Acute Delta Hepatitis in Italy spanning three decades (1991–2019): Evidence for the effectiveness of the hepatitis B vaccination campaign

Updated incidence data of acute Delta virus hepatitis (HDV) are lacking worldwide. Our aim was to evaluate incidence of and risk factors for acute HDV in Italy after the introduction of the compulsory vaccination against hepatitis B virus (HBV) in 1991. Data were obtained from the National Surveillance System of acute viral hepatitis (SEIEVA). Independent predictors of HDV were assessed by logistic-regression analysis. The incidence of acute HDV per 1-million population declined from 3.2 cases in 1987 to 0.04 in 2019, parallel to that of acute HBV per 100,000 from 10.0 to 0.39 cases during the same period. The median age of cases increased from 27 years in the decade 1991-1999 to 44 years in the decade 2010-2019 (p < .001). Over the same period, the male/female ratio decreased from 3.8 to 2.1, the proportion of coinfections increased from 55% to 75% (p = .003) and that of HBsAg positive acute hepatitis tested for by IgM anti-HDV linearly decreased from 50.1% to 34.1% (p < .001). People born abroad accounted for 24.6% of cases in 2004-2010 and 32.1% in 2011-2019. In the period 2010-2019, risky sexual behaviour (O.R. 4.2; 95%CI: 1.4-12.8) was the sole independent predictor of acute HDV; conversely intravenous drug use was no longer associated (O.R. 1.25; 95%CI: 0.15-10.22) with this. In conclusion, HBV vaccination was an effective measure to control acute HDV. Intravenous drug use is no longer an efficient mode of HDV spread. Testing for IgM-anti HDV is a grey area requiring alert. Acute HDV in foreigners should be monitored in the years to come

Colorectal Cancer Stage at Diagnosis Before vs During the COVID-19 Pandemic in Italy

IMPORTANCE Delays in screening programs and the reluctance of patients to seek medical attention because of the outbreak of SARS-CoV-2 could be associated with the risk of more advanced colorectal cancers at diagnosis. OBJECTIVE To evaluate whether the SARS-CoV-2 pandemic was associated with more advanced oncologic stage and change in clinical presentation for patients with colorectal cancer. DESIGN, SETTING, AND PARTICIPANTS This retrospective, multicenter cohort study included all 17 938 adult patients who underwent surgery for colorectal cancer from March 1, 2020, to December 31, 2021 (pandemic period), and from January 1, 2018, to February 29, 2020 (prepandemic period), in 81 participating centers in Italy, including tertiary centers and community hospitals. Follow-up was 30 days from surgery. EXPOSURES Any type of surgical procedure for colorectal cancer, including explorative surgery, palliative procedures, and atypical or segmental resections. MAIN OUTCOMES AND MEASURES The primary outcome was advanced stage of colorectal cancer at diagnosis. Secondary outcomes were distant metastasis, T4 stage, aggressive biology (defined as cancer with at least 1 of the following characteristics: signet ring cells, mucinous tumor, budding, lymphovascular invasion, perineural invasion, and lymphangitis), stenotic lesion, emergency surgery, and palliative surgery. The independent association between the pandemic period and the outcomes was assessed using multivariate random-effects logistic regression, with hospital as the cluster variable. RESULTS A total of 17 938 patients (10 007 men [55.8%]; mean [SD] age, 70.6 [12.2] years) underwent surgery for colorectal cancer: 7796 (43.5%) during the pandemic period and 10 142 (56.5%) during the prepandemic period. Logistic regression indicated that the pandemic period was significantly associated with an increased rate of advanced-stage colorectal cancer (odds ratio [OR], 1.07; 95%CI, 1.01-1.13; P = .03), aggressive biology (OR, 1.32; 95%CI, 1.15-1.53; P < .001), and stenotic lesions (OR, 1.15; 95%CI, 1.01-1.31; P = .03). CONCLUSIONS AND RELEVANCE This cohort study suggests a significant association between the SARS-CoV-2 pandemic and the risk of a more advanced oncologic stage at diagnosis among patients undergoing surgery for colorectal cancer and might indicate a potential reduction of survival for these patients

Elective cancer surgery in COVID-19-free surgical pathways during the SARS-CoV-2 pandemic: An international, multicenter, comparative cohort study

PURPOSE As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19–free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19–free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19–free surgical pathways. Patients who underwent surgery within COVID-19–free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19–free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score–matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19–free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION Within available resources, dedicated COVID-19–free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks

Elective Cancer Surgery in COVID-19-Free Surgical Pathways During the SARS-CoV-2 Pandemic: An International, Multicenter, Comparative Cohort Study.

PURPOSE: As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19-free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS: This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19-free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS: Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19-free surgical pathways. Patients who underwent surgery within COVID-19-free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19-free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score-matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19-free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION: Within available resources, dedicated COVID-19-free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks

A Study on Damping Property of NiTi Elements Produced by Selective Laser‐Beam Melting

The damping properties of NiTi elements produced through selective laser melting are investigated by tuning the process parameters. To this end, twelve parameters’ sets are selected to fabricate fully-dense NiTi specimens. Damping is evaluated through loss factor index, mechanical loading cycles (up to 104 cycles), solicitation frequency and strain amplitude. Results confirm that NiTi fabricated through selective laser-beam melting is an excellent candidate to substitute conventional materials when used in the martensite phase. Furthermore, the selected process parameters enable specific damping performances that can be collected in damping maps which turn out to be practical tools for the fabrication of NiTi parts with tunable damping response

Microstructural and Thermo-Mechanical Characterization of Cast NiTiCu20 Shape Memory Alloy

Among NiTi-based alloys, one of the most promising and exploited alloys is NiTiCu, since the addition of Cu in substitution of Ni in the binary equiatomic NiTi has a significant influence on the martensitic transformation and the thermomechanical properties of the system. A high content of Cu improves the damping properties at the expense of phase homogeneity and workability. The present study focuses on an alloy with a high copper content, i.e., 20 at.%. For this specific composition, the correlation between the thermal treatments, microstructure, formation of secondary phases, and damping properties are investigated by several analyses. The microscopic observation, together with the compositional analysis, allowed the determination of four different phases in the alloy. Both the calorimetry and dynamic thermo mechanical measurements, which confirmed the high damping ability of the alloy, provided a characterization of the martensitic transition. Finally, the electron backscatter diffraction (EBSD) analysis detected the different crystallographic structures (i.e., cubic austenite, orthorhombic martensite, and cubic (face-centered) NiTi2) and their orientation in the different phases. Therefore, the present work aims to improve the knowledge of the role of secondary phases in the optimization of the NiTiCu20 alloy as a valuable alternative to typical alloys used for damping purposes

Towards an understanding of the functional properties of NiTi produced by powder bed fusion

In this work, near fully dense NiTi components have been fabricated using a 55.2Ni-Ti (wt.%) powder through selective laser beam melting. The effect of the manufacturing process on mechanical and functional properties of the selected NiTi alloy has been systematically investigated by tuning the hatching distance, h, and the scanning speed, v, in order to define a set of 12 NiTi families. The as-built NiTi parts present phase transformation temperatures higher than those of the feedstock, ascribed to the depletion of Ni during the process. Pseudoelasticity and shape memory responses have been evaluated through uniaxial compression and bending measurements, respectively. Both quasi-static and dynamic analyses have been considered. It is shown that the resulting material may exhibit distinct damping and strain recovery responses depending on the used process parameters

Study of pseudoelastic systems for the design of complex passive dampers: Static analysis and modeling

This work presents an experimental and numerical analysis of several parallel systems of NiTi pseudoelastic wires. Standard tensile tests were accomplished to evaluate the global damping capacity, the energy dissipated per cycle and the maximum attenuated force in a static condition. Besides, a numerical model was implemented to predict the damping response of more complex pseudoelastic arrangements. It was found a damping capacity upper limit of 0.09 regardless the number and the length of the NiTi components. In addition, it was found that the energy dissipated per cycle is related to the strain and to the number of the NiTi components; furthermore, the system composed of NiTi wires with different length allows for an elastic region that is related to the numbers of wires and that presents a modulation of the stiffness. Finally, the proposed numerical model allows a precise design of complex pseudoelastic combinations as it is able to represent the rhombohedral characteristic

Investigation of microstructural influence on entropy change in magnetocaloric polycrystalline samples of NiMnGaCu ferromagnetic shape memory alloy

Among NiMnGa-based quaternary systems, NiMnGaCu exhibits an interesting giant magnetocaloric effect thanks to the temperature overlapping of magnetic transition and thermoelastic martensitic transformation (TMT), in particular for compositions with ≈6 at% Cu content. In the present work polycrystalline alloy samples with Ni50Mn18.5Cu6.5Ga25 chemical composition were prepared. We present an extensive calorimetric and structural characterization to explore the correlation between microstructural properties and magnetocaloric response induced by means of selected thermal treatments, likely driven by the contribution of TMT to the magnetocaloric effect. Our results give important hints on how the efficiency of the martensitic transition and its modulation in temperature has a final effect on the total ΔS change. Keywords: Magnetic Shape Memory Alloys, Calorimetric investigation, Thermoelastic martensitic transition, Magnetocaloric effect, Thermal treatment, NiMnGaC