The Effect of Manual Therapy Plus Exercise in Patients with Lateral Ankle Sprains: A Critically Appraised Topic with a Meta-Analysis

A high percentage of patients with lateral ankle sprains report poor outcomes and persistent neuromuscular impairment leading to chronic ankle instability and re-injury. Several interventions have been proposed and investigated, but the evidence on manual therapy combined with therapeutic exercise for pain reduction and functional improvement is still uncertain. The purpose was to study the effectiveness of adding manual therapy to therapeutic exercise in patients with lateral ankle sprains through a critically appraised topic. The literature search was performed in PubMed, PEDro, EMBASE and CINAHL databases, and only randomized clinical trials were included according to following criteria: (1) subjects with acute episodes of lateral ankle sprains, (2) administered manual therapy plus therapeutic exercise, (3) comparisons with therapeutic exercise alone and (4) reported outcomes for pain and function. Three randomized clinical trials (for a total of 180 patients) were included in the research. Meta-analyses revealed that manual therapy plus exercise was more effective than only exercises in improving dorsal (MD = 8.79, 95% CI: 6.81, 10.77) and plantar flexion (MD = 8.85, 95% CI 7.07, 10.63), lower limb function (MD = 1.20, 95% CI 0.63, 1.77) and pain (MD = -1.23; 95% IC -1.73, -0.72). Manual therapy can be used with therapeutic exercise to improve clinical outcome in patients with lateral ankle sprains

A national survey on the current status of minimally invasive gastric practice on behalf of GIRCG

: Italian Research Group for Gastric Cancer (GIRCG), during the 2013 annual Consensus Conference to gastric cancer, stated that laparoscopic or robotic approach should be limited only to early gastric cancer (EGC) and no further guidelines were currently available. However, accumulated evidences, mainly from eastern experiences, have supported the application of minimally invasive surgery also for locally advanced gastric cancer (AGC). The aim of our study is to give a snapshot of current surgical propensity of expert Italian upper gastrointestinal surgeons in performing minimally invasive techniques for the treatment of gastric cancer in order to answer to the question if clinical practice overcome the recommendation. Experts in the field among the Italian Research Group for Gastric Cancer (GIRCG) were invited to join a web 30-item survey through a formal e-mail from January 1st, 2020, to June 31st, 2020. Responses were collected from 46 participants out of 100 upper gastrointestinal surgeons. Percentage of surgeons choosing a minimally invasive approach to treat early and advanced gastric cancer was similar. Additionally analyzing data from the centers involved, we obtained that the percentage of minimally invasive total and partial gastrectomies in advanced cases augmented with the increase of surgical procedures performed per year (p = 0.02 and p = 0.04 respectively). It is reasonable to assume that there is a widening of indications given by the current national guideline into clinical practice. Propensity of expert Italian upper gastrointestinal surgeons was to perform minimally invasive surgery not only for early but also for advanced gastric cancer. Of interest volume activity correlated with the propensity of surgeons to select a minimally invasive approach

A national survey on the current status of minimally invasive gastric practice on behalf of GIRCG

: Italian Research Group for Gastric Cancer (GIRCG), during the 2013 annual Consensus Conference to gastric cancer, stated that laparoscopic or robotic approach should be limited only to early gastric cancer (EGC) and no further guidelines were currently available. However, accumulated evidences, mainly from eastern experiences, have supported the application of minimally invasive surgery also for locally advanced gastric cancer (AGC). The aim of our study is to give a snapshot of current surgical propensity of expert Italian upper gastrointestinal surgeons in performing minimally invasive techniques for the treatment of gastric cancer in order to answer to the question if clinical practice overcome the recommendation. Experts in the field among the Italian Research Group for Gastric Cancer (GIRCG) were invited to join a web 30-item survey through a formal e-mail from January 1st, 2020, to June 31st, 2020. Responses were collected from 46 participants out of 100 upper gastrointestinal surgeons. Percentage of surgeons choosing a minimally invasive approach to treat early and advanced gastric cancer was similar. Additionally analyzing data from the centers involved, we obtained that the percentage of minimally invasive total and partial gastrectomies in advanced cases augmented with the increase of surgical procedures performed per year (p = 0.02 and p = 0.04 respectively). It is reasonable to assume that there is a widening of indications given by the current national guideline into clinical practice. Propensity of expert Italian upper gastrointestinal surgeons was to perform minimally invasive surgery not only for early but also for advanced gastric cancer. Of interest volume activity correlated with the propensity of surgeons to select a minimally invasive approach

The NEMO project: A status report

none87The latest results and the activities towards the construction of a km3 Cherenkov neutrino detector carried out by the NEMO Collaboration are described. Long-term exploration of a 3500 m deep-sea site close to the Sicilian coast has shown that it is optimal for the installation of the detector. The NEMO Phase-1 project has validated several technologies proposed for the construction of the km3 detector on a test site at 2000 m depth. The new infrastructure on the candidate Capo Passero site set up as part of the Phase-2 project will provide the possibility to test detector components at 3500 m depth.M. Taiuti;S. Aiello;F. Ameli;I. Amore;M. Anghinolfi;A. Anzalone;G. Barbarino;M. Battaglieri;M. Bazzotti;A. Bersani;N. Beverini;S. Biagi;M. Bonori;B. Bouhdaef;M. Brunoldi;G. Cacopardo;A. Capone;L. Caponetto;G. Carminati;T. Chiarusi;M. Circella;R. Cocimano;R. Coniglione;M. Cordelli;M. Costa;A. D’Amico;G. De Bonis;G. De Rosa;G. De Ruvo;R. De Vita;C. Distefano;E. Falchini;V. Flaminio;K. Fratini;A. Gabrielli;S. Galatà;E. Gandolfi;G. Giacomelli;F. Giorgi;G. Giovanetti;A. Grimaldi;R. Habel;M. Imbesi;V. Kulikovsky;D. Lattuada;E. Leonora;A. Lonardo;D. Lo Presti;F. Lucarelli;A. Margiotta;A. Marinelli;A. Martini;R. Masullo;E. Migneco;S. Minutoli;M. Morganti;P. Musico;M. Musumeci;C.A. Nicolau;A. Orlando;M. Osipenko;R. Papaleo;V. Pappalardo;P. Piattelli;D. Piombo;G. Raia;N. Randazzo;S. Reito;G. Ricco;G. Riccobene;M. Ripani;A. Rovelli;M. Ruppi;G.V. Russo;S. Russo;P. Sapienza;D. Sciliberto;M. Sedita;E. Shirokov;F. Simeone;V. Sipala;M. Spurio;L. Trasatti;S. Urso;M. Vecchi;P. Vicini;R. WischnewskiTaiuti, MAURO GINO; S., Aiello; F., Ameli; I., Amore; M., Anghinolfi; A., Anzalone; G., Barbarino; M., Battaglieri; M., Bazzotti; A., Bersani; N., Beverini; S., Biagi; M., Bonori; B., Bouhdaef; Brunoldi, Marco; G., Cacopardo; A., Capone; L., Caponetto; G., Carminati; T., Chiarusi; M., Circella; R., Cocimano; R., Coniglione; M., Cordelli; M., Costa; A., D’Amico; G., De Bonis; G., De Rosa; G., De Ruvo; R., De Vita; C., Distefano; E., Falchini; V., Flaminio; Fratini, Katia; A., Gabrielli; S., Galatà; E., Gandolfi; G., Giacomelli; F., Giorgi; G., Giovanetti; A., Grimaldi; R., Habel; M., Imbesi; V., Kulikovsky; D., Lattuada; E., Leonora; A., Lonardo; D., Lo Presti; F., Lucarelli; A., Margiotta; A., Marinelli; A., Martini; R., Masullo; E., Migneco; S., Minutoli; M., Morganti; P., Musico; M., Musumeci; C. A., Nicolau; A., Orlando; M., Osipenko; R., Papaleo; V., Pappalardo; P., Piattelli; D., Piombo; G., Raia; N., Randazzo; S., Reito; Ricco, Giovanni; G., Riccobene; M., Ripani; A., Rovelli; M., Ruppi; G. V., Russo; S., Russo; P., Sapienza; D., Sciliberto; M., Sedita; E., Shirokov; F., Simeone; V., Sipala; M., Spurio; L., Trasatti; S., Urso; M., Vecchi; P., Vicini; R., Wischnewsk

KM3NeT. Conceptual Design Report for a Deep-Sea Research Infrastructure Incorporating a Very Large Volume Neutrino Telescope in the Mediterranean Sea

The scientific case for a neutrino telescope of a cubic kilometre scale is overwhelming. The infra‐structure it requires can easily be shared by a host of other, associated, sciences, making long‐term measurements in the area of oceanography, clima‐tology, geophysics, geotechnics and marine bio‐logical sciences possible. This combination of neu‐trino telescope and multidisciplinary undersea ob‐servatory, KM3NeT, is the subject of this Design Report. It summarises goals for the design and the options for its technical implementation

Breakthrough Cancer Pain: Preliminary Data of The Italian Oncologic Pain Multisetting Multicentric Survey (IOPS-MS)

Introduction: An ongoing national multicenter survey [Italian Oncologic Pain multiSetting Multicentric Survey (IOPS-MS)] is evaluating the characteristics of breakthrough cancer pain (BTP) in different clinical settings. Preliminary data from the first 1500 cancer patients with BTP enrolled in this study are presented here. Methods: Thirty-two clinical centers are involved in the survey. A diagnosis of BTP was performed by a standard algorithm. Epidemiological data, Karnofsky index, stage of disease, presence and sites of metastases, ongoing oncologic treatment, and characteristics of background pain and BTP and their treatments were recorded. Background pain and BTP intensity were measured. Patients were also questioned about BTP predictability, BTP onset (≤10 or >10 min), BTP duration, background and BTP medications and their doses, time to meaningful pain relief after BTP medication, and satisfaction with BTP medication. The occurrence of adverse reactions was also assessed, as well as mucosal toxicity. Results: Background pain was well controlled with opioid treatment (numerical rating scale 3.0 ± 1.1). Patients reported 2.5 ± 1.6 BTP episodes/day with a mean intensity of 7.5 ± 1.4 and duration of 43 ± 40 min; 977 patients (65.1%) reported non-predictable BTP, and 1076 patients (71.7%) reported a rapid onset of BTP (≤10 min). Higher patient satisfaction was reported by patients treated with fast onset opioids. Conclusions: These preliminary data underline that the standard algorithm used is a valid tool for a proper diagnosis of BTP in cancer patients. Moreover, rapid relief of pain is crucial for patients’ satisfaction. The final IOPS-MS data are necessary to understand relationships between BTP characteristics and other clinical variables in oncologic patients. Funding: Molteni Farmaceutici, Italy