Heart transplantation without informed consent: discussion of a case

OBJECTIVE: To discuss informed consent to heart transplantation in the case of an intensive care unit (ICU) patient: relatives' informed consent was refused by the patient himself whose cognitive ability appeared to be reasonable for the purpose. SETTING: ICU of a university teaching hospital. PATIENT: A 62-year-old man who underwent myocardial revascularization had in the immediate post-operative hemodynamic instability, continuous serious arrhythmias, ventilatory support, fentanyl infusion. Heart transplantation could be the only chance for his survival. INVENTION: Heart transplantation. RESULTS: Despite patient's refusal, we decided to hold the relative's consent as valid, and transplantation was accordingly performed, to the subsequent satisfaction of the patient. CONCLUSIONS: Our decision was based on two beliefs: (1) the severity of the patient's clinical condition may have impaired his cognitive abilities; (2) the very same conditions may mask impairment and certainly make reliable assessment of cognition and judgment impossible. This being so, the preservation of life assumes priority

Ribavirin Impairs Salivary gland function During Combination Treatment With Pegylated Interferon Alfa-2a In HEpatitis C patients

Background: Xerostomia is a common adverse event of unknown etiology observed during pegylated interferon (PegIFN)/Ribavirin (Rbv) treatment. Objectives: To assess the frequency and mechanisms of xerostomia during PegIFN/Rbv therapy. Patients and Methods: Thirty-one naive patients with chronic hepatitis C consecutively received PegIFN-alpha 2a (180 mu g/week) plus Rbv (800-1200 mg/day). The controls were 10 patients with chronic hepatitis B who received PegIFN-alpha 2a (180 mu g/week). During treatment and follow-up, all patients underwent basal and masticatory stimulated sialometry, otorhinolaryngoiatric (ORL) examination, and a questionnaire survey to subjectively assess symptoms of oral dryness. Results: Twenty-seven patients on PegIFN/Rbv and 4 on PegIFN (87% vs. 40%, P = 0.006) reported xerostomia. Thirty patients on PegIFN/Rbv combination therapy and 2 patients on monotherapy had ORL signs of salivary gland hypofunction (97% vs. 20%, P < 0.0001). Mean basal (A) and stimulated (B) salivary flow rates (mL/min) progressively decreased during PegIFN/Rbv treatment (A, 0.49 at baseline vs. 0.17 at the end of treatment, P < 0.0001; B,1.24 at baseline vs. 0.53 at the end of treatment, P = 0.0004). At week 24 following PegIFN/Rbv treatment, salivary flow rates were similar to baseline (A, 0.53 at the end of follow-up vs. 0.49 at baseline; B,1.19 at the end of follow-up vs. 1.24 at baseline). Salivary function was unaffected in monotherapy patients. Conclusions: Rbv causes salivary gland hypofunction in hepatitis C patients receiving PegIFN/Rbv therapy, which promptly reverts to normal upon cessation of treatment

Direct-acting antivirals and hepatocellular carcinoma in chronic hepatitis C: A few lights and many shadows

With the introduction of direct-acting antiviral agents (DAA), the rate of sustained virological response (SVR) in the treatment of hepatitis C virus (HCV) has radically improved to over 95%. Robust scientific evidence supports a beneficial role of SVR after interferon therapy in the progression of cirrhosis, resulting in a decreased incidence of hepatocellular carcinoma (HCC). However, a debate on the impact of DAAs on the development of HCC is ongoing. This review aimed to analyse the scientific literature regarding the risk of HCC in terms of its recurrence and occurrence after the use of DAAs to eradicate HCV infection. Among 11 studies examining HCC occurrence, the de novo incidence rate ranged from 0 to 7.4% (maximum follow-up: 18 mo). Among 18 studies regarding HCC recurrence, the rate ranged from 0 to 54.4% (maximum "not well-defined" followup: 32 mo). This review highlights the major difficulties in interpreting data and reconciling the results of the included studies. These difficulties include heterogeneous cohorts, potential misclassifications of HCC prior to DAA therapy, the absence of an adequate control group, short follow-up times and different kinds of follow-up. Moreover, no clinical feature-based scoring system accounts for the molecular characteristics and pathobiology of the tumours. Nonetheless, this review does not suggest that there is a higher rate of de novo HCC occurrence or recurrence after DAA therapy in patients with previous HCV infection. \ua9 2018 The Author(s). Published by Baishideng Publishing Group Inc. All rights reserved

IL28B Polymorphisms in Interferon-Treated Patients with Chronic Hepatitis B

Pegylated interferon (Peg-IFN) may achieve a sustained off-treatment response in 20-30% of the patients with chronic hepatitis B (CHB). However, given the high cost of treatment, the frequent side effects, and the lack of effectiveness in a large proportion of patients, there have been attempts to identify the subjects who are most likely to benefit with such therapy. Response rates may be significantly increased by careful selection of patients based upon baseline serum alanine aminotransferase, HBV DNA levels, and viral genotype. Recently, genome-wide association studies identified polymorphisms of the interleukin 28B (IL28B) gene as a potent predictor of sustained viral response in chronic hepatitis C patients treated with Peg-IFN plus Ribavirin, encouraging similar studies in HBV. Overall, these studies failed to provide convincing evidences that IL28B genotype significantly impacts on response to Peg-IFN in chronic hepatitis B (CHB) patients, though these studies are very heterogeneous in terms of patient populations, methodology, baseline features, treatment regimens, duration of follow-up, and ethnicity, making new studies in larger cohorts very much needed

METODI DI CONTENIMENTO DEL CINGHIALE (Sus scrofa) NELLE AREE PROTETTE: ANALISI DELLE NORMATIVE IN ITALIA CON PARTICOLARE RIFERIMENTO ALLA TUTELA DEL BENESSERE DEGLI ANIMALI CATTURATI

During 1950s in Italy wild boar (Sus scrofa) was close to extinction. Then, several introduction, re-introduction and restocking operations have been legally carried out by local administrations, or illegally by hunters for hunting purpose, so as to make the management of this species particularly problematic and needing a careful and farsighted approach. In order to limit the increasing damage to crops and biocenosis, containment plans have been carried out, even in hunting-free areas, through selective cull and capture with steady or movable cage. The destination of captured animals is the critical point of this kind of management, not only for the effectiveness of this practice but above all for animal welfare. Often these animals are destinated to game farms, private hunting areas or hunting dogs training areas. Moreover, transport of live wild boars to slaughterhouses does not respect animal welfare standards and is in contrast with European legislation for animal welfare during transport and animal management in slaughterhouse. Considering the current practices, the authors outline the current legislative framework on the subject and propose indications to include the activities of wild boar containment within the commercial chain of wild game meat.Moreover, the transport of alive wild boars to slaughterhouses is in contrast with European Regulation admitting this transport only for listed farmed animals. Considering the above-mentioned practices, the Authors outline the current legislative framework on the subject, and in the context of the activities of containment of wild boars, ask for an immediate suppression of the animals directly on the capture location, avoiding any subsequent handling and transport

A complicated relationship: Family involvement in the top management team and post-IPO survival

This exploratory study aims to analyse how and whether family involvement in the top management team of listed family firms affects post-IPO survival on capital markets. We tested our hypotheses on a data set of listed family firms over the period 2000–2011 using survival analysis. Our findings suggest that a higher number of family members in the top management team reduces the likelihood of post-IPO survival, but the relationship is affected by a family member as CEO. The number of generations is also negatively correlated with survival

Family Involvement In Top Level Positions: An Empirical Analysis Of IPO Survival

We aim to analyse how and if family involvement in TMT of listed family firms affects post-IPO survival on capital markets. We test our hypothesis on a data set of Italian listed family firms over the period 2000-2011 by employing survival analysis. Our findings suggest that a higher presence of family members in TMT reduces the likelihood of post-IPO survival, but such relationship is contingent upon the presence of family CEO. Likewise, the number of generations is negatively correlated to survival

Portaclamp in video-assisted minimally invasive cardiac surgery: surgical technique and preliminary clinical experience

Video-assisted minimally invasive cardiac surgery (VAMICS) is currently performed with various indications. However, despite the increasing evidence of its effectiveness, new approaches have to be defined to simplify this procedure, minimize its potential complications and limit its costs, for a wider use in the surgical community. The limited access to the aorta is a key point in VAMICS and mandates specific clamping modalities with their own limitations, costs and drawbacks. The Portaclamp (Cardio Life Research SA, Louvain la Neuve, Belgium), a new autoguided extravascular aortic cross-clamping system, has been recently proposed to facilitate VAMICS. Herein, we describe the Portaclamp approach and report our indications and preliminary clinical experience so to define its role in VAMICS