I.S.Mu.L.T - Rotator cuff tears guidelines

Despite the high level achieved in the field of shoulder surgery, a global consensus on rotator cuff tears management is lacking. This work is divided into two main sessions: in the first, we set questions about hot topics involved in the rotator cuff tears, from the etiopathogenesis to the surgical treatment. In the second, we answered these questions by mentioning Evidence Based Medicine. The aim of the present work is to provide easily accessible guidelines: they could be considered as recommendations for a good clinical practice developed through a process of systematic review of the literature and expert opinion, in order to improve the quality of care and rationalize the use of resources

Targeted gene panel screening is an effective tool to identify undiagnosed late onset Pompe disease

Mutations in the GAA gene may cause a late onset Pompe disease presenting with proximal weakness without the characteristic muscle pathology, and therefore a test for GAA activity is the first tier analysis in all undiagnosed patients with hyperCKemia and/or limb-girdle muscular weakness. By using MotorPlex, a targeted gene panel for next generation sequencing, we analyzed GAA and other muscle diseasegenes in a large cohort of undiagnosed patients with suspected inherited skeletal muscle disorders (n = 504). In this cohort, 275 patients presented with limb-girdle phenotype and/or an isolated hyperCKemia. Mutational analysis identified GAA mutations in ten patients. Further seven affected relatives were identified by segregation studies. All the patients carried the common GAA mutation c.-32-13T > G and a second, previously reported mutation. In the subcohort of 275 patients with proximal muscle weakness and/or hyperCKemia, we identified late-onset Pompe disease in 10 patients. The clinical overlap between Pompe disease and LGMDs or other skeletal muscle disorders suggests that GAA and the genes causing a metabolic myopathy should be analyzed in all the gene panels used for testing neuromuscular patients. However, enzymatic tests are essential for the interpretation and validation of genetic results. (C) 2018 Elsevier B.V. All rights reserved.Peer reviewe

Association between preoperative evaluation with lung ultrasound and outcome in frail elderly patients undergoing orthopedic surgery for hip fractures: study protocol for an Italian multicenter observational prospective study (LUSHIP)

Hip fracture is one of the most common orthopedic causes of hospital admission in frail elderly patients. Hip fracture fixation in this class of patients is considered a high-risk procedure. Preoperative physical examination, plasma natriuretic peptide levels (BNP, Pro-BNP), and cardiovascular scoring systems (ASA-PS, RCRI, NSQIP-MICA) have all been demonstrated to underestimate the risk of postoperative complications. We designed a prospective multicenter observational study to assess whether preoperative lung ultrasound examination can predict better postoperative events thanks to the additional information they provide in the form of "indirect" and "direct" cardiac and pulmonary lung ultrasound signs

La Scienza e l'immaginario

L’attività di divulgazione della cultura scientifica ha un ruolo fondamentale sulla società, sia in termini di applicazioni innovative che di pianificazione dell’ambiente. I ricercatori dell’IAS-CNR di Capo Granitola operano da anni nell’ambito della diffusione della cultura scientifica, attraverso processi complessi e percorsi di divulgazione in partnership con istituti scolastici del territorio, realizzando attività seminariali, convegni direttamente nelle scuole, nonché visite didattiche guidate degli alunni nei laboratori dell’Istituto ed esperimenti interdisciplinari sull’ambiente marino. Tali processi divulgativi si sono sviluppati creando numerosi percorsi, in maniera per certi aspetti analoga a quella per cui dalla mescolanza dei tre colori fondamentali si è in grado di ottenere un numero pressoché illimitato di tinte diverse. Lo scopo di questa “mescolanza” è stato quello di ottenere un ventaglio di competenze e strumentazioni che consentissero di indagare i differenti aspetti dell’ecosistema marino da diversi punti di vista ed in maniera sinergica, tale da restituire un quadro il più ricco possibile di “tinte” e particolari. (Scienza e arte di Salvatore Mazzola) La Scienza e l'immaginario di Angela Cuttitta. Il progetto “La Scienza e l’Immaginario” nasce dalla collaborazione tra l’IAS - CNR di Capo Granitola e l’Accademia di Belle Arti di Palermo, che attraverso un approccio multidisciplinare ha voluto sperimentare l’unione tra il mondo scientifico e quello artistico, mettendo i giovani artisti, attraverso proiezioni e seminari scientifici, nelle condizioni di scoprire il mondo dell’ambiente marino e degli ecosistemi in esso presenti. Il progetto è nato dalla consapevolezza di come sia necessario operare sul piano della diffusione e divulgazione della cultura scientifica nei più vasti contesti sociali, a partire dall’ambito scolastico. Le azioni divulgative mirano, infatti, a diffondere la conoscenza dei processi geologici, chimico-fisici, climatici e biologici in modo pervasivo, non limitato a singole categorie/settori. La funzione strategica di tali azioni è quella di stimolare idee ed iniziative nonché di sviluppare una maggiore sensibilità nei confronti dei fenomeni che ci circondano, quale presupposto essenziale per una corretta programmazione politico-gestionale. Lo spirito che ha mosso tutte gli attori del progetto è stato quello di sensibilizzare gli studenti nei confronti della tutela delle risorse marine proprie del loro territorio e di sviluppare e promuovere la cultura come volano dello sviluppo sostenibile, della pace e dell’integrazione sociale, in armonia con quanto indicato dal Consiglio Europeo di Lisbona 2000. Grazie al lavoro di docenti e di ricercatori, l’arte come forma espressiva si è rivelata uno strumento valido e innovativo di divulgazione della cultura scientifica e ha portato alla creazione di suggestioni sui ragazzi che hanno percepito e realizzato forme e armonie espresse in questa mostra. L’impegno per questa manifestazione rappresenta, quindi, un appuntamento importante con le forze vive siciliane nel campo delle scienze del mare segnatamente ad esperti di biologia, chimica, fisica ed al mondo fantastico dell’arte, al fine di esprimere con le varie tecniche pittoriche un momento di riflessione culturale

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Correction to: Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

The original version of this article unfortunately contained a mistake

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat