Use of Apremilast® in the psoriasis treatment: a real-life multicenter Italian experience.

BACKGROUND: Apremilast® (Amgen, Thousand Oaks, CA, USA) is the first small molecule approved for the treatment of moderate-to-severe psoriasis in adult patients; however, real-life data are still limited. We investigated the effectiveness and safety of this drug in a multicenter real-world setting. METHODS: We retrospectively reviewed data from all psoriatic patients who received at least one dose of Apremilast® (Amgen) and collected demographic data and medical history at baseline and periodically for 36 months. RESULTS: A total of 111 patients entered in the study. The mean drug survival duration was 21.8±10.6 months; however, it was significantly shorter when comorbidities were ≥3 and if biologic drugs were previously administered. ΔPASI90 was achieved in 29% of patients and ΔPASI50 in 68% at T4; the rate of ΔPASI improvement increased progressively at T12, T24, T36 in patients who continued to receive Apremilast® (Amgen). At the end of the study 50 patients discontinued the treatment because of adverse events (19.8%), primary failure (19%) or secondary failure (6.3%). CONCLUSIONS: Apremilast® (Amgen) proved to be an effective, safe, and manageable drug, showing effectiveness also in difficult-to-treat patients with psoriasis, with a favorable tolerability profile and a potentially valid weight loss effect. We believe that treating patients with few comorbidities who are naive to biological therapy may result in higher response rates and longer mean drug survival.

A Surgical Instrument Cover for the Prevention of Thermal Injuries During Laparoscopic Operations.

INTRODUCTION: Accidental thermal injuries are infrequent, nonetheless, dangerous complications in laparoscopic surgery. Burns are produced because of direct contact, lack of instrument insulation and capacitive coupling. Biological fluids on the surface of laparoscopic instruments behave as electric conductors on the sheath and may be responsible for accidental thermal injuries. Our hypothesis is that using an insulator device may prevent those injuries. MATERIALS AND METHODS: After evaluating different materials for dielectric properties, costs, and temperature increase tolerance, we selected polytetrafluoroethylene (PTFE) to develop a sleeve that works as an electrical insulator when applied on the sheath of laparoscopic instruments. Efficacy of this PTFE cover in reducing conduction of electricity was tested on both reusable and disposable laparoscopic instruments. RESULTS: Electric conduction of the laparoscopic instrument sheaths was tested using an ex vivo model that reproduces the abdominal environment in basal conditions and in presence of blood. Electric conduction of laparoscopic instruments was measured before and after the placement of the PTFE cover. We measured a significant difference in electric resistance on the sheath's surface without and with blood, revealing a weak electrical conduction: infinity versus a median value of 251.11 Mohm, respectively. CONCLUSIONS: This ex vivo study demonstrated that a PTFE sleeve may reduce electricity conduction of laparoscopic instruments. A pilot in vivo study is planned to test its safety and efficacy.

Radiofrequency-Based Identification Medical Device: An Evaluable Solution for Surgical Sponge Retrieval?

BACKGROUND: A retained surgical item in patients (gossypiboma) is a persisting problem, despite consistent improvements and existing guidelines in counting instruments and sponges. Previous experiences with radiofrequency identification technology (RFID) tracking sponges show that it could represent an innovation, in order to reduce the criticism and increase the effectiveness during surgical procedures. We present an automated system that allows reduction of errors and improves safety in the operating room. METHODS: The system consists of 3 antennas, surgical sponges containing RFID tags, and dedicated software applications, with Wi-Fi real-time communication between devices. The first antenna provides the initial count of gauzes; the second a real-time counting during surgery, including the sponges thrown into the kick-bucket; and the third can be used in the event of uneven sponge count. The software allows management at all stages of the process. RESULTS: In vitro and in vivo tests were performed: the system provided excellent results in detecting sponges in patients' body. Hundred percent retained sponges were detected correctly, even when they were overlapped. No false positive or false negative was recorded. The counting procedure turned out to be more streamlined and efficient and it could save time in a standard procedure. CONCLUSIONS: The RFID system for sponge tracking was shown to be experimentally a reliable and feasible method to track sponges with a full detection accuracy in the operating room. The results indicate the system to be safe and effective with acceptable cost-effective parameters.