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Objective: To compare the effectiveness and cost of in‐vitro fertilization (IVF) with or without preimplantation genetic testing for aneuploidy (PGT‐A) when only one or two blastocysts are obtained. Methods: A dataset was gathered from 1829 patients including 368 non‐PGT‐A and 1461 PGT‐A cycles with one or two blastocysts obtained, between April 2013 and July 2022. Patients were matched 1:1 by propensity‐score matching for maternal age, number of metaphase‐II oocytes inseminated and number of blastocysts obtained, achieving a database of 242 patients per group. The non‐PGT‐A and PGT‐A groups were compared for differences in live birth rate (LBR) per embryo transfer (ET), cumulative LBR per patient, miscarriage rate (MR) per clinical pregnancy, number of days between oocyte retrieval and conclusion of the IVF cycle (primary outcome), mean expenses incurred at the clinic and incremental cost‐effectiveness ratio (ICER). Results: More than twice as many ETs were conducted in the non‐PGT‐A group compared with the PGT‐A group, yet the cumulative LBR per patient was similar between groups (23.6% (95% CI, 18.5–29.5%) vs 27.3% (95% CI, 21.9–33.4%)). This outcome was achieved with a higher LBR per ET (16.2% (95% CI, 12.6–20.5%) vs 41.5% (95% CI, 33.9–49.4%)) and lower MR per clinical pregnancy (30.1% (95% CI, 21.8–42.6%) vs 13.9% (95% CI, 7.5–24.0%)) in the PGT‐A group. The MR per patient was also lower in the PGT‐A group (9.5% (95% CI, 6.2–14.1%) vs 4.5% (95% CI, 2.4–8.2%)). The mean duration between oocyte retrieval and IVF cycle conclusion was 131 (95% CI, 113–150) days in the non‐PGT‐A group vs 74 (95% CI, 61–87) days in the PGT‐A group (P < 0.001; power = 99.8%). The ICER of PGT‐A for the months saved between oocyte retrieval and conclusion of the IVF cycle was €499 overall, ranging between €170 and €2065 according to the number of blastocysts obtained and/or maternal age. The ICER of PGT‐A for prevented miscarriages was €18 968, decreasing to €3525 when calculated among patients aged ≥ 35 years with two blastocysts obtained. Conclusions: When conducted in expert IVF clinics for patients indicated for the procedure, PGT‐A is clinically valuable even when only one or two blastocysts are obtained. PGT‐A reduces the number of ETs and miscarriages while the cumulative LBR per patient remains unaffected, and allows these outcomes to be achieved in a shorter timeframe. The ICER of PGT‐A vs non PGT‐A decreased as maternal age increased. © 2024 International Society of Ultrasound in Obstetrics and Gynecology. [ABSTRACT FROM AUTHOR]

Genesis Potential Indices (GPIs) link the occurrence of Tropical Cyclones (TCs) to large‐scale environmental conditions favorable for TC development. In the last few decades, they have been routinely used as a way to overcome the limitations of climate models (GCM), whose resolution is too coarse to produce realistic TCs. Recently, the first GCM ensemble with high enough horizontal resolution to realistically reproduce TCs was made available. Here, we address the questions of whether GPIs are still relevant in the era of TC‐permitting climate model ensembles, and whether they have sufficient predictive skills. The predictive skills of GPIs are assessed against the TCs directly simulated in a climate model ensemble. We found that GPIs have poor skill in two key metrics: inter‐annual variability and multi‐decadal trends. We discuss possible ways to improve the understanding of the predictive skill of GPIs and therefore enhance their applicability in the era of TC‐permitting GCMs. Plain Language Summary: Tropical Cyclones are extreme weather events which cause large damage when they hit inhabited areas. Understanding future cyclone activity in advance is very important to limit the damage. Until recently, climate models that scientists use to study future extremes where not able to reproduce realistic tropical cyclones because available computers were not powerful enough. Scientists used to look at indicators of cyclone activity ‐known as genesis potential indices—based on a number of quantities responsible for cyclone formation, rather than looking at cyclones themselves. Using cyclone data from a new set of climate model projections, we show that genesis potential indices are not always accurate in explaining future cyclone activity. We discuss how future research could help us improve the understanding of the drivers of tropical cyclone activity, and therefore the accuracy of genesis potential indices. Key Points: A recently produced high‐resolution GCM ensemble allows for the first time a systematic assessment of Genesis Potential Indices (GPIs) performanceAll the analyzed GPIs show poor skill in reproducing the interannual variability and future trends of modeled cyclonesPossible ways forward include adding variables related to Tropical Cyclones small‐scale dynamics, and using advanced statistical techniques based on Machine Learning [ABSTRACT FROM AUTHOR]

The value of streamflow forecasts to inform water infrastructure operations has been extensively studied. Yet, their value in informing infrastructure design is still unexplored. In this work, we investigate how dam design is shaped by information feedbacks supporting the implementation of flexible operating policies informed by streamflow forecasts to enable the design of less costly reservoirs relative to alternatives that do not rely on forecast information. Our approach initially explores the maximum potential gain attainable by searching and using the most valuable forecast information and lead time. We then analyze the results? sensitivities relative to existing and synthetic biased forecasts. We demonstrate our approach through an ex post analysis of the Kariba Dam in the Zambezi River Basin. Results show that informing dam design with perfect forecasts enables attaining the same hydropower production of the existing dam, while reducing infrastructure size and associated capital costs by 20%. A forecast‐informed operation of the existing system can instead facilitate an annual average increase of 60 GWh in hydropower production. This finding, extrapolated to the new planned dams in the basin, suggests that forecast informed policies could yield power production benefits equal to 75% of the current annual electricity consumption of the Zambian agricultural sector. The use of biased forecasts substantially reduces this gain, showing that the ESP forecasts value is marginal and that informed infrastructure designs are particularly vulnerable to forecast overestimation. Advancing information feedbacks may therefore become a valuable asset for the ongoing hydropower expansion in the basin. Key Points: The value of using streamflow forecasts in informing joint dam design and operation is explored for the first timeThe use of perfect seasonal streamflow forecasts could enable a 20% reduction in capital costs for large reservoirsThe value of forecast information changes remarkably with dam size and operational trade‐offs [ABSTRACT FROM AUTHOR]

Globally, many countries are actively seeking to maximize the hydropower potential of major river basins, yielding proposals for constructing approximately 3,700 major dams in the near future. At present, economic cost‐benefit analyses are the dominant approach for evaluating candidate dam designs. Yet they typically fail to explore the interdependence of dam design and operation by (i) monetizing and aggregating potentially conflicting and heterogeneous objectives into a single metric and (ii) using predefined operating rules aimed at maximizing specific performance objectives for the dams to be designed. Careful consideration of alternative reservoir operating schemes can help to avoid biases in how optimal dam sizes are identified while also clarifying their capacity to adapt to changing hydroclimatic conditions and human demands. This paper presents an integrated framework to solve coupled dam sizing and operation design problems. The framework combines Multiobjective Robust Decision Making and Evolutionary Multiobjective Direct Policy Search into a novel approach to dam sizing, which internalizes the operation design problem and explicitly considers uncertainty in external drivers. We demonstrate the potential of this integrated dam design framework through an ex‐post design analysis of the Kariba dam in the Zambezi river basin. Our results show that careful exploration of the coupled planning/operation search space yields designs that significantly outperform the existing Kariba system. Moreover, we demonstrate that our framework leads to a significant reduction in capital costs (i.e., smaller reservoir sizes) while simultaneously improving system robustness with respect to changing hydroclimatology and human irrigation demands. Key Points: Dependencies across dam design and operations strongly influence attainable robustnessEx‐post analysis of the Kariba dam directly maps how operations can reshape capital investmentsThe contributed framework aids in reducing the capital costs required to improve robustness to changing drivers [ABSTRACT FROM AUTHOR]

Knowledge on the determinants and patterns of water demand for different consumers supports the design of customized demand management strategies. Smart meters coupled with big data analytics tools create a unique opportunity to support such strategies. Yet, at present, the information content of smart meter data is not fully mined and usually needs to be complemented with water fixture inventory and survey data to achieve detailed customer segmentation based on end use water usage. In this paper, we developed a data‐driven approach that extracts information on heterogeneous water end use routines, main end use components, and temporal characteristics, only via data mining existing smart meter readings at the scale of individual households. We tested our approach on data from 327 households in Australia, each monitored with smart meters logging water use readings every 5 s. As part of the approach, we first disaggregated the household‐level water use time series into different end uses via Autoflow. We then adapted a customer segmentation based on eigenbehavior analysis to discriminate among heterogeneous water end use routines and identify clusters of consumers presenting similar routines. Results revealed three main water end use profile clusters, each characterized by a primary end use: shower, clothes washing, and irrigation. Time‐of‐use and intensity‐of‐use differences exist within each class, as well as different characteristics of regularity and periodicity over time. Our customer segmentation analysis approach provides utilities with a concise snapshot of recurrent water use routines from smart meter data and can be used to support customized demand management strategies. Key Points: We investigate which water use behaviors can be identified from nonintrusive, single‐point, smart meter dataWe identify and cluster primary water use behaviors of single‐family households from disaggregated end use dataWe reveal the main water end uses driving different behaviors, usage patterns, and regularity, to support customized demand management [ABSTRACT FROM AUTHOR]

Multireservoir systems are designed to serve multiple conflicting demands over varying time scales that may be out of phase with the system's hydroclimatic inputs. Adaptive, nonlinear reservoir control policies are often best suited to serve these needs. However, nonlinear operating policies are hard to interpret, so water managers tend to favor simple, static rules that may not effectively manage conflicts between the system's multisectoral demands. In this study, we introduce an analytical framework for opening the black box of optimized nonlinear operating policies, decomposing their time‐varying information sensitivities to show how their adaptive and coordinated release prescriptions better manage hydrologic variability. Interestingly, these information sensitivities vary significantly across policies depending on how they negotiate tradeoffs between conflicting objectives. We illustrate this analysis in the Red River basin of Vietnam, where four major reservoirs serve to protect the capital of Hanoi from flooding while also providing the surrounding region with electric power and meeting multisectoral water demands for the agricultural and urban economies. Utilizing Evolutionary Multi‐Objective Direct Policy Search, we are able to design policies that, using the same information as sequential if/then/else‐based operating guidelines developed by the government, outperform these traditional rules with respect to every objective. Policy diagnostics using time‐varying sensitivity analysis illustrate how the Evolutionary Multi‐Objective Direct Policy Search operations better adapt and coordinate information use to reduce food‐energy‐water conflicts in the basin. These findings accentuate the benefits of transitioning to dynamic operating policies in order to manage evolving hydroclimatic variability and socioeconomic demands in multipurpose reservoir networks. Key Points: We contribute an analytical framework for understanding the time‐varying information sensitivities of multireservoir operating policiesWe find that adaptive and coordinated information use by optimized nonlinear operating policies yields superior multiobjective performanceThese time‐varying information sensitivities can change significantly across policies depending on how they balance conflicting objectives [ABSTRACT FROM AUTHOR]

Objective: The objective of the study was to compare the biofilm growing pattern and its morphological extent on silicone and a teflon‐like material using a sonication process and a Scanning Electron Microscope (SEM). Design: A prospective cohort study and a laboratory study. Setting: Otolaryngology ‐Head and Neck surgery Department and the Microbiology Institute. Participants: The participants included fifteen laryngectomised patients with phonatory prostheses, which were removed because of device failure, and two different kinds of phonatory prostheses from the laboratory (Provox 2 and ActiValve) that were artificially colonised by Candida albicans. Main outcome measures: Tracheo‐oesophageal puncture (TEP) is currently considered the gold standard for post‐laryngectomy voice rehabilitation. “Leakage” represents the most common cause of substitution and is generated by biofilm colonisation of the prosthesis by mixed mycotic and bacterial agents. New biomaterials have been developed that are deemed to be more resistant to the colonisation of micro‐organisms and material deformation. Results: The devices showed colonisation by mixed bacterial flora (Staphylococci 13%, Streptococci 9%, and Haemophilus influenzae 5%) and by yeasts (Candida albicans 12%). Moreover, we observed a different distribution of biofilm layers in Provox ActiValve (22.56%) compared to Provox 2 (56.82%) after experimental colonisation by the previously isolated Candida strain. Conclusion: Resident microbiological species from the upper airways unavoidably colonise the polymer surfaces, and no strategies have been effective except for the manipulation of the chemical‐physical properties of the device's polymer. Our study confirms that Provox ActiValve, which is made with a fluoroplastic material (teflon‐like), is less subject to in vitro colonisation by Candida, and thus showed a higher clinical resistance to biofilm and a longer lifespan. The sonication seems to significantly improve the knowledge of bacterial and mycotic flora in biofilm colonisation. The design of a device for the daily cleaning capable to reach and brush the oesophageal flange of the prosthesis preserving the valve mechanism could represent a practical and simple help in this still unsolved problem. [ABSTRACT FROM AUTHOR]

Abstract: Multireservoir systems require robust and adaptive control policies capable of managing hydroclimatic variability and human demands across a range of time scales. This is especially true for river basins with high intraannual and interannual variability, such as monsoonal systems that need to buffer against seasonal droughts while also managing extreme floods. Moreover, the timing, intensity, duration, and frequency of these hydrologic extremes may evolve with deeply uncertain changes in socioeconomic and climatic pressures. This study contributes an innovative method for exploring how possible changes in the timing and magnitude of the monsoonal cycle impact the robustness of reservoir operating policies designed assuming stationary hydrologic and socioeconomic conditions. We illustrate this analysis on the Red River basin in Vietnam, where reservoirs and dams serve as important sources of hydropower production, multisectoral water supply, and flood protection for the capital city of Hanoi. Applying our scenario discovery approach, we find that reservoir operations designed assuming stationarity provide robust hydropower performance in the Red River but that increased mean streamflow, amplification of the within‐year monsoonal cycle, and increased interannual variability all threaten their ability to manage flood risk. Additionally, increased agricultural water demands can only be tolerated if they are accompanied by greater mean flow, exacerbating food‐flood trade‐offs in the basin. These findings highlight the importance of exploring the impacts of a wide range of deeply uncertain socioeconomic and hydrologic factors when evaluating system robustness in monsoonal river basins, considering in particular both lower‐order moments of annual streamflow and intraannual monsoonal behavior. [ABSTRACT FROM AUTHOR]

Objectives: To investigate the quality of sleep and the psychological profiles of a large cohort of Italian patients with burning mouth syndrome (BMS) and to clarify the relationships between these variables and pain. Methods: In this case–control study, 200 patients with BMS vs an equal number of age‐ and sex‐matched healthy controls, recruited in 10 universities, were enrolled. The Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), Hamilton Rating Scale for Depression (HAM‐D), Hamilton Rating Scale for Anxiety (HAM‐A), Numeric Pain Intensity Scale (NRS) and Total Pain Rating Index (T‐PRI) were administered. Descriptive statistics, including the Mann–Whitney U test and hierarchical multiple linear regression analysis, were used. Results: Poor sleep quality (PSQI ≥ 5) was present in 78.8% (160) patients with BMS. BMS patients had statistically higher scores in all items of the PSQI and ESS than the healthy controls (p < .001). A depressed mood and anxiety correlated positively with sleep disturbance. The Pearson correlations were 0.570 for the PSQI vs HAM‐D (p < .001) and 0.549 for the PSQI vs HAM‐A (p < .001). Pain intensity (NRS) poorly correlated to sleep quality; the Pearson correlation was 0.162 for the PSQI vs NRS (p = .021). Conclusions: The BMS patients showed a poor sleep quality, anxiety and depression, as compared with the controls, highlighting the relationships between oral burning, sleep and mood. [ABSTRACT FROM AUTHOR]

Multipurpose water systems are usually operated on a tradeoff of conflicting operating objectives. Under steady state climatic and socioeconomic conditions, such tradeoff is supposed to represent a fair and/or efficient preference. Extreme variability in external forcing might affect water operators' risk aversion and force a change in her/his preference. Properly accounting for these shifts is key to any rigorous retrospective assessment of the operator's behaviors, and to build descriptive models for projecting the future system evolution. In this study, we explore how the selection of different preferences is linked to variations in the external forcing. We argue that preference selection evolves according to recent, extreme variations in system performance: underperforming in one of the objectives pushes the preference toward the harmed objective. To test this assumption, we developed a rational procedure to simulate the operator's preference selection. We map this selection onto a multilateral negotiation, where multiple virtual agents independently optimize different objectives. The agents periodically negotiate a compromise policy for the operation of the system. Agents' attitudes in each negotiation step are determined by the recent system performance measured by the specific objective they maximize. We then propose a numerical model of preference dynamics that implements a concept from cognitive psychology, the availability bias. We test our modeling framework on a synthetic lake operated for flood control and water supply. Results show that our model successfully captures the operator's preference selection and dynamic evolution driven by extreme wet and dry situations. [ABSTRACT FROM AUTHOR]

Abstract: Robustness is being used increasingly for decision analysis in relation to deep uncertainty and many metrics have been proposed for its quantification. Recent studies have shown that the application of different robustness metrics can result in different rankings of decision alternatives, but there has been little discussion of what potential causes for this might be. To shed some light on this issue, we present a unifying framework for the calculation of robustness metrics, which assists with understanding how robustness metrics work, when they should be used, and why they sometimes disagree. The framework categorizes the suitability of metrics to a decision‐maker based on (1) the decision‐context (i.e., the suitability of using absolute performance or regret), (2) the decision‐maker's preferred level of risk aversion, and (3) the decision‐maker's preference toward maximizing performance, minimizing variance, or some higher‐order moment. This article also introduces a conceptual framework describing when relative robustness values of decision alternatives obtained using different metrics are likely to agree and disagree. This is used as a measure of how “stable” the ranking of decision alternatives is when determined using different robustness metrics. The framework is tested on three case studies, including water supply augmentation in Adelaide, Australia, the operation of a multipurpose regulated lake in Italy, and flood protection for a hypothetical river based on a reach of the river Rhine in the Netherlands. The proposed conceptual framework is confirmed by the case study results, providing insight into the reasons for disagreements between rankings obtained using different robustness metrics. [ABSTRACT FROM AUTHOR]

Objectives To investigate in Parkinson's disease-affected patients a correlation between hyposmia and gastrointestinal dysfunction and their possible identical etiopathogenesis. Design Retrospective cohort study. Setting ENT and neurology departments (Gemelli Hospital, Rome, Italy). Participants A total of 78 patients with diagnosis of PD according to the UK Brain Bank criteria. Inclusion criteria: informed consent and olfactory testing executed; exclusion criteria: signs of dementia according to the DSM- IV criteria; Mini Mental State Examination score ≤26; head trauma; central neurological disorders, nasal or systemic diseases potentially affecting olfactory function. Motor condition was assessed by means of Hoehn and Yahr staging and by section III of the Unified PD Rating Scale, performed off and on medications. Main outcome measures The patients underwent olfactory evaluation ( TDI score), after rhinomanometry with nasal decongestion. A total of 25 non-motor symptoms were evaluated through an interview. Results Olfactory dysfunction was objectively found in 91.0% of patients, a percentage higher than the subjective hyposmia reported (55.1%) P = 0.0001. Seven patients (9.0%) were normosmic, 49 (62.8%) hyposmic and 22 (28.2%) anosmic. Subjective hyposmia, constipation, bloating and dyspepsia differed across groups, being higher in anosmic and hyposmic ones than in the normosmic group. P value was ≤0.05 for each symptom. Despite the original results, this study has the limitation of being based on subjective ratings by a relatively limited group of patients. Conclusions Hyposmia and gastrointestinal symptoms are correlated, and this would support a possible common origin; the CNS could be reached through two different pathways, both starting in the peripheral nervous system. [ABSTRACT FROM AUTHOR]

Managing water resources systems requires coordinated operation of system infrastructure to mitigate the impacts of hydrologic extremes while balancing conflicting multisectoral demands. Traditionally, recommended management strategies are derived by optimizing system operations under a single problem framing that is assumed to accurately represent the system objectives, tacitly ignoring the myriad of effects that could arise from simplifications and mathematical assumptions made when formulating the problem. This study illustrates the benefits of a rival framings framework in which analysts instead interrogate multiple competing hypotheses of how complex water management problems should be formulated. Analyzing rival framings helps discover unintended consequences resulting from inherent biases of alternative problem formulations. We illustrate this on the monsoonal Red River basin in Vietnam by optimizing operations of the system's four largest reservoirs under several different multiobjective problem framings. In each rival framing, we specify different quantitative representations of the system's objectives related to hydropower production, agricultural water supply, and flood protection of the capital city of Hanoi. We find that some formulations result in counterintuitive behavior. In particular, policies designed to minimize expected flood damages inadvertently increase the risk of catastrophic flood events in favor of hydropower production, while min-max objectives commonly used in robust optimization provide poor representations of system tradeoffs due to their instability. This study highlights the importance of carefully formulating and evaluating alternative mathematical abstractions of stakeholder objectives describing the multisectoral water demands and risks associated with hydrologic extremes. [ABSTRACT FROM AUTHOR]

Objectives We evaluated the virological response in patients starting a regimen based on darunavir/ritonavir ( DRV/r), which is currently the most widely used ritonavir-boosted protease inhibitor. Methods Data from 206 drug-naïve and 327 PI-experienced patients starting DRV/r 600/100 mg twice daily ( DRV600) or 800/100 mg once daily ( DRV800) were examined. The probabilities of virological success ( VS) and virological rebound ( VR) were evaluated in survival analyses. Baseline DRV/r resistance and its evolution at failure were also examined. Results DRV600 was preferentially administered in patients with complex requirements (older age, higher viraemia, lower CD4 cell count and DRV/ PI resistance) compared with DRV800. By 12 months, the probability of achieving VS was 93.2% and 84.3% in drug-naïve and PI-experienced patients, respectively. The higher the baseline viraemia, the longer was the time required to achieve VS, both in drug-naïve patients [>500 000 HIV-1 RNA copies/ mL: median [interquartile range ( IQR)] 6.1 (5.1-10.3) months; 100 000-500 000 copies/ mL: median ( IQR) 4.9 (3.8-6.1) months; <100 000 copies/ mL: median ( IQR) 3.9 (3.5-4.8) months; P < 0.001] and in PI-experienced patients [≥100 000 copies/ mL: median ( IQR) 7.2 (5.7-11.6) months; <100 000 copies/ mL: median ( IQR) 2.8 (2.4-3.3) months; P < 0.001]. In PI-experienced patients, the probability of VR was higher for higher viraemia levels (22.3% for ≥100 000 copies/ml vs. 9.7% for <100 000 copies/mL; P = 0.007). Baseline resistance did not affect the virological response. At failure, a high percentage of patients maintained virus susceptible to all PIs (drug-naïve: 95%; PI-experienced: 80%). Despite being used more often in patients with more complex requirements, DRV600 performed as well as DRV800. Conclusions In clinical practice, use of DRV/r (with its flexible dosage) results in high rates of virological response. These data support the use of PI/r in patients whose characteristics require potent drugs with a high genetic barrier. [ABSTRACT FROM AUTHOR]

Many water resource systems have been designed assuming that the statistical characteristics of future inflows are similar to those of the historical record. This assumption is no longer valid due to large-scale changes in the global climate, potentially causing declines in water resource system performance, or even complete system failure. Upgrading system infrastructure to cope with climate change can require substantial financial outlay, so it might be preferable to optimize existing system performance when possible. This paper builds on decision scaling theory by proposing a bottom-up approach to designing optimal feedback control policies for a water system exposed to a changing climate. This approach not only describes optimal operational policies for a range of potential climatic changes but also enables an assessment of a system's upper limit of its operational adaptive capacity, beyond which upgrades to infrastructure become unavoidable. The approach is illustrated using the Lake Como system in Northern Italy-a regulated system with a complex relationship between climate and system performance. By optimizing system operation under different hydrometeorological states, it is shown that the system can continue to meet its minimum performance requirements for more than three times as many states as it can under current operations. Importantly, a single management policy, no matter how robust, cannot fully utilize existing infrastructure as effectively as an ensemble of flexible management policies that are updated as the climate changes. [ABSTRACT FROM AUTHOR]

Exponentially growing water demands and increasingly uncertain hydrologic regimes due to changes in climate and land use are challenging the sustainability of agricultural water systems. Farmers must adapt their management strategies in order to secure food production and avoid crop failures. Investigating the potential for adaptation policies in agricultural systems requires accounting for their natural and human components, along with their reciprocal interactions. Yet this feedback is generally overlooked in the water resources systems literature. In this work, we contribute a novel modeling approach to study the coevolution of irrigated agriculture under changing climate, advancing the representation of the human component within agricultural systems by using normative meta-models to describe the behaviors of groups of farmers or institutional decisions. These behavioral models, validated against observational data, are then integrated into a coupled human-natural system simulation model to better represent both systems and their coevolution under future changing climate conditions, assuming the adoption of different policy adaptation options, such as cultivating less water demanding crops. The application to the pilot study of the Adda River basin in northern Italy shows that the dynamic coadaptation of water supply and demand allows farmers to avoid estimated potential losses of more than 10 M€/yr under projected climate changes, while unilateral adaptation of either the water supply or the demand are both demonstrated to be less effective. Results also show that the impact of the different policy options varies as function of drought intensity, with water demand adaptation outperforming water supply adaptation when drought conditions become more severe. [ABSTRACT FROM AUTHOR]

Objectives Despite not being approved in Europe as first-line therapy, the efavirenz ( EFV)-containing single tablet regimen ( STR) is frequently used in clinical practice in naïve patients but few data are available on this strategy. In our study, we aimed to assess the risk of EFV discontinuation in patients starting antiretroviral therapy with STR vs. non STR. Methods This was a multicentre study retrospectively enrolling naïve patients starting EFV+ TDF+ FTC. Patients were followed from the time of treatment initiation to the discontinuation of the EFV-containing regimen, comparing STR vs. non STR. Two different analyses were performed: (A) non STR patients censored at the last observation (switch to STR not considered as the end of observation); (B) non STR patients censored at the time of switch to STR. Results The study included 235 patients, of whom 74 (31.5%) directly started STR. Among patients starting non STR, 108 (67.1%) switched to STR after a median period of 6 months. Forty-four EFV discontinuations were observed (13 among STR vs. 31 among non STR patients). The overall estimated probability of discontinuation was 30% at 5 years, about half (14.8%) of these occurring during the first year. Analysis A did not show significant differences between STR and non STR regarding the probability of efavirenz discontinuation (19.9% vs. 24.7% at 5 years, P = 0.630). In contrast, Analysis B showed that the probability of EFV discontinuation was similar (8.3%) between STR and non STR patients up to 8 months. Thereafter, a significantly higher rate of discontinuation was observed in non STR patients (47.5% vs. 19.9% at 5 years, P = 0.034). Conclusions Our data suggest that an early switch to STR during the first months of treatment could reduce the risk of EFV discontinuation. [ABSTRACT FROM AUTHOR]

Objective This study aims to evaluate changes in proteomic salivary profile of patients with oral mucositis after adjuvant cancer treatments. Materials and Methods Samples were collected from patients after adjuvant cancer therapies, and were analyzed by means of SELDI/ TOF. Patients were separated in two groups: patients affected by mucositis ( MUCOSITIS) and patient without mucositis ( NO MUCOSITIS). All patients were divided in function of the anticancer treatment: patients who had radiotherapy ( MUCOSITIS RADIO), had not radiotherapy ( MUCOSITIS NO RADIO), had chemotherapy ( MUCOSITIS CHEMO), and those who had not chemotherapy ( MUCOSITIS NO CHEMO). Statistical evaluation PCA (Principal Component Analysis) was conducted with the software BIO- RAD Data Manager™ (Version 3.5). Results We found the increased peaks of 3443, 3487, and 4135 m/ z in MUCOSITIS group, while 6237 m/ z was reduced. These same peaks would the same modifications in MUCOSITIS RADIO, while in MUCOSITIS CHEMIO are increased 3443 and 6237 m/ z but 3487, 4135 m/ z are reduced. These data were confirmed by the PCA. Conclusion Anticancer therapy influenced the level expression of many salivary biomarkers in mucositis with a good significance. Therefore, 3443, 3487, 4135, and 6237 m/ z are good biomarker candidates of oral mucositis. [ABSTRACT FROM AUTHOR]

Advances in Environmental monitoring systems are making a wide range of data available at increasingly higher temporal and spatial resolution. This creates an opportunity to enhance real-time understanding of water systems conditions and to improve prediction of their future evolution, ultimately increasing our ability to make better decisions. Yet, many water systems are still operated using very simple information systems, typically based on simple statistical analysis and the operator's experience. In this work, we propose a framework to automatically select the most valuable information to inform water systems operations supported by quantitative metrics to operationally and economically assess the value of this information. The Hoa Binh reservoir in Vietnam is used to demonstrate the proposed framework in a multiobjective context, accounting for hydropower production and flood control. First, we quantify the expected value of perfect information, meaning the potential space for improvement under the assumption of exact knowledge of the future system conditions. Second, we automatically select the most valuable information that could be actually used to improve the Hoa Binh operations. Finally, we assess the economic value of sample information on the basis of the resulting policy performance. Results show that our framework successfully select information to enhance the performance of the operating policies with respect to both the competing objectives, attaining a 40% improvement close to the target trade-off selected as potentially good compromise between hydropower production and flood control. [ABSTRACT FROM AUTHOR]

This study contributes a decision analytic framework to overcome policy inertia and myopia in complex river basin management contexts. The framework combines reservoir policy identification, many-objective optimization under uncertainty, and visual analytics to characterize current operations and discover key trade-offs between alternative policies for balancing competing demands and system uncertainties. The approach is demonstrated on the Conowingo Dam, located within the Lower Susquehanna River, USA. The Lower Susquehanna River is an interstate water body that has been subject to intensive water management efforts due to competing demands from urban water supply, atomic power plant cooling, hydropower production, and federally regulated environmental flows. We have identified a baseline operating policy for the Conowingo Dam that closely reproduces the dynamics of current releases and flows for the Lower Susquehanna and thus can be used to represent the preferences structure guiding current operations. Starting from this baseline policy, our proposed decision analytic framework then combines evolutionary many-objective optimization with visual analytics to discover new operating policies that better balance the trade-offs within the Lower Susquehanna. Our results confirm that the baseline operating policy, which only considers deterministic historical inflows, significantly overestimates the system's reliability in meeting the reservoir's competing demands. Our proposed framework removes this bias by successfully identifying alternative reservoir policies that are more robust to hydroclimatic uncertainties while also better addressing the trade-offs across the Conowingo Dam's multisector services. [ABSTRACT FROM AUTHOR]

In this article, friction stir welded lap joints of innovative dissimilar aluminum alloys have been produced and tested to investigate the feasibility of using this joining technique in this configuration. The introduction of both this new welding technique alloys, such as AA 2198, could allow making lighter and stronger structures. Some experiments, carried out previously, have shown that the fixturing device, the tool geometry, and the tilt angle play a significant role in the joint soundness. A wide experimental characterization has been carried out on friction stir welded lap joints of AA 7075 T6 extrudes to AA 2198 T351 rolled plates. The results attained are allowed to put in evidence some critical issues on the investigated configuration and can be considered as a further acquired knowledge in the understanding and the design of friction stir processes. Copyright © 2013 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Many large-scale water resources systems, especially in transboundary contexts, are characterized by the presence of several and conflicting interests and managed by multiple, institutionally independent decision makers. These systems are often studied adopting a centralized approach based on the assumption of full cooperation and information exchange among the involved parties. Such a perspective is conceptually interesting to quantify the best achievable performance but might have little practical impact given the real political and institutional setting. In this work, we propose a novel decision-analytic framework based on multiagent systems to model and analyze different levels of cooperation and information exchange among multiple decision makers. The Zambezi River basin is used as a case study. According to the proposed agent-based optimization approach, each agent represents a decision maker, whose decisions are defined by an explicit optimization problem considering only the agent's local interests. The economic value of information exchange is estimated comparing a noncooperative setting, where agents act independently, with the first basic level of cooperation, i.e., coordination, characterized by full information exchange. The economic value of cooperation is also estimated by comparison with the ideal, fully cooperative management of the system. Results show that coordination, obtained with complete information exchange, allows the downstream agents to better adapt to the upstream behaviors. The impact of information exchange depends on the objective considered, and we show coordination to be particularly beneficial to environmental interests. [ABSTRACT FROM AUTHOR]

As the most common form of skin cancer, basal cell carcinoma (BCC) is typified by locally infiltrative growth and a very low risk of metastasis. On occasion, however, this otherwise indolent neoplasm may behave aggressively, demonstrating deep tissue invasion and a high rate of postsurgical recurrence. The pathogenesis and determinants of such tenacious growth are not completely understood. Only 1% of all BCC's achieve the status of 'giant', as defined in 1988 by the American Joint Committee on Cancer. In this article, the authors provide a comprehensive review of the scientific literature on giant basal cell carcinoma (GBCC) of the skin and report their experience with this rare tumour subtype. [ABSTRACT FROM AUTHOR]

Absract The present prospective study was aimed at evaluating the long-term efficacy of local electrochemotherapy ( ECT) with the intravenous administration of bleomycin, on disease progression and viral activity in classic Kaposi's sarcoma ( cKS), a vascular tumor related to human herpes virus-8 infection. Eighteen patients affected by isolate or multiple cutaneous lesions, refractory to conventional treatments, although in the absence of visceral involvement, were enrolled in a study. Follow-up visits were performed after 4 weeks and every 6 months for up to 48 months. A more extensive exploration of the immunologic status as well as of virological parameters was performed in nine patients. The results showed a significant clinical improvement in all patients after 4 weeks. A complete regression was observed in 12 patients after the first ECT, while four patients required a second treatment on the residual lesions after 4 weeks from the first intervention. The positive outcome persisted during the subsequent clinical control visits. Two patients, that showed rapidly evolving did not improve and relapsed despite a second round of ECT treatment. Effective treatment was associated with the reduction of viral load to undetectable levels. These data support the conduct of larger studies directed at validating the efficacy of ECT as a first-line therapy for cKS. [ABSTRACT FROM AUTHOR]

The relationships between grain quality and N utilization in durum wheat (Triticum durum Desf.) have not been very thoroughly investigated. The aim of this study was to evaluate the effects of N fertilizer rate and water regime on grain yield and quality under Mediterranean conditions in relation to N utilization. Four durum wheat cultivars (Appio, Creso, Ofanto, and Simeto) were grown in field trials under two water regimes (irrigated and rainfed) at three N levels (0, 60, and 120 kg ha-1) in southern Italy during two cropping seasons. At harvest, grain yield and its main components, protein and gluten content, gluten index, sodium dodecyl sulfate sedimentation test, rheological indices dough strength alveograph index (W) and tenacity/extensibility ratio (P/L), and grain yellow index were determined. For the rainfed treatment in the first (drier) year, a decrease in grain yield consistent with an increase in protein content, gluten index, and W and P/L indices was observed. With increasing N level, protein content increased in both growing seasons but a significant improvement in technological parameters was observed only in the first year, mainly under rainfed conditions. Among the investigated cultivars, only Simeto always showed both good yield and quality performance. The positive correlation between plant N content at anthesis and protein content indicated a significant contribution of pre-anthesis assimilation. The high correlations found for both N translocation and N harvest index with technological indices suggest that lately remobilized N might increase the protein polymerization degree, with a consequent improvement in grain quality. [ABSTRACT FROM AUTHOR]

Durum wheat (Triticum durum Desf.) is widely cultivated in the Mediterranean area where plants generally suffer from water stress during grain-filling period. This study was conducted to evaluate the influence of N levels and water regimes on N translocation and nitrogen use efficiency for protein (NUEP) in durum wheat grown under Mediterranean conditions. A 2-yr experiment was performed in southern Italy using four cultivars, two water regimes (irrigated and rainfed) and three N levels (0, 60, and 120 kg ha-1). Among the cultivars under study, Simeto showed the highest N translocation in both years and, together with of anto, also the highest NUEP values, especially in rainfed condition. This highlights their good adaptability to dry southern Italy environment. Nitrogen fertilization caused a general decrease of NUEP and its components in both growing seasons; this was more evident in the first drier year, mainly due to a decrease in N uptake. Under water Stress the higher N level caused a decrease in N translocation, N translocation efficiency, and grain N content. The contribution of translocated N to grain N content was 75% in the wetter year and 57% in the drier year, showing that in drought condition preanthesis N assimilation was lower. In conclusion under water stress condition the higher N level (120 kg ha-1), despite determining an increase in plant N content, did not imply an increase in grain N content, due to a decrease in N translocation and efficiency. [ABSTRACT FROM AUTHOR]

Objectives: Literature reports highlighted the presence of discriminatory episodes towards individuals infected with human immunodeficiency virus (HIV) on behalf of dental care workers. The purpose of this study was to assess hygienists' attitude when treating HIV-infected individuals in the era of highly active antiretroviral therapy (HAART). Methods: A national observational study was carried out on all the members of an Italian hygienist association. An anonymous questionnaire was mailed to 1247 hygienists: the questionnaire investigated demographic data, the relationship between the hygienists and HIV-infected persons, to identify the presence of discriminatory behaviour, the hygienists' scientific knowledge of HIVrelated problems and the precautions normally used in the office to prevent cross-infections. Results: Of the 1247 questionnaires that were delivered to hygienists, 287 (23%) were completed and returned within a 6-month period. A total of 287 hygienists answered the question 'Did you ever deny treatment to an HIV-infected persons?' and 17 hygienists (5.9%) replied 'Yes'. Protective eyewear [odds ratio (OR), 0.036; 95% confidence interval (CI), 0.002-0.818; P = 0.037] and public practice [OR, 2.93; 95% CI, 0.97-8.87; P = 0.057] were associated with refusing to treat HIV-infected persons. Conclusion: Our findings highlight the existence of episodes of discrimination by some hygienists towards HIV-infected individuals. From clinical point of view, this discriminatory behaviour may expose the dental health care workers and their patients to a greater risk of cross-infection. [ABSTRACT FROM AUTHOR]

The aim of this study is to acquire knowledge about what activities people reportedly engage in to relax when feeling stressed. A special focus is on physical activity to reduce stress and the association with socioeconomic status, general health, and leisure time activities. The data are derived from a Danish national health survey, and the variables are studied by statistical correspondence analyses. Results show that physical activity when relaxing from stress is related to an active leisure time, good health, and socioeconomic factors such as high education, employment, and good housing conditions. These findings support earlier research indicating that social inequality plays an important role in the choice of activities for stress reduction. [ABSTRACT FROM AUTHOR]

Dental schools around the world face new challenges that raise issues with regard to how they are governed, led and managed. With rapid societal changes, including globalization and consumerism, the roles of universities and their funding have become intensely debated topics. When financial burdens on universities increase, so does the pressure on dental schools. This is exacerbated by the relative expense of running dental schools and also by the limited understanding of both university managers and the public of the nature and scope of dentistry as a profession. In these circumstances, it is essential for dental schools to have good systems of leadership and management in place so that they can not only survive in difficult times, but flourish in the longer term. This paper discusses the concept of governance and how it relates to leadership, management and administration in dental schools and hospitals. Various approaches to governance and management in dental schools on different continents and regions are summarized and contrasted. A number of general governance and leadership issues are addressed. For example, a basic principle supported by the Working Group is that an effective governance structure must link authority and responsibility to performance and review, i.e. accountability, and that the mechanism for achieving this should be transparent. The paper also addresses issues specific to governing, leading and managing dental schools. Being a dean of a modern dental school is a very demanding role and some issues relating to this role are raised, including: dilemmas facing deans, preparing to be dean and succession planning. The importance of establishing a shared vision and mission, and creating the right culture and climate within a dental school, are emphasized. The Working Group advocates establishing a culture of scholarship in dental schools for both teaching and research. The paper addresses the need for effective staff management, motivation and development, and highlights the salience of good communication. The Working Group suggests establishing an advisory board to the dean and school, including lay persons and other external stakeholders, as one way of separating governance and management to some extent and providing some checks and balances within a dental school. Several other suggestions and recommendations are made about governance, management and leadership issues, including the need for schools to promote an awareness of their roles by good communication and thereby influence perceptions of others about their roles and values. [ABSTRACT FROM AUTHOR]

In the article, the authors discuss their study on the effects of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) epidemic on the sexual behaviours of men who have sex with men (MSM). Also cited are the study showing the presence of viral ribonucleic acid (RNA) in semen of patients with COVID-19, and some risk assessment tips for MSM to limit risk of SARS-CoV-2 infection like checking for symptoms among partners like fever, cough and dyspnoea.

Sunflower is a major oil seed crop worldwide, and it is also an important crop in Mediterranean areas where salinity is an increasing problem. In this paper, the effect of saline irrigation water on seed yield and quality of sunflower was evaluated. A pot experiment was carried out over two crop seasons on two hybrids – a standard one (Carlos) and a high oleic one (Tenor) – submitted to five salinity levels of irrigation water (0.6, 3, 6, 9 and 12 dS m−1). Soil salinity was monitored over the entire crop cycle, and leaf ion content was determined at maturity. Tenor showed higher Na+ and Mg2+ content but lower K+ values. No difference between the two hybrids was observed for Cl− content. A progressive increase in leaf Na+, K+ and Cl− contents and Na+/K+ ratio with increasing salinity level was observed. Seed weight per head, 1000 achene weight, number of seeds per plant and oil yield significantly decreased under salt stress in both hybrids. The percent seed yield decrease was higher per unit increase in electrical conductivity of irrigation water, ECw (8%), than per unit increase in electrical conductivity of saturated-soil extracts, ECe (5%). Concerning oil fatty acid composition, the main significant difference as result of salt stress was a progressive increase in oleic acid content, from 82.2% to 86.7% for Tenor and from 21.8% to 27.3% for Carlos, which was consistent with a decrease in linoleic acid content, from 5.9% to 3% for Tenor and from 66% to 61.3% for Carlos. These results confirm the possible inhibition of oleate desaturase under salt stress. [ABSTRACT FROM AUTHOR]

In the last years, the use of tests with predictive value for scholastic progress has become widespread. While there is an aptitude test already in use for admission to our Dental School, we have also been conducting, without consequence to their admission, an investigation into the manual dexterity of candidate students. The aim of this test is to investigate basic manual dexterity, not ability following exercise. As previous, no such specific test had been formulated; the choice of test criteria we made was new. The tests investigated over five consecutive Academic years the ability to discern characteristics of a surface, to distinguish between different types of consistency, hand–eye co-ordination, the graphic activities, laterality and muscular strength. A re-test for some years was conducted afterwards. The results provided an overall evaluation: insufficient; sufficient; good; very good; excellent. Students who came from non-technical high schools showed a good comprehension of questions put to them, use of strategy, description of procedures; and final checking but a certain clumsiness in the hand–eye co-ordination test and a tendency to use one hand only. Students coming from technical high schools showed a less immediate grasp of questions put to them, sometimes requiring their repetition, disorganised behaviour in blind-fold tests, insufficient use of strategies and little checking but notable ability in hand–eye co-ordination tests and dextrous simultaneous use of both hands. These results were then correlated with the result of the aptitude test. In conclusion, a notable correspondence between student selection based on the aptitude test and the experimental manual dexterity test was verified. This correspondence outlines that manual dexterity is not only a ‘manual’ but a ‘mental’ ability . [ABSTRACT FROM AUTHOR]

Background: Anal cytology represents a tool for anal cancer screening in high-risk populations. In addition to accuracy, the reproducibility of the interpretation is of key importance. The authors evaluated the agreement of anal cytologic interpretation between two cytopathologists., Methods: Liquid-based cytologic slides from human immunodeficiency virus (HIV)-negative men who have sex with men (MSM) were evaluated by two readers with at least 10 years of expertise in cervical cytology. Cases with a discordant interpretation were reviewed, and a consensus was reached. Human papillomavirus (HPV) genotyping was performed using a proprietary HPV genotyping test. Unweighted and weighted Cohen kappa and 95% confidence interval (CI) values were calculated., Results: Overall, 713 slides that were adequate for interpretation were evaluated (MSM: median age, 33 years). An HPV test was performed on 620 samples (87.0%). Considering a dichotomous interpretation (negative for intraepithelial lesion or malignancy vs. atypical squamous cells of undetermined significance or worse), the crude agreement between the two readers was 93.3% (kappa = 0.82; 95% CI, 0.77-0.87). Once a consensus for discordant cases was reached, the best agreement was found for the negative for intraepithelial lesion or malignancy category (511 of 528 samples; 96.8%), whereas the atypical squamous cells of undetermined significance category showed the lowest agreement (90 of 117 samples, 76.9%). Considering the individual cytologic categories, overall agreement was 92.1% (kappa = 0.85; 95% CI, 0.81-0.89). The discordant interpretations were not associated with high-risk HPV infection, HPV16 infection, or MSM age., Conclusions: The results indicating excellent interobserver agreement in this study substantiate the use of anal cytology in the setting of human immunodeficiency virus-negative MSM., (© 2024 The Authors. Cancer Cytopathology published by Wiley Periodicals LLC on behalf of American Cancer Society.)

Introduction: Anal cytology is used in the prevention of anal cancer, which disproportionally affects men who have sex with men (MSM). Data on the incidence of cytologic abnormalities in these individuals are scant., Methods: MSM with baseline negative anal cytology and at least one further adequate cytology were included. Incidence rate for positive atypical squamous cells of undetermined significance (ASC-US+) was calculated. Kaplan-Meier curves were compared by log-rank test according to HIV status, baseline high-risk human papillomavirus (HPV) (high-risk HPV-negative, HPV16-positive, other high-risk HPV-positive [non-HPV16]) and high-risk HPV persistence (positive from baseline to the first ASC-US+ or last visit for those who remained cytologically negative). Cox univariate and multivariate analyses were performed., Results: A total of 250 MSM were included: 52/153 (34.0%) HIV-uninfected MSM had an ASC-US+ report at follow-up (incidence: 13.1 × 100 person-years; 95% CI, 9.8-17.2); 48/97 (49.5%) HIV-infected MSM developed cytologic abnormalities (incidence: 16.0 × 100 person-years; 95% CI, 11.8-21.2). ASC-US+ incidence in HIV-uninfected and HIV-infected MSM did not differ significantly (p = .32). Kaplan-Meier curves did not differ significantly according to baseline high-risk HPV. Differences were significant between those with and without persistent high-risk HPVs, both among HIV-uninfected (p = .03) and HIV-infected MSM (p = .008). Age (adjusted hazard ratio [aHR], 0.98; 95% CI, 0.96-0.99), high-risk HPV persistence (aHR, 1.57; 95% CI, 1.02-2.39), and condomless receptive anal sex (aHR, 1.99; 95% CI, 1.31-3.03) were predictors for incident ASC-US+., Conclusions: Despite the limited number of subjects, in our study HIV-uninfected and HIV-infected MSM have a similar ASC-US+ incidence. Occurrence of ASC-US+ was significantly affected by age, high-risk HPV persistence, and condomless receptive anal sex. The assessment of HPV persistence might identify those MSM at higher risk for anal lesions., (© 2022 The Authors. Cancer Cytopathology published by Wiley Periodicals LLC on behalf of American Cancer Society.)

Background: The wellbeing of oral lichen planus patients (OLPs) may be strongly influenced by a poor quality of sleep (QoS) and psychological impairment. The aims were to analyze the prevalence of sleep disturbance, anxiety, and depression in OLPs and to validate the Pittsburgh Sleep Quality Index (PSQI) in OLPs., Methods: Three hundred keratotic OLPs (K-OLPs), 300 with predominant non-keratotic OLP (nK-OLPs), and 300 controls were recruited in 15 Italian universities. The PSQI, Epworth Sleepiness Scale (ESS), Hamilton Rating Scales for Depression and Anxiety (HAM-D and HAM-A), Numeric Rating Scale (NRS), and Total Pain Rating Index (T-PRI) were administered., Results: Oral lichen planus patients had statistically higher scores than the controls in the majority of the PSQI sub-items (p-values < 0.001**). Moreover, OLPs had higher scores in the HAM-D, HAM-A, NRS, and T-PRI (p-values < 0.001**). No differences in the PSQI sub-items' scores were found between the K-OLPs and nK-OLPs, although nK-OLPs suffered from higher levels of anxiety, depression, and pain (p-values: HAM-A, 0.007**, HAM-D, 0.009**, NRS, <0.001**, T-PRI, <0.001**). The female gender, anxiety, depression (p-value: 0.007**, 0.001**, 0.020*) and the intensity of pain, anxiety, and depression (p-value: 0.006**, <0.001**, 0.014*) were independent predictors of poor sleep (PSQI > 5) in K-OLPs and nK-OLPs, respectively. The PSQI's validation demonstrated good internal consistency and reliability of both the total and subscale of the PSQI., Conclusions: The OLPs reported an overall impaired QoS, which seemed to be an independent parameter according to the regression analysis. Hence, clinicians should assess QoS in OLPs and treat sleep disturbances in order to improve OLPs management., (© 2021 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Lichen sclerosus (LS) is a chronic relapsing, inflammatory skin disorder usually involving the anogenital region of both sexes lacking a resolutive therapy. This study compared adipose tissue derived-stromal vascular fraction (AD-SVF) and AD-SVF-enriched platelet-rich plasma (PRP) therapy in the management of genital LS patients. Additionally, in vitro evaluation of cells and growth factors contained in the injected SVF has been evaluated as possible predictive factors for treatment outcome. The study population was 40 patients diagnosed with LS who were symptomatic despite medical treatment. Patients (age 43-78 years) randomized into two groups using a 1:1 allocation ratio, were evaluated clinically and assessing dermatology life quality index (DLQI) before and 6 months after treatment. Both procedures demonstrated a strong safety profile with no complications linked to the therapy. After 6 months, both treatments allowed for a significant improvement respect to baseline. Combinatory therapy demonstrated decreased efficacy in late stage patients. No correlations have been found between clinical and biological findings. AD-SVF and AD-SVF plus PRP are safe and effective regenerative approaches for genital LS patients. Clinical results support the preferential use of combinatory therapy for early stage patients confirming a synergic effect of AD-SVF and PRP. In contrast, AD-SVF plus PRP is discouraged for late stage patients., (© 2020 Wiley Periodicals LLC.)

Background: No screening is available for human papillomavirus (HPV)-associated oropharyngeal cancers. The authors investigated whether cytology may be used as a screening tool and whether oral HPV infection is associated with cytologic abnormalities detected in oropharyngeal brushings and in oral rinse-and-gargle specimens from asymptomatic individuals at increased risk for oral HPV infection., Methods: Specimens were collected from men who have sex with men at 6-month intervals. Oropharyngeal samples and oral rinse-and-gargle specimens were collected using a cytobrush and mouthwash, respectively. Exfoliated cells were dispersed in PreservCyt. Liquid-based slides were stained with Papanicolaou. An HPV genotyping test using a linear array was used for HPV detection. Associations with abnormal cytology were investigated using logistic regression., Results: Overall, 631 brushings and 802 rinses collected from 310 individuals were evaluated; of these specimens, 2 brushings (0.3%) and 10 rinses (1.2%) were inadequate for morphologic evaluation. Of the adequate samples, 35 of 629 brushings (5.5%) and 19 of 792 rinses (2.4%) were abnormal. No associations of high-risk HPVs or HPV-16 infection with cytologic abnormalities were observed for oropharyngeal brushings (high-risk HPVs: odds ratio [OR], 1.19; 95% CI, 0.41-3.50; P = .75; HPV-16: OR, 0.76; 95% CI, 0.10-5.84; P = .79) or for oral rinses (high-risk HPVs: OR, 1.13; 95% CI, 0.26-4.98; P = .87; HPV-16: OR, 0.62; 95% CI, 0.04-10.60; P = .74). Concurrent moderate/heavy drinking and smoking significantly increased the risk of cytologic abnormalities in the brushings (hazard ratio, 4.84; 95% CI, 1.15-20.43; P = .03)., Conclusions: Oral HPV infection by high-risk HPVs and HPV-16 does not confer an increased risk of cytologic abnormalities in oropharyngeal brushings and oral rinses. Abnormal cytology seems to be associated with smoking and drinking habits., (© 2020 American Cancer Society.)

Background: Anal cytology may be useful for evaluating lesions associated with human papillomavirus (HPV) in individuals at increased risk for anal cancer., Methods: Liquid-based cytology was used to assess anal cytological lesions among human immunodeficiency virus (HIV)-infected and HIV-uninfected men who have sex with men (MSM). The Linear Array HPV genotyping test was used for HPV detection., Results: This cross-sectional study included 1021 MSM, of whom 388 were HIV-infected (38.0%). Anal cytological lesions (atypical squamous cells of undetermined significance or more severe [ASCUS+]) were observed in 32.5% and 53.2% of the HIV-uninfected and HIV-infected individuals, respectively (P < .0001). The highest ASCUS + prevalence was observed among ≥45-year-old HIV-uninfected MSM (37.3%) and 25-to 29-year-old HIV-infected MSM (66.7%). High-grade squamous intraepithelial lesions (HSILs) peaked in ≥ 45-year-old HIV-uninfected subjects and 35- to 39-year-old HIV-infected subjects. Individuals with anal infections with high-risk (HR) HPV types were 3 to 4 times more likely to have an ASCUS + report. An HPV-16 and/or HPV-18 infection increased the odds of HSIL or more severe cytology (HSIL+) for HIV-infected MSM almost 4 times. MSM concurrently infected with HR and low-risk HPVs were significantly more likely to have low-grade squamous intraepithelial lesions or more severe cytology (LSIL+) than those infected with only HR types. No significant associations were found between cytological abnormalities and the HIV load and nadir and current CD4 + counts., Conclusions: The prevalence of anal cytological lesions is high in MSM, even in HIV-infected individuals treated with combined antiretroviral therapy. In these subjects, HSILs occur more frequently and at a younger age in comparison with HIV-uninfected counterparts. Specific diagnostic procedures should be implemented to manage individuals at increased risk for anal cancer with an abnormal anal Papanicolaou test. Cancer Cytopathol 2018. © 2018 American Cancer Society., (© 2018 American Cancer Society.)