Direct‐acting antivirals for HCV treatment in older patients: A systematic review and meta‐analysis

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Indexed maximal left atrial volume predicts response to cardiac resynchronization therapy

Aims Cardiac resynchronization therapy (CRT) has shown morbidity and mortality benefits in patients with advanced congestive heart failure (HF). Since about one-third of the patients did not appear to respond to CRT, it would seem reasonable to try to identify patients more accurately before implantation. Left atrial (LA) dimension has been proposed as a powerful outcome predictor in patients with heart disease. Accordingly, the aim of this study is to prospectively assess the predictive value of LA for selecting CRT responders. Methods Fifty two consecutive patients with refractory HF, sinus rhythm and left bundle branch block were enrolled in the study and planned for CRT implantation. Clinical and echocardiographic evaluations were performed before CRT implantation and after 6 months. Three LA volumes indexed to body surface area (iLAV) were computed to evaluate the LA complexity: maximal LAV (iLAVmax), LAV just before atrial systole (iLAVpre), and minimal LAV (iLAVpost). CRT responders were defined as those who presented a reduction of > 10% in LVESVi at 6-month follow-up. Results Responders (63%) and nonresponders (37%) had similar baseline clinical characteristics and pre-implantation LV volumes. However, baseline LA volumes were significantly associated with the extent of LV reverse remodeling: in particular, baseline iLAVmax was remarkably lower in responders than in nonresponders (50.2 ± 14.1 ml/m2 vs 65.8 ± 15.7 ml/m2, p = 0.001) resulting predictive for CRT response. Conclusion Patients with small iLAV result as better responders to CRT than larger one. iLAVmax is an independent predictor of LV reverse remodeling and allows to indentify the best candidates for CRT. © 2013 Elsevier Ireland Ltd

The ocular surface in medically controlled glaucoma : An in vivo confocal study

PURPOSE. To study clinical and in vivo laser scanning confocal microscopy (LSCM) ocular surface findings in stable, medically controlled primary open-angle glaucoma (MCPOAG) patients. METHODS. We recruited 100 consecutive patients with MCPOAG and 50 healthy controls. Patients had to have been treated with the same medical regimen without variation for the 18 months before enrollment and were excluded if there was a history of dry eye prior to glaucoma diagnosis. Each participant underwent ocular surface clinical and LSCM examination. RESULTS. In MCPOAG patients, subbasal nerve length and tortuosity and dendritic cell density were increased compared to controls (P < 0.01), but there were no clinical abnormalities. Patients treated with preserved drugs (n = 80) had reduced tear film breakup time (P < 0.05, ANOVA), and those preserved with benzalkonium chloride (n = 72) had reduced Schirmer test values (P < 0.001). Patients (n = 50) treated with two or more drugs had increased lissamine green conjunctival staining (P < 0.001, LSD post hoc test). Patients (n = 29) treated with three or more eye drops daily had decreased Schirmer test values. Laser scanning confocal microscopy showed subbasal changes related to preservatives, type and number of drugs, and number of eye drops. CONCLUSIONS. In stable MCPOAG patients without dry eye history, the ocular surface changes due to antiglaucoma medications are mostly subclinical. Active ingredients, preservatives, number of concomitant drugs, and number of eye drops instilled per day are all elements that can induce ocular surface changes. The clinical relevance of these changes remains to be determined

The Ocular Surface in Medically Controlled Glaucoma: An In Vivo Confocal Study

METHODS. We recruited 100 consecutive patients with MCPOAG and 50 healthy controls. Patients had to have been treated with the same medical regimen without variation for the 18 months before enrollment and were excluded if there was a history of dry eye prior to glaucoma diagnosis. Each participant underwent ocular surface clinical and LSCM examination. RESULTS. In MCPOAG patients, subbasal nerve length and tortuosity and dendritic cell density were increased compared to controls (P &lt; 0.01), but there were no clinical abnormalities. Patients treated with preserved drugs (n ¼ 80) had reduced tear film breakup time (P &lt; 0.05, ANOVA), and those preserved with benzalkonium chloride (n ¼ 72) had reduced Schirmer test values (P &lt; 0.001). Patients (n ¼ 50) treated with two or more drugs had increased lissamine green conjunctival staining (P &lt; 0.001, LSD post hoc test). Patients (n ¼ 29) treated with three or more eye drops daily had decreased Schirmer test values. Laser scanning confocal microscopy showed subbasal changes related to preservatives, type and number of drugs, and number of eye drops. CONCLUSIONS. In stable MCPOAG patients without dry eye history, the ocular surface changes due to antiglaucoma medications are mostly subclinical. Active ingredients, preservatives, number of concomitant drugs, and number of eye drops instilled per day are all elements that can induce ocular surface changes. The clinical relevance of these changes remains to be determined

Prognostic role of intragastric cytopathology and microbiota in surgical patients with stomach cancer

In the last decade, analysis of malignant cells and flora in gastric lavage (GL) has provided interesting data on pathogenesis of gastric cancer (GC). For this study, combining such two aspects into one cyto-microbiologic category, we tested the prognostic role of the presence/absence of cancer cells (GL1/GL0) and bacterial microbiota (MB1/MB0) in our GC population. Material and Methods: Between April 2012 and August 2019, 79 surgical patients with GC were prospectively investigated with the determination of GL MB. Results: Compared with GL1 MB0, GL1 MB1 strongly correlated with advanced GC, portended poorer overall survival (OS) (45.8 months vs 20.5 months, P = 0.049), and resulted a significant (P = 0.008) and an independent (P = 0.013) prognostic factor unfavorable for OS. Conclusion: In the light of our results, the cyto-microbiologic parameter of GL MB should be used to gain a better prognosis of GC patients. Administration of antimicrobial treatment for MB1 subjects should be entertained because it could reduce the risk of oncogenesis

Low back pain among healthcare workers in a surgical environment: a research protocol

BACKGORUND: Nurses and surgeons are among the healthcare categories with the highest risk of developing low back pain (LBP). The aim of this study is to present the research protocol of a survey for assessing the presence of low back pain among healthcare workers of a surgical ward and its associated factors. METHODS: The survey will be conducted in the Orthopaedics ward of the teaching hospital “Policlinico Umberto I” in Rome, during the year 2018. The low-back pain will be measured using the Italian version of the Nordic Questionnaire musculoskeletal disorders. Socio-demografic and clinical data will be collected, such as: aghe, gender, heaight, weight, body mass index (BMI), type of work, years of work, working timetable. LBP intensity will be assessed with the Numerical Rating Scale. This is a one-dimension numerical scale with possible score from 0 (no pain) to 10 (the worst possible pain). The general health status will be assessed with the SF-12 questionnaire, for calculating the Mental and Physical component scales, MCS and PCS respectively. The physical activity will be assessed with the Italian version of the International Physical Activity Questionnaire. Moreover, work-related stress will be assessed using the Karasec-15 questionnaire. CONCLUSION: This research protocol will be useful for assessing the prevalence of LBP and its associated factors. These informations will be used for planning primary and tertiary prevention

Counteracting gemcitabine+nab-paclitaxel induced dysbiosis in KRAS wild type and KRASG12D mutated pancreatic cancer in vivo model

Pancreatic cancer (PC) has a very low survival rate mainly due to late diagnosis and refractoriness to therapies. The latter also cause adverse effects negatively affecting the patients' quality of life, often requiring dose reduction or discontinuation of scheduled treatments, compromising the chances of cure. We explored the effects of a specific probiotic blend on PC mice xenografted with KRAS wild-type or KRASG12D mutated cell lines alone or together with gemcitabine+nab-paclitaxel treatment to then assess tumor volume and clinical pathological variables. Beside a semi-quantitative histopathological evaluation of murine tumor and large intestine samples, histochemical and immunohistochemical analyses were carried out to evaluate collagen deposition, proliferation index Ki67, immunological microenvironment tumor-associated, DNA damage markers and also mucin production. Blood cellular and biochemical parameters and serum metabolomics were further analyzed. 16S sequencing was performed to analyze the composition of fecal microbiota. Gemcitabine+nab-paclitaxel treatment impaired gut microbial profile in KRAS wild-type and KRASG12D mice. Counteracting gemcitabine+nab-paclitaxel- induced dysbiosis through the administration of probiotics ameliorated chemotherapy side effects and decreased cancer-associated stromatogenesis. Milder intestinal damage and improved blood count were also observed upon probiotics treatment as well as a positive effect on fecal microbiota, yielding an increase in species richness and in short chain fatty acids producing- bacteria. Mice' serum metabolomic profiles revealed significant drops in many amino acids upon probiotics administration in KRAS wild-type mice while in animals transplanted with PANC-1 KRASG12D mutated all treated groups showed a sharp decline in serum levels of bile acids with respect to control mice. These results suggest that counteracting gemcitabine+nab-paclitaxel-induced dysbiosis ameliorates chemotherapy side effects by restoring a favorable microbiota composition. Relieving adverse effects of the chemotherapy through microbiota manipulation could be a desirable strategy in order to improve pancreatic cancer patients' quality of life and to increase the chance of cure

Assessment of the prevalence and risk factors of low back pain in operating room health workers: An observational study in Italy

Aim: The aim of this study was to assess the prevalence of low back pain (LBP) among healthprofessionals and the possible risk factors. Methods: The study was carried out from April 2018 to October 2018 among all health workers of theOrthopaedic Clinic and the Emergency Department of “Policlinico Umberto I” in Rome. LBP wasassessed using the Nordic Questionnaire Musculoskeletal Disorders in the section on lumbar pain.The type of physical activity carried out as prevention was investigated by use of theInternational Physical Activity Questionnaires. The overall state of health and lifestyle wasdeter- mined by the Short Form 12-item Health Survey. Job satisfaction and perceived work stresswere assessed through the 15-questions of Karasek’s Questionnaire. The intensity of the low backpain was assessed using a Numerical Rating Scale. A univariate analysis was conducted to assess theassociations between socio-demographic and working variables. Multiple logistic regression mod- elswere used to assess independent correlates of LBP. Results: One hundred thirteen subjects were enrolled, 52 women and 61 men. The annual period-prevalence of lumbar musculoskeletal disorder was found on 79.6% of participants with LBP.Mean value evidence of NRS was 2.66. The highest LBP risk over the 12 months was found in groupswith high job demand (OR = 1.18; 95%CI: 1.01 – 1.38), low decision-making opportunities (fordecision latitude OR = 0.87; (0-76 – 1.0), and low levels of physical activity (OR = 0.75; 95%CI:0.64 – 0.89). Conclusion: The working environment is a potential risk factor for the development of LBP and issuitable for prevention programmes. The protective effect of physical activity and work-relatedstress management indicate room for improvements for the prevention of LBP in these HCWs. Conflicts of interest: None declared

Assessment of the prevalence and risk factors of low back pain in operating room health workers: An observational study in Italy

Aim: The aim of this study was to assess the prevalence of low back pain (LBP) among healthprofessionals and the possible risk factors. Methods: The study was carried out from April 2018 to October 2018 among all health workers of the Orthopaedic Clinic and the Emergency Department of “Policlinico Umberto I” in Rome. LBP was assessed using the Nordic Questionnaire Musculoskeletal Disorders in the section on lumbar pain. The type of physical activity carried out as prevention was investigated by use of the International Physical Activity Questionnaires. The overall state of health and lifestyle was deter- mined by the Short Form 12-item Health Survey. Job satisfaction and perceived work stress were assessed through the 15-questions of Karasek’s Questionnaire. The intensity of the low back pain was assessed using a Numerical Rating Scale. A univariate analysis was conducted to assess the associations between socio-demographic and working variables. Multiple logistic regression mod- els were used to assess independent correlates of LBP. Results: One hundred thirteen subjects were enrolled, 52 women and 61 men. The annual period- prevalence of lumbar musculoskeletal disorder was found on 79.6% of participants with LBP. Mean value evidence of NRS was 2.66. The highest LBP risk over the 12 months was found in groups with high job demand (OR = 1.18; 95%CI: 1.01 – 1.38), low decision-making opportunities (for decision latitude OR = 0.87; (0-76 – 1.0), and low levels of physical activity (OR = 0.75; 95%CI: 0.64 – 0.89). Conclusion: The working environment is a potential risk factor for the development of LBP and is suitable for prevention programmes. The protective effect of physical activity and work-related stress management indicate room for improvements for the prevention of LBP in these HCWs. Conflicts of interest: None declared

Digital Pixel Test Structures implemented in a 65 nm CMOS process

The ALICE ITS3 (Inner Tracking System 3) upgrade project and the CERN EP R&D on monolithic pixel sensors are investigating the feasibility of the Tower Partners Semiconductor Co. 65 nm process for use in the next generation of vertex detectors. The ITS3 aims to employ wafer-scale Monolithic Active Pixel Sensors thinned down to 20 to 40 um and bent to form truly cylindrical half barrels. Among the first critical steps towards the realisation of this detector is to validate the sensor technology through extensive characterisation both in the laboratory and with in-beam measurements. The Digital Pixel Test Structure (DPTS) is one of the prototypes produced in the first sensor submission in this technology and has undergone a systematic measurement campaign whose details are presented in this article. The results confirm the goals of detection efficiency and non-ionising and ionising radiation hardness up to the expected levels for ALICE ITS3 and also demonstrate operation at +20 C and a detection efficiency of 99% for a DPTS irradiated with a dose of $10^{15}$ 1 MeV n$_{\mathrm{eq}}/$cm$^2$. Furthermore, spatial, timing and energy resolutions were measured at various settings and irradiation levels.Comment: Updated threshold calibration method. Implemented colorblind friendly color palette in all figures. Updated reference