Ospedale Eugenio Morelli

Transcervical femoral neck fractures (TFNFs) are among the most devastating fragility fractures in theelderly. TFNF are associated with excess 1-year mortality rates ranging from 15% to 30%. Treatments include conservative methods, internal fixation, and arthroplasty (partial or total hip arthroplasty). This study aims to analyze the changes in incidences of TFNF in the Italian population between 2001 and 2023 and the evolution of the choices of treatment. Using hospital discharge record (HDR) data from 2001 to 2023, records with ICD9-CM codes for femoral neck fractures (820.0 and 820.1) among diagnoses were selected and categorized into four treatment groups: totalarthroplasty,partial arthroplasty, fixation, and conservative. Time series were analyzed with stratification by sex and age. The extracted data included 1,120,724 records of TFNFs, with 871,161 cases treated surgically (total or partial arthroplasty or internal fixation) and 249,563 treated conservatively; the average patient age was 79.1years, with a higher proportion of women (72.8%). Partial hip arthroplasty was the preferred treatment overall. For younger patients, in the age classes < 45 and 45-54 years, fixation was the most chosen treatment. Over time, the use of the conservative treatment decreased from 27.5% in 2001 to 14.6% of cases in 2023. The use of partial and total hip arthroplasty increased from 40% and 13.3% in 2001 to 44.5% and 24.3% in 2023, respectively. Over the past two decades, Italy experienced declining age-adjusted incidence rates of TFNF despite persistent crude numbers (approximately 50,000 cases per year) owing to demographic aging. Partial hip arthroplasty (PHA) remained the preferred treatment, while total hip arthroplasty (THA) went from being the least used to the second-most performed treatment through the 23 observed years. Level of evidence level 1, population-based study.

<bold>Introduction:</bold> Treatment guidelines recommend adopting an integrated pharmacological andbehavioral intervention model. Cytisine, a partial agonist of nicotinic receptors, has shown promising efficacy in aiding smoking cessation based on trials conducted so far. The conventional cytisine treatment spans 25 days. However, a 40-day regimen with escalating doses and a prolonged treatment duration has been used in Italy, yet reports on its efficacy remain scarce. <bold>Methods:</bold> A retrospective, real-life observational study was conducted spanning from January 2016 to September 2022 in a University Hospital. Three hundred patients who received at least one dose of the study medication were included. The Wilcoxon-Mann-Whitney test was employed to compare continuous variables. Univariate and multivariate logistic regression models were utilized to assess self-reported seven-day point prevalence for abstinence at three, six, and 12 months. <bold>Results:</bold> The median age of the patients was 59 years, with 57% being women. The median smoking exposure was 33.8 pack-years. Self-reported smoking abstinence rates at three, six, and 12 months were 68.7%, 56.3%, and 47.3%, respectively. Eighty-four percent of patients completed the cytisine treatment, with 31.3% reporting adverse events, leading to treatment discontinuation in 8.3% of cases. <bold>Conclusion:</bold> Cytisine, administered within a novel therapeutic regimen in the real-life setting of a specialized anti-smoking center, significantly facilitates smoking abstinence. However, further randomized-controlled studies are suggested in ordet to evaluate the tolerability and efficacy of this new treatment approach.

The growing importance of psychological recovery for patients and their families following intensive care unit (ICU) experiences in recent years cannot be overemphasized. The ICU diary is used to aid patients in reducing the prevalence of post-traumatic stress disorder, anxiety, and depression. The usefulness of maintaining a diary during the grieving process has not yet been thoroughly investigated. To investigate the role of ICU diaries in the grief process experienced by family members of a person who died in the intensive care unit. Nine family members of seven deceased ICU patients with an ICU diary were contacted and interviewed by phone using a semi-structured interview. A qualitative data analysis was performed using thematic synthesis. Italian general intensive care unit. Interviewed family members felt that the diary helped them during the grieving process. The return of diaries was desired by family members for support and to remember one's loved one. The diary helped them process their losses in various ways, including signs of evidence of care, emotional involvement, consideration, and coping with grief. Four main themes emerged from the analysis: writing the diary, reading the diary, talking about the diary, and the diary during the grieving process. The overall perception of the ICU diary was positive. The diary mostly helped relatives to "give back something of what we lost". This study also affirms the positive link between ICU diaries and bereavement in Italian ICU. Further studies are required to confirm the usefulness of this tool in the grieving process. The ICU diary can help patients' family members understand what happened to their loved one and play an important role in the grieving process. The diary served as a valuable source of information that aided in providing bereavement support to the family by helping them to gain a rational and emotional understanding of the patient's death.

The prevention of surgical site infections is a priority within the objectives of the National Health System. The negative consequences that postoperative infections entail (morbidity, duration of hospitalization, mortality) represent serious events both for the individual patient and for the community, in consideration of the care resources necessary to treat them. Aim of this paper is to review the scientific evidence derived from accredited and recent guidelines regarding the available methods of infection prevention in hip arthroplasty, in order to establish those that present reliable evidence to support and that deserve to be shared, implemented and that ultimately represent an indicator of the quality of care that we are able to provide to our patients. A review was conducted on the MEDLINE, EMBASE, CINAHL and Cochrane Library databases from January 2010 to May 2021 aimed at finding guidelines of high methodological quality produced by super partes or independent international bodies. The paper analyzes risk factors for infection and provides a summary of best practices that can minimize infectious risk in hip surgery. Adherence to the recommendations expressed by multidisciplinary, evidence-based, up-to-date and authoritative guidelines is the most rigorous way to offer the patient a high standard of care.

3D-printing technologies can assist the surgical planning and prosthesis engineering for the management of extended chest wall resection. Different types of prosthesis have been utilized over time, but some concerns remain about their impact on the respiratory function. Here we present a new kind of 3D-printed titanium prosthesis designed to be either strong and flexible. The prosthesis was created on a 1:1 3D-printed anatomic replica of the chest, used to delineate surgical margins and to define the reconstructive requirements.

BackgroundThe increased incidence of drug-resistant TB is a major challenge for effective TB control. Limited therapeutic options and poor treatment outcomes of DR-TB may increase drug-resistance rates. The objective of the study is to retrospectively compare MDR-TB and pre-XDR-TB treatment regimens and outcomes in two large TB reference centres in Italy from January 2000 to January 2015.MethodsA retrospective, multicentre study was conducted at the Regional TB Reference Centre Villa Marelli Institute (Milan) and at the Reference Center for MDR-TB and HIV-TB, Eugenio Morelli Hospital (Sondalo). The supra-national Reference Laboratory in Milan performed DST. Inclusion criteria were: age ≥ 18 and culture-confirmed diagnosis of MDR- or pre-XDR TB. Chi-square or Fisher exact test was used to detect differences in the comparison between treatment outcomes, therapeutic regimens, and drug-resistances. Computations were performed with STATA 15.ResultsA total of 134 patients were selected. Median (IQR) age at admission was 33 (26–41) years and 90 patients (67.2%) were male. Pulmonary TB was diagnosed in 124 (92.5%) patients. MDR- and pre-XDR-TB cases were 91 (67.9%) and 43 (32.1%), respectively. The WHO shorter MDR-TB regimen could have been prescribed in 16/84 (19.1%) patients. Treatment success was not statistically different between MDR- and pre-XDR-TB (81.3% VS. 81.4%; P = 0.99). Mortality in MDR-TB and pre-XDR-TB groups was 4.4 and 9.3%, respectively (P = 0.2). Median duration of treatment was 18 months and a total of 110 different regimens were administered. Exposure to linezolid, meropenem, and amikacin was associated with a better outcome in both groups (P = 0.001, P < 0.001, and P = 0.004, respectively).ConclusionsTailored treatment regimens based on DST results can achieve successful outcomes in patients with pre-XDR-TB.

1Indianapolis Gastroenterology and Hepatology, Indianapolis, Indiana, USA Correspondence: Michael S Morelli, MD, CPE, FACG, Indianapolis Gastroenterology and Hepatology, 8051 South Emerson Avenue Suit 200, Indianapolis, Indiana 46237, USA. E-mail: [email protected] Guarantor of the article: Michael S. Morelli, MD, CPE, FACG. Specific author contribution: All work done by Michael S. Morelli. Financial support: None. Potential competing interests: None.