Continuous glucose monitoring in acute stroke

"Hyperglycaemia upon admission is a pathophysiological response to acute brain ischemia that has been independently associated with high mortality rate and poor prognosis. Glycaemic variability (GV) has also shown association with poor clinical outcomes among stroke patients. GV is best assessed by continuous glucose monitoring (CGM), which enables consecutives glucose measurements every 5 minutes. This pilot study aimed: 1) To describe safety, feasibility and tolerability of CGM in the acute stroke setting; and 2) To compare CGM and conventional FS glucose-based monitoring regimen in terms of their relationship with GUA and the accuracy of hypoglycaemic episodes detection. Safety, feasibility and tolerability of CGM was excellent in our cohort of 23 patients with acute stroke (61% ischemic and 39% intracerebral haemorrhage) and there were no adverse events. CGM recorded ten hypoglycaemic episodes that were not detected by conventional FS monitoring. GUA was associated with coefficient of variation (CV) of CGM (p=0.03), CV of FS (p=0.01), standard deviation (SD) of CGM (p-value=0.01) and mean amplitude of glucose excursions (MAGE) (pvalue= 0.001)."

Serious game, lectures or simulation-based mastery learning course which is the best method for training students about cardiac arrest management?

"Background and aim: This study aimed to compare a serious game and lectures for the pretraining of medical students before learning about simulation-based management of cardiac arrest. Methods: Participants were 150 volunteer second-year medical students between April and June 2018 randomly assigned to CPR training using either lectures (n = 75) or a serious game (n = 75). Each participant was evaluated on a scenario of cardiac arrest before and after exposure to the learning methods. The primary outcome measures were the median total training time needed for the student to reach the minimum passing score. This same outcome was also assessed three months later. Results: The median training time necessary for students to reach the minimum passing score was similar between the two groups (p=0,45). Achieving an appropriate degree of chest compression was the most difficult requirement to fulfill for students in both groups. Singing the refrain of the song ""staying alive"" significantly increased the number of compressions with the correct rate. Three months later, the median training time decreased significantly in both groups. However, students have remained interested in the serious game for a longer time showing a preference for using this method. Conclusions: The serious game was not superior to lectures to pretraining medical students in the management of a cardiac arrest."

ELECTROCHEMOTHERAPY: A novel treatment option for unresectable tumors

"Electrochemotherapy (ECT) is a combined treatment that exploits the administration of chemotherapeutic drugs and cell membrane reversible electroporation. ECT increases elective drug penetration into cytoplasma of treated tissues and allows a tissue sparing treatment. This article describes a single center experience of ECT for the treatment of unresectable cutaneous and subcutaneous tumors. Safety, tolerability and correlation between tumor’s characteristics and clinical response were the question of research. On the basis of the study, other important application should start."

Strategies for nose-to-brain drug delivery

"Intranasal drug administration is an effective method that has shown promise for delivering drugs directly to the brain. This approach is associated with many challenges, and efficacy in bypassing blood-brain barrier (BBB) is debated. This review describes the pathways of nose-to-brain drug delivery, physicochemical drug properties that influence drug uptake through the nasal epithelium, physiological barriers, methods to enhance nose-to-brain absorption, drug bioavailability and biodistribution, and intranasal devices for nose-to-brain drug delivery. The mechanism of each device is described and supporting evidence from clinical trials is presented. This paper summarizes strategies involved in nose-to-brain drug delivery and provides evidence of potential efficacy of nose-braindelivery from clinical trials."

A model of pilot study to assess the risk of exposure to surgical smokes for operating room personnel

"During the last decades the exposure to surgical smokes has been a long-standing concern both in open and laparoscopic surgery. The aim of this project is to assess the health risks for medical operating room (OR) personnel associated with surgical plumes derived from laparoscopic procedures. The purpose of this model is to check the correlation between the concentration of toxic elements derived from electrosurgical procedures in the operating setting air and the concentration of the same substances in urine and plasma of patients and operating staff. Moreover, it will be considered also the correlation between toxic concentration and time of exposure. The results of the study could be relevant to indicate if individual protection devices are efficacious to make the surgical procedure safe for patients and staff or if any adequacy has to be considered. Some unexpected difficulties delayed the expected results."

Model of a tracheobronchial tree for the training of bronchoscopy examinations

"Simulation in medicine has been extensively used for the training of medical students, as well as for learning new procedures or studying complex situations, which need a deep understanding of the clinical case. Specifically, in anesthesia and intensive care, bronchoscopy is a procedure entailing some risks, such as perforation, bleeding or other emergency situations. Therefore, it is necessary to train residents with the use of alternative methods before practicing on patients. In this context, we combined a physical model of the tracheobronchial tree with a virtual reality-based system to create a low-cost simulator for bronchoscopy training. Specifically, we designed and implemented a system combining a physical and a virtual model of the tracheobronchial tree of a specific patient, starting from his/hers CT image. This system represents an innovative simulator combining visual and haptic feedbacks. Indeed, our prototype is intended to enhance clinicians’ skills in a riskless environment."

A multi-modal data model for morphological segmentation in 3D dosimetry

"Patient specific dosimetry established during the last decade in modern radio-therapy. Usually, tracer kinetics in main compartments of observed metabolism is assessed from anterior and posterior whole body scans. The effective doses for each organ, derived by the MIRD scheme, provide evidence for following radiotherapeutic treatment and helps to meet vital dose limits for critical organs, e.g. kidneys. The calculation of individual dose in a three-dimensional context leads to more accurate dose estimates, as was proven by intensive research, but is still on the cusp to clinical application. In this work, a statistical approach, based on multi-modal image and feature data, is presented, to overcome manual segmentation, the most time consuming step, in 3D based dose calculation. 3D data volumes from a hybrid SPECT study, comprising SPECT and CT data, covering main compartments of metabolism, build the image features of a Gaussian classifier. From prior segmentations organspecific membership maps are derived, and substituted as additional feature into the segmentation procedure. Centroids, eccentricity and principal axes of organ models are registered to a rough thresholded image of the SPECT component, and define membership coefficients of the voxels. The new approach yields accurate results, even with real patient data. The new method needs minimal user interaction during selection of some sample regions, thus showing high potential for implementation in a clinical workflow."

3D software simulator for primary care training

"Medical software simulators are used to teach specific procedures that allow the user to follow only a strict sequence of steps without the possibility of alternative, avoiding considering the consequence of an error and then potentially admitting its tolerance. Usually these applications are a state machine implementation where learners must make a specific action to obtain a specific result. In our work we propose a brand-new approach with a “open world” serious game medical simulator, based on Agent Based Model Paradigm. Starting by these concepts, a user can learn and test his skills in a dynamic environment that changes in real time based on his actions. We provide a configurable starting set of conditions (patient heath state, available medical instruments and drugs) to create, potentially, infinite scenarios; alongside these boundary values the game permits to configure real time events that influence patient in an unpredictable way by the user side."

Training system for first response medical emergency groups to guide triage procedures

"The work presents training system which provides a structured, simple and practical approach to triage training, for first response paramedic and emergency medical services personnel, as implementation of the triaging procedures in mass casualty accidents. The proposed training system allows to train the procedures at all three levels of hierarchical chain of strategic, tactical and executive command management. It provides reliable connectivity at the scene based on Bluetooth Low Energy standard or Internet connection with the use of mobile 4G LTE communication networks infrastructure. In training system we use simulators of vital human signs based on mobile devices, which generate so-called the victim's life cycle chart, consisting of the heartbeats and respiratory rates, systolic and diastolic blood pressure, and capillary refill time, used as the basis for triage categorization. Presented training system increases trainees competence level in executive as well as control and governance skills."

Puppet mentoring: a new simulation scenario for learning surgical abilities

"Surgical simulators are now able to teach in a way that the learning curve of young surgeons can progress in a lab faster than when using other teaching models (cadaveric or animal) or real patients. The impact of surgical simulators is confirmed by the fact that, in the US, standardized training courses are needed to acquire the Board of Surgery certification. The virtual simulator set up at the University of Genoa (eLaparo4D) is based on two key features: a convincing haptic feedback and a limited cost. Nevertheless, the main issue of eLaparo4D is the “simplicity” of the virtual scenario. To improve it, a new model of simulation is proposed in this project: the “puppet mentoring”, that might enhance its characteristics. The “puppet mentoring” is based on the recording of the movements of the surgeon in the real clinical scenario, that are transferred to the virtual machine. The apprentice, in his learning session, could be led through the operation by the simulator itself, in a scenario and in a way is the same of the real one."