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1.
Nature ; 605(7909): 244-247, 2022 05.
Artigo em Inglês | MEDLINE | ID: mdl-35546195

RESUMO

Bright quasars, powered by accretion onto billion-solar-mass black holes, already existed at the epoch of reionization, when the Universe was 0.5-1 billion years old1. How these black holes formed in such a short time is the subject of debate, particularly as they lie above the correlation between black-hole mass and galaxy dynamical mass2,3 in the local Universe. What slowed down black-hole growth, leading towards the symbiotic growth observed in the local Universe, and when this process started, has hitherto not been known, although black-hole feedback is a likely driver4. Here we report optical and near-infrared observations of a sample of quasars at redshifts 5.8 ≲ z ≲ 6.6. About half of the quasar spectra reveal broad, blueshifted absorption line troughs, tracing black-hole-driven winds with extreme outflow velocities, up to 17% of the speed of light. The fraction of quasars with such outflow winds at z ≳ 5.8 is ≈2.4 times higher than at z ≈ 2-4. We infer that outflows at z ≳ 5.8 inject large amounts of energy into the interstellar medium and suppress nuclear gas accretion, slowing down black-hole growth. The outflow phase may then mark the beginning of substantial black-hole feedback. The red optical colours of outflow quasars at z ≳ 5.8 indeed suggest that these systems are dusty and may be caught during an initial quenching phase of obscured accretion5.

2.
Nature ; 545(7655): 457-461, 2017 05 24.
Artigo em Inglês | MEDLINE | ID: mdl-28541326

RESUMO

The existence of massive (1011 solar masses) elliptical galaxies by redshift z ≈ 4 (refs 1, 2, 3; when the Universe was 1.5 billion years old) necessitates the presence of galaxies with star-formation rates exceeding 100 solar masses per year at z > 6 (corresponding to an age of the Universe of less than 1 billion years). Surveys have discovered hundreds of galaxies at these early cosmic epochs, but their star-formation rates are more than an order of magnitude lower. The only known galaxies with very high star-formation rates at z > 6 are, with one exception, the host galaxies of quasars, but these galaxies also host accreting supermassive (more than 109 solar masses) black holes, which probably affect the properties of the galaxies. Here we report observations of an emission line of singly ionized carbon ([C ii] at a wavelength of 158 micrometres) in four galaxies at z > 6 that are companions of quasars, with velocity offsets of less than 600 kilometres per second and linear offsets of less than 100 kiloparsecs. The discovery of these four galaxies was serendipitous; they are close to their companion quasars and appear bright in the far-infrared. On the basis of the [C ii] measurements, we estimate star-formation rates in the companions of more than 100 solar masses per year. These sources are similar to the host galaxies of the quasars in [C ii] brightness, linewidth and implied dynamical mass, but do not show evidence for accreting supermassive black holes. Similar systems have previously been found at lower redshift. We find such close companions in four out of the twenty-five z > 6 quasars surveyed, a fraction that needs to be accounted for in simulations. If they are representative of the bright end of the [C ii] luminosity function, then they can account for the population of massive elliptical galaxies at z ≈ 4 in terms of the density of cosmic space.

3.
Neurocase ; 28(2): 194-198, 2022 04.
Artigo em Inglês | MEDLINE | ID: mdl-35465838

RESUMO

Artery of Percheron (AOP) stroke is a rare event. We describe an AOP stroke involving both thalami and the midbrain, resulting in a multifunctional clinical impairment. Intensive inpatient multidisciplinary rehabilitation favored the recovery of motor deficits, together with the improvement of cognitive dysfunctions. MRI assessment in the chronic post-stroke phase showed structural and functional reorganization in response to the extended thalamic tissue damage and absence of revascularization. Thalamo-cortical networks involving frontal and prefrontal regions, as well as parietal areas were disrupted, whereas increased functional thalamo-occipital connectivity was found. This report sheds light on brain reorganization following AOP stroke after rehabilitation..


Assuntos
Reabilitação do Acidente Vascular Cerebral , Acidente Vascular Cerebral , Artérias , Humanos , Imageamento por Ressonância Magnética/métodos , Plasticidade Neuronal/fisiologia , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/diagnóstico por imagem , Tálamo/irrigação sanguínea , Tálamo/diagnóstico por imagem
4.
Int J Environ Health Res ; 32(5): 1164-1174, 2022 May.
Artigo em Inglês | MEDLINE | ID: mdl-33249915

RESUMO

This study is part of the health surveillance system set up with the construction of a waste-to-energy (WTE) plant in Turin (Italy). Circulatory and respiratory diseases in emergency room (ER) accesses and first hospital admissions were considered. Main concerns of population living in the area near WTE were to know whether single and repeated peaks in emissions would correspond to adverse health effects. We tackle this issue using spatio-temporal analyses, comparing an exposed group (EXP) living near the WTE with a reference group (NOEXP). Age-standardized rates of ER accesses between EXP and NOEXP were temporally compared, testing whether there have been significantly different changes over time. We also examined the relationship between emission peaks and ER accesses in the following days. Finally, with time-series analysis, we investigated variations in ER accesses and pollutants before and after WTE start-up. No significant relationship has been found for the outcome considered.


Assuntos
Poluentes Ambientais , Incineração , Serviço Hospitalar de Emergência , Hospitais , Itália
5.
Int J Med Microbiol ; 309(5): 283-287, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31122879

RESUMO

BACKGROUND: Staphylococcus aureus is one of the most frequently isolated pathogens in the respiratory tract of CF patients. Recently, we characterized peculiar mucoid S. aureus isolates, which are excessive biofilm formers and which carried a 5bp-deletion within the intergenic region of the ica operon. In this prospective study, we determined the prevalence of mucoid S. aureus-isolates in the airways of CF-patients during a 3-months period. METHODS: We analyzed specimens (sputa, throat swabs) from 81 CF patients who attended two CF centers in Münster, Germany. Ten S. aureus isolates were randomly picked from every S. aureus-positive airway specimen and evaluated for mucoidy using Congo Red agar and phenotypic tests. Mucoid isolates were characterized by spa sequence typing, biofilm production and sequencing of the intergenic region of the ica operon to screen for the 5bp-deletion. RESULTS: In 7 of 81 examined patients (8.6%), we detected mucoid S. aureus phenotypes (37 out of 1050 isolates; 3.5%). Twenty-five mucoid isolates carried the 5bp-deletion. Mucoid isolates produced excessive biofilm and were significantly more resistant to certain antibiotics. CONCLUSIONS: In our prospective study, mucoid S. aureus was present in 8.6% of S. aureus-positive CF-patients. In 6 of 7 patients, mucoid isolates carried the 5bp-deletion, indicating that also other so far not identified mechanisms cause excessive biofilm formation. Further studies are necessary to ascertain the clinical impact of mucoid S. aureus phenotypes on the severity of the CF disease.


Assuntos
Fibrose Cística/microbiologia , Polissacarídeos Bacterianos/metabolismo , Staphylococcus aureus/isolamento & purificação , Adolescente , Adulto , Antibacterianos/farmacologia , Biofilmes , Criança , Feminino , Alemanha , Humanos , Masculino , Fenótipo , Prevalência , Estudos Prospectivos , Infecções Estafilocócicas/microbiologia , Staphylococcus aureus/efeitos dos fármacos , Staphylococcus aureus/genética , Adulto Jovem
6.
Int Psychogeriatr ; 30(4): 527-537, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-29145912

RESUMO

ABSTRACTBackground:In the MEETINGDEM project, the Meeting Centers Support Program (MCSP) was adaptively implemented and evaluated in three European countries: Italy, Poland, and the United Kingdom. The aim of this study was to investigate overall and country-specific facilitators and barriers to the implementation of MCSP in these European countries. METHODS: A qualitative multiple case study design was used. Based on the theoretical model of adaptive implementation, a checklist was composed of potential facilitators and barriers to the implementation of MCSP. This checklist was administered among stakeholders involved in the implementation of MCSP to trace the experienced facilitators and barriers. Twenty-eight checklists were completed. RESULTS: Main similarities between countries were related to the presence of suitable staff, management, and a project manager, and the fact that the MCSP is attuned to needs and wishes of people with dementia and informal caregivers. Main differences between countries were related to: communication with potential referrers, setting up an inter-organizational collaboration network, receiving support of national organizations, having clear discharge criteria for the MCSP and continuous PR in the region. CONCLUSION: The results of this study provide insight into generic and country specific factors that can influence the implementation of MCSP in different European countries. This study informs further implementation and dissemination of MCSP in Europe and may also serve as an example for the dissemination and implementation of other effective psychosocial support interventions for people with dementia and their informal caregivers across and beyond Europe.


Assuntos
Continuidade da Assistência ao Paciente/organização & administração , Avaliação de Programas e Projetos de Saúde/métodos , Apoio Social , Cuidadores/psicologia , Demência/psicologia , Demência/terapia , Humanos , Itália , Avaliação de Resultados em Cuidados de Saúde , Polônia , Pesquisa Qualitativa , Qualidade de Vida , Reino Unido
7.
Occup Med (Lond) ; 68(7): 459-463, 2018 Sep 13.
Artigo em Inglês | MEDLINE | ID: mdl-30020490

RESUMO

BACKGROUND: There is a procyclical relationship between economic growth and occupational injury rates in the short term. Injury rates rise during periods of economic growth and fall during recessions. AIMS: To estimate injury rates for the manufacturing sector in Italy between 1994 and 2012 and their correlation with major macroeconomic factors and to identify a possible change in the trend of injury rates at the beginning of the 2008 economic crisis. METHODS: Total and annual serious injury rates were calculated for the national sector. We used a linear autoregressive model to assess the relationship between injury rates and unemployment rate/real GDP growth, and a joint-point regression analysis to analyse changes in injury rates over time. RESULTS: After adjusting for the spontaneous dynamic change in injury rates over time, both total and serious injury rates were negatively associated with unemployment rate, and significantly positively associated with real GDP growth. Manufacturing injury rates dropped after 2008. CONCLUSIONS: Manufacturing injury rates are associated with major macroeconomic factors. Workplace injury rates declined between 1994 and 2012. This downward trend was further accelerated after 2008. The changes in workforce composition before and after 2008 partly explain the procyclical relationship between business conditions and injury rates.


Assuntos
Recessão Econômica/estatística & dados numéricos , Indústria Manufatureira/economia , Indústria Manufatureira/estatística & dados numéricos , Traumatismos Ocupacionais/diagnóstico , Emprego/estatística & dados numéricos , Humanos , Itália , Traumatismos Ocupacionais/epidemiologia
8.
BMC Geriatr ; 17(1): 79, 2017 04 04.
Artigo em Inglês | MEDLINE | ID: mdl-28376895

RESUMO

BACKGROUND: The MEETINGDEM study aims to implement and evaluate an innovative, inclusive, approach to supporting community dwelling people with mild to moderate dementia and their family carers, called the Meeting Centers Support Program (MCSP), in three countries in the European Union (EU): Italy, Poland and United Kingdom. Demonstrated benefits of this person-centered approach, developed in The Netherlands, include high user satisfaction, reduced behavioral and mood problems, delayed admission to residential care, lower levels of caregiving-related stress, higher carer competence, and improved collaboration between care and welfare organizations. METHODS: The project will be carried out over a 36 month period. Project partners in the three countries will utilize, and adapt, strategies and tools developed in the Netherlands. In Phase One (month 1-18) activities will focus on establishing an initiative group of relevant organizations and user representatives in each country, exploring pathways to care and potential facilitators and barriers to implementing the program, and developing country specific implementation plans and materials. In Phase Two (month 19­36) training will be provided to organizations and staff, after which the meeting centers will be established and evaluated for impact on behavior, mood and quality of life of people with dementia and carers, cost-effectiveness, changes in service use, user satisfaction and implementation process. DISCUSSION: An overall evaluation will draw together findings from the three countries to develop recommendations for successful implementation of MCSP across the EU. If the Meeting Centers approach can be widely implemented, this could lead to major improvements in dementia care across Europe and beyond. TRIAL REGISTRATION: The trial was retrospectively registered in May 2016: trial number: NTR5936 .


Assuntos
Cuidadores/psicologia , Continuidade da Assistência ao Paciente/organização & administração , Demência/psicologia , Apoio Social , Demência/terapia , Europa (Continente) , Humanos , Avaliação de Resultados em Cuidados de Saúde , Avaliação de Programas e Projetos de Saúde , Qualidade de Vida
9.
Aging Ment Health ; 21(1): 40-48, 2017 01.
Artigo em Inglês | MEDLINE | ID: mdl-27982713

RESUMO

OBJECTIVES: The implementation of new health services is a complex process. This study investigated the first phase of the adaptive implementation of the Dutch Meeting Centres Support Programme (MCSP) for people with dementia and their carers in three European countries (Italy, Poland, the UK) within the JPND-MEETINGDEM project. Anticipated and experienced factors influencing the implementation, and the efficacy of the implementation process, were investigated. Findings were compared with previous research in the Netherlands. METHOD: A qualitative multiple case study design was applied. Checklist on anticipated facilitators and barriers to the implementation and semi-structured interview were completed by stakeholders, respectively at the end and at the beginning of the preparation phase. RESULTS: Overall, few differences between countries were founded. Facilitators for all countries were: added value of MCSP matching needs of the target group, evidence of effectiveness of MCSP, enthusiasm of stakeholders. General barriers were: competition with existing care and welfare organizations and scarce funding. Some countries experienced improved collaborations, others had difficulties finding a socially integrated location for MCSP. The step-by-step implementation method proved efficacious. CONCLUSION: These insights into factors influencing the implementation of MCSP in three European countries and the efficacy of the step-by-step preparation may aid further implementation of MCSP in Europe.


Assuntos
Cuidadores/psicologia , Centros Comunitários de Saúde/organização & administração , Continuidade da Assistência ao Paciente/organização & administração , Demência/terapia , Apoio Social , Idoso , Demência/psicologia , Feminino , Humanos , Itália , Masculino , Pessoa de Meia-Idade , Países Baixos , Polônia , Desenvolvimento de Programas , Pesquisa Qualitativa , Reino Unido
10.
Occup Environ Med ; 73(5): 336-41, 2016 May.
Artigo em Inglês | MEDLINE | ID: mdl-26989139

RESUMO

OBJECTIVES: According to Italian law, prevention of injuries in the workplace falls under the National Health System Service of Prevention, Health and Safety at Work (SPISAL). In a sample of about 5000 industrial firms in the Veneto region (North-Eastern Italy), the study examines the impact of SPISAL safety programmes on injuries. METHODS: The study is based on the before-and-after comparison of injury rates in 795 industrial settings that were subject to SPISAL interventions and 4186 reference firms, which were all manufacturing industries with >10 employees; construction companies were excluded. The time window (2001-2007) was chosen in order to have 8 quarters of observation before and 8 after the intervention. The National Institute for Workers' Compensation provided data on injuries and plants, while SPISAL gave information on interventions carried out. The preintervention and postintervention rates of injuries were compared by means of interrupted time series analyses, estimating the rate ratio (RR) with a 95% CI. RESULTS: Inspection after injury reduced by 24% (RR=0.76; 95% CI 0.65 to 0.90; p=0.001) all injuries, and by 36% (RR=0.64; 95% CI 0.50 to 0.83; p=0.001) severe injuries (fatalities, lost workdays >30, degree of permanent disability >0). These changes occurred immediately and persisted for 2 years. The effects of programmed inspections were never significant. CONCLUSIONS: It can be presumed that, after a severe injury, the employees raised their standard of what they considered good work safety and, at the same time, the employers were pushed to improve the work environment as a result of the sudden attention from the workplace hygiene and safety authority and court authority. Inspection after injury was an effective strategy; however, confirmatory evidence is needed.


Assuntos
Acidentes de Trabalho/prevenção & controle , Indústria Manufatureira , Exposição Ocupacional/efeitos adversos , Saúde Ocupacional/normas , Segurança , Trabalho , Ferimentos e Lesões/prevenção & controle , Comércio , Humanos , Análise de Séries Temporais Interrompida , Itália , Saúde Ocupacional/legislação & jurisprudência , Avaliação de Programas e Projetos de Saúde , Medicina Estatal , Indenização aos Trabalhadores , Local de Trabalho , Ferimentos e Lesões/etiologia
11.
J Biol Regul Homeost Agents ; 29(1): 235-8, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-25864764

RESUMO

This immunohistochemical study aims to investigate the Atrial natriuretic peptide (ANP)-presence and localization in human articular cartilage. Fragments of articular cartilage covering the femoral head were removed from patients submitted to surgical operation after femoral neck fracture without joint disease. The samples were immunostained with anti-ANP antibody. The results demonstrate that ANP is present in chondrocytes in all the three zones of the articular cartilage. Superficial chondrocytes show strong ANP-immunopositivty. The presence of ANP in the articular cartilage suggests that ANP may play a role in cartilage metabolism by regulating transport of molecules through the different zones of the articular cartilage and in maintenance of its homeostasis; probably ANP could be also involved in the regulation of the balance between synovial fluid and the other body fluids.


Assuntos
Fator Natriurético Atrial/metabolismo , Cartilagem Articular/metabolismo , Cartilagem Articular/citologia , Condrócitos/metabolismo , Humanos
12.
Minerva Chir ; 70(3): 175-80, 2015 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-25960031

RESUMO

AIM: Distal pancreatectomies (DP) are associated with high risk of postoperative complications, and in many series higher morbidity rate than duodenopancreatectomies has been reported. To evaluate the role of a collagen sponge with human fibrinogen and thrombin film (TachoSil®) in limiting the incidence of complications after DP. METHODS: From 1996 to 2013, 221 patients have been submitted to distal pancreatectomy (± splenectomy) in our Division. A retrospective analysis has been conducted in a group of 36 consecutive and prospectively collected DP treated with intraoperative placement of TachoSil® on pancreatic stump from 2010 to 2013 (group 1). A control series of 36 consecutive patients (group 2) was matched 1:1 from hystorical database. The variables considered in the analysis were: age, gender, ASA score, pancreatic texture (hard vs. soft), histology, operative time, postoperative mortality, morbility (postoperative pancreatic fistula - POPF, postoperative hemorrage - PPH, delayed gastric emptying - DGE) and hospital stay. Differences between POPF, PPH, DGE and hospital stays between grops were investigated with χ² and t-Student test. Univariate analysis was conducted to determine factors related to POPF development. Statistical analysis was performed using freeware Microsoft Excel based program. RESULTS: Post operative mortality was 0% in both groups. POPF were registered in 36.1% (13/36) and 41.6 % (15/36) in groups 1 and 2, respectively (P=n.s.); in group 1 we didn't observe grade C POPF, while 4 patients in control group developed grade C POPF (P<0,05). No differences were found between two groups in terms of incidence of PPH and DGE. The median duration of postoperative hospital stay in group 1 was 21.8 (7-189) days compared with 31.13 (9-249) days in group 2 (P<0.001). CONCLUSION: The use of TachoSil® seems to be associated with lower incidence of grade C POPF but larger controlled trials are needed to surely assess the usefulness of TachoSil® in pancreatic surgery in order to reduce pancreatic specific complications and their severity.


Assuntos
Fibrinogênio/administração & dosagem , Pancreatectomia , Trombina/administração & dosagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Perda Sanguínea Cirúrgica/estatística & dados numéricos , Combinação de Medicamentos , Feminino , Humanos , Incidência , Itália/epidemiologia , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Pancreatectomia/efeitos adversos , Fístula Pancreática/prevenção & controle , Neoplasias Pancreáticas/patologia , Neoplasias Pancreáticas/cirurgia , Estudos Prospectivos , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento
13.
J Biol Regul Homeost Agents ; 28(2): 351-5, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-25001668

RESUMO

The aqueous humor is produced in the ciliary body, therefore in this study we investigated the Atrial natriuretic peptide (ANP) and vasopressin (VP)-presence in the ciliary body of the pig eye since these peptide are involved in the homeostasis of body fluids. The results show ANP-presence in the epithelial cells and in the endothelial cells of the blood vessels and VP-presence in the epithelial cells, in the endothelium of canal of Schelmm and in the muscle cells of the blood vessels. These peptides might regulate the synthesis and the composition of the aqueous humor and regulate the hydrodynamic flow and haemodynamic flow of the blood.


Assuntos
Fator Natriurético Atrial/metabolismo , Corpo Ciliar/metabolismo , Vasopressinas/metabolismo , Animais , Corpo Ciliar/irrigação sanguínea , Corpo Ciliar/citologia , Sus scrofa
14.
Ann Ig ; 26(2): 131-6, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-24763444

RESUMO

BACKGROUND: The aim of the study was to obtain local estimates of the prevalence of anxiety and dysthymic disorders among attendees of primary care at local level, useful to pursue a better management of the health care services. METHODS: The study was conducted in the Health District no. 2 of Turin (industrial town in northwest Italy). The criteria for identification of cases were based on the drugs prescriptions made by general practitioners (GPs), selected in order to assure high specificity. The study involved 86 physicians (with 87,885 attendees). RESULTS: As expected, the crude and standardized prevalences were higher in women (anxiety: 2.9% vs 1.3% in men; dysthymia: 3.8% vs 1.7% in men), with a peak in women aged over 75 yrs (anxiety: 4.8%; dysthymia: 6.2%). In comparison to male GPs, female GPs had an higher prevalence of patients with anxious disorders, whereas the prevalences of dysthymia were similar. CONCLUSIONS: Despite the discussed limitations, the used methodology allows to obtain sufficiently reliable estimates of prevalence of common mental disorders at local level, providing informations useful for organizing the primary care in the Health district.


Assuntos
Ansiedade/epidemiologia , Prescrições de Medicamentos/estatística & dados numéricos , Transtorno Distímico/epidemiologia , Atenção Primária à Saúde , Adolescente , Adulto , Idoso , Ansiedade/diagnóstico , Ansiedade/tratamento farmacológico , Transtorno Distímico/diagnóstico , Transtorno Distímico/tratamento farmacológico , Feminino , Humanos , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores de Risco
15.
Front Oncol ; 14: 1330705, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38974245

RESUMO

Background: The evaluation of existing resources and services is key to identify gaps and prioritize interventions to expand care capacity for children with central nervous system (CNS) tumors. We sought to evaluate the resources for pediatric neuro-oncology (PNO) in Mexico. Methods: A cross-sectional online survey with 35 questions was designed to assess PNO resources and services, covering aspects including number of patients, infrastructure, human resources, and diagnostic and treatment time intervals. The survey was distributed to the members of the Mexican Association of Pediatric Oncology and Hematology (AMOHP) who belong to the nation's many different health systems. Results: Responses were obtained from 33 institutions, distributed throughout the country and part of the many health systems that exist in Mexico. Twenty-one (64%) institutions had less than 10 new cases of pediatric CNS tumors per year. Although 30 (91%) institutions saw pediatric patients up to the age of 18 years, 2 (6%) had a cutoff of 15 years. Twenty-four (73%) institutions had between 1 and 3 pediatric oncologists providing care for children with CNS tumors. Six (18%) institutions did not have a neurosurgeon, while 19 (57%) institutions had a pediatric neurosurgeon. All centers had a pathology department, but 13 (39%) institutions only had access to basic histopathology. Eleven (33%) institutions reported histopathological diagnoses within one week, but 3 (9%) took more than 4 weeks. Radiotherapy for pediatric CNS tumors was referred to outside centers at 18 (55%) institutions. All centers had access to conventional cytotoxic chemotherapy, but only 6 (18%) had access to targeted therapy. Eighteen (55%) respondents estimated a survival rate of less than 60%. Fifteen (45%) centers attributed the main cause of mortality to non-tumor related factors, including infection and post-surgical complications. Conclusions: This is the first national assessment of the resources available in Mexico for the treatment of CNS tumors. It shows disparities in resource capacity and a lack of the specific and efficient diagnoses that allow timely initiation of treatment. These data will enable the prioritization of collaborative interventions in the future.

16.
Front Oncol ; 14: 1376574, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38756654

RESUMO

Introduction: Data on medulloblastoma outcomes and experiences in low- and middle-income countries, especially in Latin America, is limited. This study examines challenges in Mexico's healthcare system, focusing on assessing outcomes for children with medulloblastoma in a tertiary care setting. Methods: A retrospective analysis was conducted, involving 284 patients treated at 21 pediatric oncology centers in Mexico. Results: High-risk patients exhibited markedly lower event-free survival than standard-risk patients (43.5% vs. 78.3%, p<0.001). Influential factors on survival included anaplastic subtype (HR 2.4, p=0.003), metastatic disease (HR 1.9, p=0.001); residual tumor >1.5cm², and lower radiotherapy doses significantly impacted event-free survival (EFS) and overall survival (OS). Platinum-based chemotherapy showed better results compared to the ICE protocol in terms of OS and EFS, which was associated with higher toxicity. Patients under 3 years old displayed notably lower OS and EFS compared to older children (36.1% vs. 55.9%, p=0.01).

17.
Dig Liver Dis ; 54(11): 1520-1526, 2022 11.
Artigo em Inglês | MEDLINE | ID: mdl-35474168

RESUMO

INTRODUCTION: The concept of rebalanced hemostasis in cirrhosis challenges the policy of transfusing plasma or platelets before invasive procedures in patients with prolonged PT or severe thrombocytopenia. Recent guidelines recommend against plasma transfusion and suggest avoiding/minimizing platelet transfusions. AIM: We assessed how hepato-gastroenterologists manage prolonged PT/INR or severe thrombocytopenia before invasive procedures. METHODS: On May 2021, AISF members were sent a questionnaire addressing the PT/INR and platelet thresholds required before invasive procedures, the use of other markers of bleeding risk or other hemostatic treatments and the burden of pre-emptive plasma and platelet transfusions. RESULTS: Of 62 respondents, 94% and 100% use PT/INR and platelet count to assess bleeding risk, respectively. Only 37% and 32% require less conservative PT/INR or platelet counts thresholds for low-risk procedures, respectively. As for those applying single thresholds, 68% require PT/INR <1,5 and 86% require platelet counts ≥50 × 109/L. Half respondents use additional indicators of bleeding risk and 63% other hemostatic treatments. Low-risk procedures account for 70% of procedures, and for 50% and 59% of plasma and platelets units transfused, respectively. CONCLUSIONS: the survey indicates lack of compliance with guidelines that advise against plasma and platelet transfusions before invasive procedures and the need for prospective studies and inter-society consensus workshops.


Assuntos
Anemia , Transtornos da Coagulação Sanguínea , Hemostáticos , Trombocitopenia , Humanos , Transfusão de Componentes Sanguíneos , Estudos Prospectivos , Plasma , Transfusão de Plaquetas , Cirrose Hepática/complicações , Cirrose Hepática/terapia , Trombocitopenia/terapia , Inquéritos e Questionários
18.
Environ Pollut ; 314: 120199, 2022 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-36155226

RESUMO

The waste-to-energy (WTE) incinerator plant located in the Turin area (Italy) started to recover energy from the combustion of municipal solid waste in 2013. A health surveillance program was implemented to evaluate the potential health effects on the population living near the plant. This program included a longitudinal biomonitoring to evaluate temporal changes of some environmental pollutants, including polycyclic aromatic hydrocarbons (PAHs), in residents living in areas near the Turin incinerator (exposed group, E) compared to those observed in subjects living far from the plant (not exposed group, NE). Ten monohydroxy-PAHs (OH-PAHs), consisting in the principal metabolites of naphthalene, fluorine, phenanthrene, and pyrene, were analyzed in urines collected from the E and NE subjects after one (T1) and three years (T2) of plant activity and compared with those determined in the same cohort established before the plant start-up (T0). Spearman correlation analysis was undertaken to explore possible associations between OH-PAHs and personal characteristics, lifestyle variables, and dietary habits. A linear mixed model (LMM) approach was applied to determine temporal trends of OH-PAHs observed in the E and NE subjects and to evaluate possible differences in trend between the two groups. Temporal trends of OH-PAHs determined by LMM analysis demonstrated that, at all times, the E group had concentrations lower than those assessed in the NE group, all other conditions being equal. Moreover, no increase in OH-PAH concentrations was observed at T1 and T2 either in E or in NE group. Significant positive correlations were found between all OH-PAHs and smoking habits. Regarding variables associated to outdoor PAH exposure, residence near high traffic roads and daily time in traffic road was positively correlated with 1-hydroxynaphthalene and 1-hydroxypyrene, respectively. In conclusion, no impact of the WTE plant on exposure to PAHs was observed on the population living near the plant.


Assuntos
Poluentes Ambientais , Fenantrenos , Hidrocarbonetos Policíclicos Aromáticos , Humanos , Hidrocarbonetos Policíclicos Aromáticos/análise , Monitoramento Biológico , Resíduos Sólidos/análise , Flúor/análise , Monitoramento Ambiental , Pirenos/análise , Poluentes Ambientais/análise , Fenantrenos/análise , Naftalenos/análise , Biomarcadores
19.
Epidemiol Infect ; 139(5): 777-82, 2011 May.
Artigo em Inglês | MEDLINE | ID: mdl-20619080

RESUMO

SUMMARYA prospective cohort study with a 1-year telephone follow-up was performed to estimate the incidence of surgical-site infections (SSIs) in hip and knee prostheses. Twenty-five public hospitals equipped with orthopaedic units in two Italian regions were involved. An 8-month surveillance period was set to obtain significant data at a regional level and data were collected by the infection control nurses of each centre. One-year follow-up was completed in 75% of cases. SSIs were recorded in 45 cases (incidence rate 1·9/100 person-years, 95% CI 1·4-2·5). Thirty-six percent of SSIs were diagnosed during hospitalization and 95·3% within 90 days post-operation. This incidence is similar to that reported by European and USA surveillance systems. The proposed investigative method proved to be reliable and feasible. A prolonged surveillance for at least 3 months post-operation yields a good estimate of SSI in joint replacements.


Assuntos
Infecção Hospitalar/epidemiologia , Procedimentos Ortopédicos/efeitos adversos , Infecções Relacionadas à Prótese/epidemiologia , Infecção da Ferida Cirúrgica/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Feminino , Seguimentos , Articulação do Quadril/cirurgia , Humanos , Incidência , Itália/epidemiologia , Articulação do Joelho/cirurgia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos
20.
Neurodegener Dis ; 8(3): 129-37, 2011.
Artigo em Inglês | MEDLINE | ID: mdl-20838029

RESUMO

BACKGROUND: Byproducts of oxidative metabolic reactions could play a role in the pathogenesis of several neurodegenerative diseases (ND) including Alzheimer's disease (AD). We designed a study aimed at investigating a large set of oxidative and antioxidant markers in a sample of patients affected by different forms of dementia or memory impairment. METHODS: Serum levels of coenzyme Q(10), malondialdehyde (MDA), the total, oxidized and reduced forms of glutathione (GStot, GSSG and GSH, respectively), reactive oxygen species, anti-oxidized low-density lipoprotein antibodies and antioxidant power (PAO) were investigated in patients affected by AD, mild cognitive impairment, dementia with Lewy bodies and Parkinson's disease with dementia. The patient sample (n = 66) was compared with healthy subjects (HC; n = 62), and a comparison across pathological subgroups was also performed. A multivariate logistic regression model was implemented in order to calculate an algorithm model for predicting the risk of developing a neurodegenerative disorder. RESULTS: The comparison between the memory deficit (MD) group and HC showed a significant difference for MDA (MD: 6.3 ± 2.8 µg/l; HC: 9.1 ± 4.9 µg/l; p = 1.7 × 10(-6)), GStot (MD: 260.4 ± 62.6 mg/l; HC: 306.5 ± 60.7 mg/l; p = 2.2 × 10(-5)), GSH (MD: 208.9 ± 68.4 mg/l; HC: 295.3 ± 101.3 mg/l; p = 2.2 × 10(-7)) and PAO (MD: 1,066.5 ± 247.7 µmol; HC: 954.9 ± 200.4 µmol; p = 0.8 × 10(-3)). By contrast, no differences in the levels of the studied markers were detected across the different forms of ND. An older age, higher levels of PAO, lower levels of GSH and MDA and the use of cardiovascular or antidepressant drugs were the most important factors associated with the carrier ship of neurodegenerative disorder. CONCLUSION: To our knowledge, this is the first study reporting similar oxidative imbalance in different forms of memory impairment, regardless of the specific etiology. Low GSH levels could be considered as a favorable factor in ND; at the same time it could be suggested that higher levels of PAO represent a counteracting mechanism against an increased oxidative stress. The association between vascular risk factors, depressive status and cognitive impairment is in line with findings in the literature.


Assuntos
Transtornos Cognitivos/fisiopatologia , Transtornos da Memória/fisiopatologia , Doenças Neurodegenerativas/fisiopatologia , Estresse Oxidativo/fisiologia , Idoso , Idoso de 80 Anos ou mais , Anticorpos/sangue , Estudos de Casos e Controles , Transtornos Cognitivos/sangue , Feminino , Glutationa/sangue , Humanos , Lipoproteínas LDL/imunologia , Modelos Logísticos , Masculino , Malondialdeído/sangue , Transtornos da Memória/sangue , Doenças Neurodegenerativas/sangue , Oxirredução , Projetos Piloto , Espécies Reativas de Oxigênio/sangue , Ubiquinona/análogos & derivados , Ubiquinona/sangue
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