Few-body precursors of topological frustration

Quantum spin chains - the prototypical model for coupled two-level systems - offer a fertile playground both for fundamental and technological applications, ranging from the theory of thermalization to quantum computation. The effects of frustration induced by the boundary conditions have recently been addressed in this context. In this work, we analyze the effects of such frustration on a few spin system and we comment the strong even-odd effects induced in the ground state energy. The purpose of this work is to show that such signatures are visible on current quantum computer platforms

Disease-Modifying Therapies and Coronavirus Disease 2019 Severity in Multiple Sclerosis

Objective: This study was undertaken to assess the impact of immunosuppressive and immunomodulatory therapies on the severity of coronavirus disease 2019 (COVID-19) in people with multiple sclerosis (PwMS). Methods: We retrospectively collected data of PwMS with suspected or confirmed COVID-19. All the patients had complete follow-up to death or recovery. Severe COVID-19 was defined by a 3-level variable: mild disease not requiring hospitalization versus pneumonia or hospitalization versus intensive care unit (ICU) admission or death. We evaluated baseline characteristics and MS therapies associated with severe COVID-19 by multivariate and propensity score (PS)-weighted ordinal logistic models. Sensitivity analyses were run to confirm the results. Results: Of 844 PwMS with suspected (n = 565) or confirmed (n = 279) COVID-19, 13 (1.54%) died; 11 of them were in a progressive MS phase, and 8 were without any therapy. Thirty-eight (4.5%) were admitted to an ICU; 99 (11.7%) had radiologically documented pneumonia; 96 (11.4%) were hospitalized. After adjusting for region, age, sex, progressive MS course, Expanded Disability Status Scale, disease duration, body mass index, comorbidities, and recent methylprednisolone use, therapy with an anti-CD20 agent (ocrelizumab or rituximab) was significantly associated (odds ratio [OR] = 2.37, 95% confidence interval [CI] = 1.18-4.74, p = 0.015) with increased risk of severe COVID-19. Recent use (<1 month) of methylprednisolone was also associated with a worse outcome (OR = 5.24, 95% CI = 2.20-12.53, p = 0.001). Results were confirmed by the PS-weighted analysis and by all the sensitivity analyses. Interpretation: This study showed an acceptable level of safety of therapies with a broad array of mechanisms of action. However, some specific elements of risk emerged. These will need to be considered while the COVID-19 pandemic persists

Insight from an Italian Delphi Consensus on EVAR feasibility outside the instruction for use: the SAFE EVAR Study

BACKGROUND: The SAfety and FEasibility of standard EVAR outside the instruction for use (SAFE-EVAR) Study was designed to define the attitude of Italian vascular surgeons towards the use of standard endovascular repair (EVAR) for infrarenal abdominal aortic aneurysm (AAA) outside the instruction for use (IFU) through a Delphi consensus endorsed by the Italian Society of Vascular and Endovascular Surgery (Societa Italiana di Chirurgia Vascolare ed Endovascolare - SICVE). METHODS: A questionnaire consisting of 26 statements was developed, validated by an 18 -member Advisory Board, and then sent to 600 Italian vascular surgeons. The Delphi process was structured in three subsequent rounds which took place between April and June 2023. In the first two rounds, respondents could indicate one of the following five degrees of agreement: 1) strongly agree; 2) partially agree; 3) neither agree nor disagree; 4) partially disagree; 5) strongly disagree; while in the third round only three different choices were proposed: 1) agree; 2) neither agree nor disagree; 3) disagree. We considered the consensus reached when >70% of respondents agreed on one of the options. After the conclusion of each round, a report describing the percentage distribution of the answers was sent to all the participants. RESULTS: Two -hundred -forty-four (40.6%) Italian Vascular Surgeons agreed to participate the first round of the Delphi Consensus; the second and the third rounds of the Delphi collected 230 responders (94.3% of the first -round responders). Four statements (15.4%) reached a consensus in the first rounds. Among the 22 remaining statements, one more consensus (3.8%) was achieved in the second round. Finally, seven more statements (26.9%) reached a consensus in the simplified last round. Globally, a consensus was reached for almost half of the proposed statements (46.1%). CONCLUSIONS: The relatively low consensus rate obtained in this Delphi seems to confirm the discrepancy between Guideline recommendations and daily clinical practice. The data collected could represent the source for a possible guidelines' revision and the proposal of specific Good Practice Points in all those aspects with only little evidence available

COVID-19 Severity in Multiple Sclerosis: Putting Data Into Context

Background and objectives: It is unclear how multiple sclerosis (MS) affects the severity of COVID-19. The aim of this study is to compare COVID-19-related outcomes collected in an Italian cohort of patients with MS with the outcomes expected in the age- and sex-matched Italian population. Methods: Hospitalization, intensive care unit (ICU) admission, and death after COVID-19 diagnosis of 1,362 patients with MS were compared with the age- and sex-matched Italian population in a retrospective observational case-cohort study with population-based control. The observed vs the expected events were compared in the whole MS cohort and in different subgroups (higher risk: Expanded Disability Status Scale [EDSS] score > 3 or at least 1 comorbidity, lower risk: EDSS score ≤ 3 and no comorbidities) by the χ2 test, and the risk excess was quantified by risk ratios (RRs). Results: The risk of severe events was about twice the risk in the age- and sex-matched Italian population: RR = 2.12 for hospitalization (p < 0.001), RR = 2.19 for ICU admission (p < 0.001), and RR = 2.43 for death (p < 0.001). The excess of risk was confined to the higher-risk group (n = 553). In lower-risk patients (n = 809), the rate of events was close to that of the Italian age- and sex-matched population (RR = 1.12 for hospitalization, RR = 1.52 for ICU admission, and RR = 1.19 for death). In the lower-risk group, an increased hospitalization risk was detected in patients on anti-CD20 (RR = 3.03, p = 0.005), whereas a decrease was detected in patients on interferon (0 observed vs 4 expected events, p = 0.04). Discussion: Overall, the MS cohort had a risk of severe events that is twice the risk than the age- and sex-matched Italian population. This excess of risk is mainly explained by the EDSS score and comorbidities, whereas a residual increase of hospitalization risk was observed in patients on anti-CD20 therapies and a decrease in people on interferon

DMTs and Covid-19 severity in MS: a pooled analysis from Italy and France

We evaluated the effect of DMTs on Covid-19 severity in patients with MS, with a pooled-analysis of two large cohorts from Italy and France. The association of baseline characteristics and DMTs with Covid-19 severity was assessed by multivariate ordinal-logistic models and pooled by a fixed-effect meta-analysis. 1066 patients with MS from Italy and 721 from France were included. In the multivariate model, anti-CD20 therapies were significantly associated (OR = 2.05, 95%CI = 1.39–3.02, p < 0.001) with Covid-19 severity, whereas interferon indicated a decreased risk (OR = 0.42, 95%CI = 0.18–0.99, p = 0.047). This pooled-analysis confirms an increased risk of severe Covid-19 in patients on anti-CD20 therapies and supports the protective role of interferon

Incidence and long-term functional outcome of neurologic disorders in hospitalized COVID-19 patients infected with pre-omicron variants

Background and objective: A variety of neurological disorders has been reported as presentations or complications of COVID-19 infection. The objective of this study was to determine their incidence dynamics and long-term functional outcome. Methods: The Neuro-COVID Italy study was a multicentre, observational, cohort study with ambispective recruitment and prospective follow-up. Consecutive hospitalized patients presenting new neurological disorders associated with COVID-19 infection (neuro-COVID), independently from respiratory severity, were systematically screened and actively recruited by neurology specialists in 38 centers in Italy and the Republic of San Marino. The primary outcomes were incidence of neuro-COVID cases during the first 70 weeks of the pandemic (March 2020 to June 2021) and long-term functional outcome at 6 months, categorized as full recovery, mild symptoms, disabling symptoms or death. Results: Among 52759 hospitalized COVID patients, 1865 patients presenting 2881 new neurological disorders associated with COVID-19 infection (neuro-COVID) were recruited. Incidence of neuro-COVID cases significantly declined over time, comparing the first three pandemic waves (8.4%, 95% CI [7.9, 8.9]; 5.0%, 95% CI [4.7, 5.3]; 3.3%, 95% CI [3.0, 3.6], respectively; p = 0.027). The most frequent neurological disorders were acute encephalopathy (25.2%), hyposmia-hypogeusia (20.2%), acute ischemic stroke (18.4%) and cognitive impairment (13.7%). The onset of neurological disorders was more common in the prodromic phase (44.3%) or during the acute respiratory illness (40.9%), except for cognitive impairment whose onset prevailed during recovery (48.4%). A good functional outcome was achieved by the majority of neuro-COVID patients (64.6%) during follow-up (median 6.7 months) and the proportion of good outcome increased throughout the study period (r = 0.29, 95% CI [0.05, 0.50]; p = 0.019). Mild residual symptoms were frequently reported (28.1%), while disabling symptoms were common only in stroke survivors (47.6%). Discussion: Incidence of COVID-associated neurologic disorders decreased during the pre-vaccination phase of the pandemic. Long-term functional outcome was favourable in most neuro-COVID disorders, although mild symptoms commonly lasted over 6 months after infection

Editor's Choice - Early Outcomes of a Novel Off the Shelf Preloaded Inner Branch Endograft for the Treatment of Complex Aortic Pathologies in the ItaliaN Branched Registry of E-nside EnDograft (INBREED)

Objective: The aim of this study was to investigate the early outcomes of a novel off the shelf pre-loaded inner branched thoraco-abdominal endograft (E-nside) in the treatment of aortic pathologies. Methods: Data from a physician initiated national multicentre registry on patients treated with the E-nside endograft, were prospectively collected and analysed. Pre-operative clinical and anatomical characteristics, procedural data, and early outcomes (90 days) were recorded in a dedicated electronic data capture system. The primary endpoint was technical success. Secondary endpoints were early mortality (90 days), procedural metrics, target vessel patency, endoleak rate, and major adverse events (MAEs) at 90 days. Results: In total, 116 patients from 31 Italian centres were included. Mean ± standard deviation (SD) patient age was 73 ± 8 years and 76 (65.5%) were male. Aortic pathologies included degenerative aneurysm in 98 (84.5%), post-dissection aneurysm in five (4.3%), pseudoaneurysm in six (5.2%), penetrating aortic ulcer or intramural haematoma in four (3.4%), and subacute dissection in three (2.6%). Mean ± SD aneurysm diameter was 66 ± 17 mm; aneurysm extent was Crawford I - III in 55 (50.4%), IV in 21 (19.2%), pararenal in 29 (26.7%), and juxtarenal in four (3.7%). The procedure setting was urgent in 25 (21.5%) patients. Median procedural time was 240 minutes (interquartile range [IQR] 195, 303), with a median contrast volume of 175 mL (IQR 120, 235). The endograft's technical success rate was 98.2% and the 90 day mortality rate was 5.2% (n = 6; 2.1% for elective repair and 16% for urgent repair). The 90-days cumulative MAE rate was 24.1% (n = 28). At 90 days, there were 10 (2.3%) target vessel related events (nine occlusions and one type IC endoleak) and one type 1A endoleak requiring re-intervention. Conclusion: In this real life, non-sponsored registry, the E-nside endograft was used for the treatment of a broad spectrum of aortic pathologies, including urgent cases and different anatomies. The results showed excellent technical implantation safety and efficacy, as well as early outcomes. Longer term follow up is needed to better define the clinical role of this novel endograft

Voce: Prelievi e analisi di campioni

Con la legge 30.6.2009 n. 85 l'Italia ha ratificato l'adesione al Trattato di Pr\ufcm, in vista del rafforzamento della cooperazione tra Stati nella lotta al terrorismo, alla criminalit\ue0 transfrontaliera e alla migrazione illegale, tramite lo scambio di informazioni genetiche. La novit\ue0 pi\uf9 saliente che l'adesione al Trattato ha importato nell'ordinamento interno concerne l'introduzione di un'inedita disciplina dei prelievi coattivi di materiale biologico, volta alla tutela dei diritti individuali nell'impiego processuale di strumenti tecnico-scientifici che consentano di non disperdere il materiale probatorio relativo ad un fatto criminoso. Il tema rievoca la tradizionale distinzione che attribuisce all'imputato la duplice funzione di \u201corgano\u201d ed \u201coggetto\u201d nella formazione della prova, a seconda del contributo attivo o passivo che lo stesso apporti alla vicenda processuale. Questi \ue8 considerato \u201corgano\u201d di prova nell'espletamento di attivit\ue0 che costituiscono esercizio del diritto di difesa, nelle due componenti, positiva e negativa, del diritto di difendersi provando e del diritto al silenzio. Viceversa, si parla di imputato come \u201coggetto\u201d di prova allorquando gli sia richiesto un mero pati rispetto all'attivit\ue0 di istruzione probatoria, come accade nelle ispezioni, nelle perquisizioni, nelle ricognizioni personali, nonch\ue9, pi\uf9 in generale, negli accertamenti che si espletano sul corpo del giudicabile, il quale viene in rilievo non come parte processuale, ma come mera entit\ue0 fisica. Il regime di nuovo conio \ue8 intervenuto a colmare la lacuna normativa lasciata dalla sentenza n. 238 del 1996 con cui la Corte costituzionale aveva dichiarato l'illegittimit\ue0 dell'art. 224, comma 2, c.p.p. nella parte in cui consentiva interventi peritali sul corpo della persona, in violazione del principio di riserva di legge che presidia, ex art. 13 Cost., la libert\ue0 personale. La pronuncia ha individuato un \u201cnocciolo duro\u201d rappresentato dalla libert\ue0 corporale, indissolubilmente legata ai principi di libert\ue0 morale, integrit\ue0 psico-fisica e salute della persona, non comprimibili a fini processuali. La Carta fondamentale prevede un'unica ipotesi di lesione del diritto alla salute nell'ambito dei trattamenti sanitari obbligatori, per finalit\ue0 estranee all'accertamento penale; la libert\ue0 morale, peraltro, rappresenta il quid pluris che sopravvive alla compressione del potere statale, persino durante la pi\uf9 intensa restrizione della libert\ue0 personale. Se questo \ue8 il quadro costituzionale di riferimento, \ue8 evidente come il previgente regime in materia di prelievi biologici coattivi abbia disatteso le indicazioni provenienti dalla Consulta. Difatti, a distanza di quasi un decennio dal monito del Giudice delle leggi, il legislatore intervenne (con la legge 31 luglio 2005, n. 155) \uabin un modo persino pi\uf9 imbarazzante dell'inerzia sino ad allora mantenuta\ubb, attribuendo un potere di intrusione corporale (attraverso il prelievo di capelli o saliva nel corso delle indagini) alla polizia giudiziaria, previa autorizzazione - anche orale, purch\ue9 confermata per iscritto - del pubblico ministero, a soli fini identificativi e purch\ue9 sussistesse il pericolo di alterazione o dispersione della res. Non era contemplato il potere giudiziale di disporre un prelievo biologico a fini peritali e l\u2019esclusivo orientamento teleologico dell\u2019atto d\u2019indagine ne limitava fortemente l\u2019utilit\ue0. Veniva, pertanto, inopinatamente elusa la doppia riserva, di legge e di giurisdizione, che presidia la materia. La riforma realizza una netta soluzione di continuit\ue0 rispetto alla normativa precedente, attraverso l'individuazione nell'organo giurisdizionale del baricentro del micro-sistema normativo dedicato ai prelievi biologici coattivi. Se la libert\ue0 personale pu\uf2 subire restrizioni per atto motivato dell'autorit\ue0 giudiziaria, pertanto anche del pubblico ministero, l'intrusione nella sfera corporale esige l'egida di un soggetto super partes, indifferente rispetto all'esito del processo. Il legislatore ha costruito una disciplina minuziosa, concernente sia l'an che il quomodo dei prelievi, in ossequio alla riserva di legge dettagliata (nei \u201cmodi\u201d e nei \u201ccasi\u201d) imposta dalla Consulta. Ne \ue8 derivato un apparato \uabmulti-livello\ubb, calibrato sulla sistematica del codice e diversificato in base all'orientamento teleologico dell'accertamento \u2013istituzionale, probatorio, investigativo o identificativo-, in cui ogni tipologia \ue8 rigidamente separata dalle altre