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Widespread screening for hepatitis C virus (HCV) is necessary for Canada to meet its HCV elimination goals by 2030. People who currently or previously injected drugs are at high risk for HCV. Opioid agonist therapy (OAT, such as methadone and buprenorphine) has been shown to help stabilize the lives of people who are opioid‐dependent. The distribution of OAT in North America typically requires daily, weekly, or monthly clinic visits and presents an opportunity for engagement, screening and treatment for those at high‐risk of HCV. In this study, HCV screening was conducted by staff at OAT clinics in Ontario from 2016 to 2020 and those with chronic infections were treated on‐site with direct‐acting antivirals. Point‐of‐care or dried blood spot (DBS) testing was used for antibodies, DBS or serum for HCV RNA and serum for HCV RNA at SVR12 (sustained virological response). Clinics screened 1954 people (mean age 40 years ±12, 63% male). Forty‐five percent were antibody positive, of whom 64% were HCV RNA+. Eighty percent of those RNA+ set an appointment in which 99% attended. Ninety‐six percent started treatment with 87% completing treatment. Sixty‐eight percent of people who completed treatment submitted a sample for SVR12 testing of which 97% achieved a virological cure. Results suggest that HCV screening and treatment at OAT clinics is feasible, effective and warrants expansion. Data suggest strong treatment adherence due to high rates of SVR12 comparable with other OAT‐based HCV treatment programs. The lack of SVR12 sampling could be addressed by either on‐site phlebotomy or incentivizing SVR12 sampling. [ABSTRACT FROM AUTHOR]

The photodegradation of ceftriaxone (CFT) in aqueous solution induced by UVB irradiation was studied in the presence and in the absence of oxygen. These selected conditions simulate some natural situations of contaminated water, where dissolved oxygen and the fraction of UV radiation that penetrates the terrestrial atmosphere could participate in the photodegradative process. CFT undergoes unimolecular photodegradation when irradiated with UVB light, and in an oxygen atmosphere the photodegradation process increases due to the action of reactive oxygen species (ROS), which are generated by photosensitization processes that involve the CFT triplet excited state (3CFT*). We report here for the first time the transient absorption spectrum, the lifetime and the quantum yield of 3CFT*. In the photodegradative mechanisms, hydroxyl radicals, superoxide radical anions and hydrogen peroxide are generated and participate in the CFT photooxidation. Bioassays on the Vero cell line demonstrated that the CFT photoproducts generated in the presence and in the absence of oxygen are not cytotoxic. A decrease in the bactericidal capacity of CFT after UVB exposure against S. aureus strains was also observed. The photoproducts obtained under photooxidation mechanisms mediated by ROS suffer a greater loss of antimicrobial activity. These results, from an ecological point of view, are very interesting since the action of UVB light represents an adequate method for natural CFT degradation in water because it allows a decrease in the generation of multi-resistance to antibiotics by bacteria. Also, the presence of photolysis products does not show toxic effects on living organisms. [ABSTRACT FROM AUTHOR]

Charcot- Marie- Tooth (CMT) disease includes a group of clinically and genetically heterogeneous neuropathic disorders with an estimated frequency of 1 on 2.500 individuals. CMTs are differently classified according to the age of onset, type of inheritance, and type of inheritance plus clinical features. For these disorders, more than 100 genes have been implicated as causal factors, with mutations in the PMP22 being one of the most common. The demyelinating type (CMT1) affects more than 30% of the CMTs patients and manifests with motor and sensory dysfunctions of the peripheral nervous system mainly starting with slow progressive weakness of the lower extremities. We report here a 12 year- old boy presenting with typical features of CMT1 type, hearing impairment, and inguinal hernia who at the next-generation sequence analysis displayed a concomitant presence of two variants: the c.233 C>T p.Ser 78Leu of the MPZ gene (NM_000530.6) characterized as pathogenetic and the c.1403 G>A p.Arg 468His of the MFN2 gene (NM_014874.3) characterized as VUS. Concomitant variant mutations in CMTs have been uncommonly reported. The role of these gene mutations on the clinical expression and a literature review on this topic is discussed. [ABSTRACT FROM AUTHOR]

In this contribution, we aim at determining the role of climate in shaping the current and historical (Last Glacial Maximum and Middle Holocene) distributions of two parapatric bat species (Myotis daubentonii and Myotis capaccinii) in Europe, using ensemble Habitat Suitability Modelling (HSM). Model projection to current climatic conditions predicted distributions largely coherent with the ones observed for the two species in the study area. Temperature- and precipitation-linked variables well accounted for the observed parapatry of the two target species. Moreover, areas of co-occurrence turned out to be those where the main ecological needs concerning the most important range-limiting variables are met for both species. Model projections to past scenarios allowed us to hypothesize the effects of climatic oscillations over the distribution of the two species during the Late Pleistocene and Holocene. Extreme range contractions during the Last Glacial Maximum and the subsequent expansions during Middle Holocene were predicted, consistently with general patterns of post-glacial recolonization routes of many temperate bat species in Europe. Our findings are largely coherent with recent phylogeographic studies investigating the two target species, thus corroborating the validity of potential distribution scenarios obtained from the models and, more importantly, confirming the great influence that glacial cycles had in shaping the biogeography of the European fauna. [ABSTRACT FROM AUTHOR]

Sleep alterations are frequent occurrence in Bipolar Disorder (BD), both in acute and interepisodic phases. Sleep alterations have been also described both long before BD onset, as aspecific risk syndromes, or as immediate prodromes of BD onset. The aim of the present study is to systematically review the relationship between sleep alterations anticipating for the full-blown onset of BD, both in general and according to specific polarities of onset. A systematic literature research according to PRISMA statement and considering: 1. prospective studies about BD patients' offspring with sleep alterations who later developed BD. 2. prospective studies assessing patients with sleep disorders who later developed BD. 3. retrospective studies on BD patients where sleep alterations before BD onset of the disease were reported. A total of 16 studies were included in this review. Sleep disturbances may frequently appear 1 year before the onset of BD or more, often during childhood or adolescence. A decreased need for sleep may precede the onset of the illness, specially a manic episode, while insomnia appears to anticipate either a manic or a depressive episode. Hypersomnia seems to precede bipolar depressive episodes. Sleep alterations frequently appear long before the onset of BD, and appear to be related specifically to the polarity of the index episode. The detection and treatment of sleep alterations in special high risk populations may help achieving an earlier detection of the illness. [ABSTRACT FROM AUTHOR]

Objective: The study aimed to explore premorbid academic and social functioning in patients with schizophrenia, and its associations with the severity of negative symptoms and neurocognitive impairment. Method: Premorbid adjustment (PA) in patients with schizophrenia was compared to early adjustment in unaffected first‐degree relatives and healthy controls. Its associations with psychopathology, cognition, and real‐life functioning were investigated. The associations of PA with primary negative symptoms and their two factors were explored. Results: We found an impairment of academic and social PA in patients (P ≤ 0.000001) and an impairment of academic aspects of early adjustment in relatives (P ≤ 0.01). Patients with poor PA showed greater severity of negative symptoms (limited to avolition after excluding the effect of depression/parkinsonism), working memory, social cognition, and real‐life functioning (P ≤ 0.01 to ≤0.000001). Worse academic and social PA were associated with greater severity of psychopathology, cognitive impairment, and real‐life functioning impairment (P ≤ 0.000001). Regression analyses showed that worse PA in the academic domain was mainly associated to the impairment of working memory, whereas worse PA in the social domain to avolition (P ≤ 0.000001). Conclusion: Our findings suggest that poor early adjustment may represent a marker of vulnerability to schizophrenia and highlight the need for preventive/early interventions based on psychosocial and/or cognitive programs. [ABSTRACT FROM AUTHOR]

Summary: This study deals with the role of texture analysis as a predictive factor of radiation-induced insufficiency fractures in patients undergoing pelvic radiation. Introduction: This study aims to assess the texture analysis (TA) of computed tomography (CT) simulation scans as a predictive factor of insufficiency fractures (IFs) in patients with pelvic malignancies undergoing radiation therapy (RT). Methods: We performed an analysis of patients undergoing pelvic RT from January 2010 to December 2014, 24 of whom had developed pelvic bone IFs. We analyzed CT-simulation images using ImageJ macro software and selected two regions of interest (ROIs), which are L5 body and the femoral head. TA parameters included mean ( m), standard deviation (SD), skewness (sk), kurtosis ( k), entropy ( e), and uniformity ( u). The IFs patients were compared (1:2 ratio) with controlled patients who had not developed IFs and matched for sex, age, menopausal status, type of tumor, use of chemotherapy, and RT dose. A reliability test of intra- and inter-reader ROI TA reproducibility with the intra-class correlation coefficient (ICC) was performed. Univariate and multivariate analyses (logistic regression) were applied for TA parameters observed both in the IFs and the controlled groups. Results: Inter- and intra-reader ROI TA was highly reproducible (ICC > 0.90). Significant TA parameters on paired t test included L5 m ( p = 0.001), SD ( p = 0.002), k ( p = 0.006), e (p = 0.004), and u ( p = 0.015) and femoral head m ( p < 0.001) and SD ( p = 0.001), whereas on logistic regression analysis, L5 e ( p = 0.003) and u ( p = 0.010) and femoral head m ( p = 0.027), SD ( p = 0.015), and sex ( p = 0.044). Conclusions: In our experience, bone CT TA could be correlated to the risk of radiation-induced IFs. Studies on a large patient series and methodological refinements are warranted. [ABSTRACT FROM AUTHOR]

BackgroundFunctional decline among patients with mental illness is not unique to individuals with psychotic disorders. Despite this, research on early predictors of functional outcome mainly focused on individuals thought to have an ‘at risk mental state’ (ARMS) for psychosis. There is evidence suggesting that certain early vulnerability markers, such as neurological soft signs (NSS), may explain variability in functional outcomes independent of the level of psychosis risk and the traditional diagnostic classification.MethodStructural equation modeling was applied to baseline data from a prospective longitudinal study of 138 young individuals in treatment with secondary services for non-psychotic disorders. We evaluated theoretically based models of pathways to functional outcome starting from NSS. The intervening variables were established according to previous evidence and drawn from two general categories: cognition (neuro- and social-) and negative symptoms (expressive and experiential).ResultsA final trimmed model was a single path running from NSS to neurocognition to experiential negative symptoms to outcome. It could not be improved by adding or dropping connections that would change the single path to multiple paths. The indirect effect from NSS to outcome was significant. The validity of the model was independent of the ARMS status and the psychiatric diagnosis.ConclusionsOur results provide evidence for a single pathway model in which the starting and intervening variables represent modifiable trans-diagnostic therapeutic targets to improve functional trajectories in young individuals with a recent-onset psychiatric diagnosis and different levels of psychosis risk. [ABSTRACT FROM PUBLISHER]

The earthquake that occurred in L’Aquila (Abruzzi Region, Italy) on 6 April 2009 caused the destruction of many buildings and the deaths of 309 people. In summer 2009, new settlements were built in rural areas near L’Aquila to host part of the population whose houses were uninhabitable or had been totally destroyed. Our study is focused on the impact of these “new towns”, analyzing the variation of the micromammal community, from 2002 to 2013, through a barn owl pellet analysis. The study area is a 3-km buffer plot sited in the northwest of L’Aquila and affected by the so-called Progetto CASE (“Complessi Antisismici Sostenibili ed Ecocompatibili”) and Progetto MAP (“Moduli Abitativi Provvisori”). This analysis shows how the micromammal community has changed, qualitatively and quantitatively, because of the improvised and inadequately planned earthquake urbanization. For example, more sensitive species, such as wood mouse (Apodemus sylvaticus) and Savi’s pine vole (Microtus savii), both abundant before the earthquake, were replaced by the more anthropophilous house mouse (Mus domesticus) after the construction of the new settlements. [ABSTRACT FROM AUTHOR]

Background The prevalence of depressive disorders is high among patients with skin disease. The PC-SAD is a 37-item self-administered depression screening questionnaire that has been validated in dermatological patients. Objective The aim of this study was to develop and validate a brief depression severity instrument derived from the PC-SAD that can be used to assess severity and monitor ongoing clinical course. Methods Two patient samples participated in the study: 72 adult dermatological inpatients and 73 adults attending six primary care practices. Psychiatric assessment included the Structured Clinical Interview for DSM-IV and an 18-item version of the PC-SAD; moreover, dermatological patients completed the Patient Health Questionnaire depression scale (PHQ-9), while primary care patients were administered the Montgomery-Asberg Depression Rating Scale (MADRS). A subset of five PC-SAD items showing the best psychometric properties were selected, and the reliability and validity of the resulting instrument (PC-SAD5) were examined. Results The PC-SAD5 showed satisfactory internal consistency in both samples. There was a high correlation between PC-SAD5 and PHQ-9 and MADRS scores. Multiple regression analysis revealed a gradient of PC-SAD5 scores from patients with no mental disorder, those with milder forms of depression, to those with Major Depressive Disorder. Similar results were observed for the 18-item version of the PC-SAD. Conclusion The availability of valid and reliable continuous measures of depression severity derived from the PC-SAD extends its field of application from depression screening to use as a follow-up measure of depression severity in routine clinical practice. A validated very short instrument such as the PC-SAD5 may have substantial clinical value. [ABSTRACT FROM AUTHOR]

The proximal humeral fractures need a specific and specialist rehabilitation approach for their treatment, both for conservative or after shoulder artroplasty surgical implant. There are many factors that may influence the final recovery of the patient; the localization of the fracture (intra or extra capsular fracture), its size, the extent of the trauma, the general clinical conditions of the patient, the quality of the shoulder tissue and its personal ability to heal, the rehabilitative tecniques used, patient motivations and psicological aspects and how much time the patient have got to spend to follow the rehabilitation project to reach specific functional goals. The ROM deficit is the more common complication after proximal humeral fracture. The causes may be lack of articular congruence (stabilized meccanical rigidity without pain) or retraction of the capsulo ligament structures (changeable tissutal rigidity with pain). In most clinical situations (except prosthesis) an early passive articular mobilization in a safe range of motion (reduced ROM, on a scapular plane and avoiding rotations) will be usefull, postponing active mobilization and muscolar reinforce when there will be a safe clinical and radiological heal of the fracture or the prosthesis implant will be stable. The rehabilitation treatment of the patient that underwent surgical procedure of prosthesis implant (total shoulder arthroplasty, endoprosthesis, reverse shoulder arthroplasty, resurfacing prosthesis) needs in any case to avoid manual traction of the gleno humeral articulation or articular pompages, manual stabilizzation of the scapula, and in the first post surgery month to save humerous from rotations. In the end the clinical monitoring of many parameters (range of motion, muscolar force and endurance, coordinated skills, sportive gesture, daily living activity and functionality) using validated clinical tests (isokinetic and isometric tests, aerobic and anaerobic thereshold, scale to evaluate the functionality and the state of psychological health) will permit to understand if and at wich level the functional goals have been reached and will allow to observe far off the functional outcome. [ABSTRACT FROM AUTHOR]

Our aim in this observational study was to evaluate the feasibility of a multiphasic screening project for the detection and treatment of mood and anxiety disorders among cancer patients in a natural setting. One hundred sixty-five patients with cancer, consecutively admitted to the Oncology Division of San Camillo–Forlanini Hospital, were recruited to the study. All patients had solid tumors; the majority of them were colon, breast, and lung cancers. All patients completed the Hospital Anxiety and Depression Scale (HADS). Patients screened as positive were administered the following instruments by a psychiatrist: the Structured Clinical Interview for DSM-IV (SCID-I), the Beck Depression Inventory (BDI), the Hamilton Anxiety Rating Scale (HARS), and a validated scale for the rapid dimensional assessment of psychopathology (SVARAD). The BDI, HARS, and SVARAD were administered again at 4 and 10 weeks to all treated patients. Out of 45 patients administered the SCID-I, 37 had a mood or anxiety disorder. Adjustment disorders were identified in 20 patients, depressive disorders in 14, and anxiety disorders in three patients. Most patients were prescribed psychotropic medications: mirtazapine was prescribed to 15 patients, citalopram to 13 patients, and escitalopram to four patients. A significant improvement in symptoms of depression and anxiety was observed on all measures (P<.001). Although the design of the study prevents any firm conclusions about effectiveness, this study suggests that including psychiatric expertise in an oncology division is feasible and may lead to improved detection and treatment of psychiatric disorders among cancer patients. Further randomized trials are needed to elaborate on our findings. Depression and Anxiety 23:441–448, 2006. © 2006 Wiley-Liss, Inc. [ABSTRACT FROM AUTHOR]

Background: It has often been suggested that stress might trigger vitiligo. However, only one study supported this hypothesis, and no study explored the role of other personality or social factors.Methods: Out-patients experiencing a recent onset or exacerbation of vitiligo (n = 31) were compared with out-patients with skin conditions in which psychosomatic factors are commonly were regarded as negligible (n = 116). Stressful events during the last 12 months were assessed with Paykel's Interview for Recent Life Events. Attachment style, alexithymia and social support were assessed with the 'Experiences in Close Relationships' questionnaire, the Toronto Alexithymia Scale (TAS-20), and the Multidimensional Scale of Perceived Social Support, respectively.Results: Cases and controls did not differ regarding the total number of events and the number of undesirable, uncontrollable or major events. Three or more uncontrollable events had occurred more frequently among cases than controls. Perceived social support was lower in cases than in controls. Cases scored higher than controls on anxious attachment, tended towards higher scores on avoidant attachment and were classified more often as insecure. Cases scored higher than controls on the TAS-20 and were classified more often as alexithymic or borderline alexithymic. The occurrence of many uncontrollable events, alexithymia and anxious attachment were associated with vitiligo also in multiple logistic regression analysis.Conclusions: These findings suggest that vulnerability to vitiligo is not increased by stressful events, except for many uncontrollable events. Alexithymia, insecure attachment and poor social support appear to increase susceptibility to vitiligo, possibly through deficits in emotion regulation or reduced ability to cope effectively with stress. [ABSTRACT FROM AUTHOR]

The aim of the study was to perform a dimensional assessment of subjective stress in the Municipal Police of the City of Rome. We assessed two random samples of 590 traffic police and 590 clerical police officers of both sexes for subjective stress through the administration of the ‘Rapid Stress-Assessment Scale’ (RSA), a self-rated tool; subjects completed the questionnaire during a non-working day. Subsequently, from each sample we randomly included two subsamples of 115 subjects each, to whom we administered the RSA at the beginning and at the end of their shift. Significant differences between traffic and clerical police officers were found in the RSA total score, which was higher among traffic agents. Traffic police officers were found significantly more often in the ‘high stress class’. Gender differences analysis showed higher scores among women. The analysis of the subsample of 230 persons showed a significantly greater degree of the RSA ‘depression’ cluster at the end of the shift only in traffic police officers. The assessment of over-the-counter drug use (NSAID, analgesics, etc.) showed that, among police officers habitually using such drugs, only the traffic police subgroup scored higher on the RSA. Our results could be taken to mean that the stress response of Municipal Police officers who work outdoors is more maladaptive than that of officers working in the office; this could be compatible with the existence of different occupational stressors between the two groups. Copyright © 2002 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Unlabelled: The aim of this study was to determine whether any relationship exists between the severity of mutation of the phenylalanine hydroxylase (PAH) gene and the plasma concentrations of phenylalanine (Phe) and tyrosine (Tyr) under fasting and semifasting conditions among heterozygotes in a matched case-control study. Parents of patients affected by PAH deficiency (n = 25) detected through the Italian Neonatal Screening Program and referred from January 1994 to June 2000, and parents of healthy children were investigated. In total, 68 subjects without any disease, 34 hyperphenylalaninaemia (HPA) heterozygous parents and 34 age- and gender-matched controls, were recruited. Plasma concentrations of Phe and Tyr in fasting and semifasting (1600 mg Phe oral load) conditions were the main outcome measures. DNA analysis for PAH mutations was performed in all 68 subjects. Compared with controls, heterozygotes showed higher fasting and semifasting Phe concentrations (p < 0.0001), lower semifasting Tyr concentrations (p = 0.015), lower Tyr variations (p = 0.003) and a higher Phe/Tyr ratio (p < 0.0001) in switching from fasting to semifasting conditions. Heterozygotes carrying a severe mutation showed semifasting plasma Tyr concentrations lower than controls (p = 0.019) but not significantly different from Tyr levels found in non-severe carriers (p = 0.197). The Tyr variations were minor in severe carriers than controls (p < 0.001) and non-severe carriers too, although with lower significance (p = 0.089). In six carriers of A403V mutation, parents of mild hyperphenylalaninaemics on an unrestricted diet, significant differences in variations from fasting to semifasting conditions were found compared with parents of patients on a diet.Conclusion: Although the great heterogeneity of PAH mutations limits any general conclusion, the results suggest that monitoring plasma Tyr variations may be more sensitive than plasma Phe in assessing the severity of PAH mutations in HPA heterozygotes. [ABSTRACT FROM AUTHOR]

We have shown that treatment with interleukin-2 (IL-2) or interferon-α (IFNα) may induce depressive symptoms and activation of the cytokine network and that IL-2 treatment may diminish serum dipeptidyl pepdidase IV (DPP IV) activity. DPP IV (EC 3.4.14.5) is a membrane bound serine protease which catalyzes the cleavage of some cytokines and neuroactive peptides which modulate T cell activity. The aims of the present study were to examine the effects of IFNα-based immunotherapy on serum DPP IV activity in relation to induction of the inflammatory response system. In 18 patients with chronic active hepatitis C, we determined the Montgomery and Asberg Rating Scale (MADRS), the Hamilton Anxiety Rating Scale (HAM-A), serum DPP IV activity, the kynurenine/tryptophan (K/T) quotient, which is an indicator of cytokine (in particular IFN)-induced catabolism of tryptophan, and serum interleukin-8 (IL-8) before starting therapy and 2, 4, 16 and 24 weeks after immunotherapy with IFNα. IFNα-immunotherapy significantly suppressed serum DPP IV 2-4 weeks and 1624 weeks after starting IFNα-based immunotherapy. The reduction in serum DPP IV activity was more pronounced 16-24 weeks after starting immunotherapy than after 2-4 weeks. The IFNα-induced suppression of serum DPP IV activity was significantly correlated to IFNα-induced increases in the MADRS and HAM-A and increases in the K/T quotient and serum IL-8. In conclusion, long-term immunotherapy with IFNα suppresses serum DPP IV activity and the immunotherapyinduced changes in DPP IV are related to increases in severity of depression, anxiety and activation of the inflammatory response system. [ABSTRACT FROM AUTHOR]

Background.—Aminergic neurotransmitter activity has been studied in many neuropsychiatric diseases by means of a self-administered questionnaire proposed by Cloninger. Given that central aminergic modulation plays a major role in the pathophysiology of primary headaches, we investigated the personality dimensions related to aminergic neurotransmitter activity in patients with migraine and tension-type headache. Methods.—From a consecutive series of 230 patients, we selected those presenting with migraine and tension-type headache according to the International Headache Society criteria. All patients were assessed by means of the Cloninger 100-item self-report Tridimensional Personality Questionnaire and a depression scale. The four dimensions of personality are novelty seeking (dopaminergic), harm avoidance (serotonergic), reward dependence (noradrenergic), and persistence (glutaminergic). Results.—One hundred twenty-one patients presenting with migraine and 42 with tension-type headache were recruited. The results indicate significantly higher harm avoidance scores (P<.001) in both patients with migraine and those with tension-type headache than in controls. Furthermore, patients with migraine had a significantly low score in the novelty seeking dimension (P<.001). When we compared only the two groups of patients with headache, we found that the persistence dimension alone was significantly higher in patients with migraine than in those with tension-type headache (P<.05). No differences were observed either in the overall scores of the other personality dimensions or in the depression scale scores. Conclusions.—The Tridimensional Personality Questionnaire results support a role of the serotonergic system in both migraine and tension-type headache pathophysiology. A dysfunction of dopaminergic and glutaminergic tone seems to be a specific feature of migraine. [ABSTRACT FROM AUTHOR]