Endovenous laser ablation (EVLA) for vein insufficiency: two-year results of a multicenter experience with 1940-nm laser diode and a novel optical fiber.

Thermoablative techniques currently represent, in accordance with international guidelines, the most used methods in the treatment of varicose veins. From some years, lasers with a wavelength greater than 1900 nm have been introduced for EndoVenous Laser Ablation (EVLA) treatment. However, currently, few clinical studies regarding this new technology are reported in the medical literature. The aim of this study is to evaluate outcomes at a 2-year follow-up (mid-term) of EVLA of varicose veins of the lower limbs using a 1940-nm laser and a new cylindric monoring fiber. This clinical trial was conducted as a multicenter, retrospective, non-randomized, non-blind clinical study. Ninety-three patients were enrolled for a total of one hundred consecutive procedures performed in the period between January 2021 and May 2021 in two Italian facilities. The primary efficacy endpoint was the occlusion rate of the treated vein immediately after surgery and at the follow-up (24 months). The secondary efficacy endpoint was the evaluation of the parameters of energy delivered during the procedure (power and linear energy density or LEED). The primary safety endpoints were the incidence of pain (1 day and 7 days after surgery) and the rate of intraoperative and postoperative complications. The precepted pain was evaluated with the visual analog scale (VAS). The secondary safety endpoint was the evaluation of the improvement of the patient's symptoms related to venous disease. This evaluation was conducted by recording the changes in clinical, etiologic, anatomic, and pathophysiologic (CEAP) classification. All procedures were carried out regularly on an outpatient basis, and no intraoperative complications occurred. The occlusion rate of the target veins was 100% at 7- and 30-day controls. At follow-up controls, performed at 6 months, 1 and 2 years carried out showed an occlusion rate respectively of 99% (97 to 100), 96.9% (93.6 to 100), and 95.9% (92.1 to 99.9). The secondary efficacy endpoint was the evaluation of the parameters of energy delivered during the procedure (power watt and linear energy density): As regards the power parameters, we report an average of watts of 4.5 ± 0.8 [2.5 to 6] and linear energy density delivered (LEED) of 41.2 ± 8.6 [(21.1 to 66.7)]. The pain reported (with VAS scale) on 1 day of the procedure was 2 [1; 3] and 1 [0 to 4] at 7 days. All patients showed improved symptoms related to venous disease, with reduction of the individual CEAP class to which they belong. This study demonstrates that EndoVascular Laser Ablation (EVLA) treatment of varicose veins with a wavelength > 1900 nm is safe and effective. The overall occlusion rate was high. The reported results suggest that using lower parameters, such as output power (watts) and LEED (linear energy density), do not reduce the success rate of the treatment when used over 35 J/cm.

Third generation of laser (>1900) for endovenous thermoablation (EVLA) of varicose veins: A systematic review and meta-analysis.

OBJECTIVES: Third generation lasers with longer wavelengths (>1900 nm) have been introduced, in recent years, for the treatment of varicose veins. The possible advantage of the new generation lasers is that they allow complete damage to the vein wall using a lower Power in Watts (W: J/sec) and a lower linear energy density (LEED: J/cm). The aim of this work is to evaluate the results present in the literature regarding efficacy and safeness of the new generation lasers for the treatment of varicose veins. METHODS: Published articles were searched on PubMed database and on Cochrane Library, entering the keywords "1940 nm or 1920 nm laser AND varicose veins laser thermoablation (EVLA)." The primary endpoint of the study was to value rate of occlusion and adverse events at the short term follow-up. The search yielded a total of 14 studies. In the end, only six studies were judge eligibility. RESULTS: The studies were heterogenous in their documentation, EVLA, duplex ultrasound protocol and result reporting. A total of 540 limbs of 377 patients were treated with endovenous laser ablation (EVLA) with laser 1920-1940 nm. The treated veins had a mean diameter of 0.74 ± 0.17 cm and a mean length of 27.87 ± 20.63 cm. The pooled estimates of immediate occlusion rate was of 99.8% (95% CI: 97.9% to 100.0) with high heterogeneity (I2 = 60%; 95% PI: 89.7% to 100%), while at short-term follow-up was of 98.2% (95% CI: 94.0% to 100.0%) with higher heterogeneity (I2:79%; 95% PI: 77.1% to 100.0%). EHIT occurred in 7 cases (pooled estimate: 0.7%). The other adverse events rate reported were 1% of hyperpigmentation, 2.8% of neurological complications, 0.6% thrombophlebitis and 1.9% of bruising/hematoma. The pooled mean estimates of LEED was equal to 38.2 J/cm (95% CI: 26.3 to 50.1 J/cm) although with a very large heterogeneity (I2 = 100%). CONCLUSIONS: The overall success rate of EVLA was high. The analysis of these studies suggests that using lower parameters (Power and linear administered energy) may have no effect on the treatment success rate. Short-term results demonstrate comparable occlusion rates respect the second-generation lasers. Instead, data suggest a low complication rates. Short-term results demonstrate comparable complications rates respect the second-generation lasers (1300-1470 nm). Randomized studies with longer follow-up are required to evaluate the EVLA 1900 nm procedure further.

980 nm laser endo-perivenous treatment of lower limb reticular veins and telangiectasias. Technical notes.

INTRODUCTION: For several years, the venous aesthetic problem has been tackled mainly with sclerotherapy techniques. In recent years, laser techniques have been added, both surface (transdermal) and endo-perivenous, performed with small optical fibers (100-200 µm) and low intensities in terms of LEED and Watt. The endo-perivenous technique has extended the possibilities of laser treatment also to the nourishing veins, to telangiectasias resistant to therapies with sclerosing agents and/or transdermal lasers and to vessels with larger diameters (1-3 mm) and depths >1.3 mm. MATERIALS AND METHODS: We report a series of 20 patients affected by reticular veins and telangiectasias of the lower limbs (CEAP C1-2) treated with endo-perivenous technique. The most used setting was: 3 W (range: 2-4 W) with a mean fluence delivered of 11.25 J/cm (range: 6-18) in pulse mode with 980 nm laser, 200 µm fiber after a preventive skin cooling. Scheduled follow-up occurred 20 and 60 days after treatment. RESULTS: Total technical success, understood as complete obliteration of all treated vessels, was achieved in 70% of cases (14/20) after just one treatment. The most observed early local complications were erythema, vesicles, and small cutaneous eschars that regressed in 3 weeks. At 60-day follow-up, just one complication was observed: a small area of hyperpigmentation (5%). In this case, chemical peel procedures was performed with good clinical results. CONCLUSIONS: Endoperivenous laser treatment represents an effective and valid tool for the treatment of teleangectasias and reticular varicose veins.

Endovascular laser treatment. Comparison of lasers and fibers of different generations: study of temperatures and tissue damage produced on a porcine liver model.

The current international guidelines identify tumescent ablative techniques such as laser thermal ablation (EVLA) and radiofrequency (RFA) to be the gold standard in varicose vein surgery. New-generation lasers have been introduced, which have high wavelengths (1940 and 2000 nm) and therefore with a greater affinity for water than the old generation (980- and 1470-nm lasers). The purpose of the study was to evaluate the biological effect and the temperatures produced during the use of lasers with different wavelengths (980, 1470, and 1940 nm) and with optical fibers with different emission (radial diverging at 60° and radial with cylindrical mono-ring) on in vitro model. Porcine liver was used as an in vitro model. The laser control units used had 3 different wavelengths: 980, 1470, and 1940 nm. The optical fibers used were 2: the Corona 360 fiber (mono-ring radial fiber) and the infinite fiber (cylindrical mono-ring fiber). The laser operating parameters used included the delivery of 6 W in continuous wave (CW) mode with a standard 10 s/cm pull-back. Eleven measurements were made for each fiber and for each laser, for a total of 66 measurements. We performed measurements of the maximum transverse diameter produced with laser irradiation to evaluate the biological effectiveness of the treatment. During laser irradiation, we performed measurements of both of the temperatures reached on the external surface of the porcine tissue, near the tip of the laser catheter, and the temperatures reached inside the irradiated tissue by using a digital laser infrared thermometer with apposite probe. The calculation of the statistical significance (p-value) was obtained with the ANOVA method with two between factors. The comparison study of the maximum transverse diameter (DTM) of the lesion produced on the target tissue demonstrated the absence of statistically significant differences between the 1470-nm laser and the 1940-nm laser regardless of the type of fiber used. It was not possible to perform measurements of the maximum transverse diameter produced with the 980-nm laser as this produced no visible effect on the model. The comparison study of the temperatures developed during and immediately after the treatment instead showed higher maximum surface temperatures (TSM) and a higher thermal increase (IT) regardless of the type of fiber used in a statistically significant way (respectively, p 0.002 and 0.012) when using the 980-nm laser versus the 1940-nm laser. Comparing instead the 980-nm laser with 1470 nm, there were no differences in TI recorded during the procedure but a significantly higher VTI (p 0.029). The experiment conducted with the new generation laser, compared with those of the first and second generation, shows how this works overall at lower temperatures with the same effectiveness.

[Turn-over of non-tenured public health research personnel in an Italian public research institute (IRCCS).] / Il turn-over del personale con contratti di lavoro flessibili o borse di studio dedicato alla ricerca sanitaria in un IRCCS pubblico italiano.

BACKGROUND: The objective is to show variations in the number of non-tenured personnel (NTP) in a public health research centre (IRCCS) between 30th June 2016 and 31st December 2017. In this time interval, the issue of NTP was at the centre of governmental discussions. METHODS: Data collection was performed from CVs and scientific publications of NTP working at the Fondazione IRCCS Istituto Nazionale dei Tumori (INT). We compared the characteristics of NTP entering or leaving INT and those of NTP who remained in the considered time interval. RESULTS: NTP in INT counted 465 members of staff at 30th June 2016 and 472 at 31st December 2017. 75% of these works in the research. 26% of NTP left INT and their position resulted entirely substituted by other NTP. NTP staff who left are mainly aged under 40 and show fewer publications than those who stayed. Newly acquired NTP are younger and show a fewer number of publications compared to the personnel who left. CONCLUSIONS: 1 out of 4 NTP members of staff moved to a new job during a period in which the uncertain future of NTP research staff was under the spotlight. It appears that IRCCS are progressively being identified as suitable for hands-on, post university internships from which researchers would then choose to move, in search of a new job in public or private centres, with a consequent decline of IRCCS' role in health research.

FoxO1 regulates asymmetric dimethylarginine via downregulation of dimethylaminohydrolase 1 in human endothelial cells and subjects with atherosclerosis.

BACKGROUND AND AIMS: The O subfamily of forkhead (FoxO) 1 is a pivotal element in the regulation of endothelial activation. Compartmentalization and activity of FoxO1 is regulated by post translational modifications, but the implication in endothelial dysfunction and atherosclerosis remain controversial. Our aim was to identify FoxO1 related metabolic signatures in endothelial cells. METHODS AND RESULTS: Using metabolomics in human umbilical endothelial cells (HUVECs) overexpressing the wild type FoxO1 (FoxO1-WT), the acetylation defective mutant (FoxO1-KR), the unphosphorylated nuclear localized mutant (FoxO1-ADA) and the Green Fluorescent Protein (GFP) control vector, we identify metabolic pathways differentially affected by the different FoxO1 localization and activity. Among metabolites, asymmetric dimethylarginine (ADMA) was increased in FoxO1-ADA compared with FoxO1-WT and FoxO1-KR infected cells (p < 0.01). ADMA was further investigated to identify the molecular mechanisms to explain its link to FoxO1. We found that unrestrained FoxO1 activity leads to increase of ADMA via downregulation of its degrading enzyme, dimethylaminohydrolase (DDAH) 1. In human subjects (n = 89) the FoxO1/DDAH1/ADMA pathway marks unstable atherosclerosis. CONCLUSIONS: Our results point to ADMA as a biomarker to track deregulated FoxO1 activity in vivo.

Custo-benefício de programa de exercício físico para redução de peso em adultos / Cost-effectiveness of exercise program to reduce weight in adults

O objetivo foi estimar o custo-benefício de programa de mudança de estilo de vida na redução da obesidade. Foram reunidos dados de 271 adultos (ambos sexos) participantes de programa de exercício físico, com protocolos distintos em tipo e duração (2, 6 ou 12 meses), envolvendo aconselhamento alimentar ou adequação de fibras alimentares. Aferiu-se peso e estatura para cálculo do Índice de Massa Corporal (IMC). Considerou-se R$0,79/pessoa/ano o custo da hospitalização relacionada à obesidade e do programa R$1.580,00/mês. Em 2 meses, o grupo de caminhada e o de exercícios mistos (caminhada e força) e adequação de fibras alimentares tiveram maior redução de peso e IMC. A eutrofia aumentou em 2 meses com exercícios mistos e adequação de fibras, 6 meses de caminhada, 1 ano de exercícios mistos ou caminhada. Pelos cálculos a economia aos cofres públicos com 2 meses de exercícios mistos e fibras seria de aproximadamente R$2 milhões e, com 1 ano de exercícios mistos, de R$726.000 e com caminhada de R$2,4 milhões. O programa mostrou que a economia gerada seria suficiente para financiar a replicação deste programa em todos os municípios brasileiros.

The objective was to estimate the cost-effectiveness of lifestyle-modification program in reducing the obesity. Was collected data from 271 adults (both genders) they participated in exercise program, with different protocols as regards type and duration (2, 6 or 12 months), envolved nutritional counseling or food fiber adequacy. Weight and height were measured to calculate the Body Mass Index (BMI). The considered expenditure with obesity were R$ 0,79/person/year, and the monthly cost of the program R$1.580,00. For 2 months, the group following walk and mixed exercises (walk and strength) with food fiber adequacy achieved greater weight loss and BMI reduction, and in 6 months was the group walk. The eutrophy increased in 2 months of mixed exercises with fiber, 6 months with walk, 1 year of mixed and walk. According to the cost-benefit estimates, the economy of public revenue with 2 months of mixed exercises with fiber would be almost R$ 2,4 million, with 1 year of mixed it would be R$ 726.000 and R$ 2,4 million of walk. The program has shown that, if applied nationwide cities, the generated savings would be enough sufficient to implement this program in all municipalities in this country.

Perfil morfológico de culturistas brasileiros de elite em período competitivo / Morphological profile of elite brazilian bodybuilders in competitive season

O objetivo deste estudo foi analisar o perfil morfológico de culturistas brasileiros de elite que competiram no XXVII Campeonato Brasileiro de Culturismo-Musculação. Um total de 28 atletas (27,0 ± 7,4 anos; 78,2 ± 8,7kg; 170,1 ± 6,9cm), do sexo masculino, foram voluntariamente estudados. Medidas antropométricas (massa corporal, estatura, espessura de dobras cutâneas, perímetros e diâmetros) foram coletadas de todos os sujeitos no período da manhã, no dia da competição. Os valores estimados da composição corporal dos atletas foram os seguintes: gordura corporal relativa, 5,8 ± 0,5 por cento; massa corporal magra, 73,6 ± 8,2kg; massa muscular, 54,3 ± 6,7kg; área muscular do braço, 108,51 ± 15,19cm². Por outro lado, o somatótipo médio encontrado foi: endomorfia, 1,11 ± 0,29; mesomorfia, 8,26 ± 0,67; ectomorfia, 0,95 ± 0,53 (mesomorfo balanceado). Além de os culturistas apresentarem elevados níveis de desenvolvimento muscular (~70 por cento) e baixos depósitos de gordura corporal, verificou-se uniformidade nos acúmulos de gordura localizada. A predominância do componente mesomorfo confirmou a estrutura muscular acentuadamente desenvolvida encontrada nos atletas investigados. Portanto, os resultados do presente estudo demonstram que atletas de culturismo de elite apresentam no dia da competição grande volume muscular, bem como excelente definição muscular, proporcionalidade e simetria.

The aim of this study was to analyze the morphological profile of elite Brazilian bodybuilders who participated in the XXVII Brazilian Championship of Body Building. A total of 28 male athletes (27.0 ± 7.4 years; 78.2 ± 8.7 kg; 170.1 ± 6.9cm), were voluntarily assessed. Anthropometric measures (body mass, stature, skinfolds thickness, perimeters and diameters) were collected from all subjects in the morning shift, at the competition day. The estimated values of the body composition of the athletes were the following: relative body fat, 5.8 ± 0.5 percent; lean body mass, 73.6 ± 8.2 kg; muscular mass, 54.3 ± 6.7 kg and arm muscular area, 108.51 ± 15.19 cm². Conversely, the mean somatotype found was: endomorphy, 1.11 ± 0.29; mesomorphy, 8.26 ± 0.67; ectomorphy, 0.95 ± 0.53 (balanced mesomorphy). Besides high levels of muscular development (~70 percent) and low body fat buildup, the bodybuilders also presented uniformity in the accumulation of located fat. Predominance of the mesophormic component confirmed muscular structure remarkably developed found in the investigated athletes. Therefore, the results of the present study demonstrate that elite body building athletes present large amount of muscular volume, as well as excellent muscular definition, proportionality and symmetry at the day of the competition.

Efeito de estresse ambiental sobre a pressäo arterial de trabalhadores / Effect of environmental stress on blood pressure during the working journey

OBJETIVO: Analisar o comportamento de pressäo arterial (PA) e a freqüência cardíaca (Fc) de indivíduos ao longo da jornada de trabalho em dois ambientes com estresses ambientais distintos. MÉTODOS: Foram avaliados 46 funcionários, trabalhadores de uma indústria processadora de madeira, de Botucatu, SP, sendo 27 funcionários da linha de produçäo (esforço físico moderado-intenso, altas temperaturas e elevados níveis de ruído) (G1), e 19 da administraçäo (sem esforço físico, salas aclimatadas, baixos níveis de ruído) (G2). Todos foram submetidos a avaliaçäo antropométrica da composiçäo corporal (obesidade e adiposidade) e bioquímica do sangue (lipidemia) e, adicionalmente, o registro da PA e da Fc em três momentos do turno de serviço: início, meio e fim. RESULTADOS: Houve semelhança na variaçäo da PA entre G1 e G2, mas com maiores elevaçöes de PA e Fc em G1. Os resultados mostraram grande variabilidade na resposta da PA, levando à subdivisäo dos grupos G1 e G2 em respondedores (GR, aumento maior de 10 por cento na PA média) e näo respondedores (GN). Os subgrupos GR e GN apresentaram semelhanças nos padröes antropométrico e bioquímico diferindo apenas na resposta pressórica e no caso do GR1 na história familiar de hipertensäo. Comparando os subgrupos GR1 e GR2, foi constatado que os primeiros apresentaram maiores variaçöes de PA e Fc que os segundos. CONCLUSOES: A variaçäo individual da resposta pressórica e da Fc conforme o tipo de estresse ambiental indica ser este um fator adicional a ser considerado na avaliaçäo da pressäo arterial e, talvez, na gênese da hipertensäo arterial de operários

Perfil antropométrico de culturistas brasileiras de elite / Anthropometric profile of Brazilian elite female bodybuilders

O objetivo do presente estudo foi analisar a composição corporal e o somatótipo de culturistas brasileiras de elite, participantes do XXVII Campeonato Brasileiro de Culturismo-Musculação. Onze atletas do sexo feminino (28,7 mais ou menos 5,4 anos; 55,9 mais ou menos 8,8 kg; 161,9 mais ou menos 7,2 cm) foram estudadas. Medidas antropométricas de massa corporal, estatura, espessura de dobras cutâneas, perímetros e diâmetros foram coletadas no dia da competição, pela manhã. Os valores da composição corporal foram os seguintes: percentual de gordura corporal 8,1 mais ou menos 1,0 porcento; massa corporal magra, 51,4 mais ou menos 6,5 kg; área muscular do braço, 52,98 mais ou menos 12,18 cm. O somatótipo médio das atletas foi: endomorfia, 1,59 mais ou menos 0,53; mesomorfia, 4,45 mais ou menos 0,98; ectomorfia, 2,50 mais ou menos 0,80. As culturistas demonstraram baixos depósitos de gordura corporal e uma boa estrutura muscular...

Antropometria de atletas culturistas em relação à referência populacional / Anthropometry of body builders in relation to the population standard

Atletas de culturismo têm como alvo de treinamento a hipertrofia muscular e a redução da adiposidade. A falta de referências antropométricas apropriadas pode levar esses indivíduos a serem erroneamente considerados em situação de sobrepeso ou desnutrição. Portanto, objetivamos comparar a composição corporal de atletas de culturismo com os padrões populacionais. Foram avaliados 36 atletas, de ambos os sexos, 26 do sexo masculino (27,2 ± 7,2 anos) e 10 do sexo feminino (30,0 ± 6,1 anos), por ocasião da competição nacional, quanto aos indicadores antropométricos de peso, estatura, índice de massa corpórea, pregas cutâneas, adiposidade corpórea e circunferência muscular do braço. Os resultados foram referidos quanto à posição percentual ou de desvios-padrão (pelo escore Z) tendo como referências padrões populacionais locais. Como resultado, encontramos que os indicadores com menor contraste com os padrões adotados foram peso e estatura e os maiores contrastes foram encontrados na circunferência muscular do braço para os homens, e pregas cutâneas tricipital para as mulheres. Pelo indicador muscular todos foram classificados como obesos ou sobrepeso, enquanto que pela prega cutânea tricipital e adiposidade corpórea, a desnutrição esteve presente em 100,0 por cento das mulheres e 88,5 por cento dos homens. Fica evidenciada a inadequação da utilização do padrão antropométrico populacional para a classificação nutricional de atletas de força, em particular culturistas, sendo assim necessário o estabelecimento de padrões próprios para esse tipo de treinamento (modalidade)