Verso la validazione di simulazioni real-time dell'interazione vaso-catetere in procedure di cardiologia interventistica: caratterizzazione delle proprietà meccaniche di materiali per fantocci in vitro e analisi del loro effetto sui risultati numerici

LAUREA MAGISTRALEL'adozione delle tecniche trans-catetere per il trattamento di malattie cardiovascolari strutturali è sempre più in uso, particolarmente nei pazienti fragili e ad alto rischio. Tuttavia, il successo di tali tecniche dipende dalle competenze dell'operatore, che comprendono la difficile interpretazione di immagini bidimensionali durante l'intervento. Inoltre vi sono severi rischi per paziente e operatore associati alle radiazioni ionizzanti emesse per l’impiego della fluoroscopia. Il progetto ARTERY propone una soluzione innovativa, sviluppando una piattaforma robotica per procedure di cardiologia interventistica strutturale, eliminando l'uso della tecnica fluoroscopia e migliorando la comprensione delle immagini da RT3DTEE, tecnica spesso usata al posto di della precedente, ma non sempre applicabile. Lo studio si focalizza sulla caratterizzazione di una schiuma poliuretanica flessibile FlexFoam-iT!TM VIII come materiale adibito, in un futuro, alla realizzazione di un setup in vitro per creare un continuo equivalente che mimi l’effetto dei tessuti che circondano in vivo le vene di accesso per la procedura di impianto del sistema MitraclipTM, evidenziando requisiti come modulo elastico e coefficiente di Poisson. Una successiva analisi di sensitività applicata alla simulazione numerica di interazione catetere-vaso, rivela l'influenza minima del modulo elastico e del coefficiente di Poisson sulla deformata della femorale, mentre è mostrato come il modulo di Young e lo stesso rapporto di Poisson incidano, sebbene in misure differenti, sulle forze di contatto generate dall’interazione catetere-vaso. L'integrazione dei dati sperimentali nella simulazione fornisce risultati coerenti, indicando la schiuma come potenziale candidato per la validazione del modello in vitro e proponendo un approccio congiunto in un futuro.The adoption of trans-catheter techniques for the treatment of structural cardiovascular diseases is increasingly prevalent, especially in frail and high-risk patients. However, the success of these techniques relies on the operator's skills, involving the challenging interpretation of two-dimensional images during the procedure. Moreover, there are severe risks to both the patient and the operator associated with ionizing radiation exposure from fluoroscopy. ARTERY’s project proposes an innovative solution by developing a robotic platform for structural interventional cardiology procedures, excluding the use of fluoroscopy and enhancing the understanding of images from RT3DTEE, which is a technique often used as an alternative to fluoroscopy, but it is not always suitable to the whole set of cardiovascular interventions. The study focuses on characterizing a flexible polyurethane foam (FlexFoam-iT!TM VIII) as a material intended to a future in vitro set-up to create a continuous equivalent which is able to mimic the effect of tissues surrounding the access-veins during the MitraClipTM implantation procedure. The characterization highlights mechanical parameters such as the elastic modulus and the Poisson's ratio. As a result, the selected foam exhibits properties compatible with the objectives. A subsequent sensitivity analysis applied to the numerical simulation of catheter-vessel interaction reveals the minimal influence of elastic modulus and Poisson's ratio on the femoral deformation. However, it is demonstrated that Young's modulus and the Poisson's ratio impact, albeit to varying extents, the contact forces generated by the catheter-vessel interaction. The integration of experimental data into the simulation yields consistent results, indicating the foam as a potential candidate for in vitro model validation and proposing a combined approach in the future

Identification of the Inappropriate Clinical Actions (DON'T) to Improve the Management of Patients with Type 2 Diabetes Failing Basal Insulin Supported Oral Treatment: Results of Survey for a Panel of Diabetes Specialists in Italy

Introduction Despite the development of several recommendations, glycemic control in a large proportion of patients with type 2 diabetes, including those treated with insulin, remains suboptimal. This study is aimed to identify a set of actions to promote the reduction of inappropriate clinical practices in type 2 diabetes failing basal insulin supported oral therapy (BOT). Methods A panel of diabetes specialists was assembled to identify a list of ten corrective actions, "things not to do," for the management of type 2 diabetes: five concerning treatments, procedures and diagnostic tests and five about relationship, communication and information. The Choosing Wisely methodology and approach were the inspiration. Results A total of 73/73 (100%) panelists responded to the survey. Twenty-four actions were proposed. The final list of inappropriate actions deemed most important to improve the management of patients with type 2 diabetes failing BOT were: (1) do not use secretagogues-do not neglect the use of innovative glucose-lowering agents; (2) do not underestimate the risk of lack of hypoglycemia awareness; (3) do not underestimate the benefit of personalization of therapy; (4) do not delay insulin intensification; (5) do not delay modification of the therapeutic regimen. In the area of patient communication, the following actions were identified: (1) do not fail to train in the management of hypoglycemia; (2) do not underestimate whether the patient has understood the modification of therapy; (3) do not prescribe injection therapy without adequately instructing the patient to titrate it; (4) do not ignore the patient's adherence; (5) do not stop listening to the patient and verify learning. Conclusion A set of corrective experience-based actions to enact in a timely manner, which can assist physicians in improving clinical outcomes and patients' needs in terms of communications and interaction, is proposed. The list is intended to promote discussions among diabetes specialists to provide high-value diabetes care

The effect of exercise on IL-6-induced cachexia in the ApcMin/+ mouse

Background Cachexia involves unintentional body weight loss including diminished muscle and adipose tissue mass and is associated with an underlying disease. Systemic overexpression of IL-6 accelerates cachexia in the ApcMin/+ mouse, but does not induce wasting in control C57BL/6 mice. With many chronic diseases, chronic inflammation and metabolic dysfunction can be improved with moderate exercise. A direct effect of regular moderate exercise on the prevention of IL-6-induced cachexia in the ApcMin/+ mouse has not been investigated. The purpose of this study was to assess the effects of exercise on the development of cachexia in the ApcMin/+ mouse. Methods Mice were randomly assigned to moderate treadmill exercise (18 m/min, 1 h, 6 days/week, 5% grade) or cage control (CC) groups from 6 to 14 weeks of age. At 12 weeks of age, mice were electroporated with either IL-6- containing or control plasmid into the quadriceps muscle. Mice were killed after 2 weeks of systemic IL-6 overexpression or control treatment. Results IL-6 overexpression induced an 8% loss in body weight in CC mice, which was significantly attenuated by exercise. IL-6 overexpression in CC mice increased fasting insulin and triglyceride levels, which were normalized by exercise, and associated with increased oxidative capacity, an induction of AKT signaling, and a repression of AMPK signaling in muscle. These exercise-induced changes occurred despite elevated inflammatory signaling in skeletal muscle. Conclusion We conclude that moderate-intensity exercise can attenuate IL-6-dependent cachexia in ApcMin/+ mice, independent of changes in IL-6 concentration and muscle inflammatory signaling. The exercise effect was associated with improved insulin sensitivity and improved energy status in the muscle. © The Author(s) 2012

Pre‐gestational diabetes during the COVID‐19 pandemic in Bergamo, Italy

Effective enforcement of lockdown measures, use of technology, and implementation of telemedicine may have significantly reduced the number of diabetic pregnant women who tested positive for COVID‐19 in Bergamo, Italy