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Impact of the Community-Based Active Monitoring Program on the Long Term Care Services Use and In-Patient Admissions of the Over-74 Population

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Advances in Aging Research 2015年第6期4卷 187-194页

作者： maria Cristina Marazzi maria chiara Inzerilli Olga Madaro Leonardo Palombi Paola Scarcella Stefano Orlando Massimo Maurici Giuseppe Liotta LUMSA University Rome Italy Municipality of Rome Rome Italy Community of Sant’Egidio Long Live the Elderly Program Rome Italy Dept. of Biomedicine and Prevention University of Rome “Tor Vergata” Rome Italy

Introduction: Social isolation increases in the over-74 population and it is a risk factor for death and Long Term Care (LTC) use. In order to prevent the negative consequences of social isolation on this population community interventions focused on strengthening the social network should be intensified. The aim of this paper is to describe the impact on health care use of a Community-based pro-Active Monitoring Program (CAMP) providing phone monitoring to all the clients and home visits according to the individual’s needs. Methodology: In order to provide an evaluation of the program outcomes, the rates of clients’ hospitalization and admissions to Long Term Care facilities during 2011 have been assessed. The observed rates have been compared with expected ones calculated on available information for similar population. A cost-analysis has been also carried out to analyze the program sustainability. Results: The studied sample is made up by 1408 over-74 citizens followed up during 2011 in Rome (Italy) by CAMP. The cumulative observation time was 1362 p/y;61 individuals died during 2011 (death rate 4.3%). The hospital admission rate observed among CAMP’s clients was 254‰ (357/1408;CL95% ± 91‰), lower than the 282‰ reported for the over-74 population of Rome. This translates into 39 averted hospitalization. The LTC admission rate is also reduced among CAMP’s clients (9/1,408, 6.6‰ CL95% ± 0.8‰ vs. 9.7‰ reported for a comparable sample);it translates into 4 averted LTC admissions. The averted cost ranged between 47,153 € and 220,117 € according to the range of services used by the clients, which translates into a percentage of estimated cost reduction on yearly basis ranged between 3% and 12.5% of the whole cost of services used by the studied population. Discussion: The paper suggests the capacity of CAMP to reduce both the over-74 hospitalization rate and use of LTC. Cost analysis also indicates a cost reduction as a consequence of the CAMP implementation. Further

关键词： Social Isolation Hospitalization Long Term Care Use Active Monitoring Social Capital

Sustained attention in psychosis:Neuroimaging findings

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World Journal of Radiology 2014年第6期6卷 261-273页

作者： Gianna Sepede maria chiara Spano Marco Lorusso Domenico De Berardis Rosa maria Salerno Massimo Di Giannantonio Francesco Gambi Department of Neuroscience and Imaging Institute for Advanced Biomedical Technologies University "G. D’Annunzio" of Chieti "G. d’Annunzio" University of Chieti 66013 Chieti Scalo (CH) Italy Department of Mental Health National Health Trust 64100 Teramo Italy

To provide a systematic review of scientific literatureon functional magnetic resonance imaging(fMRI) stud-ies on sustained attention in psychosis. We searchedPubMed to identify fMRI studies pertaining sustainedattention in both affective and non-affective psycho-sis. Only studies conducted on adult patients using asustained attention task during fMRI scanning wereincluded in the final review. The search was conductedon September 10 th, 2013. 15 fMRI studies met our in-clusion criteria: 12 studies were focused on Schizophre-nia and 3 on Bipolar Disorder Type Ⅰ(BDI). Only halfof the Schizophrenia studies and two of the BDI stud-ies reported behavioral abnormalities, but all of themevidenced significant functional differences in brain re-gions related to the sustained attention system. Alteredfunctioning of the insula was found in both Schizophre-nia and BDI, and therefore proposed as a candidate trait marker for psychosis in general. On the other hand, other brain regions were differently impaired in affective and non-affective psychosis: alterations of cingulate cortex and thalamus seemed to be more common in Schizophrenia and amygdala dysfunctions in BDI. Neural correlates of sustained attention seem to be of great interest in the study of psychosis, highlight-ing differences and similarities between Schizophrenia and BDI.

关键词： Sustained attention Affective psychosis Non-affective psychosis Schizophrenia Bipolar disorder Functional magnetic resonance imaging Insula

From advanced diagnosis to advanced resection in early neoplastic colorectal lesions:Never-ending and trending topics in the 2020s

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World Journal of Gastrointestinal Surgery 2022年第7期14卷 632-655页

作者： Francesco Auriemma Sandro Sferrazza Mario Bianchetti maria Flavia Savarese Laura Lamonaca Danilo Paduano Nicole Piazza Enrica Giuffrida Lupe Sanchez Mete Alessandra Tucci Sebastian Manuel Milluzzo chiara Iannelli Alessandro Repici Benedetto Mangiavillano Gastrointestinal Endoscopy Unit Humanitas Mater DominiCastellanza 21053Italy Gastroenterology and Endoscopy Unit Santa Chiara HospitalTrento 38014Italy Digestive Endoscopy Unit San Giuseppe Hospital-MultimedicaMilan 20123Italy Department of Gastroenterology and Gastrointestinal Endoscopy General HospitalSanremo 18038Italy Gastroenterology Unit IRCCS Policlinico San DonatoSan Donato MilaneseDepartment of Biomedical Sciences for HealthUniversity of MilanMilan 20122Italy Gastroenterology and Hepatology Unit A.O.U.Policlinico"G.Giaccone"Palermo 90127Italy Department of Gastroenterology and Digestive Endoscopy IRCCS Regina Elena National Cancer InstituteRome 00144Italy Department of Gastroenterology Molinette HospitalCittàdella salute e della Scienza di TorinoTurin 10126Italy Digestive Endoscopy Unit and Gastroenterology Fondazione PoliambulanzaBrescia 25100Italy Department of Health Sciences Magna Graecia UniversityCatanzaro 88100Italy Digestive Endoscopy Unit and Gastroenterology Humanitas Clinical and Research Center and Humanitas UniversityRozzano 20089Italy Biomedical Science HunimedPieve Emanuele 20090Italy Gastrointestinal Endoscopy Unit Humanitas Mater DominiCastellanzaVarese 21053Italy

Colonoscopy represents the most widespread and effective tool for the prevention and treatment of early stage preneoplastic and neoplastic lesions in the panorama of cancer *** the world there are different approaches to the topic of colorectal cancer prevention and screening:different starting ages(45-50 years);different initial screening tools such as fecal occult blood with immunohistochemical or immune-enzymatic tests;recto-sigmoidoscopy;and *** key aspects of this scenario are composed of a proper bowel preparation that ensures a valid diagnostic examination,experienced endoscopist in detection of preneoplastic and early neoplastic lesions and open-minded to upcoming artificial intelligence-aided examination,knowledge in the field of resection of these lesions(from cold-snaring,through endoscopic mucosal resection and endoscopic submucosal dissection,up to advanced tools),and management of complications.

关键词： Colorectal lesions Colorectal tumor Endoscopic submucosal dissection Endoscopic mucosal resection Cold-endoscopic mucosal resection FTRD® Complications Adverse events Polypectomy

Physical exercise intensity prescription to improve health and fitness in overweight and obese subjects: A review of the literature

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Health 2013年第6期5卷 113-121页

作者： Gian Pietro Emerenziani Silvia Migliaccio maria chiara Gallotta Andrea Lenzi Carlo Baldari Laura Guidetti Department of Experimental Medicine University of Rome “La Sapienza” Rome Italy Department of Movement Human and Health Sciences University of Rome “Foro Italico” Rome Italy

Obesity is one of the greatest public health challenges of the 21st century. Overweight and obesity drastically increase a person’s risk of developing chronic non-communicable diseases (NCDs), including cardiovascular disease, cancer and diabetes. Furthermore, obesity is already responsible for 2% -8% of health costs and 10% -13% of deaths in several industrialized countries. Lifestyle modifications involving changes in exercise, diet and psychological support are effective in reducing the incidence of overweight. Moreover, positive effects of physical activity (PA) for weight loss and prevention of weight regain are well documented. It was recognized that health benefits regarding both psychological and physiological aspects, such as improving cardiorespiratory and muscular fitness and/or decreasing depression symptoms, can be obtained from numerous activities. Public health institutions (American College of Sports Medicine, World Health Organization) provide recommendations for PA (volume, frequency, intensity and type of exercise) to achieve positive effects, at all ages and for many diseases and disorders situations. Although exercise under guidelines can be safely performed by obese subjects, several questions still need to be fully answered. In facts, the exercise program should be tailored according to an individual’s habitual physical activity, physical function, health status, exercise responses, and stated goals. Thus, this review analyzes the intensity of PA parameters. In the last years, research has been focused on the individualization of the right intensity in which different types of subjects’ condition must undergo to achieve the health goals. Aerobic exercise has been commonly used to reach weight loss goal. Prescription of aerobic exercise in clinical practice is frequently based on the percentage of maximum heart rate (%HRmax), heart rate reserve (%HRreserve), rating of perceived exertion (RPE), maximal oxygen consumption (%VO2max) and for unheal

关键词： Obesity Overweight Exercise Intensity Prescription Gas Exchange Thresholds Health

Pneumothorax Complicating Port-a-Cath and Groshong Catheter Positioning in Children: Our Experience before Routine Ultrasound-Guided Puncture

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Open Journal of Anesthesiology 2013年第8期3卷 345-348页

作者： Silvia Guenzani Paola Previtali Federico Piccioni maria chiara Allemano Serena Catania Martin Langer Department of Anesthesia Intensive Care and Palliative Care Fondazione IRCCS Istituto Nazionale dei Tumori Milan Italy Department of Pathophysiology and Transplantation University of Milan Milan Italy Pediatric Oncology Unit Fondazione IRCCS Istituto Nazionale dei Tumori Milan Italy.

Objective: To study incidence and management of long term central venous catheter (CVC) placement related pneumothorax (PNX) in children. Aim: To construct a baseline value before the introduction of systematic use of ultrasound guidance, which requires specific training and equipment. Background: Anesthesia Service and Pediatric Oncology of the Italian National Cancer Center;patients were children (age ≤ 18 years) with solid tumors, needing long-term central venous catheters (Groshong or Port-a-Cath). Materials/Methods: Catheter placement was performed, mostly under general anesthesia, utilizing a micropuncture 5-7 Fr needle and fluoroscopy. In the study period ultrasound was used only in case of previously failed attempts. Relevant data were collected retrospectively. Results: From August 2008 to December 2011, 452 catheters were implanted to our patients. The prevalent approach was from subclavian vein (left 85.7%, right 9.7%);in few cases internal jugular vein was chosen (right 2.4%, left 2.2%). Pneumothorax occurred in 14 patients (3.1%;95%CI 1.9-5.1). In 4/14 children the PNX was considered minimal and not treated. In 10 patients the PNX was drained. In 7 cases a traditional, surgical thoracostomy was performed, while in 3 children a 14-Ga polyurethane catheter (Arrow International®) was inserted over a wire guide in the pleural space by anaesthetists. Conclusions: In our centre rates of PNX are the same as those described in literature and are expected to lower when ultrasound guidance of the puncture will be routinely applied. Percutaneous drainage of PNX seems as effective as surgically placed thoracostomy catheter, but less invasive.

关键词： Pneumothorax Central Venous Catheter Groshong Port-a-Cath Children Drainage

Does needle calibre affect pain and complication rates in patients undergoing transperineal prostate biopsy？ A prospective, randomized trial

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Asian Journal of Andrology 2009年第6期11卷 678-682页

作者： Saredi Giovanni maria chiara Sighinolfi Fidanza Francesco De Stefani Stefano Micali Salvatore Maurizio Paterlini Roberto D＇Amico Bianchi Giampaolo Department of Urology University of Modena and Reggio Emilia Modena 41100 Italy Department of Oncology University of Modena and Reggio Emilia Modena 41100 Italy

Transperineal prostate biopsy is a procedure that can be used to obtain histological samples from the prostate. To improve both the quality of the biopsy core samples and prostate cancer detection, we are currently performing a prospective, randomized trial comparing prostate biopsy samples obtained using an 18 G-needle to those obtained using a 16 G-needle. The aim of this preliminary study was to evaluate pain and complication rates in both groups in order to assess whether performing a prostate biopsy with a larger calibre needle is a feasible procedure. One hundred and eighty-seven patients undergoing transperineal prostate biopsy were prospectively evaluated and divided into two groups. The first group （94 patients, Group A） received a transperineal prostate biopsy using a 16 G-needle and the second group （93 patients, Group B） underwent transperineal prostate biopsy with an 18 G-needle. Anaesthesia was obtained with a single perineal injection at the prostatic apex in all subjects. A visual analogue scale （VAS） and facial expression scale （FES） were used to assess pain during multiple steps of the procedure in each group. A detailed questionnaire was used to obtain information about drug use because it could potentially influence the pain and complications that patients experienced. Two weeks after the procedure, early and late complications were evaluated. Statistical analysis was carried out using non-parametric tests. Prostate Specific Antigen （PSA） and drug use were similar at baseline between the two groups. Pain during prostate biopsy, which was measured with both the VAS and FES instruments, did not differ significantly between the 18- and 16 G-needle groups, and no significant differences were found in early or late complication rates between the groups. Transperineal prostate biopsy with a 16 G-needle is a feasible Further studies with larger patient populations are required to prostate cancer detection rates. procedure in terms of pain and complicati

关键词： needle calibre prostatic biopsy side effects

Acupuncture may anticipate the antalgic effects of focused shockwave therapy to rotator cuff tendinopathy:A retrospective clinical study

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World Journal of Acupuncture-Moxibustion 2020年第3期30卷 193-197页

作者： Enrico Bruno Diana Lalli Riccardo Vallorani Enrica Armienti maria chiara Vulpiani Mario Vetrano Donatella Trischitt Sveva maria Nusca Flavia Santoboni Department of Surgical and Medical Sciences and Translational Medicine Faculty of Medicine and Psychology"Sapienza"University of Romevia di Grottarossa 1035-103900189 RomeItaly Physical Medicine and Rehabilitation Unit Sant’Andrea University HospitalVia di Grottarossa 1035-103900189 RomeItaly

Objective:The purpose of the study is to evaluate whether the clinical effects of focused extracorporeal shockwave therapy(f-ESWT)and acupuncture anticipate the clinical response in patients with rotator cuff tendinopathy in the short ***:An observational retrospective clinical ***/Location:Physical Medicine and Rehabilitation Unit,Sant’Andrea University Hospital in Rome,***/Interventions:We analyzed retrospectively thirty patients(22 females and 8 males)with rotator cuff *** patients underwent f-ESWT and acupuncture combined therapy(Group A)and fifteen patients underwent only f-ESWT therapy(Group B).Outcome measures:The outcome measures were the Visual Analogic Scale(VAS),Assessment Shoulder and Elbow Scale(ASES)and Roles and Maudsley Score(RMS).The follow-ups were T0(pre-treatment),T1(3 weeks after the start of the treatment),and T2(at 8 weeks).In order to compare groups,the ANOVA and Friedman tests were *** A patients had a more rapid and statistically significant improvement trend in VAS(P<0.001),ASES scale(P<0.001),and a higher level of satisfaction to treatment assessed by RMS(P<0.001)than group B in the short ***:The study showed that combined treatment decreases the recovery time of the shoulder involved in terms of pain and motor function in the short ***,these results shall be confirmed by controlled randomized studies.

关键词： Acupuncture Focused extracorporeal shockwave therapy Rotator cuff tendinopathy

Is neutrophil gelatinase associated lipocalin useful in hepatitis C virus infection?

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World Journal of Hepatology 2016年第19期8卷 815-824页

作者： Alessio Strazzulla Giuseppe Coppolino Concetta Di Fatta Francesca Giancotti Giuseppina D'Onofrio maria Concetta Postorino maria Mazzitelli Selma Valerie Mammone Innocenza Gentile Laura Rivoli Eleonora Palella Tiziana Gravina chiara Costa Vincenzo Pisani Vincenzo De maria Giorgio Settimo Barreca Nadia Marascio Alfredo Focà Giorgio Fuiano Elio Gulletta Carlo Torti Infectious Diseases Unit Department of Medical and Surgical Sciences "Magna Graecia" University Nephrology and Dialysis Unit "Pugliese-Ciaccio" Hospital Clinical Pathology Unit Department of Health Sciences "Magna Graecia" University Hepatology Unit "Mater Domini" Teaching Hospital Nephrology Unit Department of Medical and Surgical Sciences "Magna Graecia" University Microbiology Unit Department of Health Sciences "Magna Graecia" University

AIM: To evaluate neutrophil gelatinase associated lipocalin(NGAL) in patients infected by hepatitis C virus(HCV) before and during treatment with directly acting antivirals(DAAs).METHODS: NGAL was measured in a group of patients with chronic HCV infection ranked, at baseline, by age, gender, anti-hypertensive therapy, HCV viral load, liver fibrosis stage and, either at baseline or after 1 year, estimated glomerular filtration rate(e GFR). Then, NGAL and e GFR evolutions were monitored in a subgroup of patients who started antiviral therapy with DAAs. Differences of median NGAL levels were evaluated through Wilcoxon-Mann-Whitney test for nonparametric data. Differences in dichotomous variables were evaluated through χ~2 test. At baseline, a univariate regression analysis was conducted to verify if NGAL values correlated with other quantitative variables [age, fibrosis four(FIB-4), AST to platelet ratio index(APRI), and e GFR]. RESULTS: Overall, 48 patients were enrolled, 8 of them starting HCV treatment. At baseline, statistically significant differences were found in median NGAL values only between patients with e GFR 118.11 ng/d L were compared with those of NGAL ≤ 118.11 ng/d L, not statistically significant differences were present for age, gender, chronic kidney disease classification and liver fibrosis(P > 0.05). Linear correlation was found between NGAL and both age(P = 0.0475) and e GFR(P = 0.0282) values. Not statistically significant predictions of NGAL at baseline were demonstrated for e GFR evolution 1 year later. Interestingly, in the 8 patients treated with DAAs, median NGAL significantly increased at week 12 compared to baseline(P = 0.0239).CONCLUSION: Our results suggest that NGAL should be further evaluated as an adjunct marker of kidney function in these patients.

关键词： Directly acting antivirals Hepatitis C virus Inflammation Neutrophil gelatinase lipocalin Tubular impairment

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