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The current COVID-19 pandemic presents one of the greatest challenges in human history. There is a consensus that the rapid and accurate diagnosis of COVID-19 directly affects procedures to avoid dissemination, promote treatments, and favor the prognosis of infected patients. This interdisciplinary study aims at designing new synthetic peptides inspired by the SARS-CoV-2 spike protein (SARS-CoV-2S) to produce rapid detection tests relying on nanomaterial-based colorimetric properties. Hence

BackgroundIdentifying determinants of the novel severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) transmission in settings of contagion is fundamental to inform containment strategies. We assessed SARS-CoV-2 cycle threshold value (Ct) from the first diagnostic nasal–pharyngeal swab of symptomatic index cases and which demographic or clinical characteristics among cases and contacts are associated with transmission risk within households.MethodsThis is a retrospective prevalence study on secondary SARS-CoV-2 cases (SC) among the household contacts of symptomatic adult index cases randomly sampled from all the SARS-CoV-2-positive diagnostic nasopharyngeal swabs analyzed at our regional referral hospital (Amedeo di Savoia Hospital, Turin, Italy) in March, 2020. Index cases underwent a telephone survey to collect their demographic and clinical data and all their household contacts. The Ct value of RdRp gene from the first diagnostic swab of index cases was recorded and index cases were grouped according to Ct tertiles (A < first tertile, first ≤ B ≤ second tertile, C ≥ second tertile). Post hoc analysis was performed in SC as well as contacts that did not undergo SARS-CoV-2 testing but developed compatible signs and symptoms. Non-parametric tests and generalized linear models were run.ResultsIndex (n = 72) and contact (n = 164) median age was 54 (48–63) and 32 (20–56) years, respectively. A total of 60, 50, and 54 subjects were contacts of group A, B, and C index cases, respectively; 35.9% of contacts were SC. Twenty-four further subjects (14.6%) met the criteria for symptom-based likely positive SC. The secondary attack rate was 36.0% (28.6–43.4), assuming a mean incubation period of 5 days and a maximum infectious period of 20 days. SC prevalence differed between Ct groups (53.3% A, 32.0% B, 20.4% C; p < 0.001). No difference in SC was found according to sex, presence of signs/symptoms, and COVID-19 severity of index cases, or according to contacts’ sex and number per household. The age of both index cases [aOR 4.52 (1.2–17.0) for 60 vs. ≤45 years old] and contacts [aOR 3.66 (1.3–10.6) for 60 vs. ≤45years old] and the Ct of the index [aOR 0.17 (0.07–0.4) for Ct ≥ 31.8 vs. Ct < 24.4] independently associated with SC risk. Sensitivity analysis including symptoms-based likely positive SC supported all the previous results.ConclusionIn confined transmission settings such as households, PCR Ct values may inform on the contagiousness of infected subjects and age may modulate transmission/contagion risk.

Background and objective : The causes of declining survival in cirrhotic patients are dominated by complications in developing countries. But data on survival among cirrhotics in Sub-Saharan Africa are sketchy. The general objective was to assess the survival and predictors of mortality in patients with viral cirrhosis of the liver in 3 hospitals in the Democratic Republic of Congo. Methods: A historic cohort study from 2009 to December 2018. Patients were recruited and followed up at the Ngaliema Clinic, CUK and HPGRK for 10 years. Death was the endpoint and patients lost to follow-up were censored. The Kaplan Méier curves made it possible to describe the survival of children at the threshold of p

Aims: Previous studies have demonstrated that the tumour–stroma ratio (TSR) and tumour budding are of prognostic value for oral squamous cell carcinomas (OSCCs). The aim of this study was to evaluate the prognostic significance of those histological parameters, individually and in combination, for OSCC. Methods and results: The TSR and tumour budding (the presence of five or more buds at the invasive front) were estimated in 254 patients with OSCC. The clinicopathological association was investigated with a chi‐square test, and the prognostic significance (cancer‐specific survival and disease‐free survival) was verified with Kaplan–Meier analysis and the Cox proportional hazard model. The TSR (≥50%, stroma‐rich) was significantly and independently associated with both shortened cancer‐specific survival and poor disease‐free survival, whereas tumour budding was significantly associated with reduced cancer‐specific survival. The TSR/tumour budding model was independently associated with a high risk of cancer mortality and recurrence (disease‐free survival). In patients with early‐stage tumours (clinical stage I and II, n = 103), the TSR, tumour budding and the TSR/tumour budding model were significantly associated with both cancer‐related death and recurrence, whereas, in advanced‐stage tumours (clinical stage III and IV, n = 144), only the TSR and the TSR/tumour budding model were significantly associated with cancer‐specific survival. Conclusion: The TSR, tumour budding and their combination provide significant information on OSCC outcome, suggesting that their incorporation in the routine evaluation of histopathological specimens might be useful in prognostication for OSCC patients.

Made available in DSpace on 2019-03-22T02:02:34Z (GMT). No. of bitstreams: 1 tese_13076_Tese - Berthil Borges Longo.pdf: 4884770 bytes, checksum: 9207fe4d3be5bdf04488161d2e7388b0 (MD5) Previous issue date: 2019-02-19 O objetivo de um processo de reabilitação é restaurar uma pessoa para um estado de ótimo funcionamento. Uma ampla variedade de processos de reabilitação consiste em exercícios de repetição de tarefas. Assim, Jogos Sérios podem ser utilizados como tecnologia para ajudar neste processo, motivando os pacientes a executar os exercícios durante as sessões de reabilitação, usando uma variedade de artefatos, como por exemplo, metas ou pontos a serem alcançados durante as sessões. Contudo, os jogos utilizados nesses processos podem ser jogos comerciais, projetados com função principal o entretenimento, ou jogos criados especificamente para reabilitação. Esses últimos têm algumas vantagens sobre os primeiros, pois são projetados especificamente para esse propósito, envolvendo conhecimento específico na área de reabilitação no desenvolvimento dos jogos. Entretanto, existe uma discussão sobre a eficácia clínica e a aceitação por parte de usuários e profissionais de saúde envolvidos nessa nova abordagem, e como integrá-la dentro da reabilitação convencional. De acordo com o Relatório Mundial sobre Deficiência produzido pela Organização Mundial de Saúde, pessoas com deficiência e suas famílias são mais propensas a sofrer desvantagens econômicas, educacionais e sociais do que as pessoas sem deficiência, o que também é realidade para a maioria da população brasileira. Assim, é importante que as novas abordagens desenvolvidas sejam acessíveis para todos, independentemente do seu nível social. O uso de dispositivos de baixo custo no desenvolvimento e produção de tal tecnologia reduz seu custo final, tornando-a mais acessível. Assim, este trabalho aborda o tema Jogos Serios aliados a dispositivos de baixo custo para melhorar sua acessibilidade, além de sua avaliação por parte de usuários, paciente e profissionais de saúde envolvidos em reabilitação. Para tal, jogos sérios foram criados em duas modalidades: uma delas voltada para ser usado por profissionais de saúde diretamente e pacientes que estão passando por reabilitação, e uma outra voltada para pesquisas em laboratório, ambas envolvendo o uso de dispositivos de baixo custo, sendo que todos são avaliados por questionários específicos para esse propósito.

[No abstract available]

Made available in DSpace on 2016-08-29T15:34:35Z (GMT). No. of bitstreams: 1 tese_8624_Dissertação_Berthil Borges Longo.pdf: 4375766 bytes, checksum: 54169f2de50e3e2619d7fab4a1cf0dcb (MD5) Previous issue date: 2015-03-05 Desenvolvimento de Ferramentas para Pesquisas em Tecnologias Assistivas Baseadas em Sinais Biológicos

The aim of this study was to investigate clinical and aesthetic results of simultaneous contralateral balancing procedures in unilateral DIEP flap reconstructions by means of a symmetrization algorithm. Between 2004 and 2013, 335 patients underwent DIEP flap breast reconstruction with 48 patients (mean age 51.8 years, range 32-69 years) undergoing contralateral procedure. Patients were divided in Group-A including 31 cases who underwent one-stage procedure and Group-B including 17 cases who underwent staged procedure. A symmetrization algorithm was proposed to plan immediate breast reduction/mastopexy. The groups were homogeneous regarding patient's age, BMI, mastectomy and flap weight (P 0.05). All flaps survived. No complications were observed to the mastectomy skin flaps and to the reduction mammaplasty/mastopexy procedures in both groups. The mean operation time was 5 h in Group-A while 5 h and 37 min in Group-B (P = 0.0682). Contralateral procedures included 23 breast reductions and 8 mastopexies in Group-A, while 10 breast reductions and 7 mastopexies were performed in Group-B. Two and 6 patients required revision of the balancing procedure in Group-A and Group-B, respectively. The follow-up time was 47.3 months (range 14-120 months) in Group-A and 91.3 months (range 41-110 months) in Group-B. Volume, upper/lower pole shape, projection, breast mound placement, IMF, symmetry, overall appearance, and general satisfaction sub-items obtained high-score evaluation without significant difference between the two groups (P 0.05). One-stage DIEP flap reconstruction by means of the symmetrization algorithm resulted in comparable aesthetic outcomes and patient satisfaction to a staged procedure.

Background: The Coleman technique is universally recognized as the gold standard for fat transfer, but although effective, it is tedious, time consuming, and costly. This report proposes a new and more efficient method of fat grafting (simplified lipostructure). Methods: This report introduces a modification of the standard Coleman transfer and injection technique, performed by connecting a 10-ml syringe to a 1-ml syringe and to a blunt infiltrating cannula through a "three-way stopcock valve." The study retrospectively evaluated two groups of patients who had undergone either Coleman or simplified lipostructure, comparing surgical staff, operative time, volume of infiltrated fat, cosmetic outcome, and complications. Statistical analyses were conducted using the Wilcoxon rank sum test and Spearman's rank-order correlation. Results: The simplified lipostructure group compared with Coleman lipostructure showed a reduced operative staff (1 vs. 2 members), a reduced operative time (66 vs. 74.2 min) (α = 0.0035), and an increased volume of infiltrated fat (167.2 vs. 138.7 ml) (p < 0.0001) while retaining comparable cosmetic results (7.45 vs. 7.25; visual analog scale 0-10), and only minor complications. Conclusion: The three-way stopcock valve system appears to be a smart technical solution that eases syringe refilling, improves fat transplantation times, and reduces costs. The findings show this technical modification to be easy and effective. The authors therefore recommend it to all surgeons performing fat transfer. Level of Evidence V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266. © 2014 Springer Science+Business Media New York and International Society of Aesthetic Plastic Surgery.

The aim of this study is to present our experience on the use of various recipient sites for deep inferior epigastric perforator (DIEP) flap breast reconstruction and compare them by means of objective data. Two hundred fifty six DIEP flap breast reconstructions, performed between March 2004 and May 2011, were retrospectively analyzed. Only unilateral reconstructions were included in the study and divided into three groups depending on the recipient site choice: internal mammary vessels (IMV) (n = 52), thoracodorsal vessels (TDV) (n = 109), and circumflex scapular vessels (CSV) (n = 95). Clinical records of each patient were reviewed to acquire relevant data such as operative time, postoperative complications, and use of a second vein anastomosis. CSV group showed a statistically significant lower operative time (4.92 ± 0.54 hours) compared to TDV (5.67 ± 1.01 hours) and IMV groups (6.75 ± 1.09 hours) (P 0.001). Second vein anastomosis was performed in 84 cases (88.1%) of CSV, in 85 cases (77.9%) of TDV, and in 18 cases (35.1%) of IMV groups (P 0.001). No significant differences were observed among groups regarding risk factors and complications (P 0.05). The axillary vessels seem to be the ideal recipient site because of reduced operative time and increased possibility to perform a second vein anastomosis. Among them, CSV can be safely used due to following advantages: easy dissection, larger vessel caliber, and optimal flap insetting. Moreover, their location does not expose them completely to radiotherapy consequences.

The intra-operative latissimus dorsi (LD) pedicle damage during axillary lymph-node dissection by the general surgeon is a rare complication leading to flap failure and poor outcomes. The authors present their experience on this topic and develop a classification of the thoracodorsal (TD) pedicle injuries and reconstruction algorithm. Pedicle damage of LD occurred in five cases, three of which were experienced during immediate breast reconstruction and two observed in patients who underwent prior surgery. In two cases the thoracodorsal vein (TDV) was damaged in its proximal segment, thus end-to-end anastomosis was performed between distal stump of TDV and circumflex scapular vein (CSV). In one case the TDV required simple microsurgical repair while in other two cases the severe damage of vein and artery required more complex surgical strategies in attempt to salvage the flap. Four cases completely survived with one case of rippling phenomenon. One case had partial flap necrosis that required subtotal muscle resection. Based on these cases, the authors have developed a reconstruction algorithm in attempt to repair LD pedicle damage while preserving breast reconstruction. Taking into account its anatomical conformation, TD pedicle injuries are classified in four different types and available options are suggested for all of them according to the anatomical site and to the mechanism and timing of injury.