Model of Care for Microelimination of Hepatitis C Virus Infection among People Who Inject Drugs.

BACKGROUND: People who inject drugs (PWID) are the largest group at risk for HCV infection. Despite the direct acting antivirals (DAA) advancements, HCV elimination has been hindered by real-life difficulties in PWID. AIMS: This study aimed to assess the impact of a multidisciplinary intervention strategy where HCV screening, treatment and follow-up were performed at the same location on efficacy and safety of DAA-therapy in real-life PWID population. METHODS: All HCV-infected PWID referred to five specialized outpatient centers for drug addicts (SerDs) in Northern Italy were prospectively enrolled from May 2015 to December 2019. Hepatologists and SerDs healthcare workers collaborated together in the management of PWID inside the SerDs. Sustained virologic response (SVR), safety of treatment, proportion of patients lost to follow-up and reinfection rate were evaluated. RESULTS: A total of 358 PWID started antiviral treatment. About 50% of patients had advanced fibrosis/cirrhosis, 69% received opioid substitution treatment, and 20.7% self-reported recent injecting use. SVR was achieved in 338 (94.4%) patients. Two patients died during treatment; one prematurely discontinued, resulting in a non-responder; twelve were lost during treatment/follow-up; and five relapsed. No serious adverse events were reported. SVR was lower in recent PWID than in former ones (89.2% vs. 95.8%; p = 0.028). Seven reinfections were detected, equating to an incidence of 1.25/100 person-years. Reinfection was associated with recent drug use (OR 11.07, 95%CI 2.10-58.38; p = 0.005). CONCLUSION: Our embedded treatment model could be appropriate to increase the linkage to care of HCV-infected PWID. In this setting, DAA regimens are well tolerated and highly effective, achieving a lower rate of reinfection.

Blockage of interleukin-1ß with canakinumab in patients with Covid-19.

There is the urgent need to study the effects of immunomodulating agents as therapy for Covid-19. An observational, cohort, prospective study with 30 days of observation was carried out to assess clinical outcomes in 88 patients hospitalized for Covid-19 pneumonia and treated with canakinumab (300 mg sc). Median time from diagnosis of Covid-19 by viral swab to administration of canakinumab was 7.5 days (range 0-30, IQR 4-11). Median PaO2/FiO2 increased from 160 (range 53-409, IQR 122-210) at baseline to 237 (range 72-533, IQR 158-331) at day 7 after treatment with canakinumab (p < 0.0001). Improvement of oxygen support category was observed in 61.4% of cases. Median duration of hospitalization following administration of canakinumab was 6 days (range 0-30, IQR 4-11). At 7 days, 58% of patients had been discharged and 12 (13.6%) had died. Significant differences between baseline and 7 days were observed for absolute lymphocyte counts (mean 0.60 vs 1.11 × 109/L, respectively, p < 0.0001) and C-reactive protein (mean 31.5 vs 5.8 mg/L, respectively, p < 0.0001).Overall survival at 1 month was 79.5% (95% CI 68.7-90.3). Oxygen-support requirements improved and overall mortality was 13.6%. Confirmation of the efficacy of canakinumab for Covid-19 warrants further study in randomized controlled trials.

Tunable narrow band optical reflector based on indirectly coupled micro ring resonators.

This paper presents a novel narrow band wavelength selective optical reflector implemented by indirectly coupling two micro ring resonators in silicon-on-insulator technology. The device is studied using an analytical model based on the transfer matrix method. With the proposed configuration, by electrically driving the integrated micro heaters, a single reflection wavelength with narrow bandwidth can be tuned. The experimental results show a good agreement with the model outcomes. The average measured reflectivity over a wavelength span of 37 nm is 0.55, with a peak of about 50 pm full-width-half-maximum, which corresponds to a quality factor of ∼30, 000. The proposed device can offer an alternative approach to realize compact reflective structures for single wavelength reflection operations in photonic integrated circuits.

Array of plasmonic Vivaldi antennas coupled to silicon waveguides for wireless networks through on-chip optical technology - WiNOT.

Optical technology applied to on-chip wireless communication is particularly promising to overcome the performance limitations of the state-of-the-art networks on-chip. A key enabling component for such applications is the plasmonic antenna coupled to conventional silicon waveguides, which can guarantee full compatibility with standard optical circuitry. In this paper, we propose an antenna array configuration based on tilted plasmonic Vivaldi antennas coupled to a silicon waveguide. The details of the single antenna and of the array design are reported. The radiation characteristics of the array are suitable for on-chip point-to-point communication, i.e. in-plane maximum gain of 14.70 dB for an array with five antennas. The array exploits a travelling wave feeding scheme and, therefore, is compact in size (about 3.5 µm × 8.7 µm ).

Assessment of the orthogonal and non-orthogonal coupled-mode theory for parallel optical waveguide couplers.

The coupled-mode theory (CMT) is a powerful approach routinely used to calculate the effects of spatial mode interactions in perturbed structures, such as optical waveguides. One of its basic hypotheses requires that perturbations are weak. This is usually not the case for devices fabricated with modern semiconductor-based technologies. In this paper, the CMT is studied in these critical cases to assess its validity. Attention will be focused on the quite common case of parallel coupled waveguides. For these structures, results can in fact be compared to the exact ones, obtained using super-modes. The study will show that not all the possible expressions of the coupling coefficients are equivalent, and which one can be pragmatically used to obtain results with minimum errors with respect to exact solutions.

Integrated Vivaldi plasmonic antenna for wireless on-chip optical communications.

In this paper we propose a novel hybrid optical plasmonic Vivaldi antenna for operation in the standard C telecommunication band for wavelengths in the 1550 nm range. The antenna is fed by a silicon waveguide and is designed to have high gain and large bandwidth. The shape of the radiation pattern, with a main lobe along the antenna axis, makes this antenna suitable for point-to-point connections for inter- or intra-chip optical communications. Direct port-to-port short links for different connection distances and in a homogeneous environment have also been simulated to verify, by comparing the results of a full-wave simulation with the Friis transmission equation, the correctness of the antenna parameters obtained via near-to-far field transformation.

Fournier's gangrene: Clinical case and review of the literature.

Fournier's gangrene is a life-threatening acute necrotizing fasciitis of perianal,genitourinary and perineal areas. Nowadays, is well known that Fournier gangrene is almost never an idiopathic disease. In this article we report a case of a 70-year-old patient that initially was not treated properly. The gold standard therapy of the Fournier's gangrene remains today a complete, early and extended surgical debridement.

Holey fiber mode-selective couplers.

Directional mode coupling in an asymmetric holey fiber coupler is demonstrated both numerically and experimentally for the first time. The holey fiber mode couplers have interesting spectral characteristics and are also found to exhibit increased dimensional tolerances. Following a design based on numerical investigations, a dual-core polymer holey fiber coupler for LP(01) and LP(11) mode multiplexing was fabricated via a drilling and drawing technique. The measurements are compared with the simulation results.

Tunable silicon photonics directional coupler driven by a transverse temperature gradient.

A compact directional coupler fabricated on a silicon photonic platform is presented, with a power-splitting ratio that can be tuned through a transverse temperature gradient induced by a laterally shifted integrated heater. The tuning mechanism exploits the thermally induced phase velocity mismatch between the coupled modes of the silicon waveguides. The positions of the integrated heater and the waveguide design are optimized to maximize the tuning range and to reduce electric power consumption. Asynchronous devices with an intrinsic phase mismatch are demonstrated to be more efficient, providing a tunable coupled power from 0.7 to 0.01 with 36 mW maximum power dissipation.

Reconfigurable silicon filter with continuous bandwidth tunability.

We present the design and the fabrication of compact tunable silicon-on-insulator bandpass filters based on the integration of a Mach-Zehnder interferometer with ring resonators and activated via thermo-optic phase shifters. The proposed architecture provides wide filter bandwidth tunability from 10% to 90% of the free spectral range preserving the filter off-band rejection. Possible applications are channel subset selection in wavelength division multiplexing optical systems, adaptive filtering to signal bandwidth, and reconfigurable filters for gridless networking.

A case of aseptic pleuropericarditis in a patient with chronic plaque psoriasis under methotrexate therapy.

Methotrexate may rarely provoke serositis, even with low doses and after just a few weeks of therapy. We report here a rare case of pleuropericarditis due to methotrexate. The effusion resolved after the withdrawal of the drug and the beginning of anti-inflammatory therapy; there was no relapse during a 10-month follow-up.

High performance mode adapters based on segmented SPE:LiNbO3 waveguides.

We propose a new mode adapter which allows more efficient launching of the optical power selectively in the fundamental mode of a multimode waveguide. Theoretical and experimental results confirm that such a mode adapter increases the performances in terms of coupling efficiency, coupling tolerances and transmitted power with respect to previously proposed solutions. Proof of principle of device operation is obtained with a simple Coupled Mode Theory model. Experimental results are obtained at a wavelength of 840 nm in Lithium Niobate Soft Proton Exchanged waveguides and agree very well with theoretical predictions.

Avoided-crossing-based liquid-crystal photonic-bandgap notch filter.

We demonstrate a highly tunable deep notch filter realized in a liquid-crystal photonic-bandgap (LCPBG) fiber. The filter is realized without inducing a long-period grating in the fiber but simply by filling a solid-core photonic-crystal fiber with a liquid crystal and exploiting avoided crossings within the bandgap of the LCPBG fiber. The filter is demonstrated experimentally and investigated using numerical simulations. A high degree of tuning of the spectral position of the deep notch is also demonstrated.

Continuously tunable devices based on electrical control of dual-frequency liquid crystal filled photonic bandgap fibers.

We present an electrically controlled photonic bandgap fiber device obtained by infiltrating the air holes of a photonic crystal fiber (PCF) with a dual-frequency liquid crystal (LC) with pre-tilted molecules. Compared to previously demonstrated devices of this kind, the main new feature of this one is its continuous tunability due to the fact that the used LC does not exhibit reverse tilt domain defects and threshold effects. Furthermore, the dual-frequency features of the LC enables electrical control of the spectral position of the bandgaps towards both shorter and longer wavelengths in the same device. We investigate the dynamics of this device and demonstrate a birefringence controller based on this principle.

Reformulation of the plane wave method to model photonic crystals.

A new formulation of the plane-wave method to study the characteristics (dispersion curves and field patterns) of photonic crystal structures is proposed. The expression of the dielectric constant is written using the superposition of two regular lattices, the former for the perfect structure and the latter for the defects. This turns out to be simpler to implement than the classical one, based on the supercell concept. Results on mode coupling effects in two-dimensional photonic crystal waveguides are studied and successfully compared with those provided by a Finite Difference Time Domain method. In particular the approach is shown able to determine the existence of "mini-stop bands" and the field patterns of the various interfering modes.

Full vectorial BPM modeling of Index-Guiding Photonic Crystal Fibers and Couplers.

A 3D full-vectorial Beam Propagation Method is successfully applied to compute both the propagation constants and the modal profiles in high-contrast silica-air index-guiding Photonic Crystal Fibers. The approach is intrinsically suited to investigate longitudinally varying structures or propagation and polarization effects, which are of practical interest for advanced optical applications. As an example we model a dual-core coupler, showing that efficient polarization preserving coupling can be expected.