866 results on '"Merlino, A."'
Search Results
2. The Role of Chocolate Web-Based Communication in a Regional Context: Its Implication for Open Innovation
- Author
-
Simone Blanc, Valentina Maria Merlino, Alice Versino, Giulia Mastromonaco, Antonina Sparacino, Stefano Massaglia, and Danielle Borra
- Subjects
chocolate ,web-based communication ,claims ,AGIL scheme ,open innovation ,Management. Industrial management ,HD28-70 ,Business ,HF5001-6182 - Abstract
ABSTRACT: Background: This research investigates the web-based communication and promotion strategies applied by a sample of selected chocolatiers in Piedmont, a region in the northwest of Italy known for its ancient chocolate-making tradition. Methods: the AGIL scheme was used (A-adaptation, which evaluates the persuasive approach; G-goal achievement, which evaluates the informative approach; I-integration, which evaluates the communicative approach; and L-latent model, which evaluates the identity approach). Each A-G-I-L category, subdivided into subcategories containing variables, was specifically evaluated during the analysis of the companies’ websites carried out by a group of experts. The five experts assigned a score for each variable and subcategory to each site. The average subcategory and category scores for each website were analyzed using principal component analysis, which allowed three communicative orientations to be defined: classic, consumer-centered, international-oriented. Results: In general, the results show a strong link between the tradition of artisan chocolate producers and the desire to create a relationship of trust in the brand on the part of consumers. Conclusions: This research is the first to contribute to the field of chocolate web-communication and provides a picture of a local production reality; it is interesting in terms of chocolate promotion styles based on the combination of tradition and innovation.
- Published
- 2022
- Full Text
- View/download PDF
3. A Resilient Fire Protection System for Software-Defined Factories
- Author
-
Carlo Scaffidi, Giovanni Merlino, Antonio Puliafito, Salvatore Distefano, Francesco Longo, and Giuseppe Tricomi
- Subjects
Exploit ,Computer Networks and Communications ,Event (computing) ,Computer science ,business.industry ,Control reconfiguration ,Cloud computing ,Computer security ,computer.software_genre ,Computer Science Applications ,Adaptive management ,Hardware and Architecture ,Signal Processing ,Fire protection ,Business logic ,Factory (object-oriented programming) ,business ,computer ,Information Systems - Abstract
A Smart Factory exploits information and communication technologies (ICT) to improve the production process and the working environment, usually addressing safety concerns. To this concern, factory-grade fire protection systems are governed by several procedures and standards whose application often becomes definitely challenging when the factory premises are dispersed across multiple administrative domains. In such contexts, the Smart Factory approach can prove very effective in the management and coordination of the factory-level fire protection system. However, a catastrophic event may compromise the ICT infrastructure, affecting communication among factory domains and therefore its smart services. A strategy to cope with the latter may be the introduction of mechanisms to handle data analysis on-site for a prompt response while enabling seamless data distribution and processing among neighbouring (federated) ICT infrastructures and emergency operators. In this work, a novel software-defined approach for the adaptive management of a Smart Factory infrastructure is proposed, centered around business logic rewiring and reconfiguration at run-time across different factory domains. Thereby, even in the case of catastrophic (e.g., potentially disruptive) events, working devices of the emergency system can go on with their operations, including transferring data to rescuers and others emergency control systems. To demonstrate the effectiveness of the proposed Software Defined Factory approach, a Federated Fire Protection System operating in an industrial setting is implemented as a case study, able to promptly react and adapt to infrastructure-critical fires and their consequences by leveraging all information and computing facilities pooled over Cloud/Fog/Edge devices spanning the premises.
- Published
- 2023
- Full Text
- View/download PDF
4. A Cloud-Based and Dynamic DNS Approach to Enable the Web of Things
- Author
-
Antonio Puliafito, Giovanni Merlino, Francesco Longo, and Zakaria Benomar
- Subjects
Computer Networks and Communications ,Computer science ,Internet of Things ,Interoperability ,Cloud computing ,Domain (software engineering) ,Cyber Physical Systems ,Web of Things ,Resource (project management) ,Peer-to-peer computing ,Web services ,business.industry ,REST ,Domain Name System ,XML ,Computer Science Applications ,OpenStack ,Control and Systems Engineering ,Network address ,Protocols ,Web servers ,The Internet ,business ,Computer network - Abstract
With the significant impact of Internet services and the evolution in the hardware and software fields, the Internet size and usage scope are continuously covering smaller and resource-constrained devices. Such devices, commonly called IoT devices, with sensing/actuation capabilities, are now capable of managing the complexity of communications over the Internet. However, considering the current IoT ecosystem, this field is still fragmented with respect to the communication technologies, protocols, and data formats used by the different providers. This heterogeneity makes IoT devices/systems unable to communicate seamlessly, leading to limited cooperation and tightly coupled deployments. To overwhelm the interoperability barriers in IoT, we propose, in this paper, a Cloud-based approach with a Dynamic Domain Name System (DDNS) mechanism enabling the IoT devices to communicate using the REST model. An approach that follows the Web of things (WoT) paradigm. In particular, the system enables the IoT devices' hosted resources (e.g., sensors and actuators) to be steered using globally resolvable (over the Internet) Uniform Resource Locators (URLs) even when deployed behind Network Address Translators (i.e., NATs). Besides, the solution considers security aspects related to data transmission by leveraging the use of HTTPS with a Dynamic machnism managing Domain Validation (DV) certificates.
- Published
- 2022
- Full Text
- View/download PDF
5. MW Polyomavirus in diarrheal Italian infants
- Author
-
Ilaria Galliano, Valentina Daprà, Chiara Merlino, Pier-Angelo Tovo, Massimiliano Bergallo, Marco Rassu, and Paola Montanari
- Subjects
business.industry ,MW polyomavirus ,Stool specimen ,medicine.disease_cause ,Virology ,Virus ,Diarrhea ,Real-time polymerase chain reaction ,Pediatrics, Perinatology and Child Health ,TaqMan ,medicine ,medicine.symptom ,business ,Feces - Abstract
BACKGROUND MXPyV, like MWPyV, was identified in stool samples from children suffering diarrhea in Mexico. In this study, we used a home-made real time PCR to investigate the presence of this novel viruses in stool specimen collected from under-Five- Year-Old Children with gastroenteritis. METHODS A total of 192 fecal specimens previously screened for RV, ADV, NoV, HPeV and SaV, were tested for MWPyV with Taqman real time PCR. RESULTS The most commonly detected virus was NoV GII (33.8%), followed by RV (21.3%), SaV (10.9%), HPeV(8%), NoV GI (6.7%) and AdV (1%). Real time PCR detected MWPyV in 1/192 (0.5%) patients. CONCLUSIONS We detected MWPyV in 0.5% of fecal specimens collected from pediatric patients suffering gastroenteritis which is smaller than the previously reported in literature (4.4% in Australia and 12% Mexico).
- Published
- 2023
- Full Text
- View/download PDF
6. Universal newborn hearing screening in the Italian Region of Sicily in 2018
- Author
-
Luciano Bubbico, Marina Maltese, Francesco Galletti, Alessandro Gulino, Francesco Martines, Carmen Azieli, Salvatore Coco, Antonino Maniaci, Ignazio La Mantia, Salvatore Ferlito, Graziella Poli, Margherita Ragliani, Federico Merlino, Luigi Maiolino, Paola Di Mauro, Salvatore Cocuzza, Michele Russo, Ferlito S., Maniaci A., Cocuzza S., La Mantia I., Di Mauro P., Poli G., Maiolino L., Coco S., Merlino F., Maltese M., Ragliani M., Russo M., Gulino A., Azieli C., Martines F., Galletti F., and Bubbico L.
- Subjects
Scarce data ,Pediatrics ,medicine.medical_specialty ,Hearing loss ,Otoacoustic Emissions, Spontaneous ,Hearing screening ,congenital deafness ,screening universale uditivo neonatale ,Neonatal Screening ,Congenital deafness, Neonatal hearing loss, Universal newborn hearing screening, Child, Evoked Potentials, Auditory, Brain Stem, Hearing Tests, Humans, Infant, Newborn, Otoacoustic Emissions, Spontaneous, Sicily, Hearing Loss, Neonatal Screening ,Epidemiology ,Evoked Potentials, Auditory, Brain Stem ,medicine ,Humans ,neonatal hearing loss ,Congenital deafness ,Neonatal hearing loss ,Universal newborn hearing screening ,Child ,Hearing Tests ,Infant ,Infant, Newborn ,Sicily ,Hearing Loss ,Evoked Potentials ,Auditory ,business.industry ,Spontaneous ,Bilateral hearing loss ,Audiology ,Newborn ,universal newborn hearing screening ,sordità congenita ,Patient management ,General Energy ,Auditory brainstem response ,ipoacusia neonatale ,Otorhinolaryngology ,medicine.symptom ,business ,Otoacoustic Emissions ,Brain Stem - Abstract
We have clarified the role of Universal Neonatal Hearing Screening (UNHS) for both early diagnosis and rapid treatment in order to improve the prognosis of the deaf child and reduce patient management costs. Although in Sicily UNHS has been progressively implemented, there is scarce data in the literature on this matter. Therefore, the main objective was to collect in the year 2018 the following data: number of newborns screened for hearing loss, number of infants "referred" to transiently evoked otoacoustic emissions (TEOAE), number of infants with pathologic auditory brainstem response (ABR) and number of infants affected by permanent hearing loss.UNHS monitoring was conducted through the collection of data through a questionnaire, which was analysed evaluating the effectiveness and adherence to the screening program prepared by the Department for Health Activities and the Epidemiological Observatory (DASOE).In 2018, there were 40,243 newborns in Sicily. A total of 37,562 newborns were screened (93.3%). There were 1,328 "referred" infants with TEOAE (3.5%). On the 2The monitoring of the UNHS in Sicily has allowed obtaining the data of individual centres, absent in the literature to date, to verify the effectiveness of the screening, according to JCIH criteria, to highlight some criticalities and, finally, to propose possible solutions.Screening uditivo neonatale universale nella regione Sicilia nel 2018.Abbiamo chiarito il ruolo dello screening uditivo neonatale universale (UNHS) sia come diagnosi precoce che come trattamento rapido al fine di migliorare la prognosi del bambino sordo e ridurre i costi di gestione del paziente. Anche se in Sicilia l’UNHS è stato progressivamente attuato, vi sono scarsi dati nella letteratura in materia. Pertanto, l’obiettivo principale è stato quello di raccogliere nell’anno 2018 i seguenti dati: numero di neonati sottoposti a screening per la perdita dell’udito, numero di neonati risultati “refer” alle TEOAE, numero di lattanti con ABR patologico e numero di lattanti affetti da perdita permanente dell’udito.Il monitoraggio del UNHS è stato condotto attraverso la raccolta dei dati forniti dal questionario, che valuta l’efficacia dello screening e l’aderenza alle fasi successive.Nel 2018, i nati in Sicilia sono stati 40.243. Sono stati sottoposti a screening 37.562 neonati, pari al 93,3%. Sono risultati “refer” con le TEOAE 1.328 neonati (pari al 3,5%). Al 2° livello, i neonati “refer” esaminati sono stati 1.080 su 1.328 attesi (dispersi 248 neonati refer, pari al 18,6%). I neonati “refer” confermati con le TEOAE sono stati 113 su 1.080, mentre i neonati “refer” confermati con ABR sono stati 71. Al 3° livello, i bambini esaminati sono stati 67 su 71 previsti: ventotto bambini soffrivano di perdita monolaterale dell’udito (13 lieve, 13 moderata, 1 grave e 1 profonda) e trentanove soffrivano di perdita bilaterale dell’udito (1 lieve, 19 moderata, 13 grave e 7 profonda). Escludendo 7 bambini provenienti dalla NICU, i bambini con perdita dell’udito sono stati 60 su 37.562 (pari all’1,5‰).Il monitoraggio dell’UNHS in Sicilia ha permesso di ottenere i dati dei singoli centri, dati assenti nella letteratura, di verificare l’efficacia dello screening, secondo criteri JCIH, di evidenziare alcune criticità e, infine, di proporre possibili soluzioni.
- Published
- 2021
- Full Text
- View/download PDF
7. The CRACK programme: a scientific alliance for bridging healthcare research and public health policies in Italy
- Author
-
Luca Merlino, Ovidio Brignoli, Alessandro Filippi, Giuseppe Mancia, Carlo Zocchetti, Luigi Cantarutti, Giovanni Corrao, Giorgio Vittadini, Carlo La Vecchia, Giancarlo Cesana, Flavia Carle, Alberico L. Catapano, Corrao, G, Cesana, G, La Vecchia, C, Vittadini, G, Catapano, A, Mancia, G, Brignoli, O, Filippi, A, Cantarutti, L, Merlino, L, Zocchetti, C, and Carle, F
- Subjects
Healthcare utilization database ,medicine.medical_specialty ,lcsh:R5-920 ,Comparative Effectiveness Research ,Healthcare Utilization Database ,Medical records ,Evidence-based public health ,business.industry ,Public health ,media_common.quotation_subject ,Medical record ,lcsh:Public aspects of medicine ,Comparative effectiveness research ,Psychological intervention ,Secondary data ,lcsh:RA1-1270 ,Public relations ,Nursing ,Health care ,Medicine ,Electronic data ,Quality (business) ,business ,lcsh:Medicine (General) ,Health policy ,media_common - Abstract
Healthcare utilisation databases, and other secondary data sources, have been used with growing frequency to assess health outcomes and healthcare interventions worldwide. Their increased popularity as a research tool is due to their timely availability, the large patient populations covered, low cost, and applicability for studying real-world clinical practice. Despite the need to measure Italian National Health Service performance both at regional and national levels, the wealth of good quality electronic data and the high standards of scientific research in this field, healthcare research and public health policies seem to progress along orthogonal dimensions in Italy. The main barriers to the development of evidence-based public health include the lack of understanding of evidence-based methodologies by policy makers, and of involvement of researchers in the policy process. The CRACK programme was launched by some academics from the Lombardy Region. By extensively using electronically stored data, epidemiologists, biostatisticians, pharmacologists and clinicians applied methods and evidence to several issues of healthcare research. The CRACK programme was based on their intention to remove barriers that thwart the process of bridging methods and findings from scientific journals to public health practice. This paper briefly describes aim, articulation and management of the CRACK programme, and discusses why it might find articulated application in Italy.
- Published
- 2022
8. Debunking Rumors in Networks
- Author
-
Luca Paolo Merlino and Nicole Tabasso
- Subjects
Physics - Physics and Society ,Steady state (electronics) ,Economics ,FOS: Physical sciences ,Physics and Society (physics.soc-ph) ,Homophily ,FOS: Economics and business ,Microeconomics ,TheoryofComputation_ANALYSISOFALGORITHMSANDPROBLEMCOMPLEXITY ,0502 economics and business ,Economics - Theoretical Economics ,050207 economics ,Settore SECS-P/01 - Economia Politica ,050208 finance ,Social communication ,Social network ,business.industry ,05 social sciences ,Rumors ,Verification ,Rumor ,Social Networks, Rumors, Verification ,Incentive ,Social Networks ,Theoretical Economics (econ.TH) ,business ,General Economics, Econometrics and Finance - Abstract
We study the diffusion of a true and a false message (the rumor) in a social network. Upon hearing a message, individuals may believe it, disbelieve it, or debunk it through costly verification. Whenever the truth survives in steady state, so does the rumor. Communication intensity in itself is irrelevant for relative rumor prevalence, and the effect of homophily depends on the exact verification process and equilibrium verification rates. Our model highlights that successful policies in the fight against rumors increase individuals’ incentives to verify. (JEL D83, D85, L82, Z13)
- Published
- 2023
9. Reimbursement Approaches for Radiopharmaceutical Dosimetry: Current Status and Future Opportunities
- Author
-
Alexandru Bageac, James R. Crowley, Stephen A. Graves, and Denise A.M. Merlino
- Subjects
medicine.medical_specialty ,business.industry ,Task force ,Radiotherapy Planning, Computer-Assisted ,Humans ,Medicine ,Dosimetry ,Radiology, Nuclear Medicine and imaging ,Medical physics ,Nuclear Medicine ,Radiometry ,business ,Reimbursement - Abstract
Interest in performing dosimetry for clinical radiopharmaceutical therapy procedures has grown in recent years. Several approved therapies include dosimetry in the Food and Drug Administration-approved label instructions, and other therapies are best used under a patient-tailored paradigm. This paper, which is a product of the Society of Nuclear Medicine and Molecular Imaging Dosimetry Task Force, presents motivations and general workflows for radiopharmaceutical therapy dosimetry, as well as existing strategies for obtaining reimbursement for clinical activities related to dosimetry. Several specific patient examples are provided, including suggested codes for reimbursement. In addition to current reimbursement approaches, key dosimetry services that are not supported under the current coding structure are presented and suggested as areas of focus in the coming years.
- Published
- 2021
- Full Text
- View/download PDF
10. Effect of parenteral nutrition duration on patterns of growth and body composition in very low‐birth‐weight premature infants
- Author
-
Sreekanth Viswanathan, Stephanie Merlino-Barr, Kera McNelis, Marc Collin, Alexa Brumfiel, Zaineh Alja'nini, and Sharon Groh-Wargo
- Subjects
Parenteral Nutrition ,Pediatrics ,medicine.medical_specialty ,Nutrition and Dietetics ,Vlbw infants ,business.industry ,Birth weight ,Infant, Newborn ,Infant ,Medicine (miscellaneous) ,Gestational age ,Fat mass ,Low birth weight ,Parenteral nutrition ,Negatively associated ,Case-Control Studies ,Body Composition ,medicine ,Humans ,Infant, Very Low Birth Weight ,Gestation ,medicine.symptom ,business ,Infant, Premature - Abstract
Parenteral nutrition (PN) is essential to support premature infants' growth and varies with enteral nutrition (EN) advancement rates. Data on PN duration's impact on premature infants' growth are limited. The aim of this multicenter observational study was to determine the effect of early PN duration on body composition at term corrected gestational age (CGA) in very low-birth-weight (VLBW) premature infants.VLBW infants exposed to PN in the first week of life and exposed to significantly different EN regimens were divided into two groups on the basis of early PN duration. Infants with a birth weight (BW)1000 g and PN duration28 days and infants with a BW 1000-1500 g and PN duration14 days were assigned to the "short-PN" group. Infants receiving PN for longer durations were assigned to the "long-PN" group. Body composition was assessed via air displacement plethysmography at term CGA or before discharge.Sixty-two and 53 infants were assigned to the short-PN and long-PN groups, respectively. The two groups were significantly different in BW and GA, so a nested case-control study was conducted after matching 36 infant pairs. Infants in the long-PN group had significantly lower fat-free mass (FFM) z-scores, but both groups had comparable fat mass (FM) z-scores. Long PN was a significant negative predictor of FFM z-score in the multivariate regression analysis.In VLBW premature infants, PN duration is negatively associated with FFM z-scores at term CGA without affecting FM z-scores.
- Published
- 2021
- Full Text
- View/download PDF
11. Is Switching from Oral Antidiabetic Therapy to Insulin Associated with an Increased Fracture Risk?
- Author
-
Stefano Ciardullo, Giuseppe Banfi, Luca Merlino, Matteo Monzio Compagnoni, Gianluca Perseghin, Raffaella Ronco, Giovanni Corrao, Corrao, G., Monzio Compagnoni, M., Ronco, R., Merlino, L., Ciardullo, S., Perseghin, G., Banfi, G., Corrao, G, Monzio Compagnoni, M, Ronco, R, Merlino, L, Ciardullo, S, Perseghin, G, and Banfi, G
- Subjects
Male ,Risk ,medicine.medical_specialty ,Databases, Factual ,Epidemiology ,medicine.medical_treatment ,Administration, Oral ,Hip fracture ,Fractures, Bone ,03 medical and health sciences ,0302 clinical medicine ,Bone Density ,Clinical Research ,Internal medicine ,Diabetes mellitus ,Humans ,Hypoglycemic Agents ,Insulin ,Medicine ,Orthopedics and Sports Medicine ,030212 general & internal medicine ,Aged ,Retrospective Studies ,Aged, 80 and over ,Public health ,030222 orthopedics ,business.industry ,Proportional hazards model ,Pharmacoepidemiology ,Incidence ,Diabetes ,Statistics ,Hazard ratio ,General Medicine ,Middle Aged ,medicine.disease ,Fracture ,Diabetes Mellitus, Type 2 ,Cohort ,Propensity score matching ,Female ,Surgery ,Cohort study ,business ,Healthcare Utilization databases - Abstract
BACKGROUND Observational studies showed that exposure to exogenous insulin increases fracture risk. However, it remains unclear whether the observed association is a function of the severity of underlying type 2 diabetes mellitus, complications, therapies, comorbidities, or all these factors combined. That being so, and because of the relative infrequency of these events, it is important to study this further in a large-database setting. QUESTION/PURPOSES: (1) Is switching from oral antidiabetic agents to insulin associated with an increased fracture risk? (2) How soon after switching does the increased risk appear, and for how long does this increased risk persist? METHODS Data from healthcare utilization databases of the Italian region of Lombardy were used. These healthcare utilization databases report accurate, complete, and interconnectable information of inpatient and outpatient diagnoses, therapies, and services provided to the almost 10 million residents in the region. The 216,624 patients on treatment with oral antidiabetic therapy from 2005 to 2009 were followed until 2010 to identify those who modified their antidiabetic therapy (step 1 cohort). Among the 63% (136,307 patients) who experienced a therapy modification, 21% (28,420 patients) switched to insulin (active exposure), and the remaining 79% (107,887 patients) changed to another oral medication (referent exposure). A 1:1 high-dimension propensity score matching design was adopted for balancing patients on active and referent exposure. Matching failed for 3% of patients (926 patients), so the cohort of interest was formed by 27,494 insulin-referent couples. The latter were followed until 2012 to identify those who experienced hospital admission for fracture (outcome). A Cox proportional hazard model was fitted to estimate the hazard ratio (HR) for the outcome risk associated with active-exposure (first research question). Between-exposure comparison of daily fracture hazard rates from switching until the 24 successive months was explored through the Kernel-smoothed estimator (second research question). RESULTS Compared with patients on referent exposure, those who switched to insulin had an increased risk of experiencing any fracture (HR = 1.5 [95% CI 1.3 to 1.6]; p < 0.001). The same risk was observed for hip and vertebral fractures, with HRs of 1.6 (95% CI 1.4 to 1.8; p < 0.001) and 1.8 (95% 1.5 to 2.3; p < 0.001), respectively. Differences in the daily pattern of outcome rates mainly appeared the first 2 months after switching, when the hazard rate of patients on active exposure (9 cases for every 100,000 person-days) was higher than that of patients on referent exposure (4 cases for every 100,000 person-days). These differences persisted during the remaining follow-up, though with reduced intensity. CONCLUSIONS We found quantitative evidence that switching from oral antidiabetic therapy to insulin is associated with an increased fracture risk, mainly in the period immediately after the start of insulin therapy. The observed association may result from higher hypoglycemia risk among patients on insulin, which leads to a greater number of falls and resulting fractures. However, although our study was based on a large sample size and highly accurate data, its observational design and the lack of clinical data suggest that future research will need to replicate or refute our findings and address the issue of causality, if any. Until then, though, prescribers and patients should be aware of this risk. Careful control of insulin dosage should be maintained and measures taken to reduce fall risk in these patients. LEVEL OF EVIDENCE Level III, therapeutic study.
- Published
- 2019
- Full Text
- View/download PDF
12. Number of lung resections performed and long-term mortality rates of patients after lung cancer surgery: evidence from an Italian investigation
- Author
-
Ugo Pastorino, Sandro Barni, Giovanni Corrao, Giovanni Apolone, Matteo Franchi, Federico Rea, Francesca Ieva, Luca Merlino, Rea, F, Ieva, F, Pastorino, U, Apolone, G, Barni, S, Merlino, L, Franchi, M, and Corrao, G
- Subjects
Male ,Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Lung Neoplasms ,Survival ,Lung resections ,Population ,030204 cardiovascular system & hematology ,Lung resection ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,medicine ,Humans ,Lung cancer, Lung resection, Survival, Hospital volume, Health care utilization database, Multilevel modelling ,Health care utilization database ,education ,Lung cancer ,Lung ,Lung cancer surgery ,education.field_of_study ,business.industry ,Mortality rate ,General Medicine ,medicine.disease ,Confidence interval ,Hospital volume ,Survival Rate ,Italy ,030220 oncology & carcinogenesis ,Cohort ,Female ,Surgery ,Observational study ,Multilevel modelling ,Cardiology and Cardiovascular Medicine ,business ,Hospitals, High-Volume - Abstract
OBJECTIVES Although it has been postulated that patients might benefit from the centralization of high-volume specialized centres, conflicting results have been reported on the relationship between the number of lung resections performed and the long-term, all-cause mortality rates among patients who underwent surgery for lung cancer. A population-based observational study was performed to contribute to the ongoing debate. METHODS The 2613 patients, all residents of the Lombardy region (Italy), who underwent lung resection for lung cancer from 2012 to 2014 were entered into the cohort and were followed until 2018. The hospitals were classified according to the annual number of pulmonary resections performed. Three categories of lung resection cases were identified: low (≤30), intermediate (31–95) and high (>95). The outcome of interest was all-cause death. A frailty model was used to estimate the death risk associated with the categories of numbers of lung resections performed, taking into account the multilevel structure of the data. A set of sensitivity analyses was performed to account for sources of systematic uncertainty. RESULTS The 1-year and 5-year survival rates of cohort members were 90% and 63%. Patients operated on in high-volume centres were on average younger and more often women. Compared to patients operated on in a low-volume centre, the mortality risk exhibited a significant, progressive reduction as the numbers of lung resections performed increased to intermediate (−13%; 95% confidence interval +10% to −31%) and high (−26%; 0% to −45%). Sensitivity analyses revealed that the association was consistent. CONCLUSIONS Further evidence that the volume of lung resection cases performed strongly affects the long-term survival of lung cancer patients has been supplied.
- Published
- 2020
- Full Text
- View/download PDF
13. Women discontinue antihypertensive drug therapy more than men. Evidence from an Italian population-based study
- Author
-
Marta Mella, Federico Rea, Giuseppe Mancia, Luca Merlino, Matteo Monzio Compagnoni, Anna Cantarutti, Giovanni Corrao, Rea, F, Mella, M, Monzio Compagnoni, M, Cantarutti, A, Merlino, L, Mancia, G, and Corrao, G
- Subjects
Adult ,Male ,medicine.medical_specialty ,Physiology ,medicine.drug_class ,Population ,Comorbidity ,030204 cardiovascular system & hematology ,Lower risk ,compliance ,antihypertensive treatment ,Medication Adherence ,03 medical and health sciences ,Sex Factors ,0302 clinical medicine ,Internal medicine ,Internal Medicine ,medicine ,sex ,Humans ,adherence ,030212 general & internal medicine ,Medical prescription ,Antihypertensive drug ,education ,Antihypertensive Agents ,education.field_of_study ,business.industry ,persistence ,Middle Aged ,population-based cohort studie ,medicine.disease ,Confidence interval ,Discontinuation ,Relative risk ,Hypertension ,Female ,Cardiology and Cardiovascular Medicine ,business ,healthcare utilization database - Abstract
Objective Several factors affect adherence to antihypertensive drug treatment, but whether these factors include a sex difference is unclear. Aim of the study was to compare persistence with antihypertensive drug therapy between men and women in a large cohort of patients. Methods The 60 526 residents of the Italian Lombardy Region aged 40-80 years newly treated with antihypertensive drugs during 2010 were identified and followed for 1 year after the first prescription. Discontinuation of treatment was defined as lack of prescription renewal for at least 90 days. Log-binomial regression models were fitted to estimate the risk ratio of treatment discontinuation in relation to sex. Other than for the whole population, analyses were stratified according to age, comorbidity status and the initial antihypertensive treatment strategy. Results Thirty-seven percent of the patients discontinued the drug treatment during follow-up. Compared with women, men had a 10% lower risk of discontinuation of drug treatment (95% confidence interval: 8-12). Persistence on antihypertensive treatment was better in men than in women, this being the case in both younger (40-64 years) and older patients (65-80 years), in patients starting treatment with any major antihypertensive drug and in patients who had a low comorbidity status. There was no evidence that men and women had a different risk of treatment discontinuation when their comorbidity status was worse, or initial antihypertensive treatment was based on drug combinations. Conclusion Our data show that in a real-life setting, men are more persistent to antihypertensive drug therapy than women.
- Published
- 2020
- Full Text
- View/download PDF
14. Seizures after Ischemic Stroke: A Matched Multicenter Study
- Author
-
Marian Galovic, Stefan Evers, Philip Siebel, Juliane Schweizer, Giulio Bicciato, Tim J. von Oertzen, Judith Wagner, Francesco Brigo, Michael Winklehner, Barbara Tettenborn, Julian Conrad, Nico Döhler, Estevo Santamarina, Matthias J. Koepp, Carolina Ferreira-Atuesta, Lukas L. Imbach, Mariarosaria Valente, Barbara Erdélyi-Canavese, Mira Katan, Giorgia Gregoraci, Laura Abraira, Frauke Roell, Natalie Scherrer, Ana Rita Peralta, Carla Bentes, Giovanni Merlino, Josemir W. Sander, Francesco Janes, Ansgar Felbecker, Gian Luigi Gigli, Piergiorgio Lochner, John S. Duncan, Teresa Pinho e Melo, Lucia Sinka, Mark R. Keezer, José Alvarez-Sabín, Anna Serafini, Institut Català de la Salut, [Ferreira-Atuesta C] Department of Clinical & Experimental Epilepsy, UCL Queen Square Institute of Neurology, Queen Square, London, United Kingdom. Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, United States. [Döhler N] Department of Neurology, Kantonsspital St. Gallen, St. Gallen, Switzerland. Specialist Clinic for Neurorehabilitation, Kliniken Beelitz, Beelitz-Heilstätten, Germany. [Erdélyi-Canavese B, Felbecker A, Siebel P] Department of Neurology, Kantonsspital St. Gallen, St. Gallen, Switzerland. [Scherrer N] Department of Neurology, Clinical Neuroscience Center, University Hospital and University of Zurich, Zurich, Switzerland. [Abraira L, Santamarina E, Álvarez-Sabín J] Unitat d’Epilèpsia, Servei de Neurologia, Vall d’Hebron Hospital Universitari, Barcelona, Spain. Universitat Autònoma de Barcelona, Bellaterra, Spain, and Vall d'Hebron Barcelona Hospital Campus
- Subjects
Adult ,Male ,medicine.medical_specialty ,Convulsions - Diagnòstic ,medicine.medical_treatment ,Epilèpsia - Diagnòstic ,Posterior cerebral artery ,Nervous System Diseases::Central Nervous System Diseases::Brain Diseases::Epilepsy [DISEASES] ,enfermedades del sistema nervioso::enfermedades del sistema nervioso central::enfermedades cerebrales::trastornos cerebrovasculares::isquemia cerebral [ENFERMEDADES] ,Brain Ischemia ,Otros calificadores::Otros calificadores::/complicaciones [Otros calificadores] ,Epilepsy ,Nervous System Diseases::Neurologic Manifestations::Seizures [DISEASES] ,Risk Factors ,Seizures ,medicine.artery ,Internal medicine ,medicine ,Humans ,cardiovascular diseases ,Aged ,business.industry ,Proportional hazards model ,enfermedades del sistema nervioso::manifestaciones neurológicas::convulsiones [ENFERMEDADES] ,Symptomatic seizures ,Thrombolysis ,Nervous System Diseases::Central Nervous System Diseases::Brain Diseases::Cerebrovascular Disorders::Brain Ischemia [DISEASES] ,Middle Aged ,medicine.disease ,Malalties cerebrovasculars - Complicacions ,Stroke ,Treatment Outcome ,Neurology ,Propensity score matching ,Cohort ,Cardiology ,Etiology ,enfermedades del sistema nervioso::enfermedades del sistema nervioso central::enfermedades cerebrales::epilepsia [ENFERMEDADES] ,Female ,Neurology (clinical) ,business ,Other subheadings::Other subheadings::/complications [Other subheadings] - Abstract
Accidente cerebrovascular isquémico; Tratamiento de reperfusión; Factores de riesgo Ischemic Stroke; Reperfusion treatment; Risk factors Accident cerebrovascular isquèmic; Tractament de reperfusió; Factor de risc Objective The purpose of this study was to identify risk factors for acute symptomatic seizures and post-stroke epilepsy after acute ischemic stroke and evaluate the effects of reperfusion treatment. Methods We assessed the risk factors for post-stroke seizures using logistic or Cox regression in a multicenter study, including adults from 8 European referral centers with neuroimaging-confirmed ischemic stroke. We compared the risk of post-stroke seizures between participants with or without reperfusion treatment following propensity score matching to reduce confounding due to treatment selection. Results In the overall cohort of 4,229 participants (mean age 71 years, 57% men), a higher risk of acute symptomatic seizures was observed in those with more severe strokes, infarcts located in the posterior cerebral artery territory, and strokes caused by large-artery atherosclerosis. Strokes caused by small-vessel occlusion carried a small risk of acute symptomatic seizures. 6% developed post-stroke epilepsy. Risk factors for post-stroke epilepsy were acute symptomatic seizures, more severe strokes, infarcts involving the cerebral cortex, and strokes caused by large-artery atherosclerosis. Electroencephalography findings within 7 days of stroke onset were not independently associated with the risk of post-stroke epilepsy. There was no association between reperfusion treatments in general or only intravenous thrombolysis or mechanical thrombectomy with the time to post-stroke epilepsy or the risk of acute symptomatic seizures. Interpretation Post-stroke seizures are related to stroke severity, etiology, and location, whereas an early electroencephalogram was not predictive of epilepsy. We did not find an association of reperfusion treatment with risks of acute symptomatic seizures or post-stroke epilepsy.
- Published
- 2021
- Full Text
- View/download PDF
15. Cloud-based Network Virtualization in IoT with OpenStack
- Author
-
Giovanni Merlino, Zakaria Benomar, Antonio Puliafito, and Francesco Longo
- Subjects
Edge device ,Computer Networks and Communications ,business.industry ,Computer science ,Overlay network ,Network virtualization ,Cloud computing ,computer.software_genre ,Virtual machine ,Middleware (distributed applications) ,Server ,Cloud ,edge computing ,IaaS ,IoT ,network virtualization ,Neutron ,OpenStack ,business ,computer ,Edge computing ,Computer network - Abstract
In Cloud computing deployments, specifically in the Infrastructure-as-a-Service (IaaS) model, networking is one of the core enabling facilities provided for the users. The IaaS approach ensures significant flexibility and manageability, since the networking resources and topologies are entirely under users’ control. In this context, considerable efforts have been devoted to promoting the Cloud paradigm as a suitable solution for managing IoT environments. Deep and genuine integration between the two ecosystems, Cloud and IoT, may only be attainable at the IaaS level. In light of extending the IoT domain capabilities’ with Cloud-based mechanisms akin to the IaaS Cloud model, network virtualization is a fundamental enabler of infrastructure-oriented IoT deployments. Indeed, an IoT deployment without networking resilience and adaptability makes it unsuitable to meet user-level demands and services’ requirements. Such a limitation makes the IoT-based services adopted in very specific and statically defined scenarios, thus leading to limited plurality and diversity of use cases. This article presents a Cloud-based approach for network virtualization in an IoT context using the de-facto standard IaaS middleware, OpenStack, and its networking subsystem, Neutron. OpenStack is being extended to enable the instantiation of virtual/overlay networks between Cloud-based instances (e.g., virtual machines, containers, and bare metal servers) and/or geographically distributed IoT nodes deployed at the network edge.
- Published
- 2021
- Full Text
- View/download PDF
16. Advanced Diagnostic and Therapeutic Bronchoscopy
- Author
-
Neil A. Ninan, Thomas R. Gildea, Edward Kessler, Kevin L. Kovitz, Denise A. Merlino, Neeraj R. Desai, Kim D. French, and Momen M. Wahidi
- Subjects
Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Scope (project management) ,medicine.diagnostic_test ,business.industry ,Coding (therapy) ,Critical Care and Intensive Care Medicine ,03 medical and health sciences ,0302 clinical medicine ,030228 respiratory system ,Bronchoscopy ,Health care ,Medicine ,Current Procedural Terminology ,Medical physics ,030212 general & internal medicine ,Cardiology and Cardiovascular Medicine ,business ,Reimbursement ,Relative value unit ,Electromagnetic navigation bronchoscopy - Abstract
Advanced interventional pulmonary procedures of the airways, pleural space, and mediastinum continue to evolve and be refined. Health care, finance, and clinical professionals are challenged by both the indications and related coding complexities. As the scope of interventional pulmonary procedures expands with advanced technique and medical innovation, program planning and ongoing collaboration among clinicians, finance executives, and reimbursement experts are key elements for success. We describe advanced bronchoscopic procedures, appropriate Current Procedural Terminology coding, valuations, and necessary modifiers to fill the knowledge gap between basic and advanced procedural coding. Our approach is to balance the description of procedures with the associated coding in a way that is of use to the proceduralist, the coding specialist, and other nonclinical professionals.
- Published
- 2021
- Full Text
- View/download PDF
17. Developing and Validating an Individualized Clinical Prediction Model to Forecast Psychotic Recurrence in Acute and Transient Psychotic Disorders: Electronic Health Record Cohort Study
- Author
-
Pierluigi Politi, Luisa Bernardinelli, Sergio Merlino, Teresa Fazia, Grazia Rutigliano, Stefano Damiani, Paolo Fusar-Poli, and Carlo Berzuini
- Subjects
Adult ,Male ,Risk ,Pediatrics ,medicine.medical_specialty ,03 medical and health sciences ,0302 clinical medicine ,Lasso (statistics) ,Recurrence ,Models ,London ,medicine ,Electronic Health Records ,Humans ,psychosis ,Retrospective Studies ,validation ,Models, Statistical ,Proportional hazards model ,business.industry ,Brief psychotic disorder ,Retrospective cohort study ,Middle Aged ,Statistical ,Prognosis ,medicine.disease ,Missing data ,brief psychotic disorder ,Regression ,030227 psychiatry ,schizophrenia ,Psychiatry and Mental health ,Psychotic Disorders ,Schizophrenia ,Acute Disease ,Disease Progression ,individualized prediction acute and transient psychotic disorder ,Female ,clinical prediction modeling ,business ,Follow-Up Studies ,030217 neurology & neurosurgery ,Regular Articles ,Cohort study - Abstract
Acute and transient psychotic disorders (ATPDs) include short-lived psychotic episodes with a high probability of developing psychotic recurrences. Clinical care for ATPD is currently limited by the inability to predict outcomes. Real-world electronic health record (EHR)-based retrospective cohort study STROBE/RECORD compliant included all individuals accessing the South London and Maudsley NHS Trust between 2006 and 2017 and receiving a first diagnosis of ATPD (F23, ICD-10). After imputing missing data, stepwise and LASSO Cox regression methods employing a priori predictors (n = 23) were compared to develop and internally validate an individualized risk prediction model to forecast the risk of psychotic recurrences following TRIPOD guidelines. The primary outcome was prognostic accuracy (area under the curve [AUC]). 3018 ATPD individuals were included (average age = 33.75 years, 52.7% females). Over follow-up (average 1042 ± 1011 days, up to 8 years) there were 1160 psychotic recurrences (events). Stepwise (n = 12 predictors) and LASSO (n = 17 predictors) regression methods yielded comparable prognostic accuracy, with an events per variable ratio >100 for both models. Both models showed an internally validated adequate prognostic accuracy from 4 years follow-up (AUC 0.70 for both models) and good calibration. A refined model was adapted in view of the new ICD-11 criteria on 307 subjects with polymorphic ATPD, showing fair prognostic accuracy at 4 years (AUC: stepwise 0.68; LASSO 0.70). This study presents the first clinically based prediction model internally validated to adequately predict long-term psychotic recurrence in individuals with ATPD. The model can be automatable in EHRs, supporting further external validations and refinements to improve its prognostic accuracy.
- Published
- 2021
- Full Text
- View/download PDF
18. Diagnostic and prognostic potential of the proteomic profiling of serum-derived extracellular vesicles in prostate cancer
- Author
-
Giulia Federici, Lucia Bertuccini, Lucio Crinò, Steno Sentinelli, Romina Alfonsi, Devis Collura, Antonio Addario, Michele Gallucci, Giuseppe Simone, Claudio Tabolacci, Aurora Aiello, Giovanni Muto, Michele Signore, Rocco Papalia, Désirée Bonci, Marco Diociaiuti, Simona Nanni, Alessandro Giacobbe, Tania Merlino, Anna Laura Di Pace, Isabella Sperduti, Stefania Rossi, Ruggero De Maria, Manuela Costantini, and Lidia Brunetto
- Subjects
Adult ,Male ,Proteomics ,Cancer Research ,Proteome ,Immunology ,Protein Array Analysis ,Article ,Tumour biomarkers ,Cellular and Molecular Neuroscience ,Prostate cancer ,Extracellular Vesicles ,Settore MED/04 - PATOLOGIA GENERALE ,Predictive Value of Tests ,Cell Line, Tumor ,medicine ,Biomarkers, Tumor ,Humans ,Liquid biopsy ,PI3K/AKT/mTOR pathway ,Aged ,Retrospective Studies ,QH573-671 ,Proteomic Profiling ,business.industry ,Prostatic Neoplasms ,Reproducibility of Results ,Cell Biology ,Middle Aged ,medicine.disease ,Neoplasm Proteins ,Protein-protein interaction networks ,Cancer research ,Protein microarray ,Cancer biomarkers ,business ,Cytology - Abstract
Extracellular vesicles (EVs) and their cargo represent an intriguing source of cancer biomarkers for developing robust and sensitive molecular tests by liquid biopsy. Prostate cancer (PCa) is still one of the most frequent and deadly tumor in men and analysis of EVs from biological fluids of PCa patients has proven the feasibility and the unprecedented potential of such an approach. Here, we exploited an antibody-based proteomic technology, i.e. the Reverse-Phase Protein microArrays (RPPA), to measure key antigens and activated signaling in EVs isolated from sera of PCa patients. Notably, we found tumor-specific protein profiles associated with clinical settings as well as candidate markers for EV-based tumor diagnosis. Among others, PD-L1, ERG, Integrin-β5, Survivin, TGF-β, phosphorylated-TSC2 as well as partners of the MAP-kinase and mTOR pathways emerged as differentially expressed endpoints in tumor-derived EVs. In addition, the retrospective analysis of EVs from a 15-year follow-up cohort generated a protein signature with prognostic significance. Our results confirm that serum-derived EV cargo may be exploited to improve the current diagnostic procedures while providing potential prognostic and predictive information. The approach proposed here has been already applied to tumor entities other than PCa, thus proving its value in translational medicine and paving the way to innovative, clinically meaningful tools.
- Published
- 2021
19. Recanalisation theraphy for acute ischemic stroke in cancer patients
- Author
-
Gian Luigi Gigli, Valentina Maniaci, Simone Lorenzut, Andrea Surcinelli, Mariarosaria Valente, Alessandro Marini, Carmelo Smeralda, Sara Pez, and Giovanni Merlino
- Subjects
Male ,medicine.medical_specialty ,Mechanical Thrombolysis ,medicine.medical_treatment ,Science ,Blood Pressure ,Article ,03 medical and health sciences ,0302 clinical medicine ,Heart Rate ,Internal medicine ,Neoplasms ,medicine ,Humans ,Acute ischemic stroke ,Aged ,Ischemic Stroke ,Retrospective Studies ,Thrombectomy ,Aged, 80 and over ,Multidisciplinary ,business.industry ,Cancer ,Thrombolysis ,Odds ratio ,University hospital ,medicine.disease ,Survival Analysis ,Confidence interval ,Mechanical thrombectomy ,Increased risk ,Treatment Outcome ,Neurology ,Oncology ,030220 oncology & carcinogenesis ,Medicine ,Female ,business ,Intracranial Hemorrhages ,030217 neurology & neurosurgery - Abstract
To date, very few studies focused their attention on efficacy and safety of recanalisation therapy in acute ischemic stroke (AIS) patients with cancer, reporting conflicting results. We retrospectively analysed data from our database of consecutive patients admitted to the Udine University Hospital with AIS that were treated with recanalisation therapy, i.e. intravenous thrombolysis (IVT), mechanical thrombectomy (MT), and bridging therapy, from January 2015 to December 2019. We compared 3-month dependency, 3-month mortality, and symptomatic intracranial haemorrhage (SICH) occurrence of patients with active cancer (AC) and remote cancer (RC) with that of patients without cancer (WC) undergoing recanalisation therapy for AIS. Patients were followed up for 3 months. Among the 613 AIS patients included in the study, 79 patients (12.9%) had either AC (n = 46; 7.5%) or RC (n = 33; 5.4%). Although AC patients, when treated with IVT, had a significantly increased risk of 3-month mortality [odds ratio (OR) 6.97, 95% confidence interval (CI) 2.42–20.07, p = 0.001] than WC patients, stroke-related deaths did not differ between AC and WC patients (30% vs. 28.8%, p = 0.939). There were no significant differences between AC and WC patients, when treated with MT ± IVT, regarding 3-month dependency, 3-month mortality and SICH. Functional independence, mortality, and SICH were similar between RC and WC patients. In conclusion, recanalisation therapy might be used in AIS patients with nonmetastatic AC and with RC. Further studies are needed to explore the outcome of AIS patients with metastatic cancer undergoing recanalisation therapy.
- Published
- 2021
20. 2021 Proposed Bylaws Changes
- Author
-
Missi Merlino
- Subjects
Medical–Surgical Nursing ,Information retrieval ,Text mining ,Constitution and Bylaws ,Computer science ,business.industry ,business ,United States - Published
- 2021
- Full Text
- View/download PDF
21. Melanoma models for the next generation of therapies
- Author
-
Ze'ev Ronai, Leonard I. Zon, Carmit Levy, Meenhard Herlyn, Marcus Bosenberg, Amanda W. Lund, David B. Lombard, Jean-Christophe Marine, Richard M. White, Yardena Samuels, Charles K. Kaufman, Christin E. Burd, Shaheen Khan, Marc Hurlbert, Kristen L. Mueller, Eleonora Leucci, Andrew E. Aplin, Sheri L. Holmen, Iwei Yeh, Ashani T. Weeraratna, David J. Adams, Martin McMahon, Corine Bertolotto, Florian A. Karreth, Sebastian Kobold, Glenn Merlino, Carla Daniela Robles-Espinoza, Ping Chi, Jessie Villanueva, Niroshana Anandasabapathy, Kerrie L. Marie, Maria S. Soengas, Jiyue Zhu, Richard Marais, Craig J. Ceol, and E. Elizabeth Patton
- Subjects
0301 basic medicine ,Oncology ,Cancer Research ,medicine.medical_specialty ,Skin Neoplasms ,medicine.medical_treatment ,Drug resistance ,Article ,Targeted therapy ,Metastasis ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Skin Neoplasms/drug therapy ,Tumor Microenvironment ,medicine ,Tumor Microenvironment/immunology ,Animals ,Humans ,Melanoma/drug therapy ,Melanoma ,neoplasms ,Immunity/immunology ,Tumor microenvironment ,business.industry ,Immunity ,Cell Biology ,Immunotherapy ,medicine.disease ,3. Good health ,Clinical trial ,Disease Models, Animal ,030104 developmental biology ,030220 oncology & carcinogenesis ,Genetically Engineered Mouse ,Immunotherapy/methods ,business - Abstract
Summary There is a lack of appropriate melanoma models that can be used to evaluate the efficacy of novel therapeutic modalities. Here, we discuss the current state of the art of melanoma models including genetically engineered mouse, patient-derived xenograft, zebrafish, and ex vivo and in vitro models. We also identify five major challenges that can be addressed using such models, including metastasis and tumor dormancy, drug resistance, the melanoma immune response, and the impact of aging and environmental exposures on melanoma progression and drug resistance. Additionally, we discuss the opportunity for building models for rare subtypes of melanomas, which represent an unmet critical need. Finally, we identify key recommendations for melanoma models that may improve accuracy of preclinical testing and predict efficacy in clinical trials, to help usher in the next generation of melanoma therapies.
- Published
- 2021
- Full Text
- View/download PDF
22. Appendectomy and women’s reproductive outcomes: a review of the literature
- Author
-
Federica Del Prete, Giulia Carletti, Maria Grazia Piccioni, Massimo Codacci Pisanelli, Alessandra Chiné, Lucia Merlino, and Luca Titi
- Subjects
Infertility ,Pregnancy ,medicine.medical_specialty ,030219 obstetrics & reproductive medicine ,Obstetrics ,business.industry ,media_common.quotation_subject ,Fertility ,Vascular surgery ,medicine.disease ,Appendix ,03 medical and health sciences ,Pregnancy rate ,0302 clinical medicine ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,medicine ,Surgery ,Risk factor ,infertility ,complicated appendicitis ,abdominal surgery ,abdominal adhesions and reproduction ,tubal occlusion ,business ,media_common ,Abdominal surgery - Abstract
Summary Background The most frequent abdominal surgery performed for benign disease in females of fertile age is appendectomy, which remains among the most common surgeries and is a possible cause of peritoneal adhesions. The fact that appendectomy can cause adhesions may lead one to think that this may be a relevant risk factor for infertility; however, there is no universal agreement regarding the association between appendectomy and fertility. The aim of this review is to evaluate weather appendectomy may have a relevant impact on female fertility. Methods The search was conducted in PubMed and there was no limitation set on the date of publication. All studies regarding populations of female patients who had undergone appendectomy for inflamed appendix, perforated appendix, or negative appendix between childhood and the end of the reproductive period were included. Results Some authors believe that pelvic surgery can cause adhesions which can potentially lead to tubal infertility by causing tubal obstruction or by altering motility of fimbriae, tubal fluid secretion, and embryo transport. On the other hand, the most recent evidence reported that removal of the appendix seems to be associated with an increased pregnancy rate in large population studies. Conclusion Despite the existence of contrasting opinions concerning fertility after appendectomy, the most recent evidence suggests that appendectomy may actually lead to improved fertility and decreased time to pregnancy. Appendectomy seems to be correlated with improved fertility and higher pregnancy rates.
- Published
- 2021
- Full Text
- View/download PDF
23. Adult-onset Still's disease following COVID-19 vaccination
- Author
-
Silvia Laura Bosello, Lucrezia Verardi, Angelo Zoli, Fabrizio Cocciolillo, Enrica Fiori, Pier Giacomo Cerasuolo, Maria Antonietta D'Agostino, Biagio Merlino, and Flavia Leone
- Subjects
2019-20 coronavirus outbreak ,Pediatrics ,medicine.medical_specialty ,Adult-onset Still's disease ,Settore MED/16 - REUMATOLOGIA ,Coronavirus disease 2019 (COVID-19) ,business.industry ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,Comment ,Immunology ,Medizin ,Vaccination ,Rheumatology ,Immunology and Allergy ,Medicine ,INGLESE ,business - Published
- 2021
- Full Text
- View/download PDF
24. Use of preventive drugs during the last year of life in older adults with cancer or chronic progressive diseases
- Author
-
Alessandro Nobili, Luca Merlino, Cristina Bosetti, Luca Pasina, Oscar Corli, Ida Fortino, and Claudia Santucci
- Subjects
Drug ,Pediatrics ,medicine.medical_specialty ,Epidemiology ,media_common.quotation_subject ,Drug Prescriptions ,030226 pharmacology & pharmacy ,03 medical and health sciences ,0302 clinical medicine ,Neoplasms ,Health care ,Antithrombotic ,medicine ,Humans ,Pharmacology (medical) ,030212 general & internal medicine ,Elderly adults ,Medical prescription ,Aged ,Retrospective Studies ,media_common ,business.industry ,Cancer ,medicine.disease ,Pharmaceutical Preparations ,Chronic Disease ,Deprescribing ,business ,Progressive disease - Abstract
PURPOSE To evaluate the prescription of preventive medications with questionable usefulness in community dwelling elderly adults with cancer or chronic progressive diseases during the last year of life. METHODS Through the utilization of the healthcare databases of the Lombardy region, Italy, we identified two retrospective cohorts of patients aged 65 years or more, who died in 2018 and had a diagnosis of either a solid cancer (N = 19 367) or a chronic progressive disease (N = 27 819). We estimated prescription of eight major classes of preventive drugs 1 year and 1 month before death; continuation or initiation of preventive drug use during the last month of life was also investigated. RESULTS Over the last year of life, in both oncologic and non-oncologic patients, we observed a modest decrease in the prescription of blood glucose-lowering drugs, anti-hypertensives, lipid-modifying agents, and bisphosphonates, and a slight increase in the prescription of vitamins, minerals, antianemic drugs, and antithrombotic agents (among oncologic patients only). One month before death, the prescription of preventive drugs was still common, particularly for anti-hypertensives, antithrombotics, and antianemics, with more than 60% of patients continuing to be prescribed most preventive drugs and an over 10% starting a therapy with an antithrombotic, an antianemic, or a vitamin or mineral supplement. CONCLUSION These findings support the need for an appropriate drug review and improvement in the quality of drug prescription for vulnerable populations at the end-of-life.
- Published
- 2021
- Full Text
- View/download PDF
25. Video representation and suspicious event detection using semantic technologies
- Author
-
Giovanni Merlino, Antonio Puliafito, Muneendra Ojha, Ashish Singh Patel, Om Prakash Vyas, and Dario Bruneo
- Subjects
Smart city, data integration, data modeling, surveillance video, ontology, video semantics, video dataset, object tracking ,Computer Networks and Communications ,Computer science ,Event (relativity) ,02 engineering and technology ,computer.software_genre ,video dataset ,video semantics ,0202 electrical engineering, electronic engineering, information engineering ,ontology ,data integration ,object tracking ,Smart city ,surveillance video ,business.industry ,Representation (systemics) ,020207 software engineering ,Computer Science Applications ,Semantic technology ,020201 artificial intelligence & image processing ,Artificial intelligence ,business ,computer ,Natural language processing ,data modeling ,Information Systems - Abstract
Storage and analysis of video surveillance data is a significant challenge, requiring video interpretation and event detection in the relevant context. To perform this task, the low-level features including shape, texture, and color information are extracted and represented in symbolic forms. In this work, a methodology is proposed, which extracts the salient features and properties using machine learning techniques and represent this information as Linked Data using a domain ontology that is explicitly tailored for detection of certain activities. An ontology is also developed to include concepts and properties which may be applicable in the domain of surveillance and its applications. The proposed approach is validated with actual implementation and is thus evaluated by recognizing suspicious activity in an open parking space. The suspicious activity detection is formalized through inference rules and SPARQL queries. Eventually, Semantic Web Technology has proven to be a remarkable toolchain to interpret videos, thus opening novel possibilities for video scene representation, and detection of complex events, without any human involvement. The proposed novel approach can thus have representation of frame-level information of a video in structured representation and perform event detection while reducing storage and enhancing semantically-aided retrieval of video data.
- Published
- 2021
- Full Text
- View/download PDF
26. Endoscopic surgical treatment for rhinogenic contact point headache: systematic review and meta-analysis
- Author
-
Christian Calvo-Henriquez, Giannicola Iannella, Claudio Vicini, Jerome R. Lechien, Ignazio La Mantia, Salvatore Cocuzza, Giovanni Cammaroto, Antonino Maniaci, and Federico Merlino
- Subjects
medicine.medical_specialty ,medicine.risk_factor ,rhinogenic contact point headache ,Visual analogue scale ,concha bullosa ,Review Article ,pain measurement ,endoscopic surgery ,03 medical and health sciences ,septal deviation ,0302 clinical medicine ,migraine disorders ,medicine ,septal spur ,endoscopy ,humans ,nose ,headache ,030223 otorhinolaryngology ,Nose ,Rhinogenic contact point headache · Concha bullosa · Septal spur · Septal deviation · Endoscopic surgery ,Concha bullosa ,medicine.diagnostic_test ,business.industry ,Correction ,General Medicine ,medicine.disease ,Endoscopy ,Surgery ,medicine.anatomical_structure ,Otorhinolaryngology ,Migraine ,Meta-analysis ,Neurosurgery ,business ,030217 neurology & neurosurgery - Abstract
Purpose This meta-analysis study was designed to analyze endoscopic surgery’s role in treating rhinogenic contact point headache. Methods We performed a comprehensive review of the last 20 years’ English language regarding Rhinogenic contact point headache and endoscopic surgery. We included the analysis papers reporting post-operative outcomes through the Visual Analogue Scale or the Migraine Disability Assessment scale. Results We provided 18 articles for a total of 978 RCPH patients. While 777 (81.1%) subjects underwent functional nasal surgery for RCPH, 201 patients (20.9%) were medically treated. A significant decrease from the VAS score of 7.3 ± 1.5 to 2.7 ± 1.8 was recorded (p p Conclusion At comparison, surgical treatment in patients with rhinogenic contact points exhibited significantly better values at short-term, medium-term, and long term follow up. Endoscopic surgery should be proposed as the choice method in approaching the symptomatic patient.
- Published
- 2021
- Full Text
- View/download PDF
27. Synthetic Lethal Screens Reveal Cotargeting FAK and MEK as a Multimodal Precision Therapy forGNAQ-Driven Uveal Melanoma
- Author
-
Andrew E. Aplin, Justine S. Paradis, J. Silvio Gutkind, Prashant Mali, Manoela Tiago, Robert Saddawi-Konefka, Monica Acosta, Xingyu Wu, Glenn Merlino, Chi-Ping Day, Nadia Arang, Takami Sato, Silvia Coma, Simone Lubrano, Jonathan A. Pachter, Kyle Ford, Frederico Gomes, and Ayush Kishore
- Subjects
0301 basic medicine ,YAP1 ,MAPK/ERK pathway ,Cancer Research ,GNA11 ,business.industry ,Melanoma ,Cancer ,medicine.disease ,03 medical and health sciences ,030104 developmental biology ,0302 clinical medicine ,Oncology ,030220 oncology & carcinogenesis ,medicine ,Cancer research ,Signal transduction ,business ,GNAQ ,Genetic screen - Abstract
Purpose:Uveal melanoma is the most common eye cancer in adults. Approximately 50% of patients with uveal melanoma develop metastatic uveal melanoma (mUM) in the liver, even after successful treatment of the primary lesions. mUM is refractory to current chemo- and immune-therapies, and most mUM patients die within a year. Uveal melanoma is characterized by gain-of-function mutations in GNAQ/GNA11, encoding Gαq proteins. We have recently shown that the Gαq–oncogenic signaling circuitry involves a noncanonical pathway distinct from the classical activation of PLCβ and MEK–ERK. GNAQ promotes the activation of YAP1, a key oncogenic driver, through focal adhesion kinase (FAK), thereby identifying FAK as a druggable signaling hub downstream from GNAQ. However, targeted therapies often activate compensatory resistance mechanisms leading to cancer relapse and treatment failure.Experimental Design:We performed a kinome-wide CRISPR-Cas9 sgRNA screen to identify synthetic lethal gene interactions that can be exploited therapeutically. Candidate adaptive resistance mechanisms were investigated by cotargeting strategies in uveal melanoma and mUM in vitro and in vivo experimental systems.Results:sgRNAs targeting the PKC and MEK–ERK signaling pathways were significantly depleted after FAK inhibition, with ERK activation representing a predominant resistance mechanism. Pharmacologic inhibition of MEK and FAK showed remarkable synergistic growth-inhibitory effects in uveal melanoma cells and exerted cytotoxic effects, leading to tumor collapse in uveal melanoma xenograft and liver mUM models in vivo.Conclusions:Coupling the unique genetic landscape of uveal melanoma with the power of unbiased genetic screens, our studies reveal that FAK and MEK–ERK cotargeting may provide a new network-based precision therapeutic strategy for mUM treatment.See related commentary by Harbour, p. 2967
- Published
- 2021
- Full Text
- View/download PDF
28. Inferno, disruption, concern, sense of community, teamwork, tears: reflections by renal healthcare team members on the front lines of the COVID-19 pandemic
- Author
-
Maurizio Merlino, Laura Danelli, Barbara Resmini, Simona Zerbi, Carmen Licciardello, Daniela Palmetti, and Roberta Aloardi
- Subjects
Patient Care Team ,Teamwork ,2019-20 coronavirus outbreak ,Coronavirus disease 2019 (COVID-19) ,Attitude of Health Personnel ,Personal narrative ,business.industry ,media_common.quotation_subject ,Emotions ,Sense of community ,COVID-19 ,Editorial ,Nursing ,Nephrology ,Pandemic ,Health care ,Humans ,Medicine ,business ,Front (military) ,media_common - Published
- 2021
- Full Text
- View/download PDF
29. Sociodemographic determinants of knowledge on the figure of radiologist: results of a survey in large university hospital
- Author
-
Biagio Merlino, Stefania Boccia, Giuseppe Cicchetti, Lorenzo Bonomo, Nikola Panic, and Emanuele Leoncini
- Subjects
lcsh:R5-920 ,knowledge ,medicine.medical_specialty ,Modern medicine ,Secondary education ,business.industry ,lcsh:Public aspects of medicine ,public health ,Primary education ,lcsh:RA1-1270 ,Radiological examination ,University hospital ,Sociodemographic determinants ,Radiological weapon ,Medicine ,Outpatient clinic ,survey ,Radiology ,lcsh:Medicine (General) ,radiologist ,business ,Settore MED/36 - DIAGNOSTICA PER IMMAGINI E RADIOTERAPIA - Abstract
IntroductionDespite overlaying an irreplaceable role as a key diagnostic tool in modern medicine, the role of radiologist still appears to be unclear to patients.Methods We conducted a survey in outpatient clinic of Radiological Sciences Department of the University Hospital “A. Gemelli” in Rome, aiming to assess how correct patients identify the figure of the radiologist. The patients were interviewed by the trained physician using structured questionnaire.Results We included the number of 259 patients. Majority were female 63.3%, most were 60-69 years old (24.3%), have finished second grade secondary school (35.1%) and were subjected to magnetic resonance (28.6%) while the least were subjected to chest X-ray (8.1%). Only 38.7% answered correctly to question No 1 “Who performed your examination?”, and only 30.9% correctly identified the radiologist as a person interpreting the exam (question No 2 “Who is going to interpret your radiological examination?”). Overall, 16.8% responded correctly to the both questions. Significantly less patients with primary school (OR: 0.18, CI 95% 0.06-0.49) and first grade secondary school (OR: 0.37, CI 95% 0.18-0.75) correctly addressed the question No 1 in compare to those with second grade secondary school. The first grade secondary education (OR: 0.43, CI 95% 0.20-0.92) was inversely associated with correct answer to question No 2. Patients with primary education were significantly less prone to give both correct answers (OR: 0.12, CI 95% 0.02-0.60).Conclusion We report insufficient knowledge among patients on radiologist’s role in healthcare system. The level of knowledge is associated with level of education.
- Published
- 2022
- Full Text
- View/download PDF
30. A new population-based risk stratification tool was developed and validated for predicting mortality, hospital admissions, and health care costs
- Author
-
Luca Merlino, Federico Rea, Monica Ludergnani, Giovanni Corrao, Luigi Cajazzo, Rea, F, Corrao, G, Ludergnani, M, Cajazzo, L, and Merlino, L
- Subjects
Male ,Epidemiology ,Sample (statistics) ,Comorbidity ,Risk Assessment ,State Medicine ,Record linkage ,03 medical and health sciences ,0302 clinical medicine ,Risk analysis (business) ,Health care ,Humans ,Medicine ,Hospital Mortality ,030212 general & internal medicine ,Health care utilization database ,Risk stratification ,Population-based study ,Aged ,Aged, 80 and over ,Receiver operating characteristic ,business.industry ,Proportional hazards model ,Health Care Costs ,Middle Aged ,medicine.disease ,Hospitalization ,Italy ,Prognostic score ,Area Under Curve ,Chronic Disease ,Female ,business ,030217 neurology & neurosurgery ,Demography - Abstract
Objectives The aim of this study was to develop a new population-based risk stratification tool (Chronic Related Score [CReSc]) for predicting 5-year mortality and other outcomes. Study Design and Setting The score included 31 conditions selected from a list of 65 candidates whose weights were assigned according to the Cox model coefficients. The model was built from a sample of 5.4 million National Health Service (NHS) beneficiaries from the Italian Lombardy Region and applied to the remaining 2.7 million NHS beneficiaries. Predictive performance was assessed by discrimination and calibration. CReSc ability in predicting secondary endpoints (i.e., hospital admissions and health care costs) was investigated. Finally, the relationship between CReSc and income was considered. Results Among individuals aged 50–85 years, CReSc performance showed (1) an area under the receiver operating characteristic curve of 0.730, (2) an improved reclassification from 44% to 52% with respect to other scores, and (3) a remarkable calibration. A trend toward increasing rates of all the considered endpoints as CReSc increases was observed. Compared with individuals on low–intermediate income, NHS beneficiaries on high income showed better CReSc profile. Conclusion We developed a risk stratification tool able to predict mortality, costs, and hospital admissions. The application of CReSc may generate clinically and operationally important effects.
- Published
- 2019
- Full Text
- View/download PDF
31. Assessing the citizen science approach as tool to increase awareness on the marine litter problem
- Author
-
Silvia Merlino, M. Abbate, Marina Locritani, Locritani, M., Merlino, S., and Abbate, M.
- Subjects
Anthropogenic marine debris ,Assessment ,Citizen science ,Mediterranean Sea ,SEACleaner ,Awareness ,Conservation of Natural Resources ,Environmental Health ,Italy ,Plastics ,Solid Waste ,Students ,Surveys and Questionnaires ,Water Pollutants, Chemical ,Anthropogenic marine debri ,0106 biological sciences ,media_common.quotation_subject ,Chemical ,Plastic ,010501 environmental sciences ,Aquatic Science ,Oceanography ,01 natural sciences ,Marine pollution ,Perception ,Marine debris ,Environmental monitoring ,Surveys and Questionnaire ,Water Pollutants ,Conservation of Natural Resource ,Macro ,0105 earth and related environmental sciences ,media_common ,business.industry ,010604 marine biology & hydrobiology ,Environmental resource management ,Awarene ,Pollution ,Test (assessment) ,Geography ,Environmental education ,Student ,business - Abstract
This paper provides a quantitative assessment of students' attitude and behaviors towards marine litter before and after their participation to SEACleaner, an educational and citizen science project devoted to monitor macro- and micro-litter in an Area belonging to “Pelagos Sanctuary” (Mediterranean Sea). This approach produced interesting outcomes both for the research sector of marine pollution and environmental monitoring, as well for the scientific and environmental education. Here we focus on citizen science as an effective vector for raising young people awareness of marine litter and fostering sound behaviors. A specially designed questionnaire was administered to 87 High School students, to test the validity of such approach. The results state that the students change quantitatively their perception of beach-litter causes and derived problems, and they improved their knowledge about the main marine litter sources and the role of the sea in the waste transport and deposition along the coast.
- Published
- 2019
- Full Text
- View/download PDF
32. Experimenting with smart contracts for access control and delegation in IoT
- Author
-
Antonio Puliafito, Giovanni Merlino, Nachiket Tapas, and Francesco Longo
- Subjects
Scheme (programming language) ,Blockchain ,Computer Networks and Communications ,Computer science ,media_common.quotation_subject ,Access control ,Authorization ,Cloud ,Delegation ,Ethereum ,IoT ,Smart cities ,Smart contracts ,02 engineering and technology ,Computer security ,computer.software_genre ,Smart city ,0202 electrical engineering, electronic engineering, information engineering ,computer.programming_language ,media_common ,Focus (computing) ,business.industry ,020206 networking & telecommunications ,Hardware and Architecture ,020201 artificial intelligence & image processing ,Smart environment ,business ,Internet of Things ,computer ,Software - Abstract
In a Smart City scenario, the authors envisioned an IoT-Cloud framework for the management of boards and resources scattered over a geographic area. It can also become a tool to let device owners contribute freely to the infrastructure. In this paper, we present an authorization and delegation model for the IoT-Cloud based on blockchain technology. We focus on smart city’s design and simulation of smart contracts to address the specific characteristics of smart environments and analyze access control and delegation mechanism in IoT. In particular, the scheme is implemented for the Ethereum platform in the form of smart contracts. We present the theoretical analysis of the proposed solution. We perform experiments on local testnet Ganache and public testnet Rinkeby to evaluate the performance of the presented models. Finally, we discuss the results and limitations of the system and possible solutions to issues.
- Published
- 2020
- Full Text
- View/download PDF
33. Innovation in craft beer packaging: Evaluation of consumer perception and acceptance
- Author
-
Stefano Massaglia, Danielle Borra, Valentina Maria Merlino, and Simone Blanc
- Subjects
Consumption (economics) ,business.product_category ,packaging innovation ,sensory attributes ,Advertising ,Consumer perception ,Craft beer ,Packaging innovation ,Sensory attributes ,consumer perception ,Agricultural and Biological Sciences (miscellaneous) ,lcsh:S1-972 ,Preference ,law.invention ,Likert scale ,Craft ,law ,Order (business) ,craft beer ,CLARITY ,Bottle ,Product (category theory) ,lcsh:Agriculture (General) ,business ,Food Science - Abstract
Craft beer is an authentic product characterised by unique sensory features that distinguish it from industrially produced beers. The typical consumer also closely associates craft beers with the concept of traditional products, also in terms of consumption habits and the manner in which they are packaged. In this research, 482 beer consumers were interviewed face-to-face using a paper questionnaire during the Oktoberfest (Piedmont-Northwest Italy), a traditional beer festival that draws thousands of craft beer fans. Two consumer samples were defined on the basis of individual statements regarding their preferred method of beer packaging: The “traditional” consumer, loyal to the conventional beer packaging material (glass bottle) and the “innovative” consumer more inclined to packaging innovation (the use of aluminium cans). The preference scores towards beer attributes of the two identified samples were assessed using a 5-points Likert scale. In addition, the individual socio-demographic characteristics, together with craft beer consumption habits were recorded during the data collection phase. Significant differences between the two consumer samples were found using a non-parametric test; the Mann-Whitney Wilcoxon. In particular, traditional and innovative consumer groups expressed different preference levels towards beer clarity, colour, bitterness and body. For both samples, taste intensity resulted as the top attribute for beer evaluation, highlighting that, even when canned, the consumer is able to evaluate and appreciate the aromatic and quality characteristics of the product. Therefore, although glass remains the preferred packaging material for craft beer consumers, given the increasing acceptance of canned packaging by the traditional consumer, brewers could conceivably focus on canned product lines in order to exploit the inherent logistical and marketing advantages (i.e. graphical communications).
- Published
- 2020
- Full Text
- View/download PDF
34. Innovation towards sustainable fresh-cut salad production: Are Italian consumers receptive?
- Author
-
Simone Blanc, Valentina Maria Merlino, Aurora Bargetto, Danielle Borra, and Stefano Massaglia
- Subjects
Preference analysis ,business.industry ,sustainability claims ,Public opinion ,Agricultural and Biological Sciences (miscellaneous) ,Metropolitan area ,lcsh:S1-972 ,Product (business) ,fresh-cut salads ,purchasing decision ,Sustainability ,Production (economics) ,consumer preferences ,Marketing ,Market share ,Real interest rate ,best-worst scaling ,lcsh:Agriculture (General) ,business ,Food Science - Abstract
Fresh-cut salads are ready-to-eat foodstuffs with a growing market share and increasingly popular with consumers. However, a significant part of public opinion considers that bagged salad production processes have an effect on sustainability. In parallel, fresh-cut salads producers implement high resources and innovation strategies to improve the production process and product sustainability, highlighting an increasing awareness of their responsibility. The objective of this study was to investigate whether a correspondence exists between consumer preferences and the fresh-cut salad sustainability attributes (environmental, economic and social), indicated by producers (on their packaging and/or company website). Consumer preference analysis of 12 attributes of fresh-cut salads was made using the Best-Worst scaling methodology. Among the selected attributes, 9 were related to sustainability issues and 3 to the intrinsic product characteristics. A paper questionnaire was developed and submitted directly to consumers (n = 216), at different points of sale of several large retail chains in the Turin metropolitan area (Northwest Italy). The analysis of the results highlights that no direct correspondence can be found between the companies’ communications regarding sustainability and the real interest of consumers of fresh-cut salads towards these attributes. Moreover, in contrast to the growing ‘green’ attitude among consumers, the lack of consumer interest in the attributes of environmental sustainability underlines the need to increase consumer awareness of the issue. Thus, this research could contribute to the development of more targeted and accessible communication strategies towards consumers.
- Published
- 2020
- Full Text
- View/download PDF
35. CCTA in the diagnosis of coronary artery disease
- Author
-
Lorenzo Steri, Maria Rachele Pia Carafa, Francesco Ciriaco Flammia, Biagio Merlino, Giuseppe Rovere, L Natale, Riccardo Marano, and Giancarlo Savino
- Subjects
medicine.medical_specialty ,Referral ,Computed Tomography Angiography ,medicine.medical_treatment ,Chronic coronary syndrome ,Coronary Artery Disease ,Coronary Angiography ,Risk Assessment ,030218 nuclear medicine & medical imaging ,Coronary artery disease ,Hospital ,03 medical and health sciences ,0302 clinical medicine ,Coronary artery bypass graft ,Coronary stent ,medicine ,Acute chest pain ,Humans ,Radiology, Nuclear Medicine and imaging ,Coronary CT angiography ,Angina, Stable ,Intensive care medicine ,Cardiac imaging ,Cardiovascular risk stratification ,Settore MED/36 - DIAGNOSTICA PER IMMAGINI E RADIOTERAPIA ,Neuroradiology ,Emergency Service ,medicine.diagnostic_test ,business.industry ,Interventional radiology ,General Medicine ,Angina ,medicine.disease ,Stable ,Coronary revascularization ,Clinical Practice ,Cardiovascular prevention ,030220 oncology & carcinogenesis ,Emergency Service, Hospital ,business - Abstract
The world of cardiac imaging is proposing to physicians an ever-increasing spectrum of options and tools with the disadvantages of patients presently submitted to multiple, sequential, time-consuming, and costly diagnostic procedures and tests, sometimes with contradicting results. In the last two decades, the CCTA has evolved into a valuable diagnostic test in today's patient care, changing the official existing guidelines and clinical practice with a pivotal role to exclude significant CAD, in the referral of patients to the Cath-Lab, in the follow-up after coronary revascularization, and finally in the cardiovascular risk stratification.
- Published
- 2020
- Full Text
- View/download PDF
36. Milk packaging innovation: Consumer perception and willingness to pay
- Author
-
Valentina Maria Merlino, Simone Blanc, Alice Versino, and Filippo Brun
- Subjects
Consumption (economics) ,consumer preference ,innovative perspectives ,milk packaging ,ordered logistic regression ,willingness to pay ,Agricultural and Biological Sciences (miscellaneous) ,lcsh:S1-972 ,Preference ,Purchasing ,Relevant market ,Willingness to pay ,Order (exchange) ,Business ,Product (category theory) ,Packaging and labeling ,Marketing ,lcsh:Agriculture (General) ,Food Science - Abstract
Currently the cow milk market is characterised by a decrease in consumption and sales, for both fresh and long-life products. In addition to the negative consumer perception towards milk, linked to, for example, its potential perceived negative effects on human health, at Italian level, this product is overlooked on the market in terms of communication strategies and innovation, increasingly rendering this product an undifferentiated commodity. As product packaging represents a key factor to improve and develop products on the market, the aim of this research is to analyse consumer preferences and attitudes towards different innovative strategies of milk packaging. A consumer sample from North-West Italy was involved in the experiment, to investigate their purchasing habits and preference towards cow’s milk. An ordered logit model was implemented, in order to determine consumer willingness to pay for milk packaging innovation (11 packaging indicators), in addition to establishing the best strategies for product improvement, in recognition of the emerging needs of consumers. We found that consumers express a high level of interest towards the packaging attributes associated with environmental sustainability, especially regarding the choice of packaging materials and their recyclable features (from 3.369 to 3.645 of mean preference score of the 5-points Likert scale). Furthermore, consumers declared a willingness to pay a premium price, up to 20% more, for innovative milk packaging, demonstrating the potential for general applicability in the relevant market.
- Published
- 2020
- Full Text
- View/download PDF
37. Cardiac patient care during a pandemic: how to reorganise a heart failure unit at the time of COVID-19
- Author
-
Marco Guglielmo, Anna Sudati, Francesca Susini, Emilio Assanelli, Marina Alimento, Massimo Mapelli, Andrea Baggiano, Piergiuseppe Agostoni, Giovanni Berna, Manuela Muratori, Luca Merlino, Beatrice Pezzuto, Pietro Palermo, Anna Apostolo, Edoardo Conte, Carlo Vignati, and Elisabetta Salvioni
- Subjects
Male ,medicine.medical_specialty ,Cardiac Care Facilities ,Coronavirus disease 2019 (COVID-19) ,Epidemiology ,Confronting the reality of COVID ,Pneumonia, Viral ,Population ,cardiac care ,030204 cardiovascular system & hematology ,Risk Assessment ,Unit (housing) ,Clinical Practice ,Patient Isolation ,03 medical and health sciences ,0302 clinical medicine ,Pandemic ,Health care ,Humans ,Medicine ,030212 general & internal medicine ,Myocardial infarction ,education ,Pandemics ,Heart Failure ,Infection Control ,education.field_of_study ,business.industry ,COVID-19 ,medicine.disease ,Infectious Disease Transmission, Vertical ,Organizational Innovation ,Intensive Care Units ,heart failure unit ,Italy ,Heart failure ,Emergency medicine ,Female ,Coronavirus Infections ,Cardiology and Cardiovascular Medicine ,business ,Risk assessment - Abstract
To date, the pandemic spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has involved over 100 countries in a matter of weeks, and Italy suffers from almost 1/3 of the dead cases worldwide. In this report, we show the strategies adopted to face the emergency at Centro Cardiologico Monzino, a mono-specialist cardiology hospital sited in the region of Italy most affected by the pandemic, and specifically we describe how we have progressively modified in a few weeks the organization of our Heart Failure Unit in order to cope with the new COVID-19 outbreak. In fact, on the background of the pandemic, cardiovascular diseases still occur frequently in the general population, but we observed consistent reduction in hospital admissions for acute cardiovascular events and a dramatic increase of late presentation acute myocardial infarction. Despite a reduction of healthcare workers number, our ward has been rearranged in order to take care of both COVID-19 and cardiovascular patients. In particular according to a triple step procedure we divided admitted patients in confirmed, suspected and excluded cases (respectively allocated in “red”, “pink” and “green” separated areas). Due to the absence of definite guidelines, our aim was to describe our strategy in facing the current emergency, in order to reorganize our hospital in a dynamic and proactive manner. To quote the famous Italian writer Alessandro Manzoni ‘It is less bad to be agitated in doubt than to rest in error.’
- Published
- 2020
- Full Text
- View/download PDF
38. Coronary Computed Tomography Angiography in the Clinical Workflow of Athletes With Anomalous Origin of Coronary Arteries From the Contralateral Valsalva Sinus
- Author
-
Biagio Merlino, Vincenzo Palmieri, Massimo Muciaccia, Luigi Natale, Anna Rita Larici, Riccardo Marano, Riccardo Manfredi, Paolo Zeppilli, Fabiano Paciolla, Giuseppe Rovere, Giancarlo Savino, and Francesco C. Flammia
- Subjects
Male ,Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,cardiac ,diagnostic imaging ,Computed Tomography Angiography ,Coronary Vessel Anomalies ,030204 cardiovascular system & hematology ,Coronary Angiography ,Asymptomatic ,Workflow ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,death ,Internal medicine ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,computed tomography angiography ,coronary vessel anomalies ,death, sudden, cardiac ,personalized medicine ,Settore MED/36 - DIAGNOSTICA PER IMMAGINI E RADIOTERAPIA ,Computed tomography angiography ,sudden ,medicine.diagnostic_test ,biology ,business.industry ,Athletes ,Angiography ,Sinus of Valsalva ,medicine.disease ,biology.organism_classification ,Hypoplasia ,Coronary arteries ,Ostium ,medicine.anatomical_structure ,Cohort ,Cardiology ,medicine.symptom ,business ,Artery - Abstract
PURPOSE This study aimed to assess the role of coronary computed tomography-angiography (CCTA) in the workflow of competitive sports eligibility in a cohort of athletes with anomalous origin of the left-coronary artery (AOLCA)/anomalous origin of the right-coronary artery (AORCA) in an attempt to outline relevant computed tomography features likely to impact diagnostic assessment and clinic management. MATERIALS AND METHODS Patients with suspected AOLCA/AORCA at transthoracic echocardiography or with inconclusive transthoracic echocardiography underwent CCTA to rule out/confirm and characterize the anatomic findings: partially interarterial course or full-INT, high-take-off, acute-take-off-angle (ATO), slit-like origin, intramural course (IM), interarterial-course-length, and lumen-reduction/hypoplasia (HYPO). RESULTS CCTA identified 28 athletes: 6 AOLCA (3 males; 20.3±11.0 y) and 22 AORCA (18 males; 29.1±16.5 y). Symptoms were present only in 13 athletes (46.4%; 10 AORCA). Four patients (3 AORCA) had abnormal rest electrocardiogram, 11 (40.7%; 9 AORCA) had abnormal stress-electrocardiogram. The INT course was observed in 15 athletes (53.6%): 6/6 AOLCA and 9/22 AORCA (40.9%). Slit-like origin was present in 7/22 AORCA (31.8%) and never in AOLCA. Suspected IM resulted in 3 AOLCA (50%), always with HYPO/ATO, and in 6/22 AORCA (27.3%) with HYPO. No statistically significant differences were found between asymptomatic/symptomatic patients in the prevalence of partially INT/INT courses, high-take-off/ATO, and slit-like ostium. A slightly significant relationship between suspected proximal-IM (r=0.47, P
- Published
- 2020
- Full Text
- View/download PDF
39. Biomechanical factors during common agricultural activities: Results of on-farm exposure assessments using direct measurement methods
- Author
-
Cassidy Branch, Howard Chen, Linda Merlino, Nathan B. Fethke, and Mark C. Schall
- Subjects
Male ,Sample (statistics) ,010501 environmental sciences ,01 natural sciences ,Article ,03 medical and health sciences ,0302 clinical medicine ,Occupational Exposure ,Environmental health ,Humans ,Medicine ,Musculoskeletal health ,Musculoskeletal System ,0105 earth and related environmental sciences ,Measurement method ,Electromyography ,business.industry ,Public Health, Environmental and Occupational Health ,Human factors and ergonomics ,Agriculture ,Middle Aged ,030210 environmental & occupational health ,Agricultural work ,Biomechanical Phenomena ,Occupational Diseases ,Increased risk ,Female ,business - Abstract
Agricultural work is associated with increased risk of adverse musculoskeletal health outcomes. The purpose of this study was to quantify exposure to biomechanical factors among a sample (n = 55) of farmers in the Midwest region of the U.S. while they performed a variety of routine agricultural activities, and to compare exposure levels between these activities. Surface electromyography was used to estimate activity levels of the erector spinae, upper trapezius, forearm flexor, and forearm extensor muscle groups. Simultaneously, inertial sensors were used to measure kinematics of the trunk, upper arm, and wrist. In general, lower muscle activity levels, less extreme postures, and slower movement speeds were observed during activities that involved primarily the use of agricultural machinery in comparison to manual activities, suggesting a potential advantage of mechanization relative to musculoskeletal health. Median wrist movement speeds exceeding recently proposed exposure thresholds were also observed during many manual activities, such as milking animals and repairing equipment. Upper arm postures and movement speeds did not appear to confer excessive risk for shoulder-related outcomes (on the whole), but interpretation of the results is limited by a sampling approach that may not have captured the full extent of exposure variation. Not surprisingly, substantial variation in exposure levels were observed within each agricultural activity, which is related to substantial variation in the equipment, tools, and work practices used by participants. Ultimately, the results of this study contribute to an emerging literature in which the physical demands of routine agricultural work have been described on the basis of sensor-based measurements rather than more common self-report or observation-based approaches.
- Published
- 2020
- Full Text
- View/download PDF
40. Targeting CD205 with the antibody drug conjugate MEN1309/OBT076 is an active new therapeutic strategy in lymphoma models
- Author
-
Chiara Tarantelli, Giulio Sartori, Emanuele Zucca, Monica Binaschi, Francesca Guidetti, Filippo Spriano, Renzo Lucchini, Gaetanina Golino, Anastasios Stathis, Roberta Pittau Bordone, Eugenio Gaudio, Georg Stussi, Rachel L. Dusek, Luciano Cascione, Alessandro Bressan, Davide Rossi, Christian Rohlff, Arnima Bisht, Mario Bigioni, Robert S. Boyd, Andrea Pellacani, Nickolas Attanasio, Francesco Bertoni, Afua Adjeiwaa Mensah, Merlino Giuseppe, Elena Bernasconi, Alessio Fiascarelli, and Alberto J. Arribas
- Subjects
0301 basic medicine ,Antibody-drug conjugate ,medicine.drug_class ,business.industry ,Venetoclax ,Hematology ,Monoclonal antibody ,medicine.disease ,Article ,Lymphoma ,03 medical and health sciences ,chemistry.chemical_compound ,030104 developmental biology ,0302 clinical medicine ,chemistry ,Targeted drug delivery ,In vivo ,hemic and lymphatic diseases ,030220 oncology & carcinogenesis ,medicine ,Cancer research ,Rituximab ,business ,Diffuse large B-cell lymphoma ,medicine.drug - Abstract
Antibody drug conjugates represent an important class of anti-cancer drugs in both solid tumors and hematological cancers. Here, we report preclinical data on the anti-tumor activity of the first-in-class antibody drug conjugate MEN1309/OBT076 targeting CD205. The study included preclinical in vitro activity screening on a large panel of cell lines, both as single agent and in combination and validation experiments on in vivo models. CD205 was first shown frequently expressed in lymphomas, leukemias and multiple myeloma by immunohistochemistry on tissue microarrays. Anti-tumor activity of MEN1309/OBT076 as single agent was then shown across 42 B-cell lymphoma cell lines with a median IC50 of 200 pM and induction of apoptosis in 25/42 (59.5%) of the cases. The activity appeared highly correlated with its target expression. After in vivo validation as the single agent, the antibody drug conjugate synergized with the BCL2 inhibitor venetoclax, and the anti-CD20 monoclonal antibody rituximab. The first-in-class antibody drug targeting CD205, MEN1309/OBT076, demonstrated strong pre-clinical anti-tumor activity in lymphoma, warranting further investigations as a single agent and in combination.
- Published
- 2020
- Full Text
- View/download PDF
41. SECONDARY TRAUMATIZATION IN HEALTHCARE PROFESSIONS: A CONTINUUM ON COMPASSION FATIGUE, VICARIOUS TRAUMA AND BURNOUT
- Author
-
Maria Rosaria Anna Muscatello, Carmela Mento, Toshio Kawai, Maria Catena Silvestri, Antonio Bruno, Paola Merlino, Vanessa Nocito, and Rocco Antonio Zoccali
- Subjects
Psychotherapist ,Health professionals ,Continuum (measurement) ,Compassion fatigue ,business.industry ,Secondary traumatization, compassion fatigue, vicarious trauma, healthcare professionals ,Health care ,Secondary Traumatization ,Burnout ,business ,Psychology ,General Psychology - Published
- 2020
- Full Text
- View/download PDF
42. Optimal Selection Techniques for Cloud Service Providers
- Author
-
Giuseppe Tricomi, Alfonso Panarello, Antonio Puliafito, and Giovanni Merlino
- Subjects
General Computer Science ,optimal selection ,Computer science ,Interoperability ,Cloud computing ,02 engineering and technology ,Business model ,Resource (project management) ,Order (exchange) ,multi-cloud ,matchmaking ,0202 electrical engineering, electronic engineering, information engineering ,General Materials Science ,survey ,business.industry ,General Engineering ,020206 networking & telecommunications ,Cloud service provider ,Data science ,cloud federation ,Cloud federation ,Economies of scale ,Information and Communications Technology ,Scalability ,Algorithms, cloud federation, matchmaking, multi-cloud, optimal selection, survey ,020201 artificial intelligence & image processing ,lcsh:Electrical engineering. Electronics. Nuclear engineering ,business ,lcsh:TK1-9971 ,Algorithms - Abstract
Nowadays Cloud computing permeates almost every domain in Information and Communications Technology (ICT) and, increasingly, most of the action is shifting from large, dominant players toward independent, heterogeneous, private/hybrid deployments, in line with an ever wider range of business models and stakeholders. The rapid growth in the numbers and diversity of small and medium Cloud providers is bringing new challenges in the as-a-Services space. Indeed, significant hurdles for smaller Cloud service providers in being competitive with the incumbent market leaders induce some innovative players to “federate” deployments in order to pool a larger, virtually limitless, set of resources across the federation, and stand to gain in terms of economies of scale and resource usage efficiency. Several are the challenges that need to be addressed in building and managing a federated environment, that may go under the “Security”, “Interoperability”, “Versatility”, “Automatic Selection” and “Scalability” labels. The aim of this paper is to present a survey about the approaches and challenges belonging to the “Automatic Selection” category. This work provides a literature review of different approaches adopted in the “Automatic and Optimal Cloud Service Provider Selection”, also covering “Federated and Multi-Cloud” environments.
- Published
- 2020
43. Single-nucleotide polymorphism in chronic rhinosinusitis: A systematic review
- Author
-
Stefani Stefania, Maniaci Antonino, Musso Nicolò, Cocuzza Salvatore, Viglianisi Chiara, Christian Calvo-Henriquez, Merlino Federico, Lechien Jerome Renee, Stracquadanio Stefano, Bonanno Antonio, Santagati Maria, and Ignazio La Mantia
- Subjects
medicine.medical_specialty ,Chronic rhinosinusitis ,SNP ,Single-nucleotide polymorphism ,Comorbidity ,Polymorphism, Single Nucleotide ,polymorphism ,Atopy ,Pathogenesis ,Polymorphism (computer science) ,Internal medicine ,medicine ,Eosinophilia ,Humans ,Genetic Predisposition to Disease ,Sinusitis ,Asthma ,Rhinitis ,metagenomics ,business.industry ,chronic rhinosinusitis ,sequencing ,medicine.disease ,Otorhinolaryngology ,Chronic Disease ,medicine.symptom ,business - Abstract
Objectives We performed a systematic review on single nucleotide polymorphisms and risk-related chronic rhinosinusitis. Design and setting A comprehensive review of the last 20 years' English language literature regarding chronic rhinosinusitis and single nucleotide polymorphisms was performed. We included in the synthesis all the papers reporting gene variation implicated in the pathogenesis of chronic inflammation and polyps. Results We found 12 papers with 9,127 patients, of which 2,739 CRS cases and 6388 controls. The major comorbidities reported related to chronic rhinosinusitis were Atopy in 4,555 (49.9%), Asthma in 4594 (50.33%), Samter Triad in 448 (4.9%), and Eosinophilia in 391 subjects (4.28%). Conclusion Our systematic review revealed the major SNPs significantly associated with chronic rhinosinusitis and the specific pathways involved. Given the presence of different extraction methods and samples sequencing, further studies with larger courts are necessary to identify significative single nucleotide polymorphisms.
- Published
- 2022
44. Cost-effectiveness of the adherence with recommendations for clinical monitoring of patients with diabetes
- Author
-
Giovanni Corrao, Federico Rea, Giuseppe Mancia, Gianluca Perseghin, Luca Merlino, Nello Martini, Simona Carbone, Flavia Carle, Andrea Bucci, Marianxhela Dajko, Silvia Arcà, Donata Bellentani, Velia Bruno, Carla Ceccolini, Angela De Feo, Lucia Lispi, Rosanna Mariniello, Maurizio Masullo, Federica Medici, Paola Pisanti, Modesta Visca, Rinaldo Zanini, Teresa Di Fiandra, Natalia Magliocchetti, Giovanna Romano, Anna Cantarutti, Pietro Pugni, Marina Davoli, Mirko Di Martino, Adele Lallo, Patrizia Vittori, Giuliana Vuillermin, Alfonso Bernardo, Anna Fusciante, Laura Belotti, Rossana De Palma, Enza Di Felice, Roberta Chiandetti, Elena Clagnan, Stefania Del Zotto, Andrea Di Lenarda, Aldo Mariotto, Marisa Prezza, Loris Zanier, Danilo Fusco, Chiara Marinacci, Antonio Lora, Liana Spazzafumo, Simone Pizzi, Maria Simiele, Giuseppe Massaro, Ettore Attolini, Vito Lepore, Vito Petrarolo, Giovanni De Luca, Giovanna Fantaci, Sebastiano Pollina Addario, Salvatore Scondotto, Francesco Bellomo, Mario Braga, Valeria Di Fabrizio, Silvia Forni, Paolo Francesconi, Francesco Profili, Francesco Avossa, Matteo Corradin, Silvia Vigna, Letizia Dondi, Antonella Pedrini, Carlo Piccinni, Mimma Cosentino, Maria G. Marvulli, Aldo Maggioni, Corrao, G, Rea, F, Mancia, G, Perseghin, G, Merlino, L, Martini, N, Carbone, S, Carle, F, Bucci, A, Dajko, M, Arca, S, Bellentani, D, Bruno, V, Ceccolini, C, De Feo, A, Lispi, L, Mariniello, R, Masullo, M, Medici, F, Pisanti, P, Visca, M, Zanini, R, Di Fiandra, T, Magliocchetti, N, Romano, G, Cantarutti, A, Pugni, P, Davoli, M, Di Martino, M, Lallo, A, Vittori, P, Vuillermin, G, Bernardo, A, Fusciante, A, Belotti, L, De Palma, R, Di Felice, E, Chiandetti, R, Clagnan, E, Del Zotto, S, Di Lenarda, A, Mariotto, A, Prezza, M, Zanier, L, Fusco, D, Marinacci, C, Lora, A, Spazzafumo, L, Pizzi, S, Simiele, M, Massaro, G, Attolini, E, Lepore, V, Petrarolo, V, De Luca, G, Fantaci, G, Pollina Addario, S, Scondotto, S, Bellomo, F, Braga, M, Di Fabrizio, V, Forni, S, Francesconi, P, Profili, F, Avossa, F, Corradin, M, Vigna, S, Dondi, L, Pedrini, A, Piccinni, C, Cosentino, M, Marvulli, M, and Maggioni, A
- Subjects
Diagnostic Screening Programs ,Male ,medicine.medical_specialty ,Time Factors ,Databases, Factual ,National Health Programs ,Cost effectiveness ,Endocrinology, Diabetes and Metabolism ,Cost-Benefit Analysis ,Population ,Medicine (miscellaneous) ,Audit ,Diagnostic Techniques, Ophthalmological ,Diabete ,Kidney Function Tests ,Cost Savings ,Predictive Value of Tests ,Diabetes mellitus ,Health care ,medicine ,Diabetes Mellitus ,Healthcare cost ,Humans ,education ,Aged ,Incremental cost-effectiveness ratio ,education.field_of_study ,Nutrition and Dietetics ,medicine.diagnostic_test ,business.industry ,Periodic examination ,Health Care Costs ,Middle Aged ,medicine.disease ,Prognosis ,Population-based cohort study ,Real-world ,Italy ,Cost-effectivene ,Emergency medicine ,Patient Compliance ,Female ,Cardiology and Cardiovascular Medicine ,business ,Lipid profile ,Complication ,Blood Chemical Analysis ,Cohort study - Abstract
Background and aims To validate a set of indicators for monitoring the quality of care of patients with diabetes in ‘real-life’ practice through its relationship with measurable clinical outcomes and healthcare costs. Methods and results A population-based cohort study was carried out by including the 20,635 patients, residents in the Lombardy Region (Italy), who in the year 2012 were newly taken-in-care for diabetes. Adherence with clinical recommendations (i.e., controls for glycated haemoglobin, lipid profile, urine albumin excretion and serum creatinine) was recorded during the first year after the patient was taken-in-care, and categorized according whether he/she complied with none or almost none (0 or 1), just some (2) or all or almost all (3 or 4) the recommendations, respectively denoted as poor, intermediate and high adherence. Short- and long-term complications of diabetes, and healthcare cost incurred by the National Health Service, were assessed during follow-up. Compared with patients with poor adherence, those with intermediate and high adherence respectively showed (i) a delay in outcome occurrence of 13 days (95% CI, -2 to 27) and 23 days (9 to 38), and (ii) a lower healthcare cost of 54 € and 77 €. In average, a gain of 18 Euros and 15 Euros for each day free from diabetic complication by increasing adherence respectively from poor to intermediate and from poor to high were observed. Conclusion Close control of patients with diabetes through regular clinical examinations must be considered the cornerstone of national guidance, national audits, and quality improvement incentive schemes.
- Published
- 2021
45. Modern Managers in Gig Economies: Competencies, Personality and their Effect on Manager Education in the Digital Era
- Author
-
Irina Kuzmina-Merlino, Kristīne Užule, and Massimo Merlino
- Subjects
Promotion (rank) ,Economy ,Order (exchange) ,Process (engineering) ,media_common.quotation_subject ,Management system ,Workforce ,Business sector ,Digital transformation ,Personality ,Business ,media_common - Abstract
Social and economic aspects of life of society have been impacted by digital technologies; a process, which has significantly accelerated with the new millennium. Making effective business decisions in the contemporary world of evolving digital solutions without considering digital information and sources is hardly productive. This has triggered a deep socio-economic transformation across various aspects of life of society, including a diverse range of business sectors and the emergence of the gig economy and gig workforce, which has been defined by Wood et al. (2019) as people who offer their services through mobile applications. This results in the need of more rigid management systems. Furthermore, the EU vision of competitiveness of EU economies is associated with the transformation of markets and the acquisition of digital skills by the EU workforce. However, there is a lack of management professionals with digital skills capable of fluent use of digital technologies and their promotion in their teams. Business and management programs at universities are structural units that can offer the development of such skills. The key goal of this research paper is to identify manager digital competencies that are currently in demand and to determine if entrepreneurial skills and knowledge of personality can assist in the development of digital skills in order to provide more effective educational approaches to support the management needs in the era of digital transformation. In order to attain the goal, literature review and the survey of senior managers of Latvian enterprises were conducted. Latvia was chosen because Latvia has low indicators of integrating digital technologies into the economy. The outcome of the research is the proposal of conceptual aspects of enhancing students’ digital, entrepreneurial and psychological skills in order to provide more effective educational approaches to support the management needs in the era of digital transformation and the digital quotient having been added to one of the key coefficients of people’s abilities.
- Published
- 2021
- Full Text
- View/download PDF
46. Acute revascularization treatments for ischemic stroke in the Stroke Units of Triveneto, northeast Italy: time to treatment and functional outcomes
- Author
-
Paolo Passadore, Simona Carella, Marcello Naccarato, Giulia Sajeva, Alessio Pieroni, Sandro Zambito, Giulio Bozzato, Domenico Idone, Giampietro Zanette, Anna Maria Basile, Roberta Padoan, Federica Viaro, Adriana Critelli, Salvatore Lanzafame, Paola Caruso, Giampietro Ruzza, Morena Cadaldini, Giovanni Merlino, Manuel Cappellari, Bruno Giometto, Antonella De Boni, Michele Morra, Alessandro Campagnaro, Antonio Baldi, Matteo Atzori, Simone Tonello, Agnese Tonon, Simone Lorenzut, Martina Bruno, Roberto Bombardi, Elisabetta Menegazzo, Emanuele Turinese, Bruno Bonetti, Franco Ferracci, Francesco Paladin, M. Turazzini, Luca Zanet, Marco Simonetto, Alberto Polo, Bruno Marini, Elisa Corazza, Paolo Bovi, Monia Russo, Stefano Forlivesi, Silvia Vittoria Guidoni, Anna Gaudenzi, Valeria Bignamini, Roberto L’Erario, Maela Masato, Alessandro Burlina, Carmine Tamborino, Francesco Perini, Cappellari, M., Bonetti, B., Forlivesi, S., Sajeva, G., Naccarato, M., Caruso, P., Lorenzut, S., Merlino, G., Viaro, F., Pieroni, A., Giometto, B., Bignamini, V., Perini, F., De Boni, A., Morra, M., Critelli, A., Tamborino, C., Tonello, S., Guidoni, S. V., L'Erario, R., Russo, M., Burlina, A., Turinese, E., Passadore, P., Zanet, L., Polo, A., Turazzini, M., Basile, A. M., Atzori, M., Marini, B., Bruno, M., Carella, S., Campagnaro, A., Baldi, A., Corazza, E., Zanette, G., Idone, D., Gaudenzi, A., Bombardi, R., Cadaldini, M., Lanzafame, S., Ferracci, F., Zambito, S., Ruzza, G., Simonetto, M., Menegazzo, E., Masato, M., Padoan, R., Bozzato, G., Paladin, F., Tonon, A., and Bovi, P.
- Subjects
Male ,medicine.medical_specialty ,medicine.medical_treatment ,Time to treatment ,Thrombolysi ,030204 cardiovascular system & hematology ,Revascularization ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,medicine ,80 and over ,Humans ,Thrombolytic Therapy ,030212 general & internal medicine ,Prospective Studies ,Outcome ,Thrombectomy ,Aged ,Aged, 80 and over ,Univariate analysis ,Ischemic stroke ,business.industry ,Thrombolysis ,Female ,Ischemic Stroke ,Italy ,Middle Aged ,Treatment Outcome ,Stroke units ,Hematology ,Odds ratio ,Confidence interval ,Prospective Studie ,Cardiology and Cardiovascular Medicine ,business ,Human - Abstract
It is not known whether the current territorial organization for acute revascularization treatments in ischemic stroke patients guarantees similar time to treatment and functional outcomes among different levels of institutional stroke care. We aimed to assess the impact of time to treatment on functional outcomes in ischemic stroke patients who received intravenous thrombolysis (IVT) alone, bridging (IVT plus thrombectomy), or primary thrombectomy in level 1 and level 2 Stroke Units (SUs) in Triveneto, a geographical macroarea in Northeast of Italy. We conducted an analysis of data prospectively collected from 512 consecutive ischemic stroke patients who received IVT and/or mechanical thrombectomy in 25 SUs from September 17th to December 9th 2018. The favorable outcome measures were mRS score 0–1 and 0–2 at 3months. The unfavorable outcome measures were mRS score 3–5 and death at 3months. We estimated separately the possible association of each variable for time to treatment (onset-to-door, door-to-needle, onset-to-needle, door-to-groin puncture, needle-to-groin puncture, and onset-to-groin puncture) with 3-month outcome measures by calculating the odds ratios (ORs) with two-sided 95% confidence intervals (CI) after adjustment for pre-defined variables and variables with a probability value ≤ 0.10 in the univariate analysis for each outcome measure. Distribution of acute revascularization treatments was different between level 1 and level 2 SUs (p < 0.001). Among 182 patients admitted to level 1 SUs (n = 16), treatments were IVT alone in 164 (90.1%), bridging in 12 (6.6%), and primary thrombectomy in 6 (3.3%) patients. Among 330 patients admitted to level 2 SUs (n = 9), treatments were IVT alone in 219 (66.4%), bridging in 74 (22.4%), and primary thrombectomy in 37 (11.2%) patients. Rates of excellent outcome (51.4% vs 45.9%), favorable outcome (60.1% vs 58.7%), unfavorable outcome (33.3% vs 33.8%), and death (9.8% vs 11.3%) at 3months were similar between level 1 and 2 SUs. No significant association was found between time to IVT alone (onset-to-door, door-to-needle, and onset-to-needle) and functional outcomes. After adjustment, door-to-needle time ≤ 60min (OR 4.005, 95% CI 1.232–13.016), shorter door-to-groin time (OR 0.991, 95% CI 0.983–0.999), shorter needle-to-groin time (OR 0.986, 95% CI 0.975–0.997), and shorter onset-to-groin time (OR 0.994, 95% CI 0.988–1.000) were associated with mRS 0–1. Shorter door-to-groin time (OR 0.991, 95% CI 0.984–0.998), door-to-groin time ≤ 90min (OR 12.146, 95% CI 2.193–67.280), shorter needle-to-groin time (OR 0.983, 95% CI 0.972–0.995), and shorter onset-to-groin time (OR 0.993, 95% CI 0.987–0.999) were associated with mRS 0–2. Longer door-to-groin time (OR 1.007, 95% CI 1.001–1.014) and longer needle-to-groin time (OR 1.019, 95% CI 1.005–1.034) were associated with mRS 3–5, while door-to-groin time ≤ 90min (OR 0.229, 95% CI 0.065–0.808) was inversely associated with mRS 3–5. Longer onset-to-needle time (OR 1.025, 95% CI 1.002–1.048) was associated with death. Times to treatment influenced the 3-month outcomes in patients treated with thrombectomy (bridging or primary). A revision of the current territorial organization for acute stroke treatments in Triveneto is needed to reduce transfer time and to increase the proportion of patients transferred from a level 1 SU to a level 2 SU to perform thrombectomy.
- Published
- 2021
- Full Text
- View/download PDF
47. COMPASS criteria applied to a contemporary cohort of unselected patients with stable coronary artery diseases: Insights from the STARTregistry
- Author
-
De Luca L., Formigli D., Meessen J., Uguccioni M., Cosentino N., Paolillo C., Di Lenarda A., Colivicchi F., Gabrielli D., Gulizia M. M., Scherillo M., Maras P., Ramani F., Falcone C., Passarelli I., Mauri S., Calabro P., Bianchi R., Di Palma G., Mascia F., Vetrano A., Fusco A., Proia E., Aiello A., Tomai F., Licitra R., Petrolini A., Bosco B., Magliari F., Callerame M., Mazzella T., Lettica G. V., Coco G., Incao F., Marinacci L., D'Addario S., Tartaglione S. N., Ubaldi S., Sanchez F. A., Costa P., Manca G., Failla M., Procaccini V., Senni M., Luminita E. M., Bonomo P., Mossa C., Corda S., Colavita A. R., Trevisonno G., Vizzari G., Formaro C., Nalin I. L., De Rosa F. M., Fontana F., Fuscaldo G. F., Passamonti E., Bertella E., Calvaruso E. V., Varani E., Tani F., Cicchitelli G., Paoloni P., Marziali A., Campo G., Tebaldi M., Biscaglia S., Di Biase M., Brunetti N. D., Gallotta A. M., Mattei L., Marini R., Balsemin F., D'Urbano M., Naio R., Vicinelli P., Arena G., Mazzini M., Gigli N., Miserrafiti B., Monopoli A., Mortara A., Delfino P., Chioffi M. M., Marino P., Gravellone M., Barbieri L., Ledda A., Geraci G., Carmina M. G., Raisaro A. E., Di Giacomo C., Somaschini A., Fasano M. L., Sannazzaro M., Arcieri R., Pantaleoni M., Leuzzi C., Gorlato G., Greco G., Chiera A., Ammaturo T. A., Malanchini G., Del Corral M. P., Tedesco L., Pede S., Urso L. G., Piscione F., Galasso G., Provasoli S., Fattore L., Lucca G., Cresti A., Cardillo A., Fera M. S., Vennettilli F., Gaudio C., Paravati V., Caldarola P., Locuratolo N., Verlato R., De Conti F., Turiano G., Preti G., Moretti L., Silenzi S., Colonna G., Picciolo A., Nicosia A., Cascone C., Di Sciascio G., Mangiacapra F., Russo A., Mastroianno S., Esposito G., Cosmi F., D'Orazio S., Costantini C., Lanari A., De Rosa P., Esposito L., Bilato C., Dalla Valle C., Ceresa M., Colombo E., Pennisi V., Casciola G., Driussi M., Bisceglia T., Scalvini S., Rivadossi F., Volpe M., Comito F., Scorzoni D., Grimoldi P., Lagioia R., Santoro D., De Cesare N., Comotti T., Poli A., Martina P., Musolino M. F., Multari E. I., Bilardo G., Scalchi G., Olivieri C., Caranci F., Pavan D., Ganci G., Mariani A., Falchetti E., Lanzillo T., Caccavale A., Bongo A. S., Rizzi A., Favilli R., Maffei S., Mallardo M., Fulgione C., Bordin F., Bonmassari R., Battaia E., Puzzo A., Vianello G., D'Arpino A., Romei M., Pajes G., Petronzelli S., Ghezzi F., Brigido S., Pignatelli L., Brscic E., Sori P., Russo M., Biancolillo E., Ignone G., De Giorgio N. A., Campaniello C., Ponticelli P., Margonato A., Gerosa S., Cutaia A., Casalicchio C., Bartolomucci F., Larosa C., Spadafina T., Putignano A., Se Cristofaro R., Bernardi L., Sommariva L., Celestini A., Bertucci C. M., Marchetti M., Franceschini Grisolia E., Ammendolea C., Carini M., Scipione P., Politano M., Rubino G., Reina C., Peccerillo N., Paloscia L., D'Alleva A., Petacchi R., Pignalosa M., Lucchetti D., Di Palma F., La Mastra R. A., Amico A. F., De Filippis M., Fontanella B., Zanini G., Casolo G., Del Meglio J., Parato V. M., Genovesi E., D'Alimonte A., Miglioranza A., Alessandri N., Moscariello F., Mauro C., Sasso A., Caso P., Petrillo C., Napoletano C., Paparoni S. R., Bernardo V., Serdoz R., Rotunno R., Oppo I., Aloisio A., Aurelio A., Licciardello G., Cassaniti L., Francese G. M., Marcassa C., Temporelli P. L., Villani R., Zorzoli F., Mileto F., De Vecchis M., Scolozzi D., Lupi G., Caruso D., Rebulla E., La Fata B., Anselmi M., Girardi P., Borruso E., Ferrantelli G., Sassone B., Bressan S., Capriolo M., Pelissero E., Piancastelli M., Gobbi M., Cocco F., Bruno M. G., Berti S., Lo Surdo G., Tanzi P., De Rosa R., Vilei E., De Iaco M. R., Grassi G., Zanella C., Marullo L., Alfano G., Pelaggi P., Talarico R., Tuccillo B., Irace L., Proietti F., Di Croce G., Di Lorenzo L., Zarrilli A., Bongini M., Ranise A., Aprile A., Fornengo C., Capogrosso V., Tranghese A., Golia B., Marziano A., Roncon L., Picariello C., Bagni E., Leci E., Gregorio G., Gatto F., Piemonte F., Gervasio F., Navazio A., Guerri E., Belmonte E., Marino F., Di Belardino N., Di Nuzzo M. R., Epifani M., Comolatti G., Conconi B., Benea D., Casu G., Merella P., Ammirati M. A., Corrado V. M., Spagnolo D., Caico S. I., Bonizzato S., Margheri M., Corrado L., Antonicelli R., Ferrigno C., Merlino A., Nassiacos D., Antonelli A., Marchese A., Villella A., Bechi S., Lo Bianco F., Bedogni F., Negro L., Donato L., Statile D., Cassin M., Fedele F., Granatelli A., Calcagno S., Politi A., Pani A., De Luca, L, Formigli, D, Meessen, J, Uguccioni, M, Cosentino, N, Paolillo, C, Di Lenarda, A, Colivicchi, F, Gabrielli, D, Gulizia, M, Scherillo, M, Maras, P, Ramani, F, Falcone, C, Passarelli, I, Mauri, S, Calabro, P, Bianchi, R, Di Palma, G, Mascia, F, Vetrano, A, Fusco, A, Proia, E, Aiello, A, Tomai, F, Licitra, R, Petrolini, A, Bosco, B, Magliari, F, Callerame, M, Mazzella, T, Lettica, G, Coco, G, Incao, F, Marinacci, L, D'Addario, S, Tartaglione, S, Ubaldi, S, Sanchez, F, Costa, P, Manca, G, Failla, M, Procaccini, V, Senni, M, Luminita, E, Bonomo, P, Mossa, C, Corda, S, Colavita, A, Trevisonno, G, Vizzari, G, Formaro, C, Nalin, I, De Rosa, F, Fontana, F, Fuscaldo, G, Passamonti, E, Bertella, E, Calvaruso, E, Varani, E, Tani, F, Cicchitelli, G, Paoloni, P, Marziali, A, Campo, G, Tebaldi, M, Biscaglia, S, Di Biase, M, Brunetti, N, Gallotta, A, Mattei, L, Marini, R, Balsemin, F, D'Urbano, M, Naio, R, Vicinelli, P, Arena, G, Mazzini, M, Gigli, N, Miserrafiti, B, Monopoli, A, Mortara, A, Delfino, P, Chioffi, M, Marino, P, Gravellone, M, Barbieri, L, Ledda, A, Geraci, G, Carmina, M, Raisaro, A, Di Giacomo, C, Somaschini, A, Fasano, M, Sannazzaro, M, Arcieri, R, Pantaleoni, M, Leuzzi, C, Gorlato, G, Greco, G, Chiera, A, Ammaturo, T, Malanchini, G, Del Corral, M, Tedesco, L, Pede, S, Urso, L, Piscione, F, Galasso, G, Provasoli, S, Fattore, L, Lucca, G, Cresti, A, Cardillo, A, Fera, M, Vennettilli, F, Gaudio, C, Paravati, V, Caldarola, P, Locuratolo, N, Verlato, R, De Conti, F, Turiano, G, Preti, G, Moretti, L, Silenzi, S, Colonna, G, Picciolo, A, Nicosia, A, Cascone, C, Di Sciascio, G, Mangiacapra, F, Russo, A, Mastroianno, S, Esposito, G, Cosmi, F, D'Orazio, S, Costantini, C, Lanari, A, De Rosa, P, Esposito, L, Bilato, C, Dalla Valle, C, Ceresa, M, Colombo, E, Pennisi, V, Casciola, G, Driussi, M, Bisceglia, T, Scalvini, S, Rivadossi, F, Volpe, M, Comito, F, Scorzoni, D, Grimoldi, P, Lagioia, R, Santoro, D, De Cesare, N, Comotti, T, Poli, A, Martina, P, Musolino, M, Multari, E, Bilardo, G, Scalchi, G, Olivieri, C, Caranci, F, Pavan, D, Ganci, G, Mariani, A, Falchetti, E, Lanzillo, T, Caccavale, A, Bongo, A, Rizzi, A, Favilli, R, Maffei, S, Mallardo, M, Fulgione, C, Bordin, F, Bonmassari, R, Battaia, E, Puzzo, A, Vianello, G, D'Arpino, A, Romei, M, Pajes, G, Petronzelli, S, Ghezzi, F, Brigido, S, Pignatelli, L, Brscic, E, Sori, P, Russo, M, Biancolillo, E, Ignone, G, De Giorgio, N, Campaniello, C, Ponticelli, P, Margonato, A, Gerosa, S, Cutaia, A, Casalicchio, C, Bartolomucci, F, Larosa, C, Spadafina, T, Putignano, A, Se Cristofaro, R, Bernardi, L, Sommariva, L, Celestini, A, Bertucci, C, Marchetti, M, Franceschini Grisolia, E, Ammendolea, C, Carini, M, Scipione, P, Politano, M, Rubino, G, Reina, C, Peccerillo, N, Paloscia, L, D'Alleva, A, Petacchi, R, Pignalosa, M, Lucchetti, D, Di Palma, F, La Mastra, R, Amico, A, De Filippis, M, Fontanella, B, Zanini, G, Casolo, G, Del Meglio, J, Parato, V, Genovesi, E, D'Alimonte, A, Miglioranza, A, Alessandri, N, Moscariello, F, Mauro, C, Sasso, A, Caso, P, Petrillo, C, Napoletano, C, Paparoni, S, Bernardo, V, Serdoz, R, Rotunno, R, Oppo, I, Aloisio, A, Aurelio, A, Licciardello, G, Cassaniti, L, Francese, G, Marcassa, C, Temporelli, P, Villani, R, Zorzoli, F, Mileto, F, De Vecchis, M, Scolozzi, D, Lupi, G, Caruso, D, Rebulla, E, La Fata, B, Anselmi, M, Girardi, P, Borruso, E, Ferrantelli, G, Sassone, B, Bressan, S, Capriolo, M, Pelissero, E, Piancastelli, M, Gobbi, M, Cocco, F, Bruno, M, Berti, S, Lo Surdo, G, Tanzi, P, De Rosa, R, Vilei, E, De Iaco, M, Grassi, G, Zanella, C, Marullo, L, Alfano, G, Pelaggi, P, Talarico, R, Tuccillo, B, Irace, L, Proietti, F, Di Croce, G, Di Lorenzo, L, Zarrilli, A, Bongini, M, Ranise, A, Aprile, A, Fornengo, C, Capogrosso, V, Tranghese, A, Golia, B, Marziano, A, Roncon, L, Picariello, C, Bagni, E, Leci, E, Gregorio, G, Gatto, F, Piemonte, F, Gervasio, F, Navazio, A, Guerri, E, Belmonte, E, Marino, F, Di Belardino, N, Di Nuzzo, M, Epifani, M, Comolatti, G, Conconi, B, Benea, D, Casu, G, Merella, P, Ammirati, M, Corrado, V, Spagnolo, D, Caico, S, Bonizzato, S, Margheri, M, Corrado, L, Antonicelli, R, Ferrigno, C, Merlino, A, Nassiacos, D, Antonelli, A, Marchese, A, Villella, A, Bechi, S, Lo Bianco, F, Bedogni, F, Negro, L, Donato, L, Statile, D, Cassin, M, Fedele, F, Granatelli, A, Calcagno, S, Politi, A, and Pani, A
- Subjects
medicine.medical_specialty ,animal structures ,Population ,Myocardial Infarction ,Coronary artery disease ,Rivaroxaban ,Internal medicine ,Epidemiology ,medicine ,Humans ,Registries ,Myocardial infarction ,education ,Stroke ,education.field_of_study ,Aspirin ,business.industry ,Health Policy ,Incidence (epidemiology) ,medicine.disease ,COMPASS trial ,Cohort ,Cardiology and Cardiovascular Medicine ,business ,START registry ,Mace - Abstract
Aims Recently, the cardiovascular outcomes for people using anticoagulation strategies (COMPASS) trial demonstrated that dual therapy reduced cardiovascular outcomes compared with aspirin alone in patients with stable atherosclerotic disease. Methods and results We sought to assess the proportion of patients eligible for the COMPASS trial and to compare the epidemiology and outcome of these patients with those without COMPASS inclusion or with any exclusion criteria in a contemporary, nationwide cohort of patients with stable coronary artery disease. Among the 4068 patients with detailed information allowing evaluation of eligibility, 1416 (34.8%) did not fulfil the inclusion criteria (COMPASS-Not-Included), 841 (20.7%) had exclusion criteria (COMPASS-Excluded), and the remaining 1811 (44.5%) were classified as COMPASS-Like. At 1 year, the incidence of major adverse cardiovascular event (MACE), a composite of cardiovascular death, myocardial infarction, and stroke, was 0.9% in the COMPASS-Not-Included and 2.0% in the COMPASS-Like (P = 0.01), and 5.0% in the COMPASS-Excluded group (P Conclusion In a contemporary real-world cohort registry of stable coronary artery disease, most patients resulted as eligible for the COMPASS. These patients presented a considerable annual risk of MACE that consistently increases in the presence of multiple risk factors.
- Published
- 2021
48. Association between Adherence with Recommended Antenatal Care in Low-Risk, Uncomplicated Pregnancy, and Maternal and Neonatal Adverse Outcomes: Evidence from Italy
- Author
-
Simona Carbone, Anna Locatelli, Luca Merlino, Flavia Carle, Rinaldo Zanini, Anna Cantarutti, Giovanni Corrao, and Gloria Porcu
- Subjects
medicine.medical_specialty ,Health, Toxicology and Mutagenesis ,Population ,lcsh:Medicine ,Article ,Cohort Studies ,03 medical and health sciences ,0302 clinical medicine ,antenatal care ,periodic examinations ,Intensive care ,neonatal outcomes ,Humans ,Medicine ,030212 general & internal medicine ,education ,Uncomplicated pregnancy ,Pregnancy ,education.field_of_study ,030219 obstetrics & reproductive medicine ,business.industry ,Obstetrics ,maternal outcomes ,lcsh:R ,Infant, Newborn ,Pregnancy Outcome ,Public Health, Environmental and Occupational Health ,Prenatal Care ,Infant, Low Birth Weight ,medicine.disease ,Confidence interval ,Pregnancy Complications ,Low birth weight ,Italy ,recommendations ,Patient Compliance ,Female ,Apgar score ,pregnancy ,medicine.symptom ,business ,Cohort study - Abstract
Antenatal care (ANC) aims of monitoring wellbeing of mother and foetus during pregnancy. We validate a set of indicators aimed of measuring the quality of ANC of women on low-risk, uncomplicated pregnancy through their relationship with maternal and neonatal outcomes. We conducted a population-based cohort study including 122,563 deliveries that occurred between 2015 and 2017 in the Lombardy Region, Italy. Promptness and appropriateness of number and timing of gynaecological visits, ultrasounds and laboratory tests were evaluated. We assessed several maternal and neonatal outcomes. Log-binomial regression models were used to estimate prevalence ratio (PR), and corresponding 95% confidence interval (95% CI), for the exposure&rarr, outcome association. Compared with women who adhered with recommendations, those who were no adherent had a significant higher prevalence of maternal intensive care units admission (PR: 3.1, 95%CI: 1.2&ndash, 7.9, and 2.7, 1.1&ndash, 7.0 respectively for promptness of gynaecological visits, and appropriateness of ultrasound examinations), low Apgar score (1.6, 1.1&ndash, 1.2, 1.9, 1.3&ndash, 2.7, and 2.1, 1.5&ndash, 2.8 respectively for appropriateness and promptness of gynaecological visits, and appropriateness of ultrasound examinations), and low birth weight (1.8, 1.5&ndash, 2.3 for appropriateness of laboratory test examinations). Benefits for mothers and newborn are expected from improving adherence to guidelines-driven recommendations regarding antenatal care even for low-risk, uncomplicated pregnancies.
- Published
- 2021
49. Opioids and Breast Cancer Recurrence: A Systematic Review
- Author
-
Del Prete Federica, Titi Luca, Piccioni Maria Grazia, Merlino Lucia, Mandosi Chiara, Galli Cecilia, De Marchis Laura, and Della Rocca Carlo
- Subjects
Cancer Research ,medicine.medical_specialty ,Palliative care ,Analgesic ,Disease ,anesthesia ,Breast cancer ,breast cancer ,Epidemiology ,medicine ,Intensive care medicine ,RC254-282 ,business.industry ,breast cancer recurrence ,breast cancer surgery ,opioids ,Chronic pain ,Cancer ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,medicine.disease ,Oncology ,Opioid ,Systematic Review ,business ,medicine.drug - Abstract
Simple Summary Opioids are one of the therapeutic and palliative options for breast cancer, a tumor with a strong epidemiological impact. Studies have been extensively reported in the literature that show a connection between the administration of opioids and the recurrence of the disease, both during surgery and subsequently in the management of cancer pain. This argument, in consideration of the strong impact of this cancer, is of great interest. Therefore, we decided, through the study of the existing literature, to describe the state of the art on this topic, to outline the best therapeutic approach to be adopted in these delicate patients. Abstract Breast cancer has the greatest epidemiological impact in women. Opioids represent the most prescribed analgesics, both in surgical time and in immediate postoperative period, as well as in chronic pain management as palliative care. We made a systematic review analyzing the literature’s evidence about the safety of opioids in breast cancer treatment, focusing our attention on the link between opioid administration and increased relapses. The research has been conducted using the PubMed database. Preclinical studies, retrospective and prospective clinical studies, review articles and original articles were analyzed. In the literature, there are several preclinical in vitro and in vivo studies, suggesting a possible linkage between opioids administration and progression of cancer disease. Nevertheless, these results are not confirmed by clinical studies. The most recent evidence reassures the safety of opioids during surgical time as analgesic associated with anesthetics drugs, during postoperative period for optimal cancer-related pain management and in chronic use. Currently, there is controversial evidence suggesting a possible impact of opioids on breast cancer progression, but to date, it remains an unresolved issue. Although there is no conclusive evidence, we hope to arouse interest in the scientific community to always ensure the best standards of care for these patients.
- Published
- 2021
50. Antihypertensive Treatment in Elderly Frail Patients: Evidence From a Large Italian Database
- Author
-
Luca Merlino, Andrea Ungar, Giovanni Corrao, Giuseppe Mancia, Anna Cantarutti, Federico Rea, Rea, F, Cantarutti, A, Merlino, L, Ungar, A, Corrao, G, and Mancia, G
- Subjects
Gerontology ,Male ,Databases, Factual ,medicine.drug_class ,Frail Elderly ,Population ,MEDLINE ,population ,Blood Pressure ,030204 cardiovascular system & hematology ,computer.software_genre ,Lower risk ,Logistic regression ,Medication Adherence ,03 medical and health sciences ,0302 clinical medicine ,Internal Medicine ,Medicine ,Humans ,Frail elderly ,030212 general & internal medicine ,Medical prescription ,Antihypertensive drug ,education ,Antihypertensive Agents ,Aged ,Aged, 80 and over ,education.field_of_study ,Database ,business.industry ,Confounding ,mortality ,Survival Rate ,Italy ,Cohort ,Hypertension ,antihypertensive drug ,Female ,business ,computer - Abstract
Aim of our study was to assess the relationship between adherence with antihypertensive drugs and the risk of death in frail versus nonfrail old individuals. Using the database of the Lombardy Region (Italy), we identified 1 283 602 residents aged ≥65 years (mean age 76) who had ≥3 prescriptions of antihypertensive drugs between 2011 and 2012. A nested case-control design was applied, with cases being the cohort members who died during the observation period (7 years). Logistic regression was used to model the association of interest, with adjustment for potential confounders. Adherence was measured by the proportion of the follow-up covered by prescriptions, and the analysis was separately performed in patients with a good, medium, poor, and very poor clinical status, as assessed by a score that has been shown to be a sensitive predictor of death in the Italian population. The 7-year death probability increased from 16% (good) to 64% (very poor) clinical status. Compared with patients with very low adherence with antihypertensive treatment (75% of time covered by prescriptions) exhibited a lower risk of all-cause mortality in each group, the difference decreasing progressively (−44%, −43%, −40%, and −33%) from the good to the very poor clinical status. Adherence with antihypertensive drug treatment was also associated with a lower risk of cardiovascular mortality. Adherence with antihypertensive appears to be protective in frail old patients, but the benefit is less marked than in patients with a good clinical status.
- Published
- 2020
Catalog
Discovery Service for Jio Institute Digital Library
For full access to our library's resources, please sign in.