The effect of lamivudine treatment on the outcome of patients with hepatitis B e antigen (HBeAg)‐negative chronic hepatitis is unclear. In a retrospective multicenter study, we have analyzed the ...virological events observed during lamivudine therapy in patients with HBeAg‐negative chronic hepatitis and evaluated the correlation between virological response and clinical outcomes. Among 656 patients (mean age 49.1 years) included in the database, 54% had chronic hepatitis, 30% had Child‐Turcotte‐Pugh (CTP) A cirrhosis, and 16% had CTP B/C cirrhosis. On therapy (median 22 months, range 1–66), a virological response was obtained in 616 patients (93.9%). The rate of maintained virological response was 39% after 4 years. During follow‐up, 47 (7.2%) patients underwent liver transplantation, liver disease worsened in 31 (4.7%), hepatocellular carcinoma (HCC) developed in 31 (4.7%), and 24 patients (3.6%) died of liver‐related causes. Patients who had cirrhosis and who maintained virological response were less likely than those with viral breakthrough to develop HCC (P < .001) and disease worsening (P < .001). Survival was better in CTP A patients with cirrhosis and maintained virological response (P = .01 by rank test). Multivariate analysis revealed that presence of cirrhosis and viral breakthrough were independently related to mortality and development of HCC. In conclusion, lamivudine is highly effective in reducing viral load in HBeAg‐negative patients. After 4 years of therapy, 39% of patients maintain a virological and biochemical response. Loss of virological response may lead to clinical deterioration in patients with cirrhosis. (Hepatology 2004;40:883–891).
Our goal was to compare surgical scars assessed by a validated patient reported outcome questionnaire in children undergoing open (OP), laparoscopic (LP), or robotic-assisted (RALP) pyeloplasty. Our ...secondary aim was to assess the influence on the outcomes of variables such as gender or body mass index (BMI).
We conducted an observational, cross-sectional, multicentric study of patients undergoing primary pyeloplasty between age 10 and 18 years at 5 tertiary Italian institutions during the period January 2010 to December 2019. Of 227 eligible patients 114 (50%) participated. OP was performed in 37 (32%), LP in 30 (26%) and RALP in 47 (41%), After a median (IQR) followup of 5.2 (2.3-7.8) years, scars were measured and assessed by a validated Patient Scar Assessment Questionnaire. Scores were compared among techniques and in accordance with several variables.
The median length of the surgical scar at followup was significantly larger (p <0.0001) after OP (8.1 cm vs 1.8 cm for LP and 2.0 cm for RALP), where scar length correlated with BMI (p=0.04). Ninety patients (79%) had a Patient Scar Assessment Questionnaire score within the first quartile, the most favorable. During followup, 43 (38%) participants reported scar-related symptom. Symptoms were generally more common after OP (54% vs 30% for LP and 30% for RALP, p=0.06) and scar hyperesthesia was significantly more frequent after OP (p=0.01).
Perception of the cosmetic outcomes in pre-adolescents and adolescents after pyeloplasty was generally good. LP achieved the best cosmetic results. OP was more commonly associated with scar-related symptoms and the size of the incision paralleled BMI.
The standard treatment approach in locally advanced cervical cancer (LACC) is exclusive concurrent chemoradiation therapy (RTCT). The risk of local residual disease after six months from RTCT is ...about 20-30%. It is directly related to relapse risk and poor survival, such as in patients with recurrent cervical cancer. This systematic review aims to describe studies investigating salvage surgery's role in persistent/recurrent disease in LACC patients who underwent definitive RTCT.
Studies were eligible for inclusion when patients had LACC with radiologically suspected or histologically confirmed residual disease after definitive RTCT, diagnosed with post-treatment radiological workup or biopsy. Information on complications after salvage surgery and survival outcomes had to be reported. The methodological quality of the articles was independently assessed by two researchers with the Newcastle-Ottawa scale. Following the recommendations in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement, we systematically searched the PubMed, Scopus, Cochrane, Medline, and Medscape databases in May 2022. We applied no language or geographical restrictions but considered only English studies. We included studies containing data about postoperative complications and survival outcomes.
Eleven studies fulfilled the inclusion criteria and all were retrospective observational studies. A total of 601 patients were analyzed concerning the salvage surgery in LACC patients for persistent/recurrent disease after RTCT treatment. Overall, 369 (61.4%) and 232 (38.6%) patients underwent a salvage hysterectomy (extrafascial or radical) and pelvic exenteration (anterior, posterior, or total), respectively. Four hundred and thirty-nine (73%) patients had histologically confirmed the residual disease in the salvage surgical specimen, and 109 patients had positive margins (overall range 0-43% of the patients). The risk of severe (grade ≥ 3) postoperative complications after salvage surgery is 29.8% (range 5-57.5%). After a median follow-up of 38 months, the overall RR was about 32% with an overall death rate of 40% after hysterectomy or pelvic exenteration with or without lymphadenectomy.
There is heterogeneity between the studies both in their design and results, therefore the effect of salvage surgery on survival and recurrence cannot be adequately estimated. Future homogeneous studies with an appropriately selected population are needed to analyze the safety and efficacy of salvage hysterectomy or pelvic exenteration in patients with residual tumors after definitive RTCT.
Fused Deposition Modeling (FDM) 3D printing is the most widespread technology in additive manufacturing worldwide that thanks to its low costs, finished component applications, and the production ...process of other parts. The need for lighter and higher-performance components has led to an increased usage of polymeric matrix composites in many fields ranging from automotive to aerospace. The molds used to manufacture these components are made with different technologies, depending on the number of pieces to be made. Usually, they are fiberglass molds with a thin layer of gelcoat to lower the surface roughness and obtain a smooth final surface of the component. Alternatively, they are made from metal, thus making a single carbon fiber prototype very expensive due to the mold build. Making the mold using FDM technology can be a smart solution to reduce costs, but due to the layer deposition process, the roughness is quite high. The surface can be improved by reducing the layer height, but it is still not possible to reach the same degree of surface finish of metallic or gelcoat molds without the use of fillers. Thermoplastic polymers, also used in the FDM process, are generally soluble in specific solvents. This aspect can be exploited to perform chemical smoothing of the external surface of a component. The combination of FDM and chemical smoothing can be a solution to produce low-cost molds with a very good surface finish.
To date, delirium prevalence in adult acute hospital populations has been estimated generally from pooled findings of single-center studies and/or among specific patient populations. Furthermore, the ...number of participants in these studies has not exceeded a few hundred. To overcome these limitations, we have determined, in a multicenter study, the prevalence of delirium over a single day among a large population of patients admitted to acute and rehabilitation hospital wards in Italy.
This is a point prevalence study (called "Delirium Day") including 1867 older patients (aged 65 years or more) across 108 acute and 12 rehabilitation wards in Italian hospitals. Delirium was assessed on the same day in all patients using the 4AT, a validated and briefly administered tool which does not require training. We also collected data regarding motoric subtypes of delirium, functional and nutritional status, dementia, comorbidity, medications, feeding tubes, peripheral venous and urinary catheters, and physical restraints.
The mean sample age was 82.0 ± 7.5 years (58 % female). Overall, 429 patients (22.9 %) had delirium. Hypoactive was the commonest subtype (132/344 patients, 38.5 %), followed by mixed, hyperactive, and nonmotoric delirium. The prevalence was highest in Neurology (28.5 %) and Geriatrics (24.7 %), lowest in Rehabilitation (14.0 %), and intermediate in Orthopedic (20.6 %) and Internal Medicine wards (21.4 %). In a multivariable logistic regression, age (odds ratio OR 1.03, 95 % confidence interval CI 1.01-1.05), Activities of Daily Living dependence (OR 1.19, 95 % CI 1.12-1.27), dementia (OR 3.25, 95 % CI 2.41-4.38), malnutrition (OR 2.01, 95 % CI 1.29-3.14), and use of antipsychotics (OR 2.03, 95 % CI 1.45-2.82), feeding tubes (OR 2.51, 95 % CI 1.11-5.66), peripheral venous catheters (OR 1.41, 95 % CI 1.06-1.87), urinary catheters (OR 1.73, 95 % CI 1.30-2.29), and physical restraints (OR 1.84, 95 % CI 1.40-2.40) were associated with delirium. Admission to Neurology wards was also associated with delirium (OR 2.00, 95 % CI 1.29-3.14), while admission to other settings was not.
Delirium occurred in more than one out of five patients in acute and rehabilitation hospital wards. Prevalence was highest in Neurology and lowest in Rehabilitation divisions. The "Delirium Day" project might become a useful method to assess delirium across hospital settings and a benchmarking platform for future surveys.
On-fault processes during earthquakes contribute to seismic rupture propagation and slip. Here we investigate clast fragmentation in an experimental pseudotachylyte (solidified seismic melt) produced ...with a rotary shear machine. We slid for 0.44 m (corresponding to Mw ≥ 6 earthquakes), at slip rates > 1 m/s, pre-cut samples of quartz + phyllosilicates + plagioclase + sillimanite + garnet -bearing ultramylonite, that hosts pseudotachylytes in nature. The ultramylonite minerals extensively preserved as clasts in the experimental pseudotachylyte are quartz, plagioclase, and sillimanite. Garnet is scarcely preserved, despite having a melting temperature similar to plagioclase, probably due to having low thermal shock resistance. This selective clast survival is identical to the one found in the natural pseudotachylytes. Based on these experimental observations and assuming non-equilibrium melting, the preservation of a mineral, as a clast, in the melt appears to be controlled by its thermal shock properties as well as by its melting temperature. Since the mechanical effects of rupture propagation in these experiments were negligible, we conclude that, for Mw ≥ 6 earthquakes, (i) frictional slip and heating of the slipping zone plus (ii) thermomechanical properties of minerals, rather than fault rupture processes, control mineral comminution and clast survival in frictional melts.
•Clast survival to melting of the natural pseudotachylytes reproduced experimentally.•Clast survival depends on mineral melting temperature and thermal shock resistance.•Preferential melting of garnet clasts is enhanced by thermal shock comminution.•For large earthquakes, frictional sliding and heating control clast survival.
The aims of the ERIS (Evolving Routine Standards of FFR Use) study are to describe the current use of invasive coronary physiology assessment and discern the reasons for its nonuse in daily practice.
...Adoption of coronary physiology guidance in the catheterization laboratory varies among countries, centers, and operators.
ERIS is an investigator-driven, nationwide, prospective, cross-sectional study involving 76 Italian catheterization laboratories. Each center had a 60-day window to include consecutive cases that fulfilled the inclusion and exclusion criteria. Two pre-specified groups were enrolled: 1) patients who had operators apply fractional flow reserve or instantaneous wave-free ratio assessment (physiology assessment group); and 2) patients who had operators decide not to perform fractional flow reserve or instantaneous wave-free ratio assessment, although the patients met the inclusion and exclusion criteria (visual estimation group).
Overall, 1,858 cases were included (physiology assessment group, n = 1,177; visual estimation group, n = 681). Physiology-based guidance was used in 7% and 13% of the total volume of angiographic and percutaneous coronary interventions, respectively. Its use was in line with European and American guidelines in 48% of the cases (n = 569). Physiology guidance was used in a consistent number of patients with acute coronary syndromes (n = 529 45%). The main reason for not using physiology guidance was the operator's confidence that clinical and angiographic data alone were sufficient.
Use of coronary physiology assessment in daily practice meets the current guideline indications in approximately 50% of cases. The major limiting factor for the adoption of physiology guidance was the operator's confidence in visual assessment alone. (Evolving Routine Standards of FFR Use ERIS; NCT03082989).
The circadian biological clock is essentially based on the light/dark cycle. Some people working with shift schedules cannot adjust their sleep/wake cycle to the light/dark cycle, and this may result ...in alterations of the circadian biological clock. This study explored the circadian biological clock of shift and daytime nurses using non-invasive methods. Peripheral skin temperature, cortisol and melatonin levels in saliva, and Per2 expression in pubic hair follicle cells were investigated for 24 h after a day off. Significant differences were observed in peripheral skin temperature and cortisol levels between shift and daytime nurses. No differences in melatonin levels were obtained. Per2 maximum values were significantly different between the two groups. Shift nurses exhibited lower circadian variations compared to daytime nurses, and this may indicate an adjustment of the circadian biological clock to continuous shift schedules. Non-invasive procedures, such as peripheral skin temperature measurement, determination of cortisol and melatonin in saliva, and analysis of clock genes in hair follicle cells, may be effective approaches to extensively study the circadian clock in shift workers.
Phothermal therapy (PTT) is one of the most promising techniques to treat cancer. Finding the ideal PTT agent nanomaterial has remained a challenge and has brought the interest of several ...researchers. In this work, we report the synthesis of molybdenum oxide (MoOx) nanoparticles (NPs), which exhibit absorption in the biological optical window ~840 nm, by using the laser ablation of solids in liquids (LASL) technique with nanosecond (ns) pulses. A Nd:YAG laser was used to synthesize the NPs in deionized (DI) water, free of surfactants or additives, which were optically characterized by absorption spectroscopy and TEM-EDX microscopy. Semi spherical NPs with a suitable average size and shape for potential use as PTT agents were obtained by laser ablation and ablation + fragmentation. The calculated band gap is 3.1 eV, which corresponds to MoO3. Micro-Raman spectroscopy studies determined that these NPs are composed of amorphous molybdenum oxide hydrates (MoO3 · xH2O).
•MoOx NPs were successfully synthesized by the LASL method with ns pulses.•MoOx NPs possess an absorption peak located at around 840 nm.•The produced MoOx NPs show potential for Photothermal Theraphy applications.•MoOx NPs are constituted of amorphous molybdenum oxide hydrates (MoO3·xH2O).
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