Cardiac resynchronization therapy in the real world: need to upgrade outcome research

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Assessing the environmental risks associated with contaminated sites

A risk assessment strategy considering the impact of chemicals on the whole ecosystem has been developed in order to create a sound and useful method for quantifying and comparing global risks posed by the main different hazardous chemicals found in the environment. This index, called the Environmental Risk Index for a Complete Assessment (ERICA), merges in a single number the environmental assessment, the human health risk assessment and the uncertainty caused by missing or unreliable data. ERICA uses a scoring system with parameters for the main characteristics of the pollutants. The main advantage is that it preserves a simple approach by condensing in this single value an analysis of the risk for the area under observation. The availability and reliability of the data is an important part of the work done to build the index. Experimental and predictive data were compared to evaluate the reliability. Data were derived both from literature sources (experimental models mainly) and predictive models. ERICA can be considered a diagnostic and prognostic tool for environmental contaminants in critical and potentially dangerous sites, such as incinerators, landfills and industrial areas or in broader geographical areas. The application of the proposed integrated index provides a preliminary quantitative analysis of possible environmental alerts due to the presence of one or more pollutants in the investigated site. This thesis presents the method and the equations behind the index and a first case study based on the Italian legislation and a pilot study on a location on the Italian seacoast

How to RESPOND to the quest to increase the effectiveness of cardiac resynchronization therapy?

This editorial refers to 'Contractility sensor-guided optimization of cardiac resynchronization therapy: results from the RESPOND-CRT trial', by J. Brugada et al., on page 730

The "Orthoplastic" combined surgical approach to open tibia fractures: a multicentric prospective outcome study

Introduction: Open fractures of the leg represent a severe trauma. The combined approach, shared between plastic and orthopaedic surgeons, is considered to be important, although this multidisciplinary treatment is not routinely performed. Aim of this study was to verify whether the orthoplastic treatment is of any advantage over the traditional simply orthopedic treatment, through a multicentric inclusion of these unfrequent injuries into a prospective study. Material and methods: The following trauma centres were involved: Rizzoli Orthopaedic Institute/University of Bologna (leading centre) and Maggiore Hospital (Bologna, Italy), Frenchay Hospital (Bristol, United Kingdom), Jinnah Hospital (Lahore, Pakistan). All patients consecutively hospitalized in the mentioned centres between January 2012 and December 2013 due to tibial open fractures were included in the study and prospectively followed up to December 2014. Demographics and other clinical features were recorded, including the type of treatment (orthopaedic or orthoplastic). The considered outcome measures included duration of hospitalization, time for bone union and soft tissue closure, Enneking score at 3, 6 and 12 months, the incidence of osteomyelitis and other complications. Results: A total of 164 patients were included in the study. Out of them 68% were treated with an orthoplastic approach, whereas 32% received a purely orthopedic treatment. All considered outcome measures showed to be improved by the orthoplastic approach, compared to the orthopaedic one: time for soft tissue closure (2 versus 25 weeks), duration of hospital stay (22 versus 55 days), time for bone union (6 versus 8.5 months) , number of additional operations (0.6 versus 1.2) and functional recovery of the limb at 12 months (27 versus 19, Enneking’s score). All results were statistically significant. Conclusion: The combined orthoplastic approach to the treatment of open tibia fractures, in particular for high grade injuries (Gustilo 3B), is proven to improve the outcome of these severe injuries

Spine anterior column reconstruction after tumor resection: titanium/carbon fiber cage or structural allograft?

Il rachide è stato suddiviso in tre colonne da Denis: anteriore e centrale comprendono la metà anteriore del corpo vertebrale, la metà posteriore e l’inizio dei peduncoli, mentre la colonna posteriore comprende l’arco e i peduncoli stessi. In caso di resezione o lesione della colonna anteriore e media è indicata la ricostruzione. Diverse tecniche e materiali possono essere usati per ricostruire il corpo vertebrale. Innesti vascolarizzati, autograft, allograft sono stati usati, così come impianti sintetici di titanio o materiale plastico come il PEEK (Poly etere etere ketone). Tutti questi materiali hanno vantaggi e svantaggi in termini di proprietà intrinseche, resistenza meccanica, modulo di elasticità, possibilità di trasmissione malattie, capacità di fondersi con l’osso ospite o meno. Le soluzioni più usate sono le cage in titanio o carbonio, il PMMA ( Poli methil metacrilato), gli innesti ossei massivi. Si è effettuato uno studio di coorte retrospettivo paragonando due gruppi di pazienti oncologici spinali trattati da due chirurghi esperti in un centro di riferimento, con vertebrectomia e ricostruzione della colonna anteriore: un gruppo con cage in carbonio o titanio, l’altro gruppo con allograft massivo armato di innesto autoplastico o mesh in titanio. Si sono confrontati i risultati in termini di cifosi segmenterai evolutiva, fusione ossea e qualità di vita del paziente. Il gruppo delle cage in carbonio / titanio ha avuto risultati leggermente migliori dal punto di vista biomeccanico ma non statisticamente significativo, mentre dal punto di vista della qualità di vita i risultati sono stati migliori nel gruppo allograft. Non ci sono stati fallimenti meccanici della colonna anteriore in entrambi i gruppi, con un Fu tra 12 e 60 mesi. Si sono paragonati anche i costi delle due tecniche. In conclusione l’allogar è una tecnica sicura ed efficace, con proprietà meccaniche solide, soprattutto se armato con autograft o mesi in titanio.According to Denis the spine can be subdivided in 3 columns: anterior and central made by the anterior half and posterior half of the vertebral body, and posterior column made by the pedicles and posterior arch. Reconstruction of large anterior and middle column defects is indicated in a number of pathological entities including tumor, infection, trauma and post traumatic deformity, usually after a previous partial or total vertebral body resection. Several substitutes and techniques are available for the functional restoration of the vertebral column. Vascularized bone transfers, autografts, allografts or xenografts have been used, as well as metal, plastic or ceramic implants. All of these bear potential advantages and drawbacks in terms of associated morbidity of graft harvesting, disease transmission, mechanical failure, implant incorporation and over all long term outcome. The most frequently used solutions are: PMMA, Titanium Mesh Cages, Carbon Fiber Stackable cages, Massive allografts. a retrospective cohort study has been done comparing two groups of oncologic spine patients treated by 2 surgeons with vertebrectomy and anterior reconstruction: one group with cages, the other with allograft. We have compared results in terms of post surgical kyphosis and its worsening in time, fusion of the graft, quality of life. Results have been slightly better in the cage group but with no statistical relevance. No mechanical failure of the anterior column in both groups with a FU range from 12 to 60 months. A cost comparison has also been made. In conclusion we have realized allograft are a safe and cheap alternative to carbon fiber cages, with strong mechanical properties above all if helped by small titanium cages or rib autograft inside

Extending survival by reducing sudden death with implantable cardioverter-defibrillators: a challenging clinical issue in non-ischaemic and ischaemic cardiomyopathies

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Cardiac resynchronization therapy in the real world: need to focus on implant rates, patient selection, co-morbidities, type of devices, and complications

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