Management diagnostico-terapeutico e ruolo della chirurgia nel Lichen Sclerosus ano-genitale

Scopo della tesi: analisi della letteratura riguardo la presentazione clinica, l’etiologia, la storia naturale e la gestione medica e chirurgica del lichen sclerosus. Valutazione del ruolo della chirurgia nella patologia, attraverso l’esame di alcuni casi trattati presso la nostra clinica, per verificare se vi sia uno spazio come opzione terapeutica o se invece debba essere considerata un provvedimento da utilizzare unicamente per la correzione degli esiti. Materiali e metodi: è stata svolta un’ampia ricerca nella letteratura presente in PubMed e altri database elettronici usando le keywords “lichen sclerosus”, “lichen sclerosus et atrophicus”, e “balanitis xerotica obliterans”. Questo ha permesso di analizzare il punto di vista della letteratura non solo di ambito dermatologico, ma anche urologico e ginecologico. La ricerca ha dato luogo a circa 1046 risultati, che sono stati analizzati. Analisi della casistica e della documentazione clinica a nostra disposizione. Risultati: il lichen sclerosus è una patologia cutanea cronica, verosimilmente ad etiopatogenesi immunomediata. Colpisce entrambi i sessi, con un rapporto Uomo:Donna di 1:10, e con una predilezione per la localizzazione ano-genitale. Negli ultimi decenni sono stati compiuti numerosi passi avanti per quanto riguarda la definizione dell’incidenza della malattia, che risulta essere molto maggiore di quanto si pensasse in precedenza, e per quanto riguarda le ipotesi etiopatogenetiche, ma soprattutto è stata riscontrata un stretta associazione con il carcinoma a cellule squamose. Ancora in discussione sono le modalità di gestione della malattia dal punto di vista medico e chirurgico, anche se sono ormai assodate la necessità di confermare la diagnosi con l’esame istologico su biopsia della lesione e la necessità di un follow up a lungo termine. Conclusioni: il lichen sclerosus è una patologia debilitante sia dal punto di vista fisico che psicologico, che richiede un follow-up da prolungare lifetime, soprattutto nei pazienti pediatrici. Ulteriori studi sono necessari per migliorare le conoscenze, per favorire e anticipare la diagnosi della malattia, per evitare la degenerazione neoplastica e per identificare un algoritmo gestionale ottimale. ABSTRACT Purpose: review of the literature regarding the clinical presentation, etiology, natural history, and medical and surgical management of lichen sclerosus in men and women. Evaluation of the role of surgery in the disease, through the analysis of some cases treated in our department. The main aim is to check whether there is a place for surgery in the treatment of lichen sclerosus, or whether it should be considered simply as a mean to correct the sequelae of the disease. Materials and methods: I performed a wide-ranging search of the literature in Pubmed and other electronic databases using the key words “lichen sclerosus”, “lichen sclerosus et atrophicus”, and “balanitis xerotica obliterans”. I was thus able to examine the literature produced in various different research fields, not only dermatology, but also gynecology, urology and pediatrics. The search resulted in about 1,046 sources, which I then analyzed. Case history analysis. Results: lichen sclerosus is a chronic skin disease, probably immune-mediated, with a strong genetic component. Any skin site can be affected, though it shows a predilection for the external genitalia. It is most common in postmenopausal women, although it has been documented at all ages and in both sexes. The exact prevalence of lichen sclerosus is unknown. However, in recent years much progress has been made in defining its etiology and epidemiology, and we now know that it is far more frequent than previously thought. Above all, we have come to a better appreciation of the link between lichen sclerosus and squamous cell carcinoma. In this regard, we now know that any diagnosis must be evaluated with a biopsy of the lesion, and that long-term follow up is highly advisable, even if the medical and surgical management of the disease is still the subject of controversy. Conclusions: lichen sclerosus is a chronic, debilitating condition that may progress to cause significant physical and psychological complications. The disease calls for lifetime follow-up, especially in pediatric patients. Further research is needed to improve our knowledge, particularly to make diagnosis faster and easier, to rule out malignancy and to define clear diagnostic and therapeutic protocols

numerical study of flutter stabilization in low pressure turbine rotor with intentional mistuning

Abstract Intentional mistuning concepts are used to mitigate the risk of flutter occurrence for compressor and turbine blades, as this design strategy represents one of the key aspects in nowadays turbomachinery aeroelastic design. In this paper, the effects of a mistuning pattern on LPT flutter stability are numerically investigated in order to highlight the differences with the classic tuned configuration. A LPT rotor is analysed with an intentional mistuning pattern composed by alternate blades with different additional masses at the blade tip, and the corresponding tuned configuration, consisting of the blisk (blade+disk) with identical blades. The first part of this work is devoted to the modal analysis for tuned and mistuned cases. Frequencies and mode shapes of the first bending mode family, obtained by FEM modal analysis in cyclic symmetry, are then used to perform CFD flutter analysis with moving blades. The results confirm the stabilizing effect of alternate mistuning pattern in contrast with the tuned system which denotes a strong flutter instability for a large range of negative nodal diameters. The numerically predicted flutter stabilization effect has been confirmed by measurements carried out during a tip timing experimental campaign performed within the Future EU project

Ammonium recovery from municipal wastewater by ion exchange: Development and application of a procedure for sorbent selection

Ion exchange represents one of the most promising processes for ammonium recovery from municipal wastewater (MWW). However, most previous studies on ammonium ion exchange did not optimize the process or evaluate its robustness under real operational conditions. This experimental study aimed at (i) developing a procedure for the selection of a sorbent for selective ammonium removal/recovery from MWW, (ii) validating the procedure by applying it to several sorbents, (iii) performing a preliminary optimization and robustness assessment of ammonium removal/recovery with the selected sorbent. The application of the procedure to natural and synthetic zeolites and a cation exchange resin confirmed that batch isotherm tests need to be integrated by continuous-flow tests. The selected sorbent, a natural mixture of Chabazite and Phillipsite, resulted in high performances in terms of cation exchange capacity (33 mgN gdry resin-1), ammonium operating capacity (5.2 mgN gdry resin-1), ammonium recovery yield (78-91%) and selectivity towards ammonium. The process performances resulted stable during 7 adsorption/desorption cycles conducted with MWW treatment plant effluents in a 60-cm column. The switch to a highly saline effluent produced in a hotspot of seawater intrusion did not determine significant changes in performances. Contact time was reduced to 6 min without any decrease in performances. Potassium – well tolerated by crops – was selected as the regenerating agent, in the perspective to produce a desorbed product to be re-used as fertilizer. The study shows that Chabazite/Phillipsite has a high capacity to recover ammonium from MWW in a circular economy approach

The PPARγ2 Pro12Ala variant is protective against progression of nephropathy in people with type 2 diabetes

Cross-sectional studies suggest the association between diabetic nephropathy and the PPARγ2 Pro12Ala polymorphism of the peroxisome proliferator-activated receptor γ2 (PPARγ2). Prospective data are limited to microalbuminuria and no information on renal function is available to date. The present study evaluates the association between the Pro12Ala polymorphism of PPARγ2 and the progression of albuminuria and decay in glomerular filtration rate (GFR) in type 2 diabetes

Primary Intraosseous Squamous Cell Carcinoma of the Anterior Mandible Arising in an Odontogenic Cyst in 34-Year-Old Male

Abstract: Primary intraosseous squamous cell carcinoma (PIOSCC) is a rare and aggressive malignancy arising exclusively within the jaws, without any initial connection with the oral mucosa. The etiology and the epidemiology are unclear due to the rarity of the disease, and there is no current universally accepted staging or treatment protocol. Clinically, the posterior mandible is the most a ected site, and common symptoms are swelling and pain. The diagnosis is often di cult either because it requires stringent criteria to be satisfied or because of the absence of a pathognomonic histological pattern. Aggressive surgery is the first-choice treatment, often followed by radiotherapy. The lymph nodal status seems to be the most important factor influencing the prognosis, which is usually poor, with a 5-year survival rate ranging from 30% to 40%. In the present article, we report an unusual case of cystogenic PIOSCC interesting the anterior mandible of a young 34-year-old male, which came to our attention after complaint about recurrent infective episodes a ecting a dentigerous cyst (impacted lower canine) discovered ten years before. The age, site, and extension are uncommon. Extensive surgical treatment with fibula free flap reconstruction, adjuvant therapy, and salvage surgery was carried out. The patient was disease-free at a 31-month follow-up

Translation and validation of an Italian language version of the Religious Beliefs and Mental Illness Stigma Scale (I-RBMIS)

The aim of this study is to validate the Italian version of the Religious Beliefs and Mental Illness Stigma Scale (I-RBMIS): a self-report measure of religious beliefs that may contribute to stigma regarding mental disorders. Scale validation included: linguistic validation; pilot test for understandability; face validity; factor analysis as test of dimensionality; Kaiser–Meyer–Olkin test to evaluate sample sampling adequacy; internal consistency was assessed using Cronbach’s alpha; scale validity was assessed through concurrent criterion validity using as gold standard the Italian version of Attribution Questionnaire 27 and mental health knowledge schedule; A total of 311 people agreed to participate in the study. Face validity showed that 13 items out of 16 were completely understandable while only three items (4, 9 and 13) highlighted small lexical concerns. The average compilation time was under 4 min. Bartlett’s test for sphericity was statistically significant (Χ2 = 1497.54; df = 120; p < 0.001). Cronbach's alpha values were acceptable both for the entire questionnaire (0.80) and for the morality/sin subscale (0.73), whereas it was slightly below the standard cutoff for the spiritually oriented causes/treatments (0.68). Scale validity showed a positive correlation between I-RBMIS and AQ-27-I, and a negative correlation between I-RBMIS and MAKS-I. I-RBMIS demonstrated good psychometric properties to assess stigmatizing religious beliefs toward mental illness in general population

Pontine tegmental cap dysplasia: developmental and cognitive outcome in three adolescent patients

Pontine Tegmental Cap Dysplasia (PTCD) is a recently described, rare disorder characterized by a peculiar cerebellar and brainstem malformation. Nineteen patients have been reported to date, of which only one in the adolescent age, and data on the clinical, cognitive and behavioural outcome of this syndrome are scarce

Development of a Nomogram Predicting the Risk of Persistence/Recurrence of Cervical Dysplasia

Background: Cervical dysplasia persistence/recurrence has a great impact on women's health and quality of life. In this study, we investigated whether a prognostic nomogram may improve risk assessment after primary conization. Methods: This is a retrospective multi-institutional study based on charts of consecutive patients undergoing conization between 1 January 2010 and 31 December 2014. A nomogram assessing the importance of different variables was built. A cohort of patients treated between 1 January 2015 and 30 June 2016 was used to validate the nomogram. Results: A total of 2966 patients undergoing primary conization were analyzed. The median (range) patient age was 40 (18-89) years. At 5-year of follow-up, 6% of patients (175/2966) had developed a persistent/recurrent cervical dysplasia. Median (range) recurrence-free survival was 18 (5-52) months. Diagnosis of CIN3, presence of HR-HPV types, positive endocervical margins, HPV persistence, and the omission of HPV vaccination after conization increased significantly and independently of the risk of developing cervical dysplasia persistence/recurrence. A nomogram weighting the impact of all variables was built with a C-Index of 0.809. A dataset of 549 patients was used to validate the nomogram, with a C-index of 0.809. Conclusions: The present nomogram represents a useful tool for counseling women about their risk of persistence/recurrence after primary conization. HPV vaccination after conization is associated with a reduced risk of CIN2+