Peristomal Skin Complications in Ileostomy and Colostomy Patients: What We Need to Know from a Public Health Perspective

Background: Peristomal skin complications (PSCs) are the most common skin problems seen after ostomy surgery. They have a considerable impact on a patient's quality of life and contribute to a higher cost of care. Methods: A systematic review was conducted, querying three databases. The analysis was performed on international studies focused on the clinical-epidemiological burden of PSCs in adult patients with ileostomy/colostomy. Results: Overall, 23 studies were considered. The main diseases associated with ostomy surgery were rectal, colon and gynecological cancers, inflammatory bowel diseases, diverticulitis, bowel obstruction and intestinal perforation. Erythema, papules, skin erosions, ulcers and vesicles were the most common PSCs for patients with an ostomy (or stoma). A PSCs incidence ranging from 36.3% to 73.4% was described. Skin complications increased length of stay (LOS) and rates of readmission within 120 days of surgery. Conclusions: PSCs data are still limited. A knowledge of their burden is essential to support health personnel and decision-makers in identifying the most appropriate responses to patients' needs. Proper management of these complications plays a fundamental role in improving the patient's quality of life. A multidisciplinary approach, as well as increased patient education and their empowerment, are priority measures to be implemented to foster a value-based healthcare

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

Primary Analysis and 4-Year Follow-Up of the Phase III NIBIT-M2 Trial in Melanoma Patients With Brain Metastases

Purpose: Phase II trials have shown encouraging activity with ipilimumab plus fotemustine and ipilimumab plus nivolumab in melanoma brain metastases. We report the primary analysis and 4-year follow-up of the NIBIT-M2 study, the first phase III trial comparing these regimens with fotemustine in patients with melanoma with brain metastases. Patients and methods: This phase III study recruited patients 18 years of age and older with BRAF wild-type or mutant melanoma, and active, untreated, asymptomatic brain metastases from nine centers, randomized (1:1:1) to fotemustine, ipilimumab plus fotemustine, or ipilimumab plus nivolumab. The primary endpoint was overall survival (OS). Results: From January, 2013 to September, 2018, 27, 26, and 27 patients received fotemustine, ipilimumab plus fotemustine, and ipilimumab plus nivolumab. Median OS was 8.5 months [95% confidence interval (CI), 4.8-12.2] in the fotemustine arm, 8.2 months (95% CI, 2.2-14.3) in the ipilimumab plus fotemustine arm (HR vs. fotemustine, 1.09; 95% CI, 0.59-1.99; P = 0.78), and 29.2 months (95% CI, 0-65.1) in the ipilimumab plus nivolumab arm (HR vs. fotemustine, 0.44; 95% CI, 0.22-0.87; P = 0.017). Four-year survival rate was significantly higher for ipilimumab plus nivolumab than fotemustine [(41.0%; 95% CI, 20.6-61.4) vs. 10.9% (95% CI, 0-24.4; P = 0.015)], and was 10.3% (95% CI, 0-22.6) for ipilimumab plus fotemustine. In the fotemustine, ipilimumab plus fotemustine, and ipilimumab plus nivolumab arms, respectively, 11 (48%), 18 (69%), and eight (30%) patients had treatment-related grade 3 or 4 adverse events, without treatment-related deaths. Conclusions: Compared with fotemustine, ipilimumab plus nivolumab significantly improved overall and long-term survival of patients with melanoma with asymptomatic brain metastases

Cervical cancer elimination in Italy: Current scenario and future endeavors for a value based prevention

BackgroundCervical Cancer (CC) is a vaccine-preventable disease, and it is treatable if diagnosed early and managed properly. However, it is the fourth most common cancer in women worldwide with about 604,127 cases and 341,831 deaths in 2020. In Italy, it represents the fifth most common cancer in women under 50 years of age with about 2,400 new cases in 2020. The CC elimination is today a global public health goal published by the World Health Organization (WHO) in 2020 and a commitment of the European Union that has included it in Europe's Beating Cancer Plan. Therefore, urgent action is needed, at international and national level, to implement value-based interventions regarding vaccination, screening and timely management of the disease. Our study aims to describe the state of the art of Human Papilloma Virus (HPV) prevention in Italy and to get a consensus on indicators for monitoring the progress toward CC elimination at national level. MethodsThe study envisaged the following activities: research and synthesis of the evidence on strategies and actions for CC elimination at regional Italian level; identification of indicators to monitor such strategies/actions; organization of a multi-stakeholder consensus to reach the agreement on main indicators to be used in Italy. ResultsAs for HPV vaccination coverage, the last Italian available data (December 31st, 2020) showed that it was way below the target (95%) with full cycle vaccination coverage ranging from 6 to 61.7% in female adolescents and from 5.4 to 55.4% in male adolescents (2008 birth cohorts). The coverage rate of CC screening is variable with a range of 61.7-89.6%. Furthermore, coverage rates due to organized screening programs (excluding out-of-pocket screening) shows a range from 20.7 to 71.8%. The mapping of the Italian Regions highlighted an important regional heterogeneity in respect to organizational/operational issue of HPV vaccination and CC screening. Indicators for monitoring CC elimination strategies have been drawn from the Australian experience and distinguished by disease outcomes, vaccination coverage, screening participation and treatment uptake. The highest consensus was reached for the following indicators: CC incidence; detection of high-grade cervical disease; CC mortality; full cycle vaccination coverage; screening participation; high-grade cervical disease treatment rates; CC treatment rates. ConclusionsThe assessment of the current status of CC elimination as overarching goal beyond the achievement of vaccine, screening and treatment targets represents the first step for the identification of interventions to be implemented to accelerate the path toward CC elimination. Based on this and following the WHO call, a value-based approach is proposed to untangle the full benefit of HPV-related cancers elimination strategies and identify priority and best practices

Civiltà della Campania. Anno II, n. 3 (agosto-ottobre 1975)

A. II, n.3 (agosto-ottobre 1975): Il messaggio dell’Assessore Emilio de Feo, P. 3 ; M. Parrilli, Continuità nel turismo regionale, P. 3 ; Napoli nei secoli, P. 5 ; G. Galasso, Tumulti ed elezioni del ’600, P. 6 ; N. Cilento, Nella città medioevale, P. 18 ; B. Gatta, Capri tra Napoleone e Murat, P. 24 ; R. Causa, Gioacchino Toma a Napoli, P. 30 ; A. Assante, Napoli e il suo porto, P. 34 ; G. Grimaldi, Messaggio di fede dell’Anno Santo, P. 40 ; R. Vlad, Musica all’aperto, P. 50 ; M. Stefanile, Viaggio nella storia di Amalfi, P. 52 ; D. Rea, Mappa minore, P. 60 ; M. Prisco , Incontro con la Badia, P. 68 ; P. Amos e A. Gambardella, Il villaggio di Albori, P. 74 ; R. Virtuoso, Giovanni Cuomo ritorna tra i giovani, P. 76 ; V. Panebianco, Il turismo venuto dalla storia, P. 80 ; A.P. Carbone, Le grotte di Pertosa, P. 84 ; F. de Ciuceis, Il mare di Caserta, P. 88 ; E. Tirone, Riti settennali a Guardia Sanframondi, P. 92 ; F. Calabro, Turismo e cultura a Capri, P. 98 ; F. de Ciuceis, Settembre al Borgo, P. 102 ; I. Santoro, Teggiano citta museo, P. 104 ; Notiziario, P. 108

Efficacy of Antioxidant Treatment in Reducing Resistin Serum Levels: A Randomized Study

OBJECTIVES: Few in vitro studies have examined the participation of resistin, a recently discovered adipokine, in oxidative processes. We investigated whether in vivo treatment with the antioxidant vitamin C might affect resistin serum levels. DESIGN: Randomized prospective open trial. SETTING: San Giovanni Battista Hospital, Turin, Italy. PARTICIPANTS: Eighty healthy individuals. INTERVENTION: Administration of 2 g of ascorbic acid orally for 2 wk (n = 40; experimental group) or no supplementation (n = 40; control group). OUTCOME MEASURES: The primary end point was the between-group difference in the before–after change in resistin serum level after vitamin C supplementation. Secondary endpoints were the within- and between-group changes in glucose, insulin, lipid parameters, C-reactive protein fasting values, and markers of oxidative stress. RESULTS: In the experimental group, vitamin C supplementation was significantly associated with both resistin concentration reduction (from 4.3 ± 1.5 to 2.9 ± 0.8 ng/ml; 95% confidence interval [CI] −1.87, −1.03) and ascorbic acid level increase (from 9.4 ± 2.9 to 19.0 ± 5.2 mg/l; 95% CI 7.9, 11.2). In the control group, resistin levels did not change significantly (from 4.2 ± 1.0 to 4.3 ± 0.9 ng/ml; 95% CI −0.07, 0.37). The between-group differences were highly significant (p < 0.001). Vitamin C supplementation was also associated with a statistically significant reduction in nitrotyrosine level and incremental increase in reduced glutathione. In a linear regression model, within-individual changes in vitamin C concentrations were inversely correlated with changes in resistin levels in both groups (each unit increase of vitamin C corresponded to a decrease of about 0.10 units of resistin levels (95% CI 0.13, 0.08; p < 0.001). CONCLUSION: This is to our knowledge the first randomized trial in humans that has demonstrated that short-term vitamin C supplementation could significantly reduce resistin levels, independent of changes in inflammatory or metabolic variables. Future investigations of resistin participation in oxidative processes are warranted

Final CONNECT Architecture

Interoperability remains a fundamental challenge when connecting heterogeneous systems which encounter and spontaneously communicate with one another in pervasive computing environments. This challenge is exasperated by the highly heterogeneous technologies employed by each of the interacting parties, i.e., in terms of hardware, operating system, middleware protocols, and application protocols. The key aim of the CONNECT project is to drop this heterogeneity barrier and achieve universal interoperability. Here we report on the revised CONNECT architecture, highlighting the integration of the work carried out to integrate the CONNECT enablers developed by the different partners; in particular, we present the progress of this work towards a finalised concrete architecture. In the third year this architecture has been enhanced to: i) produce concrete CONNECTors, ii) match networked systems based upon their goals and intent, and iii) use learning technologies to find the affordance of a system. We also report on the application of the CONNECT approach to streaming based systems, further considering exploitation of CONNECT in the mobile environment

Revised CONNECT Architecture

Interoperability remains a fundamental challenge when connecting heterogeneous systems which encounter and spontaneously communicate with one another in pervasive computing environments. This challenge is exasperated by the highly heterogeneous technologies employed by each of the interacting parties, i.e., in terms of hardware, operating system, middleware protocols, and application protocols. The key aim of the CONNECT project is to drop this heterogeneity barrier and achieve universal interoperability. Here we report on the revised CONNECT architecture, highlighting the integration of the work carried out to integrate the CONNECT enablers developed by the different partners; in particular, we present the progress of this work towards a finalised concrete architecture. In the third year this architecture has been enhanced to: i) produce concrete CONNECTors, ii) match networked systems based upon their goals and intent, and iii) use learning technologies to find the affordance of a system. We also report on the application of the CONNECT approach to streaming based systems, further considering exploitation of CONNECT in the mobile environment

A LEZIONE DA ROBERTO ESPOSITO. Comunità e biopolitica

Per una vivente Italian Theory: è così che si potrebbe racchiudere il percorso filosofico di Roberto Esposito, la cui mappa concettuale si disegna all’interno di un itinerario del tutto inesplorato che va dall’immanenza del conflitto alle tesi bio-politiche e tanato-immunitarie per approdare infine al paradigma della terza persona. Qui si schiude infatti una istanza teorico-politica che culmina in una nuova visione del mondo: al di qua della trappola metafisica della “persona” – che mira a separare l’essere vivente da se stesso – Esposito indica nel “vivente impersonale” il luogo a partire dal quale la nostra esistenza “si apre a ciò che non è mai ancora stata”. Le questioni cruciali del nostro tempo - legate ai concetti di sovranità e di fine del politico, che Esposito decostruisce tramite il ricorso alla categoria dell’impolitico e di biopolitica - sono affrontate senza maschere e soluzioni quietistiche. Un “pensiero vivente” capace insomma, secondo l’esempio geofilosofico tutto italiano di Machiavelli, Bruno, Vico o Gramsci, di far saltare il primato trascendentale del linguaggio e restituire la relazione costitutiva tra politica, storia e vita