Le linee guida ed il loro valore nel contesto medico legale

Negli ultimi decenni, vi è stata una crescente ricerca di interventi efficaci per migliorare la prognosi dello stroke e numerose linee guida sono state prodotte in tal senso. Ciò ha comportato ultimamente, rispetto al passato, un incremento della sopravvivenza del 10% ed un aumento di soggetti che ha superato la malattia senza riportare gravi disabilità permanenti (paralisi, perdita della parola, della visione, della memoria, ecc.) con una percentuale all’incirca identica. E’ da sottolineare che, a differenza di quanto avviene per altre malattie, dove l’attenzione per migliorare la qualità delle cure è rivolta a promuovere l’uso di singoli farmaci o interventi terapeutici, nell’ictus gli sforzi sono stati essenzialmente concentrati sugli aspetti organizzativi e di gestione multidisciplinare dell’assistenza (stroke care), cioè sul management complessivo del paziente relativamente alla gestione clinica della fase acuta, alla prevenzione delle complicanze più frequenti ed alla riabilitazione, sia in fase precoce, sia in fase post-acuta

Modular implant design affects metal ion release following metal-on-metal hip arthroplasty: a retrospective study on 75 cases

Metal-on-Metal (MoM) total hip arthroplasty (THA) has been associated to wear and metal-ions release, controversially related to a variety of clinical complications. Little is known about the relevant design-dependent parameters involved in this process. The present study investigated the correlation between metal ion release in blood and revision rate as a function of: (i) specific MoM implant modular design parameters, (i.e. acetabular cup and femoral head diameters, taper adapter material and size, femoral neck material and modularity and stem size); (ii) MoM bilaterality. Co and Cr ions concentration levels in blood of 75 patients were retrospectively-evaluated with a mean follow-up of 4.8 years (range: 1.8-6.3). Patients were divided in a unilateral and a bilateral group. Statistical analysis was performed to find any significant difference related to acetabular cup diameter, femoral head diameter, taper adapter material/size, neck material/size and stem size. The bilateral MoM group had 4-times higher metal ion levels in blood than the unilateral one (p=0.017 only Cr), related to a higher revision rate (30% vs 20%): differences were 10-times higher particularly with a 48 mm femoral head diameter (p=0.012) and a Ti-alloy neck (p=0.041). Within the monolateral group using a shorter taper adapter and a shorter neutrally-oriented neck demonstrated higher ion levels (p=0.038 only Cr and p=0.008 only Co, respectively). The aforementioned design-features and MoM bilaterality are important risk-factors for metal-ion release in modular MoM THA

Characterization of articular chondrocytes isolated from 211 osteoarthritic patients

We analyzed specific features of chondrocytes as cellular yield, cell doubling rates and the dependence between these parameters and patient-related data in a set of 211 osteoarthritic (OA) patients undergoing total joint replacement. For each patient the data available were joint type, age and gender. Knee samples chosen randomly among all biopsies were graded according to ICRS score. Patients\u2019 age ranged between 30 and 90 years with a mean age of 66 \ub1 9.7 years. Patients were divided into age classes and statistically significant differences in proliferation rate at passage 1 were found between chondrocytes derived from young and old donors, with the last ones characterized by a lower proliferation rate. A similar trend was observed for proliferation rate at passage 2. For all the samples, cellular yields ranged between 0.1 and 5.5 million cells/g of tissue. No significant correlation was observed between the level of cartilage degeneration (ICRS score) and cellular yield and proliferation rates. However, in samples with a high degree of cartilage degeneration (ICRS score 4) the cellular yield was lower compared to the other three groups (ICRS scores 1\u20133). In this study we performed a systematic characterization of basic parameters of chondrocytes originating from a wide group of OA patients. Considering the use of autologous chondrocytes in chondral treatments, the characterization of cell basic features may represent an important step to determine the quality of the cell source which is a major determinant in the outcome of cell-based therapies

Evidence of lipofuscin accumulation in the deep-water red shrimp Aristaeomorpha foliacea (Risso, 1827)

Lipofuscin, a non-degradable, degenerative fluorescent pigment which accumulates in post-mitotic cells, represents a promising method for ageing marine crustaceans. The presence and accumulation of lipofuscin has been studied in the deep-water red shrimp Aristaeomorpha foliacea (Risso, 1827) to assess its use as a tool for ageing larger (i.e., older) specimens and thus improve knowledge of the growth and longevity of this species. Specimens, gathered during experimental trawl surveys carried out in the Strait of Sicily (Mediterranean Sea), were stored directly on-board in 10% buffered formaldehyde solution; their brain was thereafter removed, prepared with various current histological techniques and examined with a binocular microscope. Thin sections of the olfactory lobe cell mass were also analyzed using fluorescence microscopy, and the lipofuscin concentration was measured through image analysis. Various indices were computed for each individual by pooling data from many images: number and coverage of the lipofuscin granules per unit area, and mean individual area of the granules. Lipofuscin was detected in all specimens investigated with characteristics (grain typology and dimension) strictly resembling those already described in other crustacean species. The present preliminary results encourage further studies to develop and validate a methodology based on the use of lipofuscin for improving the relative ageing of large A. foliacea shrimps