Risultati per: Demenze: trattamento farmacologico e non farmacologico e gestione dello stress del caregiver

Hepatocellular carcinoma (HCC) is a leading cause of cancer-related mortality worldwide. In most cases, HCC develops in an already perturbed liver microenvironment with pre-existing liver cirrhosis and tissue remodelling. Once a tumour nodule evolves, a complex ecosystem comprising tumour, immune, structural cells and extracellular matrix develops and forms the so-called tumour microenvironment (TME).1 This TME is shaped by distinct metabolic networks particularly driven by metabolic reprogramming of tumour cells, which supports their function, as one of the hallmarks of cancer.2 For example, in many cancer types, tumour cells mostly depend on glucose consumption for their energy supply, leading to lactate production and acidic conditions in the TME even with enough oxygen (Warburg effect).3 In addition, tumour cells also heavily rely on the amino acid glutamine (single letter code: Q) for their nucleotide biosynthesis and thus proliferation as well as for lipid biosynthesis and…

Praticata su una app, lo dimostra trial clinico

Praticata su una app, lo dimostra trial clinico

Introduction
Patients undergoing surgical procedures are often prone to developing acute stress disorder (ASD) postoperatively. Presently, oxytocin nasal spray has shown significant potential in the treatment of stress-related neuropsychiatric diseases. However, there are few reports on the use of oxytocin nasal spray in postoperative ASD, a condition that can potentially develop into a high-risk factor for post-traumatic stress disorder. This study aims to investigate the effect of pretreatment with oxytocin nasal spray on postoperative ASD in patients with accidental trauma and fracture to provide new clinical insights for the prevention of postoperative ASD.

Methods and analysis
This study is a single-centre, double-blind, randomised controlled clinical trial. The trial aims to recruit 328 patients with accidental traumatic fractures who underwent surgical treatment. Participants will be randomly categorised into two groups: a control group (0.9% normal saline nasal spray, 1 mL) and an oxytocin group (oxytocin nasal spray, 1 mL/40 IU) at a ratio of 1:1 using the random number table method. The primary outcome is the incidence of ASD on postoperative days 1–3. Secondary outcomes include patient resilience, anxiety, depression and pain scores on postoperative days 1–3. The exploratory results include the concentrations of stress response indicators such as malondialdehyde, cortisol and superoxide dismutase in the saliva before the first intervention and on days 1–3 after surgery.

Ethics and dissemination
The trial was approved by the clinical research ethics committee of the General Hospital of the Western Theater Command (identifier: 2024EC3-ky014). The findings of this trial will be disseminated in a peer-reviewed journal and in national or international paediatric research to guide future practice.

Trial registration number
ChiCTR2400082612.

Praticata su una app, lo dimostra trial clinico

Introduction
Reaching social milestones is an important goal of childhood. Children with acquired brain injury (ABI) and cerebral palsy (CP) frequently experience challenges with social functioning and participation. The Programme for the Education and Enrichment of Relational Skills (PEERS) is a group-based social skills programme for adolescents. This study will compare an adapted PEERS programme with usual care in a pilot randomised waitlist-controlled trial for primary and early high school-aged children with brain injuries.

Methods and analysis
This single-centre study will be conducted at the Queensland Cerebral Palsy and Rehabilitation Research Centre at the Centre for Children’s Health Research in Brisbane, Australia. Thirty-two school-aged children (grades 3+; 8–13 years) with an ABI or CP and their caregiver(s) will be recruited and randomly assigned to either 12 week PEERS Plus or waitlist usual care. The waitlist group will then participate in PEERS Plus after the 3 month retention time point. The primary outcome will measure individualised social participation goals on the Canadian Occupational Performance Measure immediately postintervention at the primary endpoint (12 weeks). Secondary outcomes include the Social Skills Improvement System Social-Emotional Learning Edition Rating Forms and Quality of Play Questionnaire immediately postintervention, 12 weeks postintervention (26 weeks postbaseline), 36 weeks postintervention (52 weeks postbaseline) for retention. Following completion of the PEERS Plus programme, semistructured focus group interviews will be conducted separately with caregivers and children to explore the lived experience of PEERS. Interpretive description will be used to identify patterns and themes related to participants’ experiences. Analyses will follow standard principles for randomised controlled trials using two-group comparisons on all participants on an intention-to-treat basis. Comparisons between groups for primary and secondary outcomes will be conducted using regression models. This study will estimate the unit costs of providing PEERS Plus at different levels of public health facilities in Australia.

Ethics and dissemination
This study has been approved by the Medical Research Ethics Committee of The University of Queensland (2022/HE002031) and the Children’s Health Queensland Hospital and Health Service Human Research Ethics Committee (HREC/22/QCHQ/87450). Recruitment and participant informed consent process will be completed in accordance with institutional ethic procedures. Dissemination plans include peer-review publication of study results, presentations, and instructional workshops at national and international conferences.

Trial registration number
ACTRN12623000515695.

This case report describes a woman in her early 60s who went into cardiac arrest immediately after administration of an echocardiogram contrast agent.

This cross-sectional study evaluates associations between neuroinflammation and stress-related suicidal ideation, negative affect, and history of suicidal behavior.

La disfunzionalità dell’adipe si riflette sui tessuti arteriosi, cardiaci e renali e queste interconnessioni rappresentano una sfida importante per il Ssn, ma anche un’opportunità per migliorare la presa in cura dei pazienti con patologie complesse

Objectives
Although croup is a common respiratory illness, there is little published regarding symptom course. We aimed to assess symptom progression and caregiver burden, and whether age, sex or season and initial severity of disease are associated with symptom duration.

Design, setting and participants
We conducted a secondary analysis of two Canadian prospective cohorts of children 0–16 years old diagnosed with croup; one recruited from a paediatric emergency department (ED) (307 children) between November 1999 and March 2000, and the other from 26 general EDs (1214 children) between September 2002 and April 2006. Baseline data included age, sex, season, corticosteroid treatment and clinical severity score based on the presence or absence of a barky cough, stridor at rest or with agitation and chest wall indrawing (mild, moderate or severe). For both cohorts, the child’s primary caregiver was telephoned daily to collect symptom progression and psychosocial data (caregiver stress, lost sleep and work) until the child was symptom-free for over 24 hours.

Results
The paediatric and general ED cohorts are reported separately; croup symptoms peaked at initial ED presentation for 96% and 77%, respectively. The longest-lived symptom was a barky cough, resolving by 34 and 47 hours for 50%, and 78 and 119 hours for 90% of children, respectively. Neither sex nor severity at presentation were significantly associated with symptom duration in either cohort. Season of illness was associated in both; age was associated in the general but not the paediatric ED cohort. The primary caregiver lost a mean (SD) of 4.1 (4.9) and 2.8 (4.7) hours of sleep during the illness.

Conclusions
Most children with croup presented for care at the peak of symptom severity. Symptoms resolved for half of the children in 1.5–2 days and for 90% in 3–5 days after presentation. Caregivers experienced a significant loss of sleep.

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