Lundbeck (Italy)

The frequent co-occurrence of major depressive disorder (MDD) and substance use disorders (SUDs) entails significant clinical challenges. Compared to patients with MDD alone, patients with MDD and SUD often show increased anhedonia, emotional blunting, and impaired cognitive function. These symptoms lead to an inability to control cravings, more substance use, increased relapse rates, and poor adherence to the treatment. This fosters a detrimental cycle leading to more severe depressive symptoms, functional impairment, and chronicity, culminating in heightened morbidity, mortality, and healthcare resource utilization. Data on antidepressant treatment of MDD-SUD patients are inconclusive and often conflicting because of a number of confounding factors in clinical trials or difficulty in dissecting the specific contributions of pharmacological versus psychological interventions in real-world studies. The patient's unique clinical features and specific SUD and MDD subtypes must be considered when choosing treatments. Ideally, drug treatment for MDD-SUD should act on both conditions and address core symptoms such as anhedonia, craving, and cognitive dysfunction while ensuring minimal emotional blunting, absence of drug interactions, and no addictive potential. This approach aims to address unmet needs and optimize the outcomes in a clinical population often underrepresented in treatment paradigms.

This study investigates the implications of using a system for the maintenance of normothermia in the treatment of patients undergoing surgery, determining whether the FAW (Forced-Air Warming) systems are more effective and efficient than the non-application of appropriate protocols (No Technology). We conducted Health Technology Assessment (HTA) analysis, using both real-world data and the data derived from literature, assuming the point of view of a medium-large hospital. The literature demonstrated that Inadvertent Perioperative Hypothermia (IPH) determines adverse events, such as surgical site infection (FAW: 3% vs. No Technology: 12%), cardiac events (FAW: 3.5% vs. No Technology: 7.6%) or the need for blood transfusions (FAW: 6.2% vs. No Technology: 7.4%). The correct use of FAW allows a medium saving of 16% per patient to be achieved, compared to the non-use of devices. The Cost Effectiveness Value (CEV) is lower in the hypothesis of FAW: it enables a higher efficacy level with a contextual optimization of patients' path costs. The social cost is reduced by around 30% and the overall hospital days are reduced by between 15% and 26%. The qualitative analyses confirmed the results. In conclusion, the evidence-based information underlines the advantages of the proper use of FAW systems in the prevention of accidental peri-operative hypothermia for patients undergoing surgery.

To evaluate the indications for, complications of, and surgical outcomes of dogs and cats that were treated with double limb amputations. 14 dogs and 4 cats that underwent double limb amputations. Data collected retrospectively included patient-specific (species, age, weight, breed, sex, existing comorbidities) and amputation-specific (indication for amputation, full or partial limb amputation, associated complications, need for revision surgeries) variables. Owner satisfaction scores were also collected. The most common indication for double amputations was trauma (12/18) patients. Eleven patients had both amputations performed simultaneously. Nine patients had double partial limb amputations versus full limb amputations. Twelve patients underwent bilateral pelvic limb amputations, 4 underwent bilateral thoracic limb amputations, and 2 had 1 pelvic and 1 contralateral thoracic limb amputated. Five patients had reported complications over the course of the follow-up period, and complications for 3 patients were considered major. Revision surgery was reported for 2 animals. Owner satisfaction scores were reported as very satisfied/excellent (14/18), mildly satisfied (3/18), and strongly dissatisfied (1/18). Median time to follow-up was 450 days (range, 85 to 4,380 days). Double limb amputation may be a viable alternative to advanced limb-sparing procedures or humane euthanasia based on the owner satisfaction data and the relatively low rate of major complications in this study. Future studies should clarify patient selection criteria and differences in function between surgical types.

Abstract ObjectivesTreatment persistence refers to the act of continuing a treatment as prescribed and reflects the patient's or doctor's judgment about efficacy, tolerability, and acceptability. In patients with schizophrenia, antipsychotic persistence is often poor, because of issues such as lack or loss of efficacy, side effects, and poor adherence, which is often related to the degree to which patients find the medication and overall intervention to be helpful, tolerable, fair, reasonable, appropriate, and consistent with expectations of treatment. Despite the poor antipsychotic persistence that has been reported to date in patients with schizophrenia, we previously observed a relatively high (86%) 6-month persistence with aripiprazole once-monthly (AOM) in a group of patients with schizophrenia, treated in the real world Italian clinical practice. The present study explores the longer-term persistence with AOM, over a mean follow-up period of 48 months MethodsThis was an observational, multicenter, retrospective, non-interventional follow-up study, aimed at evaluating the longer-term persistence with AOM in a group of patients with schizophrenia who had already shown persistence over a period of at least 6 months. The study included 161 individuals who had participated in our previous study, where 86% of participating individuals had shown persistence with AOM for at least 6 months. Non-persistence was defined as discontinuing the medication for any reason. Baseline demographic and clinical characteristics of patients who continued AOM were then compared to those of patients who discontinued the medication ResultsStudy subjects were predominantly male (64.4%) and their mean age was 39.7 (SD: 12.24). Treatment persistence with AOM was 69.6% and 112 out of 161 patients were still receiving AOM treatment at the last follow-up visit. The mean duration of AOM treatment until the last recorded observation was 55.87 months (median 56.17, SD6.23) for the 112 persistent patients and 32.23 (median 28.68.SD 15.09) months for the 49 non-persistent individuals. The mean observation period for all patients (persistent and non-persistent) was 48.78 months (median 52.54, SD 14.64). For non-persistent subjects, the observation period ended with the discontinuation of AOM. Subjects treated with AOM at 400 mg presented a 69.6% lower risk of all-cause treatment discontinuation when compared with patients treated with 300 mg (HR: 0.314; 95% confidence interval [CI]: 0.162-0.608; P=0.001). The main reasons for discontinuation were lack of efficacy (30.6%), patient/caregiver choice (18.4%), physician’s choice (16.3%), non-adherence (12.2%) and inconvenience (6.1%). Only 3 patients (6.1%) discontinued AOM for tolerability issues. ConclusionsIn subjects with schizophrenia, who had already shown a 6-month persistence with AOM, a high number of patients (69.6%) continued to be persistent over a four-year follow-up period. This may reflect a favourable profile of efficacy, tolerability, and acceptability. Larger and prospective studies are warranted to confirm our observations.

Historia Breviarium Romanum ukazuje zawsze interesujące kwestie zachodzące pomiędzy jedną a drugą reformą. Na przestrzeni wieków księga liturgiczna nabrała konotacji i wzbogacenia, które dobrze jest znać. Oficjalna modlitwa Kościoła, nazywana dziś „Liturgią Godzin - Liturgia Horarum”, w swoim czasie nosiła nazwę Breviarium. Dzieło zawierało wiele regulacji dotyczących min. rozróżnienia pomiędzy modlitwą celebrowaną przez kanoników w katedrach, a modlitwą mnichów w opactwach. W czasie Soboru Trydenckiego pojawiła się pilna potrzeba zreformowania tej modlitwy. W oparciu o warunki ustanowione przez same zgromadzenie soboru, w 1568 roku opublikowano editio princeps. Porównanie z ostatnią editio typica z 1961 r. w kontekście reformy liturgicznej umożliwia uchwycenie zasadniczej jednolitości z tekstem trydenckim.

A 5-year-old, male castrated, domestic short hair cat was referred to the authors' clinic because of wound dehiscence and exposure of tendon stumps after tenorrhaphy of the Achilles tendon. Surgical revision was done using an aponeurotic flap taken from the proximal stump of the Achilles tendon and sutured over the two tendon portions. This technique has been described in humans, but, to the authors' knowledge, this has not been reported in cats. Modified type II external fixation was used to maintain the tarsocrural joint in extension until tendon healing was confirmed ultrasonographically 35 days postoperatively. Clinical and ultrasonographic evaluation 60 and 120 days postoperatively showed normal limb function and good tendon healing. Long-term follow-up examination 8 years postoperatively revealed that the cat was in good health with normal gait and activity level.

IntroductionBipolar disorder is a chronic disease characterized by periods of mania or hypomania, depression, or a combination of both (mixed state). Because bipolar disorder is one of the leading causes of disability, it represents an important economic burden on society. Asenapine (ASE) is a new second-generation antipsychotic developed and approved for the treatment of manic or mixed episodes associated with bipolar disorder. The objective of the present study was to assess the cost-effectiveness of ASE compared to olanzapine (OLA) in the treatment of patients experiencing mixed episodes associated with bipolar I disorder in the context of the Italian National Health Service (NHS).MethodsA pharmacoeconomic model was developed to simulate the management of Italian bipolar I patients with mixed episodes over a 5-year time horizon by combining clinical parameters with resource utilization. An expert panel of Italian psychiatrists and health economists was responsible for adapting a UK model to the Italian context. The primary outcome measure of the economic evaluation was the incremental cost effectiveness ratio, where effectiveness is measured in terms of quality adjusted life-years gained. Scenario analyses, sensitivity analyses, and a probabilistic sensitivity analysis were performed to test the robustness of the model.ResultsThis pharmacoeconomic model showed that ASE resulted to be dominant over OLA; in fact, ASE was associated with lower direct costs (derived largely by the savings from hospitalizations avoided) and also generated a better quality of life. Results were robust to changes in key parameters; both scenario analyses and sensitivity analyses demonstrated model reliability.ConclusionsResults from this study suggest that the management of bipolar I patients with mixed episodes using ASE as alternative to OLA can lead to cost saving for the Italian NHS and improve patients quality of life.Electronic supplementary materialThe online version of this article (doi:10.1007/s12325-014-0139-3) contains supplementary material, which is available to authorized users.

Fullerenes C60 and C70 were brominated with liquid bromine either at room temperature with prolonged stirring or by sonication (ultrasound-assisted bromination) of the fullerene/bromine mixtures. The resulting bromofullerenes were studied by FT-IR. The amount of bromine content was determined by thermogravimetric analysis (TGA), and the thermal transitions and the decomposition temperatures of all fullerenes were measured by differential thermogravimetry (DTG) and differential thermal analysis (DTA). Depending on the conditions adopted the ultrasound assisted bromination of C60 yields C60Br12 or C60Br14. However, mechanical stirring of C60/Br2 mixtures also yields similar products. The highly brominated fullerene derivative C60Br24 cannot be synthesized by sonication but only by stirring C60/Br2 mixture for a couple of days. The sonication stops the bromination at C60Br12 or C60Br14 level. The brominated derivatives of C70 synthesized either with the aid of ultrasound or without sonication consists always C70Br12 or C70Br14. Through the thermal analysis it was found that the decomposition of bromofullerenes is always an exothermic process irrespective for the bromine content and the decomposition temperature of the bromofullerenes either C60 or C70 increases with the amount of their bromine content.

The Scholl reaction was adopted to synthesize the very large polycyclic aromatic hydrocarbons (VLPAHs) hexabenzocoronene (HBC), quaterrylene and dicoronylene as well as their nonalternant isomers. These molecules can be considered subsections of a graphene sheet since the radial diameter of HBC is 13.5 Å and the length of both quaterrylene and dicoronylene is about 17.9 Å. Improved synthetic procedures of synthesis are presented, and the resulting VLPAHs were isolated and recognized from their characteristic electronic absorption spectra. The precursor PAHs used in the Scholl's synthesis where studied by differential scanning calorimetry (DSC), and the thermal behavior of the resulting VLPAHs was studied by thermogravimetric analysis and differential thermal analysis (TGA-DTA). The VLPAHs hexabenzocoronene (HBC), quaterrylene and dicoronylene show a trend to carbonization (growth of the laminar molecules into stacked and large graphene sheets) when heated slowly to high temperature in a nitrogen atmosphere.