Evaluating methodological quality of Prognostic models Including Patient-reported HeAlth outcomes in oncologY (EPIPHANY): A systematic review protocol

Introduction While there is mounting evidence of the independent prognostic value of patient-reported outcomes (PROs) for overall survival (OS) in patients with cancer, it is known that the conduct of these studies may hold a number of methodological challenges. The aim of this systematic review is to evaluate the quality of published studies in this research area, in order to identify methodological and statistical issues deserving special attention and to also possibly provide evidence-based recommendations. Methods and analysis An electronic search strategy will be performed in PubMed to identify studies developing or validating a prognostic model which includes PROs as predictors. Two reviewers will independently be involved in data collection using a predefined and standardised data extraction form including information related to study characteristics, PROs measures used and multivariable prognostic models. Studies selection will be reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, with data extraction form using fields from the Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modelling Studies (CHARMS) checklist for multivariable models. Methodological quality assessment will also be performed and will be based on prespecified domains of the CHARMS checklist. As a substantial heterogeneity of included studies is expected, a narrative evidence synthesis will also be provided. Ethics and dissemination Given that this systematic review will use only published data, ethical permissions will not be required. Findings from this review will be published in peer-reviewed scientific journals and presented at major international conferences. We anticipate that this review will contribute to identify key areas of improvement for conducting and reporting prognostic factor analyses with PROs in oncology and will lay the groundwork for developing future evidence-based recommendations in this area of research. Prospero registration number CRD42018099160

Statistics of non-linear stochastic dynamical systems under L\'evy noises by a convolution quadrature approach

This paper describes a novel numerical approach to find the statistics of the non-stationary response of scalar non-linear systems excited by L\'evy white noises. The proposed numerical procedure relies on the introduction of an integral transform of Wiener-Hopf type into the equation governing the characteristic function. Once this equation is rewritten as partial integro-differential equation, it is then solved by applying the method of convolution quadrature originally proposed by Lubich, here extended to deal with this particular integral transform. The proposed approach is relevant for two reasons: 1) Statistics of systems with several different drift terms can be handled in an efficient way, independently from the kind of white noise; 2) The particular form of Wiener-Hopf integral transform and its numerical evaluation, both introduced in this study, are generalizations of fractional integro-differential operators of potential type and Gr\"unwald-Letnikov fractional derivatives, respectively.Comment: 20 pages, 5 figure

Should reduction of increased short-term blood pressure variability be a target of antihypertensive therapy?

It has long been known that blood pressure (BP) is characterized by marked short-term fluctuations occurring within a 24-h period and also by long-term oscillations occurring over more prolonged periods of time. An increased short-term blood pressure variability (BPV) appears to importantly contribute to target organ damage and to the enhanced cardiovascular risk of hypertensive patients, over and above the effect of an increase in mean BP levels. Reducing 24-h mean BP is the main aim of antihypertensive therapy, but initial data are available that additional cardiovascular protection can be achieved by reducing BPV. However, to definitively prove the prognostic role of short-term BPV and the need for its control by treatment, evidence is still needed from intervention trials aimed at demonstrating that by reducing BPV through administration of antihypertensive drugs, a reduction in organ damage and in the rate of cardiovascular events can be obtained

Post-acute COVID-19 neurological syndrome: A new medical challenge

In December 2019, in Wuhan (China), a highly pathogenic coronavirus, named SARS-CoV-2, dramatically emerged. This new virus, which causes severe pneumonia, is rapidly spreading around the world, hence it provoked the COVID-19 pandemic. This emergency launched by SARS-CoV-2 also had, and still has, devastating socio-economic aspects. Assessing the impact of COVID-19 on vulnerable groups of people is crucial for the adaptation of governments’ responses. Growing scientific evidence suggests that it is essential to keep the attention on people after acute SARS-CoV-2 infection; indeed, some clinical manifestations are frequently present even after recovery. There is consensus on the need to define which symptoms persist after the infection and which disabilities may arise after COVID-19. Recent reviews, case reports, and original contributions suggest that various organs may be affected, and neurological symptoms are present in about one third of patients with COVID-19. Neurological complications after severe COVID-19 infection might include delirium, brain inflammation, stroke, and nerve damage. In the recent pandemic, neurologists and neurobiologists have a chance to study key features of infection neurology. Furthermore, the psychological impact of the pandemic should not be underestimated, although there is currently no definition for this condition

Comparison of the intestinal microbiome of italian patients with multiple sclerosis and their household relatives

Multiple sclerosis (MS) is a chronic immune-mediated disease of the central nervous system, caused by a combination of genetic and environmental factors. In recent years, a role in MS pathogenesis was assigned to the gut microbiota. However, different signatures of gut dysbiosis have been shown to depend on environmental factors, like diet and lifestyle. In this study, we compared the gut microbiome in MS patients and their household healthy relatives sharing lifestyle and environmental factors. Faecal metagenomic DNA was extracted and the V3-V4 regions of the conserved bacterial 16S ribosomal RNA gene were amplified and sequenced. While overall bacterial communities were similar, specific families differed between healthy and MS subjects. We observed an increase in Ruminococcaceae, Christensenellaceae, Desulfovibrionaceae, Clostridiales, and Family XIII in MS patients, while Bacteroidaceae, Tannerellaceae, Veillonellaceae, and Burkholderiaceae were more abundant in healthy controls. In addition, principle coordinate analysis showed that the gut microbiome of all MS patients formed a cluster being less diverse than the household relatives and that gut microbiota of MS patients with EDSS 4.5-7 formed a distinct cluster in respect to their controls. Overall, our study is consistent with the hypothesis that MS patients have gut microbial dysbiosis and evidenced the importance of environmental factors in shaping the gut microbiome

Non-Destructive Techniques in the Consolidation Works of the Church of S.M. of Itria in Piazza Armerina (Italy)

A real case of consolidation works is presented in which only field testing methods can reveal the causes of instability. This paper is an update of the one presented at the SAHC 2018 conference, concerning the study of the partial collapse of the Church of Itria in Piazza Armerina (Sicily, Italy). The previous paper beared hypotheses and design solutions based only on indirect investigations, theoretical formulations and checks with software. The consolidation works, started in November 2018 and still in progress, have made it possible to formulate new and documented hypotheses on the collapse and to integrate and partly modify the solutions hypothesized previously. In particular, the reconstruction techniques of the wall and chains have been confirmed. The new interventions have, instead, concerned the consolidation of the foundation soil which was found to be insubstantial,following electrical tomographic investigations, due to the presence of voids. At the same time, inspections were carried out on an old masonry sewage pipe which revealed several points of discontinuity through which large quantities of water entered under the walls of the church causing the removal of inconsistent elements from the ground. At first, the reconstruction of the collapsed wall was done and the restoration of the existing wall structures, to eliminate the causes of the collapse through the intervention on the sewage pipe and filling the voids under the foundations. The most important intervention, which required the use of innovative materials, forefront equipment and skilled labor, involved the filling the voids under the foundations through perforations every 50 cm, both on the inner and outer wire of the collapsed wall. Clamped canes were set in order to intercept the voids highlighted by the tomography. A 100% expansive mortar was injected at low pressure through the canes, filling one cane at a time and progressively raising the point of exit of the mortar until the higher far end. After this consolidation, the foundation and the wall were rebuilt with local limestone ashlars to have fair faced aspect as the original masonry. At the end of the work, further tomographic tests are planned to verify the validity of the interventions carried out

[OP.2D.05] RELATIONSHIP OF OXIDATIVE STRESS WITH CARDIAC HYPERTROPHY IN HYPERTENSIVE PATIENTS

OBJECTIVE: Left ventricular hypertrophy is common in hypertensive patients. In these subjects increased oxidative stress has been observed. Our aim was to evaluate the association of biomarkers of both oxidative stress and inflammation with markers of cardiovascular damage in a large group of hypertensives with different stages of renal function. DESIGN AND METHOD: In 517 hypertensives we analyzed left ventricular mass indexed for body surface area, and we assayed plasma levels of 8-isoprostaglandin F2alpha and high sensitivity C reactive protein. RESULTS: Multivariate analysis carried out considering left ventricular mass as dependent variable, and including 8-isoprostaglandin F2alpha, high sensitivity C reactive protein, age, sex, body mass index, estimated glomerular filtration rate, serum glucose, (log)triglycerides, hemoglobin, pulse pressure or systolic blood pressure, mean or diastolic blood pressure, and antihypertensive treatment showed that in hypertensives plasma levels of 8-isoprostaglandin F2alpha were correlated with left ventricular mass (beta=0.269, p\u200a<\u200a0.0001).The bivariate relationship of left ventricular mass with 8-isoprostaglandin F2alpha in hypertensives with estimated glomerular filtration rate higher and lower than 60\u200aml/min/1.73m2 was also calculated separately, demonstrating no significant differences in both correlations coefficients and slopes of the regression lines (r\u200a=\u200a0.254, p\u200a<\u200a0.001 and r\u200a=\u200a0.226, p\u200a<\u200a0.002; respectively).In the overall group, receiver operating characteristic curves showed that 8-isoprostaglandin F2alpha and high sensitivity C reactive protein were predictors of left ventricular hypertrophy, p\u200a<\u200a0.0001. CONCLUSIONS: To the best of our knowledge, this is the first demonstration that in hypertensives oxidative stress is correlated to left ventricular hypertrophy independently of other confounding factors. Oxidative stress might participate in the development of hypertensive cardiac hypertrophy

INVERSE RELATIONSHIP BETWEEN AORTIC ROOT DIAMETER AND RENAL FUNCTION IN HYPERTENSIVE SUBJECTS

Recent studies suggest that enlarged aortic root diameter (ARD) may predict cardiovascular events in absence of aneurysmatic alterations. Little is known about the influence of renal function on ARD. Our study was aimed to assess the relationships between glomerular filtration rate (GFR) and ARD in hypertensive subjects