Geological, structural and geomorphological map of upper valley of the Metauro (Sant’Angelo in Vado-Lamoli) and Foglia (Piandimeleto-Sestino) rivers in the Marchean Apennine.

4th European Congress on Regional Geoscientific Cartography and Information Systems

Biomaterials for Osteochondral reconstruction

The modern regenerative procedures demonstrated to offer the replacement of the articular surface with a hyaline-like tissue, but the properties of healthy cartilage tissue are still unmatched by any available substitute. Moreover, the treatment of osteochondral lesions is even more biologically challenging since two different tissues are involved (bone and articular cartilage) with a distinctly different intrinsic healing capacity. For the repair of the entire osteochondral unit, several authors have highlighted the need for biphasic scaffolds, to reproduce the different biological and functional requirements for guiding the growht of the two tissues, and different specific scaffolds have been developed for the treatment of large chondral or osteochondral articular defects. At the time being, among these only two scaffols used for osteochondral regeneration are commercialized for clinical application. One is a bilayer porous PLGA-calcium-sulphate biopolymer. The second osteochondral scaffold is a nanostructured biomimetic HA-collagen scaffold with a porous 3-D tri-layer composite structure, mimicking the whole osteochonfral anatomy. Other osteochondral scaffolds are still under preclinical investigation. In this chapter we focus on reviewing the available evidence on the clinical outcome of these osteochondral scaffolds, as well as on reporting the new biomaterials developed and tested in preclinical studies that show to be promising for osteochondral regeneration

Comportamento del Mycobacterium tuberculosis nel processo di bonifica del latte mediante pastorizzazione. Osservazioni ed esperienze su latte naturalmente ed artificialmente contaminto

A conclusione delle loro ricerehe e tenendo conto, altresì, dei risultari di altre indagini offerte dalla letteratua, gli AA affermano che la pastorizzazione correttamente eseguita ed accompagnata da appropriate operazioni di bonifica dei contenitori (bottiglie o bidoni), è in grado di assicurare la distribuzione di lattr salubre ed igienicamente rispondente

Evaluación ecográfica de la vena cava inferior en los pacientes hemodinámicamente inestables

Describimos la técnica ecográfica para la evaluación de la variabilidad respiratoria del diámetro de la vena cava inferior (VCI) en pacientes ventilados y hemodinámicamente inestables, además de valorar su utilidad terapéutica. En pacientes sanos, los cambios en la presión intratorácica se transmiten a la VCI, disminuyendo el diámetro del vaso en un 50%, mientras que en pacientes con ventilación mecánica la fase inspiratoria produce un aumento de la presión pleural que disminuye el retorno venoso, siendo los cambios inversos en el diámetro del vaso (aumento inspiratorio y disminución espiratoria). Una variación significativa durante la inspiración diferencia a los pacientes probablemente respondedores a la terapia de reposición de fluidos. La ecografía, en corte sagital de la vena cava inferior a nivel subxifoideo, se realiza con el cursor en modo M a 3 cm del atrio derecho, registrándose el diámetro de la vena en función del tiempo. El paciente debe estar sedado y ventilado (volumen a 8-10 ml/kg), con una frecuencia respiratoria de 16 ciclos/segundo y a 0° de inclinación. Se toman los diámetros máximo y mínimo durante el ciclo respiratorio y se calcula el porcentaje de variación, con la fórmula: diámetro (D) máximo de VCI- D mínimo/D máximo. Se considera significativa una variación ≥ 12%. La técnica ecográfica para medir variabilidad de la vena cava permite seleccionar a los pacientes ventilados hemodinámicamente inestables que responderán a la terapia de reposición de fluidos. Estos son los que presentan variación en el calibre de la VCI mayor del 12%

Is the clinical outcome after cartilage treatment affected by subchondral bone edema?

Subchondral bone edema is a common finding after cartilage treatment, but its interpretation is still debated. The aim of this study is to analyse the presence of edema after matrix-assisted autologous chondrocyte transplantation (MACT) for knee cartilage lesions at different follow-up times and its correlation with the clinical outcome.Two hundred and forty-eight magnetic resonance imagings (MRIs) of patients treated with a hyaluronic acid-based MACT for lesions of the knee articular surface were considered. The MRIs belonged to 116 patients (mean age at surgery 28.6 \ub1 10.3 years, average defect size 2.4 \ub1 1.0 cm(2)), 57 affected by degenerative cartilage lesions, 27 traumatic and 32 were osteochondritis dissecans (OCD). MRI follow-up was performed from 6 to 108 months after treatment. Other than its presence or absence, the subchondral bone edema was evaluated using a 3-level grading considering extension and hyperintensity, and with the WORMS score edema classification. The IKDC subjective score was collected at the time of every MRI.An analysis of the entire MRI group showed that edema is not constantly present through the follow-up, but presents a particular and well-defined trend. Edema was present within the first 2 years and was then markedly reduced or disappeared at 2 and 3 years (p = 0.044). Afterwards the level of edema increased again (p < 0.0005) and remained steadily present at medium/long-term follow-up. Patellar lesions presented significantly lower edema (p = 0.012), whereas OCD lesions presented more edema at all follow-up (p = 0.002) and a different trend, with an increasing level of edema over time. No correlation was found between edema and clinical outcome.Edema after MACT is present during the first phases of cartilage maturation up to 2 years of follow-up, and then tends to disappear. However, after a few years, it tends to reappear. Less edema was found in the patella, whereas more edema was found in the OCD, where subchondral bone is primarily involved. Interestingly, the presence of edema was not correlated with a poorer clinical outcome. Whether this might be a prognostic factor at longer follow-up remains to be determined, but our results give some indication on what to expect on both MRI edema and clinical outcome after MACT.Case series, Level IV

Platelet-Rich Plasma Versus Hyaluronic Acid Injections for the Treatment of Knee Osteoarthritis: Results at 5 Years of a Double-Blind, Randomized Controlled Trial

Background: Platelet-rich plasma (PRP) injections have been proposed as a new conservative option for knee degeneration to provide symptomatic relief and delay surgical intervention. Although the current literature provides some evidence on the benefits of this technique compared with viscosupplementation, no studies have been performed to compare their long-term effects. Purpose: To compare the long-term clinical outcomes provided by intra-articular injections of either PRP or hyaluronic acid (HA) to treat knee degenerative disease. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: Patients with a history of chronic symptomatic knee degenerative changes and osteoarthritis (Kellgren-Lawrence grade 0-3) were enrolled: 192 patients were randomized to undergo 3 blinded weekly intra-articular injections of either PRP or HA. Patients were prospectively evaluated before the injection and then at 2, 6, 12, and 24 months and a mean of 64.3 months (SD, 7.8 months) of follow-up. Evaluation was based on International Knee Documentation Committee (IKDC) subjective (main outcome), EuroQol visual analog scale, and Tegner scores; 167 patients reached the final evaluation. Results: Both treatments were effective in improving knee functional status and symptoms over time: Mean +/- SD IKDC subjective score improved significantly for both PRP and HA groups (P &lt; .0005) and remained stable over time up to 24 months (from 53.3 +/- 14.3 to 67.3 +/- 18.1 and from 50.3 +/- 13.2 to 62.1 +/- 20.8 for PRP and HA groups, respectively). At final evaluation, a significant IKDC reduction was observed in both treatment groups, with the PRP group still presenting significantly higher values compared with baseline: PRP 60.5 +/- 19.0 (P &lt; .001 vs baseline), HA 55.7 +/- 18.8 (not significant vs baseline). A comparative analysis showed no significant intergroup difference in any of the clinical scores at any follow-up point. The median duration of patient subjective perception of symptomatic relief was 9 months for HA and 12 months for PRP (not significant). The only significant difference was observed in the rate of reintervention at 24 months, which was significantly lower in the PRP group (22.6% vs 37.1%, P = .036). Conclusion: Both treatments were effective in improving knee functional status and symptoms over time. PRP did not provide an overall superior clinical improvement compared with HA in terms of either symptomatic-functional improvement at different follow-up points or effect duration. Registration: NCT01670578 (ClinicalTrials.gov identifier)

Pitcher Aging Affects Throwing Shoulder Biomechanics and Proprioception: The Italian Experience

Introduction: Baseball is a sport increasingly practiced in Italy. The pitcher is at risk from repetitive stress on the dominant upper arm. Because of this, pitchers train far more on the dominant arm leading to asymptomatic biomechanical changes. The purpose of this study was to compare shoulder intra/extra rotational power and shoulder motor skill in young and senior athletes. Methods: Twenty right-hand healthy pitchers playing for at least four years were recruited : Group A (12\ub12yrs) and Group B (24\ub11yrs). Subjects with a history of shoulder dislocation, shoulder surgery or structural injuries to the shoulder complex were excluded from the study. Isokinetic tests (IT) were performed to evaluate intra/extra rotational power, and shoulder motor skill test (SMST) to evaluate proprioception. Results: Performing IT, we have found in both groups a significant higher external rotation compared to internal rotation in the throwing shoulder (TS), while in the contralateral shoulder (CS) the balance was preserved ( p<0.003). In Group A, SMST was 4\ub12 points (TS) and 4\ub11 points (CS), p=n.s. In Group B, SMST was 9\ub11 points (TS) and 4\ub12 points (CS), p<0.005. Discussion and Conclusion: Italian pitchers demonstrated a higher external rotational power in the throwing shoulder after only four years of practicing baseball. Motor skill ability seems to develop later in the dominant shoulder. This study suggests that a baseball training program, especially for young pitchers, should include not only exercises to restore internal/external rotation balance but also motor skill exercises, to improve throwing ability, limit the number of throws, prevent shoulder injury over time

One step surgery with a biomimetic scaffold to treat osteochondral patellar lesions: prospective study at 2 years of follow-up

Objectives: Aim of this study is to analyze the clinical outcome of an osteochondral scaffold implanted into chondral and osteohondral lesions located at the patella, site that is commonly considered as one of the more difficult to treat successfully. Methods: Forty-four patients were treated by implanting a collagenhydroxyapatite osteochondral scaffold and prospectively evaluated at initial time, then at 6, 12 and 24 months of follow-up, using the IKDC Knee documentation form and the Kujala score. They were 26 male and 18 female. Mean age was 33.2 (16\u201359) years, mean BMI 24.0 \ub1 3.0. Size of the defects was 3.3 \ub1 3.0 cm2. Fifteen Patients were operated for the first time and 23 of them requested combined procedures due to comorbidities. Four of them had multiple lesions. Etiology was degenerative in 29 cases, 10 traumatic and 5 were OCDs. Results: A statistically significant improvement and function recovery were recorded up to 24 months. IKDC subj score increased from 39.3 \ub1 15.1 to 62.6 \ub1 18.6 and 68.9 \ub1 17.8 at the 1 year and final evaluation respectively (p\0.05). Tegner score increased from 1.8 \ub1 1.1 to 3.6 \ub1 1.3 at 2 years\u2019 follow-up (p\0.05). Three patients failed, being re-operated for the same lesion. Conclusions: The use of this biomimetic cell-free scaffold for osteochondral lesions of the patella allows to obtain function recovery and a good clinical outcome at short-term follow-up, even if lower than previously reported for other site locations. These results have to be confirmed at longer follow-up to determine the possible benefit of addressing also the subchondral bone disease