Il trattamento in Terapia Intensiva dello shock cardiogeno in corso di infarto miocardico acuto con sopraslivellamento ST: risultati nell'ASL 11 Empoli dopo la riorganizzazione dell'ospedale per intensità di cure.

Vengono messi a confronto i risultati sulla mortalità intraricovero dello shock cardiogeno in corso di STEMI prima e dopo la riorganizzazione della Terapia Intensiva Cardiologica in seguito all'apertura dell'ospedale per intensità di cure dell'ASL 11 di Empoli

Discontinuity Detection by Null Rules for Adaptive Surface Reconstruction

We present a discontinuity detection method based on the so-called null rules, computed as a vector in the null space of certain collocation matrices. These rules are used as weights in a linear combination of function evaluations to indicate the local behavior of the function itself. By analyzing the asymptotic properties of the rules, we introduce two indicators (one for discontinuities of the function and one for discontinuities of its gradient) by locally computing just one rule. This leads to an efficient and reliable scheme, which allows us to effectively detect and classify points close to discontinuities. We then show how this information can be suitably combined with adaptive approximation methods based on hierarchical spline spaces in the reconstruction process of surfaces with discontinuities. The considered adaptive methods exploit the ability of the hierarchical spaces to be locally refined, and fault detection is a natural way to guide the refinement with low computational cost. A selection of test cases is presented to show the effectiveness of our approach

Physics-Informed Neural Networks for 2nd order ODEs with sharp gradients

In this work, four different methods based on Physics-Informed Neural Networks (PINNs) for solving Differential Equations (DE) are compared: Classic-PINN that makes use of Deep Neural Networks (DNNs) to approximate the DE solution;Deep-TFC improves the efficiency of classic-PINN by employing the constrained expression from the Theory of Functional Connections (TFC) so to analytically satisfy the DE constraints;PIELM that improves the accuracy of classic-PINN by employing a single-layer NN trained via Extreme Learning Machine (ELM) algorithm;X-TFC, which makes use of both constrained expression and ELM. The last has been recently introduced to solve challenging problems affected by discontinuity, learning solutions in cases where the other three methods fail. The four methods are compared by solving the boundary value problem arising from the 1D Steady-State Advection–Diffusion Equation for different values of the diffusion coefficient. The solutions of the DEs exhibit steep gradients as the value of the diffusion coefficient decreases, increasing the challenge of the problem

Oral Antiplatelet Therapy for Secondary Prevention of Non-Cardioembolic Ischemic Cerebrovascular Events

Stroke is the leading cause of disability and mortality worldwide. After an acute cerebrovascular ischemia, recurrent vascular events, including recurrent stroke or transient ischemic accidents (TIA), occur in around 20% of cases within the first 3 months. In order to minimize this percentage, antiplatelet therapy may play a key role in the management of non-cardioembolic cerebrovascular events. This review will focus on the current evidence of antiplatelet therapies most commonly discussed in practice guidelines and used in clinical practice for the treatment of stroke/TIA complications. The antiplatelet therapies most commonly used and discussed are as follows: aspirin, clopidogrel, and ticagrelor

Economic Aspects in the Management of Diabetic Macular Edema in Italy

BackgroundDiabetic Macular Edema (DME) is the most common cause of vision loss in diabetic patients. Currently, the Vascular Endothelial Growth Factor inhibitors (anti-VEGFs) are used as the first line of DME treatment and corticosteroid implants are usually used as a second-line treatment. These implants are a safe and effective therapeutic option that can improve the quality of life of DME patients by reducing the intravitreal injections number. We determined the economic impact related to DME, also from the social perspective, and the consequences of the increased use of the dexamethasone implant. MethodsThe analysis compares two scenarios: the first based on the current rate of recourse to the therapeutic alternatives available in the Italian healthcare setting (as is) and the second based on the assumption of an increased recourse to dexamethasone implants (to be). The results are expressed both in terms of the resource absorption associated with the two scenarios and in terms of the cost differential yielded by their comparison. ResultsThe increased use of the dexamethasone implant allows considerable savings in terms of healthcare professionals' time, follow-up and productivity lost by patients/caregivers. These savings would reduce healthcare costs for the management of DME patients in Italy by euro2,058,238 in 5 years. ConclusionsTo optimize the healthcare resources allocation, it is necessary to implement treatments that yield not only cost reductions but also a clinical benefit for patients. The dexamethasone implant use is an example of DME management that generates value for patients, health system and society

Bone metastases and immunotherapy in patients with advanced non-small-cell lung cancer

Background Bone metastases (BoM) are a negative prognostic factor in non-small-cell lung cancer (NSCLC). Beyond its supportive role, bone is a hematopoietic organ actively regulating immune system. We hypothesized that BoM may influence sensitivity to immunotherapy. Methods Pretreated non-squamous (cohort A) and squamous (cohort B) NSCLCs included in the Italian Expanded Access Program were evaluated for nivolumab efficacy according to BoM. Results Cohort A accounted for 1588 patients with non-squamous NSCLC, including 626 (39%) with (BoM+) and 962 (61%) without BoM (BoM-). Cohort B accounted for 371 patients with squamous histology including 120 BoM+ (32%) and 251 (68%) BoM- cases. BoM+ had lower overall response rate (ORR; Cohort A: 12% versus 23%, p < 0.0001; Cohort B: 13% versus 22%, p = 0.04), shorter progression free survival (PFS; Cohort A: 3.0 versus 4.0 months, p < 0.0001; Cohort B: 2.7 versus 5.2 months, p < 0.0001) and overall survival (OS; Cohort A: 7.4 versus 15.3 months, p < 0.0001; Cohort B: 5.0 versus 10.9 months, p < 0.0001). Moreover, BoM negatively affected outcome irrespective of performance status (PS; OS in both cohorts: p < 0.0001) and liver metastases (OS cohort A: p < 0.0001; OS Cohort B: p = 0.48). At multivariate analysis, BoM independently associated with higher risk of death (cohort A: HR 1.50; cohort B: HR 1.78). Conclusions BoM impairs immunotherapy efficacy. Accurate bone staging should be included in clinical trials with immunotherapy

Upregulation of TH/IL-17 Pathway-Related Genes in Human Coronary Endothelial Cells Stimulated with Serum of Patients with Acute Coronary Syndromes

Inflammation plays an essential role in the development and complications of atherosclerosis plaques, including acute coronary syndromes (ACS). Indeed, previous reports have shown that within the coronary circulation of ACS patients, several soluble mediators are released. Moreover, it has been demonstrated that endothelial dysfunction might play an important role in atherosclerosis as well as ACS pathophysiology. However, the mechanisms by which these soluble mediators might affect endothelial functions are still largely unknown. We have evaluated whether soluble mediators contained in serum from coronary circulation of ACS patients might promote changes of gene profile in human coronary endothelial cells (HCAECs)

Failure of knee osteotomy in a case of neuropathic arthropathy of the knee

Neuropathic arthropathy (Charcot’s joint) is a degenerative process that affects peripheral or vertebral joints as a consequence of a disturbance in proprioception and pain perception. The knee is one of the most frequently affected joints, but even when the diagnosis is made at an early stage there is no consensus on the best treatment options. An early diagnosis of neurosyphilis was made in a 55-year-old woman presenting a delayed union of an asymptomatic Schatzker type IV fracture of the proximal tibia. A medial opening wedge tibial osteotomy was performed to achieve fracture healing, to correct the medial depression of the articular surface, and possibly to avoid an early arthritis typical of the disease. To our knowledge, a knee osteotomy has never been reported at an early stage of neuropathic arthropathy. Even though the clinical and radiographic evaluation performed at 4 months follow-up showed a good stage of healing of the osteotomy and no typical features of neuropathic joint degeneration, at 8 months follow-up the knee was markedly deranged