56 research outputs found
Combined HLA matched limbal stem cells allograft with amniotic membrane transplantation as a prophylactic surgical procedure to prevent corneal graft rejection after penetrating keratoplasty: case report
Purpose. To determine if the use of combined HLA matched limbal stem cells allograft with amniotic membrane transplantation (AMT) is a safe and effective prophylactic surgical procedure to prevent corneal graft after penetrating keratoplasty (PK).Methods. We report the case of a 17 years old patient with a history of congenital glaucoma, trabeculectomy and multiple corneal graft rejections, presenting total limbal cell deficiency. To reduce the possibility of graft rejection in the left eye after a new PK, a two step procedure was performed. At first the patient underwent a combined HLA matched limbal stem cells allograft (LAT) and AMT and then, 10 months later, a new PK.Results. During 12 months of follow-up, the corneal graft remained stable and smooth, with no sign of graft rejection.Conclusions. In our patient, the prophylactic use of LAT from HLA-matched donors and AMT before PK, may result in a better prognosis of corneal graft survival.
Design of a novel bimanual robotic system for single-port laparoscopy
Abstract—This paper presents the design and fabrication of Single-Port lapaRoscopy bImaNual roboT (SPRINT), a novel tele-operated robotic system for minimally invasive surgery. SPRINT, specifically designed for single-port laparoscopy, is a high-dexterity miniature robot, able to reproduce the movement of the hands of the surgeon, who controls the system through a master interface. It comprises two arms with six degrees of freedom (DOFs) that can be individually inserted and removed in a 30-mm-diameter umbilical access port. The system is designed to leave a central lumen free during operations, thus allowing the insertion of other laparoscopic tools. The four distal DOFs of each arm are actuated by on-board brushless dc motors, while the two proximal DOFs of the shoulder are actuated by external motors. The constraints gen-erated by maximum size and power requirements led to the design of compact mechanisms for the actuation of the joints. The wrist is actuated by three motors hosted in the forearm, with a peculiar differential mechanism that allows us to have intersecting roll– pitch–roll axes. Preliminary tests and validations were performed ex vivo by surgeons on a first prototype of the system. Index Terms—Bimanual robot, miniature robotic arm, mini-mally invasive surgery, robotic surgery, single-port laparoscopy (SPL). I
Clinical and psychological correlates of health-related quality of life in obese patients
<p>Abstract</p> <p>Background</p> <p>Health-related quality of life (HRQL) is poor in obese subjects and is a relevant outcome in intervention studies. We aimed to determine factors associated with poor HRQL in obese patients seeking weight loss in medical units, outside specific research projects.</p> <p>Methods</p> <p>HRQL, together with a number of demographic and clinical parameters, was studied with generic (SF-36, PGWB) and disease-specific (ORWELL-97) questionnaires in an unselected sample of 1,886 (1,494 women; 392 men) obese (BMI > 30 kg/m<sup>2</sup>) patients aged 20-65 years attending 25 medical units scattered throughout Italy. The clinics provide weight loss treatment using different programs. General psychopathology (SCL-90 questionnaire), the presence of binge eating (Binge Eating scale), previous weight cycling and somatic comorbidity (Charlson's index) were also determined. Scores on SF-36 and PGWB were compared with Italian population norms, and their association with putative determinants of HRQL after adjustment for confounders was assessed through logistic regression analysis.</p> <p>Results</p> <p>HRQL scores were significantly lower in women than in men. A greater impairment of quality of life was observed in relation to increasing BMI class, concurrent psychopathology, associated somatic diseases, binge eating, and weight cycling. In multivariate analysis, psychopathology (presence of previously-diagnosed mental disorders and/or elevated scores on SCL-90) was associated with lower HRQL scores on both psychosocial and somatic domains; somatic diseases and higher BMI, after adjustment for confounders, were associated with impairment of physical domains, while binge eating and weight cycling appeared to affect psychosocial domains only.</p> <p>Conclusions</p> <p>Psychopathological disturbances are the most relevant factors associated with poor HRQL in obese patients, affecting not only psychosocial, but also physical domains, largely independent of the severity of obesity. Psychological/psychiatric interventions are essential for a comprehensive treatment of obesity, and to improve treatment outcome and to reduce the burden of disease.</p
Weight Loss Expectations in Obese Patients and Treatment Attrition: An Observational Multicenter Study
Objective: To investigate the influence of weight loss expectations
(expected 1-year BMI loss, dream and maximum
acceptable BMI) on attrition in obese patients seeking treatment.
Research Methods and Procedures: Obese subjects (1785;
1393 women; median age, 46 years; median BMI, 36.7
kg/m2) seeking treatment in 23 medical Italian centers were
evaluated. Baseline diet and weight history, weight loss
expectations, and primary motivation for seeking treatment
(health or improving appearance) were systematically recorded.
Psychiatric distress, binge eating, and body image
dissatisfaction were tested at baseline by self-administered
questionnaires (Symptom Check List-90, Binge Eating
Scale, and Body Uneasiness Test). Attrition and BMI
change at 12 months were prospectively recorded.
Results: At 12 months, 923 of 1785 patients (51.7%) had
discontinued treatment. Compared with continuers, dropouts
had a significantly lower age, a lower age at first
dieting, lower dream BMI, a higher expected 1-year BMI
loss, and a higher weight phobia. At logistic regression
analysis, the strongest predictors of attrition at 12 months
were lower age and higher expected 1-year BMI loss. The
risk of drop-out increased systematically for unit increase in
expected BMI loss at 12 months (hazard ratio, 1.12; 95%
confidence interval, 1.04 to 1.20; p 0.0018). The risk was
particularly elevated in the first 6 months.
Discussion: Baseline weight loss expectations are independent
cognitive predictors of attrition in obese patients entering
a weight-losing program; the higher the expectations,
the higher attrition at 12 months. Unrealistic weight goals
should be tackled at the very beginning of treatment
Exploring K2G30 Genome: A High Bacterial Cellulose Producing Strain in Glucose and Mannitol Based Media
Demands for renewable and sustainable biopolymers have rapidly increased in the last decades along with environmental issues. In this context, bacterial cellulose, as renewable and biodegradable biopolymer has received considerable attention. Particularly, acetic acid bacteria of the Komagataeibacter xylinus species can produce bacterial cellulose from several carbon sources. To fully exploit metabolic potential of cellulose producing acetic acid bacteria, an understanding of the ability of producing bacterial cellulose from different carbon sources and the characterization of the genes involved in the synthesis is required. Here, K2G30 (UMCC 2756) was studied with respect to bacterial cellulose production in mannitol, xylitol and glucose media. Moreover, the draft genome sequence with a focus on cellulose related genes was produced. A pH reduction and gluconic acid formation was observed in glucose medium which allowed to produce 6.14 ± 0.02 g/L of bacterial cellulose; the highest bacterial cellulose production obtained was in 1.5% (w/v) mannitol medium (8.77 ± 0.04 g/L), while xylitol provided the lowest (1.35 ± 0.05 g/L) yield. Genomic analysis of K2G30 revealed a peculiar gene sets of cellulose synthase; three bcs operons and a fourth copy of bcsAB gene, that encodes the catalytic core of cellulose synthase. These features can explain the high amount of bacterial cellulose produced by K2G30 strain. Results of this study provide valuable information to industrially exploit acetic acid bacteria in producing bacterial cellulose from different carbon sources including vegetable waste feedstocks containing mannitol
Psychological Distress in Morbid Obesity in Relation to Weight History
Background: Very few data are available on psychological
distress in morbidly obese subjects in relation
to the history of their weight. In subjects with childhood
obesity, psychological distress might be better
than in adult-onset obesity, because of progressive
adaptation to the social stigma.
Methods: Psychological distress was tested in relation
to BMI at age 20 years (BMI-20), weight history
and somatic co-morbidities in 632 treatment-seeking,
morbidly obese participants from the QUOVADIS
cohort (130 men, 502 women; mean age 45.5 years).
The number of dieting attempts/year, BMI increase
and cumulative BMI loss since age 20 were calculated
as weight cycling parameters.The Symptom Check
List-90 (SCL-90), the Psychological General Well-
Being (PGWB), the Binge-Eating Scale, and the
ORWELL-97 questionnaire were used to score psychometry
and health-related quality of life (HRQL).
Complications were quantitatively assessed by a
modified Charlson\u2019s score.
Results: BMI-20 was normal in 35% of cases and >35
kg/m2 in only 14%. Psychometric scores were not different
in relation to BMI-20, when corrected for age,
with the exception of the General Health scale of
PGWB, showing a greater distress in subjects with
normal BMI-20. In most cases, the prevalence of
pathological results of questionnaires showed a Jshaped
curve, with participants with normal BMI-20 or
those with Class II-III obesity in early adulthood having
the highest prevalence of psychological/psychiatric
distress and poor HRQL.Weight cycling was a risk factor
for binge-eating, depression and interpersonal
sensitivity in SCL-90, whereas somatic co-morbidities
adversely affected most SCL-90 and all PGWB scales.
Conclusion: Weight cycling and somatic co-morbidities,
but not age of onset of obesity, are the main
factors negatively influencing psychological health in
treatment-seeking, morbidly obese subjects
A simplified genomic profiling approach predicts outcome in metastatic colorectal cancer
The response of metastatic colorectal cancer (mCRC) to the first-line conventional combination therapy is highly variable, reflecting the elevated heterogeneity of the disease. The genetic alterations underlying this heterogeneity have been thoroughly characterized through omic approaches requiring elevated efforts and costs. In order to translate the knowledge of CRC molecular heterogeneity into a practical clinical approach, we utilized a simplified Next Generation Sequencing (NGS) based platform to screen a cohort of 77 patients treated with first-line conventional therapy. Samples were sequenced using a panel of hotspots and targeted regions of 22 genes commonly involved in CRC. This revealed 51 patients carrying actionable gene mutations, 22 of which carried druggable alterations. These mutations were frequently associated with additional genetic alterations. To take into account this molecular complexity and assisted by an unbiased bioinformatic analysis, we defined three subgroups of patients carrying distinct molecular patterns. We demonstrated these three molecular subgroups are associated with a different response to first-line conventional combination therapies. The best outcome was achieved in patients exclusively carrying mutations on TP53 and/or RAS genes. By contrast, in patients carrying mutations in any of the other genes, alone or associated with mutations of TP53/RAS, the expected response is much worse compared to patients with exclusive TP53/RAS mutations. Additionally, our data indicate that the standard approach has limited efficacy in patients without any mutations in the genes included in the panel. In conclusion, we identified a reliable and easy-to-use approach for a simplified molecular-based stratification of mCRC patients that predicts the efficacy of the first-line conventional combination therapy
Prevalence and burden of obesity in Rehabilitation Units in Italy: a survey
No abstract has been provide
Mask process matching using a model based data preparation solution
International audienc
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