjects would have lower rates of survival post-intubation. Methods We screened all subjects admitted to the adult critical care unit between January 2020&nbsp;and June 2020 to determine if they met the inclusion criteria.&nbsp;These subjects were required to be spontaneously ventilating upon admission and eventually required intubation.&nbsp;Subjects were selected from our electronic health record (EHR) system EPIC© (Epic Systems, Verona, WI) through a retrospective&nbsp;ICU admission analysis.&nbsp;We identified and included 267 non-COVID-19 subjects and 56 COVID-19 subjects.&nbsp;Our primary outcome of interest was intubation-related mortality.&nbsp;We defined intubation mortality as unexpected death (within 48 hours of intubation).&nbsp;Our secondary outcomes were the length of stay in the ICU, length of time requiring ventilator support, and proportion of subjects requiring tracheostomy placement. Results Compared to non-coronavirus disease (COVID) subjects, COVID subjects were more likely to be intubated for acute respiratory distress.&nbsp;COVID subjects had longer stays in the ICU and longer ventilator duration than non-COVID subjects.&nbsp;COVID-positive subjects had a decreased hazard ratio for mortality (HR = 0.42, 95% CI: 0.20-0.87, P &lt; 0.05) and increased chances of survival compared to non-COVID subjects. Conclusions We showed the&nbsp;rates of intubation survival were no different between the COVID and non-COVID groups.&nbsp;We attribute this finding to intubation preparation, a multidisciplinary team approach, and having the most experienced provider lead the intubation process