IVS posteriore, intervento chirurgico mininvasivo per la cura del prolasso vaginale: efficacia e long-term follow-up

Aim: the objective of our study was to asses the efficacy, the effectiveness and complications of the posterior intravaginal slingoplasty (IVS) for the treatment of vaginal prolapse over a period of 8 years. Methods: The posterior IVS is a minimally invasive procedure for the vaginal vault prolapse utilizing a vaginal approach. We inserted a mesh in the recto-vaginal space to the vaginal vault (to wich it was fixed) right down to the perineal body (to wich it was also fixed).44 patients who had undergone posterior IVS procedures were analyzed. The median age of the patients was 61 years (range 44-77). The median parity was 3(range 1-4). The patients were followed-up at 6 weeks, 6 months, and at yearly intervals. At each visit, a follow-up data form was completed, and were entered into the database. At the clinical examination, the Baden-Walker grading system for prolapse was used. We only used grades 3 and 4 for describing significant recurrent prolapse. Results: Neither complications intraoperatively and postoperatively occurred, nor rectal perforatios or bladder injuries. The success rate for these procedure was 94.12%. All patients were followed for 8 years. Recurrent prolapse, grade 3 and 4, developed in 2 patients (5.88%), one cystocele and one rectocele. Only one patient had an extrusion that was definitively cured by topical estrogen therapy and antibiotis. Conclusions: In eight years follow-up the posterior IVS delivered satisfactory results for vault and posterior compartment prolapse.</br

Breast cancer and timing of surgery during menstrual cycle: a 5-year analysis of 248 premenopausal women

: In the present report, we retrospectively analyzed the impact of the timing of surgery during menstrual cycle on disease-free and overall survival of 248 premenopausal patients with stage I/II breast cancer who underwent surgery followed by anthracycline-containing adjuvant chemotherapy. With a median follow-up of 5 years, no statistically significant differences were observed in disease-free or overall survival between women operated upon during the follicular (days 0-14) and the luteal (days 15-32) phase of the menstrual cycle. The impact on disease-free and overall survival of lymph-node status, tumor size and hormone receptor expression, but not of the phase of the menstrual cycle at the time of surgery, was confirmed by univariate and multivariate analysis. However, when combined with hormone receptor status, the phase of the menstrual cycle at the time of surgery proved useful to better define the prognosis of primary breast cancer patients, with significantly longer disease-free and overall survival for patients operated upon during the follicular phase and with positive hormone receptors

Surgical resection is superior to TACE in the treatment of HCC in a well selected cohort of BCLC-B elderly patients—A retrospective observational study

Simple Summary Hepatocellular carcinoma (HCC) is the most common primary liver malignancy. Liver transplantation (LT) and surgical resection (SR) are currently the primary treatments with curative intent. Nevertheless, more than two-thirds of patients are elderly and, therefore, excluded from LT; while, according to the Barcelona Clinic Liver Cancer (BCLC) system, SR should only be offered to a small group of patients with early stage HCC. The identification in stage B of an intermediate subgroup of patients that fulfill the criteria for surgery may play an important role in the implementation of potentially curative treatments. Hepatocellular carcinoma (HCC) usually develops in cirrhotic liver, with high recurrence rates. However, considering its increasing detection in non-cirrhotic liver, the choice of treatment assumes particular relevance. This study aimed to investigate outcomes of patients among BCLC stages and enrolled for surgical resection (SR) according to a more complex evaluation, to establish its safety and efficacy. A total of 186 selected HCC patients (median age 73.2 yrs), submitted to SR between January 2005 and January 2021, were retrospectively analyzed. Of which, 166 were staged 0, A, B according to the BCLC system, while 20 with a single large tumor (&gt;5 cm) were classified as stage AB. No perioperative mortality was recorded; complications occurred in 48 (25.80%) patients, and all but two were Clavien-Dindo grade I-II. Median follow-up was 9.2 years. Subsequently, 162 recurrent patients (87,1%) were selected for new treatments. Comparable overall survival rates (OS) were observed at 1, 3, 5, and 10 years in 0, A, B and AB stages (p = 0.2). Eventually, the BCLC-B group was matched to 40 BCLC-B patients treated (2015-2021) with TACE. Significant differences in baseline characteristics (p &lt;0.0001) and in OS were observed at 1 and 3 years (p &lt;0.0001); a significant difference was also observed in oncological outcomes, in terms of the absence, residual, or relapse of disease (p &lt;0.05). Surgery might be a valid treatment in HCC for patients affected by chronic liver disease in a condition of compensation, up to BCLC-B stage. Surgical indication for liver resection in case of HCC should be extensively revised

Cigarette smoking habit does not reduce the benefit from first line trastuzumab-based treatment in advanced breast cancer patients

Many ErbB2-positive cancers may show intrinsic resistance, and the frequent development of acquired resistance to ErbB-targeted agents represents a substantial clinical problem. The constitutive NF-κB activation in some HER-2/neu positive breast cancer may represent a potential cause of resistance to trastuzumab therapy. Preclinical data revealed that 4-(N-Methyl-N- nitrosamino)-1-(3-pyridyl)-1-butanone (NNK), the tobacco-specific nitrosamine is able to enhance NF-κB DNA binding activity and theoretically to increase the resistance to trastuzumab. Two hundred and forty-eight women with pathologically confirmed, uni- or bidimensionally measurable, HER-2-positive metastatic breast cancer (MBC) treated with trastuzumab-based therapy as first line combination for metastatic disease were considered eligible. For all included patients data on smoking habit were detectable from medical records. We retrospectively analysed the smoking habits of 248 MBC patients and correlated these habits with activity and efficacy of trastuzumab-based therapy. No statistically significant difference in terms of response rate (RR), time to progression (TTP) and overall survival (OS) was identified between smokers (former plus active smokers) and never smokers. Moreover, no statistically significant difference in terms of RR, TTP and OS was identified either comparing active smokers and former smokers. Moreover, we did not observed any significant statistical difference in terms of TTP and OS between smokers ≥10 cigarettes/day and ≤10 cigarettes/day. This study clearly showed lack of any correlation between cigarette smoking habit and both activity and efficacy of trastuzumab-based first line therapy in metastatic HER2/neu positive breast cancer patients. Copyright © 2011 Spandidos Publications Ltd. All rights reserved

Implementazione di metodologie di rilevamento delle intrusioni con il sistema Bro

Il numero di cyber attacchi, che ogni anno colpiscono non solamente le aziende ma più in generale chiunque possa collegarsi ad Internet, è in costante aumento. Da qui la necessità sempre più urgente di dotarsi di sistemi di sicurezza adeguati per proteggere i propri dati. Da qui gli ingenti capitali che vengono investiti annualmente nel settore della cybersecurity dalle grandi organizzazioni. Gli strumenti di difesa più utilizzati (firewall, antivirus e IDS) presentano tuttavia grossi limiti e possono essere superati con relativa facilità. Negli ultimi anni stanno perciò prendendo piede nuovi approcci basati sulla threat intelligence che tramite la condivisione di informazioni su minacce note cercano di rilevare e prevenire gli attacchi prima che questi possano colpire. Generalmente si tratta di metodi piuttosto semplici che si limitano a segnalare che un host si è collegato ad un certo IP, ha risolto un determinato DNS, ha scaricato un file con uno specifico hash e così via, metodi che nella pratica non risultano di poi così grande utilità né per le aziende né per i privati. Il progetto realizzato per questa tesi si pone l'obiettivo di estendere l'approccio tradizionale, cercando di proporre nuovi modi di utilizzare le informazioni di intelligence e introducendo il concetto di relazione tra indicatori, lasciando la porta aperta a tanti altri possibili sviluppi

Il comportamento del consumatore tra il desiderio mimetico e la ricerca di unicità: un'analisi di tipo sperimentale

Il presente elaborato è volto ad esaminare come le umane propensioni verso l’imitazione e verso la differenziazione si traducono nelle scelte di acquisto da parte dei consumatori. In particolare, è stata svolta un’analisi di tipo sperimentale attraverso lo strumento del questionario su un campione di 143 rispondenti. Dalla letteratura esistente si sono tratte tre ipotesi, le quali sono state verificate attraverso varie analisi statistiche tra cui: Anova ad una via, tabelle di contingenza, regressione logistica multinomiale. In conclusione, sono stati presentati i risultati emersi e le relative implicazioni manageriali che le aziende ne possono trarre. Inoltre, si sono riportati alcuni “case studies” che apparivano coerenti rispetto alle ipotesi precedentemente confermate. This paper is aimed at examining how human inclinations towards imitation and differentiation are declined into purchasing choices by consumers. In particular, an experimental analysis was carried out using the questionnaire tool on a sample of 143 respondents. Three hypotheses have been drawn from the existing literature, which have been verified through various statistical analyzes including: One-way Anova, contingency tables, multinomial logistic regression. In conclusion, the results and their managerial implications were presented. Furthermore, some “case studies” were reported which appeared to be consistent with the previously confirmed hypotheses

VALUTAZIONE DI TRE PROTOCOLLI ANESTESIOLOGICI PER CHIRURGIE DI MEDIA E LIEVE INTENSITA' NEL RATTO (RATTUS NORVEGICUS)

RIASSUNTO Gli animali non convenzionali (NAC) sono, al giorno d’oggi, sempre più comuni come animali domestici e i loro proprietari sono sempre più attenti alle esigenze delle loro mascotte esigendo livelli di qualità nelle prestazioni mediche pari a quelle riservate ai pets convenzionali. Questo porta alla necessità di sviluppare e migliorare sempre più i protocolli anestesiologici rendendoli al contempo efficaci e sicuri, considerando che spesso sono indispensabili al medico veterinario per effettuare anche le più semplici e non invasive procedure in questi animali, poco abituati alle manipolazioni e facilmente stressabili. Questi animali sono inoltre coinvolti in maniera preponderante nella sperimentazione scientifica rappresentando la maggior parte delle specie utilizzate nei laboratori di ricerca. Anche in questo frangente risultano fondamentali dei protocolli anestetici efficaci che siano di minimo impatto alla fisiologia dell’animale ma garantiscano allo stesso tempo un ottima sedazione e analgesia. Per rispondere a queste esigenze sono stati analizzati in questo studio gli effetti di tre protocolli anestesiologici in chirurgie di medio e basso stimolo dolorifico. Sono stati valutati sia gli effetti sulla fisiologia dei pazienti che sul loro stato di benessere generale. I risultati ottenuti portano a pensare che un aumento della dose della ketamina somministrata in fase di premedicazione e/o induzione porti ad una maggiore depressione del sistema cardiocircolatorio con una netta diminuzione della frequenza cardiaca nel tempo; senza al contempo apportare benefici in termini di riduzione dei tempi di induzione del soggetto, durata del tempo di anestesia, qualità e tempi di risveglio nonché benessere generale del paziente nel post-chirurgico. ABSTRACT Non-conventional animals (NAC) are nowadays more and more common as pets and their owners are more and more attentive to the needs of their mascots demanding quality levels in medical services equal to those reserved for conventional pets. This leads to the need to develop and improve the anesthetic protocols making them, at the same time, effective and safe; considering that they are often indispensable for the veterinary surgeon to perform even the simplest and non-invasive procedures in these animals, not accustomed to manipulations and easily stressful. These animals are also involved in scientific experimentation representing most of the species used in research laboratories. Even in this situation, effective anesthesia protocols are essential, they also must be of minimal impact to the animal's physiology but at the same time must guarantee excellent sedation and analgesia. To respond to these needs, the effects of three anesthetic protocols in medium and low pain stimulation surgeries were analyzed in this study. Both the effects on the physiology of the patients and on their general welfare have been assessed. The results obtained lead us to think that an increased dose of ketamine administered during the premedication and / or induction phase leads to a greater depression of the cardio-circulatory system with a marked decrease in heart rate over time; without bringing benefits in terms of reducing the induction time of the subject, duration of anesthesia time, quality and time of awakening and general welfare of the patient in post-surgical period