Search Results for: Passo 12. Ripulire in modo mirato le cartelle cliniche degli assisiti

L’osteoimmunologia è una recente nuova disciplina che studia le interazioni molecolari, cellulari e cliniche bidirezionali tra l’osso e il sistema immunitario, recentemente rivelatesi determinanti nella patogenesi di molte malattie reumatologiche. L’obiettivo della IV edizione del Convegno Update in Osteoimmunology è stato quello di condividere le più recenti conoscenze nel campo dell’osteoimmunologia e le abbiamo raccolte in questo Videoreportage.

Stroke, Ahead of Print. BACKGROUND:Epigenetic modifications 5-methylcytosine and 5-hydroxymethylcytosine in DNA regulate neuronal survival under ischemic stress. We previously showed that TET3 (ten-eleven translocation 3)–mediated 5-methylcytosine to 5-hydroxymethylcytosine conversion induces neuroprotective gene transcription after stroke. As TET3 neuronal isoform lacks the DNA-binding domain, how TET3 drives 5-hydroxymethylcytosine–mediated transcriptional induction in the ischemic brain remains unclear. Long noncoding RNAs (lncRNAs) act as structural scaffolds to recruit chromatin-modifying proteins and other RNAs to specific genomic loci. However, whether TET3 requires an lncRNA to drive DNA hydroxymethylation in the ischemic brain is unknown.METHODS:Adult male and female mice were subjected to transient middle cerebral artery occlusion. TET3-bound lncRNAs were immunoprecipitated from peri-infarct cortex, and TILR (TET3-interacting lncRNA; AK020504) identified was inhibited with small interfering RNA injected at 5 minutes of reperfusion. Ascorbate was administered at 30 minutes of reperfusion to induce TET3 activity. Poststroke DNA hydroxymethylation was assessed with hydroxymethylation DNA immunoprecipitation sequencing, and sensorimotor deficits, and infarct volume were evaluated between days 1 and 7 of reperfusion.RESULTS:TILR binds to TET3 with high affinity and was significantly upregulated in the peri-infarct cortex at 12 hours of reperfusion. Knockdown of TILR increased the infarct volume and reduced the motor function recovery after transient middle cerebral artery occlusion, in a TET3-dependent manner. On contrary, TET3 activation by ascorbate decreased brain damage and improved motor function recovery after ischemia. However, ascorbate-induced postischemic protection was abrogated by TILR knockdown. Genome-wide profiling showed that ascorbate increases the number of differentially hydroxymethylated regions in the poststroke genome, a neuroprotective effect that is reversed by TILR knockdown. Moreover, TILR inhibition significantly reduced the DNA hydroxymethylation in the intergenic regions associated with enhancers, super enhancers, and the promoters of other lncRNAs, microRNAs, and PIWI-interacting RNAs.CONCLUSIONS:These findings highlight the essential role of TILR in TET3-mediated 5-hydroxymethylcytosine-dependent epigenetic reprogramming in the ischemic brain.

Uno studio prospettico pubblicato su Pain and Therapy condotto presso il centro regionale per le cure palliative dell’Ospedale La Maddalena di Palermo ha analizzato, a distanza di 12 anni da una precedente indagine, le strategie di prescrizione degli oppioidi e l’efficacia analgesica in pazienti ricoverati in un’Unità di Cure Palliative Acute (APCU). I risultati mostrano che un approccio intensivo e personalizzato consente un controllo efficace del dolore senza necessità di aumentare l’equivalente in morfina orale (OME), e sottolineano l’importanza di una gestione esperta nella terapia del dolore oncologico.

Nei pazienti con psoriasi a placche da moderata a grave, il trattamento con bimekizumab ha dimostrato alti tassi di risposta clinica e di miglioramento della qualità di vita correlata alla salute nell’arco di 5 anni, come evidenziato dai dati dello studio BE BRIGHT presentati al congresso della Society of Dermatology Physician Associates (SDPA) tenutosi a Washington, DC, dal 25 al 29 giugno.

Un nuovo inibitore selettivo dell’aldosterone, baxdrostat, ha mostrato in uno studio di Fase III un’efficace riduzione della pressione arteriosa sistolica a 12 settimane, aprendo nuovi scenari terapeutici per pazienti con ipertensione non controllata o resistente.

Innanzitutto, va sottolineato che le norme approvate dal Senato a favore dei malati oncologici segnano un ulteriore passo in avanti di civiltà per i diritti dei pazienti. Di…

Introduction
Distal radius fractures account for one-fifth of all fractures in the active elderly population and may cause chronic pain, loss of hand function and reduced work productivity, imposing a significant socioeconomic burden. Most are initially treated with closed reduction and casting, but 30% subsequently require surgery due to insufficient realignment. The current approaches for analgesia for closed reduction are suboptimal. A brachial plexus nerve block provides complete pain relief and muscle relaxation distal to the elbow, potentially creating better conditions for realignment of the fractured bone ends. This may ultimately translate into reduced need for surgery and result in better functional outcomes and fewer complications compared to a haematoma block, which is the current standard care in Denmark.

Methods and analysis
The BLOCK Trial is an investigator-initiated, parallel-group, allocation-concealed, outcome assessor and analyst-blinded, superiority, randomised, controlled, clinical multicentre trial performed at 11 Danish emergency departments. Eligible adult patients with a distal radius fracture who need closed reduction will be included and allocated 1:1 to either an ultrasound-guided brachial plexus nerve block or a haematoma block. The primary outcome is the proportion of patients with distal radius fracture surgery 90 days after closed reduction. We will include 1716 participants to detect or discard a relative risk reduction of surgery of 20%. Secondary outcomes include treatment-related complications, patient-reported wrist function, pain during closed reduction and proportion of patients with unacceptable radiographic fracture position immediately after closed reduction.

Ethics and disseminationf
The trial is approved by the Danish Medicines Agency and the Danish Research Ethics Committees (EU CT number: 2024-512191-35-00). All results will be summarised on www.theblocktrial.com, clinicaltrials.gov and euclinicaltrials.eu after publication. Primary and secondary outcome results from 0 to 90 days will be presented in the main article and submitted to a peer-reviewed journal. Results from outcomes on the 12-month follow-up will be presented separately.

Trial registration number
NCT06678438.

Al Congresso ICD 2025 sono stati presentati due studi che confermano l’efficacia duratura di bimekizumab nel trattamento della psoriasi a placche da moderata a severa, con risposte cliniche mantenute fino a quattro anni. I dati confermano inoltre tempi di risposta rapidi, con miglioramenti significativi già entro le prime settimane di trattamento.

Nei bambini affetti da orticaria cronica spontanea, compresi quelli di età inferiore ai 12 anni, omalizumab ha prodotto un elevato tasso di risposta con un profilo di sicurezza accettabile, secondo quanto rilevato da una metanalisi pubblicata sulla rivista Pediatric Allergy and Immunology.

Objectives
Smoking is a well-established risk factor that exacerbates multiple sclerosis (MS) progression and increases disease activity. Smoking cessation promotion practices of MS clinicians are not meeting the needs of people with MS (pwMS). This study aimed to explore the current practices and barriers faced by MS clinicians in Germany.

Design
A qualitative study design, using semi-structured interviews and thematic analysis.

Setting
Interviews with participants were held online, via telephone or face-to-face at our institute in Hamburg, Germany.

Participants
We recruited eight neurologists and four MS nurses from hospitals, neurology practices and rehabilitation facilities in Germany via purposive and snowball sampling.

Results
We identified 27 codes across four themes: (1) knowledge: the 12 participants demonstrated a satisfactory general knowledge of the negative impacts of smoking on MS (2) current practice: significant variability was reported in the current practices, with some clinicians providing detailed advice while others merely assessing smoking status without further advice or assistance. (3) Barriers: key barriers identified included limited consultation time, perceived lack of patient motivation and insufficient availability of resources, like information material, for effective smoking cessation support. (4) Needs and wishes: participants wished for specific smoking cessation courses to which they could refer patients, as well as information material to use during patient counselling.

Conclusion
The study reveals considerable gaps in the consistency and comprehensiveness of smoking cessation support provided by MS clinicians in Germany. Addressing these gaps through targeted interventions, and improving the availability of information materials could enhance smoking cessation promotion for pwMS.

Background
Despite global improvements in antiretroviral therapy (ART) access for children and adolescents living with HIV (CALHIV), a significant proportion continue to experience unsuppressed viral load (USVL). Limited studies focus on the factors contributing to USVL among CALHIV in the Democratic Republic of the Congo (DRC), especially in the context of evolving treatment landscapes. Understanding these determinants is crucial for enhancing ART outcomes.

Objective
This study aimed to determine the prevalence of USVL and identify factors associated with USVL among CALHIV receiving ART in Lubumbashi, DRC.

Design
A multicentre retrospective cross-sectional study was conducted. Data were gathered using an observational checklist based on assessing patient file data and entered into Microsoft Excel. Analysis was performed using STATA V.16. Variables with a p value of 0.20 from the bivariable analysis were included in a multivariable logistic regression model, and significant variables (p

Introduction
Most older adults living in residential aged care facilities (RACFs) have at least one marker of potentially suboptimal prescribing. Pharmacists play a crucial role in medication management, with their effectiveness enhanced by using computerised decision support tools. The Pharmacists Review to Optimise Medicines in Residential Aged Care (PROMPT-RC) study aims to optimise medicine use by providing pharmacists in RACFs with an electronic medicine management app with integrated decision support (AusTAPER App/Pathway) to use as part of medication reviews they undertake.

Methods and analysis
The PROMPT-RC study is a parallel cluster randomised controlled trial design involving Australian RACFs. It will assess if pharmacists’ use of the AusTAPER App/Pathway for medication reviews improves medication regimens for RACF residents compared with usual care. Pharmacists in RACFs randomised to the intervention arm will be trained to use the AusTAPER App/Pathway, which flags potentially inappropriate medicines (PIMs) across a person’s entire medicine regimen. Pharmacists in RACFs randomised to the control arm will not have access to the AusTAPER App/Pathway—they will continue to provide usual care. The primary outcome is the difference in the number of regular medicines between treatment arms at 12 months. Secondary outcomes will measure the number of regular and pro re nata medicines, PIMs, medicine administration times, medicine regimen complexity, use of antipsychotics, antidepressants, and benzodiazepines, quality of life, mortality, instances of physical restraint, and the number of falls, hospitalisations and general practitioner/health professional visits. The cost-effectiveness of the AusTAPER App/Pathway compared with usual care will be calculated. Data collection will occur at baseline, 3, 6, 9 and 12 months postrandomisation and 3 and 6 months prebaseline. We aim to recruit 668 participants to adjust for an estimated 10% loss to follow-up, giving 334 participants in each arm. Data analysis will follow an intention-to-treat approach using a linear mixed model.

Ethics and dissemination
Ethical approval was obtained from The University of Western Australia Human Research Ethics Committee (Reference: 2024/ET000525; approved 14 August 2024). Reciprocal approval was also obtained in other states. This study is registered on the Australian New Zealand Clinical Trials Registry (https://anzctr.org.au). Trial findings will be disseminated through national and international peer-reviewed publications and conferences.

Trial registration number
ACTRN12624001409561.

Stroke, Ahead of Print. BACKGROUND:Poststroke depression affects up to one-third of stroke survivors, significantly impacting recovery and quality of life. However, its pathophysiology remains unclear.METHODS:We analyzed 2 independent, prospective ischemic stroke cohorts (PROSCIS-B [Prospective Cohort of Incident Stroke Berlin] and BAPTISe [Biomarkers and Perfusion-Training-Induced Changes After Stroke]; n=377) enrolled at the Charité Hospital, Germany, to identify brain regions and networks associated with depressive symptoms poststroke. Lesion-symptom mapping assessed associations between lesion location and depressive symptoms measured by the Center for Epidemiological Studies Depression Scale at 6 (BAPTISe) or 12 (PROSCIS-B) months poststroke. Lesion-network mapping evaluated lesion connectivity with brain networks. A mixed-effects model, including cohort as a random effect, assessed the relationship between network similarity (Pearson correlation) and Center for Epidemiological Studies Depression Scale scores. Dice coefficients (DC) quantified spatial overlap with canonical resting-state networks.RESULTS:Lesion-symptom mapping showed no significant associations between lesion location and depressive symptoms. In contrast, lesion-network mapping revealed that lesion connectivity to brain regions including the frontal pole, middle and inferior frontal gyri, inferior temporal gyrus, supramarginal gyrus, angular gyrus, frontal orbital cortex, and thalamus weakly correlated with Center for Epidemiological Studies Depression Scale scores (β, 11.4 [95%CI, 1.8–21.1];P=0.02). These regions overlapped with the frontoparietal (DC=0.28), salience (DC=0.27), and default mode (DC=0.20) networks, as well as a published depression circuit (DC=0.43). However, these findings did not replicate across data sets.CONCLUSIONS:Lesion location alone was not associated with poststroke depression. However, connectivity-based analyses implicated disruption of large-scale brain networks in the development of depressive symptoms. The failure to validate this association across data sets underscores the need for further studies with more comparable patient populations—particularly in terms of stroke severity and harmonized assessment time-points—to confirm these findings and their clinical relevance.REGISTRATION:URL:https://www.clinicaltrials.gov; Unique identifier: NCT01363856. URL:https://www.clinicaltrials.gov; Unique identifier: NCT01954797.

Objectives
The aim of this scoping review was to map the nature and extent of the existing literature on mental health interventions for humanitarian volunteers in disaster contexts. The study also explored how the interventions were evaluated.

Design
The methodology of this scoping review followed the extended guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Reviews.

Data sources
Five academic bibliographic databases (PubMed, Embase, Web of Science, EBSCOhost and Google Scholar), grey literature websites (Google Scholar, ProQuest, Policy Commons, etc.) and relevant organisational archives were systematically searched for eligible documents.

Eligibility criteria
Both peer-reviewed and grey literature studies on mental health interventions for humanitarian volunteers in the context of any type of disaster were eligible for inclusion. Research papers that evaluated any such intervention were also included. Documents that targeted professional humanitarian workers or explored physical health conditions or diseases in disaster contexts, letters to the editor, comments, correspondence and research protocols were excluded. There were no restrictions in terms of the date and language of the documents.

Data extraction and synthesis
A systematic search of the targeted databases was conducted from 12 May 2025 to 20 May 2025. Deduplication, screening and full-text evaluation for the selection of documents were done using the online version of Rayyan. Data were collected and recorded into a structured Microsoft Excel sheet. Two researchers individually conducted the selection of the articles and the extraction of data. A third researcher helped to resolve any discrepancies if required.

Results
A total of 2627 documents were retrieved by searching the targeted databases and websites. After matching them with the eligibility criteria, 20 documents were included in the final list. 14 of them were research papers; the rest was organisational literature. All the papers were from 2006 and later, except one that was from 1998. No documents were found from the Middle East, North Africa and Sub-Saharan regions. 10 broad categories of interventions were identified, which were either implemented in the field or suggested in the form of guidelines. Most of the interventions were postexposure and preventive in nature. Psychological first aid was the most widely used intervention in this context, being used by the national societies of the International Federation of Red Cross and Red Crescent Societies. Nine of the documents were research papers evaluating the effectiveness of the interventions using different scales and customised questionnaires. Four of them did not observe any notable effect on the mental health of the participants.

Conclusions
Over the past two decades, the evidence on mental health interventions for humanitarian volunteers has grown. The reviewed literature documented various interventions and guidelines that need further study and testing to both prove and improve their effectiveness. Organisational policies could incorporate and further evaluate these to ensure the psychosocial well-being of volunteers. A review of research papers on intervention effectiveness found heterogeneity in settings, designs, interventions and methods, precluding a systematic review. More research is needed on individual interventions, volunteer perceptions and comparing interventions to identify the most effective ones. Additionally, comparing pre-exposure and postexposure interventions with multimodal systems that support volunteers throughout deployment is recommended.

Objectives
To study the prevalence of and interplay between common neuropsychiatric sequelae 3–4 years after onset of first-ever stroke—specifically post-stroke fatigue (PSF), post-stroke depression (PSD) and post-stroke cognitive impairment (PSCI).

Design
Population-based cohort study.

Setting
Catchment area of a Swedish University Hospital.

Participants
We recruited individuals with first-ever ischaemic stroke or intracerebral haemorrhage in the initial cohort; 151 of these died prior to follow-up and 47 (12%) were lost to detailed follow-up. We followed up 202 individuals with median age: 72 (IQR 65–79), 40% female, either in clinic, via home visits or via telephone.

Primary and secondary outcome measures
Primary outcome measures included PSF (Fatigue Assessment Scale), PSD (Patient Health Questionnaire-9) and PSCI (Montreal Cognitive Assessment). Secondary outcome measures included dependency in activities of daily living (ADL; Barthel Index), health-related quality of life (HRQoL; Short-Form Questionnaire-36, EuroQoL-5D and Stroke Impact Scale) and stroke severity (National Institutes of Health Stroke Scale (NIHSS)).

Results
Significant PSF was present in 46/195 (24%), PSD in 21/191 (11%), and PSCI in 93/173 (54%) respondents. Among 169 participants with available data for all three domains, 100 (59%) had impairment in at least one domain. Participants with PSCI were older than those without (median: 75 vs 67 years; p

Introduction
Liver cirrhosis accounts for over 10 000 deaths in the UK each year with a total loss of 60 000 quality-adjusted life-years. There is a substantial cost to the NHS of £4.5 billion, with new liver-related decompensation events accounting for the majority of this. Following an acute cirrhosis decompensating event, there is a significant risk of hospital readmission with 90-day readmission rates as high as 53%. Current care in the UK is reactive and patients are often only readmitted when they have presented acutely as an emergency with significant decompensation.

Methods and analysis
CirrhoCare is a prospective, multicentre, randomised controlled trial comparing the CirrhoCare management system with standard-of-care for high-risk cirrhosis patients who have been discharged following an admission with acute decompensation. The CirrhoCare management system comprises a novel digital platform for use in a patient’s home, designed to proactively detect the first signs of new decompensation in patients with established cirrhosis, discharged to the community. This enables a clinician to instigate early community-based care or, if needed, to triage the patient for hospital interventions.
214 patients will be recruited to the CirrhoCare trial from at least 12 UK centres. Patients will be randomised on a 1:1 ratio allocation to the CirrhoCare Management System or standard of care. Participants who are randomised to CirrhoCare will receive a CirrhoCare health kit comprising a smart watch, smart phone with enabled SIM (Subscriber Identity Module) network card, blood pressure monitor, weighing scales and thermometer. Participants will take measurements every morning Monday to Friday and will be followed up for 90 days postdischarge.
The primary objective of this study is to assess the clinical effectiveness of the CirrhoCare digital management system. We hypothesise that its early community-based intervention will reduce the number of unplanned hospital interventions and admissions and prevent liver-related complications when compared with standard-of-care management.

Ethics and dissemination
CirrhoCare is a National Institute for Health and Care Research-funded study (NCT06223893). The study has UK Research Ethics Committee and Health Research Authority (HRA) approvals, with approval granted by the HRA and Health and Care Research Wales committee. The results of this study will be published in peer review journals, disseminated at international conferences as well as established Patient and Public Involvement and Engagement networks.

Trial registration number
ISRCTN11380842.