Extracciones dentarias en pacientes en tratamiento con anticoagulantes: revisión de la literatura

Objetivo del trabajo. En pacientes en terapia con anticoagulantes orales, una simple extracción puede provocar hemorragias importantes. En la literatura se describen dos enfoques terapéuticos en casos de intervenciones quirúrgicas en esta categoría de pacientes. Uno propone la reducción de la dosis terapéutica del fármaco, mientras que el segundo sugiere la sustitución con heparina. El objetivo de este trabajo es revisar la literatura que trata este tema con el fin de obtener un protocolo ideal. Conclusiones. En caso de extracciones simples es suficiente usar anestesia con vasoconstrictor (en el caso de que no haya otras contraindicaciones), realizar suturas bien tensadas, aplicar coadyuvantes hemostáticos locales y ácido tranexámico tópico. Solo en casos de intervenciones más complejas, o con valores de INR mayores a 3,5, será necesario reducir la dosis del fármaco y consecuente sustitución con heparina de acuerdo a las instrucciones del hematólogo y del cardiólogo. Aim of the work. In patients treated with oral anticoagulants, even simple tooth extractions can produce large hemorrhages. There are two main therapeutic outlines suggested in literature in case of little oral surgery. The first one is based on the reduction of the therapeutic dose of the drug, and the second one on the substitution with heparin. The aim of this paper was to review the.literature on the management of patients treated with anticoagulants in order to obtain univocal guidelines. Conclusion. In case of simple tooth extractions generally a vasoconstrictive anaesthetic (if there are no other contraindications), tight sutures, the application of hemostats and tronexamic acid are enough. Only in case of more complex surgery or of INR values higher than 3,5 it is necessory to reduce the anticoagulant dose or to change the therapy with heparin, if agreed by the hoemotologist and/ or the cardiologist

Performance Investigation and Repeatability Assessment of a Mobile Robotic System for 3D Mapping

In this paper, we present a quantitative performance investigation and repeatability assessment of a mobile robotic system for 3D mapping. With the aim of a more efficient and automatic data acquisition process with respect to well-established manual topographic operations, a 3D laser scanner coupled with an inertial measurement unit is installed on a mobile platform and used to perform a high-resolution mapping of the surrounding environment. Point clouds obtained with the use of a mobile robot are compared with those acquired with the device carried manually as well as with a terrestrial laser scanner survey that serves as a ground truth. Experimental results show that both mapping modes provide similar accuracy and repeatability, whereas the robotic system compares favorably with respect to the handheld modality in terms of noise level and point distribution. The outcomes demonstrate the feasibility of the mobile robotic platform as a promising technology for automatic and accurate 3D mapping

The experience of individuals placed in quarantine: A systematic review, meta-summary, and meta-synthesis

Objective: To summarize the experience of individuals placed in quarantine during an outbreak. Design: A meta-summary and a meta-synthesis based upon a systematic review of qualitative studies. Sample: The Cumulative Index of Nursing and Allied Health Literature, MEDLINE, and Scopus databases were all searched up to April 2020. Measurements: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed; then, the methodological quality of the studies included was assessed with the Critical Appraisal Screening Programme tool for qualitative studies. Results: Five studies have been included documenting the experience of 125 adult individuals. A total of 16 codes emerged: in the meta-summary, the most and least frequent codes were \u201cThinking about quarantine\u201d (80%) and \u201cEmotional roller coaster,\u201d \u201cBeing alert for any symptom,\u201d \u201cTrusting or not?,\u201d \u201cKnowing who brought the infection,\u201d and \u201cLiving in a surreal world\u201d (20%). The codes which emerged were categorized into three main themes which summarized the whole experience of being placed in quarantine: (a) \u201cBeing swamped with a thousand emotions\u201d; (b) \u201cBeing restrained\u201d; and (c) \u201cNeeding to be considered.\u201d. Conclusions: The experience of quarantine for people is a long journey which can feel chaotic due to uncertainty about the consequences on health, work, and the future. The findings of this study can help nurses in caring for quarantined individuals by enabling them to understand people's need for educational and emotional support. Ensuring the supply of consistent information is also important to increase people's compliance

Advanced 3D modeling versus Building Information Modeling: the case study of Palazzo Ettoreo in Sacile (Italy)

This paper presents an experience of 3D modeling starting from laser scanning data and following two alternative approaches: the first one, called \u201cAdvanced 3D modeling\u201d, based on an original meshing algorithm, while the second make use of Revit BIM software. The case study in Palace Ettoreo in Sacile (Pordenone, Italy), constructed in Renaissance Venetian style in the 16th century: it has a trapezoid plan and is developed on three floors, with the ground one endowing a portico on two fa\ue7ades. The palace has been surveyed by two terrestrial laser scanners: a Riegl Z420i for 5 external scans and a FARO Photon 120 for 53 internal scans; also a topographic surveying of 270 targets have been carried out. The final TLS cloud has 1,4 billions of points. The Advanced 3D modeling has produced a \u201csmart\u201d mesh, allowing also to model the elements with deformations (out of plumb, bulges and troughs). Moreover, this model drastically reduce the stored data: the whole palace is modeled by 111.496 polygons only. The modeling with Revit follows the classical flowchart where the principal architectonical elements are gradually composed: this HBIM process has required a strong manual work in exploiting the available parametric objects and/or in the definition of new objects. Comparing the two models with respect the points cloud, both have evidenced advantages and limitations: therefore, the best solution is a process involving their combination. At the beginning, the Advanced 3D modeling is performed onto the points cloud, so well exploiting the segmentation tools and the smart meshing of the surfaces preserving any geometrical irregularity. Such obtained model allows metrical and morphological evaluation on the various structural and architectonical elements. Afterwards, this very light model becomes the entry data for the modeling in BIM environment, where also the shape of irregular elements are so imported

Extreme Energy Cosmic Rays (EECR) Observation Capabilities of an "Airwatch from Space'' Mission

The longitudinal development and other characteristics of the EECR induced atmospheric showers can be studied from space by detecting the fluorescence light induced in the atmospheric nitrogen. According to the Airwatch concept a single fast detector can be used for measuring both intensity and time development of the streak of fluorescence light produced by the atmospheric shower induced by an EECR. In the present communication the detection capabilities for the EECR observation from space are discussed.Comment: 3 pages (LaTeX). To appear in the Proceedings of TAUP'9

Determination of parameters for the evaluation of Phosphorus/Calcium metabolism in adult normal dogs

Diseases that facilitate alterations in the metabolism of calcium (Ca) and phosphorus (Pi) are\ndiverse. Knowing and interpreting normal parameters is fundamental to making a diagnosis.\nIn this study both minerals were evaluated in the blood and urine of 52 healthy adult dogs in\nthree age ranges in years old (group A: from 1 to 5, group B: from 6 to 10, and group C: older\nthan 10).\nCalcium levels exhibited no significant difference across age groups. A significant increase (p = 0.03)\nin phosphorus was found in group C in relation to the other two groups.\nBased on the elimination of both minerals through the urine, evaluated from the fractional\nexcretion (DIP and DICa) and the relation Ca or Pi / Creatinine, a non-significant tendency\nof a lower elimination of Pi through urine was observed, according to DIP values of group C\n(p = 0.055).\nThe values of DIP and DICa were correlated with the ones in Pi or Ca/Cr in urine (r = 0.9, p < 0.0001).\nThese results allow us to infer that the mineral/Cr relation can be used when evaluating\nelimination by urine. The age range must be taken into account when interpreting results of\nphosphorus in blood and urine, since groups older than 10 years old have higher minimum\nand maximum threshold levels than the other two groups.Fil: Martiarena, B. Universidad de Buenos Aires. Facultad de Ciencias Veterinarias. Cátedra de Clínica Médica de Pequeños Animales; ArgentinaFil: Castillo, V. Universidad de Buenos Aires. Facultad de Ciencias Veterinarias. Hospital Escuela de Pequeños Animales. Unidad de Endocrinología; ArgentinaFil: Regonat, M. Universidad de Buenos Aires. Facultad de Ciencias Veterinarias. Cátedra de Patología Clínica; ArgentinaFil: Regonat, M. Universidad de Buenos Aires. Facultad de Ciencias Veterinarias. Hospital Escuela de Pequeños Animales. Unidad de Laboratorio; ArgentinaFil: Quintana, H. Universidad de Buenos Aires. Facultad de Ciencias Veterinarias. Cátedra de Nutrición; ArgentinaFil: Quintana, H. Universidad de Buenos Aires. Facultad de Ciencias Veterinarias. Hospital Escuela de Pequeños Animales. Unidad de Nutrición; ArgentinaFil: Brandi, G. Universidad de Buenos Aires. Facultad de Ciencias Veterinarias. Cátedra de Patología Clínica; ArgentinaFil: Brandi, G. Universidad de Buenos Aires. Facultad de Ciencias Veterinarias. Hospital Escuela de Pequeños Animales. Unidad de Laboratorio; ArgentinaFil: Lamarca, G. Universidad de Buenos Aires. Facultad de Ciencias Veterinarias. Cátedra de Clínica Médica de Pequeños Animales; ArgentinaFil: Molina, E. Universidad de Buenos Aires. Facultad de Ciencias Veterinarias. Hospital Escuela de Pequeños Animlaes. Unidad de Nefrología y Urología; ArgentinaFil: Ruidiaz, V. Universidad de Buenos Aires. Facultad de Ciencias Veterinarias. Cátedra de Clínica Médica de Pequeños Animales; ArgentinaFil: Visintini, A. Universidad de Buenos Aires. Facultad de Ciencias Veterinarias. Cátedra de Clínica Médica de Pequeños Animales; ArgentinaLas enfermedades que alteran el metabolismo fósforo (Pi)/calcio (Ca) son variadas. Para\ndiagnosticarlas es necesario conocer e interpretar parámetros normales. Se estudiaron ambos\nminerales, en sangre y orina, en 52 perros adultos sanos, agrupados según rango etario en años:\nGA de 1 a 5; GB de 6 a 10 y GC ? de 10.\nNo se encontraron diferencias significativas para la calcemia entre los grupos. Hubo un\nincremento significativo para la fosfatemia (p 0.03) y el producto Ca x Pi (p 0.02) en el GC\nrespecto al resto.\nDe la eliminación de ambos minerales en orina, evaluada mediante la excreción fraccional (DIP\ny DICa) y por la relación Calcio o fósforo/creatinina, se observó una tendencia, no significativa,\na una menor eliminación de fósforo, según los valores de DIP en el grupo C (p 0.055). Los\nvalores de DIP y DICa se correlacionaron con los de Fósforo o Calcio/Creatinina (r 0.9, p < 0.0001),\nhaciendo que dichas relaciones pueden ser utilizadas para evaluar la excreción urinaria.\nEl rango etario debe tenerse en cuenta para interpretar resultados del fósforo en sangre y orina,\ndado que los valores de cortes mínimos y máximos son más elevados en los mayores de 10 años

Is fluorescein-guided technique able to help in resection of high-grade gliomas?

OBJECT: Fluorescein, a dye that is widely used as a fluorescent tracer, accumulates in cerebral areas where the blood-brain barrier is damaged. This quality makes it an ideal dye for the intraoperative visualization of high-grade gliomas (HGGs). The authors report their experience with a new fluorescein-guided technique for the resection of HGGs using a dedicated filter on the surgical microscope. METHODS: The authors initiated a prospective Phase II trial (FLUOGLIO) in September 2011 with the objective of evaluating the safety of fluorescein-guided surgery for HGGs and obtaining preliminary evidence regarding its efficacy for this purpose. To be eligible for participation in the study, a patient had to have suspected HGG amenable to complete resection of the contrast-enhancing area. The present report is based on the analysis of the short- and long-term results in 20 consecutive patients with HGGs (age range 45-74 years), enrolled in the study since September 2011. In all cases fluorescein (5-10 mg/kg) was injected intravenously after intubation. Tumor resection was performed with microsurgical technique and fluorescence visualization by means of BLUE 400 or YELLOW 560 filters on a Pentero microscope. RESULTS: The median preoperative tumor volume was 30.3 cm(3) (range 2.4-87.8 cm(3)). There were no adverse reactions related to fluorescein administration. Complete removal of contrast-enhanced tumor was achieved in 80% of the patients. The median duration of follow-up was 10 months. The 6-months progression-free survival rate was 71.4% and the median survival was 11 months. CONCLUSIONS: Analysis of these 20 cases suggested that fluorescein-guided technique with a dedicated filter on the surgical microscope is safe and allows a high rate of complete resection of contrast-enhanced tumor as determined on early postoperative MRI. Clinical trial registration no.: 2011-002527-18 (EudraCT)

Therapeutic immunization with HIV-1 Tat reduces immune activation and loss of regulatory T-cells and improves immune function in subjects on HAART.

Although HAART suppresses HIV replication, it is often unable to restore immune homeostasis. Consequently, non-AIDS-defining diseases are increasingly seen in treated individuals. This is attributed to persistent virus expression in reservoirs and to cell activation. Of note, in CD4(+) T cells and monocyte-macrophages of virologically-suppressed individuals, there is continued expression of multi-spliced transcripts encoding HIV regulatory proteins. Among them, Tat is essential for virus gene expression and replication, either in primary infection or for virus reactivation during HAART, when Tat is expressed, released extracellularly and exerts, on both the virus and the immune system, effects that contribute to disease maintenance. Here we report results of an ad hoc exploratory interim analysis (up to 48 weeks) on 87 virologically-suppressed HAART-treated individuals enrolled in a phase II randomized open-label multicentric clinical trial of therapeutic immunization with Tat (ISS T-002). Eighty-eight virologically-suppressed HAART-treated individuals, enrolled in a parallel prospective observational study at the same sites (ISS OBS T-002), served for intergroup comparison. Immunization with Tat was safe, induced durable immune responses, and modified the pattern of CD4(+) and CD8(+) cellular activation (CD38 and HLA-DR) together with reduction of biochemical activation markers and persistent increases of regulatory T cells. This was accompanied by a progressive increment of CD4(+) T cells and B cells with reduction of CD8(+) T cells and NK cells, which were independent from the type of antiretroviral regimen. Increase in central and effector memory and reduction in terminally-differentiated effector memory CD4(+) and CD8(+) T cells were accompanied by increases of CD4(+) and CD8(+) T cell responses against Env and recall antigens. Of note, more immune-compromised individuals experienced greater therapeutic effects. In contrast, these changes were opposite, absent or partial in the OBS population. These findings support the use of Tat immunization to intensify HAART efficacy and to restore immune homeostasis. TRIAL REGISTRATION: ClinicalTrials.gov NCT00751595