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.

Voice and Pilates: the influence of Pilates on the singing voice / Voz y pilates: la influencia de pilates en la voz del canto

Introduction: those who use voice for professional purposes know how crucial it is to regulate posture, breath and voice to get the best vocal performance. Pilates, a fitness system that focuses on breathing and postural control, should be beneficial in optimizing singers' voice. The present study aims to demonstrate that the practice of Pilates improves the quality of artistic vocal production. Materials and methods: we collected a sample of 15 singing students that underwent ENT examination and filled in a first questionnaire. After that we proceeded to voice recording and acoustic analysis through software Praat. Next, together with a fully qualified Pilates teacher, we identified a few exercises acting on the respiratory muscles, that were explained and practiced during a Pilates lesson. These exercises were performed by each subject on his/her own at least three times a week for two months and together during other two Pilates group lessons. Finally, a second voice recording was performed, using the Praat software and under the very same condition of the first recording and a second self-assessment questionnaire was filled in. Results: the Kolmogorov-Smirnov test revealed that the Fo and Jitter parameters were not normally distributed, while the Shimmer and HNR resulted to be normally distributed. The averages of Shimmer and HNR parameters were thus analyzed through the T Test, while the F0 and Jitter parameters were analyzed through the Wilcoxon test. The analysis revealed that all the four parameters underwent statistically significant changes after the Pilates practice. Questionnaire results revealed that Pilates had a positive effect on voice production (15/15), especially on postural alignment (15/15) and respiratory capacity (13/15). Discussion: in our study the F0 increased after Pilates practice. This finding should be due to changes in the vocal folds length and tension, probably related to the postural exercises that had been performed, which conferred greater elasticity to the muscles. Contrariwise the Jitter parameter after exercising had decreased allowing us to conclude that Pilates helps to reduce vibratory perturbations of the vocal cords during vocal emission. This should have been obtained through a greater control of the respiratory dynamics provided by the exercises. The Shimmer parameter had also diminished, allowing us to hypothesize that the Pilates exercises, acting on the respiratory mechanisms, minimize intensity variations. On the contrary, HNR had increased suggesting that the amount of periodic signal in the voice after Pilates practice is greater than before. Since voices with a higher average HNR tend to be judged as more attractive, our results point to the fact that Pilates practice improves voice quality, as subjectively reported by the participants themselves. Conclusion: our study has highlighted the positive role of Pilates on vocal production in singing students: in a relatively short time, simple exercises - performed regularly - have shown a significant impact on vocal quality. It is likely that the very same positive effects could also be obtained by other occupational voice users

Introducción: los que usan la voz con fines profesionales saben lo importante que es regular postura, respiración y voz para obtener la mejor interpretación vocal. Pilates, un sistema de fitness que se enfoca en el control de la respiración y de la postura, puede ser beneficioso para optimizar la voz de los cantantes. El presente estudio tiene como objetivo demostrar que la práctica de pilates mejora la calidad de producción vocal artística. Materiales y métodos: recolectamos 15 estudiantes de canto que se sometieron a un examen otorrinolaringológico y rellenado en un primer cuestionario. Después de eso procedimos a la grabación de voz y análisis acústico a través del software Praat. A continuación, junto con un profesor de Pilates completamente calificado, se identificaron algunos ejercicios que actúan sobre los músculos respiratorios, que fueron explicados y practicados durante una lección de pilates. Estos ejercicios fueron realizados por cada sujeto por su cuenta en por lo menos tres veces por semana durante dos meses y juntos durante otras dos clases grupales de pilates. Finalmente, se realizó una segunda grabación de voz, utilizando el software Praat y bajo el mismo se completó la misma condición de la primera grabación y un segundo cuestionario de autoevaluación. Resultados: la prueba de Kolmogorov-Smirnov reveló que los parámetros de Fo y Jitter no fueron normalmente distribuidos, mientras que Shimmer y HNR resultaron ser distribuidos normalmente. Los promedios de los parámetros Shimmer y HNR se analizaron por medio de la prueba T, mientras que los parámetros F0 y Jitter fueron analizados a través de la prueba de Wilcoxon. El análisis reveló que todos los cuatro parámetros sufrieron cambios estadísticamente significativos después de la práctica de pilates. Los resultados del cuestionario revelaron que Pilates tuvo un efecto positivo en la producción de voz (15/15), especialmente en alineación postural (15/15) y capacidad respiratoria (13/15). Discusión: en nuestro estudio, el F0 aumentó después de la práctica de pilates. Este hallazgo se debe a cambios en la longitud y tensión de los pliegues vocales, probablemente relacionados con los ejercicios posturales que se han realizado, que confieren mayor elasticidad a los músculos. En cambio, el parámetro Jitter después del ejercicio había disminuido, lo que nos permite concluir que el pilates ayuda a reducir las perturbaciones vibratorias de las cuerdas vocales durante la emisión vocal. Esto debería haberse obtenido con mayor control de la dinámica respiratoria proporcionada por los ejercicios. El parámetro Shimmer también había disminuido, permitiéndonos hipotetizar que los ejercicios de pilates, actuando sobre los mecanismos respiratorios, reducen las variaciones de intensidad. En cambio, HNR había aumentado, lo que sugiere que la cantidad de señal periódica en la voz después de la práctica de pilates es mayor que antes. Dado que las voces con un HNR medio más alto tienden a ser consideradas más atractivas, nuestros resultados apuntan al hecho de que la práctica del pilates mejora la calidad de la voz, según lo informado subjetivamente por los propios participantes. Conclusión: nuestro estudio ha destacado el papel positivo del pilates en la producción vocal en estudiantes de canto: en un tiempo relativamente corto, ejercicios simples, realizados regularmente, han demostrado un impacto considerable en la calidad vocal. Es probable que los mismos efectos positivos también puedan ser obtenidos por otros usuarios de voz profesional

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.