The Recovery Orientation of a Farm Community for Severe Autism — Data from the DREEM-IT (Developing Recovery Enhancing Environment Measures — Italian Version)

Recent years have witnessed an increasing interest in the concept of ‘recovery’ in the field of mental health and psychiatry. Autism is a neurodevelopmental disorder characterized by qualitative impairments in social interaction and communication skill, along with a restricted, repetitive, and stereotyped pattern of behavior and interests. The diagnosis is lifelong and can be a major impediment to independent living. It has been previously demonstrated that organized and structured forms of intervention, starting from early childhood and developing during all the different life stages, may improve outcome and quality of life in patients with autism. It is therefore conceivable that diverse forms of recovery (e.g. optimal level of motivation, skills, social involvement) may be possible in autism. There are no fully developed tools with which to evaluate the recovery orientation of a service, but the National Institute for Mental Health in England (NIMHE) has identified the Developing Recovery Enhancing Environments Measure (DREEM) as the most promising of an emerging group of recovery sensitive measures. This study explores the use of DREEM, as a tool to evaluate the effectiveness of recovery-based care in an Italian farm community center specifically designed for adult patients with autism and intellectual disability

The validation of converting pyrite ash‐contaminated soil into End‐of‐Waste by the High‐Performance Solidification/Stabilization process application

One of the major challenges to establishing more sustainable management strategies than landfill disposal of metals-contaminated soils is the lack of End-of-Waste (EoW) criteria defined at the European and national levels. Another limitation stems from the scarcity of information on industrial-scale applications of treatment technologies able to obtain safe and reusable materials from such contaminated waste. In this context, the High-Performance Solidification/Stabilization process was applied for the full-scale remediation of pyrite ash-contaminated soil (ca. 24 000 m3), and a dedicated sampling and analytical protocol was developed and implemented to verify if the treated material obtained complied with the general EoW criteria established by article 6 of the Waste Framework Directive 2008/98/EC. The results of the leaching, ecotoxicological, and mechanical tests carried out on representative samples of the treated soil showed that this material (ca. 19 000 m3) could be classified as EoW and thus was deemed reusable both in-situ as filler for the excavation and ex-situ as road construction material. These results improve the knowledge of the performance of a state-of-the-art technique for the treatment of metals-contaminated soil. Furthermore, the developed monitoring plan can support future assessments on the compliance of materials obtained from contaminated soil with the general EoW criteria

Long term outcome of surgical treatment of chondroblastoma: analysis of local control and growth plate/articular cartilage related complications

Abstract Background Chondroblastoma (CBL) is a rare benign chondroid producing bone tumor that typically occurs in epiphysis or apophysis of growing children and young adults. Intralesional curettage is the treatment of choice, while resection is required in selected cases, even though the use of minimally invasive ablation techniques has been advocated. Authors reviewed a series of 75 CBLs with the aim of assess risk factors for local recurrence, the growth plate related complications after epiphyseal curettage and the risk of arthritis of the adjacent joint after epiphyseal curettage. Methods We retrospectively review 69 CBLs treated with intralesional curettage and 6 treated with resection from March 1995 to February 2020. The median age was 18.8 years (7 to 42, median 16). The site was proximal humerus in 18 cases, proximal tibia in 17, distal femur in 16, talus in 6, femur’s head in 4, calcaneus in 3, acromion in 3, trochanteric region in 2, distal tibia in 2, patella in 2, supracetabular region in 1 and distal humerus in 1 patient. Results Mean follow-up was 124.2 months (24 to 322, median 116). Among patients treated with curettage, 7.3% of local recurrence was observed and 12 (17.4%) patients developed osteoarthritis of the adjacent joint. Five patients (7.3%) presented limb length discrepancy of the operated limb ranging from 0.5 to 2 cm. Recurrence free survival rate was 94.2% at 5 and 91.6% at 10 years. A mean Musculoskeletal Tumor Society (MSTS) of 29.3 points (20 to 30, median 30) was observed. Conclusion More than 90% of CBLs were successfully treated with aggressive curettage but segmental resection is required in selected cases. In a relatively small proportion of cases long term complications can occur due to growth plate damage or osteoarthritis. Trial Registration Retrospectively registered

Fixed combination of manidipine and delapril in the treatment of mild to moderate essential hypertension: evaluation by 24-hour ambulatory blood pressure monitoring

This present study assessed the antihypertensive efficacy of the fixed combination of manidipine and delapril by ambulatory blood pressure monitoring in patients with hypertension inadequately controlled by monotherapy with either component. After a 2-week placebo period, 55 mild to moderate hypertensive patients were randomized to manidipine 20 mg o.d. or delapril 30 mg b.i.d. for 4 weeks. After this period, 30 patients, aged 30-76 years (18 males and 12 females) whose diastolic blood pressure was not adequately controlled (> or = 90 mmHg) by monotherapy were treated with the fixed combination of manidipine 10 mg plus delapril 30 mg o.d. for 8 weeks. A 24-h ambulatory blood pressure monitoring recording was performed at the end of the placebo washout, of the monotherapy and of the combination therapy. Blood pressure control over the 24 h was quantified by the trough-to-peak ratio and the smoothness index. As compared to placebo, the fixed combination of manidipine and delapril produced a statistically significant (p<0.01) decrease in sitting clinic (18 +/- 9/14 +/- 5 mmHg) and 24-h blood pressure (12 +/- 7/10 +/- 5 mmHg) without affecting heart rate. This reduction was greater than that observed with single components. At the end of the 8-week combination treatment period, the rate of normalilized patients was 73%. Treatment with the fixed combination was associated with a positively high smoothness index (1.2 +/- 0.7/13.8 +/- 0.8) and with a relatively good trough-to-peak ratio (0.46/0.60). The combination of manidipine and delapril produced significant and smooth reductions in blood pressure values, which persisted over the 24-h dosing interval. These results support the use of fixed manidipine-delapril combination in the treatment of mild to moderate hypertensive patients inadequately controlled by monotherap

Management of Squamous Cell Carcinoma in Chronic Osteomyelitis: Our Experience, Review of the Literature and Role of MRI in Differential Diagnosis

Background. The authors describe a series of patients with chronic osteomyelitis associated with squamous cell carcinoma, whilst analyzing its incidence in chronic osteomyelitis, surgical options for treatment and focusing on the role of MRI in differential diagnosis. Methods. The authors reviewed 73 cases of chronic osteomyelitis (CO) treated in their department between 1995 and 2019. Six of these patients (8.2%) had a malignant degeneration in squamous cell carcinoma (SCC). All cases with malignancy were evaluated with preoperative gadolinium-enhanced MRI. Results. In this series, the authors observed an incidence rate of 8.2% (6 cases out of 73); all patients were male with a mean age of 63.5 years. The mean time between the occurrence of chronic osteomyelitis and the diagnosis of squamous cell carcinoma was 36 years (range: 21–66). The treatment consisted of amputation in five patients and limb salvage with vascularized fibula autograft in one case. Conclusions. MRI played a key role in the differential diagnosis between infected and tumoral tissue, and was found to be crucial during follow-up. Amputation is the treatment of choice in extended tumoral involvement of bone and soft tissue

Remediation of a heavy metals contaminated site with a botanical garden: monitoring results of the application of an advanced s/s technique

An innovative stabilization/solidification (S/S) technology called HPSS has been applied for the first time in a very delicate environment with a historical botanic garden in Venice for the remediation of a soil contaminated by heavy metals (As, Cu, Hg, Pb, Sb, Sn). This S/S technique, based on the High Performance Concrete (HPC) know-how (Scanferla et al., 2009), has been already successfully applied for the reconversion of different industrial contaminated sites into residential ones. The technology allows the remediation of contaminated soil fine fraction which is transformed into a very dense, low porous and mechanically-resistant granular material with the environmental characteristics for its reuse as filler in direct contact with the roots of the vegetal patrimony. More than 8,000 m(3) of contaminated soil fine fraction has been treated and monitored throughout 34 representative samples. Metal leachability was verified according to a leaching test method for granular waste (EN 12457-2, 2002) in which the demineralized water has been replaced with artificial sea water in accordance to Local Environmental Agency requirement. The mechanical properties were measured according to Los Angeles (LA) test method (BS EN 1097-2, 2010) for construction aggregates obtaining very good results in toughness and abrasion resistance. The granular material has been used tout court under the final floor layer in transit way and mixed with compost and soil in green areas also beside the rhizosphere horizon