Acromion Clavicular Joint Reconstruction with LARS Ligament in Acute Dislocation

Background: The acromion clavicular joint dislocations are common injuries of the shoulder. The severity is dependent upon the degree of ligamentous injury. Surgical treatment is typically performed in higher grade acromioclavicular separation with several static and dynamic operative procedures with or without primary ligament replacement. Methods: 47 patients with acute Rockwood type III, IV, and V injuries were treated surgically with LARS reconstruction. The success of technique was evaluated by radiographic outcomes for each patient at every follow-up visit (one,three, 12 months), while to assess pain reduction and clinical evaluation Visual Analogue scale score (VAS) and Constant-Murley score (CMA) was performed, respectively. An One Way Analysis of Variance (Kruskal-Wallis test), a multiple comparison Turket test, or a t-test (Mann-Whitney Rank Sum Test) were used when required. Results: Follow-up radiographs revealed maintenance of anatomical reduction in 41 patients, and no bone erosions has been identified. In short-term joint functional recovery has been observed. Indeed, after 12 months pain on the VAS-scale in all groups decreased significantly (P < 0.05), and the CMS revealed a significant overall improvement (P < 0.05). Conclusion: These data demonstrate that the use of the LARS allows to provide stability to the joint and especially to ensure its natural elasticity, relieving pain and improving joint function already one month post-surgery. Level of evidence: II

Carmustine Wafers Implantation in Patients With Newly Diagnosed High Grade Glioma: Is It Still an Option?

Background: The implantation protocol for Carmustine Wafers (CWs) in high grade glioma (HGG) was developed to offer a bridge between surgical resection and adjuvant treatments, such as radio- and chemotherapy. In the last years, however, a widespread use of CWs has been limited due to uncertainties regarding efficacy, in addition to increased risk of infection and elevated costs of treatment. Objective: The aims of our study were to investigate the epidemiology of patients that underwent surgery for HGG with CW implantation, in addition to the assessment of related complications, long-term overall survival (OS), and associated prognostic factors. Methods: Three different medical databases were screened for conducting a systematic review of the literature, according to the PRISMA statement guidelines, evaluating the role of BCNU wafer implantation in patients with newly diagnosed HGG. The search query was based on a combination of medical subject headings (MeSH): “high grade glioma” [MeSH] AND “Carmustine” [MeSH] and free text terms: “surgery” OR “BCNU wafer” OR “Gliadel” OR “systemic treatment options” OR “overall survival.” Results: The analysis of the meta-data demonstrated that there was a significant advantage in using CWs in newly diagnosed GBM in terms of OS, and a very low heterogeneity among the included studies [mean difference 2.64 (95% CI 0.85, 4.44); p = 0.004; I2149 = 0%]. Conversely, no significant difference between the two treatment groups in terms of PFS wad detected (p = 0.55). The analysis of complications showed a relatively higher rate in Carmustine implanted patients, although this difference was not significant (p = 0.53). Conclusions: This meta-analysis seems to suggest that CWs implantation plays a significant role in improving the OS, when used in patients with newly diagnosed HGG. To minimize the risk of side effects, however, a carful patient selection based mainly on patient age and tumor volume should be desirable

Implementation and validation of a new method to model voluntary departures from emergency departments

In the literature, several organizational solutions have been proposed for determining the probability of voluntary patient discharge from the emergency department. Here, the issue of self-discharge is analyzed by Markov theory-based modeling, an innovative approach diffusely applied in the healthcare field in recent years. The aim of this work is to propose a new method for calculating the rate of voluntary discharge by defining a generic model to describe the process of first aid using a “behavioral” Markov chain model, a new approach that takes into account the satisfaction of the patient. The proposed model is then implemented in MATLAB and validated with a real case study from the hospital “A. Cardarelli” of Naples. It is found that most of the risk of self-discharge occurs during the wait time before the patient is seen and during the wait time for the final report; usually, once the analysis is requested, the patient, although not very satisfied, is willing to wait longer for the results. The model allows the description of the first aid process from the perspective of the patient. The presented model is generic and can be adapted to each hospital facility by changing only the transition probabilities between states

Optical response of a misaligned and suspended Fabry-Perot cavity

The response to a probe laser beam of a suspended, misaligned and detuned optical cavity is examined. A five degree of freedom model of the fluctuations of the longitudinal and transverse mirror coordinates is presented. Classical and quantum mechanical effects of radiation pressure are studied with the help of the optical stiffness coefficients and the signals provided by an FM sideband technique and a quadrant detector, for generic values of the product $\varpi \tau$ of the fluctuation frequency times the cavity round trip. A simplified version is presented for the case of small misalignments. Mechanical stability, mirror position entanglement and ponderomotive squeezing are accommodated in this model. Numerical plots refer to cavities under test at the so-called Pisa LF facility.Comment: 14 pages (4 figures) submitted to Phys. Rev.

A health technology assessment between two pharmacological therapies through Six Sigma: the case study of bone cancer

Purpose: Head and neck cancers are multi-factorial diseases that can affect many sides of people's life and are due to a lot of risk factors. According to their characteristics, the treatment can be surgical, use of radiation or chemotherapy. The use of a surgical treatment can lead to surgical infections that are a main theme in medicine. At the University hospital of Naples “Federico II”, two antibiotics were employed to tackle the issue of the infections and they are compared in this paper to find which one implies the lowest length of hospital stay (LOS) and the reduction of infections. Design/methodology/approach: The Six Sigma methodology and its problem-solving strategy DMAIC (define, measure, analyse, improve, control), already employed in the healthcare sector, were used as a tool of a health technology assessment between two drugs. In this paper the DMAIC roadmap is used to compare the Ceftriaxone (administered to a group of 48 patients) and the association of Cefazolin plus Clindamycin (administered to a group of 45 patients). Findings: The results show that the LOS of patients treated with Ceftriaxone is lower than those who were treated with the association of Cefazolin plus Clindamycin, the difference is about 41%. Moreover, a lower number of complications and infections was found in patients who received Ceftriaxone. Finally, a greater number of antibiotic shifts was needed by patients treated with Cefazolin plus Clindamycin. Research limitations/implications: While the paper enhances clearly the advantages for patients' outcomes regarding the LOS and the number of complications, it did not analyse the costs of the two antibiotics. Practical implications: Employing the Ceftriaxone would allow the Department of Maxillofacial Surgery to obtain lower LOS and a limited number of complications/infections for recovered patients, consequently reducing the hospitalization costs. Originality/value: There is a double value in this paper: first of all, the comparison between the two antibiotics gives an answer to one of the main issues in medicine that is the reduction of hospital-acquired infections; secondly, the Six Sigma through its DMAIC cycle can be employed also to compare two biomedical technologies as a tool of health technology assessment studies

Porous iron-nitrogen-carbon electrocatalysts for anion exchange membrane fuel cells (AEMFC)

High-performance platinum group metal-free (PGM-free) electrocatalysts were prepared from porous organic polymers (POPs) precursors with highly-porous structures and adjustable surface area. A resin phenol-melamine-based POP and an iron salt were used to synthesize Fe−N−C catalysts with different iron contents (0.2–1.3 wt.%). Electrochemical and spectroscopical characterization allowed us to elucidate the effect of Fe content on the material's structure, surface chemistry, and electrocatalytic activity toward the oxygen reduction reaction (ORR). The increase of iron content led to a specific surface area decrease, preserving the morphological structure, with the formation of highly-active catalytic sites, as indicated by X-ray photoelectron spectroscopy (XPS) analysis. The rotating ring disk electrode experiments, performed at pH=13, confirmed the high ORR activity of both 0.5 Fe (E1/2=0.84 V) and 1.3 Fe (E1/2=0.83 V) catalysts, which were assembled at the cathode of a H2-fed anion exchange membrane fuel cells (AEMFC) equipped with a FAA-3-50 membrane, evidencing promising performance (0.5 Fe, maximum power density, Max PD=69 mA cm−2 and 1.3 Fe, Max PD=87 mA cm−2) with further advancement prospects

Analytical Solution for the Deformation of a Cylinder under Tidal Gravitational Forces

Quite a few future high precision space missions for testing Special and General Relativity will use optical resonators which are used for laser frequency stabilization. These devices are used for carrying out tests of the isotropy of light (Michelson-Morley experiment) and of the universality of the gravitational redshift. As the resonator frequency not only depends on the speed of light but also on the resonator length, the quality of these measurements is very sensitive to elastic deformations of the optical resonator itself. As a consequence, a detailed knowledge about the deformations of the cavity is necessary. Therefore in this article we investigate the modeling of optical resonators in a space environment. Usually for simulation issues the Finite Element Method (FEM) is applied in order to investigate the influence of disturbances on the resonator measurements. However, for a careful control of the numerical quality of FEM simulations a comparison with an analytical solution of a simplified resonator model is beneficial. In this article we present an analytical solution for the problem of an elastic, isotropic, homogeneous free-flying cylinder in space under the influence of a tidal gravitational force. The solution is gained by solving the linear equations of elasticity for special boundary conditions. The applicability of using FEM codes for these simulations shall be verified through the comparison of the analytical solution with the results gained within the FEM code.Comment: 23 pages, 3 figure

Especies hidrófitas y palustres utilizadas como medicinales por los habitantes del norte y nordeste de la provincia del Chaco

En una encuesta a 126 habitantes, de tres departamentos del centro del chaco argentino, se refirieron al uso de especies vegetales autóctonas hidrófitas y palustres en medicina popular, identificadas por sus nombres vulgares; así, se recogió material vegetal que fue identificado y herborizado y correspondieron a: Althernanthera philoxeroides f. philoxeroides, Canna glauca var. glauca, C. indica, Eichhornia crassipes, Equisetum giganteum, Eryngium pandanifolium, Hydrocotile bonariensis, Pistia stratiotes, Polygonum acuminatum, P. punctatum, Pontederia rotundifolia, Sagittaria montevidensis, Schoenoplectus californicus var. californicus y Typha domingensis empleadas como diuréticas, depurativas, digestivas, antidiarreicas, cardiotónicas, hipotensoras, oftálmicas, laxantes suaves y emenagogas

Interrupted versus uninterrupted NOAC peri-implantation of cardiac device: A single-centre randomised prospective pilot trial

BACKGROUND: Many patients requiring cardiac implantable electronic device (CIED) implantation are on long-term oral anticoagulant therapy. While continuation of warfarin has been shown to be safe and reduce bleeding complications compared to interruption of warfarin therapy and heparin bridging, it is not known which novel oral anticoagulants (NOAC) regimen (interrupted vs. uninterrupted) is better in this setting. METHODS: One-hundred and one patients were randomized to receive CIED implantation with either interrupted or uninterrupted/continuous NOAC therapy before surgery. No heparin was used in either treatment arm. The primary end-point was the presence of a clinically significant pocket haematoma after CIED implantation. The secondary end-point was a composite of other major bleeding events, device-related infection, thrombotic events and device-related admission length post device implantation. RESULTS: Both treatment groups were equally balanced for baseline variables and concomitant medications. One clinically significant pocket haematoma occurred in the uninterrupted NOAC group and none in the interrupted group (p = 0.320). There was no difference in other bleeding complications. No thrombotic events were observed in either of the two groups. CONCLUSIONS: Despite the paucity of bleeding events, data from this pilot study suggest that uninterrupted NOAC therapy for CIED implantation appears to be as safe as NOAC interruption and does not increase bleeding complications