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Reducing mitral regurgitation (MR) during mitral transcatheter edge-to-edge repair (M-TEER) may come at the cost of increased mitral valve gradient (MVG). The combined impact of residual MR and MVG on clinical outcomes after M-TEER is unknown. This study sought to evaluate the impact of postprocedure MR and MVG on clinical outcomes after M-TEER. EXPANDed is a pooled, patient-level cohort of the EXPAND (A Contemporary, Prospective Study Evaluating Real-world Experience of Performance and Safety for the Next Generation of MitraClip Devices) and EXPAND G4 studies, which were designed to evaluate real-world safety and effectiveness of the third- and fourth-generation MitraClip TEER Systems. Subjects were categorized by echocardiographic core laboratory (ECL) assessments into 4 groups according to 30-day MR grade and mean MVG: 1) MR ≤1+/MVG <5 mm Hg; 2) MR ≤1+/MVG ≥5 mm Hg; 3) MR ≥2+/MVG <5 mm Hg; and 4) MR ≥2+/MVG ≥5 mm Hg. A total of 1,723 subjects had evaluable echocardiograms at 30 days: 72% had MR ≤1+/MVG <5 mm Hg, 18% had MR ≤1+/MVG ≥5 mm Hg, 7% had MR ≥2+/MVG <5 mm Hg, and 3% had MR ≥2+/MVG ≥5 mm Hg. MR≤1+ was sustained through 1 year in 93% of patients who achieved 30-day MR≤1+. MVG decreased from 30 days to 1 year in subjects with MVG ≥5 mm Hg (6.7 ± 4.0 to 5.5 ± 2.5 mm Hg MR ≤1+/MVG ≥5 mm Hg and 6.5 ± 1.5 to 5.5 ± 1.7 mm Hg MR ≥2+/MVG ≥5 mm Hg). One-year rates of all-cause mortality and heart failure hospitalization were lower for subjects who achieved MR ≤1+ at 30 days, regardless of MVG. Reduction of MR to mild or less after M-TEER with the latest-generation MitraClip systems was associated with clinical benefit regardless of MVG. [Display omitted] [ABSTRACT FROM AUTHOR]

This paper presents a novel approach to ontology-based automatic question generation (AQG), which aims to facilitate the creation of 'complex' educational questions, i.e. questions requiring larger knowledge cover and higher cognitive/reasoning processes. We leverage on the notion of Query Graphs, a graph-like structure that can represent natural language queries through appropriate mappings, previously used for semantic parsing. We propose the use of Query Graphs as a formalism for representing templates that incorporate multiple ontology-based constraints during question generation, which can then guide the selection of relevant ontology elements and properties. By incorporating these constraints, our approach elevates the level of reasoning required to answer the questions, therefore overcoming the limitations of existing methodologies. We evaluate the approach by modelling templates for AQG and comparing the resulting questions with existing state-of-the-art methods, on performance based on complexity levels. The empirical evaluation demonstrates that our model is indeed able to generate questions that demand higher cognitive skills. [ABSTRACT FROM AUTHOR]

Candidemia is the most common healthcare associated invasive fungal infection. Over the last few decades, candidemia caused by Candida species other than Candida albicans , particularly the Candida parapsilosis complex, has emerged worldwide. The aims of this study were: to analyze the genotypic and phenotypic characteristics of C. parapsilosis strains isolated from blood cultures and the environment in a hospital in southern Italy, to study the possible source of infection and to correlate the isolated strains. From April to October 2022, cases of candidemia due to C. parapsilosis in patients admitted to a hospital in the Apulia region were investigated. However, 119 environmental samples from the intensive care unit were collected for identification of the likely environmental reservoir of infection. Routine antifungal (amphotericin B, anidulafungin, fluconazole) susceptibility was performed on all isolates. Whole genome sequencing was performed to study the genotypic correlation of the isolates. Biofilm biomass and metabolic activity were also quantified for all isolates. A total of 43 C. parapsilosis isolates were cultured from the bloodstream of each patient in different departments, and seven surface samples were positive for C. parapsilosis. Most of the isolated yeasts (41/50; 85 %) were resistant to fluconazole and were genetically related to each other, suggesting an ongoing clonal outbreak of this pathogen. The fluconazole-susceptible isolates produced significantly more biofilm than did the resistant isolates. Metabolic activity was also higher for fluconazole-susceptible than resistant isolates. Cross-transmission of the microorganisms is suggested by the phenotypic similarity and genetic correlation between clinical and environmental strains observed in our study. [ABSTRACT FROM AUTHOR]

To assess the effectiveness and safety of cryoablation (CRA) for the treatment of recurrent or oligometastatic solid tumors located in the thoracoabdominal soft tissues. Twenty-two percutaneous CRA procedures performed in 19 patients to treat recurrent or oligometastatic tumors in thoracoabdominal soft tissue were retrospectively examined. All procedures were performed between January 2015 and June 2021 under ultrasound and computed tomography (CT) guidance, and the most complex procedures were performed with CT-based navigation systems. The histology of the primary tumors included colorectal adenocarcinoma, squamous cell lung carcinoma, pancreatic adenocarcinoma, renal cell carcinoma, and hepatocellular carcinoma. Adverse events, technical success, and local tumor control were analyzed. The mean age of the patients was 66.5 years, with a mean tumor size of 24.8 mm. The mean time of the procedures was 68 minutes, with a mean number of 2.5 cryoprobes used. Hydrodissection was performed in 63% of the procedures to protect the surrounding anatomical structures. The mean size of the ice ball, measured on axial CT scans at the end of the procedures, was 43.5 mm. No severe adverse events were observed. Technical success was achieved in all cases. Three patients experienced local tumor progression (2 residual disease and 1 recurrence), which were successfully treated with a second CRA procedure. Percutaneous CRA is a safe and effective therapy in selected cases of recurrent or oligometastatic tumors in the thoracoabdominal soft tissues. [Display omitted] [ABSTRACT FROM AUTHOR]

The third-generation MitraClip NTR/XTR transcatheter edge-to-edge repair system was introduced to assist in leaflet grasping with the longer clip arms of MitraClip XTR and to improve ease of use with the modified delivery catheter. The EXPAND study evaluated contemporary real-world outcomes in subjects with mitral regurgitation (MR) treated with the third-generation MitraClip NTR/XTR transcatheter edge-to-edge repair system. EXPAND is a prospective, multicenter, international, single-arm study that enrolled patients with primary MR and secondary MR at 57 centers. Follow-up was conducted through 12 months. Echocardiograms were analyzed by an echocardiographic core laboratories. Study outcomes included: MR severity, functional capacity measured by New York Heart Association functional class, quality of life measured by Kansas City Cardiomyopathy Questionnaire, heart failure hospitalizations, all-cause mortality. 1,041 patients were enrolled from April 2018 through March 2019, of which 50.5% had primary or mixed etiology. Implant success was 98.9%; 1.5 ± 0.6 clips were implanted per subject. Significant MR reduction from baseline (≥MR 3+: 56.0%) to 30 days (≤MR 1+:88.8%) was maintained through 1 year (MR ≤1+: 89.2%). A total of 84.5% and 93.0% of subjects in primary MR and secondary MR, respectively, had ≤1+ MR at 1 year. Significant improvements were observed in clinical outcomes (New York Heart Association functional class I/II in 80.3%, +21.6 improvement in Kansas City Cardiomyopathy Questionnaire score) at 1 year. All-cause mortality and heart failure hospitalizations at 1 year were 14.9% and 18.9%, respectively, which was significantly lower than previous studies. The study demonstrates treatment with the third-generation system resulted in substantial reduction of MR in a contemporary real-world practice, compared with the results of earlier EVEREST and COAPT trials.(The MitraClip® EXPAND Study of the Next Generation of MitraClip® Devices [EXPAND]; NCT03502811) [Display omitted] [ABSTRACT FROM AUTHOR]

In Industry 4.0, the availability of signals from multiple sensors stimulates the investigation of novel quality monitoring and prediction methods. This paper tackles the in-line machining process monitoring by exploiting big data in the shape of multi-stream complex signals, eventually containing degradation and tool wear signatures. The proposed novel solution is fed by real-time multichannel data to identify anomalous states in machining applications. We investigate the effectiveness of a category of ANNs specifically conceived to predict process patterns based on time series of sensor signals, i.e., the Gated-Recurrent-Unit-Network. A real case study shows the efficiency of the proposed solution in predicting wild, complex and drifting patterns, typical of real productions, highlighting its provided benefits for in-line big data mining in industrial applications. [ABSTRACT FROM AUTHOR]

Artichoke (Cynara cardunculus var. scolymus) is a plant well known for its nutritional properties, but generally, the food industry uses only the 20% of the whole plant represented by the "artichoke heart", while the other parts (leaves, stems and brats) are considered by-products and destined to be a waste. In the present study, two flours obtained from stems and the bracts (ASF and ABF) of the artichoke cultivar "Violetto Catanese", were previously characterized for nutritional and functional properties and then used in gluten free bread preparations. The replacement of gluten free mix formula ("NutriFree") with 7% of vegetable flour (ASF or ABF) resulted in a gluten-free bread with physico-chemical characteristics not significantly (p > 0.05) different from those of the Control but with improved fibre content. Moreover, the experimental bread obtained, had a huge amount of total polyphenols that seems to be resistant to baking process and determined an increase in the antioxidant activity of the bread. Therefore, the present work, enhances the potential use of ASF and ABF as food ingredients in order to improve the functional properties of gluten-free bread. • Preparation of vegetable flours using artichoke by-product. • Use of stems and brats flours in gluten-free formulation. • Improvement of functional properties of gluten-free bread. • Sensory evaluation of gluten-free bread made using vegetable flours. [ABSTRACT FROM AUTHOR]

The world of heart transplantation is cruelly impacted by a shortage of grafts. This can be explained by the poor quality of preservation of heart grafts before transplantation and the absence of consensus in the solutions used worldwide. We developed a new original preservation solution named LYPS (for LYon Preservative Solution). Our objective was to compare LYPS to clinical solutions and to determine the impact of temperature on cell death pathways and their impact on heart functional recovery. We used a mimetic cold-ischemia-reperfusion H9C2 cellular model (20 h preservation at 5-10-15-20 and 25 °C, followed by 2 h of reoxygenation at 37 °C). Cell necrosis, apoptosis, and mitochondrial membrane potential were evaluated by flow cytometry. In parallel, an ex vivo retrograde perfusion rat heart model was used. Hearts were submitted to static preservation in LYPS, Celsior or Plegisol at 4 °C and 15 °C, then reperfused for 1 h where cardiac functions are assessed. A preservation time kinetic was carried out to determine the maximum time at which the rat heart could be resuscitated to regain function (4-8-12-16-20 h). In vitro results showed that, after 20 h of cold hypothermia (5 °C) preservation and 2 h of reoxygenation, necrosis (2.8% LYPS vs. 79.3%, Plegisol, 61.6%, Celsior and 90% UW, respectively) and apoptosis were significantly reduced in LYPS comparing to other solutions. LYPS was effective in preserving DyM (85% in LYPS vs. 5% in other solutions). Moreover, mid-thermie seemed to be associated with less cell death with all solutions used (for ex: 90% at 4 °C vs. 31% at 20 °C in Plegisol). Preliminary ex vivo results show that, for short storage times (4 h), there is no significant difference impact of the solution used on the cardiac functions but when the storage time is extended to 8 or 12 hours, storage in LYPS seems to ensure a better functional recovery in comparison with Plegisol solution. Our preliminary data show that LYPS offers a cellular protection that allow a good preservation of cells during 20 h where commercial solutions failed. Moreover, LYPS seems to offer better functional protection in ex vivo model, when preservation time is extended. [ABSTRACT FROM AUTHOR]

Innate lymphoid cells (ILCs) comprise cytotoxic natural killer (NK) cells and helper ILCs (hILCs). Human hILC development is less characterized as compared with that of NK cells, although all ILCs are developmentally related. It has been reported that the immunosuppressive drugs glucocorticoids (GCs) regulate ILC function, but whether they control ILC differentiation from hematopoietic stem cells (HSCs) is unknown. This study sought to analyze the effect of GCs on ILC development from HSCs. This study exploited an in vitro system to generate and expand from peripheral blood HSCs a multipotent CD56+ ILC precursor able to differentiate into NK cells, ILC1s, and ILC3s. We also analyzed ex vivo , at different time points, the peripheral blood of recipients of allogeneic HSC transplantation who were or were not treated with GCs and compared ILC subset reconstitution. In vitro , GCs favor the generation of NK cells from myeloid precursors, while they strongly impair lymphoid development. In support of these data, recipients of HSC transplantation who had been treated with GCs display a lower number of circulating hILCs, including the ILC precursor (ILCP) previously identified as a systemic substrate for tissue ILC differentiation. GCs impair the development of the CD117+ ILCP from CD34+ HSCs, while they do not affect the further steps of ILCP differentiation toward NK cells and hILC subsets. This reflects an association of GC treatment with a marked reduction of circulating hILCs in the recipients of HSC transplantation. [ABSTRACT FROM AUTHOR]

Two large nationwide databases collect data on common operations in the United States. The Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) collects bariatric data, whereas the National Quality Improvement Program (NSQIP) gathers details on a broader range of general surgical cases. Evaluate the differences in rates of complications between both databases regarding Roux-en-Y gastric bypass and sleeve gastrectomy. National databases, United States. We evaluated the MBSAQIP and NSQIP from 2017 to 2019 using the procedure codes 43644 and 43775. Fifteen common complications were evaluated. Propensity-matched analyses (PMAs) were done to control for differences across databases. Significantly different variables after a PMA were included in multivariable models. The data were examined for differences between the 2 databases before and after the PMA, with and without adjustment for operation type. There were 483,361 cases reported in the MBSAQIP and 57,598 in the NSQIP. PMA matched 57,479 cases for each database. Seven complications were different, with higher rates reported in the NSQIP than in the MBSAQIP: myocardial infarction, sepsis, organ/space surgical site infections, deep vein thrombosis, urinary tract infections, pulmonary embolism, ventilator dependence >48 hours, and pneumonia. When adjusting for the procedure performed, sleeve gastrectomy in the NSQIP had higher rates of organ/space surgical site infections, deep vein thrombosis, sepsis, and death. Roux-en-Y gastric bypass in the NSQIP had higher rates of organ/space surgical site infections, ventilator dependence >48 hours, urinary tract infections, myocardial infarction, deep vein thrombosis, and sepsis. When compared with the MBSAQIP, the NSQIP reports higher rates of bariatric complications. Further studies are needed to confirm the reasons behind this. [ABSTRACT FROM AUTHOR]

In the near future, 6G networks will be able to provide its users with heterogeneous tailored end-to-end network services for edge AI-powered applications. However, in many 6G use case scenarios there may not be structured network infrastructures. One of the most appealing solutions to meet this problem is to bring computing, networking and storage facilities on site by means of UAVs. The target of this paper is the definition of a management framework for Flying Ad-Hoc Networks (FANET) aimed at bringing edge computing to remote areas, guaranteeing low latency to ground devices with heterogeneous requirements in terms of mean latency. The proposed framework allows zero-touch management of different network slices realized by partitioning the Computing Elements (CE) installed on each UAV of the FANET and wireless links connecting them to each other. An Inter-Slice Orchestrator is in charge of deciding this resource partition, while an Intra-Slice Orchestrator manages horizontal offload among UAVs for each slice via Reinforcement Learning, in order to reduce end-to-end latency and delay jitter. [ABSTRACT FROM AUTHOR]

The purpose of this study was to evaluate the P-REDI discharge tool for safe discharge to home following ambulatory surgery. A quasi-experimental, mixed methods with pre/post nurse surveys and retrospective chart review comparing pre-, interim- and post-implementation of P-REDI on unscheduled clinic visits, Emergency Department visits, hospital readmission, and length of stay. The P-REDI tool was developed in collaboration with anesthesia and based upon an extensive review of the literature on safe discharge from the Phase II Postanesthesia Care Unit (PACU). Nurse surveys and patient data extracted from the electronic health record through the computer-assisted reporting system were analyzed using descriptive statistics, bivariate statistics, and correlations to assess outcomes and relationships between variables. Nurses' perceptions of discharge criteria improved after implementation of P-REDI. There were no differences in adverse events before, during, and after the implementation of the P-REDI instrument. There was a significant decrease in Phase II time after implementation of the tool. There were also significant correlations with the P-REDI score and related variables such as length of surgical procedure time and length of stay. The P-REDI tool was developed to provide nurses a concrete, objective tool to increase their level of comfort with discharging patients from the Phase II PACU. The tool significantly decreased length of stay in Phase II without any change in adverse events. The cost savings to the institution needs to be examined in future studies. [ABSTRACT FROM AUTHOR]

Adequate long-term follow-up after metabolic and bariatric surgery (MBS) remains a challenge. To evaluate if type of insurance correlated with differences in the 5-year follow-up and outcomes of a cohort of bariatric surgery patients in a community-based accredited center. Accredited private practice bariatric center in the United States. We studied bariatric surgery patients that underwent MBS in 2015 by a single surgeon in an accredited, community practice. Electronic medical records were utilized to evaluate 5-year follow-up and outcomes data. This included demographics, type of insurance, number of follow-up visits, height, weight, body mass index (BMI), postbariatric procedures, and postbariatric emergency department (ED) utilization. There were 89 patients. The follow-up rate decreased over time, with 1% of patients at 5 years. There was a slightly higher follow-up rate in patients with commercial versus public insurance. The average BMI of patients that followed up decreased by 13.6 kg/m2 over the first postoperative year. The average number of ED visits was 1.46 (standard deviation: 2.38) overall; however, of the 89 total patients, 35 patients (39.3%) had no documented ED visits, with the remaining 61 patients (63.5%) ranging from 1–15 visits (median = 1). Overall follow-up rates were low with 4-year follow-up being 14% and 5-year follow-up being <1%. Publicly insured patients had a higher rate of follow-up. Despite low follow-up rates with the actual bariatric surgery practice, 63.5% of patients had an ED visit during the follow-up period. [ABSTRACT FROM AUTHOR]

This numerical modeling study (i) assesses the influence of the sediment erosion process on the sediment dynamics and subsequent morphological changes of a mixed-sediment environment, the macrotidal Seine estuary, when non-cohesive particles are dominant within bed mixtures (non-cohesive regime), and (ii) investigates respective contributions of bedload and suspended load in these dynamics. A three dimensional (3D) process-based morphodynamic model was set up and run under realistic forcings (including tide, waves, wind, and river discharge) during a 1-year period. Applying erosion homogeneously to bed sediment in the non-cohesive regime, i.e., average erosion parameters in the erosion law (especially the erodibility parameter, E 0), leads to higher resuspension of fine sediment due to the presence of coarser fractions within mixtures, compared to the case of an independent treatment of erosion for each sediment class. This results in more pronounced horizontal sediment flux (two-fold increase for sand, +30% for mud) and erosion/deposition patterns (up to a two-fold increase in erosion over shoals, generally associated with some coarsening of bed sediment). Compared to observed bathymetric changes, more relevant erosion/deposition patterns are derived from the model when independent resuspension fluxes are considered in the non-cohesive regime. These results suggest that this kind of approach may be more relevant when local grain-size distributions become heterogeneous and multimodal for non-cohesive particles. Bedload transport appears to be a non-dominant but significant contributor to the sediment dynamics of the Seine Estuary mouth. The residual bedload flux represents, on average, between 17 and 38% of the suspended sand flux, its contribution generally increasing when bed sediment becomes coarser (can become dominant at specific locations). The average orientation of residual fluxes and erosion/deposition patterns caused by bedload generally follow those resulting from suspended sediment dynamics. Sediment mass budgets cumulated over the simulated year reveal a relative contribution of bedload to total mass budgets around 25% over large erosion areas of shoals, which can even become higher in sedimentation zones. However, bedload-induced dynamics can locally differ from the dynamics related to suspended load, resulting in specific residual transport, erosion/deposition patterns, and changes in seabed nature. [ABSTRACT FROM AUTHOR]

While proximal hamstring tears at the myotendinous junction are common sports-related injuries that are often successfully treated nonoperatively, complete avulsions from the origin on the ischial tuberosity are less common and better treated with surgical repair to prevent significant functional limitations and ongoing weakness. The diagnosis can be easily missed, leading patients to present several months after the initial injury. In addition, some patients decide on nonoperative management initially but later present requesting surgical intervention. The delayed cases are challenging due to often significant tendon retraction, making direct repair difficult if not impossible. Techniques using allograft and autograft reconstruction have been described for this clinical situation. This Technical Note describes the use of 2 Achilles tendon allografts fixed via 5 suture anchors to reconstruct a chronic complete avulsion injury of the proximal hamstring with >5-cm retraction. [Display omitted] [ABSTRACT FROM AUTHOR]

Background and Aims: Metabolic Syndrome (MS) has been related to an impairment in arterial structural and functional properties with heterogeneous results. In this paper we focused on the effects of MS on arterial carotid-femoral PWV and common carotid IMT in two different populations, one of hypertensive patients and one of healthy controls.Methods and Results: We enrolled 816 consecutive HT and 536 healthy controls. Vascular structural (IMT) and functional (PWV) properties were evaluated. NCEP-ATP-III criteria were used for diagnosis of MS. MS was diagnosed in 26.9% and 6.9% in hypertensive and control subjects, respectively. PWV was similar in controls with and without MS (7.7 ± 1.9 vs 7.6 ± 1.1 m/s, p = 0.69), while IMT was higher in controls with than those without MS (0.64 ± 0.18 vs 0.57 ± 0.13 mm, p = 0.02). Hypertensives with MS were older (57.9 ± 12.2 vs 52.7 ± 14.1 years, p < 0.001) and showed higher PWV (9.0 ± 2.3 vs 8.4 ± 2.1 m/s, p = 0.001) and IMT (0.72 ± 0.22 vs 0.65 ± 0.17 mm, p < 0.001) than those without MS, however at the age-adjusted analysis only the difference in IMT was confirmed (p = 0.007). Regression models showed that MS was an independent determinant of IMT in both controls (β = 0.08, p = 0.03) and hypertensives (β = 0.08, p = 0.01), but not of PWV either in controls (β = 0.006, p = 0.886 and β = 0.04, p = 0.19, respectively).Conclusions: the main finding of our work is that MS is a significant determinant of IMT while this is not the case for PWV. This result have been confirmed both in hypertensive subjects and in healthy controls. [ABSTRACT FROM AUTHOR]

Magnetic sphincter augmentation (MSA) has gained popularity as a treatment for gastroesophageal reflux disease (GERD). The role of MSA in treating GERD in metabolic and bariatric surgery (MBS) patients at the time of primary MBS is unknown. To determine the short-term outcomes of MSA placed at the time of MBS. National database, United States. We queried the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database for MSA performed at time of the sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) for the years 2017–2018. A propensity adjusted analysis was performed to assess 30-day outcomes of patients who had MSA placed versus those who did not. There were 319,580 patients who underwent MBS in the study period. Twenty-four patients had MSA at time of surgery. These patients did not have a higher reported rate of preoperative GERD (P =.93). Six patients (25%) with MSA had a RYGB; the other 18 patients (75%) patients had SG (P <.001). Operative times were similar between the groups and there was no difference in length of stay. After propensity matched analysis (with 24 patients in each arm), patients who underwent an MSA had shorter discharge times (1.4 days [.8] versus 2.0 [.9], P =.012). MSA is safe in the short term in MBS. There is no difference in major morbidity or mortality and operative times are similar in MSA patients. The long-term efficacy of this practice is unknown. Magnetic sphincter augmentation (MSA) does not increase complications at the time of primary bariatric surgery. There is no significant increase in operative times in bariatric patients undergoing MSA. The long term efficacy of MSA in bariatric patients is unknown. [ABSTRACT FROM AUTHOR]

Background and Aim: Heterogeneous results have been obtained in the relationship between Uric Acid (UA) and Target Organ Damage (TOD). In the present study we sought to assess the prevalence of hyperuricemia in healthy subjects as well as the role of UA in determining TOD. We evaluated vascular, cardiac and renal TODs in the whole population as well as sub-grouped by gender.Methods and Results: As many as 379 blood donors participated at the present analysis. TOD was evaluated as Pulse Wave Velocity (PWV), Left Ventricular Mass Index (LVMI) and carotid Intima-Media Thickness (IMT). Hyperuricemia was defined with the classic cut-off (>7.0 in men and >6.0 mg/dL in women) but also with a most recently defined one (5.6 mg/dL for both sex). Hyperuricemia was present in 6.3% of the whole population (7.3% males, 2.8% females) considering the classic cut-off, while, with the recently identified one, it was present in 28.2% of the whole population (37.3% males, 4.7% females). Despite all the evaluated TODs significantly correlated with UA, linear multivariate regression analysis showed that none of them, except for GFR, displayed UA as a significant covariate. Similar figures were found also when both correlation and linear regression analyses were repeated in the two genders separately.Conclusions: Hyperuricemia is an important problem also in healthy subjects and its prevalence could further increase if lower cut-off will be used. In this specific population UA is significantly associated with renal impairment while this was not the case for cardiac and vascular damage. [ABSTRACT FROM AUTHOR]

Adolescents and young adults, aged 13–24 years, are disproportionately affected by HIV in the United States. Youth with HIV (YHIV) face many psychosocial and structural challenges resulting in poor clinical outcomes including lower rates of medication adherence and higher rates of uncontrolled HIV. The Johns Hopkins Intensive Primary Care clinic, a longstanding HIV care program in Baltimore, Maryland, cares for 76 YHIV (aged 13–24 years). The multidisciplinary team provides accessible, evidenced-based, culturally sensitive, coordinated and comprehensive patient and family-centered HIV primary care. However, the ability to provide these intensive, in-person services was abruptly disrupted by the necessary institutional, state, and national coronavirus disease 2019 (COVID-19) mitigation strategies. As most of our YHIV are from marginalized communities (racial/ethnic, sexual, and gender minorities) with existing health and social inequities that impede successful clinical outcomes and increase HIV disparities, there was heightened concern that COVID-19 would exacerbate these inequities and amplify the known HIV disparities. We chronicle the structural and logistic approaches that our team has taken to proactively address the social determinants of health that will be negatively impacted by the COVID-19 pandemic, while supporting YHIV to maintain medication adherence and viral suppression. [ABSTRACT FROM AUTHOR]

In the recent years, several studies and industrial developments have been devoted to the improvement of process repeatability, stability and robustness to enhance the industrial breakthrough of Additive Manufacturing (AM) technologies. Indeed, highly regulated sectors like aerospace and healthcare have been pulling the industrial innovation in metal AM, and this makes defect avoidance and qualification issues of fundamental importance. This imposes an urgent need for novel in-line and in-situ qualification and control tools able to guarantee a stable process and defect-free products. On the one hand, the layerwise paradigm of AM processes enables the capability of acquiring a large amount of data during the process to measure quality characteristics of the part and measure process signatures that are proxies of the process stability over time. On the other hand, data mining and statistical methods are needed to make sense of big data streams gathered in-line and in-situ, to design automated and robust defect detection tools. This paper reviews the opportunities and challenges related to in-situ sensing and monitoring solutions for zero-defect and first-time-right AM processes, with a special focus on metal Powder Bed Fusion (PBF) processes. [ABSTRACT FROM AUTHOR]

• Aging in air of Li 4 SiO 4 modifies its initial CO 2 capture capacity and kinetics. • LiOH is formed at the surface of Li 4 SiO 4 during water vapor exposure. • The reaction between Li 4 SiO 4 and CO 2 present in air is promoted by water vapor. • The properties of Li 4 SiO 4 powders with high surface area could be regenerated by heating at 700 °C. In this study, we evaluated the physicochemical stability of lithium orthosilicate (Li 4 SiO 4) powders after aging in air. Thermogravimetric (TG) analysis in CO 2 flow evidences that as-milled Li 4 SiO 4 stored in a closed plastic container in air at Room Temperature (RT) suffers a time progressive CO 2 absorption. This carbonation is clearly noticed in the samples with greater specific surface area and depends on two factors: the time of air exposure and the renewal of the air atmosphere in the plastic container, both of them modifying the CO 2 capture capacity and kinetics of the material. Specific experiments to analyze the effect of water vapor and carbon dioxide atmospheres on the CO 2 capture properties of Li 4 SiO 4 were designed. TG, X-ray diffraction and spectroscopic studies demonstrate that the reaction between as-milled Li 4 SiO 4 and CO 2 present in air was promoted by exposure to humidity. In fact, LiOH and LiOH.H 2 O were formed at the surface of Li 4 SiO 4 during water vapor exposure. These phases enhance the reaction with CO 2 from the air to form Li 2 CO 3 at RT before the first carbonation cycle. As a consequence, the CO 2 capture capacity of Li 4 SiO 4 in the first carbonation cycle was smaller than the one of Li 4 SiO 4 without water vapor exposure. In opposition, negligible CO 2 absorption occurred at RT under CO 2 atmosphere. The original properties of Li 4 SiO 4 powders with high specific surface area could be regenerated by heating at 700 °C. Consequently, the storage conditions of Li 4 SiO 4 powders should be considered for their use in different applications. [ABSTRACT FROM AUTHOR]

The surgical approach to the axilla in breast cancer has been a controversial issue for more than three decades. Data from recently published trials have provided practice-changing recommendations in this scenario. However, further controversies have been triggered in the surgical community, resulting in heterogeneous diffusion of these recommendations. The development of clinical guidelines for the management of the axilla in patients with breast cancer is a work in progress. A multidisciplinary team discussion was held at the research hospital Policlinico San Matteo from the Università degli Studi di Pavia with the aim to update recommendations for the management of the axilla in patients with breast cancer. An evidence-based approach is presented. Our multidisciplinary panel determined that axillary dissection after a positive sentinel lymph node biopsy may be avoided in cN0 patients with micro/macrometastasis to ≤2 sentinel nodes, with age ≥40y, lesions ≤3 cm, who have not received neoadjuvant chemotherapy and have planned breast conservation (BCS) with whole breast radiotherapy (WBRT). Cases with gross (>2 mm) ECE in SLNs are evaluated on individual basis for completion ALND, axillary radiotherapy or omission of both. Patients fulfilling the criteria listed above who undergo mastectomy, may also avoid axillary dissection after multidisciplinary discussion of individual cases for consideration of axillary irradiation. Women 70 years or older with hormone receptors positive invasive lesions ≤3 cm, clinically negative nodes, and serious or multiple comorbidities who undergo BCS with WBRT, may forgo axillary staging/surgery (if mastectomy or larger tumor, comorbidities and life expectancy are taken into account). [ABSTRACT FROM AUTHOR]

Environmental pollution is a topic of great interest because it directly affects the quality of ecosystems and of all living organisms at different trophic and systematic levels. Together with the global climate change, the long-term surviving of many species of plants and animals is threaten, distributional patterns at global and regional levels are altered and it results in local assemblages of species that are quite different from those that currently constitute coevolved communities. .For this study, the species Myotis myotis was used as bioindicator and it was sampled from two caves in the south-east of Sicily, Pipistrelli chosen as control area and Palombara chosen as polluted area, to measure the concentrations of trace elements in fur and liver tissues. Results showed higher content of essential elements in fur in bats sampled from Pipistrelli. Conversely, higher concentrations of toxic metals in liver such as As, Cd, Pb and Hg were measured in bat samples in Palombara cave, where specimens have a hunting area extended within the boundaries of the petrochemical plant. Nevertheless, we cannot consider Palombara population as polluted by metal contamination since their tissue concentrations are overall lower than toxic thresholds values suggested for small mammals. Likewise, we cannot exclude other kind of pollutants as potential stressors of the examined population, contributing with the decreasing of bat colonies in Sicily. [ABSTRACT FROM AUTHOR]

Endoscopic treatment of vesicoureteral reflux (VUR) is an important minimally invasive surgical approach in patients undergoing surgical treatment of VUR. In our past experience, we observed that a bulking agent mound sagittal diameter of 10 mm is the main predictor of effectiveness of the procedure. Moreover we noticed that the use of intraoperative ultrasound, allows the surgeon to better identify the site, volume and shape of the bulking agent injected, finally reducing operative time. We aimed to evaluate if the intraoperative ultrasound assistance could definitively improve effectiveness of the endoscopic procedure. We retrospectively compared two series treated with endoscopic procedures for intermediate and high grade primary VUR, respectively without (series A) and with (series B) intraoperative ultrasound (IO-US). In all patients VCUG was performed to assess VUR grade and to verify resolution or VUR downgrading during the follow-up. A total of 177 ureteric units were treated. Endoscopic procedures globally were effective in 68/96 ureters (70.8 %) in series A and in 68/81 ureters (83.9 %) in series B. No significant differences in effectiveness were observed comparing the series with regard to VUR grades, but a significant difference is shown (p < 0.05) when grouping grades III-V VUR. No significance in differences of volume injected were detected, but operative time was significantly lower in series B (27.5 min vs 19.6 min, p < 0.05). Mean sagittal mound diameter measured during cystoscopy in series B was 10.45 mm (range 8.5–14.2 mm). The intraoperative ultrasound assistance during endoscopic treatment of VUR could represent a valid tool for surgeons to better identify location, volume and shape of the bulking agent. Furthermore, the use of an objective parameter of evaluation of the implant can overcome the subjective intraoperative evaluation of the implant itself, improving results for experienced surgeons and reducing the learning-curve for inexperienced ones. Results of endoscopic injection of bulking-agent can be improved with intraoperative ultrasound, allowing at the same time a significant reduction of operative time. [ABSTRACT FROM AUTHOR]

Mutualistic associations between ants and honeydew-producing hemipterans have a great ecological and evolutionary significance across terrestrial habitats but can also cause pest outbreaks in agroecosystems. At the same time, ants are often effective predators of several agricultural pests, can improve soil quality, and can control some plant pathogens. Neither ant attendance of hemipteran pests alone, nor a positive correlation between the abundance of ants and hemipterans automatically imply that ants are a worthy target or a key element in hemipteran management strategies. The main tactics in the management of ant-hemipteran associations in agroecosystems include the use of sticky or insecticidal barriers, low-toxicity baits, alternative sugary sources, or ant-adapted biocontrol agents. Barriers can quickly seal ground-nesting ants from the canopy of perennial plants but are unselective towards other arthropods and costly in terms of maintenance. Low-toxicity baits have been particularly tested against invasive and supercolonial ant species and yet are worth considering only when the complete elimination of ant colonies can be desirable. More recently developed and not yet widely available methods based on the provision of alternative sugary sources to manipulate ant behavior can allow to retain or even enhance the contribution of ants to the control of other phytophagous insects or plant pathogens while effective disrupting their mutualism with hemipteran pests. Finally, many parasitoids and predators possess specific adaptations to bypass attending ants, but the existence of species-specific factors complicatesthese networks. Further basic research and longer-term studies are needed to refine and improve the development of sustainable management strategies. • Ants are related to different services and disservices to agricultural activities. • Some species can cause critical outbreaks of honeydew-producing hemipteran pests. • Alternative management approaches offer different balances of pros and cons. • Innovative strategies may control hemipterans without hindering ant activity. • Future research directions on these complex multitrophic networks are discussed. [ABSTRACT FROM AUTHOR]

It is well known that heart graft deteriorates rapidly during the hypothermic preservation phase before transplantation. Many preservative solutions are used in clinical practice, but there is no consensus on any of them. A new preservation solution named LYon Preservative Solution (LYPS) was developed in our laboratory to improve heart survival during preservation to allow a better functional recovery after transplantation. Our objective is to understand cell death mechanisms that occur during cold ischemia at different temperatures and to test the LYPS compared to the other solutions currently used in clinic (UW, Celsior, and Plégisol). We performed 20 hours of cold to mild-hypothermic (5, 10, 15 and 20 °C) static preservation, followed by 2 hours of warm "reoxygenation" (37 °C) on H9C2 cells. PI, Annexin V and DILC1 flow cytometry staining were used to determined cell necrosis, cell apoptosis and mitochondrial membrane potential respectively at the end of the preservation, and at the end of the reoxygenation. Apoptosis was also quantified by caspase 3 cleavage by Western-Blot. Evaluation of autophagy was made using immunofluorescent labelling of LC3B protein. It appears that LYPS solution protects from necrotic cell death compared to Celsior, UW and Plegisol (8.8% compared to 72.8%; 66.2%; 95% respectively at 5 °C). In addition, LYPS allows a better maintenance of the mitochondrial membrane potential (76% compared to 4.6%; 26%; 3.3%, respectively). This trend is observed at all temperatures studied. Furthermore, we observed that autophagic marker LC3B was stimulated in LYPS compared to other studied solutions. All of these data show that the LYPS solution allows better activation of survival signals, preservation of mitochondrial membrane potential and protection against necrosis. The next step is now to study other cell death pathways such as necroptosis, pyroptosis, and ferroptosis to better understand the mechanisms involved in graft deterioration during preservation in order to find the best preservation conditions and expand the number of potential grafts. [ABSTRACT FROM AUTHOR]

Control of airborne microbial contamination is important in operating rooms (ORs). To keep airborne contamination low, guidelines should highlight the importance of air turnover. The aims of the study were: (1) to verify the association between air turnover and airborne contamination in ORs; and (2) to identify a statistical relationship between air turnover and airborne microbial contamination. A cross sectional study was carried out from November 2014 to July 2017 in the teaching Hospital of Siena. Nineteen ORs (14 with turbulent and 5 with laminar flow ventilation) were surveyed a total of 59 times under operating conditions. Air samples were collected with an air sampler. Petri dishes, incubated at 36 °C for 48 h, were used to quantify colony forming units in the samples (CFU). The data was transformed to evaluate several statistically significant nonlinear associations between air turnover, quantified as air changes per hour (ACH) and CFU per cubic meter of air (p < 0.05). A log-linear regression model provided the best fit between ACH and CFU for laminar (p = 0.013; R2 = 0.3911) and turbulent flow systems (p = 0.002; R2 = 0.3443). The corresponding model was: ln(CFU) = (a − b*ACH), where the regression parameters were estimated at a = 4.02 and b = 0.037 for laminar flow and a = 5.24 and b = 0.067 for turbulent flow. Italian guidelines indicate microbial load limits of 20 and 180 CFU/m3 for operating rooms with laminar and turbulent flow ventilation, respectively. The model allowed us to evaluate the minimum number of ACHs to keep CFU within these limits. Ad hoc measurements in other environments can be used to calibrate the relationship between ACH and CFU. [ABSTRACT FROM AUTHOR]

Limited evidence is available on 5-year clinical outcomes after percutaneous edge-to-edge mitral valve repair.Methods: The Getting Reduction of mitrAl inSufficiency by Percutaneous clip implantation in ITaly (GRASP-IT) is a multicenter registry including 304 consecutive patients undergoing Mitraclip between October 2008 and October 2013 at 4 Italian centers. Primary end point (all-cause mortality) and secondary end point (all-cause mortality or heart failure [HF] hospitalization) were evaluated up to 5 years and between 1 and 5 years.Results: Cumulative incidence of the primary and secondary end points at 1, 2, 3, 4, and 5 years were 15.1%, 26.4%, 35.5%, 42.1%, and 47.3% and 29.1%, 41.7%, 49.8%, 56%, and 62.3%, respectively. Landmark analysis between 1 and 5 years showed an incidence of primary and secondary end point of 37.9% and 46.8%, respectively. Five-year event rates were significantly higher in patients with functional ischemic mitral regurgitation (MR) compared to other etiologies. MR recurrence and left ventricular ejection fraction <30% were associated with an increased risk of both primary and secondary end points. EuroSCORE II >5% was associated with an increased risk of 5-year mortality. Ischemic etiology of MR, baseline serum creatinine >1.5 mg/dL, chronic obstructive pulmonary disease, and previous HF hospitalizations were independent predictors of 5-year secondary end point.Conclusions: At 5-year follow-up after Mitraclip, nearly half of patients died and almost two thirds died or were admitted for HF. MR recurrence, ischemic etiology, high comorbidity burden (ie, EuroSCORE II >5%, chronic obstructive pulmonary disease), and advanced cardiomyopathy (ie, left ventricular ejection fraction <30%, prior HF admission, creatinine >1.5 mg/dL) significantly increase the relative risk of 5-year clinical events. [ABSTRACT FROM AUTHOR]

The aim of this work was to evaluate the characteristics of nine kaki vinegars produced using different yeasts and bacteria traditionally involved in wine production, and to evaluate their acidity, density, total phenolic content, and antioxidant activity. Furthermore, the study characterized the volatile fingerprinting by headspace-gas chromatography-ion mobility spectrometry (HS-GC-IMS) and by two-dimensional gas chromatography coupled to mass spectrometry (GCxGC-TOF-MS). Finally, individual carotenoids were characterized using high performance liquid chromatography (HPLC). More than a thousand distinguishing molecules were found. It was discovered that vinegars fermented with S. cerevisiae produced a larger number of volatile chemicals. Among the three vinegars produced with this strain, the one fermented with Acetobacter _vino seemed to have a more elaborate flavour profile than all the other samples. The vinegar produced utilizing the mixture of T. delbruekii and Acetobacter was the only kind to have a high concentration of carotenoids. [Display omitted] • Nine kaki vinegars were produced with various yeasts and bacteria. • Kaki wines produced after the first fermentation were also characterized. • More than a thousand unique molecules were detected with GCxGC-TOF-MS. • Vinegars made with S. cerevisiae had a more complex volatile profile. • Vinegars made with T. delbruekii and Acetobacter had a high carotenoids content. [ABSTRACT FROM AUTHOR]

Abstract Background The Middle East and North Africa (MENA) region faces a dual challenge with regard to influenza infection due to severe zoonotic influenza outbreaks episodes and the circulation of Northern Hemisphere human influenza viruses among pilgrims. Methods The MENA Influenza Stakeholder Network (MENA-ISN) was set-up with the aim of increasing seasonal influenza vaccination coverage by (i) enhancing evidence-based exchanges, and (ii) increasing awareness on the safety and benefits of seasonal vaccination. During the 7th MENA-ISN meeting, representatives from 8 countries presented their influenza surveillance, vaccination coverage and actions achieved and provided a list of country objectives for the upcoming 3 years. Results MENA-ISN countries share the goal to reduce influenza related morbidity and mortality. Participants admitted that lack of knowledge about influenza, its consequences in terms of morbidity, mortality and economy are the major barrier to attaining higher influenza vaccination coverage in their countries. The cost of the vaccine is another key barrier that could contribute to low vaccination coverage. Participants drew a list of strategic interventions to bridge gaps in the knowledge of influenza burden in this region. Conclusions Participating countries concluded that despite an increase in vaccine uptake observed during the last few years, influenza vaccination coverage remains relatively low. Priority areas should be identified and action plans tailored to each country situation set-up to investigate the best way to move forward. [ABSTRACT FROM AUTHOR]

Abstract Metal additive manufacturing (AM) technologies enable the production of complex shapes, lightweight structures and novel functional features. Such increased complexity of the products imposes various challenges in terms of statistical process monitoring and quality assessment. However, one great potential of AM processes, compared to conventional ones, consists of the possibility of gathering a large amount of data layer by layer. This study investigates a data fusion methodology to combine in-situ data from multiple sensors embedded in Electron Beam Melting (EBM) systems to automatically detect faults and process errors. The aim consists of making sense of information already available from the system to enhance its embedded intelligence via novel data mining techniques. A real case study in EBM is presented and discussed. [ABSTRACT FROM AUTHOR]

Highlights • Addressing the complexity and sustainability of healthcare. • Reconciling standardization and differentiation in healthcare. • Exploring possibilities offered by technology in healthcare variety management. • An intelligent use of 3D-printing technology in producing personalized medications. • An industrial technological revolution of compounding pharmacy. Abstract Healthcare represents a key issue for management in every country. A fundamental problem affects almost every healthcare system: the trade-off between the need to deliver effective healthcare services and the need to control expenses and to ensure the overall sustainability of the system. This problem is a clear expression of management complexity in healthcare systems. With the purpose of searching opportunities for reconciling standardization and differentiation in healthcare management, this work aims to explore possibilities offered by technology by investigating the criticalities and potentialities of the use of 3D printing in producing personalized medications. By adopting an organizational and managerial perspective, our exploratory study focuses on the context in which basic needs and opportunities of personalization in dosage forms mainly emerge: the stage of drug prescription and delivery processes that involve doctors, patients, and pharmacists. Obstacles, risks, and advantages of personalized medicine (PM) are discussed highlighting opportunities offered by the introduction of 3D printing technologies and conditions of success in terms of both effectiveness and cost of healthcare. Key findings lead to a possible model of synthesis in which the potential revolutionary role of drug 3D printing in pharmaceutical compounding and/or manufacturing is highlighted. A 3D printing empowered compounding pharmacy is an innovation we envision to progress toward smarter and more sustainable healthcare. [ABSTRACT FROM AUTHOR]

Peaks in climate change newspaper coverage have been attributed to key events, such as major international climate change summits, on the basis that these are reported. This approach overlooks the possibility that unreported events have capacity to focus journalists’ and editors’ attention on climate change. This study considers the extent to which meteorological and political events – derived externally from what is reported in the media itself (some reported, some not) – coincide with attention to climate change in four UK newspapers. We call these events ‘news prompts’, since they are potential rather than actual news pegs: some are translated into news stories, others are not. The study brings together literatures on agenda-setting, newsroom practices, and the political economy and ideologies of newspapers. We find that the four newspapers we analyse have responded differently to climate-change related events including international policy events and extreme weather. In recent years, The Mail, The Telegraph and The Times have been relatively insensitive to climate change news prompts in comparison to the more left-leaning Guardian . As climate change coverage increases, so does sensitivity to climate news prompts. This suggests that the ideology of newspapers and the political economy of media outlets may drive climate coverage as much as routine newsgathering practices. [ABSTRACT FROM AUTHOR]

In this practical application, we describe the steps to build a decision-support tool using GeNIe 2.1 software. The method incorporates principles of decision analyses and allows for a systematic strategy to balance treatment efficacy data with patient preferences. We illustrate the utility for helping clinicians and patients choose between two or more efficacious treatment options (CBT, medication, or their combination). Preliminary pilot data from families ( n = 5) seeking services at a specialty clinic for childhood anxiety disorders support the usability of the tool and high patient satisfaction. We use case examples and sample graphical output to illustrate how the decision-support system can be used to integrate data on (a) baseline symptom severity, (b) the relative effectiveness of two or more treatment options, and (c) patient preferences and values, to arrive at a personalized treatment recommendation. The decision-support tool enabled child and parent preferences to be explicitly stated and facilitated discussions about how best to incorporate their preferences into an evidence-based treatment strategy. [ABSTRACT FROM AUTHOR]

Study Objective: To evaluate the intraoperative effects of gonadotropin-releasing hormone (GnRH) analogue pretreatment in patients undergoing cold loop hysteroscopic myomectomy.Design: Randomized controlled trial (Canadian Task Force classification I).Setting: Arbor Vitae Center for Endoscopic Gynecology, Rome, Italy.Patients: A total of 99 patients were randomized and subsequently allocated to the GnRH analogue group or to the nonpharmacologic treatment control group. Fifteen patients were lost after allocation, and 42 patients per group underwent hysteroscopic myomectomy.Interventions: Cold loop hysteroscopic myomectomy.Measurements and Main Results: The control group accomplished the treatment in a 1-step procedure more frequently than the GnRH analogue group (92.85% and 73.8% of cases, respectively; p = .040). The completion of the treatment was more unlikely in case of G2 myomas (p = .006), whereas no differences were recorded for G1 and G0 myomas. The multivariate analysis showed a significant correlation between the multiple-step treatment and the use of GnRH analogue (odds ratio, 5.365; 95% confidence interval [CI], 1.018-28.284; p = .048), grading (odds ratio, 4.503; 95% CI, 1.049-19.329; p = .043), and size of myomas (odds ratio, 1.128; 95% CI, 1.026-1.239; p = .013).Conclusions: Preoperative GnRH analogue administration did not facilitate the completion of cold loop hysteroscopic myomectomy in a single surgical procedure in G2 myomas and was correlated with a longer duration of the surgery. No significant benefits were found for G0 and G1 myomas. (ClinicalTrials.gov: NCT01873378.). [ABSTRACT FROM AUTHOR]

It has been 20 years since two seminal publications about ecosystem services came out: an edited book by Gretchen Daily and an article in Nature by a group of ecologists and economists on the value of the world’s ecosystem services. Both of these have been very highly cited and kicked off an explosion of research, policy, and applications of the idea, including the establishment of this journal. This article traces the history leading up to these publications and the subsequent debates, research, institutions, policies, on-the-ground actions, and controversies they triggered. It also explores what we have learned during this period about the key issues: from definitions to classification to valuation, from integrated modelling to public participation and communication, and the evolution of institutions and governance innovation. Finally, it provides recommendations for the future. In particular, it points to the weakness of the mainstream economic approaches to valuation, growth, and development. It concludes that the substantial contributions of ecosystem services to the sustainable wellbeing of humans and the rest of nature should be at the core of the fundamental change needed in economic theory and practice if we are to achieve a societal transformation to a sustainable and desirable future. [ABSTRACT FROM AUTHOR]

Background Mother-to-child transmission is still considered a major factor in the spread of hepatitis viruses. Nevertheless, epidemiological data on hepatitis B virus (HBV) and hepatitis C virus (HCV) in reproductive-age women are limited even in areas like the South of Italy where both viruses had been widespread. Aim The aim of this study was to investigate the prevalence of HBV and HCV serum markers in a large cohort of pregnant women from Southern Italy. Methods Data concerning 7558 pregnant women consecutively admitted to an Obstetric Division of a Sicilian University Hospital over a six-year period (January 2010–December 2015) were retrospectively collected from clinical notes. Results Positivity for both HBV s-antigen (HBsAg) and antibodies to HCV (anti- HCV) was very low (0.5% and 0.2%, respectively). HBsAg prevalence was significantly higher in non-Italian than in Italian women (p < 0.001). On the contrary, all the anti-HCV positive cases were of Italian origin. Age was not significantly different between positive and negative women. Conclusion These results confirm the dramatic decline of HBV and HCV prevalence that recently occurred in Southern Italy, and highlight the importance and cost-effectiveness of systematic HBV and HCV screening in childbearing age women in order to properly apply the available preventive measures and definitively eliminate the risk of vertical transmission for both viruses. [ABSTRACT FROM AUTHOR]

Heavy metal pollution is one of the greatest threats to the ecosystems because it degrades the habitat and is potentially toxic to wildlife and human populations. In the last few decades, bioaccumulation studies performed with a multimarker approach have been a valuable tool for the investigation of environmental and animal safety. We perform an analysis of a benthic teleost fish species – Parablennius sanguinolentus – sampled at several Italian coastal sites with different degrees of anthropogenic pressure. Our integrative analysis encompasses bioaccumulation of 10 metals, biomarkers of environmental stress (micronuclei and nuclear abnormalities) and neutral genetic variation (using sequences of the mtDNA control region). We find a clear and significant correlation of metal bioaccumulation with micronuclei and nuclear abnormalities, especially with undisputed genotoxic metals, such as Cd, Cr, Hg and Pb. Furthermore, the molecular genetic analysis revealed a decrease of genetic variability in the populations more subjected to anthropic pressure. [ABSTRACT FROM AUTHOR]

Background and aims Perception of quality of care is important in the management of patients with chronic diseases, particularly inflammatory bowel disease. Aims and methods This longitudinal study aimed to investigate variations of the Quality of Care through the Patients' Eyes (QUOTE-IBD) questionnaire scores one year after the basal evaluation in the S tudio O sservazionale qua L ità c U re malat TI e cr O niche intesti N ali (SOLUTION-1) study. Results Of the cohort of 992 patients, 936 were evaluable. The QUOTE-IBD score overcame satisfactory levels of more than the 80%, overall and in all subdomains except for the “Continuity of Care” sub-dimension (mean, 8.3; standard deviation, 1.49), scored satisfactory only by 34% of the patients. No significant changes in satisfaction were recorded overall, or considering patients subgroups. Significant differences were found at the end of the follow-up between physicians’ and patients’ perceptions of quality of care, with the former over-rating their performance in “Continuity of Cares” and under-rating “Costs”, “Competence”, and “Accessibility” sub-domains of the score (p < 0.05 for all). Conclusion Perceived quality of care in a large cohort of Italian patients with inflammatory bowel disease remains unchanged after one-year follow-up and was not significantly affected by disease activity or therapeutic interventions. Differences between physicians’ and patients’ perceptions of quality of care should be taken into account. [ABSTRACT FROM AUTHOR]

Background and aims Whether Fibroscan thresholds can be immediately adopted for none, some or all other shear wave elastography techniques has not been tested. The aim of the present study was to test the concordance of the findings obtained from 7 of the most recent ultrasound elastography machines with respect to Fibroscan. Methods Sixteen hepatitis C virus-related patients with fibrosis ≥2 and having reliable results at Fibroscan were investigated in two intercostal spaces using 7 different elastography machines. Coefficients of both precision (an index of data dispersion) and accuracy (an index of bias correction factors expressing different magnitudes of changes in comparison to the reference) were calculated. Results Median stiffness values differed among the different machines as did coefficients of both precision (range 0.54–0.72) and accuracy (range 0.28–0.87). When the average of the measurements of two intercostal spaces was considered, coefficients of precision significantly increased with all machines (range 0.72–0.90) whereas of accuracy improved more scatteredly and by a smaller degree (range 0.40–0.99). Conclusions The present results showed only moderate concordance of the majority of elastography machines with the Fibroscan results, preventing the possibility of the immediate universal adoption of Fibroscan thresholds for defining liver fibrosis staging for all new machines. [ABSTRACT FROM AUTHOR]

To achieve the Paris Agreement abatement goals, the use of consumption-based carbon accounting (CBA) as a target base, i.e., as a reference scale for emissions reductions, has potential advantages of fairness, effectiveness, and cost. At the same time, CBA also has rather high political feasibility. However, CBA has not yet been adopted, not even experimentally. Nevertheless, major concurrent reasons suggest that the time is ripe for employing this accounting system as a target base. Accordingly, this review article indicates a strategy that leverages the potential of CBA to take advantage of the ripeness of the time through the activation of governance measures that increase the likelihood of its adoption as a target base. This strategy can shape converging preferences in support of CBA among stakeholders belonging to different political traditions and subject to different political constraints, and increase the chances of this accounting system being adopted as a target base. [ABSTRACT FROM AUTHOR]

Hepatitis D virus (HDV) affects approximately 5% of chronically infected hepatitis B (HBV) patients and remains a common indication for liver transplantation (LT), which is the only therapeutic option for patients with end-stage liver disease and unresectable hepatocellular carcinoma (HCC). Our aim was to investigate the different characteristics, indications to LT and long-term patient survival of HDV-coinfected patients compared to HBV-monoinfected patients. All patients waitlisted for LT at our Center between 2006 and 2020 were retrospectively evaluated. Demographic characteristics, indication to LT, liver function, type of antiviral therapy before and after LT were recorded. A total of 1555 patients were included in the waiting list (WL): 18.2% of patients were HBsAg positive of which 32.6% were HDV-coinfected. At the time of admission to WL, HBVD patients differed significantly from HBV-monoinfected patients in terms of gender (females 42.4% vs 14%, p<0.001), and age (54, IQR 45 – 56 vs. 56, IQR 51 – 61, p=0.017). HDV-coinfected patients had significantly lower rate of HCC diagnoses (36/92 – 22% vs 128/192 – 66%, p<0.001) and HCC as indication to LT (21/92 – 17.2% vs 101/192 – 52.6%, p<0.001). Patients with HBVD had similar probability to LT (65.7% vs 64.7%, OR 1.046 CI95% 0.5-2.3, p=0.9) and death (21% vs 19%, OR 1.13 CI95% 0.5-2.8, p=0.8) than monoinfected patients, but they were less often excluded from WL due to stability of disease (1% vs. 5%). HBVD patients had similar patient survival (p=0.981) as HBV-monoinfected patients. Post-transplant prophylaxis was based on combination therapy with NUCs and HBIG. HDV-coinfected patients did not experience viral relapse after LT. Hepatis D infection is still significantly prevalent among HBsAg carriers. LT is the only curative approach for end-stage liver disease. Survival after LT was comparable to that of HBV-monoinfected patients. [ABSTRACT FROM AUTHOR]