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Technostress is an emergent phenomenon related to the pervasive use of technology and is associated with the increased computerisation and digitalisation seen over recent decades. This cross-sectional observational study aims to investigate the impact that stress from the use of technologies (i.e. technostress) has on the productivity and life of an individual. Cross-sectional study. Data were collected using a previously proposed and validated questionnaire. The questionnaire was translated into Italian and transformed into an online format with a Google Docs form. The questionnaire was then associated with a link and QR code (also available in paper format) and disseminated manually and through the use of e-mail and social networks, such as Facebook and Twitter. The study sample included 313 individuals, 54.6% of whom were women. The mean age of the sample participants was 34.7 years. The dependent variables were technstressors (i.e. techno-overload, techno-invasion, techno-complexity, techno-insecurity and techno-uncertainty), role stressors (i.e. role overload and role conflict) and productivity. In the multivariate analysis, techno-overload was significantly associated with female gender (β = 0.128; P = 0.018) and unemployment (β = −0.303; P < 0.001); techno-invasion was significantly associated with female gender (β = 0.098; P = 0.081) and degree-level education (β = 0.149; P = 0.008); techno-complexity was significantly associated with female gender (β = 0.107; P = 0.057) and being married (β = 0.113; P = 0.046); techno-uncertainty was significantly associated with unemployment (β = 0.337; P < 0.001); role overload was significantly associated with female gender (β = 0.160; P = 0.014) and productivity was significantly associated with degree-level education (β = 0.125; P = 0.057). This observational study evaluated the phenomenon of both work-related and non–work-related technostress of 313 individuals aged between 16 and 65 years. The present study investigated the impact of five techno-stressors, two role stressors and productivity. The results indicate that different techno-stressors are significantly associated with female gender, degree-level education and unemployment. Further research in this field is required to better understand and clarify the epidemiology, clinical presentation and determinants of technostress. • Technostress is an emergent phenomenon related to the pervasive use of technology in the current digital age. • Different techno-stressors are significantly associated with female gender, degree-level education and unemployment. • Further research is required on the epidemiology, clinical presentation and determinants of technostress. [ABSTRACT FROM AUTHOR]

The objective of this study was to measure the burden of burnout in a sample of healthcare workers (HCWs) consisting of general practitioners, professors from the Faculty of Medicine and Surgery, nurses, medical students and nursing students. Cross-sectional questionnaire survey. A descriptive analysis was carried out, using averages, medians, standard deviations (SD) and ranges for quantitative variables. Univariate, bivariate and multivariate analyses were also performed. In total, 535 HCWs completed the survey. Multivariate analysis shows that increasing age (β = −0.183; P = 0.047), being a university professor (β = −0.118; P = 0.001), having a high physical score (β = −0.370; P < 0.001) and a high mental score (β = −0.574; P < 0.001) resulted in less personal burnout. Low work burnout was associated with being a student (β = −0.144; P < 0.001), a university professor (β = −0.146; P < 0.001), having a high physical score (β = −0.366; P < 0.001) and having a high mental score (β = −0.648; P < 0.001). Being female (β = −0.122; P < 0.001), a university professor (β = −0.333; P = 0.001), a student (β = −0.433; P < 0.001), having a high physical score (β = −0.26; P < 0.01) and having a high mental score (β = −0.460; P < 0.001) were predictors for reduced client burnout. However, high client burnout was seen in individuals who had a commuting time >30 min (β = 0.084; P = 0.012) predicts. This study shows that burnout is an important issue among HCWs and that prevention strategies must be considered, with a particular focus on physical and mental health. [ABSTRACT FROM AUTHOR]

Highlights • Low PFCs concentration in children living in Sicily. • PFSO concentration is higher in girls. • Maternal parity is significantly associated with PFDA and PFHxS. • Months of breastfeeding is significantly correlated with PFUnDA. Abstract Perfluorinated compounds (PFCs) are a large group of man-made chemicals characterized by a completely fluorinated hydrophobic linear carbon chain attached to a hydrophilic head. The presence of PFCs has been related with various adverse effects on several organs and systems. 61 children (6–11 years of age) living in Sicily underwent medical examination and blood and urine routinary tests, as well as the serum concentration of 16 PFCs. These compounds (∑PFCs = 5.888 ng/mL, range 1.035–12.94 ng/mL) were widely detected in the samples of all children, showing that they had been extensively exposed to PFCs, especially perfluorooctane sulfonate (PFOS), perfluorooctanoic acid (PFOA), perfluorohexanesulfonate (PFHxs) and perfluorodecanoic acid (PFDA). In addition, long-chained PFCs were found in children's blood correlated with short-chained ones. Perfluorodecanoic acid (PFDA) (beta=−0.114) and PFHxS (beta = 0.003) levels were correlated with maternal parity; while the "months of breastfeeding" variable is correlated with perfluoroundecanoic acid (PFUnDA) concentrations (beta = 0.008). Female gender is negatively associated with PFOS (beta = 0.008). The adverse health effects of PFCs on young children should be noted, due to their growing phase. Therefore, further studies are needed to monitor and address adverse health outcomes of PFCs on children, especially those living in industrial regions. [ABSTRACT FROM AUTHOR]

Abstract: Introduction: Health Technology Assessment (HTA) approach was applied to Human Papilloma Virus (HPV) vaccine in the Italian context. Methods: Epidemiology and costs of HPV infection and related diseases, vaccine efficacy, clinical and economic impact of the HPV vaccination and women''s knowledge and attitudes towards vaccination were assessed. Results: HPV infections pooled prevalence in Italy was 19% (95%CI: 10–30%) and cervical cancer incidence was 9.8/100,000 per year. The mean costs for in situ and invasive carcinoma hospitalisation were estimated respectively in €1745.87 and €2616.16. HPV vaccines have demonstrated high efficacy and good safety profile. The meta-analysis on efficacy results in preventing persistent cervical infections by HPV16 and 18 for both HPV vaccines resulted in 87% (95%CI: 80–91%) and 78% (95%CI: 62–87%). Modelling the impact of vaccination with bivalent vaccine, it would reduce cancer cases by 67% and be cost-effective, with a cost per Quality Adjusted Life Years (QALYs) gained of €22,055. Conclusion: The thoroughness of the evaluation allowed us accounting for all the aspects of HPV infection/diseases. The HTA report on the HPV vaccine demonstrated to be a comprehensive tool for an informed decision making process. [Copyright &y& Elsevier]

Summary: Background: Out-of-hospital cardiac arrest (OHCA) accounts for 250.000–350.000 sudden cardiac deaths per year in the United States. The availability of automated external defibrillators (AEDs) promoted the implementation of public access defibrillation programs based on out-of-hospital early defibrillation by non-healthcare professionals. Aim of the study: To perform a systematic review and a meta-analysis of the pooled effect of studies comparing the outcome of pts receiving cardiopulmonary resuscitation plus AED therapy (CPR+AED) vs. cardiopulmonary resuscitation (CPR) alone, both delivered by non-healthcare professionals, for the treatment of OHCA. Methods: We performed a search of the relevant literature exploring major scientific databases, carrying out a hand search of key journals, analysing conference proceedings and abstracts and discussing the topic with other researchers. Two analyses were planned to assess the outcomes of interest (survival to hospital admission and survival to hospital discharge). Results: Three studies were selected for the meta-analysis. The first meta-analysis evidenced a RR of 1.22 (95% C.I.: 1.04–1.43) of surviving to hospital admission for people treated with CPR+AED as compared to CPR-only. The second meta-analysis showed a RR of 1.39 (95% C.I.: 1.06–1.83) of surviving to hospital discharge for people treated with CPR+AED as compared to CPR-only. Conclusions: The results of our meta-analysis demonstrate that programs based on CPR plus early defibrillation with AEDs by trained non-healthcare professionals offer a survival advantage over CPR-only in OHCA. The conclusions of our meta-analysis add to previous evidence in favour of developing public-health strategies based on AED use by trained layrescuers. [Copyright &y& Elsevier]

Abstract: Objective: To verify whether the distribution of paresthesias in patients with Carpal Tunnel Syndrome (CTS) is related to the degree of the neurophysiological involvement. Methods: We performed a cross-sectional study and retrospectively evaluated 163 patients who referred to our electromyography lab and to which a clinical and electrophysiological diagnosis of CTS was made. We divided the patients into two groups: (1) patients complaining of paresthesias at the hand as a whole and (2) patients with paresthesias in the territory of the median nerve. We referred to the distribution of paresthesias at the hand as GLOVE and to the distribution in the territory of the median nerve as MEDIAN. We compared the neurophysiological impairment in GLOVE and MEDIAN distributions. Moreover, we performed multiple regression analysis to evaluate which clinical–neurophysiological variables determined GLOVE and MEDIAN distribution. Results: In our sample, 70.4% of patients had GLOVE distribution and 29.6% of patients MEDIAN distribution. The risk of presenting MEDIAN distribution increases about twice (OR=2.07; 95% IC: 1.51–2.83) for each unitary increment of neurophysiological class. Conclusions: The distribution of paresthesias reflects the degree of nerve damage at wrist; patients suffering of SEV/EXT CTS present MEDIAN distribution. Significance: Our data have important clinical implications because they strongly suggest that we have to consider the possibility of a severe neurophysiological involvement of the median nerve at wrist in patients complaining of MEDIAN distribution. [Copyright &y& Elsevier]

Abstract: Susceptibility to gastric cancer may be in part attributable to inter-individual variability in metabolic activation or detoxification of carcinogens, and in this context the polymorphic GSTM1 gene has been extensively studied. Seventeen reports detailing a possible association between GSTM1 deletion and gastric cancer have been published so far. In order to examine the risk of gastric cancer associated with GSTM1 null genotype, a meta-analysis of published case–control studies was undertaken using a random effect model. Two studies were excluded because some data were missing in the results. The principal outcome measure was the odds ratio for the risk of gastric cancer. Pooling all the 15 studies identified, the overall odds ratio of gastric cancer risk associated with GSTM1 deficiency was 1.24 (95% confidence interval, 1.00–1.54). Furthermore, by pooling four studies detailing the possible interaction between GSTM1 status smoking habits and gastric cancer risk, an overall estimate of odds ratio of 2.93 (95% confidence interval, 1.56–5.47) for ever smokers with GSTM1 deficiency compared to non-smokers with GSTM1 normal genotype has emerged. These results suggest that GSTM1 status probably has no effect on the risk of gastric cancer per se, but may modulate tobacco-related carcinogenesis of gastric cancer. Greater attention should therefore be paid to the design of future studies: only well designed population-based control studies considering all the possible confounding risk factors and based on a sample size commensurate with the detection of small genotypic risk may allow a more definitive conclusion. [Copyright &y& Elsevier]

Summary: Over the past two decades, scientific research has led to the development of a huge number of new health technologies, among which new vaccines. The decision process underlying the introduction of a new vaccine will be of particular concern in the future and a useful tool is needed to orientate decision makers towards better allocation of economic resources. Health Technology Assessment (HTA) is a multidisciplinary tool that aims to examine the clinical, economic, organizational, ethical, juridical, social and cultural implications of the introduction or the implementation of a specific technology; it could so represent an innovative and effective approach in order to support decision-making processes. [Copyright &y& Elsevier]

Abstract: Epidemiological studies suggest that n-3 polyunsaturated fatty acid (n-3 FA) deficiency is a risk factor for bipolar disorders (BDs). The aim of this study was to determine whether such a deficit does exist in patients with BD and to characterize the overall plasma fatty acid (FA) profile in these patients. Using gas chromatography/mass spectrometry, we measured fasting plasma levels of 15 FAs in 42 patients diagnosed with BD according to DSM-IV criteria and in 57 age- and gender-matched healthy controls. Plasma docosahexaenoic acid (DHA) levels were significantly decreased in bipolar patients (p < 0.001 versus healthy controls). Compared with controls, patients had higher plasma levels of all other FAs, including arachidonic acid (AA, p < 0.001), alpha-linolenic acid (ALA, p < 0.001), and eicosapentaenoic acid (EPA) (p < 0.001). Although in the present study we observed significant DHA deficits in the plasma of bipolar patients our findings do not support the therapeutic use of ALA and/or EPA supplementation. DHA may provide a basis for possible pharmacological intervention in psychiatric disorders at the level of second messengers linked to the phosphatidylinositol cycle. Finally, measurement of FA levels in plasma seems to be more reliable and reproducible than assays of erythrocyte FA content. [Copyright &y& Elsevier]

Abstract: Objective: To evaluate, in 5 simulated motor nerves with patchy demyelination: (1) the sensitivity of the conventional motor conduction examination; (2) the conduction velocity of single axons (SA-CV). Methods: Four damaged segments were simulated in each nerve. Myelin impairment was generated by varying two parameters: (1) percent reduction in conduction velocity, i.e. degree of damage (DEGREE); (2) percentage of affected axons, i.e. extent of damage (EXTENT). Myelin impairment was simulated in axons with different diameters. We evaluated: (1) conduction velocity; (2) temporal dispersion of the negative phase of compound motor action potential (CMAP); (3) amplitude decay of CMAP; (4) SA-CV of 20 randomly-chosen axons. Results: When the damage involved both large and small axons, the conduction velocity was pathological only when severe myelin damage involved a large number of axons. Temporal dispersion and amplitude decay were more sensitive than conduction velocity in detecting the damage. In damage involving only large axons or only small axons, all parameters remained in the normal range. SA-CV evaluation was much more sensitive than the conventional studies, regardless of the diameter of the damaged axons. Conclusions: Conventional studies are not sensitive in detecting minimal myelin damage. Decomposing the CMAPs and randomly studying 20 SA-CVs would increase the sensitivity of damage detection. Significance: These results contribute to a better understanding of the relationship between axonal properties and neurophysiological findings in motor nerve demyelination. [Copyright &y& Elsevier]

Abstract: Sulfotransferases (SULT) catalyse both the bioactivation and detoxification of a wide range of promutagens and carcinogens. The SULT1A1 gene possesses a G→A polymorphism that results in a Arg to His substitution at codon 213, and the His allele has been shown to have a low activity and thermal stability. To test the hypothesis that individuals carrying the variant allele may be at high risk of gastric cancer, we identified the SULT1A1 Arg213His genotype by a PCR-based RFLP in a preliminary study of 76 gastric adenocarcinoma patients that underwent curative gastrectomy and 260 age and sex-matched controls from a medical centre in Rome. A comprehensive epidemiological interview was conducted on all participants to collect lifestyle data. The prognostic significance of the SULT1A1 Arg213His polymorphism with respect to staging, differentiation and histological type of gastric cancer was also evaluated. The frequencies of His/His in cases and controls were 11.9% (9/76) and 5% (13/260), respectively (P=0.025). After adjusting for substance use, age, gender and physical activity, individuals with His/His showed a 3.32 fold increased risk of developing gastric cancer compared to those with Arg/Arg (95% CI=1.17–9.45). This positive association was more pronounced amongst males, alcohol drinkers, current smokers and consumers of grilled/barbecued meat and, unexpectedly, amongst individuals with a high intake of fruit. A statistically significant association was also found between the diffuse type of gastric cancer and the heterozygous SULT1A1 genotype. Our preliminary findings suggest for the first time that the SULT1A1 His 213 allele may be important in the development of gastric cancer, with other factors modulating such effect. [Copyright &y& Elsevier]

Detect and quantify morpho-functional alterations of the retina and choroid in patients affected by familial hypercholesterolemia (FH) treated with lipoprotein apheresis (LA) using optic coherence tomography (OCT) and optic coherence tomography-angriography (OCTA). Observational study. To be diagnosed: A group of 20 patients (40 eyes) being clinically and genetically diagnosed as FH and under treatment (FH-Group)", for at least 2 years, was compared to a control group of 20 healthy subjects (40 eyes), with a normal lipid profile and no ocular disease (CT-Group). Participants were studied with the slit lamp, binocular indirect fundoscopy, OCT and OCTA. Best corrected visual acuity (BVCA), spherical equivalent (SE), intraocular pressure (IOP), central macular thickness (CMT), choroidal thickness (CHT), retinal nerve fiber layer in four quadrants (RNFL (Superior = Sup; Inferior = Inf; Nasal = Nas Temporal = Temp), and the mean value across the four quadrants (RNFL G), foveal avascular zone (FAZ) and vascular density (VD). FH subjects had smaller RNFL superiorly (108 ± 19,38 μm OD/111 ± 16,56 μm OS FH-Group vs 127 ± 7,42 μm OD/129 ± 14,64 μm OS CT-Group; P < 0,001 for both OD and OS) and inferiorly (108 ± 23,58 μm OD/115 ± 17,33 μm OS FH-Group vs 128 ± 18,15 μm OD/133 ± 17,38 μm OS CT-Group; P = 0,002 OD; P = 0,001 OS). G RNFL was consequently smaller (93 ± 12,94 μm OD/94 ± 10,49 μm OS FH-Group vs 101 ± 9,01 μm OD/101 ± 10,20 μm OS CT-Group; P = 0,03 OD; P = 0,02 OS). FH subjects had a larger FAZ (0,31 ± 0,08 mm2 OD/0,33 ± 0,10 mm2 in OS FH-Group vs 0,21 ± 0,05 mm2 OD/0,21 ± 0,07 mm2 OS CT-Group; P < 0,001 OD; P = 0,002 OS). Early signs of retinal vessel damage in FH patients can be detected and quantified with OCT and OCTA. [ABSTRACT FROM AUTHOR]

The concentration of road transport emissions impacts on air quality, is responsible for climate change and increases the average temperatures. The aim of this study was to analyze the trends of atmospheric emissions within the road transport sector in Italy between 1990 and 2016. A principal component analysis (PCA) was carried out to investigate the pollutants that showed similar trends over time. The Kendall's rank correlation coefficient was studied to establish the statistically dependent variables. Finally, a joinpoint regression analysis was performed to evaluate the time-trends of pollutants' emissions. The Pearson's correlation coefficients were positive for all pollutants except for CO 2 , that demonstrated an inverse relationship with CH 4 (−0.07), NOx (−0.089) and NMVOC (−0.128); NO 2 demonstrated inverse relationship with all other pollutants. According to the main component analysis, most pollutants were assimilable in their behavior, except for NO 2 , CO2 and N 2 O. The joinpoint analysis describes a general decrease of emissions over time with exception of N 2 O, NO 2 and CO 2 , that showed different trends. This study shows that road traffic-related emissions in Italy, between 1990 and 2016, recorded significant reductions for most of the recorded pollutants. However, CO 2 and N 2 O maintained a stable trend while NO 2 showed an increasing trend. Unlabelled Image • Between 1990 and 2016, a strong decrease of greenhouse gases emission was recorded. • NMVOC, CH 4 , NOx, PM 2.5 and PM 10 demonstrated a rate of decrease over time. • N 2 O emission levels grew until 1996, decreased until 2012 and rose again until 2016. • CO 2 emissions maintained a steady trend over time. [ABSTRACT FROM AUTHOR]

Background The aim was to perform a systematic review and meta-analysis on the relationship between tobacco smoking and the onset of acute myeloid leukemia (AML) in adults. Methods PubMed and Scopus databases were systematically searched. In the meta-analysis, random or fixed effects models were used according to the presence of heterogeneity. Study quality was assessed using the Newcastle-Ottawa Scale. Results Twenty-seven articles were included. Case-control and cohort meta-analyses show that current, ever and former smokers have a significant increased risk to develop AML compared to never smokers [current: OR = 1.36 (1.11–1.66) and RR = 1.52 (1.10–2.14); ever: OR = 1.25 (1.14–1.38) and RR = 1.45 (1.10–1.90); former: OR = 1.21 (1.03–1.41) and RR = 1.45 (1.08–1.94)]. Moreover, increasing smoking intensity and duration is associated with an increase of the risk, OR shift from 1.14 (1–20 pack/years) to 2.36 (>40 pack/years). Discussion and conclusion Smoking may have a significant role in AML onset in a multistep pathogenesis. [ABSTRACT FROM AUTHOR]

Objectives: Tobacco packaging represents an important form of promotion of tobacco products and for this reason plain packaging (PP) can be considered an additional tobacco control measure. In Italy the current tobacco packaging is branded with textual warnings. The study investigated the perception of PP with textual warnings (PPTWs) and pictorial warnings (PPPWs) in Italy. Study design: Cross-sectional. Methods: The study was conducted on adults who were current, never and former smokers. The participants watched out three types of packages (current packaging, PPTWs and PPPWs) and eight pictorial warnings, and indicated which they considered the most effective ones to motivate smoking cessation or reduction and to prevent the onset. Results: 1065 subjects were recruited. The PPPWs were considered the most effective in motivating to quit, reduce and prevent the smoking habits (ranged 83.4%-96.1%) in all tobacco users and age groups (<40/>40 years) (P < 0.005). In general PP does not seem to be very effective in quitting for three-quarters of the smokers and 60% declared that they would have still started smoking with PP. The younger group believed less than the older one that PP gives a motivation to quit (29.4% vs 39.1%, P = 0.002). The pictures perceived as most effective in communicating the smoking effects were lung cancer and gangrene (about one-third of the sample). [ABSTRACT FROM AUTHOR]

Mathematical modeling constitutes an emerging area of oncological research aiming to predict spatial and temporal evolution of tumors, by describing many different phenomena which occur at different scales. Among these, modeling at the macroscopic scale has a great potential of application, when diagnostic imaging evaluation is used to identify the metabolic tumor volume undergoing proliferation. With breast carcinoma one of the most common cancer occurrences, the personal involvement for the patient and the cost for the national health system vary considerably with the adopted treatment. When a neoadjuvant (volume reducing) drug therapy is a direct option, the choice of drug may dictate the physical burden and the surgical strategy for subsequent lumpectomy/mastectomy. This paper employs a mass transfer modeling approach in order to gain deeper insight into breast carcinoma proliferation and therapy at the tissue scale. The aim is to develop a predictive, quantitative method for each given patient. Model flexibility is demonstrated, to facilitate model replication for large patient cohorts. The proposed procedure may serve as a basis for a decision support system for surgeons and towards personalized treatment optimization of breast tumors. [ABSTRACT FROM AUTHOR]

Abstract: Benzene is a widespread air pollutant and a well-known human carcinogen. Evidence is needed regarding benzene intake in the pediatric age group. We investigated the use of urinary (u) trans,trans-muconic acid (t,t-MA), S-phenylmercapturic acid (SPMA), and unmodified benzene (UB) for assessing exposure to low concentrations of environmental benzene and the role of living environment on benzene exposure in childhood. u-t,t-MA, u-SPMA, u-UB and u-cotinine were measured in urine samples of 243 Italian children (5–11years) recruited in a cross-sectional study. Analytical results were compared with data obtained from questionnaires about participants'' main potential exposure factors. u-UB, u-t,t-MA and u-SPMA concentrations were about 1.5-fold higher in children living in urban areas than in those in the rural group. Univariate analyses showed that u-UB was the only biomarker able to discriminate secondhand smoke (SHS) exposure in urban and rural children (medians=411.50 and 210.50ng/L, respectively); these results were confirmed by the strong correlation between u-UB and u-cotinine in the SHS-exposed group and by multivariate analyses. A regression model on u-SPMA showed that the metabolite is related to residence area (p <0.001), SHS exposure (p =0.048) and gender (p =0.027). u-UB is the best marker of benzene exposure in children in the present study, and it can be used as a good carcinogen-derived biomarker of exposure to passive smoking, especially related to benzene, when urine sample is collected at the end of the day. In addition, it is important to highlight that SHS resulted the most important contributor to benzene exposure, underlining the need for an information campaign against passive smoking exposure. [Copyright &y& Elsevier]

Background / Aims: The association between NAFLD and psoriasis has never been explored in prospective epidemiological studies. The aim of this 2-phase study was to study the clinical features of NAFLD in patients with psoriasis. Methods: Phase 1: Investigation of prevalence and characteristics of NAFLD in an unselected cohort of 142 adult Italian outpatients with psoriasis vulgaris. Phase 2: Comparison of the psoriasis cohort subgroup with NAFLD and an age- and body mass index-matched retrospective cohort of 125 non-psoriasis patients with biopsy proven NAFLD. Results: Based on histories, laboratory tests, and ultrasound studies, 84 (59.2%) received clinical diagnosis of NAFLD; 30 had factors potentially associated with liver disease other than NAFLD (e.g., viral hepatitis, significant ethanol, methotrexate use); and 28 (19.7%) had normal livers. Comparison of the normal-liver and NAFLD subgroups revealed that NAFLD in psoriasis patients (Ps-NAFLD) was significantly correlated with metabolic syndrome (p <0.05); obesity (p =0.043); hypercholesterolemia (p =0.029); hypertriglyceridemia (p <0.001); AST/ALT ratio >1 (p =0.019), and psoriatic arthritis (PsA) (p =0.036). The association with PsA remained significant after logistic regression analysis (OR=3.94 [CI, 1.07–14.46]). Compared with the retrospective non-psoriatic NAFLD cohort (controls), Ps-NAFLD patients (cases) were likely to have severe NAFLD reflected by non-invasive NAFLD Fibrosis Scores and AST/ALT >1. Conclusions: NAFLD is highly prevalent among psoriasis patients, where it is closely associated with obesity (overall and abdominal), metabolic syndrome, and PsA, and more likely to cause severe liver fibrosis (compared with nonPs-NAFLD). Routine work-up for NAFLD may be warranted in patients with psoriasis, especially when potentially hepatotoxic drug therapy is being considered. [Copyright &y& Elsevier]

Abstract: Background and purpose: A systematic review and meta-analysis was performed to assess the impact of radiotherapy on both 3- and 5-year survival in patients with resectable gastric cancer. Methods: Randomized Clinical Trials (RCTs) in which radiotherapy, (preoperative, postoperative and/or intraoperative), was compared with surgery alone or surgery plus chemotherapy in resectable gastric cancer were identified by searching web-based databases and supplemented by manual examination of reference lists. Meta-analysis was performed using Risk Ratios (RRs). Random or fixed effects models were used to combine data. The methodological quality was evaluated by Chalmers’ score. Results: Radiotherapy had a significant impact on 5-year survival. Using an intent to treat (ITT) and a Per Protocol (PP) analysis, the overall 5-year RR was 1.26 (95% CI: 1.08–1.48; NNT=17) and 1.31 (95% CI: 1.04–1.66; NNT=13), respectively. Although the quality of the studies was variable, the data were consistent and no clear publication bias was found. Conclusion: This meta-analysis showed a statistically significant 5-year survival benefit with the addition of radiotherapy in patients with resectable gastric cancer. Radiotherapy remains a standard component in the treatment of resectable gastric cancer and new RCTs need to address the impact of new conformal radiotherapy technologies. [Copyright &y& Elsevier]

Purpose: In the literature, a favorable prognosis was observed for complete pathologic response after preoperative therapy (ypCR) in patients with locally advanced rectal cancer. The aim of this study is to verify whether ypCR predicts a favorable outcome in a large series of patients. Methods and Materials: The Gastro-Intestinal Working Group of the Italian Association of Radiation Oncology collected clinical data for 566 patients with ypCR (ypT0N0) after neoadjuvant therapy. Eligibility criteria included locally advanced rectal cancer with no evidence of metastases at the time of diagnosis, evidence of ypCR after preoperative radiotherapy ± chemotherapy (CT). Results: Median radiation dose was 50 Gy. A total of 527 patients (93%) received one of 12 different neoadjuvant CT schedules. Sphincter preservation, anteroposterior resection, and endoscopic surgery were performed in 73%, 22%, and 5% of patients, respectively. Adjuvant CT was administered to 22% of patients. Median follow-up was 46.4 months. Locoregional recurrence occurred in 7 patients (1.6%). Distant metastases occurred in 49 patients (8.9%). Overall, 5-year rates of disease-free survival, overall survival, and cancer-specific survival were 85%, 90%, and 94%, respectively. In multivariate analysis, only age and clinical stage statistically correlated with survival outcome. Adjuvant CT was still of borderline significance (worse for adjuvant CT). No relation was found between survival and neoadjuvant CT schedules. Conclusion: A ypCR after neoadjuvant therapy identified a favorable group of patients, even in this large series of 566 patients collected in 61 centers. Locoregional recurrence occurred only in 1.6% patients. [Copyright &y& Elsevier]

Abstract: Background: The aim of the present study was to evaluate if serum Tg mRNA assay predicts recurrence in patients undergoing thyroidectomy for cancer. Methods: Sixty-four consecutive patients undergoing surgery between April 1997 and July 1999 were studied. One year after surgery, blood samples were taken for serum thyroglobulin (Tg) immunoassay and for Tg mRNA assay by reverse transcription–polymerase chain reaction (RT-PCR). All patients underwent periodical clinical examination, including laboratory tests for serum Tg immunoassay, neck ultrasound, radioiodine scans, and treatment if indicated. Kaplan-Meier estimates of survival were calculated according to the presence or absence of circulating Tg mRNA and according to baseline Tg levels. Results: Tg mRNA was detected in 14 (21.8%) of 64 patients with thyroid carcinoma. After a median follow-up of 110 months, 8 patients (12.5%) relapsed. Among patients with detectable Tg mRNA (n. 14), only 1 distant metastasis occurred (7%), whereas lymph node metastases (n = 3) or distant metastases (n = 4) were detected in 7 of 50 patients (14%) with undetectable Tg mRNA. Tumor relapse occurred in all 7 patients with increased serum Tg and only in 1 out of 57 patients (1.7%) with normal or undetectable serum Tg. The disease-free interval of patients positive at baseline for Tg mRNA was similar to that of patients with undetectable Tg mRNA at baseline. Similar results were obtained when we limited the analysis to only patients who received postsurgical radioiodine ablation. Conclusions: The results of present study suggest that detection of circulating Tg mRNA 1 year after thyroidectomy for cancer might be of no utility in predicting early and midterm local and distant recurrences. [Copyright &y& Elsevier]

Objectives: We sought to evaluate the value of the extent of microvascular damage as assessed with myocardial contrast echocardiography (MCE) in the prediction of left ventricular (LV) remodeling after ST-segment elevation myocardial infarction (STEMI) as compared with established clinical and angiographic parameters of reperfusion. Background: Early identification of post-percutaneous coronary intervention microvascular dysfunction may help in tailoring appropriate pharmacological interventions in high-risk patients. The ideal method to establish effective microvascular reperfusion after percutaneous coronary intervention remains to be determined. Methods: A total of 110 patients with first successfully reperfused STEMI were enrolled in the AMICI (Acute Myocardial Infarction Contrast Imaging) multicenter study. After reperfusion, peak creatine kinase, ST-segment reduction, and Thrombolysis In Myocardial Infarction (TIMI) and myocardial blush grade were calculated. We evaluated perfusion defects with MCE by using continuous infusion of Sonovue (Bracco, Milan, Italy) in real-time imaging. The endocardial length of contrast defect (CD) on day 1 after reperfusion was calculated. Wall motion score index, the extent of wall motion abnormalities, LV end-diastolic volume, and ejection fraction after reperfusion and at follow-up also were calculated. Results: Of 110 patients, 25% evolved in LV remodeling and 75% did not. Although peak creatine kinase, ST-segment reduction >70%, and myocardial blush grade were not different between groups, in patients exhibiting LV remodeling, TIMI flow grade 3 was less frequent (p < 0.001), wall motion score index was greater (p < 0.001), and CD was greater (p < 0.001). At multivariate analysis, only TIMI flow grade <3 and CD with a cutoff of >25% were independently associated with LV remodeling. Among patients with TIMI flow grade 3, CD was the only independent variable associated with LV remodeling. Conclusions: Among patients with TIMI flow grade 3, the extent of microvascular damage, detected and quantitated by MCE, is the most powerful independent predictor of LV remodeling after STEMI as compared with persistent ST-segment elevation and myocardial blush grade. [Copyright &y& Elsevier]

Purpose: To prospectively compare the rates of pathologic response, acute toxicity, and sphincter preservation with two different schedules of preoperative chemoradiotherapy in patients with cT3 mid-distal rectal cancer. Methods and Materials: Patients with cT3 and/or N+ resectable rectal carcinoma were randomized to receive one of the two following chemoradiotherapy regimens: cisplatin, 5-fluorouracil, and radiotherapy (PLAFUR) or raltitrexed, oxaliplatin, and radiotherapy (TOMOX-RT). For PLAFUR, cisplatin (60 mg/m2) was given on Days 1 and 29, with a prolonged infusion of 5-fluorouracil (1,000 mg/m2) on Days 1–4 and 29–32, plus concurrent radiotherapy (50.4 Gy in 1.8-Gy fractions daily). For TOMOX-RT, raltitrexed (3 mg/m2) and oxaliplatin (130 mg/m2) was given on Days 1, 19, and 38 with the same radiotherapy regimen as used for PLAFUR. Surgery was performed 6–8 weeks after completion of chemoradiotherapy. All pathologic specimens were reviewed by a designated expert pathologist. The primary endpoint of this study was pathologic tumor downstaging (defined as tumor regression grade 1-2). Secondary endpoints included the incidence of ypT0, clinical tumor downstaging, sphincter-saving surgery, and acute treatment-related toxicity. Results: Between 2002 and 2005, 164 patients were accrued in 10 Italian centers, 83 patients in the PLAFUR arm and 81 in the TOMOX-RT arm. Overall, tumor regression grade 1-2 was observed in 76 patients (46.4%) and ypT0 in 49 (29.9%). The tumor regression grade 1-2 rate was 41.0% vs. 51.9% (p = 0.162) and the ypT0 rate was 24.1% vs. 35.8% (p = 0.102) for the PLAFUR vs. TOMOX-RT arm, respectively. The overall rate of tumor regression grade 1 and ypN+ was 4.6%. The occurrence of ypT downstaging was significantly greater in the TOMOX-RT arm (p = 0.035). Grade 3-4 acute toxicity occurred in 19 patients (11.6%): 7.1% in the PLAFUR arm vs. 16.4% in the TOMOX-RT arm. Sphincter-saving surgery was performed in 143 patients (87.2%) overall: 87.9% in the PLAFUR arm and 86.4% in the TOMOX-RT arm. Conclusions: Compared with the PLAFUR regimen, TOMOX-RT achieved a greater incidence of downstaging but was associated with a correspondingly greater rate of acute Grade 3+ toxicity. With longer follow-up, the local control and survival rates might offer additional guidance as to the choice of regimen. [Copyright &y& Elsevier]

Objectives: We evaluated telomerase activity in circulating polymorphonuclear neutrophils (PMN) and in PMN isolated from coronary atherosclerotic plaques by a novel approach. Background: Delayed apoptosis of PMN have been demonstrated in unstable angina (UA). These cells have a finite lifespan with low telomerase activity, a polymerase that extends telomeres, structures essential for cell aging. Reactivation of telomerase has been associated with resistance to apoptosis. Methods: We studied 20 patients with UA and 6 patients with chronic stable angina (SA), undergoing a percutaneous coronary intervention. Circulating PMN were isolated from venous blood and PMN derived from coronary plaque were isolated from washing medium of angioplasty balloons. Results: Telomerase activity was higher in coronary plaque PMN of UA patients than in coronary plaque PMN of SA patients (122.7, range 20.5 to 3,696; and 47.7, range 16 to 212.6, respectively, p = 0.001) and higher than in peripheral PMN of SA patients (122.7, range 20.5 to 3,696 vs. 59, range 16.5 to 132.5, p = 0.001). We found a statistically significant difference between venous and coronary plaque PMN telomerase activity in UA patients (z = −2.875; p = 0.004). Among UA patients, a shorter time interval from symptom onset to coronary PMN sampling was the only independent predictor of high telomerase activity in coronary plaque PMN (p < 0.001, R2 = 0.75). Conclusions: In UA patients, telomerase activity is high in coronary plaque PMN, while it is low in peripheral PMN. Telomerase reactivation in resident PMN resulting in a prolonged lifespan might play a key role in the early phases of instability. [Copyright &y& Elsevier]

Abstract: Recently the influence of polymorphisms of different genes involved in metabolism of chemoterapic agents have been studied especially in childhood acute lymphoblastic leukemia (ALL). We evaluated the influence of C677T and A1298C methylenetetrahydrofolate reductase (MTHFR) polymorphisms on time to relapse and survival and on methotrexate (MTX) toxicity in 82 ALL adult patients. Relapse free survival and event free survival between homozygous wild-type and variant patients in both polymorphisms were not significantly different. However, we observed an association between 677TT variant and survival in a subset of ALL patients homogenously treated with MTX-based maintenance (p =0.02). In the same subgroup we confirmed the role of 677TT variant on toxicity during MTX treatment (p =0.003). [Copyright &y& Elsevier]