Ablation of painful metastatic bone tumors: A systematic review

AbstractThe pain is the most common problem in patients with bone metastases. It is not related to the characteristics of the tumor (type, location, number or size of metastases). Currently, the bone metastases can be treated with chemotherapy, hormonal therapy, surgery and radiotherapy, but the drugs most used in the treatment of pain are opioids. These drugs give benefit between 8 and 12weeks and often give non-negligible toxic effects. Percutaneous techniques are varied and, when there is indication, can be used to reduce pain and dose of morphine in these patients, being safe and effective techniques already at 4weeks of treatment.The choice of a methodical of ablation compared to another depends on the type, size and location of the lesion. Moreover, the combined treatments of ablation and cementoplastic are also useful to stabilize the bone lesion.This review article analyzes techniques and effectiveness of percutaneous treatments of skeletal metastases

Osteoimmunology of Spondyloarthritis

: The mechanisms underlying the development of bone damage in the context of spondyloarthritis (SpA) are not completely understood. To date, a considerable amount of evidence indicates that several developmental pathways are crucially involved in osteoimmunology. The present review explores the biological mechanisms underlying the relationship between inflammatory dysregulation, structural progression, and osteoporosis in this diverse family of conditions. we summarize the current knowledge of bone biology and balance and the foundations of bone regulation, including bone morphogenetic protein, the Wnt pathway, and Hedgehog signaling, as well as the role of cytokines in the development of bone damage in SpA. other areas surveyed include the pathobiology of bone damage and systemic bone loss (osteoporosis) in SpA and the effects of pharmacological treatment on focal bone damage. Lastly, we present data relative to a survey of bone metabolic assessment in SpA from Italian bone specialist rheumatology centers. The results confirm that most of the attention to bone health is given to postmenopausal subjects and that the aspect of metabolic bone health may still be underrepresented. In our opinion, it may be the time for a call to action to increase the interest in and focus on the diagnosis and management of SpA

MRI pattern characterization of cerebral cardioembolic lesions following atrial fibrillation ablation

BackgroundRecognizing etiology is essential for treatment and secondary prevention of cerebral ischemic events. A magnetic resonance imaging (MRI) pattern suggestive of an embolic etiology has been described but, to date, there are no uniformly accepted criteria.AimThe purpose of the study is to describe MRI features of ischemic cerebral lesions occurring after transcatheter ablation of atrial fibrillation (AF).MethodsA systematic review and meta-analysis of studies performing brain imaging investigations before and after AF transcatheter ablation was performed. The incidence of cerebral ischemic lesions after AF transcatheter ablation was the primary endpoint. The co-primary endpoints were the prevalence of the different neuroimaging features regarding the embolic cerebral ischemic lesions.ResultsA total of 25 studies, encompassing 3,304 patients, were included in the final analysis. The incidence of ischemic cerebral lesions following AF transcatheter ablation was 17.2% [95% confidence interval (CI) 12.2%–23.8%], of which a minimal fraction was symptomatic [0.60% (95% CI 0.09%–3.9%)]. Only 1.6% of the lesions (95% CI 0.9%–3.0%) had a diameter >10 mm, and in 20.5% of the cases the lesions were multiple (95% CI 17.1%–24.4%). Brain lesions were equally distributed across the two hemispheres and the different lobes; cortical location was more frequent [64.0% (95% CI 42.9%–80.8%)] while the middle cerebral artery territory was the most involved 37.0% (95% CI 27.3–48.0).ConclusionsThe prevailing MRI pattern comprises a predominance of small (<10 mm) cortical lesions, more prevalent in the territory of the middle cerebral artery

Quality of residential facilities in Italy: satisfaction and quality of life of residents with schizophrenia spectrum~disorders

Background Recovery and human rights promotion for people with Schizophrenia Spectrum Disorders (SSDs) is fundamental to provide good care in Residential Facilities (RFs). However, there is a concern about rehabilitation ethos in RFs. This study aimed to investigate the care quality of Italian RFs, the quality of life (QoL) and care experience of residents with SSD. Methods Fourty-eight RFs were assessed using a quality assessment tool (QuIRC-SA) and 161 residents with SSD were enrolled. Seventeen RFs provided high intensity rehabilitation (SRP1), 15 medium intensity (SRP2), and 16 medium-low level support (SRP3). Staff-rated tools measured psychiatric symptoms and psychosocial functioning; user-rated tools assessed QoL and satisfaction with services. RFs comparisons were made using ANOVA and Chi-squared. Results Over two-thirds patients (41.5 y.o., SD 9.7) were male. Seventy-six were recruited from SRP1 services, 48 from SRP2, and 27 from SRP3. The lowest QuIRC-SA scoring was Recovery Based Practice (45.8%), and the highest was promotion of Human Rights (58.4%). SRP2 had the lowest QuIRC-SA ratings and SRP3 the highest. Residents had similar psychopathology (p = 0.140) and functioning (p = 0.537). SRP3 residents were more employed (18.9%) than SRP1 (7.9%) or SRP2 (2.2%) ones, and had less severe negative symptoms (p = 0.016) and better QoL (p = 0.020) than SRP2 residents. There were no differences in the RF therapeutic milieu and their satisfaction with care. Conclusions Residents of the lowest supported RFs in Italy had less severe negative symptoms, better QoL and more employment than others. The lowest ratings for Recovery Based Practice across all RFs suggest more work is needed to improve recovery

TSH cordonale e TSH a un mese di vita in un gruppo di nati a termine da madre con patologia tiroidea

L’ipotiroidismo congenito è l’endocrinopatica più frequente dell’età evolutiva ed è anche la più frequente causa prevenibile di ritardo mentale. Tuttavia, gli studi degli ultimi decenni hanno mostrato come tutte le ipertireotropinemie nel neonato, persino quelle transitorie, se non trattate prontamente, si associno ad alterazioni dello sviluppo psicomotorio e neurocognitivo, con più bassi valori di QI rispetto alla popolazione di neonati sana, già nella prima infanzia. Lo screening introdotto nei paesi a medio-alto sviluppo socio-economico ha senz’altro portato a un netto innalzamento dell’incidenza di ipotiroidismo congenito, da 1:7.000-10.000 in epoca pre-screening, sino a 1:2.000-3.000, ad oggi. Ancora rimangono da chiarire alcuni fattori prenatali e postnatali che possano favorire lo sviluppo di ipertireotropinemie nella primissima infanzia. Nel nostro studio retrospettivo abbiamo raccolto i dati di 254 neonati nati a termine a Pisa tra settembre del 2018 e febbraio 2020, tutti nati da madri con tireopatia e abbiamo cercato le possibili correlazioni tra la patologia neonatale e materna, andando a valutare, in aggiunta, altri possibili fattori di rischio per ipertireotropinemia. Sono stati dosati i livelli di TSH dal sangue cordonale di tutti i neonati che poi abbiamo compreso nello studio; inoltre, è stato valutato il TSH tramite prelievi ematici a partire da un mese di vita. Dall’analisi dei dati è emerso che i neonati da madre in terapia con levotiroxina durante la gestazione presentavano valori di TSH cordonale più elevati. Questa correlazione spariva, però, sul TSH ad un mese di vita. Sul campione totale, 4 neonati, con TSH screening negativo, hanno necessitato di terapia con levotiroxina in seguito a riscontro di ipertireotropinemia dopo il primo mese di vita. Dall’analisi è inoltre emerso che nei gemelli, in accordo con la letteratura, si ha una tendenza ad un TSH cordonale più elevato e ad una maggior necessità di terapia rispetto ai neonati da parto singolo, con evidenze di livelli maggiori di TSH a partire dal primo mese di vita. Sono necessari ulteriori studi per trarre conclusioni certe riguardanti i fattori di rischio per ipertireotropinemia e per comprendere a fondo l’influenza della patologia e della terapia materne sulla funzionalità tiroidea del neonato