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Although none of the goals of the United Nations Agenda 2030 is dedicated to finance, can the use of financial instruments play a role in achieving some of the Sustainable Development Goals? Can financial instruments contribute to the reduction of hunger and poverty, to ensuring healthy lives, gender equality, decent jobs and the growth of micro, small and medium-sized enterprises (MSMEs), reducing inequalities, enhancing an effective fight against corruption and increasing the mobilization of additional financial resources? This article highlights how financial inclusion, meaning the access to financial services, allows the weakest to contribute to the achievement of the SDGs and to improve their life conditions. From the evidence of the UNSGSA (2018) report on integrating SDG progress through digital financial inclusion, it becomes clear that digital finance is a key that can help in boosting financial inclusion. [ABSTRACT FROM AUTHOR]

Objective: To retrospectively evaluate the open reduction internal fixation and total hip arthroplasty directions, results and complications associated with internal fixation in managing these fractures. Methods: In 8 years at 4 centers, 61 patients with associated acetabular fractures (Letournel classification) were treated. The patients were divided into two groups. The total hip arthoplasty (THA) group consisted of 30 patients, while the open reduction internal fixation group had 31 patients. The average age of the patients was 74.7 years. The following parameters were compared: the duration of surgery and hospitalization, the international unit of red blood cell concentrate transfusion, the time for the verticalization of the patient, perioperative complications, Harris hip score, and the short form (12) health survey. The clinical and radiographic follow-up was performed at 1 month, 3 months, 6 months and 12 months and annually thereafter. Patients with post-traumatic osteoarthritis formed the third comparison group. P ≤ 0.05 was considered statistically significant according to the analytical Student's t-test. Results: The P < 0.05 in favor of the THA group was: surgical time, length of stay, number of the international unit of red blood cell concentrate transfusions, verticalization, quality of life and hip function, a reduction of perioperative complications and reinterventions. Conclusions: Our experience shows that the THA treatment for acetabular fractures in the elderly is to be preferred. [ABSTRACT FROM AUTHOR]

Objective To investigate if a locking intramedullary nail could be useful in the treatment of fractures of the humeral head in 3 and 4-fragments operated within 48 h from the trauma. Methods During the period of February 2011–May 2013, we performed 21 cases of humeral fractures treated with the Polarus intramedullary nail (Acumed). We considered parameters such as age, sex, time of radiological healing and functional outcome, which were assessed by Constant shoulder score, University of California at Los Angeles shoulder score, Oxford shoulder score and Dash score. The study was designed as a prospective cohort study. Results Clinical and radiographic follow-up of patients was performed at 1, 2, 3, 6, 12, and 24 months after surgery. Evidence of radiographic bone healing occurred at an average of 2.42 months post-surgery (range: 1–6 months, median 2). There were no cases of avascular necrosis of the humeral head or failure of the synthesis. The functional outcome was excellent in 6 out of 21 cases (Constant score > 86%); good in 11 out of 21 cases (Constant score 71–85); satisfactory in 3 out of 21 cases (Constant score 56–70); only in one case we recorded poor outcome (Constant score = 55). Conclusions The nail utilized is provided with locking and multiplanar proximal screws and could be applied through a mini-invasive anterolateral approach. This enables the reduction of the fracture fragments, while preserving vascularization of the scapulo-humeral joint. Our results confirm that the indication of endomedullary nail could be extended to the treatment of complex proximal humeral fractures with 3 and 4 fragments (level of evidence IV, according to the Oxford Centre for Evidence Based Medicine Levels of Evidence Working Group). [ABSTRACT FROM AUTHOR]

Objectives To report our experience of regional referral center for the pelvis. Methods We treated 526 pelvic fractures from January 2004 to December 2014 in three regional reference centers for pelvic trauma. Men were 480 and women were 46 and ages ranged from 16 to 93 years old. Car (65%) and farm (20%) crashes were the most frequent causes of pelvis fractures. Injury severity scores ranged from 9.0 to 75.0, with a mean of 37.5. A defined algorithm for fracture management has been in place and employed to assure adequate resuscitation and fracture care. Results There were 24 deaths in total (4.56%). Sixty three (11.98%) patients underwent angio-embolization for control of bleeding (12 deaths). The average amount of blood transfused was 8.3 IU. Hospital lengths of stay ranged between 1-35 days. Among the 502 alive patients, 55.98% were able to be discharged at home while the remaining 44.02% being transferred to various rehabilitation facilities or extended care facilities. Conclusions The goal of initial management is to restore vital indicators, urinary excretion function and protect the patient from infectious complications. An emergency decisional algorithm helps manage hemodynamic instability. Initial bone and ligament procedures should reduce displacement and make it possible for the patient to wait until his condition is stable enough for definitive surgical fixation. [ABSTRACT FROM AUTHOR]

The article focuses on two proposals for the paintings of Niccolò di Liberatore in Umbria, Italy. He became the contemporary of Carlo Crivelli and both are active in the Marches. His role in the development of Marchigian painting has been much less thoroughly studied. The Budapest Saint Bernardino was found to be very close in physiognomy and drapery to the figure of the saint in his painting "Christ Crucified with Sts Francis and Bernardino" in 1497. The triptych of his "Madonna del Soccorso" painting is considered unusual due to its single panel representations.

Introduction. Thoracolumbar spinal injuries indicated for surgical intervention specify the necessity of intervention within 24 hours. The traumatologists working in a structure without a Spinal Unit must be able to evaluate such injury and set indications for surgical treatment, that is, nonoperative treatment. The purpose of this study is to evaluate if Thoracolumbar Injury Severity Score (TLISS) is still a good base for the classification of thoracolumbar spinal injuries and to give a correct indication for nonoperative, that is, surgical treatment. Patients and Methods. Six Orthopaedics and Traumatology residents from Siena (Italy), five Orthopaedics and Traumatology residents from the Clinical Centre of Banja Luka (Bosnia and Herzegovina) and five Orthopaedics and Traumatology residents from the Alta Val d'Elsa Hospital, Siena (Italy) were presented 24 clinical cases from professional literature where the following data were indicated: patient's age, neurological conditions, description of the injury, mechanism of the injury and radiological findings (RTG, MR). The abovementioned 24 patients were chosen from the literature based on the injuries mostly seen by an orthopaedist with a lack of experience in the problems of spinal column trauma (low energy trauma, with partial or without neurological impairments, with the TLISS score of 4). The residents from the three groups had to classify all patients according to the TLISS score and to define the most appropriate method of treatment-conservative or surgical, and after that, all classifications, as well as the therapeutic decisions, were compared. The statistical methods used in this study include: statistical significance, reliability (P

Context: Vulvodynia is defined as a chronic vulvar pain non-associated with infectious, inflammatory, neoplastic or hormonal disorders., Objectives: To present a case demonstrating the difficulty in assessing concomitant disease in vulvodynia., Methods: A 26-year-old woman, presented with persistent vulvodynia. She received oral and topical medications and behavioural interventions to lessen sexual pain and restore sexuality. As sexual pain decreased, the patient reported symptoms previously not mentioned: continuous, intense periclitoral pain and numbness at the perineum when sitting for a long time. These new symptoms suggest the involvement of the peripheral neural system. The physical evaluation confirmed right-side pelvic distortion, and pathological increase in lumbar lordosis, which caused neuralgia radiating to the external genitalia and perineum, and overlapping with sexual pain. After diagnosing pudendal neuralgia according to the Nantes criteria, physical treatment and relaxation exercises to de-contract the spine were added to the vulvodynia regimen., Results: During treatment, vulvodynia was sometimes present but never unbearable, allowing satisfactory sex. With physical therapy, the symptoms of pudendal neuralgia decreased., Conclusion: Differentiating the presence of two conditions with overlapping symptoms is difficult because the vestibular pain had shadowed pudendal neuralgia symptoms at initial assessment. Syndromes of chronic pain tend to associate with each other and one syndrome may shadow symptoms of the concomitant condition affecting adjacent anatomical areas. Only the accurate identification of all the syndromes involved allows adopting the correct treatment., Competing Interests: Conflict of interest: The author(s) declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article.

Allografts techniques remain the best reconstructive strategy for chronic extensor mechanism lesions after total knee arthroplasty (3) but outcomes depend strictly on the host tissue-allograft junctions healing. The purpose of this study is to evaluate if modern techniques of adding autologous bone marrow cells concentrate enriched with platelet-rich fibrin, provide better healing of the allograft. We present the case of an 86 years old patient affected by patellar tendon rupture after TKA. A whole extensor mechanism allograft was performed adding a bone marrow cells concentrate enriched with platelet-rich fibrin on the host tissue-allograft junctions. Preoperatively and at each follow-up the value of Knee Society Score and radiographic consolidation signs were recorded. Radiographic controls showed clear signs of consolidation already at 1 months follow-up and a solid fusion at 3 months. This case report describes a valid method to improve healing using a tissue-construct engineered with stem cells and growth factors.

Objectives: To assess the diagnostic performance of ultrasound (US), x-rays, and microscopic analysis of synovial fluid (SF) for calcium pyrophosphate dihydrate crystal deposition disease (CPPD) using histology as a reference standard., Methods: We enrolled consecutive patients with osteoarthritis waiting to undergo knee replacement surgery. Each patient underwent US of the knee, focusing on menisci and the hyaline cartilage, the day before surgery. During surgery, SF, menisci and condyles were retrieved and examined microscopically. For the meniscus and cartilage microscopic analysis, 8 samples were collected from each specimen and knee radiographs, performed up to 3 months before surgery, were also assessed. A dichotomous score was given for the presence/absence of CPP for each method. Microscopic findings of the specimens were considered the reference standard. All the procedures followed were in accordance with the ethical standards of the local responsible committee., Results: 42 patients (14 males) were enrolled. All patients underwent US, 34 had eligible radiographs and 32 had SF analysis. 25 patients (59.5%) were positive for CPP at US, 15 (44.1%) at X-ray and 14 (43.7%) at SF. Sensitivity and specificity values were 96% and 87% for US, 75% and 93% for radiography and 77% and 100% for SF respectively. There were no statistically significant differences between the diagnostic performance across single tests., Conclusions: US proved to be at least as accurate as SF analysis for the diagnosis of CPPD. US, which is feasible and harmless, could be considered the first exam of choice for CPPD diagnosis.