Therapeutic management of chronic hepatitis B in clinical Practice: a region-wide survey

Goals: To characterize the clinical and treatment pattern in a large population of hepatitis B virus (HBV) patients managed at tertiary referral centers in clinical practice. Background: Successful treatment, either with interferon (IFN) or nucleos(t)ide analogs (NUCs), of chronic HBV infection is associated with improved long-term patient outcome. However, in clinical practice, the actual management of these patients is not well characterized, and data regarding treatment pattern in this setting are lacking. Methods: In this cross-sectional study, we evaluated 505 patients chronically infected with HBV alone and who had at least 1-year follow-up. We assessed indication to, rate of, and type of treatment as well as the characteristics of treated patients. Results: Overall prevalence of positivity for HBe antigen was 19.3%, and the majority of patients had chronic hepatitis (47.5%). Non-Italian patients represented approximately one third of the population (27.1%). Among patients with indication to antiviral therapy (n = 318), treatment was actually carried out in 264 patients (83.0%), prevalently with NUCs (65.9%). IFN-treated patients were younger (P < 0.001), more frequently male (P = 0.025) and HBeAg positive (P = 0.003), and less frequently cirrhotics (P < 0.001) as compared with patients treated with NUCs. Conclusions: In a geographical area with a low positivity for HBe antigen, antiviral therapy is actually carried out in the majority of patients who have indication to treatment, prevalently with NUCs, whereas IFN treatment is more frequently carried out in young, HBe antigen positive patients who do not have advanced liver disease

Clinical Impact and Predictors of Aneurysmal Rebleeding in Poor-Grade Subarachnoid Hemorrhage: Results From the National POGASH Registry

Background: Scarce data are available regarding rebleeding predictors in poor-grade aneurysmal subarachnoid hemorrhage (aSAH). Objectives: To investigate predictors and clinical impact of rebleeding in a national multicentric poor-grade aSAH. Methods: Retrospective analysis of prospectively collected data from the multicentric Poor Grade Aneurysmal Subarachnoid Hemorrhage Study Group (POGASH) registry of consecutive patients treated from January 1, 2015, to June 30th, 2021. Grading was defined as pretreatment World Federation of Neurological Surgeons grading scale IV-V. Ultra-early vasospasm (UEV) was defined as luminal narrowing of intracranial arteries not due to intrinsic disease. Rebleeding was defined as clinical deterioration with evidence of increased hemorrhage on subsequent computed tomography scans, fresh blood from the external ventricular drain, or deterioration before neuroradiological evaluation. Outcome was assessed by the modified Rankin Scale. Results: Among 443 consecutive World Federation of Neurological Surgeons grades IV-V patients with aSAH treated within a median of 5 (IQR 4-9) hours since onset, rebleeding occurred in 78 (17.6%). UEV (adjusted odds ratio [OR] 6.8, 95% CI 3.2-14.4; P < .001) and presence of dissecting aneurysm (adjusted OR 3.5, 95% CI 1.3-9.3; P = .011) independently predicted rebleeding while history of hypertension (adjusted OR 0.4, 95% CI 0.2-0.8; P = .011) independently reduced its chances. 143 (32.3) patients died during hospitalization. Rebleeding emerged, among others, as an independent predictor of intrahospital mortality (adjusted OR 2.2, 95% CI 1.2-4.1; P = .009). Conclusion: UEV and presence of dissecting aneurysms are the strongest predictors of aneurysmal rebleeding. Their presence should be carefully evaluated in the acute management of poor-grade aSAH

High precision measurements of neutrino fluxes with ENUBET

Neutrino fluxes are currently affected by large normalization uncertainties (5-10%). Neutrino physics will require measurements of absolute neutrino cross sections at the GeV scale with exquisite (1%) precision in the near future. For this reason a reduction of the present uncertainties by one order of magnitude would be highly beneficial. This goal might be achieved by producing a sign and momentum selected narrow band beam and monitoring the production of $e^{+}$ in the decay tunnel from the decays of charged Kaons ($K_{e3}$ channel). This technique, which requires a special instrumented beam-line, would allow a 1% level measurement of the cross-sections of the neutrino species ($\nu_e$ and $\bar{\nu}_e$) which are the final states involved in the searches for CP violation with muon neutrino beams at long-baseline. The ENUBET Horizon-2020 ERC Consolidator Grant, approved by the European Research Council in 2015, is the framework within which such a non conventional beam-line will be developed. We present a progress report of the project (2016-2021) after about one year of work, the experimental results on ultra-compact calorimeters suited for the instrumenting the decay tunnel and the R&D in the design of the hadronic beamline

Lepton reconstruction in the ENUBET tagger

The ENUBET project aims at demonstrating the feasibility of a monitored neutrino beam in which the measurement of associated charged leptons in the instrumented decay region of a conventional beam is used to constrain the neutrino flux to unprecedented precision ($\mathcal{O}$(1\%)). Large angle muons and positrons from kaon decays are detected on the decay tunnel walls equipped with a sampling calorimeter with longitudinal, radial and azimuthal segmentation. After a brief description of the ENUBET beamline and of the detectors employed in the lepton tagger, the analysis chain for the event reconstruction, the background suppression and the identification of positrons and muons will be described

The ENUBET narrow band neutrino beam

ENUBET has been conceived to monitor positrons from $K_{e3}$ decays in conventional neutrino beam decay tunnels in order to provide a direct determination of the $\nu_e$ flux at the source, paving the way to a measurement of electron neutrino cross section with 1% precision. Since 2016 remarkable results on the prototyping and testing of the tunnel instrumentation for positron tagging have been achieved, as well as on the design and simulation of the proton extraction scheme, the focusing system and the meson transfer line. In particular the demonstration of the viability of a static focusing extend the potential of monitored neutrino beams beyond the original aim of ENUBET: the flux measurement at the 1% level also for $\nu_{\mu}$ produced in the beam. Particular emphasys will be given on this topic and on the possibility to determine the neutrino energy without relying on final state particle reconstruction, thanks to the narrow momentum width of the selected mesons

The ENUBET ERC project for an instrumented decay tunnel for future neutrino beams

The ENUBET ERC project (2016–2021) is studying a narrow band neutrino beam where lepton production can be monitored at single particle level. For this purpose, the decay tunnel is instrumented with longitudinally segmented calorimeters. Three different specialized calorimeters have been designed and tested, two of which based on the shashlik calorimetric concept with a compact readout while the third is a less compact version with a lateral readout. All of the prototypes are composed of thick steel absorbers coupled to plastic scintillators. Regarding the shashlik modules, a matrix of 3 × 3 fibers runs transversely with a density of one fiber/cm$^2$ . The fibers are coupled individually to silicon photomultipliers mounted on a custom PCB allowing to reduce the dead zones between adjacent modules to an extremely small level compared to the “fiber bundling” configurations. This setup allows a very effective longitudinal segmentation and hence $e / \pi$ separation. The second shashlik module is based on polysiloxane scintillators which come in liquid form, are poured around the fiber arrays and finally made solid with a thermal treatment. Finally, the lateral readout module, light is collected from both sides of each scintillator tile and the 10 fibers from the same UCM are bundled to a single SiPM. Here are discussed the results of test beams performed in 2016–2018 at the CERN-PS East Area and the characterization of SiPMs of different cell size ( 12 μm and 15 μm ) before and after being exposed to neutron fluxes up to 10$^{12}$ /cm$^2$ at the INFN-LNL CN accelerator facility