Medicina
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Randomized Controlled Trial
Application of Closed Incision Negative Pressure Wound Therapy in Ventral Hernia Repair Surgery Using a Polypropylene Mesh: A Randomized Clinical Trial.
Background and Objectives: Surgical site infections (SSIs) are a significant complication following ventral hernia repair, potentially leading to prolonged hospital stays and increased morbidity. This study aimed to evaluate whether closed incision negative pressure wound therapy (ciNPWT) reduces the incidence of SSI after ventral hernia repair with polypropylene mesh compared to standard wound care. Materials and Methods: A randomized study was conducted with 100 patients undergoing ventral hernia repair using a polypropylene mesh. ⋯ Larger hernias in the non-ciNPWT group were more prone to SSIs, as expected. Conclusions: Although limited by a small sample size, the findings suggest that ciNPWT may be associated with a reduced rate of SSI following ventral hernia repair. Further studies with larger populations are needed to confirm these results.
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Life expectancy and overall function of amputated patients have improved significantly over the last few decades; for this reason, amputees are more exposed to primary or secondary degenerative disease of the hip, requiring total hip arthroplasty (THA) surgery. However, during training, not all the surgeons acquire adequate skills to manage these patients, and only a few studies and case reports describe technical pearls and outcomes of THA in patients with ipsilateral lower limb amputation, either above or below the knee. The objective of this narrative review is to present current evidence and surgical tips for performing THA in ipsilateral amputated patients, with a focus on the differences between patients with above- (AKA) and below-knee amputation (BKA). ⋯ In dealing with the post-traumatic and multi-comorbidity patients, rehabilitation goals should be considered prior to surgery and should drive the surgical strategy. We found that BKA patients typically have high functional demands, necessitating precise positioning of the components and an aggressive post-operative physiotherapy regimen to avoid unsatisfactory outcomes. AKA patients, on the other hand, often present with altered anatomy, and typically require more surgical instruments and expertise to achieve intraoperative dislocation of the hip joint.
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Comparative Study
Comparing Implant Macrodesigns and Their Impact on Stability: A Year-Long Clinical Study.
Background and Objectives: The aim of this study was to clinically evaluate the primary and secondary stability of dental implants with different macrodesigns using resonance frequency analysis and to determine whether implant design and length influence implant stability. Materials and methods: This study included 48 healthy patients receiving dental implants, and a pre-implant planning protocol was used, which involved detailed bone analysis, clinical examinations, and Cone beam computed tomography (CBCT) analysis. The implants were of various types and dimensions (Alpha-Bio Tec (Israel), DFI, SPI, and NEO), and the surgical procedures were performed using standard methods. ⋯ Similarly, based on the Friedman ANOVA test, the differences in the stability measurements for the 10 mm and 11.5 mm DFI implants and for the 10 mm and 11.5 mm NEO implants in the mandible on day 0 and after 3, 6, and 12 months were significant at p < 0.05 (p = 0.00000). Conclusions: Universal tapered implants of the NEO type stood out as the optimal choice, as they provided statistically significantly higher primary stability in both soft and hard bone types compared to other implants. The implant length did not significantly affect this stability.
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Background and Objectives: Orienteering is a sport characterized by high physical exertion and intense mental demands, which increase susceptibility to errors. Understanding the impact of such errors on psychophysiological responses, particularly on heart rate variability (HRV), is essential. This study aimed to investigate the relationship between psychophysiological indicators and checkpoint errors made by elite orienteers during official competition. ⋯ Additionally, a significant effect of sex on the normalized the root mean square of successive differences (r-MSSD) before and after the error was observed. Conclusions: The findings of this study underscore the significant impact of errors made by orienteers on cardiovascular responses, as evidenced by measurable alterations in HRV metrics. Cardiovascular activity, represented by the HRV, can provide useful information for coaches and sport psychologists to adopt effective training programs for athletes.
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Peripheral artery disease (PAD) is an atherosclerotic condition commonly complicating type 2 diabetes (T2D), leading to poor quality of life and increased risk of major adverse lower-limb (MALE) and cardiovascular (CV) events (MACE). Therapeutic management of PAD in T2D patients is much more arduous, often due to bilateral, multi-vessel, and distal vascular involvement, in addition to increased systemic polyvascular atherosclerotic burden. On the other hand, the pathophysiological link between PAD and T2D is very complex, involving mechanisms such as endothelial dysfunction and increased subclinical inflammation in addition to chronic hyperglycemia. ⋯ The main outcomes considered were MACE-including nonfatal acute myocardial infarction, nonfatal stroke, and CV death-and MALE-defined as lower-limb complications, amputations, or need for revascularization. To the best of our current knowledge, GLP-1 receptor agonists and SGLT2 inhibitors represent the best choice to reduce CV risk in T2D and PAD settings, but a personalized approach should be considered. GLP-1 receptor agonists should be preferred in subjects with prevalent atherosclerotic burden and a history of previous MALE, while SGLT2 inhibitors should be used in those with heart failure if overall CV benefits outweigh the risk of lower-limb complications.