Incidenza della sclerosi multipla in Toscana: uno studio basato su dati amministrativi

INTRODUZIONE L’Italia è un’area ad elevato rischio di sclerosi multipla (SM) con una prevalenza stimata di 75.000 casi e un’incidenza di 2.000 casi annui. Gli ultimi dati pubblicati sull’incidenza sono 5,5 casi/105 a Padova (2000-09), 6,6 a Genova (1998-2007) e 9,7 in Sardegna (2003-07). In Toscana è presente un registro regionale della SM ma, ad oggi, non è rappresentativo dell’intera popolazione. Una possibile alternativa per studiare l’epidemiologia è attraverso i dati amministrativi. Questi, infatti, coprono l’intera popolazione residente e vengono raccolti di routine in un modo standardizzato ai fini della gestione del servizio sanitario. Il nostro scopo è calcolare l’incidenza della SM in Toscana utilizzando dati amministrativi. METODI Per il calcolo dell’incidenza abbiamo creato il seguente algoritmo: ospedalizzazione in reparto per acuti e con diagnosi primaria di SM, esenzione attiva per SM, e prescrizione di farmaci specifici. I casi incidenti sono stati identificati come quei casi catturati dall’algoritmo non tracciati in precedenza nei flussi amministrativi, e la data della prima traccia è stata considerata quale data di diagnosi della SM. Da questa coorte di soggetti abbiamo selezionato i pazienti con un’età ≤ 55 anni, residenti in Toscana al momento della diagnosi e presenti in anagrafe da almeno 10 anni (o nati in Toscana se età <10). Abbiamo calcolato i tassi grezzi e standardizzati e gli intervalli di confidenza (IC) al 95% per gli anni 2011-2015. RISULTATI Abbiamo identificato, negli anni analizzati, 1.056 nuovi casi con un’incidenza che varia da 5,04/105 nel 2011 a 6,02 casi/105nel 2015 (Tab 1). Nelle donne l’incidenza è circa due volte più alta rispetto agli uomini con un range che va da 6,48 a 7,96/105 nelle donne, e da 3,49 a 3,93/105 negli uomini. CONCLUSIONI L’incidenza calcolata risulta elevata, soprattutto nelle donne, ma comunque in linea ai dati pubblicati in altre Regioni, al di là dei bias metodologici legati all’uso di dati amministrativi

About an unique case of embryocarcinoma with nasal onset.

Primary extragonadal germ cell tumours (PEGCT) are rare neoplasms with generally poor prognosis, different behavior, and natural course compared to their gonadal counterparts. Both primary and salvage treatment of these tumours constitute a challenge. Embryocarcinoma (EC) constitutes one of the subtypes of germ cell tumours. Its site of primary onset can either be gonadal or extragonadal, more frequent in infancy and childhood, the sacral and cranial regions being the most affected, while gonadal sites (ovary and testis) are more frequently involved in childhood. The authors observed a case of EC with nasal onset in a young male, never reported before in the literature. The patient underwent 6 courses of chemotherapy and further surgery by means of an endoscopic approach, without postsurgical sequelae. A 5-years follow-up, with periodic controls, laboratory tests and imaging, all without signs of recurrence, confirmed that this unusual location of EC responded exclusively to primary chemotherapy, while earlier studies proved EC being responsive, in other sites of onset, to a combination of chemotherapy, radical surgical excision of the neoplasm, and radiotherapy

Percutaneous treatment of hepatic cysts by aspiration and sclerotherapy

We treated 35 patients who had hepatic cysts (30 congenital cysts, 5 hydatid cysts) with percutaneous puncture and sclerotherapy. After puncture and drainage of the cyst, a 95% alcohol solution was instilled as sclerosing agent into the cystic cavity. In all the patients, cyst puncture and drainage was successful. Follow-up in all cases was at least 12 months. In three uncooperative patients, cysts recurred due to incomplete sclerosis of the lining epithelium of the cyst wall. No major complications were encountered in all cases. All congenital cysts were treated on an outpatient basis. Patients with hydatid cyst were hospitalized for 48 h after puncture and aspiration. In our opinion, percutaneous drainage and sclerosis of congenital hepatic cysts can be considered an effective alternative to surgical treatment

Exploring machine learning algorithms to identify heart failure patients: The tuscany region case study

Heart failure patients have become an important challenge for the healthcare system, since they represent a medical, social and economic problem. Early heart failure diagnoses can be very useful to improve patients' quality of life and to reduce the resources consumption, but they can be complex for the general practitioners. Data mining and machine learning techniques can really help in this field. The aim of this study is to validate some machine learning models to identify heart failure patients, starting from administrative data, and to make them transparent and interpretable. Despite the lack of clinical data, not available in Italy, but the most employed for the identification of heart failure patients, the results are comparable with the state-of-the-art ones and the models outperform the performances already obtained in Tuscany

Percutaneous treatment of hepatic cysts by aspiration and sclerotherapy

We treated 35 patients who had hepatic cysts (30 congenital cysts, 5 hydatid cysts) with percutaneous puncture and sclerotherapy. After puncture and drainage of the cyst, a 95% alcohol solution was instilled as sclerosing agent into the cystic cavity. In all the patients, cyst puncture and drainage was successful. Follow-up in all cases was at least 12 months. In three uncooperative patients, cysts recurred due to incomplete sclerosis of the lining epithelium of the cyst wall. No major complications were encountered in all cases. All congenital cysts were treated on an outpatient basis. Patients with hydatid cyst were hospitalized for 48 h after puncture and aspiration. In our opinion, percutaneous drainage and sclerosis of congenital hepatic cysts can be considered an effective alternative to surgical treatment

Aerodynamic optimization of a vertical axis wind turbine equipped with a two-element airfoil

The results for the optimization of the Darrieus rotor equipped with a slat airfoil are presented. The problem appears to be well defined with respect to the adopted optimization routine and decision variables. These independently provide the maximum performance for a given value, which was correctly included in its range of variation. The physical reasons behind the optimal slat airfoil position are linked to the rotor aerodynamics, given the increase in the main airfoil operative range which is obtained by introducing the secondary airfoil. Moreover, the analysis of the parameters such as the slat airfoil pitch angle and chord length highlighted a variation in the optimal operating conditions in the considered range. Depending on the slat characteristics, in fact, the aerodynamic effect is enhanced for different angles of attack and, therefore, different tip speed ratios. The maximum performance is however achieved for a particular operating condition which is maintained along the optimization process

The effect of miniaturized manual versus mechanical instruments on calculus removal and root surface characteristics: An in vitro light microscopic study

bjectives: The aim of this study was to evaluate by light microscopy analysis the effect of the use of miniaturised piezoelectric tips versus mini-five area specific curets on calculus removal and postoperative root surface alterations. Methods: A total of 20 extracted teeth were used. Two square surfaces (5×5 mm) were marked on each root surface with a diamond bur mounted on a high-speed handpiece. Before and after instrumentation, a series of magnified images (4.2×) of each experimental surface were taken with a standardized approach. According to a randomization list, the two surfaces on each sample were instrumented in a standardised fashion either with a mine-five curet or a slim piezoelectric tip. The images were processed using an imaging software. Data were summarised as means and standard deviations for the two outcomes (calculus and alterations.) at each time (pre and post) for both of the groups (manual and mechanical). Results: Both manual and mechanical instrumentation significantly reduced the calculus deposits (p < .001) without significant differences between the two groups. Both manual and mechanical treatments significantly increased alterations (p < .01). There was a statistically significant evidence of a greater increase in alterations from mechanical treatment. Conclusions: Slim mechanical piezoelectric tips and manual mini-five area-specific curets have similar effects on calculus removal. Manual instrumentation results in a more homogeneous postoperative root surface with less root alterations

The demand for polyvalent immunoglobulins in Italy

[No abstract available