Design, optimization and experimental characterization of RF injectors for high brightness electron beams and plasma acceleration

In this article, we share our experience related to the new photo-injector commissioning at the SPARC\_LAB test facility. The new photo-injector was installed into an existing machine and our goal was not only to improve the final beam parameters themselves but to improve the machine handling in day-to-day operations as well. Thus, besides the pure beam characterization, this article contains information about the improvements, that were introduced into the new photo-injector design from the machine maintenance point of view, and the benefits, that we gained by using the new technique to assemble the gun itself

Electrical storm: A clinical and electrophysiological overview

Electrical storm (ES) is a clinical condition characterized by three or more ventricular arrhythmia episodes leading to appropriate implantable cardioverterdefibrillator (ICD) therapies in a 24 h period. Mostly, arrhythmias responsible of ES are multiple morphologies of monomorphic ventricular tachycardia (VT), but polymorphic VT and ventricular fibrillation can also result in ES. Clinical presentation is very dramatic in most cases, strictly related to the cardiac disease that may worsen electrical and hemodynamic decompensation. Therefore ES management is challenging in the majority of cases and a high mortality is the rule both in the acute and in the long-term phases. Different underlying cardiomyopathies provide significant clues into the mechanism of ES, which can arise in the setting of structural arrhythmogenic cardiomyopathies or rarely in patients with inherited arrhythmic syndrome, impacting on pharmacological treatment, on ICD programming, and on the opportunity to apply strategies of catheter ablation. This latter has become a pivotal form of treatment due to its high efficacy in modifying the arrhythmogenic substrate and in achieving rhythm stability, aiming at reducing recurrences of ventricular arrhythmia and at improving overall survival. In this review, the most relevant epidemiological and clinical aspects of ES, with regard to the acute and long-term follow-up implications, were evaluated, focusing on these novel therapeutic strategies of treatment

Efficacy of standard and low dose hydrochlorothiazide in the recurrence prevention of calcium nephrolithiasis (NOSTONE trial): protocol for a randomized double-blind placebo-controlled trial.

Nephrolithiasis is a global healthcare problem with a current lifetime risk of 18.8% in men and 9.4% in women. Given the high cost of medical treatments and surgical interventions as well as the morbidity related to symptomatic stone disease, medical prophylaxis for stone recurrence is an attractive approach. Thiazide diuretics have been the cornerstone of pharmacologic metaphylaxis for more than 40 years. However, evidence for benefits and harms of thiazides in the prevention of calcium containing kidney stones in general remains unclear. In addition, the efficacy of the currently employed low dose thiazide regimens to prevent stone recurrence is not known. The NOSTONE trial is an investigator-initiated 3-year prospective, multicenter, double-blind, placebo-controlled trial to assess the efficacy of standard and low dose hydrochlorothiazide treatment in the recurrence prevention of calcium containing kidney stones. We plan to include 416 adult (≥ 18 years) patients with recurrent (≥ 2 stone episodes in the last 10 years) calcium containing kidney stones (containing ≥50% of calcium oxalate, calcium phosphate or a mixture of both). Patients will be randomly allocated to 50 mg or 25 mg or 12.5 mg hydrochlorothiazide or placebo. The primary outcome will be incidence of stone recurrence (a composite of symptomatic or radiologic recurrence). Secondary outcomes will be individual components of the composite primary outcome, safety and tolerability of hydrochlorothiazide treatment, changes in urinary biochemistry elicited by hydrochlorothiazide treatment and impact of baseline disease severity, biochemical abnormalities and stone composition on treatment response. The NOSTONE study will provide long-sought information on the efficacy of hydrochlorothiazide in the recurrence prevention of calcium containing kidney stones. Strengths of the study include the randomized, double-blind and placebo-controlled design, the large amount of patients studied, the employment of high sensitivity and high specificity imaging and the exclusive public funding support. ClinicalTrials.gov, NCT03057431 . Registered on February 20 2017

Dépistage de l’artériopathie oblitérante des membres inférieurs : rôle du médecin de premier recours [Screening for peripheral arterial disease : role of the primary care physician]

Peripheral arterial disease (PAD) is a widespread disease with high impact on global health. While general population screening is not currently indicated, the primary care physician has the critical role of identifying asymptomatic patients who are particularly at risk for PAD and could therefore benefit from screening. In addition, he or she must recognize the typical and atypical clinical presentations of patients with symptomatic PAD to ensure proper diagnosis and care. After an adequate medical history and clinical examination, the first diagnostic test is the « Ankle-Brachial Index » (ABI) calculation. In case of pathologic ABI (≤ 0.9, or > 1.4), or in case of normal or borderline ABI with symptoms, the patient should be referred to a vascular medicine physician for diagnostic confirmation and management

Assessment of chronic pain and access to pain therapy: a cross-sectional population-based study

Rosaria Del Giorno,1 Paolo Frumento,2 Giustino Varrassi,3 Antonella Paladini,3 Stefano Coaccioli1,4 1Department of Internal Medicine, Rheumatology and Medical Pain Therapy, “Santa Maria” General Hospital, Terni, Italy; 2Unit of Biostatistics, Institute of Environmental Medicine (IMM), Karolinska Institute, Stockholm, Sweden; 3Department of MESVA, University of L’Aquila. L’Aquila, Italy; 4Department of Internal Medicine, Perugia University School of Medicine, Perugia, Italy Background: Chronic pain (CP) has been shown as an important public health problem, and several studies emphasize the need to strengthen the health care and social systems to reduce its marginalization. This study aimed to: evaluate the epidemiology of CP in the general population in an Italian area; and assess the awareness of a specific law, unanimously approved in Parliament, which provides citizens the right to access pain management ­(Italian Law 38/2010). Methods: A cross-sectional population-based study carried out during the spring of 2014 at Narni, Umbria, Italy. All the citizens residing in that area, aged >18, were enrolled in the study. Outcome measures were: prevalence of CP and therapies. The awareness of the Italian Law 38/2010 was also recorded. Results: Data of 1293 questionnaires were analyzed. The prevalence of CP was 28.4%. In 51.5% of cases, pain was severe, with higher prevalence in females (p<0.001). Moreover, pain was generally increasing with age (p<0.001). The risk of suffering from severe pain was modeled using logistic regression. Significant predictors were female gender (OR 2.59; 95% CI: 1.77–3.79), living in an urban area (OR 0.63; 95% CI 0.45–0.88), and age (OR 1.06; 95% CI: 1.04–1.08). Among people with CP, 77.9% were receiving therapy; the proportion of individuals in therapy for severe pain significantly increased with age (OR 1.03; 95% CI: 1.02–1.05) and was smaller in individuals with light pain (OR 0.21; 95% CI: 0.07–0.66). The majority of subjects (61.9%) are not aware of the existence of a specific law stating their rights to receive pain management. Conclusion: CP, at least in the rural part of the community investigated in Italy, is not perceived as a chronic disease in its own right. A socio-cultural transformation in patients and in the health care system seems necessary. Keywords: cross-sectional study, chronic pain, palliative care, pain therapy, pain control&nbsp

Comparative analysis of the long-term effect of two families of high-flux polysulfone dialysers on platelet count: a retrospective cross-sectional study

Rosaria Del Giorno,1 Lorenzo Berwert,1 Silvio Pianca,2 Giorgia Bianchi,3 Olivier Giannini,4 Luca Gabutti1 1Department of Internal Medicine, Nephrology and Dialysis Unit, Regional Hospital of Bellinzona and Valli, Ente Ospedaliero Cantonale, Bellinzona, 2Nephrology Unit, Civico Hospital, Ente Ospedaliero Cantonale, Lugano, 3Nephrology Unit, La Carità Hospital, Ente Ospedaliero Cantonale, Locarno, 4Nephrology Unit, Beata Vergine Hospital, Ente Ospedaliero Cantonale, Mendrisio, Switzerland Introduction: Thrombocytopenia is a potential complication of hemodialysis (HD), and its occurrence has been described even with highly biocompatible polysulfone (PSf) membranes. Dialysis units routinely monitor platelet (PLT) count at the beginning of HD sessions. However, considering that the long-term effects on PLT count could easily be missed, the prevalence of HD-related thrombocytopenia could be underestimated. In the present study, we aimed to investigate the following: 1) the long-term impact of HD treatment on PLT count, comparing two families of dialysis membranes made up of similar PSfs; 2) whether the switch between the dialysis membranes studied significantly affects PLT count; and 3) the prevalence and the risk of HD-induced thrombocytopenia according to the dialysis membranes used. Methods: A cross-sectional retrospective study was performed comprising 157 adult chronic HD patients. The HD membranes under investigation were of the series FX, Helixone® Fresenius (Filters A), and Polyflux® Gambro (Filters B). Patients were treated in 4 dialysis units in Southern Switzerland. Data were collected from a centralized computing platform. Findings: PLT count significantly differs between Filters A and B with, respectively, 188 (153–243) ×10E9/L versus 214 (179–255) ×10E9/L (p=0.036). The prevalence of thrombocytopenia was higher for Filter A compared with Filter B (28.4% versus 12.8%; p<0.001). The switch from Filter A to Filter B significantly affected PLT count: from 189 (146–217) ×10E9/L to 217 (163–253) ×10E9/L (p<0.001; analysis on 26 patients). A linear random-intercept model confirmed the results (β coefficient =35.214; SE =5.956; p<0.001). In a mixed-effects logistic regression model, the risk of thrombocytopenia for Filter B was 0.157 (CI =0.056–0.442). Discussion: Our data suggest that among the PSf membranes studied, the FX membrane induced a lasting decrease in PLT count and caused significantly more thrombocytopenia. Prospective studies are warranted to verify our findings. Keywords: comparative analysis, polysulfone membranes, platelet count, retrospective pilot study, thrombocytopeni

Adult attachment style and salivary alpha-amylase and emotional responses to a psychosocial stressor in women with eating disorders

Background: The fine-tuning of the endogenous stress response system, which includes the hypothalamus-pituitary-adrenal axis and the sympathetic nervous system (SNS), is influenced by early attachment relationships. A higher prevalence of insecure attachment has been detected in people with eating disorders (EDs). Thus, we investigated the emotional and the SNS reactivity to the Trier Social Stress Test (TSST) in women with EDs in relation to their attachment profiles. Methods: Fifty women with EDs and 20 healthy women participated into an experimental study. Attachment was evaluated by Experience in Close Relationship questionnaire. Salivary α-amylase (sAA) levels were measured to assess the SNS reactivity to TSST while the emotional response was measured by the STAI state scale. Results: Compared to women with EDs and low attachment anxiety and healthy controls, women with EDs and high attachment anxiety showed lower TSST-induced sAA production without difference in anxiety scores. Women with EDs and high attachment avoidance showed similar sAA response to TSST but higher levels of anxiety scores compared to those with low attachment avoidance and healthy controls. Conclusions: Our findings corroborate the idea that adult attachment may be associated with variability in emotional and biological responses to a psychosocial stressor in women with EDs

Passeport vasculaire : un outil pour la prévention secondaire des patients avec maladie artérielle périphérique [Vascular passport : a tool for secondary prevention among patients with peripheral artery disease]

Peripheral arterial disease (PAD) is a major health problem in Switzerland, as myocardial infarction or stroke, all three sharing common cardiovascular (CV) risk factors and similar pathophysiological mechanisms (atherosclerosis). Unfortunately, PAD is still often overlooked, despite being fraught with significant morbidity/mortality and increasing the patient's overall CV risk. It is therefore essential to improve secondary prevention in order to decrease this burden and the overall CV risk of the patient. We will review the treatment targets for CV risk factors as secondary prevention in patients with PAD and see how the use of a vascular passport may improve management