Chiara Orsi

Is fluorescein-guided technique able to help in resection of high-grade gliomas?

OBJECT Fluorescein, a dye that is widely used as a fluorescent tracer, accumulates in cerebral areas where the blood-brain barrier is damaged. This quality makes it an ideal dye for the intraoperative visualization of high-grade gliomas (HGGs). The authors report their experience with a new fluorescein-guided technique for the resection of HGGs using a dedicated filter on the surgical microscope. METHODS The authors initiated a prospective Phase II trial (FLUOGLIO) in September 2011 with the objective of evaluating the safety of fluorescein-guided surgery for HGGs and obtaining preliminary evidence regarding its efficacy for this purpose. To be eligible for participation in the study, a patient had to have suspected HGG amenable to complete resection of the contrast-enhancing area. The present report is based on the analysis of the short- and long-term results in 20 consecutive patients with HGGs (age range 45-74 years), enrolled in the study since September 2011. In all cases fluorescein (5-10 mg/kg) was injected intravenously after intubation. Tumor resection was performed with microsurgical technique and fluorescence visualization by means of BLUE 400 or YELLOW 560 filters on a Pentero microscope. RESULTS The median preoperative tumor volume was 30.3 cm(3) (range 2.4-87.8 cm(3)). There were no adverse reactions related to fluorescein administration. Complete removal of contrast-enhanced tumor was achieved in 80% of the patients. The median duration of follow-up was 10 months. The 6-months progression-free survival rate was 71.4% and the median survival was 11 months. CONCLUSIONS Analysis of these 20 cases suggested that fluorescein-guided technique with a dedicated filter on the surgical microscope is safe and allows a high rate of complete resection of contrast-enhanced tumor as determined on early postoperative MRI. Clinical trial registration no.: 2011-002527-18 (EudraCT).

Clinical and molecular cross-sectional study of a cohort of adult type III spinal muscular atrophy patients: clues from a biomarker study.

Proximal spinal muscular atrophy (SMA) is an autosomal recessive neuromuscular disorder caused by mutations of the SMN1 gene. Based on severity, three forms of SMA are recognized (types I–III). All patients usually have 2–4 copies of a highly homologous gene (SMN2), which produces insufficient levels of functional survival motor neuron (SMN) protein due to the alternative splicing of exon 7. The availability of potential candidates to the treatment of SMA has raised a number of issues, including the availability of biomarkers. This study was aimed at evaluating whether the quantification of SMN2 products in peripheral blood is a suitable biomarker for SMA. Forty-five adult type III patients were evaluated by Manual Muscle Testing, North Star Ambulatory Assessment scale, 6-min walk test, myometry, forced vital capacity, and dual X-ray absorptiometry. Molecular assessments included SMN2 copy number, levels of full-length SMN2 (SMN2-fl) transcripts and those lacking exon 7 and SMN protein. Clinical outcome measures strongly correlated to each other. Lean body mass correlated inversely with years from diagnosis and with several aspects of motor performance. SMN2 copy number and SMN protein levels were not associated with motor performance or transcript levels. SMN2-fl levels correlated with motor performance in ambulant patients. Our results indicate that SMN2-fl levels correlate with motor performance only in patients preserving higher levels of motor function, whereas motor performance was strongly influenced by disease duration and lean body mass. If not taken into account, the confounding effect of disease duration may impair the identification of potential SMA biomarkers.

Alcohol consumption, helmet use and head trauma in cycling collisions in Germany

Cycling, being easy, inexpensive and healthy, is becoming one of the most popular means of transport. Cyclists, however, are among the most vulnerable road users in traffic collisions. The aims of this study were to establish which cyclist and cycling accident characteristics are associated with alcohol consumption and helmet use in Germany and to identify risk factors related to head trauma sustained in cycling accidents. The source used for the present analysis was the database of the German in-depth accident study (GIDAS). All cyclists who had been involved in a road accident between 2000 and 2010 and submitted to an alcohol test were selected. Logistic regression analyses were carried out to evaluate various aspects: alcohol consumption, helmet use, head trauma, and cyclist/accident characteristics. Female riders were less likely to have consumed alcohol (OR=0.23, 95% CI: 0.08-0.66); cyclists who did not wear a helmet were more likely to have consumed alcohol (OR=2.41, 95% CI: 1.08-5.38); cyclists who were not responsible for the collision were less likely to have consumed alcohol than those who were partially responsible for the accident (OR=0.22, 95% CI: 0.08-0.61). Cyclists involved in collisions with another vehicle, motorised or not, had a lower risk of suffering a head injury compared with those involved in single-vehicle accidents (OR=0.27, 95% CI: 0.12-0.62, and OR=0.08, 95% CI: 0.03-0.22, respectively). The prevention or limiting of alcohol consumption among cyclists and the corresponding testing of cyclists must be improved. Training initiatives on helmet protection should be encouraged.

Motorcycle riders' perception of helmet use: Complaints and dissatisfaction

In accidents which involve two-wheeled vehicles the helmet plays a life-saving role, but very little is known about the motorcycle riders perception of the helmet. We evaluated the relationships between having been involved in an accident and dissatisfaction with the helmet, and between the perception of motorcycle riders and the objective features of the helmet. This was a case-control study: riders of motorized two-wheelers who had been involved in accidents (accident cases) were compared against a similarly interviewed sample of riders that had not been in accidents (control cases). Information about the driver, the vehicle and the helmet was collected in all interviews. To evaluate the relationships, logistic regressions were carried out. The majority of drivers were dissatisfied with their helmets, but no evidence was found to link this dissatisfaction with having been involved in an accident. The two most common complaints related to noisiness, followed by the helmet visor. Complaints did not seem to be statistically associated with physical features of the helmet.

Hospitalization costs and estimates of direct and indirect economic losses due to injury sustained in road traffic crashes: Results from a one-year cohort study in three European countries (The REHABILAID project)

Introduction The financial cost of injuries sustained in road traffic crashes is high for victims, families and national budgets, but there is limited information on the cost of injury from the victims’ perspective, especially in terms of the hard-to-reach multi-trauma patient population such as those admitted to the intensive care units of hospitals. Materials and methods The current study received funding by the European Commission Directorate-General Mobility and Transport. It is a prospective, prevalence-based, cost-of-illness study. Participants admitted in the intensive care units of seven public hospitals in Greece, Germany and Italy because of injuries from road traffic crashes, during one year, were enrolled in the study. Patients were followed-up for one year after the intensive care unit admission to report emerging direct and indirect costs related to their injury. Results A total of 120 people were enrolled. Males, those aged 25–49, motorcyclists and those severely injured (Maximum Abbreviated Injury Scale (MAIS) 3+) with highest severity located at the central part of the body, accounted for the highest percentages of both the direct and indirect injury costs. The highest average direct costs were for females, those aged 50–64, pedestrians and those slightly injured (MAIS 1 or 2) with highest severity at the central region of the body. Males, patients aged 25–49, car passengers and truck drivers as well as those slightly injured (MAIS 1 or 2) with highest severity at multiple locations were over-represented in the average indirect costs. Conclusions Those groups that account for a high percentage of injury costs should be targeted in health policy initiatives.

Road accidents involving bicycles: configurations and injuries

ABSTRACT This study analyzed the most common types of accident involving bicycles and compared the frequency of injuries. The data source was the database of German In-Depth Accident Study (GIDAS). Cases consist of bicycles and their riders involved in accidents between 2000 and 2010. In most collisions, the bicycle impacted with a car. The percentage of injured bicyclists was higher in collisions with a heavy vehicle and decreased when the bicycle impacted with lighter vehicles. A high percentage of injured bicyclists in single accidents was observed; the most severe injury was more frequently to head and extremities. Accidents involving a car and a bicycle with the right of way in a bicycle path represented about 20% of involved and injured bicyclists. The ten most frequent configurations represented about 60% of involved and injured bicyclists. These results contribute to understand the dangerous scenarios for bicyclists and to suggest preventive actions.

Bicycle helmet use patterns in Italy. A description and analysis of survey data from an Italian friends of cycling association

Cycling is becoming one of the most popular forms of recreation and transport the world over, but cyclists still have a high level of vulnerability. A bicycle helmet is an important safety device available to cyclists, but little is known regarding possible determinants of helmet use among adults. This study aims at providing information on helmet usage patterns in Italy and identifying the factors associated with bicycle helmet use. Data on 2072 bicycle riders from an Italian friends of cycling association aged 18 years or older who had ridden a bicycle in the last month were collected using an ad-hoc questionnaire via the web. The sample was equally distributed among subjects who always, most of the time, sometimes, rarely, or never use a helmet. To evaluate the association among socio-demographic and bicycle use characteristics and helmet use, a multinomial logistic regression model was performed. The results show a higher propensity to use a helmet among males, riders coming from Central and Southern Italy, people who cycles more than 60kilometres in a week, cyclists who have already had a crash, people who do not cycle daily or almost daily, riders of sport bikes. Moreover, the propensity to use a helmet increases with age. The survey provided a first step in approaching the lack of data on cycling behaviour and the wearing of a helmet in Italy.

Characteristics of Helmets, Dissatisfaction with the Helmet and Accident Risk: A Case-Control Study

In road accidents which involve two-wheeled vehicles the helmet plays a fundamental life-saving role. The drivers perception can be influenced by some features of the helmet, such as noisiness, temperature, ventilation, field of vision and size. Using data collected in the European study COST 357 – PROHELM (Accident Prevention Options with Motorcycle Helmets), we evaluated the relationships between having been involved in an accident and dissatisfaction with the helmet and between the cognitive capacity of the motorcycle riders and the objective features of the helmet. It is a case-control study: riders of motorised two-wheelers who have been involved in accidents (cases) were compared with a sample of riders interviewed as control cases. The variables, collected using standardised procedures in the various countries, concern information about the driver, the vehicle and the helmet, perceptions and use of the helmet and accident circumstances (only for cases). To evaluate the relationships, logistic regressions were carried out. Dissatisfaction with the helmet is complained of by the majority of drivers (about 70%), but evidence of an association with being involved in an accident has not been found. The most common complaints are about noisiness, followed by visor. Complaints do not seem to be associated with the objective features of the helmet. These results provide useful information about helmet comfort and the main causes of dissatisfaction reported by riders. This information should be of value to helmet manufacturers and designers to increase the pleasure of the helmet.

Road accident causes among truck drivers: a multicentric study

Few studies are available regarding accidents involving trucks and even less is known about the cause. To fill in this lack of knowledge, we performed an analysis in order to identify the main causes of accidents involving trucks, using data obtained form European Truck Accident Causation a research conducted across France, Germany, Hungary, Italy, Slovenia, Spain and The Netherlands. Accidents involving at least one truck and one injured person have been investigated. Data collection started on April 2004 and finished on September 2006. Accidents were collected from sample areas representative of the national truck accident situation. The first investigation was on the spot of the accident as quickly as possible; if necessary, investigators investigated again the accident. Parameters on infrastructure, vehicles and people involved were evaluated. In total, 624 accidents have been investigated. The majority of truck drivers was professional drivers (97.0%) involved in the accident while working (86.8%). In 91.7% of cases the main accident cause is linked to human factors. The main cause varied according to the accident configuration. In accidents at intersection was the failure to observe road rules; in accidents in queue or during an overtaking manoeuvre was inattention; for accidents due to a lane departure were non-adapted speed and improper manoeuvre when turning; for single-vehicle accidents was overfatigue/falling asleep. This information can be used to give guidance to policy and decision makers for future action which can contribute to the improvement of road and occupational safety.