Low Noise Opto-Electro-Mechanical Modulator for RF-to-Optical Transduction in Quantum Communications

In this work, we present an Opto-Electro-Mechanical Modulator (OEMM) for RF-to-optical transduction realized via an ultra-coherent nanomembrane resonator capacitively coupled to an rf injection circuit made of a microfabricated read-out able to improve the electro-optomechanical interaction. This device configuration can be embedded in a Fabry-Perot cavity for electromagnetic cooling of the LC circuit in a dilution refrigerator exploiting the opto-electro-mechanical interaction. To this aim, an optically measured steady-state frequency shift of 380 Hz was seen with a polarization voltage of 30 V and a $Q$-factor of the assembled device above $10^6$ at room temperature. The rf-sputtered titanium nitride layer can be made superconductive to develop efficient quantum~transducers.Comment: 14 pages, 8 figure

Benign Paroxysmal Positional Vertigo (BPPV) in COVID-19

Objective: The purpose of this article is to describe BPPV in COVID-19 patients by discussing the possible mechanisms underlying the onset of this vertigo. Methods: We studied eight patients (4 F, 4 M, aged between 44 and 69 years) with COVID-19 infections complaining of vertigo. Patients were evaluated at the end of infection with an accurate clinical history, and the investigation of spontaneous, positional and positioning nystagmus. Results: The vestibular findings showed benign paroxysmal positional vertigo (BPPV) in all the patients. Three patients had a mild phenotype of the COVID infection, whereas five subjects were hospitalized for the COVID infection and in three cases intensive care was required. Vestibular evaluation showed an involvement of posterior semicircular canals in five patients and horizontal in three. Three patients were treated with the Epley maneuver, two with Semont, one with Lempert and two with Gufoni maneuvers. Conclusions: We hypothesize that BPPV in COVID-19 infections can be relate to drugs, prolonged bed rest and to direct damage by viral infection on the peripheral vestibular system and in particular on the otolitic membrane due to the cytopathic effect of the virus and to the inflammatory response. Studies on large series of patients are needed to confirm our preliminary observation and to better evaluate the pathophysiological mechanisms underlying BPPV in these patients

Assessment of Sexual Dysfunction in Cervical Cancer Patients after Different Treatment Modality: A Systematic Review

Background and Objectives: Cervical cancer is a leading cause of mortality among women. Chemo-radiation followed by interventional radiotherapy (IRT) is the standard of care for stage IB-IVA FIGO. Several studies have shown that image-guided adaptive IRT resulted in excellent local and pelvic control, but it is associated with vaginal toxicity and intercourse problems. The purpose of this review is to evaluate the dysfunctions of the sexual sphere in patients with cervical cancer undergoing different cervix cancer treatments. Materials and Methods: We performed a comprehensive literature search using Pub med, Scopus and Cochrane to identify all the full articles evaluating the dysfunctions of the sexual sphere. ClinicalTrials.gov was searched for ongoing or recently completed trials, and PROSPERO was searched for ongoing or recently completed systematic reviews. Results: One thousand three hundred fifty-six women included in five studies published from 2016 to 2022 were analyzed. The median age was 50 years (range 46-56 years). The median follow-up was 12 months (range 0-60). Cervical cancer diagnosis and treatment (radiotherapy, chemotherapy and surgery) negatively affected sexual intercourse. Sexual symptoms such as fibrosis, strictures, decreased elasticity and depth and mucosal atrophy promote sexual dysfunction by causing frigidity, lack of lubrication, arousal, orgasm and libido and dyspareunia. Conclusions: Physical, physiological and social factors all contribute to the modification of the sexual sphere. Cervical cancer survivors who were irradiated have lower sexual and vaginal function than the normal population. Although there are cures for reducing discomfort, effective communication about sexual dysfunctions following treatment is essential

Decision Making on Vestibular Schwannoma: Lessons from a Multidisciplinary Board

BACKGROUND: Management of vestibular schwannoma (VS) is a complex process aimed at identifying a clinical indication for fractionated stereotactic radiotherapy (sRT) or radiosurgery, microsurgical resection, or wait and scan (WS). We describe the experience of our VS multidisciplinary team (MDT) at a tertiary university referral center created for diagnosis, treatment, and follow-up of VS patients. METHODS: We conducted a retrospective study on 132 consecutive patients referred to the MDT and managed by observation (WS), microsurgery, or fractionated sRT. The analysis included patient age, tumor size, hearing level, facial nerve function, tumor control, complications, and quality of life questionnaires. RESULTS: Among the patients, 21% were subjected to microsurgery, 10% to sRT, and 69% to WS. The median follow-up time was 30 months. Outcomes based on different management modalities are described. Statistically significant differences among groups were detected in terms of quality of life (physical domain). CONCLUSIONS: MDT may provide the best individualized therapy for VS patients compared with a single gold standard strategy

"Delirium Day": A nationwide point prevalence study of delirium in older hospitalized patients using an easy standardized diagnostic tool

Background: 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. Methods: 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. Results: 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. Conclusions: 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

The role of radiation therapy and systemic therapies in elderly with breast cancer

The focus of this review deals with the management of elderly patients with early stage breast cancer, discussing the role of systemic therapies [endocrine therapy (ET), chemotherapy, novel agents] and radiation therapy (RT). Several studies have evaluated in elderly low risk patients the possibility of omitting the RT but, at the same time, higher locoregional relapse (LR) rates without significant impact on overall survival (OS) were observed in all studies when RT was excluded. Technological improvements [intensity-modulated RT (IMRT), volumetric modulated arc therapy (VMAT), high dose brachy therapy (HDBT)] are very useful in order to reduce cosmetic outcome and improve quality of life of frail patients. The optimal sequence of ET, concomitant or sequential to RT, is currently under investigation, and specifically in the elderly it is questioned the possible choice of prolonged therapy after standard 5 years. Data regarding chemotherapy suggesting no benefit of OS in endocrine responsive diseases, whereas endocrine non-responsive breast cancer still showed a better outcome. Cyclophosphamide, methotrexate and 5-fluorouracil (CMF) regimen is recognized as the standard protocol, although age-dependent increase in therapy related mortality was reported. Neoadjuvant chemotherapy in elderly showed a lower ratio of pathological complete response in comparison to younger patients, but triple negative breast cancer patients showed a good prognosis regarding OS, comparable to younger patients. The risk of cardiotoxicity seems to increase with age, so the use trastuzumab in this setting is much debated. Currently, other anti-HER2 agents (pertuzumab, lapatinib) are used in neoadjuvant setting, but the data on elderly are still premature. Novel molecules are rapidly changing the clinical management of breast cancer patients but are tested especially in locally advanced and metastatic setting. Among these, particularly interesting are inhibitors of CDK4 and 6, alpelisib (PI3K enzymes mutations), immune checkpoint (PD1, PDL1, CTLA4) inhibitors, atezolizumab. Elderly patients are under-represented in clinical trials, although ageing can be frequently correlated with a decrease in the effectiveness of the immune system. For elderly women, treatment decisions should be individually decided, taking into account the geriatric assessment and limited life expectancy and tumor characteristics

Three-dimensional STI assessment of right ventricular function in acute cor pulmonale

Purpose. We aimed to assess changes in right ventricular (RV) parameters determined by three-dimensional speckle tracking imaging (3D-STI) before and after long-term acute pulmonary embolism (PE) treatment. Methods. We enrolled 23 patients with acute PE confirmed by multidetector row chest computed tomography. 23 healthy subjects without signs of cardiopulmonary dysfunction served as a control group. Conventional echo RV parameters included tricuspid annular plane systolic excursion (TAPSE), myocardial performance index (RV-MPI) and RV fractional area change (RV-FAC). Pulmonary arterial systolic pressure was obtained by standard Doppler methods. Pulmonary hypertension was defined as a pulmonary artery systolic pressure of 40 mmHg or greater. RV end-diastolic and end-systolic volumes were measured from three-dimensional echocardiographic datasets and right ventricular ejection fraction (3D-RVEF) was calculated. 3D-STI was used to determine RV peak systolic strain, time to peak-systolic strain from the onset of QRS, standard deviation of the time to peak-systolic strain, and global area strain (RV-GAS). RV dyssynchrony was defined as the standard deviation of the six time to peak systolic strain values. Global longitudinal strain (RV-GLS) was calculated by averaging local strains along the entire right ventricle. Data analysis was performed offline using the original raw data from all 3DE data sets on a software workstation for semiautomated endocardial surface detection (EchoPAC BT11, 4D Auto LVQ, GE Vingmed Ultrasound, Horten, Norway). Results. Mean percentage intraobserver variability was 8% for RV-GLS and 6% for RV-GAS, and mean percentage interobserver variability was 11% for RV-GLS and 8% for RV-GAS. TAPSE, RV-MPI, RV-FAC (p<0.005) and RV-GAS (p<0.0001) were lower in patients with PE and pulmonary hypertension compared to the control group. A significant correlation was found between RV-GAS and pulmonary artery systolic pressure (r = 0.76, p <0.001), between RV-GAS and RV dyssynchrony (r = 0.71, p <0.005), and between RV-GAS and RV-GLS (r = 0.68, p <0.005). Decreased RV-GAS (<25%) and 3D-RVEF (< 45%) persisted in 5/23 pts after one month of medical treatment and in 4/23 pts after one year. By multivariate analysis, 3D-RVEF (p=0.03) and RV-GAS (p=0.008) were predictive of pulmonary arterial hypertension. Conclusions. Our findings show that acute PE has a significant impact on RV function as assessed by 3D-STI. 3D-RVEF and RV-GAS correlate with pulmonary hypertension and abnormal values may persist long-term during the pts follow-up