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Dieterich S.,Stanford University | Cavedon C.,Azienda Ospedaliera Universitaria Integrata di Verona | Chuang C.F.,University of California at San Francisco | Cohen A.B.,Accuray | And 7 more authors.
Medical Physics | Year: 2011

The task group (TG) for quality assurance for robotic radiosurgery was formed by the American Association of Physicists in Medicine's Science Council under the direction of the Radiation Therapy Committee and the Quality Assurance (QA) Subcommittee. The task group (TG-135) had three main charges: (1) To make recommendations on a code of practice for Robotic Radiosurgery QA; (2) To make recommendations on quality assurance and dosimetric verification techniques, especially in regard to real-time respiratory motion tracking software; (3) To make recommendations on issues which require further research and development. This report provides a general functional overview of the only clinically implemented robotic radiosurgery device, the CyberKnife®. This report includes sections on device components and their individual component QA recommendations, followed by a section on the QA requirements for integrated systems. Examples of checklists for daily, monthly, annual, and upgrade QA are given as guidance for medical physicists. Areas in which QA procedures are still under development are discussed. © 2011 American Association of Physicists in Medicine.


Faggiano E.,Polytechnic of Milan | Antiga L.,OROBIX Srl | Puppini G.,Azienda Ospedaliera Universitaria Integrata di Verona | Quarteroni A.,Polytechnic of Milan | And 3 more authors.
Biomechanics and Modeling in Mechanobiology | Year: 2013

Bicuspid aortic valve (BAV) is associated with aortic dilatation and aneurysm. Several studies evidenced an eccentric systolic flow in ascending aorta associated with increased wall shear stresses (WSS) and the occurrence of an helical systolic flow. This study seeks to elucidate the connections between jet asymmetry and helical flow in patients with normally functioning BAV and dilated ascending aorta. We performed a computational parametric study by varying, for a patient-specific geometry, the valve area and the flow rate entering the aorta and drawing also a tricuspid valve (TAV). We considered also phase-contrast magnetic resonance imaging of four BAV and TAV patients. Measurement of normalized flow asymmetry index, systolic WSS and of a new index (positive helix fraction, PHF) quantifying the presence of a single a single helical flow were performed. In our computation, BAV cases featured higher values of all indices with respect to TAV in both numerical and imaged-based results. Moreover, all indices increased with decreasing valve area and/or with increasing flow rate. This allowed to separate the BAV and TAV cases with respect to the jet asymmetry, WSS localization and helical flow. Interestingly, these results were obtained without modeling the leaflets. © 2012 Springer-Verlag Berlin Heidelberg.


Patent
Azienda Ospedaliera Universitaria Integrata Di Verona, Rare Partners S.R.L., University of Bari and University of Ferrara | Date: 2012-06-13

The invention relates to the use of 4,6,4-trimethylangelicin (TMA) and structural analogues thereof to prepare a medicament for the treatment of cystic fibrosis with the primary objective of correcting the defective CFTR in a sub-group of cystic fibrosis patients consisting of patients carrying the F508de1-CFTR mutation.


Graziani M.S.,Azienda Ospedaliera Universitaria Integrata di Verona | Merlini G.,University of Pavia
Expert Review of Molecular Diagnostics | Year: 2014

The serum free light chain (FLC) assay is an important tool in the management of patients with monoclonal gammopathies. MEDLINE®, the Cochrane Central Register of Controlled Trials and the Cochrane Database of Systematic Reviews from January 2000 through July 2013, were used as data sources. The available evidence is rather weak. For screening of multiple myeloma and related conditions, the association of the FLC assay with the traditional serum tests avoids urine study. Screening for immunoglobulin light-chain (AL) amyloidosis or other rare syndromes requires the urine examination. FLC measurement is used in the assessment of the risk of progression of precursor diseases to overt myeloma, and for risk stratification in solitary plasmacytoma, multiple myeloma and AL amyloidosis. In patients with oligosecretory myeloma and AL amyloidosis, the quantification of FLC is essential for monitoring and categorization of response to therapy. Further studies with improved design are warranted to strengthen the available evidence. © 2014 Informa UK, Ltd.


Zanolla L.,Azienda Ospedaliera Universitaria Integrata di Verona | Graziani M.S.,Azienda Ospedaliera Universitaria Integrata di Verona
Biochimica Clinica | Year: 2016

A number of recent contributions about the P value in statistics gave the spur to consider different aspects of its use in scientific papers. There is indeed a need of correct information on how and when to apply the P value to evaluate results of a scientific experiment and how to appropriately interpret the numerical value as well, considering that the P statistic is rather frequently reported in the medical literature. In this paper we first described the origin of the P value and its correct significance, using examples where the statistical significance of the P value does not necessarily mean a clinical significance. Then, we defined which kind of assumptions cannot be drawn from the a P value. The most common misuse is when a non-statistically significant P value is used to establish that two laboratory techniques are equivalent. Finally, some alternatives are given, the most common being the use of the confidence intervals. In spite of the interpretation mistakes commonly observed in scientific articles, the P value remains a useful statistic tool to be utilized and interpreted with better consciousness.


Rocca G.,Azienda Ospedaliera Universitaria Integrata di Verona | Spina M.,Azienda Ospedaliera Universitaria Integrata di Verona | Mazzi M.,Azienda Ospedaliera Universitaria Integrata di Verona
Injury | Year: 2014

Purpose We present our experience of using the Anterior Combined Endopelvic (ACE) approach, which consists of a combination of a newly modified Stoppa approach with the lateral approach to the iliac crest. This approach is discussed in terms of fracture reduction and fixation, technical aspects, and the incidence of complications, and as an alternative to the ilioinguinal approach for the treatment of acetabular fractures.Methods A consecutive group of 34 adult patients with acetabular fractures treated surgically with the ACE approach was compared with a group of 42 adult patients treated with the ilioinguinal approach between 2010 and 2013. Both approaches were performed by a single surgeon to fix the acetabular fractures with main anterior displacement and the anterior and lateral parts of the pelvis. All the patients were analysed with typical X-ray projections for acetabular fractures and CT-scan. Charts and radiographs were reviewed for fracture pattern. Operative time, blood loss, quality of reduction, functional outcomes and perioperative complications were compared between the two groups of patients.Results The mean follow-up of patients was 26 months (range 6-49 months), with a median of 24.5 months. The types of acetabular fraction in the study were as follows: 32 anterior and posterior columns, 18 anterior columns, 10 anterior columns with posterior hemitransverse, 10 transverse associated with posterior walls, two transverse; two T-Type transverse and two anterior walls. Average blood loss was 1090 mL in the ACE group and 1200 mL in the ilioinguinal group. Anatomic or satisfactory reduction was achieved in 94% of the acetabular fractures. Two patients (one in each group) had mild symptoms of the lateral femoral cutaneous nerve and improved within 4-6 months; one patient in the ilioinguinal group developed ossification Brooks grade III.Conclusion The ACE approach for the treatment of acetabular fractures is highly recommended when the fracture involves the quadrilateral surface and anterior column. This approach provides a direct good-to-excellent visualisation and access to the entire fracture, which makes reduction and fixation easier. The clinical outcomes were slightly better with ACE compared with the ilioinguinal approach. Complication rate was similar in the two groups. The ACE technique is a viable alternative to the ilioinguinal approach when exposure of the anterior acetabulum is required. © 2014 Elsevier Ltd. All rights reserved.


Zanolla L.,Azienda Ospedaliera Universitaria Integrata di Verona | Graziani M.S.,Azienda Ospedaliera Universitaria Integrata di Verona
Biochimica Clinica | Year: 2014

The medical literature uses statistics to describe results of observational studies, clinical trials and experimental studies and to test the underlying scientific hypothesis. The statistic language could, however, not be familiar to any reader; this can hamper the correct comprehension of the paper and the appropriate interpretation of results. These considerations represented the spur to formulate a glossary of the more common statistical terms. To facilitate the reading of the vast majority of articles, which are written in English, corresponding English terms are also reported. The present document represents the first part of the project, related to descriptive statistics.


Zanolla L.,Azienda Ospedaliera Universitaria Integrata di Verona | Graziani M.S.,Azienda Ospedaliera Universitaria Integrata di Verona
Biochimica Clinica | Year: 2014

This document represents the second part of the project related to a glossary for statistics. The inferential statistics is the part of the statistic used to formulate statements about the characteristics of a population from a sample of it, selected randomly. The document includes statistical terms of more common use. To facilitate the reading of the vast majority of articles, which are written in English, corresponding English terms are also reported.


An update of the 2002 guidelines for the evaluation and management of chronic kidney disease (CKD) has recently been published by the Kidney Disease Improving Global Outcomes (KDIGO) initiative. This report intends to summarize and comment the topics of interest for the clinical laboratory, emphasizing differences with the previous guideline. Clinical biochemists are explicitly mentioned among the target audience of new guidelines, because of the fundamental role that laboratory tests have in the detection and follow up of CKD; this is certainly something new in the history of clinical guidelines. The most important differences between 2002 and new guidelines are: a new risk prediction model including cause, glomerular filtration rate (GFR) and urine albumin results; a higher role assigned to urine albumin considered both as a component of risk prediction and as the primary test to detect proteinuria; the suggestion to use the Chronic Kidney Disease-Epidemiology Collaboration (CKD-EPI) equation (considered more accurate than the Modification of Diet in Renal Disease (MDRD) formula) to calculate GFR; the utility of using cystatin C and the GFR formulas based on this protein to confirm the renal impairment in certain categories of patients. Laboratorians can find in the guidelines a number of detailed indications on how to report and interpret laboratory tests for CKD, ranging from the type of sample to be used for urine albumin measurement (i.e., the first morning void) to the way of estimated GFR reporting (rounded to the nearest whole number) and to creatinine and cystatin C calibration approaches that should be traceable to the international reference materials.


Soardi G.A.,Azienda Ospedaliera Universitaria Integrata di Verona | Perandini S.,Azienda Ospedaliera Universitaria Integrata di Verona | Motton M.,Azienda Ospedaliera Universitaria Integrata di Verona | Montemezzi S.,Azienda Ospedaliera Universitaria Integrata di Verona
European Radiology | Year: 2015

Objectives: A crucial point in the work-up of a solitary pulmonary nodule (SPN) is to accurately characterise the lesion on the basis of imaging and clinical data available. We introduce a new Bayesian calculator as a tool to assess and grade SPN risk of malignancy.Methods: A set of 343 consecutive biopsy or interval proven SPNs was used to develop a calculator to predict SPN probability of malignancy. The model was validated on the study population in a “round-robin” fashion and compared with results obtained from current models described in literature.Results: In our case series, receiver operating characteristic (ROC) analysis showed an area under the curve (AUC) of 0.893 for the proposed model and 0.795 for its best competitor, which was the Gurney calculator. Using observational thresholds of 5 % and 10 % our model returned fewer false-negative results, while showing constant superiority in avoiding false-positive results for each surgical threshold tested. The main downside of the proposed calculator was a slightly higher proportion of indeterminate SPNs.Conclusions: We believe the proposed model to be an important update of current Bayesian analysis of SPNs, and to allow for better discrimination between malignancies and benign entities on the basis of clinical and imaging data. © 2014, European Society of Radiology.

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