E ora come si fa? Realizzare una tesi di laurea multidisciplinare in ambito audio-otologico, radiologico e pediatrico

L\u2019Organizzazione Mondiale della Sanit\ue0 (OMS) ha posto in evidenza la dimensione sociale della disabilit\ue0 fin dagli anni \u201880, e, nel 2001, ne ha successivamente rivoluzionato l\u2019approccio, guardando alla disabilit\ue0 non come una lineare e logica conseguenza della menomazione, ma come il risultato di un\u2019interazione tra lo stato di salute della persona e l\u2019ambiente in cui vive. Nonostante quest\u2019ultima visione della disabilit\ue0 sia oggi universalmente condivisa, il pensiero e la pratica medica, l\u2019organizzazione sanitaria ospedaliera e le successive strategie socio-assistenziali, faticano ancor\u2019oggi a staccarsi da un sistema tradizionale, che mette maggiormente a fuoco la diagnosi, il trattamento e il generale \u201csupporto\u201d alle patologie croniche, trascurando la prospettiva orientata allo sviluppo e alla disabilit\ue0 nella sua accezione compiuta. In sintonia con i principi emergenti in sanit\ue0, e cio\ue8 la centralit\ue0 del paziente e della sua rete di cura, il termine disabilit\ue0 vuole in definitiva evidenziare che il deficit e l\u2019eventuale presenza di patologie associate non sono i soli elementi da prendere in considerazione nel trattamento. L\u2019approccio di cura alle condizioni croniche deve diventare multi-prospettico: non solo biomedico, anche individuale, sociale, ambientale. Queste considerazioni risultano valere ancor di pi\uf9 quando si curano ipoacusie e sordit\ue0 congenite o preverbali, condizioni che si manifestano all\u2019inizio o precocemente nella vita di un bambino, e che durano per tutta la vita, con conseguenze funzionali che possono fortemente condizionare le traiettorie dello sviluppo. Il contributo pi\uf9 specifico del sottoscritto \ue8 nel paragrafo: "E ora come si fa? Realizzare una tesi di laurea multidisciplinare in ambito Audio-Otologico, Radiologico e Pediatrico

Acute myocardial infarction in non-cardiac critically ill patients: a clinical-pathological study.

Background: in patients admitted to the Intensive Care Unit (ICU) for non cardiac disease, the diagnosis of acute coronary syndromes can be challenging. The aim of the study was to define the rate of discrepancies concerning the diagnosis of acute myocardial infarction and to evaluate the presence of risk factors that could be helpful in identifying patients at higher risk of missed diagnosis. Methods: we compared clinical and autopsy records of 600 critically ill patients who died in our ICU in a 10-years period. We identified patients in whom acute myocardial infarction was reported as the cause of death on the clinical records or was discovered only at post-mortem examination. These subjects were subsequently divided into two Groups: patients in Group 1 underwent diagnostic evaluation for acute myocardial infarction whereas those in Group 2 were not investigated for. Results: In Group 1, a definite clinical diagnosis was reached in 11 patients (14,7%) but remained undetermined in 37 patients (48%). The diagnosis was totally missed in 8 patients in Group 1 (10,6%) and in 20 patients of Group 2 (26,6%). The diagnostic discrepancy was higher in septic patients, in whom the correct diagnosis of acute myocardial infarction was established at a rate lower than 50% in respect to non-septic patients. Conclusions: Our experience strengthens the role of post-mortem examination as a source of feed-back of the overall diagnostic and therapeutic approach especially in septic patients, where the diagnostic error is more frequent

Satisfaction with online teaching of medical statistics during the COVID-19 pandemic: A survey by the Education Committee of the Italian Society of Medical Statistics and Clinical Epidemiology

: On May 2020, after 2 months of online teaching with no face-to-face lectures, the Education Committee of the Italian scientific Society of Medical Statistics and Clinical Epidemiology conceived an online survey to assess satisfaction of Italian academics of medical statistics with online teaching and remote exams. This survey highlighted teachers' perceptions as well as opportunities and limitations of online teaching of medical statistics, biostatistics, and epidemiology. Although 61% of Italian academics of medical statistics declared to be favorable to provide online teaching of medical statistics, biostatistics, and epidemiology in the future, we recognize that distance education cannot substitute the unique value of teaching and knowledge exchange that could only be transmitted through a personal interaction between students and teachers. These indications may be useful to improve the quality of the teaching process in the future

Influence of Maxillary Sinus Width on New Bone Formation After Transcrestal Sinus Floor Elevation: A Proof-of-Concept Prospective Cohort Study

PURPOSE: Graft maturation in the maxillary sinus requires adequate angiogenesis and osteoprogenitor cells migration from the surrounding bony walls: the aim of this study was to analyze the correlation between sinus cavity dimensions and new bone formation after transcrestal sinus floor elevation (tSFE). METHODS: Patients needing maxillary sinus augmentation (residual crest height 64 4 mm) were treated with tSFE using xenogeneic granules. Six months later, bone-core biopsies were retrieved for histological analysis in the implant insertion sites. Buccopalatal sinus width (SW) was evaluated on cone beam computed tomography, and correlations between histomorphometric and anatomical parameters were quantified by means of linear regression analysis. RESULTS: Eight consecutive patients underwent tSFE procedures: at 6 months, average percentage of newly formed bone resulted 24.2% \ub1 7.9%. Statistical analysis showed a strong inverse correlation between SW and new bone formation (R = 0.88), and a strong direct correlation between the number of exposed bone walls and new bone formation (R = 0.82). CONCLUSION: Within the limitations of this proof-of-concept study, in which a restricted number of patients were analyzed, tSFE showed more predictable results in narrow than in large sinuses, in terms of new bone formation

Accuracy of the digital workflow for guided insertion of orthodontic palatal TADs: a step-by-step 3D analysis

BACKGROUND: The introduction in the orthodontic field of the digital workflow for guided insertion of palatal TADs and the development of the 1-visit protocol led to the reduction of chair time and the possibility of complete customization of designs and materials. Conversely, the reduction of operative steps implicates a lower tolerance of deviations between the planned and the actual position of the miniscrews, particularly when the orthodontic device is fixed on 4 palatal TADs or has a rigid structure. This study aims to analyze the influence of each step of the digital workflow on the deviation of the miniscrews' axis of insertion in a bicortical sample. The null hypothesis is that there are no significant differences in the deviations among the operative steps. METHODS: 33 subjects were selected for insertion of bicortical palatal miniscrews with a 1-visit protocol. Digital files were collected at the three stages of the workflow (i.e., digital planning, laboratory prototype, post-insertion impression). A 3D software analysis was performed on a total of 64 miniscrews. After automatic shape recognition of the guiding holes of the digital plan and the scanbodies of the laboratory prototype and post-insertion impression as geometric cylinders, their three-dimensional longitudinal axis was traced and the deviation among them was calculated. Friedman test with Bonferroni correction was performed to assess the significance of the deviations among the three steps, with significance set at p < 0.05. RESULTS: The laboratory step has a significantly lower degree of deviations (2.12° ± 1.62) than both the clinical step (6.23° ± 3.75) and the total deviations (5.70° ± 3.42). No significant differences were found between miniscrews inserted on the left or the right side. CONCLUSIONS: This study suggests that laboratory procedures such as surgical guide production or rapid prototyping don't play a significant role in the degree of deviations between the planned and the positioned palatal TADs. Conversely, the clinical steps have a bigger influence and need to be carefully evaluated. Despite this difference, there is a cumulative effect of deviations that can lead to the failure of the 1-visit protocol

Pediatric males receiving hematopoietic stem cell transplant lose their male disadvantage in disease risk after the procedure: A retrospective observational study

Sex differences play a relevant role in cancer susceptibility, incidence and survival. Exploring such differences is difficult because of the close interplay of genetic, epigenetic and hormonal factors. However, a better understanding of the role of such disparities in cancer mechanisms could improve its prevention and therapy. Our study explores how sex differences in pediatric outcomes vary after undergoing first and advanced-line therapy for hematological malignancies. The primary goal was to evaluate if sex differences in pediatric outcomes after first-line therapy persist after allogeneic hematopoietic stem cell transplantation (HSCT). The secondary goal was to analyze sex differences in disease risk at onset and pediatric outcomes after first-line therapy to compare our results with the literature's reported results. Among a total of 485 patients (280 males, 205 females) admitted for hematological malignancies, disease risk at the onset was significantly higher in males (P &lt; .05). One hundred and seventy-four patients (111 males and 63 females) had a high-risk disease requiring HSCT. Before HSCT, all patients underwent myeloablative conditioning, which substantially impaired gonadal function. Although the number of boys undergoing HSCT was almost double that of girls, there were no sex-related differences in overall survival, cancer relapse and complications after HSCT exposure (P &gt; .05). These findings suggest that the existing sex differences in cancer risk ab initio can be somehow flattened by a conditioning regimen, shedding new light on the role of hormonal factors in cancer mechanism and management

Early Recovery of Aphasia through Thrombolysis: The Significance of Spontaneous Speech

Aphasia in one of the most devastating stroke-related consequences for social interaction and daily activities. Aphasia recovery in acute stroke depends on the degree of reperfusion after thrombolysis or thrombectomy. As aphasia assessment tests are often time-consuming for patients with acute troke, physicians have been developing rapid and simple tests. The aim of our study is to evaluate the improvement of language functions in the earliest stage in patients treated with thrombolysis and in nontreated patients using our rapid screening tes

Knowledge and awareness of oral cancer: A cross-sectional survey in Trieste, Italy

The aim of the study was to verify the knowledge on oral cancer and to assess possible differences in awareness and information basing on different demographic and subject-related factors. An anonymous survey was provided to 750 random subjects using online-based questionnaires. Statistical analysis was performed in order to evaluate the influence of demographic variables (gender, age, education) on knowledge of oral cancer and its risk factors. 68.4% of individuals knew about the existence of oral cancer, mostly from media and family/friends. Awareness was significantly influenced by gender and higher education, but not by age. Most participants recognized smoking as a risk factor, but alcohol abuse and sunlight exposure are less known, especially among less educated subjects. On the contrary, our study shows a diffusion of false information: more than 30% of the participants indicated the possible role of amalgam fillings in oral cancer onset, independently of gender, age or education. The results of our study suggest the need for oral cancer awareness campaigns, where school and healthcare professionals should be actively involved in promoting, organizing and finding methods to monitor the medium and long-term efficacy with proper methodological quality

Identification of point mutations and large intragenic deletions in Fanconi anemia using next-generation sequencing technology

Fanconi anemia (FA) is a rare bone marrow failure disorder characterized by clinical and genetic heterogeneity with at least 17 genes involved, which make molecular diagnosis complex and time-consuming. Since next-generation sequencing technologies could greatly improve the genetic testing in FA, we sequenced DNA samples with known and unknown mutant alleles using the Ion PGMTM system (IPGM). The molecular target of 74.2 kb in size covered 96% of the FA-coding exons and their flanking regions. Quality control testing revealed high coverage. Comparing the IPGM and Sanger sequencing output of FANCA, FANCC, and FANCG we found no false-positive and a few false-negative variants, which led to high sensitivity (95.58%) and specificity (100%) at least for these two most frequently mutated genes. The analysis also identified novel mutant alleles, including those in rare complementation groups FANCF and FANCL. Moreover, quantitative evaluation allowed us to characterize large intragenic deletions of FANCA and FANCD2, suggesting that IPGM is suitable for identification of not only point mutations but also copy number variations

Uso sinergico della reologia e della risonanza magnetica nucleare a basso campo per caratterizzare l’espettorato di pazienti con fibrosi cistica

Hyper-concentrated and more viscous mucus presents in the lungs of patients suffering from cystic fibrosis (CF) provoke mucus stasis providing an optimal environment for bacterial growth. The sputum of CF patients has been subjected to rheological and low-field NMR investigation, providing information on i) the state of viscoelasticity (G0, h 0 ) and mucus hydration (T2avg), ii) possible correlations also with parameter of patients clinical status given by spirometry(FEV1) iii) the structure of the polymeric network in mucus. The absence of correlation among magnetic and mechanical-rheological relaxation notes that these phenomena are linked to different aspects of sputum. However, correlations exist among FEV1, T2av and rheological properties G0, h 0. Moreover, T2avg correlates with the mucociliary clearability index (MCI) and cough clearability index (CCI), two indices derived from the rheological characterization. The clinical condition of the patient can, therefore, be summarized by T2avg alone. Finally, information from the two characterizations make it possible to estimate the mesh size distribution of the polymeric network pervading sputum. This knowledge is very useful to better understand drugs penetration in mucus