Polysaccharides-based medical devices for tissue engineering

Lo scopo di questo progetto di dottorato è stato la progettazione e lo sviluppo di piattaforme terapeutiche multifunzionali come sostituti della pelle per ripristinare l'integrità dei tessuti. Il capitolo 1 esamina i dispositivi medici basati sulla nanotecnologia intesi come sostituti della pelle. La discussione è incentrata sulla definizione degli attributi critici di qualità, sulla valutazione preclinica, sulla valutazione clinica e sulla marcatura CE di dispositivi medici a base di nanotecnologie. Il capitolo 2 si concentra sullo sviluppo di scaffold nanofibrosi elettrofilati a base di gelatina e-polisaccaridi destinati alla guarigione delle ferite della tasca parodontale. Il capitolo 3 si concentra sullo sviluppo di scaffold elettrofilati a base di maltodestrina e reticolati con la reazione di Maillard per la rigenerazione delle ferite croniche. Il capitolo 4 si concentra sullo sviluppo di microparticelle a base di destrano o maltodestrina caricate con nanoparticelle di ZnO o CuO per combinare le proprietà di guarigione delle ferite e l'attività antimicrobica. Il capitolo 5 si concentra sullo sviluppo di microsfere di fibroina/gomme da inserire nella tasca parodontale per ripristinare l'integrità dei tessuti. Il capitolo 6 si concentra sulla progettazione di microsfere a base di grilli e polisaccaridi algali per la rigenerazione del tessuto parodontale.The aim of this PhD project was the design and the development of multifunctional therapeutic platforms as skin substitutes to restore tissue integrity. Chapter 1 reviews nanotechnology-based medical devices intended as skin substitutes. The discussion is focused on the definition of critical quality attributes, the preclinical evaluation, the clinical evaluation, and the CE marking of nanotechnology-based MDs. Chapter 2 focuses on the development of gelatin-polysaccharides based-electrospun nanofibrous scaffolds intended for wound healing of the periodontal pocket. Chapter 3 focuses on the development of electrospun scaffolds based on maltodextrin and cross-linked with Maillard-type reaction for regeneration of chronic wounds. Chapter 4 focuses on the development of dextran or maltodextrin-based microparticles doped with ZnO or CuO nanoparticles to combine wound healing properties and antimicrobial activity. Chapter 5 focuses on the development of fibroin/gums microspheres to be inserted in the periodontal pocket to restore tissue integrity. Chapter 6 focuses on the design of microspheres based on crickets and seaweed polysaccharides for regeneration of the periodontal tissue

Should we be concerned about stigma and discrimination in people at risk for psychosis? A systematic review.

AbstractBackgroundPrevious studies have provided initial evidence that people at risk for psychosis (PR) suffer from stigma and discrimination related to their condition. However, no study has systematically reviewed stigma and discrimination associated with being at PR and the potential underlying mechanisms.MethodsThis work aimed to systematically review all studies addressing stigma and discrimination in PR people in order to assess: (1) the occurrence of this phenomenon and its different components (public, internalized, perceived, and labeling-related), (2) whether stigma affects outcomes of the PR state, and (3) whether other factors modulate stigma among PR individuals.ResultsThe reviewed studies (n = 38) widely differ in their design, methodological quality, and populations under investigation, thus limiting direct comparison of findings. However, converging evidence suggests that the general public endorses stigmatizing attitudes towards PR individuals, and that this is more frequent in people with a low educational level or with no direct experience of the PR state. PR individuals experience more internalized stigma and perceive more discrimination than healthy subjects or patients with non-psychotic disorders. Further, PR labeling is equally associated with both positive (e.g. validation and relief) and negative effects (e.g. status loss and discrimination). Moreover, stigma increases the likelihood of poor outcome, transition to full-psychosis, disengagement from services, and family stigma among PR individuals. Finally, very limited evidence awaiting replication supports the efficacy of cognitive therapies in mitigating the negative effects of stigma.ConclusionsEvidence confirms previous concerns about stigma and its negative consequences for PR individuals, thus having important public health implications

Thrombotic and hemorrhagic complications in idiopathic erythrocytosis

We report clinical features of a large cohort of patients with IE compared to a cohort of patients with PV, focusing on the thrombotic and hemorrhagic risk

Prevention and early intervention in youth mental health: is it time for a multidisciplinary and trans-diagnostic model for care?

Background: Similar to other health care sectors, mental health has moved towards the secondary prevention, with the effort to detect and treat mental disorders as early as possible. However, converging evidence sheds new light on the potential of primary preventive and promotion strategies for mental health of young people. We aimed to reap- praise such evidence. Methods: We reviewed the current state of knowledge on delivering promotion and preventive interventions addressing youth mental health. Results: Half of all mental disorders start by 14 years and are usually preceded by non-specific psychosocial distur- bances potentially evolving in any major mental disorder and accounting for 45% of the global burden of disease across the 0\u201325 age span. While some action has been taken to promote the implementation of services dedicated to young people, mental health needs during this critical period are still largely unmet. This urges redesigning preven- tive strategies in a youth-focused multidisciplinary and trans-diagnostic framework which might early modify possible psychopathological trajectories. Conclusions: Evidence suggests that it would be unrealistic to consider promotion and prevention in mental health responsibility of mental health professionals alone. Integrated and multidisciplinary services are needed to increase the range of possible interventions and limit the risk of poor long-term outcome, with also potential benefits in terms of healthcare system costs. However, mental health professionals have the scientific, ethical, and moral responsibility to indicate the direction to all social, political, and other health care bodies involved in the process of meeting mental health needs during youth years

Cannabis and cognition: connecting the dots towards the understanding of the relationship

Several studies have advanced the understanding of the effects of cannabis on cognitive function. A comprehensive reappraisal of such literature may help in drawing conclusions about the potential risks associated with cannabis use. In summary, the evidence suggests that earlier age of use, high-frequency and high-potency cannabis use, as well as sustained use over time and use of synthetic cannabinoids, are all correlated with a higher likelihood of developing potentially severe and persistent executive function impairments. While the exact mechanisms underlying the adverse effects of cannabis on cognition are not completely clear, Magnetic Resonance Imaging (MRI) studies support the presence of both structural and functional alterations associated with cannabis use. Cognitive dysfunction is also a core feature of many neuropsychiatric disorders and care must be taken regarding the effects of cannabis use in these patient populations. Cognitive impairments affect patients' daily functions, sociability, and long-term outcome, posing elevated economic, social, and clinical burdens. There is, thus, a compelling case for implementing behavioral and cognitive rehabilitation therapies for these patients, as well as investigating the endocannabinoid system in the development of new psychopharmacological treatments

Unraveling the Intoxicating and Therapeutic Effects of Cannabis Ingredients on Psychosis and Cognition

Research evidence suggests a dose-response relationship for the association between cannabis use and risk of psychosis. Such relationship seems to reflect an increased risk of psychosis not only as a function of frequent cannabis use, but also of high-potency cannabis use in terms of concentration of \u394-9-tetrahydrocannabinol (\u3949-THC), its main psychoactive component. This finding would be in line with the evidence that \u3949-THC administration induces transient psychosis-like symptoms in otherwise healthy individuals. Conversely, low-potency varieties would be less harmful because of their lower amount of \u3949-THC and potential compresence of another cannabinoid, cannabidiol (CBD), which seems to mitigate \u3949-THC detrimental effects. A growing body of studies begins to suggest that CBD may have not only protective effects against the psychotomimetic effects of \u3949-THC but even therapeutic properties on its own, opening new prospects for the treatment of psychosis. Despite being more limited, evidence of the effects of cannabis on cognition seems to come to similar conclusions, with increasing \u3949-THC exposure being responsible for the cognitive impairments attributed to recreational cannabis use while CBD preventing such effects and, when administered alone, enhancing cognition. Molecular evidence indicates that \u3949-THC and CBD may interact with cannabinoid receptors with almost opposite mechanisms, with \u3949-THC being a partial agonist and CBD an inverse agonist/antagonist. With the help of imaging techniques, pharmacological studies in vivo have been able to show opposite effects of \u3949-THC and CBD also on brain function. Altogether, they may account for the intoxicating and therapeutic effects of cannabis on psychosis and cognition

Corticosteroidi per via Intravitreale per il Trattamento Dell'edema Maculare: Revisione e Valutazione Della Qualità Dell'evidenza:

Intravitreal corticosteroids for the treatment of macular edema: review and assessment of quality of the evidenceIntroductionTreatment options for macular edema include intravitreal corticosteroids. Traditionally, an injectable suspension of triamcinolone acetonide (TA) had been employed off-label; in recent years, authorities have approved sustained-release drug delivery systems (DDSs) for corticosteroids. This review aims to compare the quality of the evidence on efficacy and safety of three different formulations of intravitreal corticosteroids: the dexamethasone (DEX) implant, the fluocinolone acetonide (FA) implant, and the preservative-free injectable suspensions of TA, in the management of two retinal pathologies: diabetic macular edema (DME) and macular edema secondary to retinal vein occlusion (RVO).MethodsA search of clinical trials on MEDLINE from 01/01/2000 to 12/16/2015 was performed. Studies were included in the analysis if they met the following criteria: i) related to at least one of the preparations of interest in patients with DME or macular edema secondary to RVO; ii) included a control group treated with placebo, observation, sham procedures or conventional treatments; and iii) included visual acuity, retinal thickness and/or safety parameters as outcomes. Results were summarized in a narrative manner.ResultsTwenty-five publications from 19 RCTs were included. We observed increased attention of researchers towards TA compared to DEX and FA; however, studies for TA are less robust. Scientific publications related to DEX and FA implants are of higher quality, especially in terms of randomization and masking procedures.DiscussionAlthough trials on TA are numerous, evidence on DEX and FA implants is more robust. Since their introduction, these relatively new DDSs have been included in the main guidelines for the management of macular edema