Analysis of risk factors for lymph nodal involvement in early stages of rectal cancer: When can local excision be considered an appropriate treatment? systematic review and meta-analysis of the literature
Carrara A.,S Chiara Hospital |
Mangiola D.,Policlinic G. B. Rossi |
Pertile R.,APSS |
Ricci A.,Policlinic G. B. Rossi |
And 5 more authors.
International Journal of Surgical Oncology | Year: 2012
Background. Over the past ten years oncological outcomes achieved by local excision techniques (LETs) as the sole treatment for early stages of rectal cancer (ESRC) have been often disappointing. The reasons for these poor results lie mostly in the high risk of the disease's diffusion to local-regional lymph nodes even in ESRC. Aims. This study aims to find the correct indications for LET in ESRC taking into consideration clinical-pathological features of tumours that may reduce the risk of lymph node metastasis to zero. Methods. Systematic literature review and meta-analysis of casistics of ESRC treated with total mesorectal excision with the aim of identifying risk factors for nodal involvement. Results. The risk of lymph node metastasis is higher in G < 2 and T < 2 tumours with lymphatic and/or vascular invasion. Other features which have not yet been sufficiently investigated include female gender, TSM stage >1, presence of tumour budding and/or perineural invasion. Conclusions. Results comparable to radical surgery can be achieved by LET only in patients with T 1 N 0 G 1 tumours with low-risk histological features, whereas deeper or more aggressive tumours should be addressed by radical surgery (RS). © 2012 Alessandro Carrara et al.
Fasoli R.,Institution of Ospedale Santa Chiara |
Pertile R.,APSS |
Seligman S.,Institution of Ospedale Santa Chiara |
De Pretis G.,Institution of Ospedale Santa Chiara
Gastroenterology Nursing | Year: 2015
The possible involvement, although limited to the diagnostic phase of the procedure, of nonmedical staff (particularly endoscopy nurses) in lower digestive endoscopy has recently been suggested. Computer-based simulators have demonstrated objective evaluation of technical skills in digestive endoscopy. The aim of this study was to evaluate basic colonoscopy skills of endoscopy nurses (naive operators), as compared with junior physician staff and senior endoscopists, through a virtual reality colonoscopy simulator. In this single-center, prospective, nonrandomized study, 3 groups of digestive endoscopy operators (endoscopy nurses, junior doctors [<150 previous colonoscopies], expert doctors [>500 previous colonoscopies and >200/year]) completed six diagnostic cases generated by an endoscopic simulator (AccuTouch, Immersion Medical, Gaithersburg, MD). The performance parameters, collected by the simulator, were compared between groups. Five parameters have been considered for statistical analysis: time spent to reach the cecum; pain of any degree; severe/extreme pain; amount of insufflated air; percentage of visualized mucosa. Statistical analysis to compare the three groups has been performed by means of Wilcoxon test for two independent samples and by means of Kruskal-Wallis test for three independent samples (p < .05). Sixteen operators have been studied (six endoscopy nurses, five junior doctors, and five senior doctors); 96 colonoscopic procedures have been evaluated. Statistically significant differences between experts and naive operators were observed regarding time to reach the cecum and induction of severe/extreme pain, with both Kruskal-Wallis and Wilcoxon test (p <.05); all other comparisons did not reach statistical significance. Although, as expected, expert doctors exceeded both junior doctors and naive operators in some relevant quality parameters of simulated diagnostic colonoscopies, the results obtained by less expert performers-and particularly by nursing staff-appear satisfactory as in regards to most of the considered quality parameters and suggest a potential value of this device in effectively teaching basic lower digestive endoscopy to beginners in a relatively short time. Copyright © 2015 Society of Gastroenterology Nurses and Associates.
Torri E.,APSS |
Mayora O.,CREATE-NET |
Cobo J.,CSPT |
Proceedings of the 2015 9th International Conference on Pervasive Computing Technologies for Healthcare, PervasiveHealth 2015 | Year: 2015
This paper presents the patient and caregiver perspectives on ICTs (information and communication technologies) supporting bipolar disorder management in multinational healthcare provisioning contexts. The envisioned mHealth (mobile health) solutions should incorporate general requirements that can be instantiated into different clinical settings. The involvement of users in designing new technologies for mental health is crucial in ensuring patient empowerment and the patient-centeredness of services. We conducted focus groups to understand user needs, attitudes, and experiences with regard to the supportive ICTs in the two target regions where the expected solutions will operate. The survey results provided valuable inputs for the formulation of the clinical requirements for the development of a transnational call for tender concerning mHealth solutions aimed at supporting treatment for bipolar disorder. This tender was open to public purchasers in different European countries. The study was part of the NYMHPA-MD (Next Generation Mobile Platform for Health in Mental Disorders) project, which was co-funded by the European Commission. © 2015 ICST.
Sacchetto D.,IM |
Morra L.,IM |
Agliozzo S.,IM |
Bernardi D.,APSS |
And 25 more authors.
Journal of Nanoparticle Research | Year: 2015
Objectives: To compare breast density (BD) assessment provided by an automated BD evaluator (ABDE) with that provided by a panel of experienced breast radiologists, on a multivendor dataset. Methods: Twenty-one radiologists assessed 613 screening/diagnostic digital mammograms from nine centers and six different vendors, using the BI-RADS a, b, c, and d density classification. The same mammograms were also evaluated by an ABDE providing the ratio between fibroglandular and total breast area on a continuous scale and, automatically, the BI-RADS score. A panel majority report (PMR) was used as reference standard. Agreement (κ) and accuracy (proportion of cases correctly classified) were calculated for binary (BI-RADS a-b versus c-d) and 4-class classification. Results: While the agreement of individual radiologists with the PMR ranged from κ = 0.483 to κ = 0.885, the ABDE correctly classified 563/613 mammograms (92 %). A substantial agreement for binary classification was found for individual reader pairs (κ = 0.620, standard deviation [SD] = 0.140), individual versus PMR (κ = 0.736, SD = 0.117), and individual versus ABDE (κ = 0.674, SD = 0.095). Agreement between ABDE and PMR was almost perfect (κ = 0.831). Conclusions: The ABDE showed an almost perfect agreement with a 21-radiologist panel in binary BD classification on a multivendor dataset, earning a chance as a reproducible alternative to visual evaluation. Key Points: • Individual BD assessment differs from PMR with κ as low as 0.483. • An ABDE correctly classified 92 % of mammograms with almost perfect agreement (κ = 0.831). • An ABDE can be a valid alternative to subjective BD assessment. © 2015, European Society of Radiology.
Stroffolini T.,Policlinico Umberto I |
D'Egidio P.F.,Addiction Service |
Aceti A.,University of Rome La Sapienza |
Filippini P.,2nd University of Naples |
And 27 more authors.
Journal of Medical Virology | Year: 2012
There is a lack of updated nationwide records regarding hepatitis C virus (HCV) infection among drug addicts in Italy. The prevalence and characteristics of HCV infection in a national sample of drug addicts in Italy were determined. Five hundred forty-three drug addicts (mean age 35.3 years, 85.1% males), selected from 25 Italian Centers for Substance Dependence were enrolled to be evaluated for anti-HCV, HCV-RNA, HCV genotype, HBV markers, anti-HDV, and anti-HIV during the period of April-November 2009. Anti-HCV prevalence was 63.9%. HCV-RNA was detected in 68.3% of patients positive for anti-HCV. Genotypes 1 and 3 prevailed (49.3% and 39.7%, respectively). However, 9.3% of the subjects had genotype 4, a rate over threefold higher than the one observed in 1996 among drug addicts in central Italy. Needle sharing was the strongest independent predictor of the likelihood to contract an HCV infection (OR 8.9; 95% CI: 5.0-16.0). Only 19.3% of subjects received antiviral treatment for HCV. The prevalence of HBsAg and HIV positivity was 2.8% and 3.1%, respectively. The pattern of HBV markers showed that nearly one-third of subjects had been vaccinated, while 42.3% were negative for any marker of HCV. The prevalence of HCV infection is high among drug addicts in Italy. The incidence of Genotype 4 is increasing and this may lead to the spreading of the disease to the general population in the near future. Efforts should be made to improve the rate of antiviral treatment for drug addicts with HCV infection and vaccination against hepatitis B. © 2012 Wiley Periodicals, Inc.