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HBV/HCV co-infection is common in HIV-1-infected prisoners. To investigate the characteristics of HIV co-infections, and to evaluate the molecular heterogeneity of HIV, HBV and HCV in prisoners, we carried-out a multicenter cross-sectional study, including 65 HIV-1-infected inmates enrolled in 5 Italian detention centers during the period 2017–2019. HIV-1 subtyping showed that 77.1% of inmates were infected with B subtype and 22.9% with non-B subtypes. Italian nationals were all infected with subtype B (93.1%), except two individuals, one infected with the recombinant form CRF72_BF1, and the other with the HIV-1 sub-subtype A6, both previously not identified in inmates of Italian nationality. Non-Italian nationals were infected with subtype B (52.6%), CRFs (36.8%) and sub-subtypes A1 and A3 (5.2%). HIV variants carrying resistance mutations to NRTI, NNRTI, PI and InSTI were found in 7 inmates, 4 of which were never exposed to the relevant classes of drugs associated with these mutations. HBV and/or HCV co-infections markers were found in 49/65 (75.4%) inmates, while 27/65 (41.5%) showed markers of both HBV and HCV coinfection. Further, Italian nationals showed a significant higher presence of HCV markers as compared to non-Italian nationals (p = 0.0001). Finally, HCV phylogenetic analysis performed in 18 inmates revealed the presence of HCV subtypes 1a, 3a, 4d (66.6%, 16.7% and 16.7%, respectively). Our data suggest the need to monitor HIV, HBV and HCV infections in prisons in order to prevent spreading of these viruses both in jails and in the general population, and to implement effective public health programs that limit the circulation of different genetic forms as well as of viral variants with mutations conferring resistance to treatment. [ABSTRACT FROM AUTHOR]

This study concerns those crystallographic and microstructural features that can provide indications on the actual origin of red pigments based on hematite (Fe2O3). The main features of natural and artificial hematite are recalled and used to discuss the results obtained from the characterization of red-ochre samples coming from the Palaeolithic site of Riparo Dalmeri, a rock-shelter located in northeastern Italy, dated to 13 000 cal. bp, and notorious for the presence, among the other finds, of red-painted calcareous stones. Painting and the treatment of leather and hides obtained from the intensive hunting activity were the main uses of the hematite-based red-ochres at Riparo Dalmeri. It turns out that hematite was mostly obtained from the thermal treatment of goethite, which, unlike hematite, was and still is widely available in the neighbourhood of the site. [ABSTRACT FROM AUTHOR]

Samples of a prehistoric consolidated vegetable basketry, coming from an important pile building in the North-East of Italy (Fiavé Carrera, Trento), had been irradiated with excimer laser pulses to remove the consolidant layer and restore the artifact. Some problems, related to the nature of the consolidant resin, were found in the preliminary laser cleaning process. The two main obstacles were related to the unknown composition of the polymeric resin and to the irregular surface morphology of the archaeological find. We observed that large numbers of laser pulses, for selected laser parameters, strongly modify the resin surface morphology with formation of a large number of cones. After cone formation, the surface was so irregular that it was almost impossible to complete the laser cleaning procedure. To find a solution to the problem, we here try to understand the mechanisms of cone formation in the present polymeric material. Scanning electron microscopy (SEM) and Fourier transformation infrared spectroscopy (FTIR) have been used to study surface morphology and chemical modification after selected irradiation processes. To understand the influence of laser irradiation on surface modifications and to establish a cleaning procedure for this specific application, investigations have been carried out separately on models of resin consolidants and wood (both dried and buried wood sample). The consolidants were commercial resins, typically used in archaeological conservation (Plexisol and Paraloid), deposited on a silicon substrate. Silicon was used because it is an appropriate substrate in FT-IR analysis. Finally, we chose wood because of its wide use in prehistoric artefact (Viburnum lantana). [ABSTRACT FROM AUTHOR]

New chairside CAD/CAM materials are thought to perform reliably under clinical conditions. This is mainly proven by the collection of extensive and precise experimental data on fracture strength or toughness. Labs worldwide are using laboratory cutting, grinding, and polishing devices to measure the remaining strength of a material. As strength of brittle materials is a direct function of the surface state, we questioned if the CAD/CAM procedure might create a different flaw population and hence different mechanical strength compared to standard laboratory procedures. Plates (n=30 each group, fine grinding protocol) of dimensions 12x12x1.2 mm were either CAM machined (M5, Zirkonzahn, Italy) out of L14 chairside blocks from the materials IPS e.max® CAD (EMC, Ivoclar), Enamic® (ENA, Vita Zahnfabrik), and Grandio® Blocs (GRB, Voco, Germany) or cut, finished, and polished (4000 grit) according to standard laboratory rotational techniques. Biaxial flexural strength was measured using the ball-on-three-balls setup, after dry storage for 24 h, at a crosshead speed of 1 mm/min. Maximum surface roughness (Sz) was controlled in high-precision non-contact profilometer and fractography was performed on selected specimens from each group. Data were statistically treated using Weibull and ANOVA procedures. The Weibull characteristic strength of EMC (machined/polished) was measured to 486/610 MPa, of ENA to 163/193 MPa, and of GRB to 299/353 MPa. The Weibull modulus was m=6.2/13.4 for EMC, m=19.3/18.8 for ENA, and m=19.0/12.4 for GRB. CAM machining led to a drop in strength of 20.3% (EMC), 15.5% (ENA), and 15.1% (GRB). As Weibull modulus m significantly changed for materials EMC and GRB upon processing, fractography confirmed variations in the fracture mode. Surface roughness could not be correlated to the strength, indicating a different flaw population and subsurface effects taking place. [ABSTRACT FROM AUTHOR]

The proportion of new diagnoses of HIV infection in immigrants residing in Italy raised from 11% in 1992 to 29.7% in 2018. To investigate the HIV clades circulating in this community a retrospective study was performed in 557 HIV-infected immigrants living in 12 Italian cities. Immigrants originated from East-Europe and Central-Asia (11.7%), North Africa and Middle East (7.3%), South and South-East Asia (7.2%), Latin America and the Caribbean (14.4%), and sub-Saharan Africa (59.4%). More than 87% of immigrants were on antiretroviral therapy (ART), although 26.6% of them were viremic. A 22.0% of immigrants had hepatitis (HBV and/or HCV) and/or tuberculosis. HIV phylogenetic analysis on sequences from 192 immigrants showed the presence of clades B (23.4%), G (16.1%), C (10.4%), A1 (9.4%), F1 (5.2%), D (1.6%) and Circulating Recombinant Forms (CRFs) (33.9%). CRF02_AG represented 72.3% of the total CRFs. Clusters between immigrants and Italian natives were also present. Drug resistance mutations to NRTI, NNRTI, and PI drug classes occurred in 29.1% of ART-treated and in 12.9% of ART-naïve individuals. These data highlight the need for tailored public health interventions in immigrants to avoid spreading in Italy of HIV genetic forms and ART-resistant variants, as well as HIV co-morbidities.

Objective: Data on the incidence of new onset atrial fibrillation and flutter (AF/f) in patients with acute pericarditis are limited. We sought to determine the incidence and prognostic significance of AF/f in this setting., Methods: Between January 2006 and June 2014, consecutive new cases of acute pericarditis were included in two urban referral centres for pericardial diseases. All new cases of AF/f defined as episodes lasting ≥30 s were recorded. Events considered during follow-up consisted of AF/f and pericarditis recurrence, cardiac tamponade, pericardial constriction and death., Results: 822 consecutive new cases of acute pericarditis (mean age 53±15 years, 444 men) were analysed. AF/f was detected in 35 patients (4.3%, mean age 66.5±11.3 years, 18 men). Patients with AF/f were significantly older (p=0.017) and presented more frequently with pericardial effusion (p<0.001). Arrhythmias developed within 24 h of pericarditis onset in 91.4% of cases, lasted >24 h in 25.7% and spontaneously converted in 74.3% of patients. Underlying structural heart disease was present in 17% of AF/f cases. In a 30-month follow-up, patients with history of AF/f at the initial episode had a higher rate of arrhythmia occurrence (34.3% vs 0.9%, p<0.001), mostly (75%) within 3 months. No other differences were detected in additional clinical events including haemorrhagic complications in patients receiving oral anticoagulation., Conclusions: The occurrence of AF/f in acute pericarditis identifies a predisposed population to AF/f with a high recurrence risk (about 35%): in these patients, pericarditis may act as an arrhythmic trigger and oral anticoagulation should be seriously considered according to guidelines., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.)

Introduction: The epidemiology of infective endocarditis (IE) is changing due to a number of factors, including aging and health related comorbidities and medical procedures. The aim of this study is to describe the main clinical, epidemiologic and etiologic changes of IE from a large database in Italy., Methods: We prospectively collected episodes of IE in 17 Italian centers from July 2007 to December 2010., Results: We enrolled 677 patients with definite IE, of which 24% health-care associated. Patients were male (73%) with a median age of 62 years (IQR: 49-74) and 61% had several comorbidities. One hundred and twenty-eight (19%) patients had prosthetic left side IE, 391 (58%) native left side IE, 94 (14%) device-related IE and 54 (8%) right side IE. A predisposing cardiopathy was present in 50%, while odontoiatric and non odontoiatric procedures were reported in 5% and 21% of patients respectively. Symptoms were usually atypical and precocious. The prevalent etiology was represented by Staphylococcus aureus (27%) followed by coagulase-negative staphylococci (CNS, 21%), Streptococcus viridans (15%) and enterococci (14%). CNS and enterococci were relatively more frequent in patients with intravascular devices and prosthesis and S. viridans in left native valve. Diagnosis was made by transthoracic and transesophageal echocardiography in 62% and 94% of cases, respectively. The in-hospital mortality was 14% and 1-year mortality was 21%., Conclusion: The epidemiology is changing in Italy, where IE more often affects older patients with comorbidities and intravascular devices, with an acute onset and including a high frequency of enterococci. There were few preceding odontoiatric procedures., (Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.)

Aim: There is still controversy regarding the benefit of percutaneous closure of patent foramen ovale (PFO) among patients with cryptogenic stroke. Here we aimed to evaluate the factors associated with treatment choice and predictors of adverse events in patients with cryptogenic stroke or transient ischemic attack (TIA) and PFO., Methods: Of 418 consecutive patients with PFO and cryptogenic stroke or TIA, 262 underwent percutaneous PFO closure, whereas 156 were medically treated. Multivariable logistic regression models were developed to evaluate factors influencing the treatment strategy and predictors of outcome, a composite of stroke, TIA or all-cause mortality., Results: Patients with large interatrial right-to-left shunt were more likely treated with percutaneous closure [odds ratio (OR) = 4.79, 95% confidence interval (2.73-8.42); P < 0.0001], whereas those with multiple cerebrovascular accident (CVA) risk factors were more likely treated medically [OR = 0.15 (0.03-0.60); P = 0.023]. Age greater than 55 years [OR = 2.70 (1.05-6.88); P = 0.04], previous CVAs [OR = 2.49 (1.03-6.02); P = 0.02] and atrial septal aneurism [ASA, OR = 2.64 (1.09-6.39); P = 0.02], but not percutaneous closure of PFO [OR = 1.10 (0.44-2.74); P = 0.81], were independent predictors of outcome., Conclusion: Among patients with cryptogenic stroke and PFO, the presence of large interatrial right-to-left shunt and multiple CVA risk factors influenced the treatment choice. Older age, multiple previous CVAs and ASA, but not PFO closure, independently predicted the composite outcome of cryptogenic stroke, TIA or all-cause mortality.

Background: Percutaneous coronary interventions (PCI) are widespread procedures in the Italian Healthcare System, but concerns are raised about their economic sustainability. In the last decade, public hospitals have outsourced the PCI services (building and maintaining the technological instruments and the personnel) "buying" them from private companies (Buy) rather than building and maintaining them through public expenditure (Make). The aim of this study was to compare the economic and clinical impact of these two management solutions (Buy and Make) in two community hospitals located in the Turin metropolitan area (Italy)., Methods: We conducted: 1) a quantitative assessment in order to compare differences in the economic impact between Buy and Make for providing PCI; 2) a qualitative assessment comparing the clinical characteristics of two inpatient populations undergoing PCI and then analyzing the efficacy of the procedure in-hospital and at 6-month follow-up., Results: Between January and June 2010, a total of 332 patients underwent PCI at the "degli Infermi" Hospital in Rivoli and 340 at the "Maria Vittoria" Hospital in Turin (Italy). There were no significant differences between the two populations neither about the clinical characteristics nor in procedural efficacy (either immediate or at follow-up). For 600 units of diagnostic-therapeutic pathway, the net present value at a discount rate of 3.5% of the Make project is higher than that of the Buy by €278.402,25, and is therefore the less convenient of the two solutions. The Buy solution is still the more convenient of the two at volumes <700 units., Conclusions: Our findings show that the Buy solution, if tailored to the specific local needs, provides access to sophisticated technology without making worse quality of services and may save capital expenditure below 700 PCI/years.

Background: Optimal management of multivessel disease (MVD) in ST-segment elevation myocardial infarction (STEMI) patients treated by primary percutaneous coronary intervention (PCI) is still unclear., Objectives: To compare short- and long-term clinical outcomes of early-staged, angio-guided approach and delayed, ischemia-guided treatment of non-infarct-related arteries (IRAs)., Methods: Consecutive patients with STEMI and MVD treated with primary PCI in 6 tertiary care centers were retrospectively selected and analyzed. Major adverse cardiac events (MACE) were defined as the composite end-point of death, MI, and repeat revascularization. All the events were adjudicated according to the Academic Research Consortium (ARC) definitions., Results: In the time period 2004-2008, 800 primary PCIs in STEMI patients with MVD were performed. Four hundred and seventeen were addressed to early-staged, angio-guided PCI of non-IRAs (CR group) and 383 to an incomplete revascularization (IncR group). During the hospital stay, no difference in terms of death and repeat revascularization was found between groups but the incidence of periprocedural MI/reinfarction and MACE was significantly higher in the CR group (13.9% vs. 3.1%, P = 0.01 and 14.1% vs. 9.1%, P = 0.017, respectively). At a mean follow-up of 642 ± 545 days, no difference in terms of death and MI was found between the CR and IncR group. The MACE-free survival was significantly higher in the IncR group (73.8% vs. 57%, log rank 0.05), mainly driven by the lower incidence of re-PCI., Conclusions: Early complete revascularization based only on angiographic findings in patients with STEMI and MVD is associated with an excess of periprocedural/re-MI and with a significantly higher incidence of MACE at follow-up., (©2011, Wiley Periodicals, Inc.)

Background: No preventive pharmacologic strategies have been proven efficacious for the prevention of postoperative effusions after cardiac surgery. Colchicine is safe and efficacious for the prevention of pericarditis. On this basis, we realized a substudy of the COPPS trial to assess the efficacy and safety of colchicine for the prevention of postoperative pericardial and pleural effusions., Methods: The COPPS is a multicenter, double-blind, randomized trial, where 360 consecutive patients (mean age 65.7 ± 12.3 years, 66% men), 180 in each treatment arm, were randomized on the third postoperative day to receive placebo or colchicine for 1 month (1.0 mg twice daily for the first day, followed by a maintenance dose of 0.5 mg twice daily in patients ≥70 kg, and halved doses for patients <70 kg). The incidence of postoperative effusions was evaluated in each study group., Results: Despite similar baseline features, colchicine significantly reduced the incidence of postoperative pericardial (12.8% vs 22.8%, P = .019, relative risk reduction 43.9%, no. of patients needed to treat 10) and pleural effusions (12.2% vs 25.6%, P = .002, relative risk reduction 52.3%, no. of patients needed to treat 8). The rate of side effects (only gastrointestinal intolerance) and drug withdrawal was similar in the study groups with a trend toward an increased rate of both events for colchicine. In multivariable analysis, female gender (hazard ratio 1.76, 95% CI 1.03-3.03, P = .040) and pleura incision (hazard ratio 2.58, 95% CI 1.53-4.53, P < .001) were risk factors for postoperative effusions., Conclusions: Colchicine is safe and efficacious for the primary prevention of postoperative effusions after cardiac surgery., (Copyright © 2011 Mosby, Inc. All rights reserved.)

Background: Only 30% of survivors from out-of-hospital cardiac arrest receive basic life support (BLS) before the arrival of emergency personnel. This is also due to reluctance to perform BLS, especially mouth-to-mouth ventilation without barrier devices in victims who are unknown to the rescuer (either layperson or healthcare provider)., Methods: To evaluate the incidence of reluctance to perform mouth-to-mouth ventilation without barrier devices and its consequences in a simulated BLS scenario proposed by a questionnaire to healthcare providers of critical area in a public general hospital., Results: Answers were collected from 128 of 165 (77.5%) interviewed healthcare providers. Physicians were 46 of 128 (35.9%), professional nurses were 78 of 128 (60.9%) and 4 of 128 (3.2%) were other health workers devoted to patient assistance. Seventy-five of 128 (58.6 %) were reluctant to perform mouth-to-mouth ventilation without barrier devices; 68 of 75 (90.6%) would perform BLS only by chest compression. Compared with non-reluctant providers, they would have been available to perform assisted ventilation by non-validated alternative methods (54.2 vs 18.8% respectively, p < 0.001). Seven of 75 (9.6%, no physician among them) would perform no BLS at all. The most significant predictors of reluctance were age < 40 years (p = 0.07) and previous attendance of BLS-BLSD courses (p = 0.07)., Conclusions: Reluctance to perform mouth-to-mouth ventilation without barrier devices is frequent and may reduce the number of potential BLS providers. Because of the concern about disease transmission between victim and rescuer, rescuers with a duty to respond such as healthcare providers should follow precautions including the use of barrier device also outside their workplace. When barrier devices are unavailable first responders should consider chest compression alone instead of not performing any BLS maneuvers. BLS training should help give a greater emphasis on this topics.

Background: Reperfusion therapy of ST-elevation myocardial infarction (STEMI) with primary coronary angioplasty (PTCA) is becoming an accepted therapeutical strategy because of a lower incidence of reinfarction, of hemorrhagic stroke and for a greater reduction of the infarct size in comparison to thrombolytic therapy. In this study we evaluated the feasibility and the effectiveness of such a strategy in two hospitals without on-site heart surgery but with a high volume of admission for acute coronary syndrome and a high caseload of elective interventional procedures., Methods: Since January 2001 we started a program of primary PTCA for all STEMI patients presenting within 12 hours of symptom onset. An interventional team (physician, nurse and technician) were on call in a 24/7/365 fashion. Aspirin, heparin and abciximab were administered in the emergency room to all patients. Immediately after the procedure patients were given clopidogrel., Results: Up to December 2003, 464 patients (mean age 63 +/- 12 years, 19.8% female) underwent primary PTCA. The symptom-emergency room interval was 3 +/- 3.9 hours, while the door-to-balloon time was 52.5 +/- 39.4 min. A TIMI 0-1 flow in the infarct-related artery was present in 55.8% of patients. Seventy patients (15.1%) presented with shock. In 430 patients (92.7%) a TIMI 3 flow was restored followed by a reduction in ST-segment elevation > 50% in 356 patients (76.7%). Total in-hospital mortality was 4.9% (23 out of 464 patients). The mortality of patients with shock was 31.4% (22 out of 70 patients). Two patients (0.4%) underwent emergency bypass. Four patients (0.8%) were electively referred to surgery prior to discharge in order to complete revascularization, which could not be obtained with further PTCA. The rate of major hemorrhagic complications was 0.8%., Conclusions: Primary PTCA for STEMI is a reperfusion strategy feasible and effective even in hospitals without on-site heart surgery, provided that a high volume of routine and emergency interventional procedures is maintained and when such a strategy is timely performed according to international guidelines.

Background: Percutaneous transluminal coronary angioplasty (POBA) of complex lesions is hindered by a lower success rate and a higher risk of complications. New devices are now available for treatment of this type of lesions (type B-C of the modified AHA/ACC classification). We present our experience in the treatment of calcified, ostial, angled and long coronary lesions by means of percutaneous transluminal coronary rotational ablation (PTCRA, Rotablator Heart Technology, Bellevue, Washington)., Material and Methods: From June 1991 to November 1995 we performed 71 procedures of rotational atherectomy on 72 lesions in 62 patients. Twenty-three patients presented stable angina, 30 patients unstable angina and 9 silent myocardial ischemia. Thirty-five patients had single, 16 double and 11 triple vessel coronary artery disease. Left ventricular mean ejection fraction was 58 +/- 8%. The lesions attempted were classified as type A in 2 cases, B1 in 23 cases, B2 in 31 cases and C in 16 cases according to the AHA/ACC modified classification. Calcifications detected at coronary angiography were present in 66 lesions; 53 lesions were longer than 10 mm; 12 were more than 45 degrees angulated; 9 were at a bifurcation site and 3 were ostial in location. The vessels treated were in 1 case a protected Left Main Trunk, in 40 the Left Anterior Descending, in 9 the Circumflex and in 22 the Right Coronary Artery. We did not treat lesions containing visible thrombus or located on old saphenous vein grafts because of the high risk of peripheral embolization. An average of 2 +/- 1 burrs was used; the mean burr/vessel diameter ratio was 0.59 +/- .07. "Complementary" low pressure PTCA was performed in all but 4 cases ("stand alone procedure")., Results: Primary success was obtained in 62/71 procedures (92%) and in 67/72 lesions (94%). There were two major cardiac events during the hospital stay: one death and one acute myocardial infarction which occurred respectively at four days and 48 hours after the procedure due to late occlusion of the vessel treated with primary success. In three cases the procedure was unsuccessful but uncomplicated: In one the stenosis could not be crossed, in a second case a residual stenosis > 50% was present, in a third case the procedure resulted in dissection and occlusion of a vessel served by good intercoronary collaterals. No emergency or elective coronary artery bypass surgery was necessary. Coronary spasm occurred in 6 cases (9%). In two of them spasm was refractory to intracoronary nitrates and Verapamil, and stent implantation was required. Urapidil, a selective alpha 1 blocker, completely abolished the occurrence of coronary vasospasm in the last 16 cases. A no reflow phenomenon was observed in two cases associated with mild CK-MB elevation. In conclusions: our experience suggests that rotational atherectomy performed on lesions with complex morphology, most of them calcified, is a safe and effective procedure which therefore can be undertaken even in hospitals without on site cardiac surgery. Our data on late restenosis are inconclusive because of the lack of angiographic follow up.

Background: The concept of the absolute need of surgical standby for coronary angioplasty, although still strongly supported by the Task Force of the AHA and ACC, has been changing over the years according to the developments of PTCA equipment and the introduction of autoperfusion balloon catheters and coronary stents. In many European countries and in Canada, due to the relative lack of institutions performing cardiac surgery, almost 40% of cardiac laboratories are now performing PTCA without on-site surgical standby., Methods and Results: Following a previous experience in another institution with on-site cardiac surgery, since January 1991 until February 1994, 742 Patients underwent PTCA in our Hospital not provided with on-site cardiac surgery. Surgical standby was requested in 99 cases to nearby surgical centers and it was utilized in 6 cases. Primary success was achieved in 91% of stenoses (94% in non occlusive and 69% in totally occlusive lesions). The mortality rate in cases other than cardiogenic shock was 0.13%, the myocardial infarction rate was 1.2% and the rate of emergency coronary bypass operation was 0.8%., Conclusions: PTCA in our view, as well as others', can be successfully performed in Institutions without on-site surgical support, provided the cardiac team has achieved a satisfactory experience and skill, the correct equipment for treatment of occlusive complications is available and a nearby surgical institution is alerted for procedures considered at particular risk, due to the amount of myocardium in jeopardy in case of irreversible arterial occlusion.