Retroperitoneal fibrosis: a case of a patient (63y/o) treated with low-dose methotrexate (MTX) and 6-methylprednisolone (6-MP)

Retroperitoneal fibrosis (RPF), is a rare fibroinflammatory disease. The pathogenesis of RPF is still unclear and numerous theories have been reported such as environmental factors, immunologic process, genetic component, local inflammation and advanced atherosclerosis. RPF is characterized by the presence of a particular retroperitoneal fibrotic tissue which is white, woody and involving retroperitoneal structures such as the great vessels, ureters and psoas muscle. The main complication of RPF is the obstruction of local structures such as the ureters due to the fibrosis and the treatment of this aspect represents the main challenge for this pathology. RPF medical treatment consists of corticosteroids or/and immunosuppressive therapy. We report a case of a patient (63y/o) affected by idiopathic RPF treated with low-dose methotrexate (MTX) and 6-methylprednisolone (6-MP) for two years, describing and confirming the effectiveness and safety of a long-term low-dose MTX and 6-MP treatment

On the homogenization of periodic beam-like structures

Abstract A homogenization method for periodic beam-like structures that is based on the unit cell force transmission modes is presented. Its main advantage is that to identify the principal vectors of the state transfer matrix corresponding to the transmission modes it operates directly on the sub-partitions of the unit cell stiffness matrix and allows to overcome the problems due to ill-conditioning of the transfer matrix. As case study, the Pratt girder is considered. Closed form solutions for the transmission modes of this girder are achieved and used into homogenization. Since the pure bending mode shows that the Pratt unit cell transmits two kinds of bending moments, one given by the axial forces and the other originated by nodal moments, the Timoshenko couple-stress beam is employed as substitute continuum. Finally, a validation of the proposed procedure is carried out comparing the predictions of the homogenized models with the results of a series of girder f.e. analyses

Transverse strength of railway tracks : Part 2. Test system for ballast resistance in line measurement

© Gruppo Italiano Frattura 2014. This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: https://creativecommons.org/licenses/by/4.0/In the present paper, testing methods currently adopted to measure the in service ballast resistance are synthetically reviewed to identify the main sources of uncertainty influencing the test loads and to define an experimental methodology allowing the optimal control of the testing parameters without the introduction of spurious or parasitic actions on the track sample. An alternative testing system, which allows applying on a full-scale sample of a railway track testing loads very close the real ones, is presented. Of the new system, both the ways of use for measuring the transversal and axial ballast strength, the general procedure to carry out the experimentation and its application to a real scenario are described, highlighting its main advantages in terms both of modalities for applying the loads and of testing parameter control.Peer reviewe

Measuring and interpreting CO2 fluxes at regional scale: the case of the Apennines, Italy

Tectonically active regions are often characterized by large amounts of carbon dioxide degassing, and estimation of the total CO2 discharged to the atmosphere from tectonic structures, hydrothermal systems and inactive volcanic areas is crucial for the definition of present-day global Earth degassing. The carbon balance of regional aquifers is a powerful tool to quantify the diffuse degassing of deep inorganic carbon sources because the method integrates the CO2 flux over large areas. Its application to peninsular Italy shows that the region is characterized by specific CO2 fluxes higher than the baseline determined for the geothermal regions of the world, and that the amount of endogenous CO2 discharged through diffuse regional degassing (c. 2.1 × 1011 mol a−1) is the major component of the geological CO2 budget of Italy, definitely prevailing over the CO2 discharged by Italian active volcanoes and volcanoes with hydrothermal activity. Furthermore, the positive correlation between geothermal heat and deep CO2 dissolved in the groundwater of central Italy suggests that (1) the geothermal heat is transported into the aquifers by the same hot CO2-rich fluids causing the Italian CO2 anomaly and (2) the advective heat flow is the dominant form of heat transfer of the region. Supplementary material: The location, flow rate, extent of the hydrogeological basin, chemical and isotopic analyses of the 160 springs considered in this study, and the results of the carbon mass balance are reported in a table available at https://doi.org/10.6084/m9.figshare.c.423702

Transverse strength of railway tracks : Part 3. Multiple scenarios test field

© Gruppo Italiano Frattura 2014. This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: https://creativecommons.org/licenses/by/4.0/In the present paper the design and construction choices of a test field for the ballast lateral resistance measurement, in order to produce data useful for the development of a numerical model able to simulate the service critical conditions of a continuous welded rail track, are described. Some construction details described herein allow to better understand the methodological approach followed in the design of experiments, the tests management philosophy as well as of the accuracy achieved in their implementation.Peer reviewe

Modello di stima dei costi sanitari e della capacity delle terapie intensive in Italia nel trattamento di pazienti affetti da COVID-19: valutazione dell’impatto di remdesivir

Introduction: Coronavirus disease 2019 (COVID-19) is caused by a severe acute respiratory syndrome coronavirus 2, which is a human coronavirus responsible for a pandemic. Direct interventions, i.e. physical distancing and use of protective devices, can prevent or limit contagions, however, it is also required to evaluate the optimization of limited resources, such as the Intensive Care Unit (ICU). For this purpose, it is relevant to estimate the impact of therapeutic solutions that reduce the probability that the patient transits to ICU in symptomatic subjects and in need of hospitalization. The therapeutic solutions allow a more rapid recovery of the patient and save scarce resources that can be used in the treatment of other patients. Methods: A forecasting model is designed to estimate the impact of one therapeutic solution, i.e. the antiretroviral Remdesivir, on both the capacity of intensive care and the healthcare costs for hospitals when managing the current emergency. A base case is presented as well as a best and a worst case scenario deriving from the sensitivity analyses. Results: The introduction of Remdesivir in patients receiving low-flow oxygen therapy with the purpose of reducing ICU accesses and deaths leads to 431 million euros cost savings and avoids 17,150 hospitalizations in intensive care and 6,923 deaths. In the best case, 294 million euros savings are estimated, whilst in the worst case the model estimates a saving of 512 million euros. Conclusions: Remdesivir has the potential to reduce the negative effects of the Coronavirus disease, improving patient conditions and reducing death tolls, and can also save scarce healthcare resources during this pandemic, resulting in a shorter hospital stay and fewer ICU admissions

Influences of Age and Comorbidities on Indication for Partial Nephrectomy: A Systematic Review

BACKGROUND: The influence of age and comorbidities during decision-making for patients with renal cell carcinoma remains controversial. OBJECTIVE: To comprehensively review the available evidence regarding the impacts of age and comorbidities on the decision to perform partial nephrectomy (PN). EVIDENCE ACQUISITION: A systematic review was conducted in accordance with PRISMA and registered with PROSPERO (CRD42022344759). Only randomized control trials, prospective cohort studies, registry-based studies, or single/multi-institutional retrospective cohort studies comparing PN to other therapeutic options for cT1N0M0 renal masses were considered. The primary outcome was to assess differences in patients' baseline characteristics between different treatments in order to investigate how those aspects have influenced clinical decision-making. Finally, perioperative outcomes were compared across the different options. EVIDENCE SYNTHESIS: Overall, patients who underwent PN were 3 to 11 years younger than those who underwent other treatments. Baseline renal function was slightly better in patients who underwent PN than in those who underwent radical nephrectomy (RN), active surveillance (AS), or tumor ablation. Patients undergoing PN had an average pre-treatment eGFR 4 to 6 points (mL/min/1.73 m2) higher than patients undergoing RN or tumor ablation. Likewise, the proportion of baseline chronic kidney disease (CKD) before treatment was higher in patients undergoing other treatments, with a rate of CKD between 6% and 56% higher compared with that for PN. A slightly higher proportion of baseline diabetes mellitus (DM) and cardiovascular comorbidities (CVD) were found in patients who underwent PN than in those who underwent RN (20% vs. 21% for DM and 37% vs. 41% for CVD). On average, patients who underwent AS and tumor ablation had more comorbidities, in terms of Charlson comorbidity index (CCI), DM, and CVD (50% vs. 38% for CCI ≥2; 25% vs. 20% for DM; and 43% vs. 37% for CVD). In terms of Eastern Cooperative Oncology Group (ECOG) Performance Status and American Society of Anesthesiologists (ASA) classification, no major differences were found between PN and other treatments, but a trend emerged whereby more fit patients underwent PN compared with RN (16% of ECOG >1 for PN vs. 18% for RN and 15% of ASA grade ≥3 for PN vs. 26% for RN). Again, tumor ablation was preferred for less fit patients (31% of ASA grade ≥3). No study included in our systematic review reported the baseline frailty status of patients treated for cT1 renal masses. The rates of perioperative complications and length of hospital stay (LOS) were similar between different techniques. CONCLUSIONS: Patients who underwent PN tended to be younger and fitter than those who underwent other available treatments for cT1 renal masses. Since this technique aims at reducing renal function impairment after surgery, a greater effort should be made to optimize patient selection to include more comorbid patients for whom PN might be useful

Intra-and extra-hospitalization monitoring of vital signs. Two sides of the same coin. Perspectives from Lims and Greenline study operators

Background: In recent years, due to the epidemiological transition, the burden of very complex patients in hospital wards has increased. Telemedicine usage appears to be a potential high-impact factor in helping with patient management, allowing hospital personnel to assess conditions in out-of-hospital scenarios. Methods: To investigate the management of chronic patients during both hospitalization for disease and discharge, randomized studies (LIMS and Greenline-HT) are ongoing in the Internal Medicine Unit at ASL Roma 6 Castelli Hospital. The study endpoints are clinical outcomes (from a patient’s perspective). In this perspective paper, the main findings of these studies, from the operators’ point of view, are reported. Operator opinions were collected from structured and unstructured surveys conducted among the staff involved, and their main themes are reported in a narrative manner. Results: Telemonitoring appears to be linked to a reduction in side-events and side-effects, which represent some of most commons risk factors for re-hospitalization and for delayed discharge during hospitalization. The main perceived advantages are increased patient safety and the quick response in case of emergency. The main disadvantages are believed to be related to low patient compliance and an infrastructural lack of optimization. Conclusions: The evidence of wireless monitoring studies, combined with the analysis of activity data, suggests the need for a model of patient management that envisages an increase in the territory of structures capable of offering patients subacute care (the possibility of antibiotic treatments, blood transfusions, infusion support, and pain therapy) for the timely management of chronic patients in the terminal phase, for which treatment in acute wards must be guaranteed only for a limited time for the management of the acute phase of their diseases

How future surgery will benefit from SARS-COV-2-related measures: a SPIGC survey conveying the perspective of Italian surgeons

COVID-19 negatively affected surgical activity, but the potential benefits resulting from adopted measures remain unclear. The aim of this study was to evaluate the change in surgical activity and potential benefit from COVID-19 measures in perspective of Italian surgeons on behalf of SPIGC. A nationwide online survey on surgical practice before, during, and after COVID-19 pandemic was conducted in March-April 2022 (NCT:05323851). Effects of COVID-19 hospital-related measures on surgical patients' management and personal professional development across surgical specialties were explored. Data on demographics, pre-operative/peri-operative/post-operative management, and professional development were collected. Outcomes were matched with the corresponding volume. Four hundred and seventy-three respondents were included in final analysis across 14 surgical specialties. Since SARS-CoV-2 pandemic, application of telematic consultations (4.1% vs. 21.6%; p < 0.0001) and diagnostic evaluations (16.4% vs. 42.2%; p < 0.0001) increased. Elective surgical activities significantly reduced and surgeons opted more frequently for conservative management with a possible indication for elective (26.3% vs. 35.7%; p < 0.0001) or urgent (20.4% vs. 38.5%; p < 0.0001) surgery. All new COVID-related measures are perceived to be maintained in the future. Surgeons' personal education online increased from 12.6% (pre-COVID) to 86.6% (post-COVID; p < 0.0001). Online educational activities are considered a beneficial effect from COVID pandemic (56.4%). COVID-19 had a great impact on surgical specialties, with significant reduction of operation volume. However, some forced changes turned out to be benefits. Isolation measures pushed the use of telemedicine and telemetric devices for outpatient practice and favored communication for educational purposes and surgeon-patient/family communication. From the Italian surgeons' perspective, COVID-related measures will continue to influence future surgical clinical practice

Perceived risk of infection and death from COVID-19 among community members of low- and middle-income countries: A cross-sectional study [version 1; peer review: awaiting peer review]

Background: Risk perceptions of coronavirus disease 2019 (COVID-19) are considered important as they impact community health behaviors. The aim of this study was to determine the perceived risk of infection and death due to COVID-19 and to assess the factors associated with such risk perceptions among community members in low- and middle-income countries (LMICs) in Africa, Asia, and South America. Methods: An online cross-sectional study was conducted in 10 LMICs in Africa, Asia, and South America from February to May 2021. A questionnaire was utilized to assess the perceived risk of infection and death from COVID-19 and its plausible determinants. A logistic regression model was used to identify the factors associated with such risk perceptions. Results: A total of 1,646 responses were included in the analysis of the perceived risk of becoming infected and dying from COVID-19. Our data suggested that 36.4% of participants had a high perceived risk of COVID-19 infection, while only 22.4% had a perceived risk of dying from COVID-19. Being a woman, working in healthcare-related sectors, contracting pulmonary disease, knowing people in the immediate social environment who are or have been infected with COVID-19, as well as seeing or reading about individuals infected with COVID-19 on social media or TV were all associated with a higher perceived risk of becoming infected with COVID-19. In addition, being a woman, elderly, having heart disease and pulmonary disease, knowing people in the immediate social environment who are or have been infected with COVID-19, and seeing or reading about individuals infected with COVID-19 on social media or TV had a higher perceived risk of dying from COVID-19. Conclusions: The perceived risk of infection and death due to COVID-19 are relatively low among respondents; this suggests the need to conduct health campaigns to disseminate knowledge and information on the ongoing pandemic