Incidence and Predictors of Esophagogastric Varices Bleeding in Patients with Hepatocellular Carcinoma in Lenvatinib.

Introduction: Lenvatinib is indicated for the forefront treatment of advanced hepatocellular carcinoma (aHCC), but its use may be limited by the risk of esophagogastric varices (EGV) bleeding. This study assessed the prevalence, predictors, and complications of EGV in aHCC patients treated with lenvatinib. Methods: In this multicenter international retrospective study, cirrhotic patients treated with lenvatinib for aHCC, were enrolled if upper-gastrointestinal endoscopy was available within 6 months before treatment. Primary endpoint was the incidence of EGV bleeding during lenvatinib therapy; secondary endpoints were predictors for EGV bleeding, prevalence, and risk factors for the presence of EGV and high-risk EGV at baseline, as well as impact of EGV bleeding on patients' survival. Results: 535 patients were enrolled in the study (median age: 72 years, 78% male, 63% viral etiology, 89% Child-Pugh A, 16% neoplastic portal vein thrombosis [nPVT], 56% Barcelona Clinic Liver Cancer-C): 234 had EGV (44%), 70 (30%) were at high risk and 59 were on primary prophylaxis. During lenvatinib treatment, 17 patients bled from EGV (3 grade 5), the 12-month cumulative incidence being 3%. The only baseline independent predictor of EGV bleeding was the presence of baseline high-risk EGV (hazard ratio: 6.94, 95% confidence interval [CI]: 2.23-21.57, p = 0.001). In these patients the 12-month risk was 17%. High-risk varices were independently associated with Child-Pugh B score (odds ratio [OR]: 2.12; 95% CI: 1.08-4.17, p = 0.03), nPVT (OR: 2.54; 95% CI: 1.40-4.61, p = 0.002), and platelets <150,000/µL (OR: 2.47; 95% CI: 1.35-4.50, p = 0.003). Conclusion: In hepatocellular carcinoma patients treated with lenvatinib, the risk of EGV bleeding was mostly low but significant only in patients with high-risk EGV at baseline.

When solid recovered fuel (SRF) production and consumption maximize environmental benefits? A life cycle assessment.

Solid recovered fuel (SRF) from non-recyclable waste obtained from source separation and mechanical treatments can replace carbon coke in cement plants, contributing to the carbon neutrality. A life cycle assessment (LCA) of the SRF production from non-recyclable and selected waste was conducted in an Italian mechanical treatment plant to estimate the potential environmental impacts per ton of SRF produced. The analysis would contribute to evaluate the benefits that can be obtained due to coke substitution in best- and worst-case scenarios. The avoided impacts achieved were assessed, together with an evaluation of the variables that can affect the environmental benefits: SRF biogenic carbon content (in percentage of paper and cardboard); transportation distances travelled from the treatment plant to the cement kiln; the renewable energy used in the mechanical facility. On average, about 35.6 kgCO2-eq are generated by the SRF transportation and production phase. These impacts are greatly compensated by coke substitution, obtaining a net value of about -1.1 tCO2-eq avoided per ton of SRF. On balance, the global warming potential due to SRF production and consumption ranges from about -542 kgCO2-eq to about -1729 kgCO2-eq. The research recommended the use of SRF to substitute coke in cement kilns also in low densely-populated areas to mitigate environmental impacts and achieve carbon neutrality at a global level.

Comparative Analysis of Subclassification Systems in Patients with Intermediate-Stage Hepatocellular Carcinoma (Barcelona Clinic Liver Classification B) Receiving Systemic Therapy.

BACKGROUND: Intermediate-stage hepatocellular carcinoma (BCLC B HCC) occurs in a heterogeneous group of patients and can be addressed with a wide spectrum of treatments. Consequently, survival significantly varies among patients. In recent years, several subclassification systems have been proposed to stratify patients' prognosis. We analyzed and compared these systems (Bolondi, Yamakado, Kinki, Wang, Lee, and Kim criteria) in patients undergoing systemic therapy. METHODS: We considered 171 patients with BCLC B HCC treated with sorafenib as first-line systemic therapy in six Italian centers from 2010 to 2021 and retrospectively applied the criteria of six different subclassification systems. RESULTS: Except for the Yamakado criteria, all the subclassification systems showed a statistically significant correlation to overall survival (OS). In the postestimation analysis, the Bolondi criteria (OS of subgroups 22.5, 11.9, and 6.6 mo, respectively; C-index 0.586; AIC 1338; BIC 1344) and the Wang criteria (OS of subgroups 20.6, 11.9, and 7.0, respectively; C-index 0.607; AIC 1337; BIC 1344) presented the best accuracy. Further analyses of these two subclassification systems implemented with the prognostic factor of alpha-fetoprotein (AFP) > 400 ng/mL have shown an increase in accuracy for both systems (C-index 0.599 and 0.624, respectively). CONCLUSIONS: Intermediate-stage subclassification systems maintain their predictive value also in the setting of systemic therapy. The Bolondi and Wang criteria showed the highest accuracy. AFP > 400 ng/mL enhances the performance of these systems.

Best practices, errors, and perspectives of half a century of plant translocation in Italy.

Conservation translocations are becoming common conservation practice, so there is an increasing need to understand the drivers of plant translocation performance through reviews of cases at global and regional levels. The establishment of the Italian Database of Plant Translocation (IDPlanT) provides the opportunity to review the techniques used in 186 plant translocation cases performed in the last 50 years in the heart of the Mediterranean Biodiversity Hotspot. We described techniques and information available in IDPlanT and used these data to identify drivers of translocation outcomes. We tested the effect of 15 variables on survival of translocated propagules as of the last monitoring date with binomial logistic mixed-effect models. Eleven variables significantly affected survival of transplants: life form, site protection, material source, number of source populations, propagation methods, propagule life stage, planting methods, habitat suitability assessment, site preparation, aftercare, and costs. The integration of vegetation studies in the selection of suitable planting sites significantly increased the success of translocation efforts. Although posttranslocation watering had a generally positive effect on translocation outcome, other aftercare techniques did not always increase transplant survival. Finally, we found that how funds were spent appeared to be more important than the actual amount spent. Plant translocations in Italy and in the Mediterranean area should account for the complexity of speciation, gene flow, and plant migrations that has led to local adaptations and has important implications for the choice and constitution of source material.

Mejores prácticas, errores y perspectivas tras medio siglo de reubicaciones botánicas en Italia Resumen Las reubicaciones son una práctica cada vez más común en la conservación, por lo que hay una necesidad creciente por entender los factores del desempeño de las reubicaciones botánicas por medio de la revisión de casos regionales y globales. La creación de la Italian Database of Plant Translocation (IDPlanT) proporciona una oportunidad para revisar las técnicas usadas para los casos de reubicación de 186 plantas realizados durante los últimos cincuenta años en el centro del punto caliente de biodiversidad mediterránea. Describimos las técnicas y la información disponible en IDPlanT y usamos estos datos para identificar los factores involucrados en los resultados de las reubicaciones. Usamos modelos logísticos binomiales de efectos mixtos para analizar el efecto de 15 variables sobre la supervivencia de los propágulos reubicados a partir de la última fecha de monitoreo. Once de las variables afectaron de manera significativa la supervivencia de las plantas: forma de vida, protección del sitio, fuente de materiales, cantidad de poblaciones originarias, método de propagación, etapa de vida del propágulo, método de siembra, evaluación de idoneidad del hábitat, preparación del sitio, cuidados posteriores y costos. La integración de los estudios botánicos a la selección de los sitios idóneos para plantar aumentó el éxito de los esfuerzos de reubicación. Aunque el riego posterior a la reubicación tuvo un efecto positivo general sobre el resultado, las otras técnicas de cuidado posterior no siempre incrementaron la supervivencia de la planta reubicada. Por último, descubrimos que parece ser más importante cómo se utilizan los fondos que la cantidad actual empleada. Las reubicaciones botánicas en Italia y en el área del Mediterráneo deben considerar lo complejo de la especiación, el flujo génico y la migración botánica que han derivado en adaptaciones locales y que han tenido implicaciones importantes para la elección y constitución del material de origen.

Pedicularis rostratospicata subsp. marsica (P. Sect. Rostratae, Orobanchaceae), a New Subspecies from the Central Apennines (Italy).

The new subspecies Pedicularis rostratospicata subsp. marsica is here described based on morphological and molecular analyses. The new taxon is endemic to few localities of the Central Apennines within the Abruzzo, Lazio and Molise National Park (Central Italy). Pedicularis rostratospicata subsp. marsica can be distinguished from the other two currently accepted subspecies (subsp. rostratospicata and subsp. helvetica) by their taller stems, shorter petioles of basal and middle leaves, narrower blades of basal leaves, longer inflorescences with longer internodes and more flowers, and longer calyx lobes. Molecular analysis confirmed the autonomy of the new taxon. Furthermore, the conservation status assessment of the new subspecies according to IUCN categories and criteria is proposed and discussed, and an analytical key to the three subspecies of P. rostratospicata is presented.

Identification of Aluminothermic Reaction and Molten Aluminum Level through Vision System.

During the secondary production of aluminum, upon melting the scrap in a furnace, there is the possibility of developing an aluminothermic reaction, which produces oxides in the molten metal bath. Aluminum oxides must be identified and removed from the bath, as they modify the chemical composition and reduce the purity of the product. Furthermore, accurate measurement of molten aluminum level in a casting furnace is crucial to obtain an optimal liquid metal flow rate which influences the final product quality and process efficiency. This paper proposes methods for the identification of aluminothermic reactions and molten aluminum levels in aluminum furnaces. An RGB Camera was used to acquire video from the furnace interior, and computer vision algorithms were developed to identify the aluminothermic reaction and melt level. The algorithms were developed to process the image frames of video acquired from the furnace. Results showed that the proposed system allowed the online identification of the aluminothermic reaction and the molten aluminum level present inside the furnace at a computation time of 0.7 s and 0.4 s per frame, respectively. The advantages and limitations of the different algorithms are presented and discussed.

Taxonomy and Distribution of Spiraea hypericifolia in Italy and Typification of the Name S. flabellata (Rosaceae).

Spiraea hypericifolia is a Eurasiatic species, distributed from SW Europe to C and SW Asia. In Italy, only the alien S. hypericifolia subsp. obovata was recorded, as naturalized in the Central Apennines. Spiraea flabellata was described from Abruzzo (Central Apennines, Italy) by Gussone in 1826 and is currently regarded as a synonym of S. hypericifolia subsp. obovata. Based on the study of living plants from locus classicus and the analysis of the original material traced in BOLO and NAP, S. flabellata should be referred instead to S. hypericifolia subsp. hypericifolia, a taxon reported here for the first time in Italy. The name S. flabellata is lectotypified with a specimen kept in NAP. Based on our study, S. hypericifolia subsp. obovata should be excluded from Italian flora. Spiraea hypericifolia subsp. hypericifolia should be considered native to Italy and added to the contingent of steppe plants of phytogeographic and conservation interest recorded in the Central Apennines. Finally, the conservation status assessment of S. hypericifolia subsp. hypericifolia according to IUCN categories and criteria, is proposed and discussed.

Adonis fucensis (A. sect. Adonanthe, Ranunculaceae), a New Species from the Central Apennines (Italy).

Adonis fucensis is herein described as a new species based on morphological and molecular analyses. It is endemic to one locality of the Central Apennines between Amplero and Fucino plains within the NATURA 2000 network in the SAC IT7110205 (Central Italy). The only discovered population is composed of 65 individuals and is at risk of extinction. The conservation status assessment according to IUCN categories and criteria is proposed and discussed. The new species belongs to A. sect. Adonanthe and is morphologically similar to A. volgensis (incl. A. transsilvanica), a species distributed in Hungary, Romania, Bulgaria, and Turkey as well as eastward to SW Siberia and Central Asia. Adonis fucensis can be distinguished from A. volgensis by larger cauline leaves, pentagonal with lobes lanceolate, larger stipules with more lobes and teeth, and larger flowers. Finally, an analytical key to Adonis species belonging to sect. Adonanthe distributed in Europe is presented.

Comparison of environmental impacts related to municipal solid waste and construction and demolition waste management and recycling in a Latin American developing city.

Construction and demolition waste (CDW) and municipal solid waste (MSW) are the waste flows mostly generated at a global level. In developing countries, most of these waste streams are disposed of in open dumps. Policy-makers should be informed in which priorities should be established in order to improve the quality of the environment. The current research compares the environmental impacts generated by the MSW and CDW management system of La Paz (Bolivia). The aim is to evaluate (1) which environmental impact indicators are more important per waste flow and (2) if recycling can be considered a good option for mitigating such environmental footprint. A life cycle assessment (LCA) of the formal MSW management and the CDW mismanagement (i.e., open dumping) were conducted. The analysis of the management system (2019) is compared with future developments in recycling that counts with the support of an international cooperative project financed by the Italian cooperation. Results reported that, at a municipal level, CDW mismanagement contributes more than 60% to the freshwater aquatic ecotoxicity, which represents the most relevant impact generated by this waste stream. Recycling allows achieving avoided impacts higher than the ones produced for three of six environmental impacts, suggesting MSW and CDW recovery as an important option for preventing environmental degradation. The research is the first attempt to highlight the importance of organizing appropriate CDW management systems into an integrated waste management scheme for mitigating environmental impacts in developing cities.

Construction and demolition waste recycling in developing cities: management and cost analysis.

In Bolivia, construction and demolition waste (CDW) is unmanaged. The current research implemented a CDW flow analysis and a cost assessment in the city of La Paz, aiming to compare future recycling scenarios. Lack of data is challenging; therefore, a review of 31 international studies has been conducted. Results report that the waste generation rate (WGR) of concrete residential buildings can be of about 91.9-113.3 kg m-2 for construction and about 867.2-1064.8 kg m-2 for demolition. In addition, positive correlation was found in national WGR with number of inhabitants and the GDP. By these results, it was estimated that about 271,051-349,418 tonnes of CDW are potentially generated yearly in La Paz, about two times more than the CDW projected by local authorities. By the scenarios analysis, it was estimated that 56.1-71.1% of the inert aggregates can be recycled. The cost of the system is estimated between 7.8 and 31.1 USD tCDW-1, for a total annual cost (20 years horizon) of about 2.3-9 million USD y-1 depending on the management scenario. In the best scenario, an average fee of less than 1% of the current costs of a flat in La Paz can be required, potentially affordable for the local economy. The most attractive scenario involves the source separation of recyclable materials and the hybrid organization of stationary and mobile recycling facilities. Results show that a CDW management can be implemented in La Paz to foster a circular economy in developing cities.

Floristic Richness in a Mediterranean Hotspot: A Journey across Italy.

Species richness is a fundamental property of biodiversity patterns and is properly expressed by the species-area relationship (SAR), namely the increase in the number of species with the area. Here, we studied and explored the species-area relationship with respect to vascular plant species in Italy and compared vascular plant richness among Italian administrative regions. Concerning the entire vascular flora (native and alien), the best-performing formula is the Arrhenius' Power function: S = c Az. The constants of this function are c = 241.2 and z = 0.281. The best-performing formula concerning just native (c = 245.2 and z = 0.263) and alien (c = 10.1 and z = 0.404) richness is the Power function as well. The floristically richest Italian regions considering the entire flora are Liguria, Friuli Venezia Giulia, and Trentino-Alto Adige, which are also the regions that are richest in alien flora unfortunately. Regions of particular naturalistic interest are Abruzzo, Valle d'Aosta, and Molise, because only these three regions exhibit native floristic richness that is higher than expected, and this is coupled with an alien floristic richness that is lower than expected. On the contrary, four regions (Lombardia, Veneto, Toscana, and Emilia-Romagna) show potentially severe conservation problems due to biological invasions since they experience native floristic richness that is lower than expected, with an alien floristic richness that is higher than expected. This study offers for the first time the 'c' and 'z' constants specifically calibrated at the national level for Italian vascular flora. The availability of such constants allows the calculation of the number of expected species for a given area to be investigated, providing a robust starting hypothesis for floristic studies.

Nomenclatural Synopsis, Revised Distribution and Conservation Status of Ranunculus gracilis (Ranunculaceae) in Italy.

Ranuculus gracilis is endemic to the SE Euro-Mediterranean area and its presence in Italy is controversial. Based on analysis of the relevant literature, field surveys and examination of herbarium specimens, a revised distribution of this species in Italy is presented and its conservation status is assessed. Ranunculus agerii, described by Antonio Bertoloni from Bologna (Emilia-Romagna, Northern Italy), and R. schowii, described by Vincenzo Tineo from Vittoria and Terranova (Sicily), usually regarded as synonyms of R. gracilis, are here lectotypified and their taxonomic status discussed. Thanks to our study, the presence of R. gracilis in Italy is confirmed and, now, it is reported in a national conservation framework.

Relationships within Mcneillia Indicate a Complex Evolutionary History and Reveal a New Species of Minuartiella (Caryophyllaceae, Alsinoideae).

The genus Mcneillia has been recently segregated from Minuartia L. based on molecular results, also supported by morphology. However, to date, a comprehensive study on the phylogenetic relationships within this genus is lacking. In this paper, we provide a multigene phylogeny of all the species and subspecies of Mcneillia employing two nuclear and six chloroplast markers. We documented extensive gene flow between taxa, sometimes separated at specific rank. In addition, Mcneillia as currently circumscribed, is not monophyletic. In fact, Mcneillia graminifolia subsp. brachypetala, strictly endemic to Greece, truly belongs to Minuartiella, a genus otherwise limited to South-West Asia. Moreover, even after removal of this taxon, our results do not support the monophyly of the taxa included in M. graminifolia s.l., the most variable and widespread species of the genus. Further controversial subspecies of Mcneillia graminifolia, i.e., subsp. hungarica and subsp. rosanoi, are shown to deserve taxonomic recognition as separate species, whereas Mc. moraldoi is not distinct at specific rank. In addition, Mc. saxifraga subsp. tmolea is here regarded as a further distinct species. A consistent taxonomic treatment is therefore proposed with six new combinations and nomenclatural notes, providing the necessary typifications.

Allium ducissae (A. subgen. Polyprason, Amaryllidaceae) a New Species from the Central Apennines (Italy).

In this paper, Allium ducissae (the LSID for the name Allium ducissae is: 77254606-1) is described as a new species based on morphological and molecular analyses, and its taxonomic relationships are discussed. It grows in crevices on calcareous rocks, rocky slopes and grassy ledges in the subalpine belt, within two regional protected areas in the Lazio and Abruzzo administrative regions (Central Apennines, Italy). Previously, these populations were attributed to A. strictum, a species described from Siberia, belonging to A. sect. Reticulatobulbosa. The new species is distinct from A. strictum in the morphology of vegetative and reproductive structures. Indeed, it is close to A. palentinum, an endemic species to Cantabrian Mountains (NW Spain). Both molecular and morphological data support the recognition of the Allium populations coming from the Central Apennines as a new species. Allium ducissae can be clearly distinguished from A. palentinum by longer and wider tepals, longer filaments, tooth of inner filament, flower pedicels, spathe appendage, and smaller seeds. Moreover, seed testa micro-sculptures revealed slight differences between A. ducissae and A. palentinum. Chromosome counts showed that A. ducissae is diploid with 2n = 16 chromosomes, as already known for A. palentinum. Molecular analyses support the affiliation of A. ducissae and A. palentinum to A. sect. Falcatifolia, contrary to what is known for the latter species, usually included in A. sect. Daghestanica. Finally, the IUCN assessment for the newly described species is proposed and briefly discussed.

Hepatocellular carcinoma recurrence after direct-acting antiviral therapy: an individual patient data meta-analysis.

OBJECTIVE: The benefit of direct-acting antivirals (DAAs) against HCV following successful treatment of hepatocellular carcinoma (HCC) remains controversial. This meta-analysis of individual patient data assessed HCC recurrence risk following DAA administration. DESIGN: We pooled the data of 977 consecutive patients from 21 studies of HCV-related cirrhosis and HCC, who achieved complete radiological response after surgical/locoregional treatments and received DAAs (DAA group). Recurrence or death risk was expressed as HCC recurrence or death per 100 person-years (100PY). Propensity score-matched patients from the ITA.LI.CA. cohort (n=328) served as DAA-unexposed controls (no-DAA group). Risk factors for HCC recurrence were identified using random-effects Poisson. RESULTS: Recurrence rate and death risk per 100PY in DAA-treated patients were 20 (95% CI 13.9 to 29.8, I2=74.6%) and 5.7 (2.5 to 15.3, I2=54.3), respectively. Predictive factors for recurrence were alpha-fetoprotein logarithm (relative risk (RR)=1.11, 95% CI 1.03 to 1.19; p=0.01, per 1 log of ng/mL), HCC recurrence history pre-DAA initiation (RR=1.11, 95% CI 1.07 to 1.16; p<0.001), performance status (2 vs 0, RR=4.35, 95% CI 1.54 to 11.11; 2 vs 1, RR=3.7, 95% CI 1.3 to 11.11; p=0.01) and tumour burden pre-HCC treatment (multifocal vs solitary nodule, RR=1.75, 95% CI 1.25 to 2.43; p<0.001). No significant difference was observed in RR between the DAA-exposed and DAA-unexposed groups in propensity score-matched patients (RR=0.64, 95% CI 0.37 to 1.1; p=0.1). CONCLUSION: Effects of DAA exposure on HCC recurrence risk remain inconclusive. Active clinical and radiological follow-up of patients with HCC after HCV eradication with DAA is justified.

The performance evaluation of wastewater service: a protocol based on performance indicators applied to sewer systems and wastewater treatment plants.

This research aimed to identify a tool to objectively analyse the performance and the environmental contextualisation of sewer systems (SwSs) and wastewater treatment plants (WWTPs). This procedure performs assessment by calculating performance indices which could be subsequently applied to SwSs and WWTPs with different characteristics. The proposed tool can be applied conveniently over the years by managers of integrated urban water management systems for the analysis of different realities also allowing the evaluation of the effects of upgrades carried out during the management phases. The proposed analysis allows the optimisation of SwSs and can profitably guide the choice and the priority among possible interventions for the sewerage infrastructure and WWTPs providing a verification and evaluation protocol as well as a financial planning tool.

Role of circulating microRNAs to predict hepatocellular carcinoma recurrence in patients treated with radiofrequency ablation or surgery.

BACKGROUND: Loco-regional treatments have improved the survival of patients with early hepatocellular carcinoma (HCC), but tumor relapse is a frequent event and survival rates remain low. Moreover, conflicting evidences address early HCC patients to surgery or radiofrequency ablation (RFA), with the clinical need to find predictive non-invasive biomarkers able to guide treatment choice and define patients survival. METHODS: Two independent case series of treatment-naïve HCC patients treated with local RFA, and a cohort of 30 HCC patients treated with liver surgery were enrolled. On the basis of literature evidence, we customized a panel of 21 miRNAs correlated with relapse and prognosis after local curative treatment of HCC. RESULTS: Expression levels of let-7c predict tumor relapse after RFA; we also investigated the same panel in a small cohort of HCC patients undergoing surgery, finding no statistically significance in predicting tumor relapse or survival. Moreover, interaction test indicated that let-7c expression levels are predictive for identifying a subset of patients that should be addressed to surgery. CONCLUSION: Results from this study could predict prognosis of early HCC patients, helping to address early HCC patients to surgery or RFA treatment.

Environmental assessment of construction and demolition waste recycling in Bolivia: Focus on transportation distances and selective collection rates.

Construction and demolition waste (CDW) management in developing countries is a global concern. The analysis of scenarios and the implementation of life cycle assessment (LCA) support decision-makers in introducing integrated CDW management systems. This paper introduces the application of an LCA in La Paz (Bolivia), where CDW is mainly dumped in open areas. The aim of the research is to evaluate the benefits of inert CDW recycling in function of the selective collection rate, defined as the amount of waste (%wt.) sorted at the source in relation to the total waste amount produced, and the distances from the CDW generation to the material recycling facility. The outcomes of the research suggest that increasing the selective collection rates (5% to 99%) spread the importance of transportation distances planning since it affects the magnitude of the environmental impacts (1.05 tCO2-eq to 20.7 tCO2-eq per km traveled). Transportation limits have been found to be lower than about 40 km in order to make recycling beneficial for all environmental impacts and for all selective collection rate, with the eutrophication potential as the limiting indicator. The theoretical analysis suggests implementing LCA with primary data and involving statistics related to the transportation of virgin materials avoided thanks to recycling. The outcomes of the research support the implementation of CDW recycling in developing countries since it has been found that material recovery is always beneficial.

Comparing Fatigue Reducing Stimulation Strategies During Cycling Induced by Functional Electrical Stimulation: a Case Study with one Spinal Cord Injured Subject.

This case study was designed starting from our experience at CYBATHLON 2020. The specific aim of this work was to compare the effectiveness of different fatigue reducing stimulation strategies during cycling induced by Functional Electrical Stimulation (FES). The compared stimulation strategies were: traditional constant frequency trains (CFTs) at 30 and 40Hz, doublet frequency trains (DFTs) and spatially distributed sequential stimulation (SDSS) on the quadriceps muscles. One Spinal Cord Injured (SCI) subject (39 years, T5-T6, male, ASIA A) was involved in 12 experimental sessions during which the four strategies were tested in a randomized order during FES-induced cycling performed on a passive trike at a constant cadence of 35 RPM. FES was delivered to four muscle groups (quadriceps, gluteal muscles, hamstrings and gastrocnemius) for each leg. The performance was evaluated in terms of saturation time (i.e., the time elapsed from the beginning of the stimulation until the predetermined maximum value of current amplitude is reached) and root mean square error (RMSE) of the actual cadence with respect to the target value. SDSS achieved a statistical lower saturation time and a qualitative higher RMSE of the cadence with respect to CFTs both at 30 and 40Hz.Clinical relevance- Conversely to previous literature, SDSS seems to be ineffective to reduce muscle fatigue during FES-induced cycling. Further experiments are needed to confirm this result.

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.