Femoroacetabular impingement (FAI): comparison between conservative and surgical treatment.

openObiettivi: attraverso una revisione della letteratura e delle evidenze più recenti, inquadrare clinicamente il conflitto femoro-acetabolare (FAI), indagando le modalità diagnostiche e descrivendo le possibilità di trattamento. In particolare, valutare l’efficacia del trattamento conservativo e del trattamento chirurgico e stabilire, attraverso un confronto tra i due, quale sia il trattamento di elezione nei pazienti con questa patologia. Materiali e metodi: è stata condotta una ricerca bibliografica attraverso l’analisi di articoli raccolti nelle banche dati PUBMED, PEDRO, COCHRANE. Sono stati utilizzati dei criteri di inclusione e di esclusione degli articoli: pertinenza fisioterapica, data di pubblicazione, lingua, tipologia di studi. Per la stesura è stata data precedenza agli articoli con elevata validità scientifica, dando maggior rilievo a revisioni sistematiche e metanalisi. Discussione: nell’ultimo decennio è aumentato l’interesse nei confronti del FAI e di conseguenza è incrementato il numero di pubblicazioni scientifiche. Ad oggi è possibile effettuare la diagnosi di questa patologia con una buona precisione e una discreta tempestività, elementi fondamentali per permettere un intervento quanto più precoce possibile. In letteratura vengono descritti due principali approcci di trattamento per questa patologia: il trattamento chirurgico e il trattamento conservativo. Negli ultimi anni è cresciuto in maniera esponenziale il numero di pazienti con FAI che sceglie di sottoporsi alla chirurgia per la risoluzione dei sintomi e diverse pubblicazioni recenti sembrano confermare la sicurezza e l’efficacia di questo approccio in termini di risultati nel breve e nel lungo termine. Alcuni studi confermano l’efficacia e la possibilità di ottenere un miglioramento dei sintomi con il trattamento conservativo fisioterapico; tuttavia, in letteratura non sono ancora presenti delle linee guida e dei punti di riferimento precisi. Conclusione: negli ultimi anni l’interesse scientifico per il conflitto femoro-acetabolare è aumentato e ad oggi è possibile effettuare un inquadramento clinico completo e preciso dei pazienti con FAI. Entrambi gli approcci di trattamento (conservativo e chirurgico) risultano efficaci nella gestione dei pazienti ma gli articoli più recenti sembrano confermare la superiorità dell’intervento chirurgico. In merito al trattamento conservativo nella letteratura scientifica sono ancora presenti delle importanti lacune e per questo vi è la necessità di continuare nella ricerca per stilare delle linee guida. È opportuno, inoltre, effettuare nuovi studi di alta qualità per confrontare il trattamento chirurgico e il trattamento conservativo

Dimensional analysis identifies contrasting dynamics of past climate states and critical transitions

While one can unequivocally identify past climate transitions, we lack comprehensive knowledge about their underlying mechanisms and timescales. Our study employs a dimensional analysis of benthic stable isotope records to uncover, across different timescales, how the climatic fluctuation of the Cenozoic are associated with changes in the number of effective degrees of freedom. Precession timescales dominate the Hothouse and Warmhouse states, while the Icehouse climate is primarily influenced by obliquity and eccentricity timescales. Notably, the Coolhouse state lacks dominant timescales. Our analysis proves effective in objectively identifying abrupt climate shifts and extremes. This is also demonstrated using high-resolution data from the last glacial cycle, revealing abrupt climate shifts within a single climate state. These findings significantly impact our understanding of the inherent stability of each climate state and the evaluation of (paleo-)climate models' ability to replicate key features of past/future climate states and transitions

Budget impact analysis of the use of daclatasvir in Italy for the treatment of Hepatitis C Virus (HCV) genotype 3 patients

BACKGROUND: Hepatitis C Virus (HCV) infection represents a global health problem, leading to chronic cirrhosis, hepatocellular carcinoma (HCC), hepatic decompensation and liver transplant. The aim of the study was the evaluation of the impact on the budget of the Italian National Health Service (INHS) of the use of Daclatasvir (DCV) for the treatment of HCV genotype 3 in patients with advanced fibrosis.METHODS: An analytical decision model with a five year time horizon was implemented. Two scenarios were considered: a. 100% of market share for Interferon (INF-α)+Ribavirin (RBV)+Sofosbuvir (SOF) for 12 weeks; b. SOF+DCV+RBV for 24 weeks with annual market shares of 50% in 2015 and 2016, 55% in 2017 and 2018, 60% in 2019, and INF-α+RBV+SOF for 12 weeks with the remaining market shares. Every annual cycle a percentage of patients equal to the effectiveness of the antiviral treatment reach a sustained virologic response and during the first year of treatment patients may experience treatment related adverse events. The costs considered (2015) are those of the antiviral therapy, and direct medical costs for health state and adverse events management. Univariate and multivariate sensitivity analyses were performed.RESULTS: DCV would lead to an increase of the costs for the INHS (year 1 +21.31 millions, year 2 +21.35 millions, year 3 + 23.37 millions, year 4 + 23.26 millions and year 5 +16.37 millions). The sensitivity analysis confirmed the robustness of the results.CONCLUSIONS: The use of DCV is likely to have a short term impact on the INHS budget increasing resources use compared to the sole use of INF-α+RBV+SOF. However, a trend of reduction of the costs increase is observed due to the management of health states and adverse events which may lead to the possibility to reduce costs in the long term

Treatment and outcome of metastatic parathyroid carcinoma: A systematic review and pooled analysis of published cases

Parathyroid carcinoma (PC) is an extremely rare malignant tumor with an incidence of about 6 new cases per 10 million inhabitants per year. While several papers have been published on treatments and outcomes of PC patients with loco-regional disease, little is known about the prognosis, treatment strategies, and prognostic factors of patients with distant metastasis

Interrupting vaccination policies can greatly spread SARS-CoV-2 and enhance mortality from COVID-19 disease: the AstraZeneca case for France and Italy

Several European countries have suspended the inoculation of the AstraZeneca vaccine out of suspicion that it causes deep vein thrombosis. In this letter, we report some Fermi estimates performed using a stochastic model aimed at making a risk–benefit analysis of the interruption of the delivery of the AstraZeneca vaccine in France and Italy. Our results clearly show that excess deaths due to the interruption of the vaccination campaign injections largely overrun those due to thrombosis even in worst case scenarios of frequency and gravity of the vaccine side effects. We analyze, in the framework of epidemiological modeling, the stop in the deployment of the AstraZeneca vaccine due to some suspected side effects. Indeed, a few dozen suspicious cases of deep vein thrombosis (DVT) over 5×106 vaccinations have arisen in Europe and pushed several European countries to suspend AstraZeneca injections. Using both an epidemiological susceptible-exposed-infected-recovered model and statistical analysis of publicly available data, we estimate the excess deaths resulting from missing inoculations of the vaccine and those potentially linked to DVT side effects in France and Italy. We find that, despite the many simplifications and limitations in our analysis, the excess deaths differ by at least an order of magnitude in the two strategies, that the relative benefits are wider in situations where the reproduction number is larger, and they increase with the temporal duration of the vaccine ban

Bayesian radiocarbon modeling and the absolute chronology of the Middle Bronze Age Thapsos facies in mainland Sicily : a view from St. Ippolito (Caltagirone)

One of the most debated and explored period of the prehistory of Sicily is the Middle Bronze Age (15th-13th century BCE), which is considered as a crucial moment for the development of local prehistoric social, economic, and cross-cultural dynamics. The local Thapsos culture is what best represents this chronological period and is characterized at some sites by theoccurrence of datable ceramic imports from the Aegean alongside their local replicas. These have helped researchers with estab-lishing a local relative chronology based indirect beacons with eastern Mediterranean contexts. However, when it comes to an independent absolute chronology for MBA context in mainland Sicily, no recent program of radiocarbon dating has been carried out so far. In this contribution, the authors devise a Bayesian model based on evidence from a stratified MBA context at St. Ippolito (Caltagirone, central-eastern Sicily) where a set of seven samples have been radiocarbon dated. The study aims to assess which part of the overall development of the MBA the analyzed context corresponds to, to absolute date the activities represented by the deposit’s layers, and to lay the basis to tentatively bracket in time the use of some associated ceramic materials.peer-reviewe

Contrasting information disorder by leveraging people’s biases and pains: innovating in the post-truth era

Disinformation and misinformation have been around since the advent of the media. Many solutions have been developed to contrast this phenomenon such as automated fact-checking tools, media literacy programs, or content moderation strategies. However, these endeavours are limited in scope and easily succumb to the ever changing online information landscape. In addition to that, the human brain is extremely susceptible to fake contents due to frequent biases and illusory effects. On this basis, the present paper describes the application of slightly readapted design thinking methodologies in tackling information disorder as an unconventional approach to global challenges

Study of the Application of CCUS in a WtE Italian Plant

Municipal Solid Waste (MSW) contains materials of biogenic and non-biogenic origin. When incinerated, the biogenic component produces CO2, which does not lead to an increase in atmospheric CO2 levels. For WtE plants operating on MSW with a significant biogenic component, Carbon Capture Utilization and Storage (CCUS) can provide a path to negative CO2 emissions by producing energy and managing locally produced waste. This work focuses on the study of a process for treating a flue gas stream from WtE in an Italian context, i.e. the incinerator plant located in Como, to remove CO2 that is, then, planned to be utilized. The CO2 capture process is based on chemical absorption by two different amine solvents: MonoEthanolAmine and Piperazine. The design of the CO2 removal section has been carried out specifically for the considered flue gas to be treated, containing about 7 mol % CO2, by selecting the main process parameters (e.g., absorber packing height, regenerator packing height, lean loading, gas inlet temperature, solvent inlet temperature, regenerator pressure) in order to optimize the reboiler duty and the water requirement. The performances of the two processes have been compared for the same 90 % removal of CO2