Characteristics of somatic tinnitus patients with and without hyperacusis

Objective: Determine if somatic tinnitus patients with hyperacusis have different characteristics from those without hyperacusis. Patients and methods: 172 somatic tinnitus patients with (n = 82) and without (n = 90) hyperacusis referred to the Tinnitus Unit of Sapienza University of Rome between June 2012 and June 2016 were compared for demographic characteristics, tinnitus features, self-administered questionnaire scores, nature of somatic modulation and history. Results: Compared to those without hyperacusis, patients with somatic tinnitus and hyperacusis: (a) were older (43.38 vs 39.12 years, p = 0.05), (b) were more likely to have bilateral tinnitus (67.08% vs 55.56%, p = 0.04), (c) had a higher prevalence of somatic modulation of tinnitus (53.65% vs 36.66%, p = 0.02) and (d) scored significantly worse on tinnitus annoyance (39.34 vs 22.81, p<0.001) and subjective hearing level (8.04 vs 1.83, p<0.001). Conclusion: Our study shows significantly higher tinnitus modulation and worse self-rating of tinnitus and hearing ability in somatic tinnitus patients with hyperacusis versus somatic tinnitus patients without hyperacusis. These differences could prove useful in developing a better understanding of the pathophysiology and establishing a course of treatment for these two groups of patients

Work-related noise exposure in a cohort of patients with chronic tinnitus: analysis of demographic and audiological characteristics

Work-related noise exposure is one of the major factors contributing to the development of adult-onset hearing loss and tinnitus. The aim of this study was to analyze, in patients with chronic tinnitus and long-term occupational noise exposure, (A) characteristics of hearing loss, tinnitus, comorbidities, demographic characteristics and a history of work-related noise exposure and (B) differences among individuals employed in occupations with high and low risk of developing work-related noise-induced hearing loss (NIHL). One hundred thirty six patients with chronic tinnitus and at least a 10 year-long working history were divided into two groups based on the risk of their profession to induce NIHL. Individuals employed in jobs at high risk for NIHL were mostly males and exhibited a poorer hearing threshold, more evident in the left ear. Tinnitus was mostly bilateral; the next largest presentation was left-sided; patients described their tinnitus as buzzing or high-pitched. Correlation between age, length of tinnitus and worse hearing was found. Patients with a higher degree of hearing impairment were mostly males and were more likely to have a family history of hearing loss and at least one cardiovascular comorbidity. Our study shows some differences in individuals with tinnitus and a history of a profession associated with increased exposure to NIHL compared to those without such a history

Cachrys libanotis L. Extracts: Photocytotoxic Effects on UVA-Irradiated Human Melanoma Cells

Melanoma is the most aggressive form of skin cancer. Photochemotherapy, combining the action of a light source and a chemical photosensitizer, is one of the most interesting current therapeutic approaches. Plants represent a rich source of photoactive compounds, and furanocoumarins are some of the most important naturally occurring phytoconstituents. The aim of this study was to evaluate the photocytotoxic potential of Cachrys libanotis L. (Apiaceae) from Southern Italy. This species belongs to a genus rich in furanocoumarins and widely distributed in Europe. The aerial parts were extracted through both traditional maceration and pressurized cyclic solid-liquid (PCSL) extraction using Naviglio extractor®. Qualitative and quantitative analyses were performed to detect the coumarins content using GC-MS, and the photocytotoxic effects of the extracts were assessed on UVA-irradiated C32 melanoma cells. The apoptotic responses were also evaluated. Furthermore, phenolic content and the in vitro antioxidant potential were also estimated. Xanthotoxin, bergapten and isopimpinellin were identified and quantified. Both extracts affected cell viability in a concentration-dependent manner after irradiation for 1 hour at a dose of 1.08 J/cm2. Sample obtained through PCSL extraction was the most effective, with an IC50 equal to 3.16 μg/mL, a very interesting value if compared with the positive control bergapten. This extract induced up-regulation of apoptotic signals such as BAX and PARP cleavage and, in the presence of UVA radiation, it caused a greater upregulation of p21 protein. Obtained results suggest that investigated species could be a good candidate for further studies aimed to find new drugs with photocytotoxic potential

Potential use in the treatment of inflammatory disorders and obesity of selected wild edible plants from Calabria region (Southern Italy)

Abstract The potential role of plants and their metabolites has been recently considered in the search for new well-tolerated anti-arthritic and anti-obesity drugs. This study was designed to assess the potential effectiveness of the methanolic extracts from four wild edible species from Southern Italy, Asparagus officinalis L., Bellis perennis L., Daucus carota L. and Sambucus nigra L. All these plants have a history as anti-rheumatic or anti-arthritic remedies. The chemical constituents were identified through GC–MS and HPTLC analyses and the in vitro antioxidant activity was determined by means of DPPH, ABTS, FRAP-Ferrozine and β-carotene bleaching tests. To assess the anti-inflammatory and anti-arthritic potentials, the capacity to inhibit nitric oxide production in murine macrophage RAW 264.7 cells and protein denaturation was measured. The anti-obesity potential was determined by evaluating the ability of the sample to inhibit pancreatic lipase, a key enzyme for dietary fats absorption. The raw extract of D. carota showed the best inhibitory activity on NO production (IC50 = 45.1 ± 1.0 μg/mL), followed by B. perennis and A. officinalis (IC50 equal to 193.1 ± 3.2 μg/mL and 506.3 ± 5.1 μg/mL, respectively). D. carota induced also inhibitory effects against the heat-induced denaturation of bovine serum albumin (IC50 = 878.7 ± 19.09 μg/mL) and the best lipase inhibitory potential (IC50 = 1.63 ± 0.07 mg/mL). Our findings suggest that this species could be a potential effective therapeutic agent to treat inflammation and arthritis, supporting the traditional popular use of this plant

Repercusiones de la pandemia COVID-19 en los ingresos y egresos económicos del odontólogo general

Objective. To determine the opinions of Peruvian dentists regarding the impact of the COVID- 19 pandemic on their income and expenses. Methods. Qualitative study with a phenomenographic focus that used the technique of in-depth interviews with seven dentists in the context of the pandemic during the month of May 2020 in Lima (Peru). The interviews were conducted virtually and the categories included: cost-effectiveness of dental care delivery; perspective on dental care productivity during periods of social isolation and reintegration into routine activities. Results. The dentists interviewed perceive that during this period there has been a reduction in income from dental care delivery, either because of the measures of social restriction established in Peru, or because of the low profitability of emergency and urgent dental treatment. For this reason, the viability of dental care during the period of social isolation has been affected by both, the increase in the conventional budget to provide the service and the additional expenses to comply with new healthcare providers’ guidelines. Conclusions. A decrease in economic income is perceived in dental care, in addition to an increase in economic expenditures during periods of social isolation and reinsertion into routine work activities.Objetivo. Conocer las opiniones de los odontólogos peruanos respecto a las repercusiones que ha tenido la pandemia COVID-19 en sus ingresos y egresos económicos. Métodos. Estudio cualitativo con enfoque fenomenográfico que utilizó la técnica de la entrevista a profundidad dirigida a siete odontólogos en el contexto de la pandemia durante el mes de mayo del 2020 en Lima (Perú). Las entrevistas se desarrollaron de forma virtual y las categorías incluyeron: rentabilidad del ejercicio de la atención odontológica; perspectiva con respecto al ingreso de la atención odontológica en los periodos de aislamiento social y reinserción de las actividades de rutina. Resultados. Los odontólogos entrevistados perciben que durante este periodo se ha reducido los ingresos en la atención odontológica, ya sea por las medidas de restricción social instauradas en el Perú, además de la baja rentabilidad de los tratamientos de urgencia y emergencia dental. Por ello, la viabilidad de la atención odontológica durante el periodo de aislamiento social se ha visto perjudicada tanto en el aumento del presupuesto convencional para brindar el servicio y los egresos adicionales que se estiman para cumplir con los lineamientos sanitarios para el retorno de las actividades laborales. Conclusiones. Se percibe una disminución de los ingresos económicos en la atención odontológica, además de un aumento de los egresos económicos durante los periodos de aislamiento social y reinserción a las actividades laborales de rutina

Italian Translation and Validation of the Original ABC Taxonomy for Medication Adherence

Medication adherence represents a complex and multifaceted process. Standardized terminology is essential to enable a reproducible process in various languages. The study's aim was to translate and adapt the original Ascertaining Barriers for Compliance (ABC) Taxonomy on medication adherence, first proposed in 2012, into Italian language. The study was carried out according to the Preferred Methods for Translation of the ABC Taxonomy for Medication Adherence adopted by the ESPACOMP. Key steps included: (1) a systematic literature review using PubMed and Embase according to the PRISMA Guidelines to identify published Italian terms and definitions, and Italian adherence experts; (2) a forward translation of terms and definitions; (3) panelists' selection; (4) a three-round Delphi survey. From the systematic review, 19 studies allowed detection of 4 terms, 4 definitions and 767 Italian experts. To these, Italian ESPACOMP members and experts though snowball sampling were added. The identified Italian adherence experts received the Delphi questionnaire. The Italian ABC Taxonomy was achieved after three rounds of Delphi survey by reaching at least a moderate consensus on unambiguous naming and definition of medication adherence-related terms. The Taxonomy is intended to be used in research, academic, and professional fields in order to harmonize adherence terminology and avoid confusion in comparing research findings

APOLLO 11 Project, Consortium in Advanced Lung Cancer Patients Treated With Innovative Therapies: Integration of Real-World Data and Translational Research

Introduction: Despite several therapeutic efforts, lung cancer remains a highly lethal disease. Novel therapeutic approaches encompass immune-checkpoint inhibitors, targeted therapeutics and antibody-drug conjugates, with different results. Several studies have been aimed at identifying biomarkers able to predict benefit from these therapies and create a prediction model of response, despite this there is a lack of information to help clinicians in the choice of therapy for lung cancer patients with advanced disease. This is primarily due to the complexity of lung cancer biology, where a single or few biomarkers are not sufficient to provide enough predictive capability to explain biologic differences; other reasons include the paucity of data collected by single studies performed in heterogeneous unmatched cohorts and the methodology of analysis. In fact, classical statistical methods are unable to analyze and integrate the magnitude of information from multiple biological and clinical sources (eg, genomics, transcriptomics, and radiomics). Methods and objectives: APOLLO11 is an Italian multicentre, observational study involving patients with a diagnosis of advanced lung cancer (NSCLC and SCLC) treated with innovative therapies. Retrospective and prospective collection of multiomic data, such as tissue- (eg, for genomic, transcriptomic analysis) and blood-based biologic material (eg, ctDNA, PBMC), in addition to clinical and radiological data (eg, for radiomic analysis) will be collected. The overall aim of the project is to build a consortium integrating different datasets and a virtual biobank from participating Italian lung cancer centers. To face with the large amount of data provided, AI and ML techniques will be applied will be applied to manage this large dataset in an effort to build an R-Model, integrating retrospective and prospective population-based data. The ultimate goal is to create a tool able to help physicians and patients to make treatment decisions. Conclusion: APOLLO11 aims to propose a breakthrough approach in lung cancer research, replacing the old, monocentric viewpoint towards a multicomprehensive, multiomic, multicenter model. Multicenter cancer datasets incorporating common virtual biobank and new methodologic approaches including artificial intelligence, machine learning up to deep learning is the road to the future in oncology launched by this project

Tumor-Infiltrating Lymphocytes and Prognosis: A Pooled Individual Patient Analysis of Early-Stage Triple-Negative Breast Cancers

PURPOSE: The aim of the current study was to conduct a pooled analysis of studies that have investigated the prognostic value of tumor-infiltrating lymphocytes (TILs) in early-stage triple negative breast cancer (TNBC). METHODS: Participating studies had evaluated the percentage infiltration of stromally located TILs (sTILs) that were quantified in the same manner in patient diagnostic samples of early-stage TNBC treated with anthracycline-based chemotherapy with or without taxanes. Cox proportional hazards regression models stratified by trial were used for invasive disease-free survival (iDFS; primary end point), distant disease-free survival (D-DFS), and overall survival (OS), fitting sTILs as a continuous variable adjusted for clinicopathologic factors. RESULTS: We collected individual data from 2,148 patients from nine studies. Average age was 50 years (range, 22 to 85 years), and 33% of patients were node negative. The average value of sTILs was 23% (standard deviation, 20%), and 77% of patients had 1% or more sTILs. sTILs were significantly lower with older age ( P = .001), larger tumor size ( P = .01), more nodal involvement ( P = .02), and lower histologic grade ( P = .001). A total of 736 iDFS and 548 D-DFS events and 533 deaths were observed. In the multivariable model, sTILs added significant independent prognostic information for all end points (likelihood ratio \u3c72, 48.9 iDFS; P < .001; \u3c72, 55.8 D-DFS; P < .001; \u3c72, 48.5 OS; P < .001). Each 10% increment in sTILs corresponded to an iDFS hazard ratio of 0.87 (95% CI, 0.83 to 0.91) for iDFS, 0.83 (95% CI, 0.79 to 0.88) for D-DFS, and 0.84 (95% CI, 0.79 to 0.89) for OS. In node-negative patients with sTILs 65 30%, 3-year iDFS was 92% (95% CI, 89% to 98%), D-DFS was 97% (95% CI, 95% to 99%), and OS was 99% (95% CI, 97% to 100%). CONCLUSION: This pooled data analysis confirms the strong prognostic role of sTILs in early-stage TNBC and excellent survival of patients with high sTILs after adjuvant chemotherapy and supports the integration of sTILs in a clinicopathologic prognostic model for patients with TNBC. This model can be found at www.tilsinbreastcancer.org

&quot;Delirium Day&quot;: 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