Invasive intraneural interfaces: foreign body reaction issues

Intraneural interfaces are stimulation/registration devices designed to couple the peripheral nervous system (PNS) with the environment. Over the last years, their use has increased in a wide range of applications, such as the control of a new generation of neural-interfaced prostheses. At present, the success of this technology is limited by an electrical impedance increase, due to an inflammatory response called foreign body reaction (FBR), which leads to the formation of a fibrotic tissue around the interface, eventually causing an inefficient transduction of the electrical signal. Based on recent developments in biomaterials and inflammatory/fibrotic pathologies, we explore and select the biological solutions that might be adopted in the neural interfaces FBR context: modifications of the interface surface, such as organic and synthetic coatings; the use of specific drugs or molecular biology tools to target the microenvironment around the interface; the development of bio-engineered-scaffold to reduce immune response and promote interface-tissue integration. By linking what we believe are the major crucial steps of the FBR process with related solutions, we point out the main issues that future research has to focus on: biocompatibility without losing signal conduction properties, good reproducible in vitro/in vivo models, drugs exhaustion and undesired side effects. The underlined pros and cons of proposed solutions show clearly the importance of a better understanding of all the molecular and cellular pathways involved and the need of a multi-target action based on a bio-engineered combination approach

Role of computed tomography in the evaluation of advanced endometrial carcinoma.

Role of computed tomography in the evaluation of advanced endometrial carcinoma

Gli indicatori AHRQ PSI per la gestione della sicurezza del paziente nell\u2019Azienda Ospedaliera di Verona

La US Agency for Healthcare Research and Quality (US AHRQ) ha ideato degli indicatori (chiamati AHRQ PSI) da utilizzare al fine di individuare, caratterizzare e prevenire gli eventi avversi legati all\u2019assistenza ospedaliera. Il nostro studio ha valutato la capacit\ue0 degli AHRQ PSI applicati presso l\u2019Azienda Ospedaliera di Verona di fornire informazioni adeguate per tale scopo

Study of adverse events by reviewing the medical records: The experience of the University Hospital of Verona (Italy)

Patient safety is worldwide recognized as a high priority for health care systems. One important indicator of patient safety is the rate of Adverse Events (AEs) occurred among hospitalized patients. Retrospective studies of hospital case records have shown that a significant proportion of hospital admissions result in AEs in a variety of countries. The survey was carried out at the University Hospital of Verona as a pilot study for the application in the Italian context of a tool of retrospective detection of adverse events by reviewing the medical records as applied in British hospitals. 1,2 Objective of this study was to determine the incidence of AEs among hospitalized patients, examine their preventability and compare the incidence found with the international studies. The tool of \u201cclinical audit\u201d was used as second step to identify in the more critical cases the improvement actions to be introduced. The final aim was to solve the emerged problematic issues in a targeted, shared and appropriate way

The transpedicular approach for the study of intervertebral disc regeneration strategies: in vivo characterization

Purpose To characterize in vivo the transpedicular approach (TA) as an alternative route to study interverte- bral disc (IVD) regeneration strategies in a sheep model. Methods 48 IVD of 12 sheep were used. TA was per- formed under fluoroscopy, followed by nucleotomy (2-mm shaver resector). A polyurethane scaffold was used to repair the end-plate. X-ray and MRI images were acquired pre-, intra- and post-operatively (1, 3, 6 months). Com- plications were recorded. Results TA was feasible in all animals; nucleus pulposus (NP) from L1 to L5 was accessible. Nucleotomy followed by end-plate repair was achieved. Loss of NP signal intensity was shown in MRI images of the nucleotomy group. Conclusions TA is feasible in vivo, repeatable after only a short learning period and safely performed without sig- nificant morbidity. This animal model allows the study of IVD degeneration physiopathology and investigation of IVD regeneration techniques in vivo

GLI INCIDENTI NELLO SCI ALPINO: VALUTAZIONE DELLA CASISTICA E DEFINIZIONE DEGLI INTERVENTI DI PREVENZIONE

Lo sci alpino \ue8 uno sport praticato in Italia da circa 2,3 milioni di persone ogni anno. Vista la numerosit\ue0 delle persone coinvolte ed i molti fattori di rischio correlati, questa attivit\ue0 sportiva comporta un numero elevato di incidenti con un rilevante impatto sui servizi sanitari. Il presente studio \ue8 finalizzato a valutare i volumi e la tipologia di interventi di primo soccorso al fine di definire modalit\ue0 specifiche di prevenzione degli incidenti da sci alpino in un'area del Nord-Est d'Italia

Impiego della tomografia computerizzata (TC) nello staging dell\u2019adenocarcinoma endometriale allo stadio I FIGO.

[Use of computerized tomography in the staging of endometrial adenocarcinoma at stage I FIGO]

Invasive neural interfaces: the perspective of the surgeon.

Abstract Background By implanting electrodes inside peripheral nerves, amputee's intentions are picked up and exploited to control novel dexterous sensorized hand prostheses. Under the pretext of presenting surgical technique and clinical outcomes of the implant of invasive peripheral neural interfaces in a human amputee, this article critically comments, from the point of view of the surgeon, strengths and weaknesses of the procedure. Materials and methods Four multielectrodes were implanted in the medial and ulnar nerves of a young volunteer, which, following a car-crash, had a left transradial amputation. Both nerves were approached with a single incision in the medial aspect of the upper arm. Four weeks later, the electrodes were removed. Results Even if the trauma and the postamputation plastic processes altered the anatomy, electrodes were proficiently implanted with an overall success of 66%. Looking at the procedure from the surgeon's viewpoint unveils few still open issues. Electrodes weaknesses were related to the absence of stabilizing structures, the cable transit through the skin, the implant angle, and the unproven magnetic resonance imaging compatibility. Future investigations are needed to definitely address the better anesthesia, number and sites of incisions, the nerves to implant, and the convenience of performing epineural microdissection. Conclusions Invasive neural interfaces developmental process almost completely relies on the efforts of bioengineers and neurophysiologists; however, the surgeon is responsible for intra and perioperative factors. Therefore, he deserves to play a major role also at the stage of specifying the requirements, to satisfy the requisites of a safe, stable, and long-lasting implant. Keywords Upper limb surgery; Hand prostheses; Peripheral nerves; Invasive neural interface; Amputee