Endoluminal calprotectin measurement in assessment of pouchitis and a new index of disease activity. A pilot study

Pouchitis is the most common complication following proctocolectomy with ileal pouch-anal anastomosis for ulcerative colitis (UC). To provide a standardized definition of pouchitis clinical, endoscopic and histological markers were grouped and weighted in the pouch disease activity index (PDAI). However, the delay in the assessment of the final score due to the time requested for histological analysis remains the main obstacle to the index implementation in clinical practice so that the use of modified-PDAI (mPDAI) with exclusion of histologic subscore has been proposed. We tested the ability of calprotectin measurement in the pouch endoluminal content to mimic the histologic score as defined in the PDAI, the index that we adopted as gold standard for pouchitis diagnosis. Calprotectin was measured by ELISA in the pouch endoluminal content collected during endoscopy in 40 consecutive patients with J-pouch. In each patient PDAI and mPDAI were calculated and 15% of patients were erroneously classified by mPDAI. ROC analysis of calprotectin values vs. acute histological subscore 3 identified different calprotectin cut-off values with corresponding sensitivity and specificity allowing the definition and scoring of different range of calprotectin subscores. We incorporated the calprotectin score in the mPDAI obtaining a new score that shows the same specificity as PDAI for diagnosis of pouchitis and higher sensitivity when compared with mPDAI. The use of the proposed new score, once validated in a larger series of patients, might be useful in the early management of patients with symptoms of pouchitis

Glutamate-Mediated Primary Somatosensory Cortex Excitability Correlated with Circulating Copper and Ceruloplasmin

Objective. To verify whether markers of metal homeostasis are related to a magnetoencephalographic index representative of glutamate-mediated excitability of the primary somatosensory cortex. The index is identified as the source strength of the earliest component (M20) of the somatosensory magnetic fields (SEFs) evoked by right median nerve stimulation at wrist. Method. Thirty healthy right-handed subjects (51 ± 22 years) were enrolled in the study. A source reconstruction algorithm was applied to assess the amount of synchronously activated neurons subtending the M20 and the following SEF component (M30), which is generated by two independent contributions of gabaergic and glutamatergic transmission. Serum copper, ceruloplasmin, iron, transferrin, transferrin saturation, and zinc levels were measured. Results. Total copper and ceruloplasmin negatively correlated with the M20 source strength. Conclusion. This pilot study suggests that higher level of body copper reserve, as marked by ceruloplasmin variations, parallels lower cortical glutamatergic responsiveness

Surface decontamination protocols for surgical treatment of peri-implantitis: A systematic review with meta-analysis

OBJECTIVE: To answer the following PICO question: “In patients requiring surgical treatment of peri‐implantitis (P), is any implant surface decontamination protocol (I) superior to others (C) in terms of clinical and radiographic parameters (O)?” METHODS: Randomized clinical trials (RCTs) comparing two or more decontamination protocols as part of the surgical treatment of peri‐implantitis were included. Two authors independently searched for eligible studies, screened titles and abstracts, did full‐text analysis, extracted data, and performed the risk‐of‐bias assessment. Whenever possible, results were summarized through random effects meta‐analyses. RESULTS: Twenty‐two manuscripts reporting on 16 RCTs were included, testing mechanical, chemical and physical decontamination protocols. All of them resulted in an improvement in clinical parameters; however, the superiority of specific protocols over others is mainly based on single RCTs. The use of titanium brushes and implantoplasty showed favorable results as single decontamination methods. Meta‐analyses indicated a lack of added effect of Er:Yag laser on probing pocket depth (PPD) reduction (n = 2, WMD = −0.24 mm, 95% confidence interval [CI] [−1.10; 0.63], p = .59); while systemic antimicrobials (amoxicillin or azithromycin) showed an added effect on treatment success ([PPD ≤5 mm, no bleeding or suppuration, no progressive bone loss]; n = 2, RR = 1.84, 95% CI [1.17;2.91], p = .008), but not in terms of PPD reduction (n = 2, WMD = 0.93 mm, 95% CI [−0.69; 2.55], p = .26), even if with substantial heterogeneity. CONCLUSIONS: No single decontamination method demonstrated clear evidence of superiority compared to the others. Systemic antibiotics, but not Er:Yag laser, may provide short‐term clinical benefits in terms of treatment success (CRD42020182303)

Surgical Management of Patients with Parotid Involvement from Non-Melanoma Skin Cancer of the Head and Neck

We conducted a retrospective, longitudinal study on a single-center series of patients who underwent parotidectomy in the management of advanced head and neck non-melanoma skin cancer (hnNMSC). The aim of this study was to identify prognostic factors associated with worse outcomes. Forty-one men and nine women were included. The mean age at the time of surgery was 78.9 years. The 5-year overall survival, disease-specific survival, locoregional recurrence-free survival, and distant metastasis-free survival calculated with Kaplan-Meier curves were 39.9%, 56.3%, 58.6%, and 82.1%, respectively. A univariate analysis showed that the status of the margins, facial nerve direct involvement, lymph vascular invasion, and histological grading were associated with worse outcomes (p < 0.05). Positive margins were associated with worse disease-specific survival also in a multivariate analysis (p = 0.001, HR = 32.02, and CIs 4.338 to 351.3). Because the resection in free margins is the most important prognostic factor, early diagnosis or, in the case of advanced disease, extensive surgical resection with concomitant reconstruction is needed. Adjuvant therapy is indicated in selected cases

Oxygen Gas Sensing Using a Hydrogel-Based Organic Electrochemical Transistor for Work Safety Applications

open8noOxygen depletion in confined spaces represents one of the most serious and underestimated dangers for workers. Despite the existence of several commercially available and widely used gas oxygen sensors, injuries and deaths from reduced oxygen levels are still more common than for other hazardous gases. Here, we present hydrogel-based organic electrochemical transistors (OECTs) made with the conducting polymer poly(3,4-ethylenedioxythiophene): poly(styrene sulfonate) (PEDOT:PSS) as wearable and real-time oxygen gas sensors. After comparing OECT performances using liquid and hydrogel electrolytes, we identified the best PEDOT:PSS active layer and hydrogel coating (30 µm) combination for sensing oxygen in the concentration range of 13–21% (v/v), critical for work safety applications. The fast O2 solubilization in the hydrogel allowed for gaseous oxygen transduction in an electrical signal thanks to the electrocatalytic activity of PEDOT:PSS, while OECT architecture amplified the response (gain ̴ 104). OECTs proved to have comparable sensitivities if fabricated on glass and thin plastic substrates, (−12.2 ± 0.6) and (−15.4 ± 0.4) µA/dec, respectively, with low power consumption (<40 µW). Sample bending does not influence the device response, demonstrating that our real-time conformable and lightweight sensor could be implemented as a wearable, noninvasive safety tool for operators working in potentially hazardous confined spaces.The work was supported by the European Union FESR FSE, PON Research and Innovation 2014-2020 and FSC, project number ARS01-00996 "TEXT-STYLENuovi tessuti intelligenti e sostenibilimultisettoriali per il design creative e stileMade-in-Italy" and by the Italian Ministry of Economic Development 2020-Project "AlmaMater patents-Monitoraggio in continuo di pH e idratazione-MIRAGE".openFrancesco Decataldo, Filippo Bonafè, Federica Mariani, Martina Serafini, Marta Tessarolo, Isacco Gualandi, Erika Scavetta, Beatrice FraboniFrancesco Decataldo, Filippo Bonafè, Federica Mariani, Martina Serafini, Marta Tessarolo, Isacco Gualandi, Erika Scavetta, Beatrice Frabon

Similar rate of return to sports activity between posterior-stabilised and cruciate-retaining primary total knee arthroplasty in young and active patient

PURPOSE Cruciate-retaining and posterior-stabilised implant designs are available for primary total knee arthroplasty. However, whether the implant design is associated with a difference in the level of activity still remains unclear. This clinical trial compared posterior-stabilised and cruciate-retaining implants in sport-related patient-reported outcome measures, range of motion, rate of return to sport, and weekly time dedicated to sport in active adults. It was also hypothesised that in young and active patients both implants lead to a similar rate of return to sport in terms of hours per week, type of sport, and joint mobility. METHODS All patients were evaluated preoperatively and for a minimum of 36 months follow-up. The University of California Los Angeles activity scores, High-Activity Arthroplasty Score, and Visual Analogue Scale were administered preoperatively and at the last follow-up. The range of motion was investigated at admission and the last follow-up. Data concerning the hours per week dedicated to sports and the type of sport practiced were also collected at admission and at the last follow-up. The Kaplan-Meier Curve was performed to compare implant survivorship. RESULTS Data from 227 procedures (cruciate-retaining: 109, posterior-stabilised: 118) were prospectively collected. At the last follow-up, no difference was reported in The University of California Los Angeles activity scores (p = 0.6), High-Activity Arthroplasty Score (p = 0.1), Visual Analogue Scale (p = 0.9), flexion (p = 0.7) and extension (p = 0.4). No difference was found in the rate of return (p = 0.1) and weekly hours dedicated to sport (p = 0.3). The Kaplan-Meier curve evidenced no statistically significant difference in implant survivorship (p = 0.6). CONCLUSIONS At approximately five years of follow-up, no difference was reported between cruciate-retaining and posterior-stabilised implants in active adults in sport-related patient-reported outcomes measures, range of motion, pain, weekly time dedicated to sport, rate of return to sport, and implant survivorship. LEVEL OF EVIDENCE Level II, prospective study

Management and Oncologic Outcomes of Close and Positive Margins after Transoral CO2 Laser Microsurgery for Early Glottic Carcinoma

Background: The present study analyzed the impact of margin status on local control and survival, and the management of close/positive margins after transoral CO2 laser microsurgery for early glottic carcinoma. Methods: 351 patients (328 males, 23 females, mean age 65.6 years) underwent surgery. We identified the following margin statuses: negative, close superficial (CS), close deep (CD), positive single superficial (SS), positive multiple superficial (MS), and positive deep (DEEP). Results: A total of 286 patients (81.5%) had negative margins, 23 (6.5%) had close margins (8 CS, 15 CD) and 42 (12%) had positive margins (16 SS, 9 MS, 17 DEEP). Among the 65 patients with close/positive margins, 44 patients underwent enlargement, 6 radiotherapy and 15 follow-up. Twenty-two patients (6.3%) recurred. Patients with DEEP or CD margins showed a higher risk of recurrence (hazard ratios of 2.863 and 2.537, respectively), compared to patients with negative margins. Local control with laser alone, overall laryngeal preservation and disease-specific survival decreased significantly in patients with DEEP margins (57.5%, 86.9% and 92.9%, p < 0.05). Conclusions: Patients with CS or SS margins could be safely submitted to follow-up. In the case of CD and MS margins, any additional treatment should be discussed with the patient. In the case of DEEP margin, additional treatment is always recommended

The Language of Pain in the Hypermobile Ehlers–Danlos Syndrome: Metaphors as a Key to Understanding the Experience of Pain and as a Rehabilitation Tool

Ehlers-Danlos syndromes are a heterogeneous group of Heritable Connective Tissue Disorders characterized by joint hypermobility, skin hyperextensibility, and tissue fragility. Among the different types, the hypermobile Ehlers-Danlos syndrome is the most frequent and includes generalized joint hypermobility as the major diagnostic criterion. Joint hypermobility in hypermobile Ehlers-Danlos syndrome is often associated with pain that does not always allow the use of effective pain-reducing treatments. Patients with hEDS constantly describe their pain in detail. Eighty-nine patients with hEDS diagnoses were recruited and evaluated. They were asked to describe their pain in writing. The texts were examined through Linguistic Inquiry and Word Count. Correlational analyses were conducted between pain perception and language. A comparison of high/low pain perception and the quality of metaphors was carried out. The results showed that language quality varies depending on how much pain is perceived. The greater the pain is perceived, the lesser the positive effects and the greater the negative effects and dehumanizing metaphors are being used. Moreover, a greater pain seems to be related to a verbal experience of greater isolation and less self-care. In conclusion, the use of metaphors is a useful tool for examining illness experience and may help clinicians in the rehabilitation program

Innovative value-based price assessment in data-rich environments: Leveraging online review analytics through data envelopment analysis to empower managers and entrepreneurs

This work introduces, develops, and empirically applies an innovative approach aimed at assessing selling prices based on the value perceived by the customers, as measured by electronic word-of-mouth (eWOM) in the guise of online reviews. To achieve this aim, it applies a constant return to scale Data Envelopment Analysis (DEA) approach where the price is the input, and the value attributes are the outputs measured through eWOM in the form of online reviews. We empirically apply the model to the hotel sector by considering both the prices and the service attributes (i.e., staff, location, cleanliness, comfort, facilities and free wi-fi) of 364 hotels based in two leading Italian tourism destinations: Milan and Rome. Our findings suggest that online review analytics can be suitably embedded into analytical models to assess prices. The index developed innovatively supports value-based pricing by means of online review analytics and it is easy-to-perform, and parsimonious as it is based on widely available information on the Internet