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Firenze, Italy

Kang B.,Italian Institute of Technology | Kang B.,SantAnna School of Advanced Studies | Castelli V.,Italian Institute of Technology | Diversi C.,Italian Institute of Technology | And 4 more authors.
2014 36th Annual International Conference of the IEEE Engineering in Medicine and Biology Society, EMBC 2014 | Year: 2014

We considered a robot-assisted neuroendoscopy, and we developed a handling interface for linking a clinically-used endoscope to a lightweight robot (tool holder) with 7 DoFs. Such a robot holds potential for soft interaction with the surgeon, yet its intrinsic compliance must be suitably tamed not to lose tool targeting accuracy. Starting from practical specifications by neurosurgeons, we designed, fabricated and preliminarily assessed a compact and ergonomic handling interface. Such an interface permitted to easily insert/retract the tool (the measured force was 2 N), and to accurately hit a predefined target (the mean targeting error was below 0.5 mm, within the accuracy level of the optical tracker used for tool localization and pose). The feedback by neurosurgeons was very positive, thus encouraging further developments. © 2014 IEEE. Source

Valentini P.,Catholic University of the Sacred Heart | Buonsenso D.,Catholic University of the Sacred Heart | Barone G.,Catholic University of the Sacred Heart | Serranti D.,Meyer Pediatric Hospital | And 5 more authors.
Journal of Perinatology | Year: 2015

OBJECTIVE: To compare the effectiviness of spiramycin/cotrimoxazole (Sp/C) versus pyrimethamine/sulfonamide (Pyr/Sul) and spiramycin alone (Spy) on mother-to-child transmission of toxoplasmosis infection in pregnancy. STUDY DESIGN: Retrospective study of pregnant women evaluated for suspected toxoplasmosis between 1992 and 2011. RESULT: A total of 120 mothers and their 123 newborns were included. Prenatal treatment consisted of spiramycin in 43 mothers (35%), spiramycin/cotrimoxazole in 70 (56.9%) and pyrimethamine/sulfonamide in 10 (8.1%). A trend toward reduction in toxoplasmosis transmission was found when Sp/C was compared with Pyr/Sul and particularly with Spy alone (P = 0.014). In particular, Spy increased the risk of congenital infection when compared with Sp/C (odds ratio (OR) 4.368; 95% CI: 1.253 to 15.219), but there was no significant reduction when Sp/C was compared with Pyr/Sul (OR 1.83; 95% CI: 0.184 to 18.274). CONCLUSION: The treatment based on Sp/C has significant efficacy in reducing maternal-fetal transmission of Toxoplasma gondii when compared with Pyr/Sul and particularly to Spy. Randomized controlled trials would be required. © 2015 Nature America, Inc. Source

Scialpi M.,University of Perugia | Pierotti L.,University of Perugia | Gravante S.,University of Perugia | Piscioli I.,Budrio Hospital | And 3 more authors.
Journal of Medical Case Reports | Year: 2014

Introduction: Computed tomography and magnetic resonance imaging are able to demonstrate and to diagnose hepatic focal nodular hyperplasia when a typical pattern of a well-circumscribed lesion with a central scar is present. Our aim is to propose the split-bolus multidetector-row computed tomography technique as an alternative to the conventional triphasic technique in the detection and characterization of focal nodular hyperplasia to reduce the radiation dose to the patient. To the best of our knowledge, this is the first report regarding the application of the split-bolus computed tomography technique in the evaluation of hepatic focal nodular hyperplasia. Case presentation: We describe a case of focal nodular hyperplasia of the liver in a 53-year-old Caucasian woman (weight 75Kg) with a colorectal adenocarcinoma histologically confirmed. An innovative split-bolus multidetector-row computed tomography technique was used that, by splitting intravenous contrast material in two boli, combined two phases (hepatic arterial phase and portal venous phase) in a single pass; a delayed (5 minutes) phase was obtained to compare the findings with that of triphasic multidetector-row computed tomography. Conclusions: Split-bolus multidetector-row computed tomography was able to show the same appearance of the lesion as the triphasic multidetector-row computed tomography technique. This is the first case demonstrating the effectiveness of the split-bolus multidetector-row computed tomography technique in the detection and characterization of focal nodular hyperplasia with a significant reduction in radiation dose to the patient with respect to triphasic multidetector-row computed tomography technique. © 2014 Scialpi et al.; licensee BioMed Central Ltd. Source

Niccolini M.,Italian Institute of Technology | Castelli V.,Italian Institute of Technology | Diversi C.,Italian Institute of Technology | Kang B.,Italian Institute of Technology | And 3 more authors.
International Journal of Medical Robotics and Computer Assisted Surgery | Year: 2016

Background: Ventriculostomy is a widely performed neurosurgical procedure; some risk factors can be mitigated by computer/robot-assisted approaches. Platforms fostering synergistic robot-surgeon integration are pursued, for which lightweight robots with compliant controlled joints must be assessed (because compliance hampers accuracy). Methods: We developed a platform encompassing, in particular, a lightweight robot and an optical tracker also used to enhance robot accuracy. Based on specifications by neurosurgeons, we designed a neuroendoscope-handling interface and assessed targeting accuracy in a model ventriculostomy where the robot was operated both autonomously and in hands-on (i.e. co-operative) mode. Results: Targeting errors were systematically below the procedure accuracy threshold (1 mm); the rms targeting errors were 0.51 and 0.54 mm for autonomous and hands-on control, respectively. No significant difference was observed between the considered control modes. Very positive feedback was gathered from neurosurgeons. Conclusions: Accurate tool targeting under both autonomous and hands-on control was achieved. © 2016 John Wiley & Sons, Ltd. Source

Modena P.,Centro Of Riferimento Oncologico | Modena P.,Italian National Cancer Institute | Buttarelli F.R.,Policlinico Umberto I | Miceli R.,Centro Of Riferimento Oncologico | And 16 more authors.
Neuro-Oncology | Year: 2012

Several molecular biomarkers have been suggested as predictors of outcome for pediatric ependymomas but deserve further validation in independent case series. We analyzed intracranial ependymomas belonging to a series of 60 patients prospectively treated according to the protocol sponsored by the Italian Association of Pediatric Hematology-Oncology. We used a tissue microarray to analyze nucleolin (NCL), cyclin-dependent kinase inhibitor 2A (CDKN2A), tumor protein 53 (TP53), and epidermal growth factor receptor (EGFR) by immunohistochemistry and by 1q gain by fluorescent in situ hybridization. The mRNA expression levels of EGFR, human telomerase reverse-transcriptase (HTERT), and Prominin 1 (PROM 1)/CD133 were evaluated by quantitative real-time PCR from cases with fresh-frozen tumor material available. Univariate and multivariate analyses of updated clinical data confirmed the prognostic significance of surgery (P <. 01) and tumor grading (P <. 05) for both relapse-free survival (RFS) and overall survival (OS). Among biomolecular markers, HTERT mRNA expression emerged with the strongest association with OS at multivariate analysis (hazard ratio [HR] 9.9; P <. 011); the 5-year OS was 84 versus 48 in the subgroups with HTERT median value <6 versus <6, respectively (P<. 005). Five-year RFS was 46 versus 20 in the subgroups with low versus high NCL protein expression, respectively (P< . 004), while multivariate Cox analyses gave suggestively high HRs for high versus low NCL (HR 1.9; P< . 090). The other genes tested were not significant at multivariate analyses, and genetic alterations of CDKN2A, TP53, EGFR, and HTERT loci were rare. The PROM1/CD133 cancer stem cell marker was strongly expressed at both RNA and protein levels in a substantial fraction of cases and was suggestively associated with a more indolent form of the disease. We conclude that NCL and HTERT represent the strongest prognostic biomarkers of RFS and OS, respectively, in our ependymoma case series. © 2012 The Author(s). Source

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