Choice of three different intramedullary nails in the treatment of trochanteric fractures: outcome, analysis and consideration in midterm

paragone di 3 differenti impianti per frattura pertrocanterica femoreThe purpose of this study is to compare the results obtained using three different systems of osteosynthesis, developed for the surgical treatment of fractures of the trochanteric region of the femur, based on the principle intramedullary nailing: the Gamma nail, the Affixus nail and the ZNN nail. This is a retrospective study: 72 trochanteric fractures treated with the Gamma nail, 68 treated with the Affixus nail and 69 treated with the ZNN nail, between the years 2012 and 2014, with the prerequisite of a minimum follow-up of 18 months. The fractures were classified according to the AO system; the most commonly reported subtype was the A2 fracture. Clinical and radiographic examinations were performed, both at hospital admission and post-operatively, at 1, 3, 6, 12 and 18 months. Of the 209 patients, 171 were women and 38 were men. The average age was 83.12 years old. All three systems guaranteed an early mobilization and ambulation in most of the patients. There were no significant differences in the use of the three nails in terms of recovery of previous functional capacity, or in terms of the time required for the fracture to heal. There were no advantages encountered with the use of one intramedullary nail over another and, in particular, when observing the complications and patient outcome, there were no statistically significant differences detected

Cardiovascular abnormalities and impaired exercise performance in adolescents with congenital adrenal hyperplasia

Context: Patients with classic Congenital Adrenal Hyperplasia (CAH) are treated with lifelong glucocorticoids (GCS). Cardiovascular (CV) and metabolic effects of such therapy in adolescents have never been quantified. Objective: To investigate left ventricular (LV) morphology, function and exercise performance in adolescents with CAH. Design and Setting: cross-sectional and controlled study conducted at a tertiary referral centre. Patients: Twenty patients with classic CAH (10 females) aged 13.6±2.5 years and 20 healthy controls comparable for sex and pubertal status were enrolled in the study and compared to a group of 18 patients without CAH receiving a similar dose of GCS for Juvenile Idiopathic Arthritis (JIA). Main Outcomes Measures: Echocardiographic assessment and symptom-limited exercise testing were performed. Anthropometric, hormonal and biochemical parameters were also measured. Results: Compared to healthy controls, patients with CAH exhibited an increased BMI (p<0.001), waist-to-height ratio (p<0.001), percentage of body fat (p<0.001) as well as higher insulin concentrations and HOMA index even after adjustment for BMI (p=0.03 and p=0.05, respectively). Moreover, CAH patients exhibited an impaired exercise capacity as shown by reduced peak workload (99±27 vs 126±27 W, p<0.01) and higher systolic blood pressure response at peak (156±18 vs 132±11 mmHg, p<0.01; Δ=45±24 vs 22±10 mmHg, p=0.05) with respect to healthy controls. CAH males displayed mild LV diastolic dysfunction as documented by significant prolongation of both isovolumic relaxation time (IRT) (118±18 vs 98±11ms, p<0.05) and mitral deceleration time (MDT) (138±25 vs 111±15 ms, p<0.01). No significant differences in CV function were found between CAH and JIA patients. Conclusion: Adolescents with CAH exhibit impaired exercise performance and enhanced systolic blood pressure response during exercise. In our population, such abnormalities appear related to GCS therapy rather than CAH per se. CAH males, but no females, present mild LV diastolic dysfunction that correlates with testosterone concentrations suggesting a sex hormone related difference

Bilateral 5 Hz transcranial alternating current stimulation on fronto-temporal areas modulates resting-state EEG

Rhythmic non-invasive brain stimulations are promising tools to modulate brain activity by entraining neural oscillations in specific cortical networks. The aim of the study was to assess the possibility to influence the neural circuits of the wake-sleep transition in awake subjects via a bilateral transcranial alternating current stimulation at 5 Hz (theta-tACS) on fronto-temporal areas. 25 healthy volunteers participated in two within-subject sessions (theta-tACS and sham), one week apart and in counterbalanced order. We assessed the stimulation effects on cortical EEG activity (28 derivations) and self-reported sleepiness (Karolinska Sleepiness Scale). theta-tACS induced significant increases of the theta activity in temporo-parieto-occipital areas and centro-frontal increases in the alpha activity compared to sham but failed to induce any online effect on sleepiness. Since the total energy delivered in the sham condition was much less than in the active theta-tACS, the current data are unable to isolate the specific effect of entrained theta oscillatory activity per se on sleepiness scores. On this basis, we concluded that theta-tACS modulated theta and alpha EEG activity with a topography consistent with high sleep pressure conditions. However, no causal relation can be traced on the basis of the current results between these rhythms and changes on sleepines

The relationship between drive to thinness, conscientiousness and bulimic traits during adolescence: a comparison between younger and older cases in 608 healthy volunteers

Adolescence represents one of the critical transitions in the life span and is characterized by a tremendous pace in growth and change that is second only to that of infancy. Both biological and psychological changes occurring during early adolescence may also influence the definition of subsequent late adolescence or early adulthood physiological or (psycho)-pathological features, including bulimia nervosa (BN) whenever occurring. Therefore, a pre-emptive assessment of suggestive psychological traits, including bulimic ones, during early and late years of adolescence, is recommended and represents the goal of the present study

Work-related eye injuries: A relevant health problem. main epidemiological data from a highly-industrialized area of northern Italy

The province of Modena is one of the most industrialized areas of Northern Italy. The medical records of the Ophthalmological Emergency Department (OED) of Modena University Hospital were studied: there were 13, 470 OED accesses in 2014 and in 754 cases that an occupational eye injury occurred. The frequency of work-related eye injuries (3â°) was lower compared to other published studies, but the absolute number is still relevant, showing the need for more adequate prevention, especially in metal work, construction work, and agriculture, where the worst prognoses were observed. Intervention programs must be implemented as early as possible in the working life, considering that the frequency in younger workers is about double that of the oldest age class (3.5â°vs. 1.8â°), and special attention should also be given to foreigners, who have a 50% higher injury risk. Furthermore, the planning of specific interventions for eye-injured workers may be useful, considering that a previous injury does not appear to encourage the adoption of preventive interventions, and a subgroup of eye-injured workers have a potential risk for new injuries. Finally, the data presented here indicates how OED records, integrated with specific occupational information, can be applied for studies on work-related eye injuries

Dermoscopy and methyl aminolevulinate: A study for detection and evaluation of field cancerization

Actinic keratosis (AK) is a keratinocyte intraepidermal neoplasia UV light – induced that frequently appears in sun-exposed areas of the skin. Although historically AK was de fi ned as “ precancerous ” , actually it is considered as the earliest stage of squamous cell carcinoma (SCC) in situ. Since AKs can progress into invasive SCC, their treatment isrecommended. AKsrarely developasa singlelesion;usually multiplelesions commonly affect anen- tire area of chronically actinic damaged skin. This has led to the concept of “ fi eld cancerization ” , an area chroni- cally sun-exposed that surrounds peripherally visible lesions, in which are individualized subclinical alterations. One of the main principles endpoint in the management of AKs is the evaluation and the treatment of fi eld cancerization. In this view, in order to detect and quantify fi eld cancerization, we employed a method based on the topical application of methyl aminolevulinate (MAL) and the detection of the fl uorescence emitted by its metabolite Protoporphyrin IX (PpIX); then, considering the extension and the intensity of measured fl uores- cence, we create a score of fi eld cancerization. The results show that patients underwent to daylight PDT had a reduction of total score, from T0 to T2. Whereas in the group untreated we observed a stability of total score or a slightly worse. So, the method and the score used allows to evaluate with a good approximation the dimension of fi eld cancerization and show the modi fi cation of it after treatment

Web-Shaped Model for Head Pose Estimation: an Approach for Best Exemplar Selection

Head pose estimation is a sensitive topic in video surveillance/smart ambient scenarios since head rotations can hide/distort discriminative features of the face. Face recognition would often tackle the problem of video frames where subjects appear in poses making it quite impossible. In this respect, the selection of the frames with the best face orientation can allow triggering recognition only on these, therefore decreasing the possibility of errors. This paper proposes a novel approach to head pose estimation for smart cities and video surveillance scenarios, aiming at this goal. The method relies on a cascade of two models: the first one predicts the positions of 68 well-known face landmarks; the second one applies a web-shaped model over the detected landmarks, to associate each of them to a specific face sector. The method can work on detected faces at a reasonable distance and with a resolution that is supported by several present devices. Results of experiments executed over some classical pose estimation benchmarks, namely Point '04, Biwi, and AFLW datasets show good performance in terms of both pose estimation and computing time. Further results refer to noisy images that are typical of the addressed settings. Finally, examples demonstrate the selection of the best frames from videos captured in video surveillance conditions

Results and complications of surgeons-in-training learning bimanual microincision cataract surgery

PURPOSE: To evaluate visual outcomes and complications of bimanual microincision cataract surgery performed by surgeons in training. SETTING: Institute of Ophthalmology, University of Modena and Reggio Emilia, Modena, Italy. DESIGN: Prospective case series. METHODS: The corrected distance visual acuity (CDVA), astigmatism, corneal pachymetry, and endothelial cell count were evaluated before and 7 and 30 days after bimanual MICS performed by surgeons in training. Intraoperative and postoperative complications were also recorded. RESULTS: Three surgeons in training performed bimanual MICS in 150 eyes of 131 patients. There were 18 intraoperative complications (12.0%) (10 iris traumas [6.6%]; 4 capsule ruptures without vitreous loss [2.7%]; 3 capsule ruptures with vitreous loss [2.0%]; 1 intraocular lens [IOL] implantation in the sulcus due to zonular laxity [0.7%]). There were 5 postoperative complications (3.3%) (2 iris prolapses [1.3%]; 1 IOL loop malposition [0.7%]; 1 narrowing of anterior chamber [0.7%]; 1 capsulorhexis phimosis [0.7%]). Thirty days postoperatively, the mean CDVA improvement was 0.53 ± 0.20 (Snellen decimal) (P &lt; .05), the mean decrease in astigmatism was 0.09 ± 0.54 diopter (P = .29), and the mean increase in corneal pachymetry was 7.42 ± 22.01 μm (P = .12). There was statistically significant endothelial cell loss (mean 496.50 ± 469.66 cells/mm(2)) (P &lt; .05). CONCLUSIONS: Bimanual MICS performed by surgeons in training was safe and effective. Visual outcomes and complication rates were similar to those reported for coaxial cataract surgery performed by surgeons in training