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Di Sacco F, Antognetti D, Ciapini G, Nicastro M, Scaglione M, Bottai V. Teriparatide and clodronate combination as a potential treatment for complex regional pain syndrome type I in delayed consolidation after foot surgery: a case report and review of the literature. J Med Case Rep 2024; 18:142. [PMID: 38454520 PMCID: PMC10921770 DOI: 10.1186/s13256-024-04391-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 01/14/2024] [Indexed: 03/09/2024] Open
Abstract
BACKGROUND Complex regional pain syndrome type I is a pathological condition characterized by an exaggerated response of tissues to low or moderate pain stimuli. The exact pathogenesis and optimal medical treatment for complex regional pain syndrome type I are still not fully understood, although bisphosphonates have shown positive effects in reducing pain. Foot surgery can be complicated by the development of complex regional pain syndrome type I, leading to functional decline and difficulties in weight-bearing. CASE PRESENTATION The authors present a clinical case involving complex regional pain syndrome type I that developed after surgical foot arthrodesis. The patient, a 42-year-old Caucasian male, did not respond to clodronate treatment but experienced successful outcomes upon the addition of teriparatide, which effectively stimulated the healing of arthrodesis. CONCLUSION Teriparatide cannot be considered the primary treatment for complex regional pain syndrome due to insufficient solid clinical data. However, when complex regional pain syndrome is associated with or caused by delayed union, teriparatide can be used to address the underlying cause of complex regional pain syndrome.
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Affiliation(s)
- F Di Sacco
- Department of Orthopedics and Trauma Surgery, University of Pisa, Pisa, Italy.
| | - D Antognetti
- Section of Neurorehabilitation, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - G Ciapini
- Department of Orthopedics and Trauma Surgery, University of Pisa, Pisa, Italy
| | - M Nicastro
- Department of Anaesthesia and Critical Care Medicine, Azienda Ospedaliera Universitaria Pisana, University of Pisa, Pisa, Italy
| | - M Scaglione
- Department of Orthopedics and Trauma Surgery, University of Pisa, Pisa, Italy
| | - V Bottai
- Department of Orthopedics and Trauma Surgery, University of Pisa, Pisa, Italy
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Ciapini G, Varchetta G, Bizzocchi F, Gadsby G, Lombardi L, Sgadò F, Ipponi E, Scaglione M, Parchi PD. All-Inside Arthroscopic Meniscus Repair for Patients Over 40 Years of Age: Is Forty the New Twenty? Cureus 2024; 16:e56413. [PMID: 38638784 PMCID: PMC11024730 DOI: 10.7759/cureus.56413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2024] [Indexed: 04/20/2024] Open
Abstract
INTRODUCTION Meniscal injuries are a common challenge in orthopedic surgery. For decades, partial or total meniscectomy has been the primary surgical treatment for meniscal tears. In recent years, the increased recognition of menisci's biomechanical importance has progressively shifted the paradigm towards meniscus repair. However, meniscus-sparing surgery remains the treatment of choice for selected lesions in young and active patients, especially for young and active patients. In this study, we evaluated the effectiveness of all-inside sutures in treating meniscus tears in patients over 40. METHODS In our retrospective evaluation, we evaluated the clinical and functional outcomes of cases over 40 years of age with post-traumatic acute meniscus tears that received meniscus repairs using the all-inside technique. The pre-operative and post-operative functionality of treated patients were assessed using the knee injury and osteoarthritis outcome score (KOOS) score. Major complications were recorded. RESULTS Twenty-three cases met our inclusion criteria. Eight females and fifteen males with a mean age of 44.9 were included in our study. Their mean follow-up was 35.1 months. Before surgery, our patients' mean KOOS score was 55.4 (18-80). At the patients' latest follow-up, the value had risen to 87.4 (63-100). There was no statistical correlation between patients' age and their functional recovery. No surgical failure was recorded at the latest follow-up. CONCLUSION The all-inside suture technique can represent a suitable and reliable solution for suturable meniscal tears, even for patients over 40. Preserving the meniscus and restoring patients' functionality allows patients to return to their daily activities and promote their quality of life.
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Affiliation(s)
- Gianluca Ciapini
- Department of Orthopedics and Traumatology, University of Pisa, Pisa, ITA
| | - Giorgio Varchetta
- Department of Orthopedics and Traumatology, University of Pisa, Pisa, ITA
| | - Federico Bizzocchi
- Department of Orthopedics and Traumatology, University of Pisa, Pisa, ITA
| | - Giulio Gadsby
- Department of Orthopedics and Traumatology, University of Pisa, Pisa, ITA
| | - Leonardo Lombardi
- Department of Orthopedics and Traumatology, University of Pisa, Pisa, ITA
| | - Francesca Sgadò
- Department of Orthopedics and Traumatology, University of Pisa, Pisa, ITA
| | - Edoardo Ipponi
- Department of Orthopedics and Traumatology, University of Pisa, Pisa, ITA
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Carbone M, Viglialoro RM, Stagnari S, Condino S, Gesi M, Scaglione M, Parchi PD. Design, Fabrication, and Preliminary Validation of Patient-Specific Spine Section Phantoms for Use in Training Spine Surgeons Outside the Operating Room/Theatre. Bioengineering (Basel) 2023; 10:1345. [PMID: 38135936 PMCID: PMC10740604 DOI: 10.3390/bioengineering10121345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 11/13/2023] [Accepted: 11/21/2023] [Indexed: 12/24/2023] Open
Abstract
Pedicle screw fixation (PSF) demands rigorous training to mitigate the risk of severe neurovascular complications arising from screw misplacement. This paper introduces a patient-specific phantom designed for PSF training, extending a portion of the learning process beyond the confines of the surgical room. Six phantoms of the thoracolumbar region were fabricated from radiological datasets, combining 3D printing and casting techniques. The phantoms were employed in three training sessions by a fifth-year resident who performed full training on all six phantoms; he/she placed a total of 57 pedicle screws. Analysis of the learning curve, focusing on time per screw and positioning accuracy, revealed attainment of an asymptotic performance level (around 3 min per screw) after 40 screws. The phantom's efficacy was evaluated by three experts and six residents, each inserting a minimum of four screws. Initial assessments confirmed face, content, and construct validity, affirming the patient-specific phantoms as a valuable training resource. These proposed phantoms exhibit great promise as an essential tool in surgical training as they exhibited a demonstrable learning effect on the PSF technique. This study lays the foundation for further exploration and underscores the potential impact of these patient-specific phantoms on the future of spinal surgical education.
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Affiliation(s)
- Marina Carbone
- Department of Information Engineering, University of Pisa, 56126 Pisa, Italy;
- EndoCAS Center, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy;
| | - Rosanna Maria Viglialoro
- EndoCAS Center, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy;
| | - Sara Stagnari
- Department of Orthopaedics and Trauma Surgery, University of Pisa, 56100 Pisa, Italy; (S.S.); (M.S.); (P.D.P.)
| | - Sara Condino
- Department of Information Engineering, University of Pisa, 56126 Pisa, Italy;
- EndoCAS Center, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy;
| | - Marco Gesi
- Center for Rehabilitative Medicine “Sport and Anatomy”, University of Pisa, 56121 Pisa, Italy;
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy
| | - Michelangelo Scaglione
- Department of Orthopaedics and Trauma Surgery, University of Pisa, 56100 Pisa, Italy; (S.S.); (M.S.); (P.D.P.)
| | - Paolo Domenico Parchi
- Department of Orthopaedics and Trauma Surgery, University of Pisa, 56100 Pisa, Italy; (S.S.); (M.S.); (P.D.P.)
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Pappalardo M, Gori L, Randazzo E, Morganti R, Scaglione M, Valiani M, Beni A, Di Cicco M, Peroni DG, Franzoni F, Comberiati P. Ultrasound and Clinical Alterations in the Foot of Children with Obesity and Diabetes. Diagnostics (Basel) 2023; 13:2781. [PMID: 37685319 PMCID: PMC10486527 DOI: 10.3390/diagnostics13172781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 08/22/2023] [Accepted: 08/25/2023] [Indexed: 09/10/2023] Open
Abstract
BACKGROUND Alterations in plantar soft tissues are often reported in adults with diabetes, whereas data on children are conflicting. Also, the extent of foot damage caused by excess body fat in children has not been fully characterized yet. This study aimed to address the relationship between body mass and structural changes of the foot in children and adolescents with and without diabetes. METHODS In a case-control study, 43 participants (age 13 ± 2.6 years) were recruited, 29 (67%) with type 1 diabetes (T1D) and 14 (33%) controls. Anthropometric parameters [body mass index (BMI), waist circumference (WC), and waist-to-height ratio (WHtR)], foot posture index-6 (FPI-6) for static foot posture, and navicular drop test (NDT) for medial longitudinal arch height (MLA) were measured in all participants. The thickness of the midfoot plantar fascia (MPF) and medial midfoot fat pad (MMFP) were quantified using ultrasound. RESULTS No differences in clinical and ultrasonographical parameters were observed between the study groups. MMFP thickness was correlated with MPF thickness (p = 0.027). MMFP and MPF thicknesses were positively associated with BMI (p < 0.001 and p = 0.013, respectively), WC (p < 0.001 and p = 0.013), and WHtR (p < 0.001 and p = 0.026). The NDT measured on the right and left foot correlated with WHtR (p = 0.038 and p = 0.009, respectively), but not with WC and BMI. CONCLUSIONS Children with T1D show structural alterations of plantar soft tissues which seem related to body mass increase rather than diabetes pathology. Ultrasound is a valuable tool to assess early structural changes of the foot in young people with an elevated BMI.
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Affiliation(s)
- Martina Pappalardo
- Azienda Ospedaliero Universitaria Pisana, UO Pediatria Universitaria, 56126 Pisa, Italy
| | - Laura Gori
- Azienda Ospedaliero Universitaria Pisana, UO Pediatria Universitaria, 56126 Pisa, Italy
| | - Emioli Randazzo
- Azienda Ospedaliero Universitaria Pisana, UO Pediatria Universitaria, 56126 Pisa, Italy
| | - Riccardo Morganti
- Section of Statistics, University Hospital of Pisa, 56126 Pisa, Italy
| | | | - Margherita Valiani
- Azienda Ospedaliero Universitaria Pisana, UO Pediatria Universitaria, 56126 Pisa, Italy
| | - Alessandra Beni
- Azienda Ospedaliero Universitaria Pisana, UO Pediatria Universitaria, 56126 Pisa, Italy
| | - Maria Di Cicco
- Azienda Ospedaliero Universitaria Pisana, UO Pediatria Universitaria, 56126 Pisa, Italy
- Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy
| | - Diego G. Peroni
- Azienda Ospedaliero Universitaria Pisana, UO Pediatria Universitaria, 56126 Pisa, Italy
- Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy
| | - Ferdinando Franzoni
- Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy
| | - Pasquale Comberiati
- Azienda Ospedaliero Universitaria Pisana, UO Pediatria Universitaria, 56126 Pisa, Italy
- Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy
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De Franco S, Ipponi E, Ruinato AD, Parchi PD, Andreani L, Scaglione M, Capanna R. Femoral neck fractures treated with cannulated screws: can surgeons predict functional outcomes and minimize the risk of necrosis? Acta Biomed 2023; 94:e2023013. [PMID: 36786271 PMCID: PMC9987480 DOI: 10.23750/abm.v94i1.13058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Accepted: 05/06/2022] [Indexed: 02/15/2023]
Abstract
BACKGROUND AND AIM Femoral neck fractures are among the most frequent in mankind. Screw fixation is considered a suitable approach specially for undisplaced or slightly displaced fractures that occur to young patients. We conducted our study in order to evaluate both functional outcomes and complication rates of patients who received this treatment in our institution. A particular focus was given to the aseptic necrosis of the head, trying to identify if anamnestic, clinical or radiological data could play a significant role as prognostic factors. METHODS For each case who was treated with screw fixation due to a femoral neck fracture, we recorded data regarding, among the others, BMI and whether they used tobacco products or corticosteroids on a regular basis. Necrosis of the femoral head and mechanical complications were recorded. Functional outcome was evaluated using the Harris Hip Score. Results: 74 cases were included in our study. The mean Harris Hip score was 89.5. Aseptic necrosis of the femoral head occurred in 9 cases (12.2%). Regular use of tobacco was associated with a higher risk to develop necrosis (p=0.007). The Body Mass Index was significantly higher in cases who had necrosis compared to the rest of our population (p=0.043) and was inversely proportional to the post-operative Harris hip score (p=0.001). CONCLUSIONS While considering screw fixation to treat cases with femoral neck fractures, patient's weight and use of tobacco should be considered as prognostic factors. (www.actabiomedica.it).
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Affiliation(s)
- Silvia De Franco
- Department of Orthopedics and Trauma Surgery, University of Pisa, Pisa, Italy .
| | | | | | | | - Lorenzo Andreani
- Department of Orthopedics and Trauma Surgery, University of Pisa, Pisa, Italy .
| | | | - Rodolfo Capanna
- Department of Orthopedics and Trauma Surgery, University of Pisa, Pisa, Italy .
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Delmas C, Scaglione M, Bouisset F, Roubille F. Post-mRNA COVID-19 vaccines myocarditis: Not so rare in cardiology practice. Archives of Cardiovascular Diseases Supplements 2023. [PMCID: PMC9800765 DOI: 10.1016/j.acvdsp.2022.10.087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Ciapini G, Simonettii M, Giuntoli M, Varchetta G, De Franco S, Ipponi E, Scaglione M, Parchi PD. Is the Combination of Platelet-Rich Plasma and Hyaluronic Acid the Best Injective Treatment for Grade II-III Knee Osteoarthritis? A Prospective Study. Adv Orthop 2023; 2023:1868943. [PMID: 36938102 PMCID: PMC10023227 DOI: 10.1155/2023/1868943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 02/27/2023] [Accepted: 02/28/2023] [Indexed: 03/21/2023] Open
Abstract
Background Knee osteoarthritis is a common disease with increasing incidence and prevalence in western countries. It can cause severe pain and functional limitations, thereby representing a threat for patients' quality of life and a burden for national health systems. Intra-articular injections with hyaluronic acid (HA) and platelet-rich plasma (PRP) have been used for decades in order to reduce the symptoms caused by osteoarthritis. In recent years, a combination of HA and PRP has been introduced in clinical practice with the aim to minimize the clinical presentation of osteoarthritis and potentially delay articular degeneration. Materials and Methods Sixty cases with grade II-III knee osteoarthritis according to the Kellgren-Lawrence classification were included in a prospective study, focused on the evaluation of clinical and functional outcomes after intra-articular knee injections. Cases were randomly divided into three groups. Twenty cases (Group A) were injected with HA, 20 (Group B) had PRP, and the remaining 20 (Group C) received a combination of HA and PRP. Basal WOMAC score and VAS score were recorded before the treatment and repeated within 3 and 6 months after the treatment. Results At 6-month follow-up, Group C (PRP + HA) was the one with the lowest WOMAC and VAS mean values. It was also the only group that reported a reduction in the two values both in the first three months and in the following three months. No major complication was recorded. Conclusion The combination of platelet-rich plasma and hyaluronic acid can be effective in the treatment of grade II-III knee osteoarthritis in a short-to-mid-term scenario. It represents an innovative and valuable alternative to the administration of its two components alone.
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Affiliation(s)
- Gianluca Ciapini
- Department of Orthopedics and Trauma Surgery, University of Pisa, Pisa 56124, Italy
| | - Matteo Simonettii
- Department of Orthopedics and Trauma Surgery, University of Pisa, Pisa 56124, Italy
| | - Michele Giuntoli
- Department of Orthopedics and Trauma Surgery, University of Pisa, Pisa 56124, Italy
| | - Giorgio Varchetta
- Department of Orthopedics and Trauma Surgery, University of Pisa, Pisa 56124, Italy
| | - Silvia De Franco
- Department of Orthopedics and Trauma Surgery, University of Pisa, Pisa 56124, Italy
| | - Edoardo Ipponi
- Department of Orthopedics and Trauma Surgery, University of Pisa, Pisa 56124, Italy
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Bottai V, Piolanti N, Digrandi G, Menconi A, Antognetti D, Di Lonardo M, Scaglione M, Raffaetà G. Impending atypical femoral fractures associated with bisphosphonates: postoperative diagnosis after hip prosthesis. Clinical cases presentation. Acta Biomed 2022; 93:e2022257. [PMID: 36129726 PMCID: PMC10510971 DOI: 10.23750/abm.v93is1.13084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 05/12/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND AIM Number of hip prosthesis implants in arthritis, number of patients treated with bisphosphonates to prevent fragility fractures and, together, number of atypical femoral fracture's cases are increasing. CASE SERIES This article describes two cases of hip arthritis, treated with hip replacement, in patients using bisphosphonates for a long time; in both cases an incomplete atypical femoral fracture was misdiagnosed before the surgery. Authors describe the importance to carry out a complete osteometabolic and radiographic pre-operative examination of patients in treatment with bisphosphonates going to hip replacement, to check the possible presence of incomplete atypical femoral fracture and to optimize surgical and pharmacological treatment. CONCLUSIONS In hip prosthesis surgery, prior diagnosis of incomplete atypical femoral fractures can indicate the choice of a different kind of prosthesis stem to optimize surgical results. This can also positively impact to rehabilitation in term of duration and daily activities recovery.
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Affiliation(s)
- Vanna Bottai
- Second Orthopedic and Traumatologic Clinic, University of Pisa, Pisa, Toscana, IT.
| | - Nicola Piolanti
- First Orthopedic and Traumatologic Clinic, University of Pisa, Pisa, Toscana, IT.
| | - Giuseppe Digrandi
- First Orthopedic and Traumatologic Clinic, University of Pisa, Pisa, Toscana, IT.
| | - Agnese Menconi
- Orthopedic Rehabilitation Department Section, University of Pisa, Pisa, Toscana, IT.
| | - Damiano Antognetti
- Orthopedic Rehabilitation Department Section, University of Pisa, Pisa, Toscana, IT.
| | - Michele Di Lonardo
- Second Orthopedic and Traumatologic Clinic University of Pisa, Pisa, Toscana, IT.
| | | | - Gloria Raffaetà
- Orthopedic Rehabilitation Department Section, University of Pisa, Pisa, Toscana, IT.
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Abu-Omar A, Kennedy P, Yakub M, Robbins JB, Yassin A, Verma N, Scaglione M, Khosa F. Extra credit for disruption: trend of disruption in radiology academic journals. Clin Radiol 2022; 77:893-901. [PMID: 36150935 DOI: 10.1016/j.crad.2022.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Accepted: 07/05/2022] [Indexed: 11/03/2022]
Abstract
AIM To identify the most disruptive publications, which are those that are cited more frequently than their own references, in academic radiology journals and their characteristics, such as the number of authors and relative time to publication. MATERIAL AND METHODS A comprehensive literature search was undertaken to identify the 100 most disruptive publications in the field of radiology. Subsequently, statistical analysis was applied to establish the distribution of disruptive scores of the isolated publications using a non-parametric probability density function. The relation between disruptive scores and citation counts was then determined, with the aid of a correlation coefficient. Finally, data regarding any significant connection between disruption scores and time of publication, number of authors, and study design were examined. RESULTS Analysing the top 100 papers in increments of 10-year periods showed no significant difference in the distribution of disruption scores over time. No correlation between an article's citation count and disruption score was established. Additionally, no significant relation between the number of authors/study design and disruption scores was identified. CONCLUSION The disruption score highlights significant impact elements not entirely accounted for by citation count. Its potential benefit in assessing scientific impact should be contemplated.
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Affiliation(s)
- A Abu-Omar
- Department of Radiology, The James Cook University Hospital NHS Foundation Trust, Middlesbrough, UK.
| | - P Kennedy
- Department of Radiology, Cork University Hospital, Cork, Ireland
| | - M Yakub
- Physiotherapy and Nutrition, California University of Science and Medicine, California, USA
| | - J B Robbins
- Faculty Development and Enrichment, University of Wisconsin School of Medicine and Public Health, Wisconsin, USA
| | - A Yassin
- Department of Radiology, Ain Shams University, Cairo, Egypt
| | - N Verma
- Abdominal and Cardiac Imaging, University of Florida, Florida, USA
| | - M Scaglione
- Department of Radiology, The James Cook University Hospital NHS Foundation Trust, Middlesbrough, UK; Department of Radiology, University of Sassari, Sardinia, Italy; Department of Radiology, Pineta Grande Hospital, Castel Volturno, Italy
| | - F Khosa
- Department of Emergency Radiology, University of British Columbia, Vancouver General Hospital, Vancouver, Canada
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Scaglione M, Casella F, Ipponi E, Agretti F, Polloni S, Giuntoli M, Marchetti S. Multifocal Humeral Fractures: Clinical Results, Functional Outcomes and Flowchart of Surgical Treatment. Strategies Trauma Limb Reconstr 2022; 17:81-87. [PMID: 35990178 PMCID: PMC9357792 DOI: 10.5005/jp-journals-10080-1559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Aim and objective Materials and methods Results Conclusion Clinical significance How to cite this article
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Affiliation(s)
| | - Francesco Casella
- Department of Orthopedics and Trauma Surgery, University of Pisa, Pisa, Italy
| | - Edoardo Ipponi
- Department of Orthopedics and Trauma Surgery, University of Pisa, Pisa, Italy
- Edoardo Ipponi, Department of Orthopedics and Trauma Surgery, University of Pisa, Pisa, Italy, Phone: +39 050993415, e-mail:
| | - Federico Agretti
- Department of Orthopedics and Trauma Surgery, University of Pisa, Pisa, Italy
| | - Simone Polloni
- Department of Orthopedics and Trauma Surgery, University of Pisa, Pisa, Italy
| | - Michele Giuntoli
- Department of Orthopedics and Trauma Surgery, University of Pisa, Pisa, Italy
| | - Stefano Marchetti
- Department of Orthopedics and Trauma Surgery, University of Pisa, Pisa, Italy
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Meynet I, Stabile G, Mantica M, Ferraro A, D’ammando M, Scaglione M, Di Cori A, Schillaci V, Ottaviano L, Mantovan R, Ferrari F, Bianchi S, Solimene F, Malacrida M, De Sanctis V. The impact of RF wattage level on local impedance and procedural parameters in AF ablation cases. Europace 2022. [DOI: 10.1093/europace/euac053.222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Local impedance (LI) measurement can provide information on catheter tip contact, but also changes in LI during ablation can inform the extent and effectiveness of RF energy delivery. To date the relationship between highly LI measurements and contact force (CF) during atrial fibrillation (AF) ablation at different levels of energy delivery is still lacking.
Purpose
We aimed to evaluate the impact of power setting on LI and key procedural parameters in AF ablation cases.
Methods
A novel CF ablation catheter equipped with dedicated algorithm was used to measure LI at the distal electrode of this catheter. Radiofrequency (RF) catheter applications ≥45 watts were categorized as high power (HP) and applications <45w as standard power (SP). Ablations were also grouped according to different levels of CF (<5g, 5-14g, 15-24g and ≥25g). Data are reported as mean±SD.
Results
Sixty-two consecutive pts undergoing RF catheter ablation of AF from the CHARISMA registry were included A total of 4619 ablation spots performed around PVs were analyzed (58% paroxysmal, 84% de novo, RF deliveries per pt=76±27, RF delivery time=9.1±5s, CF=12.3±8g). The majority of these were HP applications (n=4192, 91%). The mean LI was 158±17Ω prior to ablation and 138±14Ω after ablation (p<0.0001, absolute LI drop of 21.9±8Ω) with a LI drop rate equal to 4.4±3Ω/s. HP ablations had significantly shorter RF delivery times, 8.8±4s vs 12±7s (p<0.0001), larger LI drops (22.2±8Ω vs 19.3±9Ω, p<0.0001) and higher LI drop rates (4.5±3Ω/s vs 3.6±2Ω/s, p<0.0001) than SP, respectively. For both HP and SP settings, the magnitude of LI drop increased and RF delivery time decreased with increasing amounts of CF. The largest differences between HP and SP were found when CF was <15g (RF delivery time: 9±5s at HP vs 12.9±7s at SP, percentage of difference 26.3%, p<0.0001; LI drop: 21.2±8Ω at HP vs 18.6±9Ω, percentage of difference -14.3%, p<0.0001). No major complications occurred during the procedures. All PVs were successfully isolated.
Conclusions
This preliminary experience suggests that, HP ablation is effective and safe and resulting in shorter RF delivery times and larger LI drops than SP ablation.
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Affiliation(s)
| | - G Stabile
- Montevergine Clinic, Mercogliano, Italy
| | - M Mantica
- Clinical Institute Saint Ambrogio, Milan, Italy
| | | | - M D’ammando
- Hospital Santa Maria Della Misericordia, Perugia, Italy
| | | | - A Di Cori
- University Hospital of Pisa, Pisa, Italy
| | | | - L Ottaviano
- Clinical Institute Saint Ambrogio, Milan, Italy
| | - R Mantovan
- Conegliano General Hospital, Conegliano, Italy
| | - F Ferrari
- Hospital Molinette of the University Hospital S. Giovanni Battista, Turin, Italy
| | - S Bianchi
- Giovanni Calibita Fatebenefratelli Hospital, Rome, Italy
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Viola G, Stabile G, Rossi L, Figus F, Gazzale E, Casu G, Bottoni N, Deruvo E, Scaglione M, Santoro A, Armenta-Pastor J, Primo J, Ferraris F, Castro A, Donzelli S. Long term success of cavotricuspid isthmus ablation guided by the ablation index: results of the FLAI registry. Europace 2022. [DOI: 10.1093/europace/euac053.069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Introduction
Cavotricuspid isthmus ablation (CTIA) is an effective treatment for typical atrial flutter (AFL) with a recurrence rate of about 10%. A prospective multicentric registry (FLAI registry) has recently shown that a protocol including ‘point by point’ CTI ablation targeting an a quality lesion marker (Ablation Index AI) ≥ 500 and a maximum inter-lesion distance (ILD) measurement of ≤6 mm allowed an acute success rate of 98.3%. In this study, we aimed to describe the incidence and predictors of recurrence of both AFL and atrial fibrillation (AF) in a long-term follow-up of the patients enrolled in the FLAI registry.
Methods
The FLAI registry was a multicentric non-randomized study that enrolled 412 consecutive patients (mean age 64.9±9.8; 72.1% males; 27.7% with structural heart disease). Patients with typical AFL underwent an AI-guided cavotricuspid isthmus ablation. The procedures targeted an AI of 500 and an ILD measurement of ≤ 6mm. The primary endpoints were CTI ‘first pass’ block and persistent block after a 20-minute waiting period. The CTI bidirectional "first pass block" was reached in 355 patients (88.3%), whereas CTI block at the end of the waiting period was achieved in 405 patients (98.3%). No complications were reported.
The mean time of follow-up was 21±4.24 months and it was available for 397 patients. The FU included outpatient clinical evaluation, ECG and 24-h Holter ECG at three, six- and 12-months post-ablation, followed by an annual clinical evaluation and ECG. Documented ECG Atrial fibrillation events, in follow up, were also included in the data set.
Results
Atrial flutter recurrence: 22 AFL events were observed (5.5%) at 34 months. According to the Kaplan Meier analysis, the growth of recurrence rate was constant between 6 and 12 months, after 19 months recurrences were unlikely. At the univariate analysis predictors of AFL recurrence were: absence of bidirectional block after the waiting time period (p= 0,001); failure of the CTIA index procedure (p=<0,0005); ablation line lengths > 32 mm (p=0.,018), number of automatic ablation lesion tags (VISITAG) > 20 (p=0,.005) and At the increathe reported numbers of ‘g"gap’" in the ablation line lengths: the more the gaps increase the more the probability of AFL recurrence in FU increases (p=0.,037).
In the Multivariate aAnalysis, the independent predictors of AFL recurrence were: the procedural success and the number of VISITAG (OR =1.062)
Atrial fibrillation recurrence: 45 patients developed atrial fibrillation after CTI ablation (11.3%). In the multivariate analysis, the major independent predictor was a documented pre-procedural Afib and the risk increases with the younger age (< 53 yo).
Conclusions
The FLAI protocol is safe, reproducible and effective in the follow-up, with a long term success of 94,5%. The reported incidence of atrial fibrillation in FU was 11,3%
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Affiliation(s)
- G Viola
- SS. Annunziata Hospital, Cardiology, Sassari, Italy
| | - G Stabile
- Montevergine Clinic, Cardiology, Mercogliano, Italy
| | - L Rossi
- Guglielmo da Saliceto Hospital, Cardiology, Piacenza, Italy
| | - F Figus
- SS. Annunziata Hospital, Cardiology, Sassari, Italy
| | - E Gazzale
- SS. Annunziata Hospital, Cardiology, Sassari, Italy
| | - G Casu
- SS. Annunziata Hospital, Cardiology, Sassari, Italy
| | - N Bottoni
- Santa Maria Nuova Hospital, Cardiology, Reggio Emilia, Italy
| | - E Deruvo
- Polyclinic Casilino, Rome, Italy
| | - M Scaglione
- Cardinal Massaia Hospital, Cardiology, Asti, Italy
| | - A Santoro
- Polyclinic Santa Maria alle Scotte, Cardiology, Siena, Italy
| | | | - J Primo
- Hospital da Luz Arrabida, Cardiology, Vila Nova de Gaia, Portugal
| | | | - A Castro
- Sandro Pertini Hospital, Cardiology, Rome, Italy
| | - S Donzelli
- Hospital Santa Maria, Cardiology, Terni, Italy
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13
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Battaglia A, Calvanese R, Pandozi C, Tola G, Solimene F, Rossi L, Cauti F, Pedretti S, Mantovan R, Pelargonio G, Castro A, Gagliardi M, Izzo G, Malacrida M, Scaglione M. Ventricular tachycardia channels ablation incorporating automated high-density mapping guidance: data from the CHARISMA registry. Europace 2022. [DOI: 10.1093/europace/euac053.358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Ventricular tachycardia (VT) ablation targeting conducting channels (CC)s based on timing of late potentials (LPs) during sinus rhythm (dechanneling) may facilitate a scar homogenization strategy without the need for extensive ablation and possibly lead to higher successful rate.
Purpose
We evaluated the feasibility and safety of a CC identification and ablation approach by means of an ultra-high density mapping system with a novel automated algorithm in ischemic VT procedures.
Methods
Consecutive patients indicated for ischemic VT ablation were prospectively included. A complete map of the left ventricle was performed prior and after ablation through the Rhythmia mapping system. Channels were defined as any signal activity bounded by anatomic and functional barriers and characterized through the Lumipoint (LM) tool and continuous activation was used on the whole ventricular substrate. Procedural end point was the elimination of all identified CCs by ablation at the CC entrance and exit followed by abolition of any residual LPs inside the CC. The ablation endpoint was noninducibility. Data are reported as mean±SD.
Results
A total of 36 channels were identified through LM from 28 patients (1.2±0.5 per patient): 21 (75%) patients had 1 CC, 6 (21.4%) had 2 CCs and 1 (3.6%) had 3 CCs. LPs were identified inside CCs in 19 cases (67.9%). In 8 cases (28.6%) LPs were present both inside and outside and in 1 (3.6%) case LPs were present only outside the CC. LPs inside channels covered an area of 7.6±5 mm2 with a ratio between LPs area and CCs’ area of 67.4±31.8%. In 12 (43%) cases LPs area covered more than 90% of the CCs’ area. At voltage map analysis a total of 34 CC were identified: 1 CC was present in 75% of the cases, 2 CCs in 17.9% and 3 CCs in 3.6%. LPs were identified only inside CCs in 46.4% of the cases, both inside and outside in 42.9% and only outside in 10.7%. Healthy tissue (voltage level≥0.5mV) was prevalent (68.2±17%), followed by intermediate voltage areas (0.5-0.05 mV; 31.1±17%) and very low voltage areas (<0.05mV; 0.7±1%). LPs were found mostly at intermediate voltage areas (57.0±34% of the covered area; 39.1±33% at healthy tissue and 3.4±13% at very low voltage areas). LM was more accurate than traditional voltage mapping in identifying CCs: in 6 (21.4%) cases voltage map overestimated LPs areas, in 2 (7.1%) cases failed to fully identify LPs and only in 19 out 28 (67.8%) LM and voltage map had a complete agreement. All CCs’ entrance and exit were successfully ablated and abolition of any residual LPs inside the CC was achieved in all patients. No complication occurred. Noninducibility was achieved in all (100%) the cases.
Conclusions
In this experience, a channel identification approach through the advanced Lumipoint tool was more accurate than traditional voltage mapping and seems to be safe, feasible, and effective at least in the acute setting of ischemic VT ablation.
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Affiliation(s)
| | | | - C Pandozi
- San Filippo Neri Hospital, Rome, Italy
| | - G Tola
- AO Brotzu Hospital, Cagliari, Italy
| | | | - L Rossi
- Guglielmo da Saliceto Hospital, Piacenza, Italy
| | - F Cauti
- Giovanni Calibita Fatebenefratelli Hospital, Rome, Italy
| | | | | | - G Pelargonio
- Fondazione Policlinico Universitario A. Gemelli IRCSS, Rome, Italy
| | - A Castro
- Sandro Pertini Hospital, Rome, Italy
| | | | - G Izzo
- Ospedale Del Mare, Naples, Italy
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14
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Bricco G, Coppolino A, Valeri L, Amoroso G, Cavallero E, Iacovino C, Barbero U, Battisti A, Scaglione M, Correndo L, Bessignana A, De Benedictis M. P172 AN ACCESSORY PATHWAY WITHOUT REENTRANT TACHYCARDIA. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartj/suac012.165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
A 65–year–old patient, hypertensive, dyslipidemic, strong smoker. He has heart disease with hypokinetic evolution EF 47%, mild MI. Negative Dipyridamole–stress echocardiography dated January 2008. Recently atrial fibrillation (AF) is found and anticoagulant therapy was started. Dyspnea and weight loss occurred in past two months. Detected keratinizing squamous pulmonary Ca with negative markers. This injury was judged to be inoperable, and the patient get indications for chemotherapy and radiotherapy. The patient also starts complaining of dyspnea and chest pain on exertion: Not serological modification, not ischemic ECG. Echocardiogram LVEF 47–50% highlights diffuse hypokinesia, regular valves. Ergometric test was not evaluable for ischemia. Coronary angiography shows stenosis of proximal and middle anterior interventricular coronary and non–critical lesions of circumflex and right coronary. Ecodobutamine test was positive for ischemia and arrhythmias (AF and wide QRS tachycardias in recovery phase), but negative for angor. The patient was treated with CT and IVA I – II. angioplasty Monitoring shows AF with high penetrance, wide QRS tachycardia runs and very short TVNS. ECG 1: During atrial tachycardia, show broad QRS conduction to BBSX alternating with narrow QRS with the same RR interval. ECG 2. show fusion between the wavefront conducted with narrow QRS and that with wide QRS. These are supraventricular arrhythmias that run along the atrioventricular nodal pathway (NAV) in the narrow QRS tracts and take an accessory pathway in the wide QRS run.
The Mahaim fibers have decremental conductivities like the AV node, therefore high ventricular frequencies does not occur AF appeared during ecodobutamine, but some beats were conducted by an anomalous path in a discontinuous way); they are generally directed from the atrium or the NAV, towards another part of the right ventricular conduction system, with atrium wave or NAV – RB, therefore the early activation of the RB generates a widened QRS, with a LBB morphology. ECG 3 Re–entry on Mahaim pathway, ventricular activation widened through Mahaim fiber, which generate LBB morphology with retrograde atrial depolarization. In this case there is no reentry, but we have an atrial tachycardia conducted alternately on an accessory pathway and across the NAV. Given the patient‘s clinical problems and the total absence of symptoms, the patient remains asymptomatic during therapy with amiodarone and beta–blocker.
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Affiliation(s)
- G Bricco
- CARDIOLOGIA SAVIGLIANO ASLCN1, SAVIGLIANO; ASLAT, ASTI
| | - A Coppolino
- CARDIOLOGIA SAVIGLIANO ASLCN1, SAVIGLIANO; ASLAT, ASTI
| | - L Valeri
- CARDIOLOGIA SAVIGLIANO ASLCN1, SAVIGLIANO; ASLAT, ASTI
| | - G Amoroso
- CARDIOLOGIA SAVIGLIANO ASLCN1, SAVIGLIANO; ASLAT, ASTI
| | - E Cavallero
- CARDIOLOGIA SAVIGLIANO ASLCN1, SAVIGLIANO; ASLAT, ASTI
| | - C Iacovino
- CARDIOLOGIA SAVIGLIANO ASLCN1, SAVIGLIANO; ASLAT, ASTI
| | - U Barbero
- CARDIOLOGIA SAVIGLIANO ASLCN1, SAVIGLIANO; ASLAT, ASTI
| | - A Battisti
- CARDIOLOGIA SAVIGLIANO ASLCN1, SAVIGLIANO; ASLAT, ASTI
| | - M Scaglione
- CARDIOLOGIA SAVIGLIANO ASLCN1, SAVIGLIANO; ASLAT, ASTI
| | - L Correndo
- CARDIOLOGIA SAVIGLIANO ASLCN1, SAVIGLIANO; ASLAT, ASTI
| | - A Bessignana
- CARDIOLOGIA SAVIGLIANO ASLCN1, SAVIGLIANO; ASLAT, ASTI
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15
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Agostini G, Angelini I, Citarelli C, Andreani L, Carmassi F, Scaglione M, Capanna R. Clinical and radiographical outcome after surgical treatment of periprosthetic type B proximal femur fractures: a retrospective study. Musculoskelet Surg 2022; 106:83-87. [PMID: 32949004 DOI: 10.1007/s12306-020-00676-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 07/27/2020] [Indexed: 06/11/2023]
Abstract
PURPOSE Periprosthetic fractures after hip prosthesis represent a constantly increasing clinical problem and a challenging complication to treat surgically. Among these, type B proximal femur fractures should be diagnosed correctly to be treated surgically. The aim of this study was to re-evaluate the type of surgical treatment of periprosthetic fractures. METHODS We examined the cases treated between January 2012 and February 2018, classifying them according to the U.C.S. AO/OTA. We evaluated the radiographic outcome according to the Beals and Tower criteria. Patients still alive were also re-evaluated according to the H.H.S. and the WOMAC score. RESULTS We treated 48 patients (12 men, 35 women, average age 81 years), divided into 24 type B1, 14 type B2 and 10 type B3 fractures. The overall consolidation rate was 95.4%, while the major complication (implant dislocation, pseudoarthrosis and deep infection) rate was 12.5%. Clinically, it was possible to reassess 34 patients with a mean follow-up of 38.4 months, an average HHS of 75.89 and a mean WOMAC score of 79.93. CONCLUSIONS Periprosthetic type B fractures are difficult to manage and require careful preoperative planning and appropriate intraoperative management. However, the overall clinical and radiographic result was satisfactory, although patients should still be aware of the risk of complications associated with this type of fracture.
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Affiliation(s)
- G Agostini
- Department of Orthopaedic and Trauma Surgery, University of Pisa, Pisa, Italy.
| | - I Angelini
- Department of Orthopaedic and Trauma Surgery, University of Pisa, Pisa, Italy
| | - C Citarelli
- Department of Orthopaedic and Trauma Surgery, University of Pisa, Pisa, Italy
| | - L Andreani
- Department of Orthopaedic and Trauma Surgery, University of Pisa, Pisa, Italy
| | - F Carmassi
- Department of Orthopaedic and Trauma Surgery, University of Pisa, Pisa, Italy
| | - M Scaglione
- Department of Orthopaedic and Trauma Surgery, University of Pisa, Pisa, Italy
| | - R Capanna
- Department of Orthopaedic and Trauma Surgery, University of Pisa, Pisa, Italy
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16
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Giuntoli M, Scaglione M, Bonicoli E, Piolanti N, Puccioni G, Zepeda K, Giannini E, Marchetti S, Indelli PF. Intraoperative Load Sensing in Total Knee Arthroplasty Leads to a Functional but Not Clinical Difference: A Comparative, Gait Analysis Evaluation. J Funct Morphol Kinesiol 2022; 7:jfmk7010023. [PMID: 35225909 PMCID: PMC8883885 DOI: 10.3390/jfmk7010023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 02/14/2022] [Accepted: 02/16/2022] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Although Total Knee Arthroplasty (TKA) is a successful procedure, a significant number of patients are still unsatisfied, reporting instability at the mid-flexion range (Mid-Flexion Instability-MFI). To avoid this complication, many innovations, including load sensors (LS), have been introduced. The intraoperative use of LS may facilitate the balance of the knee during the entire range of motion to avoid MFI postoperatively. The objective of this study was to perform a Gait Analysis (GA) evaluation of a series of patients who underwent primary TKA using a single LS technology. METHODS The authors matched and compared two groups of patients treated with the same posterior stabilized TKA design. In Group A, 10 knees were intraoperatively balanced with LS technology, while 10 knees (Group B) underwent standard TKA. The correct TKA alignment was preoperatively determined aiming for a mechanical alignment. Clinical evaluation was performed according to the WOMAC, Knee Society Score (KSS) and Forgotten Joint Score, while functional evaluation was performed using a state-of-the-art GA platform. RESULTS We reported excellent clinical results in both groups without any statistical difference in patient reported outcome measurements (PROMs); from a functional standpoint, several GA space-time parameters were closer to normal in the sensor group when compared to the standard group, but a statistically significant difference was not reached. CONCLUSIONS Gait Analysis represents a valid method to evaluate TKA kinematics. This study, with its limitations, showed that pressure sensitive technology represents a valid aid for surgeons aiming to improve the postoperative stability of TKA; however, other factors (i.e., level of intra-articular constraint and alignment) may play a major role in reproducing the normal knee biomechanics.
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Affiliation(s)
- Michele Giuntoli
- Department of Orthopaedic Surgery, University of Pisa, Via Paradisa 2, Cisanello, 56124 Pisa, Italy; (M.S.); (E.B.); (N.P.); (G.P.); (S.M.)
- Correspondence:
| | - Michelangelo Scaglione
- Department of Orthopaedic Surgery, University of Pisa, Via Paradisa 2, Cisanello, 56124 Pisa, Italy; (M.S.); (E.B.); (N.P.); (G.P.); (S.M.)
| | - Enrico Bonicoli
- Department of Orthopaedic Surgery, University of Pisa, Via Paradisa 2, Cisanello, 56124 Pisa, Italy; (M.S.); (E.B.); (N.P.); (G.P.); (S.M.)
| | - Nicola Piolanti
- Department of Orthopaedic Surgery, University of Pisa, Via Paradisa 2, Cisanello, 56124 Pisa, Italy; (M.S.); (E.B.); (N.P.); (G.P.); (S.M.)
| | - Gianmarco Puccioni
- Department of Orthopaedic Surgery, University of Pisa, Via Paradisa 2, Cisanello, 56124 Pisa, Italy; (M.S.); (E.B.); (N.P.); (G.P.); (S.M.)
| | - Karlos Zepeda
- Harlem Campus, Touro College of Osteopathic Medicine, Harlem, New York, NY 10027, USA;
| | | | - Stefano Marchetti
- Department of Orthopaedic Surgery, University of Pisa, Via Paradisa 2, Cisanello, 56124 Pisa, Italy; (M.S.); (E.B.); (N.P.); (G.P.); (S.M.)
| | - Pier Francesco Indelli
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, CA 94305, USA;
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17
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Neri E, Gabriele L, Bottai V, Andreani L, Bonicoli E, Scaglione M. Preventive bilateral femoral nailing in atypical femoral fracture non responder to anabolic therapy: case report and mini-review. Acta Biomed 2022; 92:e2021130. [PMID: 35049529 PMCID: PMC10523052 DOI: 10.23750/abm.v92is1.10452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Accepted: 10/04/2020] [Indexed: 06/14/2023]
Abstract
Currently bisphosphonates are the main antiresorptive medications used in osteoporosis. However, a prolonged use of these drugs is associated to an increased risk of atypical femoral fractures, especially in patients suffering from others predisposing clinical conditions. This report describes a case of a woman presenting bilateral impending femoral fracture initially treated with bisphosphonates suspension and intramedullary nailing of right femur. Despite anabolic therapy, the patient presented progression of incomplete contralateral femoral fracture which required a second surgical treatment.
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18
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Del Chiaro A, Marchetti S, Parchi PD, Caprili G, Ipponi E, Scaglione M. Use of Statins and Hip Fracture Risk: a Case-Control Study. Acta Chir Orthop Traumatol Cech 2022; 89:104-107. [PMID: 35621399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
PURPOSE OF THE STUDY To evaluate a possible association between hip fracture and statin use. MATERIAL AND METHODS In this case-control study we compared the use of statins between two groups of 210 patients: the first group (case group) included patients hospitalized for hip fractures while the second group (control group) included patients who did not suffer femur bone injuries. The two groups were matched for age, sex, year of hospitalization and possible confounding factors. Inside the group of cases, we also evaluated the differences in terms of fracture type, presence of previous fragility fracture and mortality between statin users and non-users. RESULTS The use of statins was most common among patients without previous fractures (OR=0.54; 95% CI=0.33-0.89; p=0.0138), especially in older patients (OR=0.40; 95% CI=0.22-0.76). We did not find any significant difference in statin intake between men and women in the control group. In the case group, those who did not use statins were more likely to undergo a medial hip fracture (28.5% vs 16.1%). Patients from case group also presented a greater mortality (27.9% vs 19.35%) and an higher percentage of previous hip fractures (20.11% vs 9.7%). However, they didn't presented a significant higher rate of fragility fractures in other sites. DISCUSSION AND CONCLUSIONS Our study suggests a reduced hip fracture risk, especially in cases aged 80 or more, a different fracture pattern (lower percentage of medial fractures) and a reduced mortality at 9 months in patients treated with HMG-CoA reductase inhibitors, confirming the previous evidences reported in literature. Key words: statin, hip fractures, fracture risk, osteoporosis.
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Affiliation(s)
- A Del Chiaro
- Department of Orthopaedics and Trauma Surgery, University of Pisa, Pisa, Italy
| | - S Marchetti
- Department of Orthopaedics and Trauma Surgery, University of Pisa, Pisa, Italy
| | - P D Parchi
- Department of Orthopaedics and Trauma Surgery, University of Pisa, Pisa, Italy
| | - G Caprili
- Department of Orthopaedics and Trauma Surgery, University of Pisa, Pisa, Italy
| | - E Ipponi
- Department of Orthopaedics and Trauma Surgery, University of Pisa, Pisa, Italy
| | - M Scaglione
- Department of Orthopaedics and Trauma Surgery, University of Pisa, Pisa, Italy
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19
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Coccolini F, Cicuttin E, Cremonini C, Tartaglia D, Viaggi B, Kuriyama A, Picetti E, Ball C, Abu-Zidan F, Ceresoli M, Turri B, Jain S, Palombo C, Guirao X, Rodrigues G, Gachabayov M, Machado F, Eftychios L, Kanj SS, Di Carlo I, Di Saverio S, Khokha V, Kirkpatrick A, Massalou D, Forfori F, Corradi F, Delibegovic S, Machain Vega GM, Fantoni M, Demetriades D, Kapoor G, Kluger Y, Ansari S, Maier R, Leppaniemi A, Hardcastle T, Vereczkei A, Karamagioli E, Pikoulis E, Pistello M, Sakakushev BE, Navsaria PH, Galeiras R, Yahya AI, Osipov AV, Dimitrov E, Doklestić K, Pisano M, Malacarne P, Carcoforo P, Sibilla MG, Kryvoruchko IA, Bonavina L, Kim JI, Shelat VG, Czepiel J, Maseda E, Marwah S, Chirica M, Biancofiore G, Podda M, Cobianchi L, Ansaloni L, Fugazzola P, Seretis C, Gomez CA, Tumietto F, Malbrain M, Reichert M, Augustin G, Amato B, Puzziello A, Hecker A, Gemignani A, Isik A, Cucchetti A, Nacoti M, Kopelman D, Mesina C, Ghannam W, Ben-Ishay O, Dhingra S, Coimbra R, Moore EE, Cui Y, Quiodettis MA, Bala M, Testini M, Diaz J, Girardis M, Biffl WL, Hecker M, Sall I, Boggi U, Materazzi G, Ghiadoni L, Matsumoto J, Zuidema WP, Ivatury R, Enani MA, Litvin A, Al-Hasan MN, Demetrashvili Z, Baraket O, Ordoñez CA, Negoi I, Kiguba R, Memish ZA, Elmangory MM, Tolonen M, Das K, Ribeiro J, O’Connor DB, Tan BK, Van Goor H, Baral S, De Simone B, Corbella D, Brambillasca P, Scaglione M, Basolo F, De’Angelis N, Bendinelli C, Weber D, Pagani L, Monti C, Baiocchi G, Chiarugi M, Catena F, Sartelli M. A pandemic recap: lessons we have learned. World J Emerg Surg 2021; 16:46. [PMID: 34507603 PMCID: PMC8430288 DOI: 10.1186/s13017-021-00393-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 08/29/2021] [Indexed: 02/08/2023] Open
Abstract
On January 2020, the WHO Director General declared that the outbreak constitutes a Public Health Emergency of International Concern. The world has faced a worldwide spread crisis and is still dealing with it. The present paper represents a white paper concerning the tough lessons we have learned from the COVID-19 pandemic. Thus, an international and heterogenous multidisciplinary panel of very differentiated people would like to share global experiences and lessons with all interested and especially those responsible for future healthcare decision making. With the present paper, international and heterogenous multidisciplinary panel of very differentiated people would like to share global experiences and lessons with all interested and especially those responsible for future healthcare decision making.
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Affiliation(s)
- Federico Coccolini
- grid.144189.10000 0004 1756 8209General, Emergency and Trauma Surgery Department, Pisa University Hospital, Via Paradisa, 2, 56124 Pisa, Italy
| | - Enrico Cicuttin
- grid.144189.10000 0004 1756 8209General, Emergency and Trauma Surgery Department, Pisa University Hospital, Via Paradisa, 2, 56124 Pisa, Italy
| | - Camilla Cremonini
- grid.144189.10000 0004 1756 8209General, Emergency and Trauma Surgery Department, Pisa University Hospital, Via Paradisa, 2, 56124 Pisa, Italy
| | - Dario Tartaglia
- grid.144189.10000 0004 1756 8209General, Emergency and Trauma Surgery Department, Pisa University Hospital, Via Paradisa, 2, 56124 Pisa, Italy
| | - Bruno Viaggi
- grid.24704.350000 0004 1759 9494Infectious Disease Department, Careggi Hospital, Florence, Italy
| | - Akira Kuriyama
- grid.415565.60000 0001 0688 6269Emergency and Critical Care Center, Kurashiki Central Hospital, Kurashiki, Japan
| | - Edoardo Picetti
- grid.411482.aDepartment of Anesthesia and Intensive Care, Parma University Hospital, Parma, Italy
| | - Chad Ball
- grid.414959.40000 0004 0469 2139Hepatobiliary and Pancreatic Surgery Trauma and Acute Care Surgery, Foothills Medical Center, Calgary, AB Canada
| | - Fikri Abu-Zidan
- grid.43519.3a0000 0001 2193 6666Department of Surgery, College of Medicine and Health Sciences, UAE University, Al-Ain, UAE
| | - Marco Ceresoli
- grid.18887.3e0000000417581884General Surgery Department, Monza University Hospital, Monza, Italy
| | - Bruno Turri
- grid.414682.d0000 0004 1758 8744General Emergency and Trauma Surgery Department, Bufalini Hospital, Cesena, Italy
| | - Sumita Jain
- grid.416077.30000 0004 1767 3615Department of Surgery, SMS Medical College and Hospital, Jaipur, India
| | - Carlo Palombo
- grid.5395.a0000 0004 1757 3729Cardiology Division 1, Department of Surgical, Medical, Molecular Pathology, and Critical Medicine, School of Medicine, University of Pisa, Pisa, Italy
| | - Xavier Guirao
- grid.428313.f0000 0000 9238 6887Department of Surgery, Parc Tauli, Hospital Universitari, Sabadell, Spain
| | - Gabriel Rodrigues
- grid.415066.00000 0004 1805 8200Department of General Surgery, Kasturba Medical College and Hospital, Manipal, Karnataka India
| | - Mahir Gachabayov
- Department of Abdominal Surgery, Vladimir City Emergency Hospital, Vladimir City, Russia
| | - Fernando Machado
- General Surgery Department, Montevideo Hospital, Montevideo, Paraguay
| | | | - Souha S. Kanj
- grid.411654.30000 0004 0581 3406Antimicrobial Stewardship Program, American University of Beirut Medical Center, Beirut, Lebanon
| | - Isidoro Di Carlo
- grid.8158.40000 0004 1757 1969Department of Surgical Sciences and Advanced Technologies, General Surgery, University of Catania, Cannizzaro Hospital, Catania, Italy
| | - Salomone Di Saverio
- General Surgery, ASUR Marche 5, San Benedetto del Tronto General Hospital, San Benedetto del Tronto, Italy
| | | | - Andrew Kirkpatrick
- grid.414959.40000 0004 0469 2139General, Acute Care, Abdominal Wall Reconstruction, and Trauma Surgery, Foothills Medical Centre, Calgary, AB Canada
| | - Damien Massalou
- grid.410528.a0000 0001 2322 4179Acute Care Surgery, University Hospital of Nice (CHU de Nice)/Université Côte d’Azur, Nice, France
| | - Francesco Forfori
- grid.144189.10000 0004 1756 8209ICU Department, Pisa University Hospital, Pisa, Italy
| | - Francesco Corradi
- grid.144189.10000 0004 1756 8209ICU Department, Pisa University Hospital, Pisa, Italy
| | - Samir Delibegovic
- grid.412410.20000 0001 0682 9061General Surgery, University Clinical Center Tuzla, Tuzla, Bosnia and Herzegovina
| | - Gustavo M. Machain Vega
- grid.412213.70000 0001 2289 5077Servicio de Cirugia General, Universidad Nacional de Asuncion, Hospital de Clinicas Ii Cátedra de Clinica Quirúrgica, Asunción, Paraguay
| | - Massimo Fantoni
- grid.411075.60000 0004 1760 4193Dipartimento Di Scienze Di Laboratorio E Infettivologiche, Fondazione Policlinico Universitario Agostino Gemelli Irccs, Roma, Italy
| | - Demetrios Demetriades
- grid.411409.90000 0001 0084 1895Division of Trauma, Emergency Surgery, and Surgical Critical Care, LAC+USC Medical Center, Los Angeles, USA
| | - Garima Kapoor
- grid.415285.fDepartment of Microbiology, Gandhi Medical College, Bhopal, India
| | - Yoram Kluger
- General Surgery Department, Rambam Medical Centre, Tel Aviv, Israel
| | - Shamshul Ansari
- grid.488411.00000 0004 5998 7153Department of Microbiology, Chitwan Medical College and Teaching Hospital, Bharatpur, Chitwan, Nepal
| | - Ron Maier
- grid.34477.330000000122986657Harborview Medical Center, University of Washington, Seattle, WA USA
| | - Ari Leppaniemi
- grid.15485.3d0000 0000 9950 5666HUS Abdominal Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Timothy Hardcastle
- Trauma and Burns, Inkosi Albert Luthuli Central Hospital and DoH-KZN, Mayville, South Africa
| | - Andras Vereczkei
- grid.9679.10000 0001 0663 9479Department of Surgery, Medical School, University of Pécs, Pecs, Hungary
| | - Evika Karamagioli
- grid.5216.00000 0001 2155 0800Medical School, National and Kapodistrian University of Athens, (NKUA), Athens, Greece
| | - Emmanouil Pikoulis
- grid.5216.00000 0001 2155 0800Medical School, National and Kapodistrian University of Athens, (NKUA), Athens, Greece
| | - Mauro Pistello
- grid.5395.a0000 0004 1757 3729Department of Translational Research, University of Pisa, Pisa, Italy
| | - Boris E. Sakakushev
- grid.35371.330000 0001 0726 0380Research Institute at Medical University Plovdiv/University Hospital St George, Plovdiv, Bulgaria
| | - Pradeep H. Navsaria
- grid.7836.a0000 0004 1937 1151Trauma Center, Groote Schuur Hospital, Faculty of Health Sciences, University of Cape Town, Cape Town, 7925 South Africa
| | - Rita Galeiras
- grid.488921.eCritical Care Unit, Complexo Hospitalario Universitario A Coruña, Instituto de Investigación Biomédica de A Coruña, A Coruña, Spain
| | - Ali I. Yahya
- General Surgery Department, Zliten Medical Center, Zliten, Libya
| | - Aleksei V. Osipov
- Division of Emergency Surgery, Saint-Petersburg Research Institute of Emergency Medicine, Saint-Petersburg, Russian Federation
| | - Evgeni Dimitrov
- Department of Surgical Diseases, University Hospital “Prof. Dr. Stoyan Kirkovich”, 2A Gen. Stoletov Str., 6000 Stara Zagora, Bulgaria
| | | | - Michele Pisano
- 1St General Surgery Unit, Department of Emergency, ASST Papa Giovanni, Bergamo, Italy
| | - Paolo Malacarne
- grid.144189.10000 0004 1756 8209Department of Anaesthesia and Critical Care Medicine, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | - Paolo Carcoforo
- grid.416315.4General and Emergency Surgery Unit, Sant’Anna University-Hospital, Ferrara, Italy
| | - Maria Grazia Sibilla
- grid.416315.4General and Emergency Surgery Unit, Sant’Anna University-Hospital, Ferrara, Italy
| | - Igor A. Kryvoruchko
- grid.445504.40000 0004 0529 6576Department of Surgery No2, Kharkiv National Medical University, Kharkiv, Ukraine
| | - Luigi Bonavina
- grid.4708.b0000 0004 1757 2822Division of General and Foregut Surgery, University of Milan, IRCCS Policlinico San Donato, Milan, Italy
| | - Jae Il Kim
- grid.411633.20000 0004 0371 8173Department of Surgery, Inje University, Ilsan Paik Hospital, Goyang-si, South Korea
| | - Vishal G. Shelat
- grid.240988.fDepartment of General Surgery, Tan Tock Seng Hospital, Singapore, Singapore
| | - Jacek Czepiel
- grid.5522.00000 0001 2162 9631Department of Infectious and Tropical Diseases, Jagiellonian University Medical College, Kraków, Poland
| | - Emilio Maseda
- Surgical Critical Care, Department of Anesthesia, Hospital Valdecilla Santander, Santander, Spain
| | - Sanjay Marwah
- grid.412572.70000 0004 1771 1642Post-Graduate Institute of Medical Sciences, Rohtak, 124001 India
| | - Mircea Chirica
- grid.410529.b0000 0001 0792 4829Department of Digestive Surgery, Centre Hospitalier Universitaire Grenoble Alpes, La Tronche, France
| | - Giandomenico Biancofiore
- grid.5395.a0000 0004 1757 3729Operative Unit of Anesthesia and Transplant Resuscitation, University of Pisa, Pisa, Italy
| | - Mauro Podda
- grid.7763.50000 0004 1755 3242Department of Emergency Surgery, Cagliari University Hospital, Cagliari, Italy
| | - Lorenzo Cobianchi
- grid.419425.f0000 0004 1760 3027Department of Clinical, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
- grid.8982.b0000 0004 1762 5736Department of Clinical, Diagnostic, and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Luca Ansaloni
- grid.419425.f0000 0004 1760 3027Department of Clinical, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
- grid.8982.b0000 0004 1762 5736Department of Clinical, Diagnostic, and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Paola Fugazzola
- grid.419425.f0000 0004 1760 3027Department of Clinical, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
- grid.8982.b0000 0004 1762 5736Department of Clinical, Diagnostic, and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Charalampos Seretis
- grid.412924.80000 0004 0446 0530Department of General Surgery, George Eliot Hospital NHS Trust, Warwickshire, UK
| | | | - Fabio Tumietto
- Azienda Ospedaliero Universitaria Di Bologna, Unità Operativa Malattie Infettive, Bologna, Italy
| | - Manu Malbrain
- Internal Medicine – Intensive Care, AZ Jan Palfijn Gent, Gent, Belgium
- grid.411484.c0000 0001 1033 7158First Department of Anaesthesia and Intensive Therapy, Medical University of Lublin, Lublin, Poland
| | - Martin Reichert
- grid.411067.50000 0000 8584 9230Department of General, Visceral, Thoracic, Transplant and Pediatric Surgery, University Hospital of Giessen, Giessen, Germany
| | - Goran Augustin
- grid.412688.10000 0004 0397 9648Department of Surgery, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Bruno Amato
- grid.4691.a0000 0001 0790 385XDepartment of Public Health, Medical School, University of Naples Federico II, Naples, Italy
| | - Alessandro Puzziello
- grid.11780.3f0000 0004 1937 0335Dipartimento Di Medicina, Chirurgia E Odontoiatria, Campus Universitario di Baronissi - Università Di Salerno, Salerno, Italy
| | - Andreas Hecker
- grid.411067.50000 0000 8584 9230Department of General and Thoracic Surgery, University Hospital of Giessen, Marburg, Germany
| | - Angelo Gemignani
- grid.5395.a0000 0004 1757 3729Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | - Arda Isik
- grid.411776.20000 0004 0454 921XGeneral Surgery Department, Istanbul Medeniyet University, Istanbul, Turkey
| | - Alessandro Cucchetti
- grid.6292.f0000 0004 1757 1758Department of Medical and Surgical Sciences – DIMEC, Alma Mater Studiorum - University of Bologna, Bologna, Italy
- grid.415079.e0000 0004 1759 989XGeneral Surgery of the Morgagni - Pierantoni Hospital, Forlì, Italy
| | - Mirco Nacoti
- grid.460094.f0000 0004 1757 8431Pediatric Intensive Care Unit, Department of Anesthesia and Intensive Care, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Doron Kopelman
- grid.469889.20000 0004 0497 6510Hepato-Billiary-Pancreatic (HPB) Surgery Center, Emek Medical Center, Afula, Israel
| | - Cristian Mesina
- grid.452359.cEmergency County Hospital of Craiova, Craiova, Romania
| | - Wagih Ghannam
- grid.10251.370000000103426662Mansoura Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Offir Ben-Ishay
- grid.6451.60000000121102151The Ruth and Bruce Rappaport Faculty of Medicine, Technion – Israel Institute of Technology, Rambam Health Care Campus, Haifa, Israel
| | - Sameer Dhingra
- grid.419631.80000 0000 8877 852XDepartment of Pharmacy Practice, National Institute of Pharmaceutical Education and Research (NIPER), Hajipur Vaishali, Bihar, India
| | - Raul Coimbra
- grid.488519.90000 0004 5946 0028Department of Surgery, Riverside University Health System, Moreno Valley, CA USA
- grid.43582.380000 0000 9852 649XSchool of Medicine, Loma Linda University, Loma Linda, CA USA
| | - Ernest E. Moore
- grid.239638.50000 0001 0369 638XShock Trauma Center at Denver Health, Denver, CO USA
| | - Yunfeng Cui
- grid.265021.20000 0000 9792 1228Department of Surgery, Tianjin Nankai Hospital, Nankai Clinical School of Medicine, Tianjin Medical University, Tianjin, China
| | | | - Miklosh Bala
- grid.17788.310000 0001 2221 2926Trauma and Acute Care Surgery Unit, Hadassah - Hebrew University Medical Center, Jerusalem, Israel
| | - Mario Testini
- grid.7644.10000 0001 0120 3326Department of Biomedical Sciences and Human Oncology, University of Bari, Bari, Italy
| | - Jose Diaz
- grid.411024.20000 0001 2175 4264University of Maryland School of Medicine, Baltimore, MD USA
| | - Massimo Girardis
- grid.413363.00000 0004 1769 5275Intensive Care Unit, University Hospital of Modena, Modena, Italy
| | | | - Matthias Hecker
- grid.411067.50000 0000 8584 9230Department of Respiratory and Critical Care Medicine, University Hospital Giessen, Giessen, Germany
| | - Ibrahima Sall
- grid.414281.aDepartment of General Surgery, Military Teaching Hospital, Hôpital Principal de Dakar, Dakar, Senegal
| | - Ugo Boggi
- grid.5395.a0000 0004 1757 3729Division of General and Transplant Surgery, University of Pisa, Pisa, Italy
| | - Gabriele Materazzi
- grid.5395.a0000 0004 1757 3729Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | - Lorenzo Ghiadoni
- grid.144189.10000 0004 1756 8209Emergency Medical Department, Pisa University Hospital, Pisa, Italy
| | - Junichi Matsumoto
- grid.412764.20000 0004 0372 3116Department of Emergency and Critical Care Medicine, Saint-Marianna University School of Medicine, Kawasaki, Japan
| | - Wietse P. Zuidema
- grid.509540.d0000 0004 6880 3010Department of Surgery, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Rao Ivatury
- grid.224260.00000 0004 0458 8737Professor Emeritus, Virginia Commonwealth University, Richmond, VA USA
| | - Mushira A. Enani
- grid.415277.20000 0004 0593 1832Infectious Diseases Section, King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Andrey Litvin
- grid.410686.d0000 0001 1018 9204Immanuel Kant Baltic Federal University, Regional Clinic Hospital, Kaliningrad, Russia
| | - Majdi N. Al-Hasan
- grid.254567.70000 0000 9075 106XDepartment of Internal Medicine, University of South Carolina School of Medicine, Prisma Health-Midlands, Columbia, SC USA
| | - Zaza Demetrashvili
- grid.412274.60000 0004 0428 8304Department of Surgery, Tbilisi State Medical University, Kipshidze Central University Hospital, Tbilisi, Georgia
| | - Oussama Baraket
- Department of Surgery, Bizerte Hospital, Bizerte, Tunisia
- grid.265234.40000 0001 2177 9066Faculty of Medicine, Tunis University, Tunis ElManar, Tunisia
| | - Carlos A. Ordoñez
- grid.8271.c0000 0001 2295 7397Division of Trauma and Acute Care Surgery, Department of Surgery, Universidad del Valle, Cali, Colombia
| | - Ionut Negoi
- grid.8194.40000 0000 9828 7548General Surgery Department, Emergency Hospital of Bucharest, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Ronald Kiguba
- grid.11194.3c0000 0004 0620 0548Department of Pharmacology and Therapeutics, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Ziad A. Memish
- grid.411335.10000 0004 1758 7207King Saud Medical City, Ministry of Health and College of Medicine, AlFaisal University, Riyadh, Kingdom of Saudi Arabia
| | | | - Matti Tolonen
- grid.15485.3d0000 0000 9950 5666HUS Abdominal Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Korey Das
- General Surgery, University of Health Sciences, Adana City Training and Research Hospital, Adana, Turkey
| | - Julival Ribeiro
- grid.414433.5Infection Control Coordinator, Hospital de Base Do Distrito Federal /IGESDF, Brasilia, Brazil
| | - Donal B. O’Connor
- grid.8217.c0000 0004 1936 9705Department of Surgery, Trinity College Dublin, Dublin, Ireland
| | - Boun Kim Tan
- Infection Prevention and Control Unit, Centre des Massues, French-Red Cross, Lyon, France
| | - Harry Van Goor
- grid.10417.330000 0004 0444 9382Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Suman Baral
- General Surgery, Dirghayu Pokhara Hospital, Pokhara, Nepal
| | - Belinda De Simone
- grid.418056.e0000 0004 1765 2558Department of Emergency, Digestive and Metabolic Minimally Invasive Surgery, Centre Hospitalier Intercommunal de Poissy, Saint Germain en Laye, France
| | | | | | - Michelangelo Scaglione
- grid.144189.10000 0004 1756 8209Orthopedic and Traumatology Department, Pisa University Hospital, Pisa, Italy
| | - Fulvio Basolo
- grid.5395.a0000 0004 1757 3729Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | - Nicola De’Angelis
- grid.412116.10000 0001 2292 1474General Surgery, Department, Henri Mondor Hospital, Paris, France
| | - Cino Bendinelli
- grid.414724.00000 0004 0577 6676Department of Surgery, John Hunter Hospital, Newcastle, Australia
- grid.266842.c0000 0000 8831 109XUniversity of Newcastle, Callaghan, Australia
| | - Dieter Weber
- grid.1012.20000 0004 1936 7910General Surgery, Royal Perth Hospital, The University of Western Australia, Perth, Australia
| | - Leonardo Pagani
- grid.415844.8Infectious Diseases Unit, Bolzano Central Hospital, Bolzano, Italy
| | - Cinzia Monti
- Radiology Department, Gavazzeni Hospital, Bergamo, Italy
| | - Gianluca Baiocchi
- grid.419450.dGeneral Surgery Department, Cremona Hospital, Cremona, Italy
| | - Massimo Chiarugi
- grid.144189.10000 0004 1756 8209General, Emergency and Trauma Surgery Department, Pisa University Hospital, Via Paradisa, 2, 56124 Pisa, Italy
| | - Fausto Catena
- grid.414682.d0000 0004 1758 8744General Emergency and Trauma Surgery Department, Bufalini Hospital, Cesena, Italy
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20
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Matassi F, Piolanti N, Filoni G, Giabbani N, Nulvesu G, Rostagno C, Civinini R, Scaglione M. The New Challenge in the Management of Proximal Femur Fractures during SARS Cov-2 outbreak. Acta Biomed 2021; 92:e2021338. [PMID: 34487092 PMCID: PMC8477100 DOI: 10.23750/abm.v92i4.10965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 12/28/2020] [Indexed: 11/23/2022]
Abstract
The aim of this study is to evaluate how the spread of Sars-Cov-2 has changed the epidemiology of proximal femur fractures in two major trauma centers in Italy, understanding the workload and the best allocation of the resources for the orthopedics department in such an emergency situation. The rate of patients from January 2019 to April 2020 hospitalized with femoral neck fractures (group A) and trochanteric fractures (group B) were recorded. Demographic data, timing of surgical treatment and the length of stay were recorded. Data show that the number of proximal femur fractures has remained unchanged in the COVID and pre-COVID era (ranging from an average of 91.14/month in the pre-COVID era to 76/month in March and 80/month in April). In our trauma centers, the rate of patients operated on within 48 hours has remained stable (78.19% vs 77.92%), while the length of stay has decreased during the COVID period (8.9 days vs 6.5 days in March and 6.8 days in April). Proximal femur fractures, even during the COVID period, are a constant issue and a new challenge for the healthcare system. The main goals of management are to preserve patients from viral infection, to provide early surgical treatment and fast track protocol for discharge.
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Affiliation(s)
- Fabrizio Matassi
- Orthopaedic Clinic - University of Florence - Largo Palagi, 1 - 50139 - Florence, Italy.
| | - Nicola Piolanti
- Orthopaedic and Trauma Clinic - University of Pisa - Via Paradisa 2 - 56124 - Pisa, Italy.
| | - Gabriele Filoni
- Orthopaedic and Trauma Clinic - University of Pisa - Via Paradisa 2 - 56124 - Pisa, Italy.
| | - Niccolò Giabbani
- Orthopaedic Clinic - University of Florence - Largo Palagi, 1 - 50139 - Florence, Italy.
| | - Gianluca Nulvesu
- Orthopaedic and Trauma Clinic - University of Pisa - Via Paradisa 2 - 56124 - Pisa, Italy.
| | - Carlo Rostagno
- Department of experimental clinical medicine - University of Florence - Largo Palagi, 1 - 50139 - Florence, Italy.
| | - Roberto Civinini
- Orthopaedic Clinic - University of Florence - Largo Palagi, 1 - 50139 - Florence, Italy.
| | - Michelangelo Scaglione
- Orthopaedic and Trauma Clinic - University of Pisa - Via Paradisa 2 - 56124 - Pisa, Italy.
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21
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Barachini S, Montali M, Panvini FM, Carnicelli V, Gatti GL, Piolanti N, Bonicoli E, Scaglione M, Buda G, Parchi PD. Mesangiogenic Progenitor Cells Are Tissue Specific and Cannot Be Isolated From Adipose Tissue or Umbilical Cord Blood. Front Cell Dev Biol 2021; 9:669381. [PMID: 34291045 PMCID: PMC8287027 DOI: 10.3389/fcell.2021.669381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 05/24/2021] [Indexed: 11/17/2022] Open
Abstract
Mesangiogenic progenitor cells (MPCs) have been isolated from human bone marrow (BM) mononuclear cells. They attracted particular attention for the ability to differentiate into exponentially growing mesenchymal stromal cells while retaining endothelial differentiative potential. MPC power to couple mesengenesis and angiogenesis highlights their tissue regenerative potential and clinical value, with particular reference to musculoskeletal tissues regeneration. BM and adipose tissue represent the most promising adult multipotent cell sources for bone and cartilage repair, although discussion is still open on their respective profitability. Culture determinants, as well as tissues of origin, appeared to strongly affect the regenerative potential of cell preparations, making reliable methods for cell isolation and growth a prerequisite to obtain cell-based medicinal products. Our group had established a definite consistent protocol for MPC culture, and here, we present data showing MPCs to be tissue specific.
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Affiliation(s)
- Serena Barachini
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Marina Montali
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Francesca M Panvini
- Sant'Anna School of Advanced Studies, Institute of Life Sciences, Pisa, Italy
| | - Vittoria Carnicelli
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | - Gian Luca Gatti
- Plastic and Reconstructive Surgery Unit, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Nicola Piolanti
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Enrico Bonicoli
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Michelangelo Scaglione
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Gabriele Buda
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Paolo D Parchi
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
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22
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Mani O, Nucci AM, Scaglione M, Bonicoli E, Parchi PD, Piolanti N. Bibliometric trend analysis in a decade of European Orthopaedic literature. Acta Biomed 2021; 92:e2021280. [PMID: 34212934 PMCID: PMC8343746 DOI: 10.23750/abm.v92i3.9512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 08/31/2020] [Indexed: 11/23/2022]
Abstract
Purpose: The purpose of this bibliometric study was to summarize European orthopedic literature produced by EFORT memberships between 2009 and 2019 and to identify the 100 most cited articles, analyzing the characteristics that made them so interesting for the orthopedic scientific world. Method: A search of the literature was conducted using Clarivate Analytics Web of Science in the subject category “orthopaedics”; then the results were summarized using Web of Science tools. Results: A total of 160.375 articles were found: most of these were produced by England. In particular the most prolific institution was the University of London. Analyzing in detail the 100 most cited publications emerged that most of them were review published in journal with high impact factor (Q1). The University of Oxford was the institution with the greatest number of contributions (13%). The most cited topics were osteoarthritis (24%), followed by orthopedic basic science (22%). Bio-materials was the most common topic by ordering the 100 analyzed articles according to “usage count”, a recent indicator of the level of interest in a specific item. Conclusion: This bibliometric study can be useful to identify topics of interest for future scientific research and to outline the features that make some publications more interesting than others. (www.actabiomedica.it)
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23
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Segreti L, De Simone A, Schillaci V, Pandozi C, Bongiorni MG, Stabile G, Arestia A, Giannotti Santoro M, Pelargonio G, Scaglione M, Rossi P, Pecora D, Stocco C, Malacrida M, Solimene F. Early rhythm-control ablation therapy in preventing AF recurrences: insight from the CHARISMA Registry. Europace 2021. [DOI: 10.1093/europace/euab116.192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
An early and comprehensive rhythm-control therapy emerges as a need to treat AF in an effective way and to improve the ablation outcomes, in terms of arrhythmia-free survival.
Purpose
We aimed to investigate the importance of timing of ablation in preventing AF recurrences.
Methods
153 consecutive patients (pts) undergoing AF ablation from the CHARISMA registry at 8 Italian centres were included. Ablations were guided by a novel radiofrequency ablation catheter with local impedance (LI)-sensing capability through a dedicated algorithm (DirectSense, Boston Scientific). Pts were grouped as early treated (ET) if the procedure was performed within 1 year after the first AF episode and as delayed treated (DT) if admitted for ablation after more than 1 year. The ablation endpoint was PVI as assessed by entrance and exit block. Post-ablation follow-up was scheduled at 3, 6 and 12 months. AF and atrial tachycardia (AT) recurrences were considered as long-term endpoint.
Results
Of the 153 pts enrolled (69.9% male, 59 ± 10 years, 61.4% paroxysmal AF, 38.6% persistent AF), 123 (80.4%) met Class I indications, 23 (15%) Class IIa indications and 7 (4.6%) Class IIb indications according to current ESC AF guidelines. The mean time to ablation procedure from the first AF episode was 1034 ± 1483 days. Eighty pts (52.3%) were included in ET group, whereas 73 pts (47.7%) in DT group. No differences were found between AF type in terms of ablation strategy (53.3% of the cases -52 out 94- were classified as ET for paroxysmal AF vs 47.5% of the cases -28 out 59- were ET for persistent AF, p = 0.4346). At the end of the procedures, all PVs had been successfully isolated in all study pts. During a mean follow-up of 366 ± 130 days, 18 pts (11.8%) suffered an AF/AT recurrence after the 90-day blanking period. Recurrences occurred mostly in the DT group compared to the ET one (13 out 73 -17.8%- vs 5 out 80 -6.3%-, p = 0.042) and the time to AT/AF recurrence was longer in the ET group (HR = 0.2876, 95%CI: 0.1029 to 0.8038; p = 0.0181). On multivariate logistic analysis adjusted for baseline confounders, only hypertension (HR = 4.66, 95%CI: 1.5 to 14.48, p = 0.0081) was independently associated with recurrences. An early rhythm-control therapy was associated with a low risk of recurrences beyond the hypertension risk factor, ranging from 2% (no hypertension and an ET ablation therapy) to 30.3% (with hypertension and a DT procedure) (Figure 1).
Conclusion
A LI-guided ablation strategy for PVI proved to be safe and effective and resulted in a very high recurrence-free rate. An early rhythm-control therapy in the absence of common risk factors was associated with the lowest rate of recurrences. Abstract Figure. AT/AF Recurrence
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Affiliation(s)
- L Segreti
- Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | | | - V Schillaci
- Montevergine Cardiology Clinic, Mercogliano, Italy
| | - C Pandozi
- San Filippo Neri Hospital, Rome, Italy
| | - MG Bongiorni
- Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - G Stabile
- Casa di cura San Michele, Maddaloni, Italy
| | - A Arestia
- Montevergine Cardiology Clinic, Mercogliano, Italy
| | | | - G Pelargonio
- Fondazione Policlinico Universitario Gemelli IRCCS, Catholic University, Rome, Italy
| | | | - P Rossi
- Giovanni Calibita Fatebenefratelli Hospital, Rome, Italy
| | - D Pecora
- Poliambulanza Foundation Hospital Institute of Brescia, Brescia, Italy
| | - C Stocco
- Boston Scientific Italy, Milan, Italy
| | | | - F Solimene
- Montevergine Cardiology Clinic, Mercogliano, Italy
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Scaglione M, Calvanese R, Pandozi C, Pedretti S, Rossi L, Pelargonio G, Mantovan R, Solimene F, Canciello M, Fonte G, Biagi A, Caponi D, Cerrato N, Malacrida M, Battaglia A. Impact of channels identification and ablation in ventricular tachycardia patients through high-density mapping: preliminary experience from an Italian registry. Europace 2021. [DOI: 10.1093/europace/euab116.352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Ventricular tachycardia (VT) ablation techniques in ischemic cardiomyopathy have evolved during the recent years. However, the long-term success rate remains disappointing. A technique based on channel identification and ablation through a novel automated algorithm may limit the extent of ablation needed and possibly lead to higher successful rate.
Purpose
To report preliminary data on feasibility and safety of a channel identification approach and to characterize late potentials (LPs) features using an ultra-high density mapping system with a novel analysis tool in ischemic VT procedures.
Methods
Consecutive patients (pts) indicated for ischemic VT ablation were enrolled in the CHARISMA study. A complete map of the left ventricle was performed prior and after ablation through the Rhythmia mapping system. For our purpose channels were defined as any signal activity bounded by anatomic and functional barriers and characterized through a novel map analysis tool (Lumipoint-LM-) that automatically identifies fragmented late potentials (LPs) and continuous activation was used on the whole ventricular substrate. Procedural endpoint was the elimination of all identified conducting channels (CCs) by ablation at the CC entrance and exit followed by abolition of any residual LPs inside the CC. The ablation endpoint was noninducibility.
Results
A total of 18 channels were identified through LM from 14 pts: 71.4% of the pts had 1 CC, 28.6% had 2 CCs. In the majority of the cases LPs where identified only inside CCs (57.1%), whereas in 6 cases (42.9%) LPs were present both inside and outside. The mean conduction time inside CCs was 50.3 ± 30ms, the mean CC length was 32.6 ± 17mm and the conduction velocity was 0.8 ± 0.5 mm/ms. LPs covered a mean area of 7.0 ± 5mm2 (ratio between LPs area and CCs’ area = 52.4 ± 33.7%). At voltage map analysis 1 CC was present in 78.6% of the cases (2 CCs in 21.4%). LPs were identified only inside CCs in 42.9% of the cases, both inside and outside in 50% and only outside in 7.1%. Healthy tissue (voltage level≥0.5mV) was prevalent (61.2 ± 13.8%), followed by intermediate voltage areas (0.5-0.05mV; 37.5 ± 13.7%) and very low voltage areas (<0.05mV; 1.2 ± 2%). LPs were found mostly at intermediate voltage areas (54.1 ± 31.7% of the covered area; 39.1 ± 28.4% at healthy tissue and 6.8 ± 17.8% at very low voltage areas). Agreement in CCs identification between advanced analysis through LM and voltage map was fair (9/14 with complete agreement). In 3 cases voltage map overestimated LPs areas, in 2 cases failed to fully identify LPs. All CCs’ entrance and exit were successfully ablated and abolition of any residual LPs inside the CC was achieved in all pts. No complication occurred. Noninducibility was achieved in all the cases.
Conclusions
In our preliminary experience, a new channel identification approach through the advanced Lumipoint algorithm seems to be safe, feasible and effective at least in the acute setting of ischemic VT ablation.
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Affiliation(s)
| | | | - C Pandozi
- San Filippo Neri Hospital, Rome, Italy
| | | | - L Rossi
- Guglielmo da Saliceto Hospital, Piacenza, Italy
| | - G Pelargonio
- Fondazione Policlinico Universitario A. Gemelli IRCSS, Rome, Italy
| | - R Mantovan
- Conegliano General Hospital, Conegliano, Italy
| | - F Solimene
- Montevergine Cardiology Clinic, Mercogliano, Italy
| | | | - G Fonte
- Sant"Anna Hospital, Como, Italy
| | - A Biagi
- Guglielmo da Saliceto Hospital, Piacenza, Italy
| | - D Caponi
- Cardinal Massaia Hospital, Asti, Italy
| | - N Cerrato
- Cardinal Massaia Hospital, Asti, Italy
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Ziacchi M, Capucci A, Tola G, Scaglione M, D"onofrio A, Guerra F, Scalone A, Battaglia A, D"alterio G, Biffi M. Wearable Cardioverter Defibrillator (WCD) in Italy: results from the nationwide multicenter registry WEAR-ITA. Europace 2021. [DOI: 10.1093/europace/euab116.364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
BACKGROUND
The Wearable Cardioverter Defibrillators (WCD) has been used extensively in Italy since 2015, following long years of experience in other countries. This technology provides temporary protection from Sudden Cardiac Death (SCD) for patients with an evolving risk profile that may not yet be eligible for an Implantable Cardioverter Defibrillator (ICD). Collecting national data on use of the device can help build a picture that will enable an understanding on how to use the WCD appropriately in the future.
PURPOSE
Our purpose has been to investigate WCD usage on a nationwide level. This is in terms of target population, average wear time, patient compliance, diagnosed and treated arrhythmic events and patient outcome once they stopped wearing the device.
METHODS
WEAR-ITA is a nationwide, multi-centre retrospective observational project. Patient data was retrospectively collected from the Italian hospitals that agreed to take part in the data collection for all patients fitted with a WCD between April 2015 to May 2018. All data refers to the range from the first day of wear until the end of use.
RESULTS
We collected data for 411 patients from 15 (75%) Italian regions. WCD use among the different regions was heterogeneous with a median of 0.5 (0.2-1.2) WCD wore/105 inhabitants. The mean age of the population was 55(±14) and the majority of patients were male (79%). Main WCD indication was non-ischemic cardiomyopathy with reduced ejection fraction (51%), ischemic etiology with severe systolic dysfunction (31%), uncertain or unidentified diagnosis (10%) that then revealed to be predominantly channelopathies or myocarditis and after ICD extraction (8%). Patients wore the WCD for a median of 59 (33-90) days and the median daily weartime was 23 (22,7-23,8) hours. In 15 patients (4%), the WCD recorded non sustained ventricular tachycardia (VT), 10 patients (2%) had hemodynamically well-tolerated sustained VT not needing a shock. 8 patients (2%) received effective appropriate shocks. Time to episodes were respectively 61 (14-61) days for non-sustained VT and 28 (19-70) days for VT/VF. 2 patients (0.5%) received inappropriate shocks for sinus tachycardia and atrial fibrillation (AF) respectively. WCD recorded new onset of supra ventricular tachycardia episodes in 12 patients (3%) and of atrial fibrillation (AF) in 7 patients (2%). 7 patients (2%) died while wearing WCD; none of them from SCD. At the end of the WCD use, 195 patients (47%) did not receive an ICD while 209 patients (51%)were implanted.
CONCLUSIONS
WCD is an effective therapy for the treatment of SCD with a very low complication rates. The indication and penetration in Italy is quite heterogeneous. The patient’s compliance is high over time. The incidence of appropriate shock is not negligible; only half of patients, who wore WCD, received an ICD. There is however still a requirement to conduct further randomized trials to understand which patients could most benefit from the use of WCD. Abstract Figure. Wereable Cardioverter Defibrillator
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Affiliation(s)
- M Ziacchi
- Azienda Ospedaliero, Universitaria di Bologna, Policlinico S.Orsola-Malpigh, Institute of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine, Bologna, Italy
| | - A Capucci
- Marche Polytechnic University of Ancona, Cardiology and Arrhythmology Clinic, University Hospital Umberto, Lancisi, Salesi, Ancona, Italy
| | - G Tola
- AO Brotzu Hospital, Division of Cardiology, Cagliari, Italy
| | - M Scaglione
- Cardinal Massaia Hospital, Division of Cardiology, Asti, Italy
| | - A D"onofrio
- Ospedale Monaldi, Departmental Unit of Electrophysiology, Evaluation and Treatment of Arrhythmias, Naples, Italy
| | - F Guerra
- Marche Polytechnic University of Ancona, Cardiology and Arrhythmology Clinic, University Hospital Umberto, Lancisi, Salesi, Ancona, Italy
| | - A Scalone
- AO Brotzu Hospital, Division of Cardiology, Cagliari, Italy
| | - A Battaglia
- Cardinal Massaia Hospital, Division of Cardiology, Asti, Italy
| | - G D"alterio
- Ospedale Monaldi, Departmental Unit of Electrophysiology, Evaluation and Treatment of Arrhythmias, Naples, Italy
| | - M Biffi
- Azienda Ospedaliero, Universitaria di Bologna, Policlinico S.Orsola-Malpigh, Institute of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine, Bologna, Italy
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La Greca C, Cauti FM, Piro A, Di Belardino N, Anselmino M, Scaglione M, Pecora D, Rossi L, Di Cori A, Tola G, Pedretti S, Mantovan R, Solimene F, Rossi P, Bianchi S. Minimal fluoroscopic approaches and factors associated with radiation dose when high-definition mapping is used for supraventricular tachycardia ablation: insight from the CHARISMA registry. Europace 2021. [DOI: 10.1093/europace/euab116.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Limited data exist on factors associated with radiation exposure during ablation procedures when a high definition mapping technology is used.
Purpose
To report factors associated with radiation exposure and data on feasibility and safety of a minimal fluoroscopic approach using the Rhythmia mapping system in supraventricular tachycardia (SVT) ablation procedures.
Methods
Consecutive patients indicated for arrhythmia ablation were enrolled in the CHARISMA study at 12 centers. We included in this analysis consecutive right-side procedures performed through a minimal fluoroscopy approach with the Rhythmia mapping system were analyzed. A 3D geometry of chambers of interest was reconstructed on the basis of the electroanatomic information taken from the mapping system. Fluoroscopy was used only if deemed necessary. The effective dose (ED) was calculated using accepted formula. For our purpose high dose exposure was defined as an ED greater than the median value of ED of the population exposed to radiation.
Results
This analysis included 325 patients (mean age = 56 ± 17 years, 57% male) undergoing SVT procedures (152 AVNRT, 116 AFL, 41 AP and 16 AT). During the study, 27481 seconds of fluoroscopy was used (84.6 ± 224 seconds per procedure), resulting in a mean equivalent ED of 1.1 ± 3.7 mSv per patient. The mean reconstructed RA volume was 99 ± 54 ml in a mean mapping time of 12.2 ± 7 min. The mean number of radiofrequency ablations (RFC) to terminate each arrhythmia was 9.4 ± 9 (mean RFC delivery time equal to 6.7 ± 6 min). 192 procedures (59.1%) were completed without any use of fluoroscopy; during the remaining 133 procedures (39.9%), 206.6 ± 313.4 seconds of fluoroscopy was used (median ED = 1.2 mSv). In a minority of the cases (n = 25, 7.7%) the fluoroscopy time was higher than 5 minutes (median ED = 6.5 mSv), whereas radiologic exposure time greater than 1 minute occurred in ninety cases (27.7%, median ED = 2.1 mSv). On multivariate logistic analysis adjusted for baseline confounders the RFC application time (OR = 1.0014, 95%CI: 1.0007 to 1.0022; p = 0.0001) was independently associated to an ED greater than 1.2 mSv, whereas female gender had an inverse association (0.54, 0.29 to 0.98; p = 0.0435). Acute success was reached in 97.8% of the cases. During a mean of 290.7 ± 169.6 days follow-up, no major adverse events related to the procedure were reported. Overall, the recurrence rate of the primary arrhythmia during follow-up was 2.5%.
Conclusions
In our experience, arrhythmias ablation through minimal fluoroscopy approach with the use of a novel ablation technology is safe, feasible, and effective in common right atrial arrhythmias. High-dose exposure occurred in a very limited number of cases, without any reduction of the safety and acute and long-term effectiveness profile.
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Affiliation(s)
- C La Greca
- Poliambulanza Foundation Hospital Institute of Brescia, Cardiology, Brescia, Italy
| | - FM Cauti
- Giovanni Calibita Fatebenefratelli Hospital, Rome, Italy
| | - A Piro
- Umberto I Polyclinic of Rome, Rome, Italy
| | | | | | | | - D Pecora
- Poliambulanza Foundation Hospital Institute of Brescia, Cardiology, Brescia, Italy
| | - L Rossi
- Guglielmo da Saliceto Hospital, Piacenza, Italy
| | - A Di Cori
- Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - G Tola
- AO Brotzu Hospital, Cagliari, Italy
| | | | - R Mantovan
- Conegliano General Hospital, Conegliano, Italy
| | - F Solimene
- Montevergine Cardiology Clinic, Mercogliano, Italy
| | - P Rossi
- Giovanni Calibita Fatebenefratelli Hospital, Rome, Italy
| | - S Bianchi
- Giovanni Calibita Fatebenefratelli Hospital, Rome, Italy
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Grossi S, Ipponi E, Bufalino E, Gariffo G, Filoni G, Ceccoli M, Simonetti M, Ciapini G, Scaglione M. All-Inside Arthroscopic Repair For Longitudinal Meniscal Tears: Clinical and Functional Results. Surg Technol Int 2021; 38:387-392. [PMID: 33624831 DOI: 10.52198/21.sti.38.os1396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Meniscal injuries are a common challenge in orthopaedic surgery. Depending on their location and the patient's age and functional needs, they can be treated either conservatively or surgically. A surgical approach can consist of arthroscopic meniscectomy or meniscal suture. The latter is the treatment of choice in case of lesions involving the red-red or red-white areas of the meniscus, especially for young high-demanding patients. We report here our experience with the repair of longitudinal meniscal tears using the all-inside technique with the Fast-Fix™ 360 Meniscal Repair System (Smith & Nephew Endoscopy, Andover, MA). We retrospectively evaluated 20 consecutive cases of longitudinal meniscal tears. In 4 cases, concomitant ACL rupture was diagnosed and treated alongside the meniscal repair. All patients underwent periodic clinical evaluations. At the latest check-up, their functional outcomes were rated according to the Tegner-Lysholm Knee and KOOS scoring scales. The mean Tegner-Lysholm Knee score was 84.85 (44-100) and the mean KOOS score was 88.58. No failure or major complications were observed. Furthermore, a negative statistical association was observed between age at surgery and the post-operative Tegner-Lysholm Knee score (coef. = -1.01189 [-1.942073,-0.0817063], p = 0.035). This relation, independent of gender, meniscus involved, eventual associated ACL reconstruction, and chondral injury, suggests that functional outcomes worsen with increasing patient age. Our results suggest that the arthroscopic all-inside suture is both safe and effective in cases of longitudinal meniscal tear, considering the good post-operative functionality and low rates of local complications and surgical failures.
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Affiliation(s)
- Stefano Grossi
- Unità Operativa di Ortopedia e Traumatologia, Ospedale di Cecina, Usl Toscana Nord Ovest, Cecina, Italy
| | - Edoardo Ipponi
- Dipartimento di Chirurgia Traslazionale e Nuove Tecnologie, Clinica Ortopedica I, Azienda Ospedaliero Universitaria Pisana, Cisanello, Università di Pisa, Pisa, Italy
| | - Eric Bufalino
- Dipartimento di Chirurgia Traslazionale e Nuove Tecnologie, Clinica Ortopedica I, Azienda Ospedaliero Universitaria Pisana, Cisanello, Università di Pisa, Pisa, Italy
| | - Gabriele Gariffo
- Dipartimento di Chirurgia Traslazionale e Nuove Tecnologie, Clinica Ortopedica I, Azienda Ospedaliero Universitaria Pisana, Cisanello, Università di Pisa, Pisa, Italy
| | - Gabriele Filoni
- Dipartimento di Chirurgia Traslazionale e Nuove Tecnologie, Clinica Ortopedica I, Azienda Ospedaliero Universitaria Pisana, Cisanello, Università di Pisa, Pisa, Italy
| | - Matteo Ceccoli
- Unità Operativa di Ortopedia e Traumatologia, Ospedale di Cecina, Usl Toscana Nord Ovest, Cecina, Italy
| | - Matteo Simonetti
- Dipartimento di Chirurgia Traslazionale e Nuove Tecnologie, Clinica Ortopedica I, Azienda Ospedaliero Universitaria Pisana, Cisanello, Università di Pisa, Pisa, Italy
| | - Gianluca Ciapini
- Dipartimento di Chirurgia Traslazionale e Nuove Tecnologie, Clinica Ortopedica I, Azienda Ospedaliero Universitaria Pisana, Cisanello, Università di Pisa, Pisa, Italy
| | - Michelangelo Scaglione
- Dipartimento di Chirurgia Traslazionale e Nuove Tecnologie, Clinica Ortopedica I, Azienda Ospedaliero Universitaria Pisana, Cisanello, Università di Pisa, Pisa, Italy
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Lepillier A, Strisciuglio T, De Ruvo E, Scaglione M, Anselmino M, Sebag FA, Pecora D, Gallagher MM, Rillo M, Viola G, Pisanò E, Abbey S, Lamberti F, Pani A, Zucchelli G, Sgarito G, De Simone A, Bertaglia E, Solimene F, Stabile G. Impact of ablation index settings on pulmonary vein reconnection. J Interv Card Electrophysiol 2021; 63:133-142. [PMID: 33570717 DOI: 10.1007/s10840-021-00944-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 01/11/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE Ablation index (AI) is a radiofrequency lesion quality marker. The AI value that allows effective and safe pulmonary vein isolation (PVI) is still debated. We evaluated the incidence of acute and late PV reconnection (PVR) with different AI settings and its predictors. METHODS The Ablation Index Registry is a multicenter study that included patients with paroxysmal/persistent atrial fibrillation (AF) who underwent first-time ablation. Each operator performed the ablation using his preferred ablation catheter (ThermoCool® SmartTouch or Surround Flow) and AI setting (380 posterior-500 anterior and 330 posterior-450 anterior). We divided the study population into two groups according to the AI setting used: group 1 (330-450) and group 2 (380-500). Incidence of acute PVR was validated within 30 min after PVI, whereas the incidence of late PVR was evaluated at repeat procedure. RESULTS Overall, 490 patients were divided into groups 1 (258) and 2 (232). There was no significant difference in the procedural time, fluoroscopy time, and rate of the first-pass PVI between the two study groups. Acute PVR was observed in 5.6% PVs. The rate of acute PVR was slightly higher in group 2 (64/943, 6.8%, PVs) than in group 1 (48/1045, 4.6% PVs, p = 0.04). Thirty patients (6%) underwent a repeat procedure and late PVR was observed in 57/116 (49%) PVs (number of reconnected PV per patient of 1.9 ± 1.6). A similar rate of late PVR was found in the two study groups. No predictors of acute and late PVR were found. CONCLUSION Ablation with a lower range of AI is highly effective and is not associated with a higher rate of acute and late PVR. No predictors of PV reconnection were found.
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Affiliation(s)
- A Lepillier
- Centre Cardiologique du Nord, St Denis, Paris, France
| | - T Strisciuglio
- Clinica Montevergine, Mercogliano, Avellino, Italy.,University of Naples Federico II, Naples, Italy
| | | | | | - M Anselmino
- A.O.U. Citta della Salute e della Scienza di Torino, Department of Medical Sciences, University of Turin, Turin, Italy
| | - F A Sebag
- Institut Mutualiste Montsouris, Paris, France
| | - D Pecora
- Fondazione Poliambulanza, Brescia, Italy
| | | | - M Rillo
- Casa di Cura Villa Verde, Taranto, Italy
| | - G Viola
- Ospedale San Francesco, Nuoro, Italy
| | - E Pisanò
- Ospedale Vito Fazzi, Lecce, Italy
| | - S Abbey
- Hôpital Privé Du Confluent (HPCN), Nantes, France
| | | | - A Pani
- Ospedale di Lecco, Lecco, Italy
| | | | - G Sgarito
- A.R.N.A.S. Civico Cristina Benfratelli, Palermo, Italy
| | - A De Simone
- Clinica San Michele, via Montella 16, 81024, Maddaloni, Caserta, Italy
| | - E Bertaglia
- Department of Cardiac, Thoracic, and Vascular Sciences, University of Padova, Padova, Italy
| | - F Solimene
- Clinica Montevergine, Mercogliano, Avellino, Italy
| | - Giuseppe Stabile
- Clinica Montevergine, Mercogliano, Avellino, Italy. .,Clinica San Michele, via Montella 16, 81024, Maddaloni, Caserta, Italy. .,Anthea Hospital, Bari, Italy.
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Lepillier A, Solimene F, De Ruvo E, Scaglione M, Anselmino M, Sebag F, Pecora D, Gallagher M, Rillo M, Stabile G. Reproducibility of pulmonary vein isolation guided by the ablation index: One-year outcome of the AIR registry. Archives of Cardiovascular Diseases Supplements 2021. [DOI: 10.1016/j.acvdsp.2020.10.202] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Scaglione M, Casella F, Giuntoli M, Celli F, Fabbri L, Marchetti S. The role of superior capsular approach (SuperPATH) in the treatment of femoral neck fractures with hemiarthroplasty implantation: our experience and review of literature. Acta Biomed 2020; 91:e2020114. [PMID: 33525290 PMCID: PMC7927471 DOI: 10.23750/abm.v91i4.9089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 03/27/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND AIM OF THE WORK since 2003, a series of so called 'micro-posterior' approaches have been developed in the orthopaedic surgery to perform total hip replacement. These techniques present several theoretical advantages compared to the classic postero-lateral approach: reduction in blood loss, post-operative pain, and length of stay but also improving functional outcomes. In our hypothesis these goals could also be obtained in patients with femoral neck fractures, especially in the elderly with several comorbidities. METHODS In our series we performed 50 consecutive cemented hemiarthroplasties through SuperPATH approach. At the latest follow-up (FU) 41 patients were included in the study. Clinical and radiological evaluation was performed before the surgery and at the latest FU using VAS score, Harris Hip Score (HHS) and conventional AP and LL X-rays. RESULTS We didn't report any intra-operative complication (i.e. periprosthetic fractures, vasculo-nervous injuries or dislocations) or any case with a dysmetria greater than 1 cm. Mean blood transfusion units were 0.8 during surgery (0 - 4) and 1,6 after surgery (0-4). We reported a mean length of stay of 9.7 days (range 7-15) mainly due to our patients' high comorbidity rate. At the last one-year FU no cases of dislocation, infection and clinical or radiographical signs of prosthetic loosening were recorded. All our patients returned to the same activity level before femoral fracture occurred, according to HHS. CONCLUSION The SuperPATH is a real minimally invasive approach with a low rate of intra- and post-operative complications. It is related to a reduced dislocation rate and potentially to a reduced infection rate compared to the conventional surgical approaches, allowing, furthermore, a faster functional recovery. According to our experience the advantages of this type of approach can be obtained in the trauma field too.
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Affiliation(s)
| | - Francesco Casella
- Orthopaedic Department, University of Pisa, Via Paradisa 2, 56100 Pisa, PI, Italy.
| | | | - Fabio Celli
- Orthopaedic Department, University of Pisa, Via Paradisa 2, 56100 Pisa, PI, Italy..
| | - Luca Fabbri
- Orthopaedic Department, University of Pisa, Via Paradisa 2, 56100 Pisa, PI, Italy..
| | - Stefano Marchetti
- 1st Orthopaedic Division, University of Pisa, Via Paradisa 2, 56100 Pisa, PI, Italy..
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Giuntoli M, Bonicoli E, Piolanti N, Ipponi E, Vigorito A, Marchetti S, Scaglione M. Which role for synthetic ligaments in the reconstruction of patellar tendon chronic rupture after TKA? Mid-term outcomes using LARS ligament. Acta Biomed 2020; 91:e2020113. [PMID: 33525289 PMCID: PMC7927510 DOI: 10.23750/abm.v91i4.9088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 02/14/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND AIM OF THE WORK Patellar tendon rupture is a rare complication after Total Knee Arthroplasty (TKA) which often requires surgical treatment. Patients with chronic lesions or tendon degenerations showed good results when treated using autografts or allografts, but these techniques showed poor outcomes at long-term follow-up (FU). Moreover, allografts have high costs and limited availability, not to mention the increased risk of immune reactions and infections. Recently, the use of synthetic ligaments for patellar tendon reconstruction has taken hold with encouraging results. We report our experience in the treatment of patellar tendon ruptures after TKA using the Ligament Advanced Reinforcement System-LARS®. METHODS Clinical evaluation was performed using the Knee Society Score and recording extensor lag. Instrumental evaluation was performed using ultrasound imaging to assess patellar tendon thickness and using conventional x-rays to assess prosthesis' mobilization signs and patella's height. RESULTS At the final FU, 6 knees were included in our study. Patient's mean age was 66.7. Patellar tendon reconstruction occurred after a mean time of 4 months from the previous surgery. The mean FU was 44,2 months. The mean Knee Score was 63.3 and the mean Function Score was 35. In 4 knees the extensor lag was < 10° while in 2 knees it was > 20°. The mean ISI was 1.16, while the average increment in tendon thickness was 127.12%. CONCLUSIONS In our opinion, synthetic ligaments can be successfully employed for the reconstruction of patellar tendon breakage after TKA and rTKA in selected patients, in order to quickly return them to their activity of daily living.
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Affiliation(s)
| | - Enrico Bonicoli
- 1st Orthopaedic Division, University of Pisa, Via Paradisa 2, 56100 Pisa, PI, Italy..
| | - Nicola Piolanti
- 1st Orthopaedic Division, University of Pisa, Via Paradisa 2, 56100 Pisa, PI, Italy..
| | - Edoardo Ipponi
- 1st Orthopaedic Division, University of Pisa, Via Paradisa 2, 56100 Pisa, PI, Italy..
| | - Antonella Vigorito
- 1st Orthopaedic Division, University of Pisa, Via Paradisa 2, 56100 Pisa, PI, Italy.
| | - Stefano Marchetti
- 1st Orthopaedic Division, University of Pisa, Via Paradisa 2, 56100 Pisa, PI, Italy.
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Bonicoli E, Piolanti N, Giuntoli M, Polloni S, Scaglione M. Septic femoral shaft non-union treated by one-step surgery using a custom-made intramedullary antibiotic cement-coated carbon nail: case report and focus on surgical technique. Acta Biomed 2020; 91:e2020176. [PMID: 33525303 PMCID: PMC7927500 DOI: 10.23750/abm.v91i4.8266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 11/24/2019] [Indexed: 11/23/2022]
Abstract
Background and aim of the work: In the orthopaedic and traumatological fields septic non-unions represent a severe complication, hard to manage and treat. Traditionally, the surgical technique consists in to two sequential steps: debridement with administration of local and systemic antibiotics associated with temporary stabilization of the fracture and subsequent reconstruction of bone and soft tissues. Recently, the use of some devices to treat septic non-union by one-step surgery have been introduced with encouraging resultsMethods: We reported our experience with a case treated by one-step procedure using a custom-made intramedullary antibiotic cement-coated carbon nail. We reviewed the literature and described the surgical technique employed in this case. Results: At 6 months from surgery the patient was able to perform full weight-bearing and carry out the normal activities of daily living. Serum inflammatory markers normalized and radiographic controls showed the presence of a mechanically good bone callus at the non-union site. The bone resection carried out determined a limb length discrepancy of 3 cm, that was corrected through a temporary shoe lift, currently well tolerated. The patient regained full ROM of the right knee. Conclusion: Intramedullary antibiotic cement-coated nail associated with systemic antibiotic therapy proved to be an effective treatment to control the infection and provide immediate stability at the septic non-union/fracture site, allowing a rapid functional recovery. It represents a valid option especially in patients who refuse external devices or surgical additional procedures, as in our case. (www.actabiomedica.it).
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Affiliation(s)
- Enrico Bonicoli
- Orthopaedic Department, University of Pisa, Via Paradisa 2, 56100 Pisa, PI, Italy..
| | - Nicola Piolanti
- Orthopaedic Department, University of Pisa, Via Paradisa 2, 56100 Pisa, PI, Italy..
| | | | - Simone Polloni
- Orthopaedic Department, University of Pisa, Via Paradisa 2, 56100 Pisa, PI, Italy..
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Anselmino M, Cauti F, Piro A, Di Belardino N, Scaglione M, Pecora D, Rossi L, Di Cori A, Tola G, Pedretti S, Mantovan R, Solimene F, Rossi P, Iaia L, Bianchi S. Minimal fluoroscopy approach in current clinical practice with a novel ablation technology for supraventricular tachycardia: a large multicenter experience from an Italian registry. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Electrophysiological studies and ablation procedures expose both physicians and patients to a large amount of radiation. Most of 3-D mapping systems provide improved tracking of catheters, possibly allowing relevant reductions in radiation exposure. No data exists on the ability of the Rhythmia mapping system to minimize fluoroscopy time and dose.
Purpose
To report preliminary data on feasibility and safety of a minimal fluoroscopic approach using the Rhythmia mapping system in supraventricular tachycardia (SVT) procedures.
Methods
Consecutive patients indicated for arrhythmia ablation were enrolled in the CHARISMA study at 12 centers. For our purpose consecutive right-side procedures performed through a minimal fluoroscopy approach with the Rhythmia mapping system were analyzed. A 3D geometry of chambers of interest was reconstructed on the basis of the electroanatomic information taken from the mapping system. Fluoroscopy was used only if deemed necessary.
Results
This analysis included 266 patients (mean age = 57±17 years, 57% male) undergoing SVT procedures (120 AVNRT, 91 AFL, 32 AP, 11 AT and 12 other right atrial procedures). In all cases, diagnostic EP and ablation catheters were positioned using a low fluoroscopic electroanatomic guided approach. The mean fluoroscopy time needed for each procedure was 55±128 s. The median reconstructed RA volume was 92 [63–131] ml in a median mapping time of 11 [7–17] min. The median number of radiofrequency ablations to terminate each arrhythmia was 6 [3–12] (total RF delivery time of 291 [180–505] s). Sixty-five percent of the procedures (n=174) were completed with less than 10 s of fluoroscopy. Low fluoroscopy approach with less than 10 s (minimal fluoroscopy approach) was most frequently obtained in case of AVNRT (91, 76%) compared to other arrhythmias' ablation (83, 57%, p=0.001) Achievement of a minimal fluoroscopic approach was not affected by operator's experience (65% vs 66%, p=1.00, respectively within physician with more or less of 10 years of active practice), whereas it was affected by presence of a fellow in training during the procedure (72% without fellow vs 26% with fellow, p<0.0001). A 100% rate of acute success was observed, and no procedure-related complications occurred. At multivariate logistic regression analysis adjusted for baseline confounders, both the total number of RF ablations (OR: 0.93 (95% CI:0.88 to 0.96; p=0.0053) and the presence of a fellow in training during the procedure (OR: 0.29; 95% CI: 0.1 to 0.87; p=0.0278) had an inverse association to the achievement of a minimal fluoroscopic approach.
Conclusions
In our preliminary experience, arrhythmias' ablation through minimal fluoroscopy approach with the use of a novel ablation technology seems to be safe, feasible, and effective in common right atrial arrhythmias. Use of fluoroscopy can be dramatically reduced in most cases, without any reduction of the safety and acute effectiveness profile.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- M Anselmino
- A.O.U. Citta della Salute e della Scienza di Torino, Turin, Italy
| | - F.M Cauti
- Ospedale S. Giovanni Calibita, Fatebenefratelli Isola Tiberina, Rome, Italy
| | - A Piro
- Umberto I Polyclinic of Rome, Rome, Italy
| | | | | | - D Pecora
- Poliambulanza Foundation Hospital Institute of Brescia, Brescia, Italy
| | - L Rossi
- Guglielmo da Saliceto Hospital, Piacenza, Italy
| | - A Di Cori
- Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - G Tola
- AO Brotzu Hospital, Cagliari, Italy
| | | | - R Mantovan
- Conegliano General Hospital, Conegliano, Italy
| | - F Solimene
- Montevergine Cardiology Clinic, Mercogliano, Italy
| | - P Rossi
- Ospedale S. Giovanni Calibita, Fatebenefratelli Isola Tiberina, Rome, Italy
| | - L Iaia
- Ospedale S. Giovanni Calibita, Fatebenefratelli Isola Tiberina, Rome, Italy
| | - S Bianchi
- Ospedale S. Giovanni Calibita, Fatebenefratelli Isola Tiberina, Rome, Italy
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Barachini S, Pacini S, Montali M, Panvini FM, Carnicelli V, Piolanti N, Bonicoli E, Scaglione M, Parchi PD. Mesangiogenic Progenitor Cells and musculoskeletal tissue regeneration: differences between adipose-derived and bone marrow-derived cells? J BIOL REG HOMEOS AG 2020; 34:33-38. IORS Special Issue on Orthopedics. [PMID: 33739002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Mesangiogenic Progenitor cells (MPCs) have been isolated from human bone marrow mononuclear cells (hBM-MNCs) and attracted particular attention for their ability to efficiently differentiate into exponentially growing mesenchymal stromal cells (MSCs) and toward endothelial lineage, suggesting the term "mesangiogenic". Coupling mesengenesis and angiogenis, MPCs has been hypothesized retaining a great tissue regenerative potential in musculoskeletal tissues regeneration. Bone marrow and adipose tissue (AT) represent most promising adult multipotent cell sources attempting to repair bone and cartilage, with controversial results regarding advantages applying BM- or AT-derived cells. As different culture determinants as well as tissue of origins, could strongly affect regenerative potential of cell preparations, we hypothesize that MPCs counterpart could have a role in defining efficacy of applying a cell-based medicinal product in musculoskeletal tissue repair. Here we present convincing data demonstrating that the ex vivo progenitors of MPCs are tissue specific and can be detected exclusively in hBM-MNCs.
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Affiliation(s)
- S Barachini
- Hematology Division, Dept. Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - S Pacini
- Hematology Division, Dept. Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - M Montali
- Hematology Division, Dept. Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - F M Panvini
- Hematology Division, Dept. Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - V Carnicelli
- Dept. Surgical, Medical, Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | - N Piolanti
- First Orthopedic Division University of Pisa, Italy
| | - E Bonicoli
- First Orthopedic Division University of Pisa, Italy
| | - M Scaglione
- First Orthopedic Division University of Pisa, Italy
| | - P D Parchi
- First Orthopedic Division University of Pisa, Italy
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Cosseddu F, Shytaj S, Sacchetti F, Capanna R, Manca M, Parchi PD, Scaglione M, Andreani L. Total hip replacement: a retrospective multicentric analysis on re-intervention rate after single component revision. J BIOL REG HOMEOS AG 2020; 34:191-196. Congress of the Italian Orthopaedic Research Society. [PMID: 33261276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Total hip arthroplasty (THA) revision is a procedure consisting in the replacement of a single or multiple implant components and could take place once or more times (re-revision). The aim of this multicentre study is to evaluate the benefits of single component revision in respect of the principles that define implant stability. Two hundred and forty-two patients underwent THA revision at Orthopaedic Clinic of Pisa and Versilia (ITA) from January 2007 to December 2016. We have systematically excluded revisions due to septic or traumatic prosthesis loosening, revisions of both implant components (cotyle and stem) and replacement alone. To evaluate implant stability, we used preoperative X ray and intra-operative mechanical stress tests, applying accredited criteria. Two hundred and twenty-six patients (93%) underwent a single procedure of THA revision: 193 had cotyle replacement and 33 had femoral stem replacement. The remaining 16 (7 %) underwent at least two procedures: 10 of them had consecutive failure of the same component, while the other 6 had revision of the other component after the first procedure. Considering our cases series, we can assert that single component revision is the best choice when no signs of loosening are present on the remaining component. Nevertheless, an accurate evaluation with unanimous radiological criteria and intraoperative testing is essential for the surgeon to choose the most suitable treatment.
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Affiliation(s)
- F Cosseddu
- 2nd Orthopedic Division University of Pisa, Italy
| | - S Shytaj
- 2nd Orthopedic Division University of Pisa, Italy
| | - F Sacchetti
- 1st Orthopedic Division University di Pisa, Italy
| | - R Capanna
- 2nd Orthopedic Division University of Pisa, Italy
| | - M Manca
- Orthopedic Division, Versilia Hospital, Lido di Camaiore (LU), Italy
| | - P D Parchi
- 1st Orthopedic Division University di Pisa, Italy
| | - M Scaglione
- 1st Orthopedic Division University di Pisa, Italy
| | - L Andreani
- 2nd Orthopedic Division University of Pisa, Italy
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Cauti FM, Piro A, Di Belardino N, Tola G, Anselmino M, Pecora D, Scaglione M, Rossi L, Pedretti S, Solimene F, Mantovan R, Di Cori A, Rossi P, Iaia L, Bianchi S. P1452Low fluoroscopy approach with a novel ablation technology in right side procedures: a large multicenter experience from the CHARISMA registry. Europace 2020. [DOI: 10.1093/europace/euaa162.247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Funding Acknowledgements
NO FUNDING
Background
Electrophysiological studies and ablation procedures expose both physicians and patients to a significant amount of radiation. Nowadays, most of 3-D mapping systems allow for improved tracking of catheters with possible reduction in radiation exposure. No data exists on the ability to minimize fluoroscopy time and dose while using the Rhythmia mapping system.
Purpose
To report preliminary data on feasibility and safety of a low fluoroscopic approach using the Rhythmia mapping system in SVT procedures.
Methods
The CHARISMA study is a non-randomized, multicenter, prospective study in which consecutive patients indicated for arrhythmia were enrolled. For our purpose consecutive right-side procedures performed through a low fluoroscopy approach with the Rhythmia mapping system were analyzed. The mapping system was used to create the 3D geometry of chambers of interest and anatomic reference points and to visualize the catheters from the beginning to the end of the procedure. Fluoroscopy was used only if deemed necessary.
Results
204 unselected consecutive cases of SVT from 11 centers were included in the study (mean age = 55 ± 18 years, 53% male, 85 AVNRT, 75 AFL, 28 AP, 9 AT and 7 other right atrial procedures). In all the cases, diagnostic EP and ablation catheters were positioned using only the low fluoroscopic guided mapping approach. During the study, a total of 7157 s of fluoroscopy was needed in 204 patients (51 ± 137 s per procedure). One hundred fourty-one procedures (69%) were completed with less than 10 seconds of fluoroscopy, whereas in 169 (83%) of the cases the fluoroscopy time was lower than 60 seconds. Low fluoroscopy approach with less than 10 seconds was less frequently obtained in case of AFL (46, 61.3%) compared to AVNRT ablation (65, 76.5%, p = 0.041) whereas no differences were found comparing with AP (21, 75%, p = 0.248). The median reconstructed RA volume was 94[65-133] ml in a median mapping time of 11 [6-16] min. The median number of radiofrequency ablations to terminate each arrhythmia was 5 [3-12] (total RF delivery time of 293 [180-505] sec). A 100% rate of acute success was observed in our case series. No complications occurred.
Conclusions
In our preliminary experience, arrhythmias ablation through low fluoroscopy approach and the use of a novel ablation technology seems to be safe, feasible, and effective in common right atrial arrhythmias. Use of fluoroscopy can be nearly avoided in most cases, without any reduction of the safety and effectiveness profile.
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Affiliation(s)
- F M Cauti
- S.Giovanni Calibita Fatebenefratelli Hospital, Rome, Italy
| | - A Piro
- Umberto I Polyclinic of Rome, Rome, Italy
| | | | - G Tola
- AO Brotzu Hospital, Cagliari, Italy
| | - M Anselmino
- Hospital Molinette of the University Hospital S. Giovanni Battista/City University Hosp of Health an, Turin, Italy
| | - D Pecora
- Poliambulanza Foundation Hospital Institute of Brescia, Brescia, Italy
| | | | - L Rossi
- Guglielmo da Saliceto Hospital, Piacenza, Italy
| | | | - F Solimene
- Montevergine Cardiology Clinic, Mercogliano, Italy
| | - R Mantovan
- Conegliano General Hospital, Conegliano, Italy
| | - A Di Cori
- Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - P Rossi
- S.Giovanni Calibita Fatebenefratelli Hospital, Rome, Italy
| | - L Iaia
- S.Giovanni Calibita Fatebenefratelli Hospital, Rome, Italy
| | - S Bianchi
- S.Giovanni Calibita Fatebenefratelli Hospital, Rome, Italy
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Addevico F, Morandi M, Scaglione M, Solitro GF. Screw insertion torque as parameter to judge the fixation. Assessment of torque and pull-out strength in different bone densities and screw-pitches. Clin Biomech (Bristol, Avon) 2020; 72:130-135. [PMID: 31864036 DOI: 10.1016/j.clinbiomech.2019.12.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 11/27/2019] [Accepted: 12/03/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Pull-out strength is a critical parameter to judge screw fixation in orthopaedic implants. However, the insertion torque is the main feeling in the hand of a surgeon relating to the strength of synthesis. The correlation between pull-out strength and torque is not completely understood. This creates uncertainty about the key-question: Should the torque be considered a valid parameter to judge the quality of fixation? METHODS Using the ASTM F543 as reference, three screws differing only in pitch (1.5, 2.1, 2.8 mm pitches) were tested in three foam-block densities (10, 15, and 20 pcf). The correlation was investigated by assessing the role of density and screw geometry. FINDINGS Torque was related to pull-out strength in all configurations (R = 0.979, P = 0.000). No difference in pull-out strength was found when screws were tightened to a range of 71.6%, SD = 7.6, of torque to fail (P > 0.05). Torque and pull-out strength were stratified according to density that influenced the two parameters up to 524% (P < 0.000). Pitch determined pull-out strength up to 33% (P < 0.000) while the 2.1 mm screw pitch showed the highest pull-out strength and torque in all configurations. INTERPRETATION Insertion torque was demonstrated to be a valid parameter to judge the quality of bone under fixation and therefore, the strength of the synthesis. Surgeons should not tighten the screws to values approaching torque to fail to obtain the highest pull-out strength. Density was the main factor influencing pull-out strength and torque. Pitch is another parameter deciding screw holding capacity.
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Affiliation(s)
| | - Massimo Morandi
- Division of Orthopaedic Trauma, Department of Orthopaedic Surgery, Louisiana State University Health, Science Center Shreveport, LA, USA
| | | | - Giovanni F Solitro
- Biomechanics Laboratory, Department of Orthopaedic Surgery, Louisiana State University Health, Science Center Shreveport, LA, USA
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Kostoris F, Addevico F, Murena L, Scaglione M, Poggetti A. Proposal of a New Dynamic Distraction Device to Treat Complex Periarticular Fractures of the Metacarpophalangeal Joint of Long Finger. Hand (N Y) 2020; 15:87-91. [PMID: 30015515 PMCID: PMC6966295 DOI: 10.1177/1558944718787859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: Complex periarticular fractures of the metacarpophalangeal joint (MCPJ) are often challenging to treat. Conservative and operative treatments are often burdened with stiffness, loss of function, and poor clinical outcome. These phenomena could be a direct consequence of long period of immobilization. To promote a short time of immobilization and a quick return to daily activities, it is mandatory to stabilize the fracture maintaining the active range of motion (AROM) of the ray. A simple solution is to reduce the fragments by means of dynamic ligamentotaxis. The authors propose a new dynamic distraction device (DDD) for the MCPJ. Methods: The DDD for the MCPJ was made of Kirschner wires bent and connected to counteract dislocation forces and to allow mobilization of the joint. The DDD was tested on a cadaver model under a simulated load in physiological conditions, and also in metacarpal and proximal phalanx (P1) fracture patterns. The effectiveness of the device was evaluated under fluoroscopy. Results: The data showed that DDD is able to achieve fracture reduction through ligamentotaxis and primary fragments stability and to avoid secondary dislocation during AROM of complex periarticular fractures of the MCPJ. Conclusions: The frame could be an alternative option to treat periarticular fractures of the MCPJ. The DDD implant has several advantages: It is time efficient because assembly and application take only few minutes. Furthermore, it is very versatile; indeed, it can be used in all metacarpal and phalanx bones, even in the central rays.
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Affiliation(s)
- Francesco Kostoris
- Azienda Sanitaria Universitaria
Integrata di Trieste, Italy,Francesco Kostoris, Orthopaedics
Traumatology Unit, Cattinara Hospital, Azienda Sanitaria Universitaria Integrata
di Trieste, Strada di Fiume 447, Trieste 34149, Italy.
| | | | - Luigi Murena
- Azienda Sanitaria Universitaria
Integrata di Trieste, Italy
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Maglia G, Calo' L, Pentimalli F, Solimene F, Infusino T, Perego GB, Stabile G, Rago A, Tomasi C, Zingarini G, Devecchi C, La Greca C, Scaglione M, Malacrida M, Verlato R. P1009Procedural success and long-term outcome of CTI ablation targeted with maximum voltage-guided approach: preliminary results from an Italian multicenter registry. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Ablation technique targeting high-amplitude signals (maximum voltage guided - MVG -) on the cavotricuspid isthmus (CTI) has emerged as viable alternative option compared to standard anatomical approach (ST) for the creation of bidirectional conduction block (BDB) across the isthmus but limited data are available to date.
Purpose
To evaluate the effectiveness of acute and long-term outcome of CTI ablation through MVG technique for AFL compared to standard linear (SL) lesion ablation.
Methods
Atrial Flutter Ablation in a Real World Population (LEONARDO) is a prospective, multicenter cohort study aimed at providing an estimate of acute to long-term outcome in a large population of patients (pts) indicated for AFL ablation. Recurrence of AFL were retrieved at 12-month follow-up. Complete BDB was defined by agreement with the presence of widely split double potentials (DP) along the ablation line and assessment of the atrial activation sequence (AAS). For MVG technique the ablation catheter was positioned at the site of maximum local electrogram voltage.
Results
Two-hundred fifteen consecutive pts were included (mean age 68 years, 73% male). A median of 4 [2–6] ablation lesions were required. Median follow up was 359 [192–443] days. Complete BDB was achieved in 175 (81.4%) pts (9 pts had DP only criterion, 30 pts had AAS only criterion whereas in 1 pt we failed to reach a BDB). In the 106 pts with complete data at 1-year follow-up, 10 (9.4%) had a recurrence of AFL. 171 pts (79%) underwent a SL ablation whereas 44 pts (21%) were treated by MVG approach. The median number of lesions/pt was significantly lower in the group of pts targeted with MVG compared to the SL approach (3 [2–4] vs 4 [2–8], p<0.01), whereas no differences were found in terms of fluoroscopy time (16 [12–18] min vs 12 [7–22] min, p=NS) or proportion of pts with BDB achievement (86.4% of the cases for MVG vs 80.1% of the cases for ST, p=NS). No complications were reported. AFL recurrence was comparable during follow-up between groups (8.3% for MVG vs 9.8% for SL ablation; p=NS).
Conclusion
Ablation of a targeted site through MGV approach seems to be safe and effective as standard anatomical ablation technique. This strategy may avoid unnecessary ablation of the entire anatomic isthmus.
Acknowledgement/Funding
None
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Affiliation(s)
- G Maglia
- Civil Hospital of Pugliese, Catanzaro, Italy
| | - L Calo'
- Polyclinic Casilino of Rome, Rome, Italy
| | | | - F Solimene
- Montevergine Cardiology Clinic, Mercogliano, Italy
| | | | - G B Perego
- Italian Institute for Auxology IRCCS, Milan, Italy
| | | | - A Rago
- Second University of Naples, Naples, Italy
| | - C Tomasi
- Santa Maria delle Croci Hospital, Ravenna, Italy
| | - G Zingarini
- Hospital Santa Maria Della Misericordia, Perugia, Italy
| | | | - C La Greca
- Poliambulanza Foundation Hospital Institute of Brescia, Brescia, Italy
| | | | | | - R Verlato
- Hospital of Camposampiero, Camposampiero, Italy
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Scaglione M, Battaglia A, Di Donna P, Peyracchia M, Bolzan B, Mazzucchi P, Muro M, Caponi D. Hypnotic communication for periprocedural analgesia during transcatheter ablation of atrial fibrillation. Int J Cardiol Heart Vasc 2019; 24:100405. [PMID: 31388561 PMCID: PMC6669807 DOI: 10.1016/j.ijcha.2019.100405] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 06/28/2019] [Accepted: 07/14/2019] [Indexed: 10/26/2022]
Abstract
Introduction Hypnosis is a therapeutic strategy for pain control. We aimed at investigating the use of this technique in a large population undergoing atrial fibrillation (AF) ablation. Methods 70 consecutive AF patients referred for transcatheter ablation, underwent hypnotic communication for periprocedural analgesia (Group A), were compared with 70 patients undergoing conventional analgesia (Group B). Procedural data, anxiety, perceived pain, perceived procedural duration and the dosages of administered analgesic drugs were compared using validated score scales. Results Hypnotic communication (Group A) resulted in a significant procedural-related anxiety reduction (Pre procedural 4.7 ± 2.9 Vs Intra Procedural 0.8 ± 1.2, P < 0.001) and perceived procedural duration (Real length 108 ± 33 min Vs Perceived Length 77 ± 39 min, P < 0.001). Group A patients reported a painless procedure in 78% (Pain scale ≤2). Regarding analgesic drug, Group A used only Fentanyl and Paracetamol. The Fentanyl dosage was similar in Group A and B (mean 0.142 Vs 0.146 mg, P = 0.65) while higher Paracetamol dosage was reported in Group A (mean 853 Vs 337 mg, P < 0.001). Group B also used Midazolam (mean 1.8 mg), Propofol (mean 43.8 mg) and narcosis was required in 2 patients. Total radiofrequency (RF) delivered time did not differ between the two groups (mean 28.9 Vs 27.6 min, P = 0.623) as well as mean RF power (mean 35.3 Vs 35.5 W, P = 0.424). No complications occurred. Conclusion Hypnotic communication during AF ablation was related to a significant reduction of intra-procedural anxiety, perceived pain, procedural analgesic drugs dosage and perceived procedural duration without affecting total RF delivered time and procedural safety.
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Affiliation(s)
- M Scaglione
- Division of Cardiology, Cardinal G. Massaia Hospital, Asti, Italy
| | - A Battaglia
- Division of Cardiology, Cardinal G. Massaia Hospital, Asti, Italy
| | - P Di Donna
- Division of Cardiology, Cardinal G. Massaia Hospital, Asti, Italy
| | - M Peyracchia
- Division of Cardiology, Cardinal G. Massaia Hospital, Asti, Italy
| | - B Bolzan
- Division of Cardiology, Cardinal G. Massaia Hospital, Asti, Italy
| | - P Mazzucchi
- Division of Cardiology, Cardinal G. Massaia Hospital, Asti, Italy
| | - M Muro
- Pain Therapy and Palliative Care, Azienda Ospedaliero-Universitaria Citta` della Salute e della Scienza di Torino
| | - D Caponi
- Division of Cardiology, Cardinal G. Massaia Hospital, Asti, Italy
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Scaglione M, Celli F, Casella F, Fabbri L. Tibial pilon fractures treated with hybrid external fixator: analysis of 75 cases. Musculoskelet Surg 2019; 103:83-89. [PMID: 29974393 DOI: 10.1007/s12306-018-0550-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Accepted: 06/24/2018] [Indexed: 06/08/2023]
Abstract
INTRODUCTION The treatment of tibial pilon fractures is a surgical challenge due to the particular anatomical and vascular characteristics of this area, and the severity of the injury that can compromise soft tissues. Nowadays there is no gold-standard treatment for these fractures. MATERIALS AND METHODS We reviewed 75 patients with tibial pilon fracture type C (AO classification) treated with hybrid external fixation (Stryker TenXor®). The surgical technique was reported. We evaluated clinical (Tornetta's score, VAS score, range of motion) and radiographic outcomes. RESULTS In 71 cases, the first surgical treatment was definitive. Instead, in four cases, it was necessary a second surgical procedure to achieve fracture healing. We obtained 44% excellent, 40% good, 7% discrete, and 9% bad results. We found a 30% of superficial infections of the pin site, resolved with oral antibiotic treatment (amoxicillin and clavulanic acid). We never had deep infections, no neurovascular injury, and no cases of secondary amputation. Although not statistically significant, we noticed a correlation between longer recovery times and trauma severity, with slower recovery in open or grade III fractures or when associated with other fractures. CONCLUSIONS According to the recent literature, we think that the best treatment for non-articular fracture is the internal osteosynthesis within 6 h or after 6 days from trauma. In articular fractures, the elective treatment is the two-step management. In complicated articular fractures (Tscherne > 2, open, comminuted type III) is highly indicated the external fixation combined with minimal internal synthesis.
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Affiliation(s)
- M Scaglione
- Department of Orthopaedics and Traumatology, Hospital University of Pisa, Pisa, Italy
| | - F Celli
- Orthopaedics Department, Hospital of Piombino, Piombino, Italy.
| | - F Casella
- Department of Orthopaedics and Traumatology, Hospital University of Pisa, Pisa, Italy
| | - L Fabbri
- Department of Orthopaedics and Traumatology, Hospital University of Pisa, Pisa, Italy
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Novi M, Vanni C, Parchi PD, Di Paolo M, Piolanti N, Scaglione M. Claims in total hip arthroplasty: analysis of the instigating factors, costs and possible solution. Musculoskelet Surg 2019. [PMID: 30758765 DOI: 10.1007/s12306-019-00590-6.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE Over the years, the number of total hip replacements has been steadily increasing. Despite the improvement in surgical results, the number of claims for malpractice is higher. The primary endpoint of this work is to provide an analysis of litigation after hip replacement, to outline what are the instigating causes and costs. The secondary endpoint is to propose a possible preventive strategy for an improved care and a reduction in legal proceedings. MATERIALS AND METHODS The data of this study were collected from medical and legal files and from professional liability insurance of our institution from January 2005 to December 2016. RESULTS Out of a total of 4770 THA, 40 claims were received. Peripheral nerve injuries represent the first cause of litigation (37%), followed by infectious complications, leg length discrepancy, metallosis, dislocations of the implant and a case of deep vein thrombosis. From the analysis of the past trial judgment, complications such as nerve lesions and infections are almost always recognized, as a medical error, with a high percentage of claims settled. CONCLUSION This study shows the necessity of preventive strategies to reduce the higher number of claims for malpractice in total hip arthroplasty. Some complications such as nerve injuries and infection are frequently considered directly dependent on physician's errors. Litigations can be reduced providing evidence of a diligent execution of the surgical procedure and of a proper postoperative management: the correct compilation of a specific informed consent and adequate doctor-patient communication.
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Affiliation(s)
- M Novi
- 1° Orthopaedic and Traumatology Unit, Department of Translational Research and New Technology in Medicine and Surgery, University Hospital of Pisa, Via Paradisa, 2, 56100, Pisa, Italy.
| | - C Vanni
- Law Medicine Unit, University Hospital of Pisa, Pisa, Italy
| | - P D Parchi
- 1° Orthopaedic and Traumatology Unit, Department of Translational Research and New Technology in Medicine and Surgery, University Hospital of Pisa, Via Paradisa, 2, 56100, Pisa, Italy
| | - M Di Paolo
- Law Medicine Unit, University Hospital of Pisa, Pisa, Italy
| | - N Piolanti
- 1° Orthopaedic and Traumatology Unit, Department of Translational Research and New Technology in Medicine and Surgery, University Hospital of Pisa, Via Paradisa, 2, 56100, Pisa, Italy
| | - M Scaglione
- 1° Orthopaedic and Traumatology Unit, Department of Translational Research and New Technology in Medicine and Surgery, University Hospital of Pisa, Via Paradisa, 2, 56100, Pisa, Italy
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Novi M, Vanni C, Parchi PD, Di Paolo M, Piolanti N, Scaglione M. Claims in total hip arthroplasty: analysis of the instigating factors, costs and possible solution. Musculoskelet Surg 2019; 104:43-48. [PMID: 30758765 DOI: 10.1007/s12306-019-00590-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 02/08/2019] [Indexed: 10/27/2022]
Abstract
PURPOSE Over the years, the number of total hip replacements has been steadily increasing. Despite the improvement in surgical results, the number of claims for malpractice is higher. The primary endpoint of this work is to provide an analysis of litigation after hip replacement, to outline what are the instigating causes and costs. The secondary endpoint is to propose a possible preventive strategy for an improved care and a reduction in legal proceedings. MATERIALS AND METHODS The data of this study were collected from medical and legal files and from professional liability insurance of our institution from January 2005 to December 2016. RESULTS Out of a total of 4770 THA, 40 claims were received. Peripheral nerve injuries represent the first cause of litigation (37%), followed by infectious complications, leg length discrepancy, metallosis, dislocations of the implant and a case of deep vein thrombosis. From the analysis of the past trial judgment, complications such as nerve lesions and infections are almost always recognized, as a medical error, with a high percentage of claims settled. CONCLUSION This study shows the necessity of preventive strategies to reduce the higher number of claims for malpractice in total hip arthroplasty. Some complications such as nerve injuries and infection are frequently considered directly dependent on physician's errors. Litigations can be reduced providing evidence of a diligent execution of the surgical procedure and of a proper postoperative management: the correct compilation of a specific informed consent and adequate doctor-patient communication.
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Affiliation(s)
- M Novi
- 1° Orthopaedic and Traumatology Unit, Department of Translational Research and New Technology in Medicine and Surgery, University Hospital of Pisa, Via Paradisa, 2, 56100, Pisa, Italy.
| | - C Vanni
- Law Medicine Unit, University Hospital of Pisa, Pisa, Italy
| | - P D Parchi
- 1° Orthopaedic and Traumatology Unit, Department of Translational Research and New Technology in Medicine and Surgery, University Hospital of Pisa, Via Paradisa, 2, 56100, Pisa, Italy
| | - M Di Paolo
- Law Medicine Unit, University Hospital of Pisa, Pisa, Italy
| | - N Piolanti
- 1° Orthopaedic and Traumatology Unit, Department of Translational Research and New Technology in Medicine and Surgery, University Hospital of Pisa, Via Paradisa, 2, 56100, Pisa, Italy
| | - M Scaglione
- 1° Orthopaedic and Traumatology Unit, Department of Translational Research and New Technology in Medicine and Surgery, University Hospital of Pisa, Via Paradisa, 2, 56100, Pisa, Italy
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Piolanti N, Poggetti A, Nucci AM, Nesti A, Marchetti S, Parchi PD, Scaglione M. The 50 most cited articles about wrist surgery. Orthop Rev (Pavia) 2018; 10:7715. [PMID: 30662683 PMCID: PMC6315303 DOI: 10.4081/or.2018.7715] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 05/07/2018] [Indexed: 11/23/2022] Open
Abstract
The purpose was to establish a ranking of the 50 most cited articles about wrist surgery and analyse their features. Science Citation Index Expanded was used to identify the 50 most frequently cited orthopaedic journal articles written in English, searching for the topic “wrist surgery” in the subject category ‘‘Orthopaedics’’. Then, we analysed the number of citations, citation density, authorship, article institution, the year of publication, the country of origin of the article, name and impact factor of the journal, and publication type of the article. The 50 most cited articles were published in only 6 of the 74 journals included under the category “orthopaedics”. Citation count ranged from 256 for the first one to 67 for the 50th article. Most of them were written by American authors. These articles were published between 1991 and 2011. “Distal Radius Fractures” was the most common issue. This type of bibliographic analysis could be particularly useful for other young Authors who would like to improve their research in wrist and hand surgery and make their publications more citable and appreciated by the scientific community.
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Affiliation(s)
- Nicola Piolanti
- Department of Translational Research on New Technologies in Medicine and Surgery, Azienda Ospedaliera Universitaria Pisana, University of Pisa, Italy
| | - Andrea Poggetti
- Department of Translational Research on New Technologies in Medicine and Surgery, Azienda Ospedaliera Universitaria Pisana, University of Pisa, Italy
| | - Anna Maria Nucci
- Department of Translational Research on New Technologies in Medicine and Surgery, Azienda Ospedaliera Universitaria Pisana, University of Pisa, Italy
| | - Agnese Nesti
- Department of Translational Research on New Technologies in Medicine and Surgery, Azienda Ospedaliera Universitaria Pisana, University of Pisa, Italy
| | - Stefano Marchetti
- Department of Translational Research on New Technologies in Medicine and Surgery, Azienda Ospedaliera Universitaria Pisana, University of Pisa, Italy
| | - Paolo Domenico Parchi
- Department of Translational Research on New Technologies in Medicine and Surgery, Azienda Ospedaliera Universitaria Pisana, University of Pisa, Italy
| | - Michelangelo Scaglione
- Department of Translational Research on New Technologies in Medicine and Surgery, Azienda Ospedaliera Universitaria Pisana, University of Pisa, Italy
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Piolanti N, Polloni S, Bonicoli E, Giuntoli M, Scaglione M, Indelli PF. Giovanni Alfonso Borelli: The Precursor of Medial Pivot Concept in Knee Biomechanics. Joints 2018; 6:167-172. [PMID: 30582105 PMCID: PMC6301847 DOI: 10.1055/s-0038-1675164] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Accepted: 09/09/2018] [Indexed: 12/02/2022]
Abstract
A new philosophy of science and medicine had spread throughout the 17th-century Italy: the “Scientific Revolution.” Giovanni Alfonso Borelli (1608–1679) was one of the most charismatic and brilliant scientists of his generation in Europe. He extended to biology the rigorous analytic methods developed by his indirect mentor Galileo in the field of mechanics. In his masterpiece “
De Motu Animalium
,” Borelli analyzed structure, motion, balance, and forces concerning almost all the principal joints of the human body, in static and dynamic situations. In particular, he accurately studied the anatomy and biomechanics of the knee joint. He sustained that femoral condyles shift backward during flexion, allowing a wider range of movement. Furthermore, he observed that, when the knee flexes, the lateral condyle moves backward more than the medial condyle: this concept is nowadays known as medial pivoting. The aim of this article is to describe the life and work of this important Italian scientist and to present his unrecognized contribution to modern knee biomechanics.
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Affiliation(s)
- Nicola Piolanti
- Dipartimento di Ricerca Traslazionale e delle Nuove Tecnologie in Medicina e Chirurgia, Università degli Studi di Pisa, Pisa, Italy
| | - Simone Polloni
- Dipartimento di Ricerca Traslazionale e delle Nuove Tecnologie in Medicina e Chirurgia, Università degli Studi di Pisa, Pisa, Italy
| | - Enrico Bonicoli
- Dipartimento di Ricerca Traslazionale e delle Nuove Tecnologie in Medicina e Chirurgia, Università degli Studi di Pisa, Pisa, Italy
| | - Michele Giuntoli
- Dipartimento di Ricerca Traslazionale e delle Nuove Tecnologie in Medicina e Chirurgia, Università degli Studi di Pisa, Pisa, Italy
| | - Michelangelo Scaglione
- Dipartimento di Ricerca Traslazionale e delle Nuove Tecnologie in Medicina e Chirurgia, Università degli Studi di Pisa, Pisa, Italy
| | - Pier Francesco Indelli
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford University, Stanford, California, United States
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Poggetti A, Del Chiaro A, Nicastro M, Parchi P, Piolanti N, Scaglione M. A local anesthesia without tourniquet for distal fibula hardware removal after open reduction and internal fixation: the safe use of epinephrine in the foot. A randomized clinical study. J BIOL REG HOMEOS AG 2018; 32:57-63. [PMID: 30644283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Hardware removal after surgical treatment fracture is one of the most common procedures in orthopaedic daily activity. A percentage from 14.5 to 21 of total removal involves the ankle joint. Trying to reduce the important socio-economic impact of this surgical procedure, we thought to perform it using the Wide Awake Local Anaesthesia Without Tourniquet (WALANT), a particular technique presented by D. Lalonde that associated a local anaesthetic drug with epinephrine in order to obtain an effective haemostatic effect despite the lack of a tourniquet. Nowadays, the WALANT efficiency and safety in hand surgery is widely demonstrated in literature but there are no data about its use in lower limb extremity surgeries. Authors performed a randomized study with 60 patients whom underwent distal fibula hardware removal between 2014 and 2016; they were divided into two groups: Group A under loco-regional anaesthesia with tourniquet and Group B under WALANT. We did not find significant differences in term of maximum pain level felt during the anaesthesiologic and surgical procedure. However, the use of WALANT significantly reduced post-operative pain levels. The WALANT procedures also reduced the number of hospitalization days. No differences in term of post-operative complication rates were found. In conclusion, the WALANT can be considered as a suitable option for distal fibula hardware removal in selected patients; it shows important clinical and economic advantages compared to the traditional loco-regional anaesthesia with tourniquet. This study also lays the foundation for the use of the WALANT beyond the field of hand surgery only.
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Affiliation(s)
- A Poggetti
- Hand and Reconstructive Microsurgery Unit, AOU Careggi, Italy
| | | | - M Nicastro
- Orthopaedic and Trauma Division, University of Pisa, Italy
| | - P Parchi
- Intensive Unit Care, University of Pisa, Italy
| | - N Piolanti
- Intensive Unit Care, University of Pisa, Italy
| | - M Scaglione
- Intensive Unit Care, University of Pisa, Italy
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47
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Addevico F, Nucci AM, Rosati M, Poggetti A, Scaglione M. Traumatic anterior dislocation of a prosthetic knee, from trauma to delayed onset of vascular injury. Arthroplast Today 2018; 4:407-410. [PMID: 30569005 PMCID: PMC6287958 DOI: 10.1016/j.artd.2018.09.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 08/29/2018] [Accepted: 09/03/2018] [Indexed: 12/03/2022] Open
Abstract
Anterior dislocation of a prosthetic knee is a rare event. Only few episodes have been described in the past and have never been linked with neurovascular injury. This could lead orthopaedic surgeons to focus on the implant instability factors and underrate other complications. The authors report a case of a patient who experienced popliteal artery dissection 80 hours after traumatic anterior knee dislocation of a previously well-functioning total knee arthroplasty. Given that there is a lack of clinical cases that have established guidelines for management of this problem, the authors have focused on the importance of performing computed tomography angiography in the management of an anterior traumatic knee dislocation of a prosthetic knee.
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Affiliation(s)
- Francesco Addevico
- Orthopeadic and Traumatology, I orthopedic and traumatological Clinic, University of Pisa, Pisa, Pisa, Italy
| | - Anna Maria Nucci
- Orthopeadic and Traumatology, I orthopedic and traumatological Clinic, University of Pisa, Pisa, Pisa, Italy
| | - Marco Rosati
- I orthopedic and traumatological Clinic, AOUP, Pisa, Pisa, Italy
| | - Andrea Poggetti
- Chirugia della mano e Microchirurgia ricostruttiva, AUO, Careggi, Firenze, Firenze, Italy
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Bajocco S, Smiraglia D, Scaglione M, Raparelli E, Salvati L. Exploring the role of land degradation on agricultural land use change dynamics. Sci Total Environ 2018; 636:1373-1381. [PMID: 29913598 DOI: 10.1016/j.scitotenv.2018.04.412] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Revised: 04/21/2018] [Accepted: 04/30/2018] [Indexed: 06/08/2023]
Abstract
The role that land-use and socioeconomic factors exert on consolidating land degradation (LD) processes is a major research issue. However, intensity and type of the impact played by LD on such land use factors is still underexplored. The present study investigates the role of LD on land-use change (LUC) trajectories of land abandonment (LA) and urban expansion (URB) in the three geographical repartitions (North, Centre, South) of Italy between 1990 and 2012, by means of the Environmental Niche Factor Analysis (ENFA). ENFA is a multivariate approach originally introduced in the analysis of animal ecology allowing to compute habitat suitability (HS) models without requiring presence/absence data. Four environmental quality indices about climate (CQI), soil (SQI), vegetation (VQI) and land management (MQI) have been analyzed for the years 1990 and 2000 and related to the trajectories of LA and URB, respectively, for the time periods 1990-2000 and 2000-2012. Empirical results have indicated that different driving forces are linked to LA and URB, and that for each trajectory, the role of some forces may change over time. Evidence shows that soil quality and low human pressure represent the main drivers of LA. By contrast, as for URB, high human pressure represented the main driving factor throughout the country, both during 1990-2000 and 2000-2012. The HS maps show the probability arrangement of LA and URB in the three geographical repartitions. Starting from this work, further research is increasingly required to implement prediction models of future LA and URB trajectories according to the current land quality status.
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Affiliation(s)
- S Bajocco
- Council for Agricultural Research and Economics (CREA), Research Centre for Agriculture and Environment, Via della Navicella 2-4, IT-00184 Rome, Italy
| | - D Smiraglia
- Council for Agricultural Research and Economics (CREA), Research Centre for Agriculture and Environment, Via della Navicella 2-4, IT-00184 Rome, Italy.
| | - M Scaglione
- Council for Agricultural Research and Economics (CREA), Research Centre for Agriculture and Environment, Via della Navicella 2-4, IT-00184 Rome, Italy
| | - E Raparelli
- Council for Agricultural Research and Economics (CREA), Research Centre for Agriculture and Environment, Via della Navicella 2-4, IT-00184 Rome, Italy
| | - L Salvati
- Council for Agricultural Research and Economics (CREA), Research Centre for Forestry and Wood, Viale S. Margherita 80, IT-52100 Arezzo, Italy
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Scaglione M, Anselmino M, Bolao I, Stabile G, Solimene F, De Bellis A, Pepe M, Panella A, Ferraris F, Malacrida M, Maddaluno F, Gaita F, De Simone A. P4839Identification of the best ablation target and its relationship with mid-diastolic activity in re-entrant intra-atrial tachycardia. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p4839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - M Anselmino
- Hospital 'Città della Salute e della Scienza di Torino', Turin, Italy
| | - I Bolao
- Hospital de Navarra, Pamplona, Spain
| | | | - F Solimene
- Montevergine Cardiology Clinic, Mercogliano, Italy
| | | | - M Pepe
- Casa di cura San Michele, Maddaloni, Italy
| | - A Panella
- Casa di cura San Michele, Maddaloni, Italy
| | - F Ferraris
- Hospital 'Città della Salute e della Scienza di Torino', Turin, Italy
| | | | | | - F Gaita
- Hospital 'Città della Salute e della Scienza di Torino', Turin, Italy
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Parchi PD, Ciapini G, Paglialunga C, Giuntoli M, Picece C, Chiellini F, Lisanti M, Scaglione M. Anterior Cruciate Ligament Reconstruction with LARS Artificial Ligament-Clinical Results after a Long-Term Follow-Up. Joints 2018; 6:75-79. [PMID: 30051101 PMCID: PMC6059861 DOI: 10.1055/s-0038-1653950] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 04/08/2018] [Indexed: 02/08/2023]
Abstract
Purpose
The aim of this retrospective study was to evaluate the subjective and functional outcome of anterior cruciate ligament (ACL) reconstruction with the synthetic Ligament Advanced Reinforcement System (LARS) ligament.
Methods
Twenty-six patients were reviewed at an average follow-up of 11.6 years. Objective clinical evaluation was performed with stability tests. Patient-reported outcomes (Visual Analogue Scale, Knee Injury and Osteoarthritis Outcome Score, and Cincinnati Knee Rating Scale) were used to assess subjective and functional outcomes.
Results
Overall satisfactory results were obtained in 22 cases (84.6%). Four patients (15.4%) showed mechanical failure of the graft. No cases of synovitis or infection were reported.
Conclusion
LARS ligament can be considered a safe and suitable option for ACL reconstruction in carefully selected cases, especially elderly patients needing a rapid postoperative recovery.
Level of Evidence
Level IV, retrospective case series.
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Affiliation(s)
- Paolo Domenico Parchi
- 1st Orthopedic Division of Pisa University, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Gianluca Ciapini
- 1st Orthopedic Division of Pisa University, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Carlo Paglialunga
- 1st Orthopedic Division of Pisa University, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Michele Giuntoli
- 1st Orthopedic Division of Pisa University, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Carmine Picece
- 1st Orthopedic Division of Pisa University, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Fabio Chiellini
- 1st Orthopedic Division of Pisa University, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Michele Lisanti
- 1st Orthopedic Division of Pisa University, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Michelangelo Scaglione
- 1st Orthopedic Division of Pisa University, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
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