The DAMA Project - Disabled Advanced Medical Assistance.

The Convention on the Rights of Persons with Disabilities (CRPD) enshrines the right of persons with disabilities to enjoy the highest standard of health and access to health care without discrimination, but persons with disabilities have logistical and assistive support needs that must be known in order to build a health service offer that meets their needs and respects their rights in line with the CRPD. Examples of accessibility of medical care include the removal of an architectural barrier, the adaptation of a protocol, and ensuring information about care is delivered using easy to understand means of communications. An example of full inclusion and accessibility of the healthcare system for persons with intellectual disabilities is the DAMA (Disabled Advanced Medical Assistance), a project developed and tested at the Milan San Paolo Hospital. DAMA is an inclusive service provision methodology and offers a model that can follow, with a multidisciplinary approach, the person at every stage of the diagnostic and clinical pathway, and to support his or her family in dealing with the hospital. The diffusion of the DAMA model has demonstrated the flexibility of the model itself and its ability to adapt to hospitals with different characteristics and dimensions. The future is the institution of an organized network of all DAMA centres that share common clinical protocols and homogeneous archives. It will grant us the capability of collecting consistent epidemiological and clinical data, valuable for scientific researching and for training health personnel.

The Prognostic Importance of TAPSE in Early and in Stable Cardiovascular Diseases.

The identification of predictors of major cardiovascular events (MACES) represents a big challenge, especially in early and stable cardiovascular diseases. This prospective study comparatively evaluated the prognostic importance of left ventricular (LV) and right ventricular (RV) systolic and diastolic function, pulmonary artery pressure (PAP) and pulmonary vascular resistance (PVR) in a stable patient's cohort with cardiovascular risk factors. The LV ejection fraction, mitral annular plane systolic excursion (MAPSE), tricuspid annular plane systolic excursion (TAPSE), functional mitral regurgitation (FMR), doppler tissue imaging of mitral and tricuspid annulus with systolic and diastolic peaks estimation, tricuspid regurgitation velocity (TRV), pulmonary velocity outflow time integral (PVTI), mean pulmonary artery pressure (MPAP) and PVR were estimated at enrollment. During the follow-up, MACES and all-cause mortality were recorded. 369 subjects with or without previous MACES were enrolled. Bivariate analysis revealed LVEF, TAPSE, MPAP, TRV, PVR, LV diastolic function, and FMR were associated with the endpoints. When computing the influence of covariates to the primary endpoint (all-cause mortality and MACES) through Cox analysis, only LV diastolic function and TAPSE entered the final model; for the secondary endpoint (MACES) only TAPSE entered. TAPSE was able to predict MACES and all-cause mortality in early and stable cardiovascular diseases. The use of TAPSE should be implemented.

[Descending necrotising mediastinitis: report of two cases]. / Descrizione di due casi di mediastinite discendente.

Descending necrotising mediastinitis is a severe infection spreading from the cervical region to the mediastinal connective tissue. It represents a virulent form of mediastinal infection, requiring prompt diagnosis and treatment to reduce the high mortality associated. An optimal debridement and drainage through an open thoracotomy access are the keys for a successful outcome. Two patients, males, 70 and 75-years-old with descending necrotising mediastinitis were treated in our Institution in April '05. One had an odontogenic abscess and the other had a retropharyngeal abscess. Operative procedures included thoracotomy with radical surgical debridement of the mediastinum and excision of necrotic tissue associated with transcervical surgical debridement and drainage. Postoperatively mediastinum-pleural and cervical irrigation with iodopovidone 2 per thousand was performed until a culture of pleural effusion become negative. Postoperatively both patients suffered from severe complication including septic shock and acute respiratory distress syndrome. The 70-years-old patient had an acute renal failure too. Postoperatively the length of the intensive care unit stay was 40 and 42 days, respectively. The outcome was favorable in both patients. Early detection and immediate open surgical treatment could be the best way to reduce morbidity and mortality rate. Descending Necrotising Mediastinitis cannot be adequately treated without mediastinal and cervical excision of necrotic tissue and drainage including an open thoracic and cervical approach.

Violation of distribution symmetry in statistical evaluation of absolute enantioselective synthesis.

Enantiomeric excesses obtained in absolute enantioselective synthesis by chiral autocatalysis (Soai-reaction) were statistically analyzed. Two sets of parallel experiments, which were performed under chemically different conditions, are available. One group contains 37, while the other contains 84 preparative results. The former group shows some interesting tendencies but does not give conclusive statistical results. The sample of 84 parallel experiments, providing 39 R- and 45 S-excesses have shown that these data represent two distinct, non-symmetric sets with different non-Gaussian distributions. Clear S preference was found.

Limits of the Classical Concept of Concentration.

Solutions of very low concentrations cannot be treated by the usual concept of concentration. Stochastic calculations are performed for the analysis of such solutions containing one or a few molecule(s). It is concluded that these systems escape the usual concentration parameters. Two "case histories" are also shown for demonstration of the practical consequences of the theoretical analysis.

Stochastic and empirical models of the absolute asymmetric synthesis by the Soai-autocatalysis.

Absolute asymmetric synthesis (AAS) is the preparation of pure (or excess of one) enantiomer of a chiral compound from achiral precursor(s) by a chemical reaction, without enantiopure chiral additive and/or without applied asymmetric physical field. Only one well-characterized example of AAS is known today: the Soai-autocatalysis. In an attempt at clarification of the mechanism of this particular reaction we have undertaken empirical and stochastic analysis of several parallel AAS experiments. Our results show that the initial steps of the reaction might be controlled by simple normal distribution ("coin tossing") formalism. Advanced stages of the reaction, however, appear to be of a more complicated nature. Symmetric beta distribution formalism could not be brought into correspondence with the experimental observations. A bimodal beta distribution algorithm provided suitable agreement with the experimental data. The parameters of this bimodal beta function were determined by a Pólya-urn experiment (simulated by computer). Interestingly, parameters of the resulting bimodal beta function give a golden section ratio. These results show, that in this highly interesting autocatalysis two or even perhaps three catalytic cycles are cooperating. An attempt at constructing a "designed" Soai-type reaction system has also been made.