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1.
Clin Ter ; 173(2): 184-186, 2022 04 04.
Article in English | MEDLINE | ID: mdl-35385043

ABSTRACT

Abstract: Nurses working rotating shifts (RS) are at risk of circadian rhythm disruption, which can affect sleep quality and can lead to emotional stress, anxiety, and depression. Aerobic exercise is a type of repetitive and structured physical activity that involves the metabolic system, which utilizes oxygen to produce energy and has been demonstrated to improve shift-workers' health and well-being. The main purpose of engaging in regular moderate-intensity aerobic exercise is to improve cardiopulmonary fitness and functional capacity. When engaging in moderate-intensity aerobic exercise, the increase in arterial pressure is accompanied by a simultaneous increase in heart rate, which signifi-cantly contributes to the rise in blood pressure, which is reversed after exercise due to an increase in parasympathetic activity and a decrease in sympathetic activity. Moderate-intensity aerobic exercise includes walking at a moderate pace, water aerobics, dancing, recreational swimming, gardening, table tennis, and stair climbing at a moderate pace and represents a cost-effective health promotion strategy for im-proving sleep quality and duration. Adherence to a moderate-intensity aerobic exercise program may increase both sleep quality and duration by improving melatonin concentrations, endocrine activities, heart rate and slow wave sleep among nurses working RS. Occupational medicine practitioners should consider creating a workplace health promotion program that incorporates moderate-intensity aerobic exercise for RS-nurses to minimize the impact of shift work on their sleep quality.


Subject(s)
Sleep Quality , Work Schedule Tolerance , Circadian Rhythm/physiology , Exercise/physiology , Humans , Sleep/physiology , Work Schedule Tolerance/physiology
2.
J Endocrinol Invest ; 45(6): 1151-1160, 2022 Jun.
Article in English | MEDLINE | ID: mdl-35113404

ABSTRACT

Human body is colonized by trillions of microbes, influenced by several factors, both endogenous, as hormones and circadian regulation, and exogenous as, life-style habits and nutrition. The alteration of such factors can lead to microbial dysbiosis, a phenomenon which, in turn, represents a risk factor in many different pathologies including cancer, diabetes, autoimmune and cardiovascular disease, and infertility. Female microbiota dysbiosis (vaginal, endometrial, placental) and male microbiota dysbiosis (seminal fluid) can influence the fertility, determining a detrimental impact on various conditions, as pre-term birth, neonatal illnesses, and macroscopic sperm parameters impairments. Furthermore, unprotected sexual intercourse creates a bacterial exchange between partners, and, in addition, each partner can influence the microbiota composition of partner's reproductive tracts. This comprehensive overview of the effects of bacterial dysbiosis in both sexes and how partners might influence each other will allow for better personalization of infertility management.


Subject(s)
Infertility , Microbiota , Dysbiosis/microbiology , Female , Humans , Infant, Newborn , Infertility/etiology , Male , Placenta , Pregnancy , Vagina
3.
Infection ; 49(5): 965-975, 2021 Oct.
Article in English | MEDLINE | ID: mdl-34036458

ABSTRACT

BACKGROUND: Little is known in distinguishing clinical features and outcomes between coronavirus disease-19 (COVID-19) and influenza (FLU). MATERIALS/METHODS: Retrospective, single-centre study including patients with COVID-19 or FLU pneumonia admitted to the Intensive care Unit (ICU) of Policlinico Umberto I (Rome). Aims were: (1) to assess clinical features and differences of patients with COVID-19 and FLU, (2) to identify clinical and/or laboratory factors associated with FLU or COVID-19 and (3) to evaluate 30-day mortality, bacterial superinfections, thrombotic events and invasive pulmonary aspergillosis (IPA) in patients with FLU versus COVID-19. RESULTS: Overall, 74 patients were included (19, 25.7%, FLU and 55, 74.3%, COVID-19), median age 67 years (58-76). COVID-19 patients were more male (p = 0.013), with a lower percentage of COPD (Chronic Obstructive Pulmonary Disease) and chronic kidney disease (CKD) (p = 0.001 and p = 0.037, respectively) than FLU. SOFA score was higher (p = 0.020) and lymphocytes were significantly lower in FLU than in COVID-19 [395.5 vs 770.0 cells/mmc, p = 0.005]. At multivariable analysis, male sex (OR 6.1, p < 0.002), age > 65 years (OR 2.4, p = 0.024) and lymphocyte count > 725 cells/mmc at ICU admission (OR 5.1, p = 0.024) were significantly associated with COVID-19, whereas CKD and COPD were associated with FLU (OR 0.1 and OR 0.16, p = 0.020 and p < 0.001, respectively). No differences in mortality, bacterial superinfections and thrombotic events were observed, whereas IPA was mostly associated with FLU (31.5% vs 3.6%, p = 0.0029). CONCLUSIONS: In critically ill patients, male sex, age > 65 years and lymphocytes > 725 cells/mmc are related to COVID-19. FLU is associated with a significantly higher risk of IPA than COVID-19.


Subject(s)
COVID-19 , Influenza, Human , Aged , Humans , Influenza, Human/complications , Influenza, Human/epidemiology , Intensive Care Units , Male , Retrospective Studies , SARS-CoV-2
4.
Br J Surg ; 108(2): 196-204, 2021 03 12.
Article in English | MEDLINE | ID: mdl-33711132

ABSTRACT

BACKGROUND: Laparoscopic liver resection for hepatocellular carcinoma (HCC) in Child-Pugh A cirrhosis has been demonstrated as beneficial. However, the role of laparoscopy in Child-Pugh B cirrhosis is undetermined. The aim of this retrospective cohort study was to compare open and laparoscopic resection for HCC with Child-Pugh B cirrhosis. METHODS: Data on liver resections were gathered from 17 centres. A 1 : 1 propensity score matching was performed according to 17 predefined variables. RESULTS: Of 382 available liver resections, 100 laparoscopic and 100 open resections were matched and analysed. The 90-day postoperative mortality rate was similar in open and laparoscopic groups (4.0 versus 2.0 per cent respectively; P = 0.687). Laparoscopy was associated with lower blood loss (median 110 ml versus 400 ml in the open group; P = 0.004), less morbidity (38.0 versus 51.0 per cent respectively; P = 0.041) and fewer major complications (7.0 versus 21.0 per cent; P = 0.010), and ascites was lower on postoperative days 1, 3 and 5. For laparoscopic resections, patients with portal hypertension developed more complications than those without (26 versus 12 per cent respectively; P = 0.002), and patients with a Child-Pugh B9 score had higher morbidity rates than those with B8 and B7 (7 of 8, 10 of 16 and 21 of 76 respectively; P < 0.001). Median hospital stay was 7.5 (range 2-243) days for laparoscopic liver resection and 18 (3-104) days for the open approach (P = 0.058). The 5-year overall survival rate was 47 per cent for open and 65 per cent for laparoscopic resection (P = 0.142). The 5-year disease-free survival rate was 32 and 37 per cent respectively (P = 0.742). CONCLUSION: Patients without preoperative portal hypertension and Child-Pugh B7 cirrhosis may benefit most from laparoscopic liver surgery.


Subject(s)
Carcinoma, Hepatocellular/surgery , Hepatectomy , Laparoscopy , Liver Neoplasms/surgery , Adult , Aged , Aged, 80 and over , Blood Loss, Surgical/statistics & numerical data , Carcinoma, Hepatocellular/diagnosis , Carcinoma, Hepatocellular/mortality , Carcinoma, Hepatocellular/pathology , Disease-Free Survival , Female , Hepatectomy/adverse effects , Hepatectomy/methods , Hepatectomy/mortality , Humans , Hypertension, Portal/pathology , Laparoscopy/adverse effects , Laparoscopy/methods , Laparoscopy/mortality , Length of Stay/statistics & numerical data , Liver Cirrhosis/pathology , Liver Neoplasms/diagnosis , Liver Neoplasms/mortality , Liver Neoplasms/pathology , Male , Middle Aged , Prognosis , Propensity Score , Retrospective Studies , Severity of Illness Index , Survival Analysis , Young Adult
5.
HIV Med ; 21(8): 523-535, 2020 09.
Article in English | MEDLINE | ID: mdl-32578947

ABSTRACT

OBJECTIVES: The aim of this study was to evaluate the factors that can influence an incomplete viral response (IVR) after acute and early HIV infection (AEHI). METHODS: This was a retrospective, observational study including patients with AEHI (Fiebig stages I-V) diagnosed between January 2008 and December 2014 at 20 Italian centres. IVR was defined by: (1) viral blip (51-1000 HIV-1 RNA copies/mL after achievement of < 50 HIV-1 RNA copies/mL); (2) virologic failure [> 1000 copies/mL after achievement of < 200 copies/mL, or ≥ 200 copies/mL after 24 weeks on an antiretroviral therapy (ART)]; (3) suboptimal viral response (> 50 copies/mL after 48 weeks on ART or two consecutive HIV-1 RNA levels with ascending trend during ART). Cox regression analysis was used to calculate the hazard ratios (HRs) and 95% confidence intervals (95% CIs) for IVR. RESULTS: In all, 263 patients were studied, 227 (86%) males, with a median [interquartile range (IQR)] age of 38 (30-46) years. During a median follow-up of 13.0 (5.7-31.1) months, 38 (14.4%) had IVR. The presence of central nervous system (CNS) symptoms was linked to a higher risk of IVR (HR = 4.70, 95% CI: 1.56-14.17), while a higher CD4/CD8 cell count ratio (HR = 0.13, 95% CI: 0.03-0.51 for each point increase) and first-line ART with three-drug regimens recommended by current guidelines (HR = 0.40, 95% CI: 0.18-0.91 compared with other regimens including four or five drugs, older drugs or non-standard backbones) were protective against IVR. CONCLUSIONS: Patients with lower CD4/CD8 ratio and CNS symptoms could be at a higher risk of IVR after AEHI. The use of recommended ART may be relevant for improving short-term viral efficacy in this group of patients.


Subject(s)
Anti-HIV Agents/therapeutic use , Central Nervous System Diseases/etiology , HIV Infections/drug therapy , HIV-1/genetics , Acute Disease , Adult , Anti-HIV Agents/pharmacology , CD4 Lymphocyte Count , Female , HIV Infections/blood , HIV Infections/virology , HIV-1/drug effects , Humans , Italy , Male , Middle Aged , RNA, Viral/genetics , Regression Analysis , Retrospective Studies , Risk Factors , Treatment Failure , Viral Load/drug effects
7.
Br J Surg ; 107(4): 443-451, 2020 03.
Article in English | MEDLINE | ID: mdl-32167174

ABSTRACT

BACKGROUND: Surgical outcomes may be associated with hospital volume and the influence of volume on minimally invasive liver surgery (MILS) is not known. METHODS: Patients entered into the prospective registry of the Italian Group of MILS from 2014 to 2018 were considered. Only centres with an accrual period of at least 12 months and stable MILS activity during the enrolment period were included. Case volume was defined by the mean number of minimally invasive liver resections performed per month (MILS/month). RESULTS: A total of 2225 MILS operations were undertaken by 46 centres; nine centres performed more than two MILS/month (1376 patients) and 37 centres carried out two or fewer MILS/month (849 patients). The proportion of resections of anterolateral segments decreased with case volume, whereas that of major hepatectomies increased. Left lateral sectionectomies and resections of anterolateral segments had similar outcome in the two groups. Resections of posterosuperior segments and major hepatectomies had higher overall and severe morbidity rates in centres performing two or fewer MILS/month than in those undertaking a larger number (posterosuperior segments resections: overall morbidity 30·4 versus 18·7 per cent respectively, and severe morbidity 9·9 versus 4·0 per cent; left hepatectomy: 46 versus 22 per cent, and 19 versus 5 per cent; right hepatectomy: 42 versus 34 per cent, and 25 versus 15 per cent). CONCLUSION: A volume-outcome association existed for minimally invasive hepatectomy. Complex and major resections may be best managed in high-volume centres.


ANTECEDENTES: Los resultados quirúrgicos pueden estar relacionados con el volumen de casos del hospital, pero no se conoce la influencia en la cirugía mínimamente invasiva del hígado (minimally­invasive liver surgery, MILS). MÉTODOS: Se incluyeron los pacientes registrados en el registro prospectivo del grupo italiano de MILS desde 2014 a 2018. Solo se consideraron centros con extensión de ≥ 12 meses y actividad estable de MILS durante el periodo de reclutamiento. El volumen de casos se definió como el número de MILS efectuado por mes. RESULTADOS: Se llevaron a cabo un total de 2.225 MILS en 46 centros, 9 de ellos con > 2 MILS/mes (n = 1.376 pacientes) y 37 centros con ≤ 2 MILS/mes (n = 849). La proporción de resecciones de segmentos anterolaterales disminuyó con el volumen de casos, mientras que la proporción de hepatectomías mayores aumentó. Los resultados para ambos grupos fueron similares en las seccionectomías lateral izquierda y en las resecciones del segmento anterolateral. Las resecciones del segmento posterosuperior y las hepatectomías mayores presentaron tasas más altas de morbilidad global y morbilidad grave en centros que realizaban ≤ 2 MILS/mes que en los que realizaban > 2 MILS/mes (resecciones del segmento posterosuperior, morbilidad global 30,4 versus 18,7%, morbilidad grave 9,9 versus 4,0%; hepatectomía izquierda, 46,2 versus 22,0%, 19,2 versus 5,5%; hepatectomía derecha, 41,7 versus 33,8%, 25,0 versus 14.9%). CONCLUSIÓN: Se observó una asociación volumen­resultado para la resección hepática mínimamente invasiva. Las resecciones complejas y mayores se pueden manejar mejor en centros de gran volumen.


Subject(s)
Hepatectomy/statistics & numerical data , Minimally Invasive Surgical Procedures/statistics & numerical data , Aged , Female , Hepatectomy/adverse effects , Hepatectomy/methods , Hepatectomy/mortality , Humans , Italy/epidemiology , Liver Neoplasms/surgery , Male , Minimally Invasive Surgical Procedures/adverse effects , Minimally Invasive Surgical Procedures/methods , Minimally Invasive Surgical Procedures/mortality , Registries , Retrospective Studies , Treatment Outcome
8.
Br J Surg ; 107(7): 845-853, 2020 06.
Article in English | MEDLINE | ID: mdl-31925777

ABSTRACT

BACKGROUND: This study aimed to assess the best achievable outcomes in laparoscopic liver resection (LLR) after risk adjustment based on surgical technical difficulty using a national registry. METHODS: LLRs registered in the Italian Group of Minimally Invasive Liver Surgery registry from November 2014 to March 2018 were considered. Benchmarks were calculated according to the Achievable Benchmark of Care (ABC™). LLRs at each centre were divided into three clusters (groups I, II and III) based on the Kawaguchi classification. ABCs for overall and major morbidity were calculated in each cluster. Multivariable analysis was used to identify independent risk factors for overall and major morbidity. Significant variables were used in further risk adjustment. RESULTS: A total of 1752 of 2263 patients fulfilled the inclusion criteria: 1096 (62·6 per cent) in group I, 435 (24·8 per cent) in group II and 221 (12·6 per cent) in group III. The ABCs for overall morbidity (7·8, 14·2 and 26·4 per cent for grades I, II and II respectively) and major morbidity (1·4, 2·2 and 5·7 per cent) increased with the difficulty of LLR. Multivariable analysis showed an increased risk of overall morbidity associated with multiple LLRs (odds ratio (OR) 1·35), simultaneous intestinal resection (OR 3·76) and cirrhosis (OR 1·83), and an increased risk of major morbidity with intestinal resection (OR 4·61). ABCs for overall and major morbidity were 14·4 and 3·2 per cent respectively for multiple LLRs, 30 and 11·1 per cent for intestinal resection, and 14·9 and 4·8 per cent for cirrhosis. CONCLUSION: Overall morbidity benchmarks for LLR ranged from 7·8 to 26·4 per cent, and those for major morbidity from 1·4 to 5·7 per cent, depending on complexity. Benchmark values should be adjusted according to multiple LLRs or simultaneous intestinal resection and cirrhosis.


ANTECEDENTES: Este estudio tuvo como objetivo evaluar los mejores resultados que se pueden conseguir en la resección hepática laparoscópica (laparoscopic liver resection, LLR) después del ajuste por riesgos basado en la dificultad de la técnica quirúrgica utilizando un registro nacional. MÉTODOS: Se consideraron las LLRs incluidas en el Registro del Grupo Italiano de Cirugía Hepática Mínimamente Invasiva desde 11/2014 a 03/2018. Los resultados de referencia (benchmarks) se calcularon de acuerdo con el Achievable Benchmark of Care (ABC™). Las LLRs de cada uno de los centros se dividieron en 3 grupos (Grupo I, II y III) en base a la clasificación de Kawaguchi. Se calculó el ABC de la morbilidad global y de la morbilidad mayor para cada grupo. Se realizó un análisis multivariable para identificar los factores independientes de riesgos para la morbilidad global y morbilidad mayor. Se utilizaron variables significativas para realizar ajustes de riesgo adicionales. RESULTADOS: Un total de 1.752 pacientes de los 2.263 cumplían los criterios de inclusión, de los cuales 1.096 (62,6%) se incluyeron en el Grupo I, 435 (24,8%) en el Grupo II y 221 (12,6%) en el Grupo III. El ABC de la morbilidad global (7,8%, 14,2%, 26,4%) y de la morbilidad mayor (1,4%, 2,2%, 5,7%) aumentó del Grupo I al Grupo III. El análisis multivariable mostró un incremento del riesgo para la morbilidad global asociada con múltiples LLRs (razón de oportunidades, odds ratio, OR 1,349), resección intestinal simultánea (OR 3,760) y cirrosis (OR 1,825), y para la morbilidad mayor con la resección intestinal (OR 4,606). Los ABC de la morbilidad global y morbilidad mayor fueron 14,4% y 3,2% para las LLR múltiples, 30% y 11% para la resección intestinal, y 14,9% y 4,8% para la cirrosis, respectivamente. CONCLUSIÓN: Los resultados de referencia (benchmark) para la morbilidad global y morbilidad mayor en la LLR variaron entre un 8% y un 26% y entre un 1,4% y un 5,7%, dependiendo de la complejidad. Los valores de referencia deberían ajustarse de acuerdo con la práctica de LLRs múltiples o resección intestinal simultánea y cirrosis.


Subject(s)
Benchmarking/methods , Hepatectomy , Laparoscopy , Female , Hepatectomy/adverse effects , Hepatectomy/standards , Humans , Italy/epidemiology , Laparoscopy/adverse effects , Laparoscopy/standards , Male , Postoperative Complications/epidemiology , Postoperative Complications/etiology , Quality of Health Care/standards , Registries , Risk Factors , Treatment Outcome
9.
Ann Ig ; 32(2): 99-108, 2020.
Article in English | MEDLINE | ID: mdl-31944205

ABSTRACT

BACKGROUND: The risk assessment of workplace violence in emergency departments represents a global challenge for both healthcare organizations and workers. Recent studies have revealed increased rates of workplace violence towards physicians and nurses employed in emergency departments and have shown that type II is the most common typology of workplace violence among the four types of workplace violence defined by the National Institute for Occupational Safety and Health. The present study aimed to develop a methodological technique for a preliminary assessment of type II workplace violence risk in emergency departments. METHODS: The Delphi method was used to develop a questionnaire entitled Emergency Department Workplace Violence-Questionnaire which was composed of two sections: 1) sentinel events, and 2) risk factors. The authors used the Emergency Department Workplace Violence-Questionnaire to evaluate the workplace violence risk among physicians and nurses employed in a hospital emergency department. RESULTS: The Emergency Department Workplace Violence-Questionnaire was composed of 21 items. The sentinel events section consisted of three company indicators related to workplace violence and identified three areas of risk. The risk factors section identified 18 organizational and environmental factors associated with workplace violence occurrence. The assessment of workplace violence risk in the targeted hospital emergency departments, obtained through the use of the Emergency Department Workplace Violence-Questionnaire, showed a medium risk of workplace violence for both physicians (score=18) and nurses (score=19.5); the analysis found objective risk factors associated with workplace violence and led us to suggest organizational and environmental interventions for reducing the sources of risk among healthcare workers and to prioritize the interventions targeted at the problematical issues detected by the Emergency Department Workplace Violence-Questionnaire. The corrective interventions were focused on an engineering level (i.e. absence of areas for patients/clients to de-escalate, absence of alarm systems) and regarding the organizational environment (i.e. absence of a Workplace Violence Task Force to assess workplace violence risk and develop solutions, working alone). CONCLUSION: The proposed questionnaire proved to be a valid, structured, and reliable tool for assessing the risk of workplace violence in the targeted emergency departments and allowed for the identification of improvement actions targeted at specific critical issues which could be minimized through strategic interventions.


Subject(s)
Emergency Service, Hospital/statistics & numerical data , Workplace Violence/statistics & numerical data , Humans , Medical Staff, Hospital , Nursing Staff, Hospital , Risk Assessment , Surveys and Questionnaires
10.
Int J Antimicrob Agents ; 55(4): 105908, 2020 Apr.
Article in English | MEDLINE | ID: mdl-31991223

ABSTRACT

BACKGROUND: The incidence of cardiovascular disorders in people living with HIV (PLWH) is higher than that in non-infected individuals. Traditional and specific risk factors have been described but the role of the gut microbiota-dependent choline metabolite, trimethylamine-N-oxide (TMAO) is still unclear. METHODS: A cross-sectional analysis and a longitudinal analysis (with high-dose probiotic supplementation) were performed to measure serum TMAO concentrations through UHPLC-MS/MS. Stable outpatients living with HIV on highly active antiretroviral treatment with no major cardiovascular disease were enrolled. Non-parametric tests (bivariate and paired tests) and a multivariate linear regression analysis were used. RESULTS: A total of 175 participants were enrolled in the study. Median serum TMAO concentrations were 165 (103-273) ng/mL. An association with age, serum creatinine, number of antiretrovirals, multimorbidity and polypharmacy was observed; at linear logistic regression analysis, multimorbidity was the only independent predictor of TMAO concentrations. Carotid intima media thickness (IMT) was 0.85 (0.71-1.21) mm, with a trend towards higher TMAO concentrations observed in patients with IMT >0.9 mm (P=0.087). In the 25 participants who received probiotic supplementation, TMAO levels did not significantly change after 24 weeks (Wilcoxon paired P=0.220). CONCLUSION: Serum TMAO levels in PLWH were associated with multimorbidity, higher cardiovascular risk and subclinical atherosclerosis and were not affected by 6 months of high-dose probiotic supplementation.


Subject(s)
Cardiovascular Diseases/epidemiology , HIV Infections/diet therapy , Heart Disease Risk Factors , Methylamines/blood , Probiotics/therapeutic use , Adult , Anti-Retroviral Agents/therapeutic use , Atherosclerosis/pathology , Biomarkers/blood , Cardiovascular Diseases/prevention & control , Cardiovascular Diseases/virology , Carotid Intima-Media Thickness , Creatinine/blood , Cross-Sectional Studies , Dietary Supplements , Female , Gastrointestinal Microbiome/physiology , HIV Infections/blood , HIV Infections/drug therapy , HIV Infections/pathology , Humans , Male , Middle Aged
11.
Br J Surg ; 106(13): 1837-1846, 2019 12.
Article in English | MEDLINE | ID: mdl-31424576

ABSTRACT

BACKGROUND: Secondary resection of initially unresectable colorectal cancer liver metastases (CRLM) can prolong survival. The added value of selective internal radiotherapy (SIRT) to downsize lesions for resection is not known. This study evaluated the change in technical resectability of CRLM with the addition of SIRT to FOLFOX-based chemotherapy. METHODS: Baseline and follow-up hepatic imaging of patients who received modified FOLFOX (mFOLFOX6: fluorouracil, leucovorin, oxaliplatin) chemotherapy with or without bevacizumab (control arm) versus mFOLFOX6 (with or without bevacizumab) plus SIRT using yttrium-90 resin microspheres (SIRT arm) in the phase III SIRFLOX trial were reviewed by three or five (of 14) expert hepatopancreatobiliary surgeons for resectability. Reviewers were blinded to one another, treatment assignment, extrahepatic disease status, and information on clinical and scanning time points. Technical resectability was defined as at least 60 per cent of reviewers (3 of 5, or 2 of 3) assessing a patient's liver metastases as surgically removable. RESULTS: Some 472 patients were evaluable (SIRT, 244; control, 228). There was no significant baseline difference in the proportion of technically resectable liver metastases between SIRT (29, 11·9 per cent) and control (25, 11·0 per cent) arms (P = 0·775). At follow-up, significantly more patients in both arms were deemed technically resectable compared with baseline: 159 of 472 (33·7 per cent) versus 54 of 472 (11·4 per cent) respectively (P = 0·001). More patients were resectable in the SIRT than in the control arm: 93 of 244 (38·1 per cent) versus 66 of 228 (28·9 per cent) respectively (P < 0·001). CONCLUSION: Adding SIRT to chemotherapy may improve the resectability of unresectable CRLM.


ANTECEDENTES: La resección secundaria de metástasis hepáticas de cáncer colorrectal (colorectal cancer liver metastases, CRLM) inicialmente irresecables puede prolongar la supervivencia. Se desconoce el valor añadido de la radioterapia interna selectiva (selective internal radiation therapy, SIRT). Este estudio evaluó el cambio en la resecabilidad técnica de las CRLM secundario a la adición de SIRT a una quimioterapia tipo FOLFOX. MÉTODOS: Las pruebas de radioimagen basales y durante el seguimiento de pacientes tratados con un régimen FOLFOX modificado (mFOLFOX6: fluorouracilo, leucovorina, oxaliplatino) ± bevacizumab (grupo control) versus mFOLFOX6 (± bevacizumab) más SIRT usando microesferas de resina de yttrium-90, en el ensayo de fase III SIRFLOX, fueron revisadas por 3-5 (de 14) cirujanos expertos hepatobiliares para determinar la resecabilidad. Los expertos efectuaron la revisión de forma ciega unos respecto a otros en relación con la asignación al tratamiento, estado de la enfermedad extra-hepática y situación clínica en el momento del estudio radiológico. La resecabilidad técnica se definió como ≥ 60% de revisores evaluando las metástasis del paciente como quirúrgicamente resecables. RESULTADOS: Fueron evaluables un total de 472 pacientes (control, n = 228; SIRT, n = 244). No hubo diferencias significativas basales en la proporción de metástasis hepáticas técnicamente resecables entre SIRT (29/244; 11,9%) y el grupo control (25/228; 11,0%: P = 0,775). Durante el seguimiento y en ambos brazos de tratamiento, un número significativamente mayor de pacientes se consideraron técnicamente resecables en comparación con la situación basal (54/472 (11,4%) basal y 159/472 (33,7%) al seguimiento). Hubo más pacientes resecables en el grupo SIRT que en el control (93/244 (38,1%) y 66/228 (28,9%); P < 0,001, respectivamente). CONCLUSIÓN: La adición de SIRT a la quimioterapia puede mejorar la resecabilidad de las CRLM irresecables.


Subject(s)
Antineoplastic Agents/therapeutic use , Colorectal Neoplasms/pathology , Hepatectomy/methods , Liver Neoplasms/therapy , Colorectal Neoplasms/therapy , Female , Follow-Up Studies , Humans , Liver Neoplasms/diagnosis , Liver Neoplasms/secondary , Male , Middle Aged , Neoplasm Metastasis , Radiotherapy, Adjuvant , Retrospective Studies , Time Factors , Tomography, X-Ray Computed , Treatment Outcome
12.
Ann Ig ; 30(4): 297-306, 2018.
Article in English | MEDLINE | ID: mdl-29895047

ABSTRACT

BACKGROUND: The safety and health of healthcare workers employed in twenty-four-hour hospital wards and exposed to rotational shiftwork (RS), including night shift, is an hot topic of international literature; in fact shift workers incur increased rates of burnout, accidents and injuries, absenteeism and, consequently, reduced work efficiency than non-shift workers. The aims of the present study were: 1) to analyze the occupational risk associated with RS in healthcare sector and 2) to detect the consequent interventions effective in minimizing RS risk. METHODS: The authors designed a questionnaire entitled Rotating Shiftwork Questionnaire (RSQ) which is made up of two sections: 1) Sentinel Events; 2) Risk Factors. The authors used the RSQ to evaluate the RS-Risk among homogeneous groups employed in a twenty-four-hour hospital department. RESULTS: Results. The authors found a medium level of risk among all homogeneous groups. The analysis led to suggest organizational interventions for reducing the sources of RS-risk among healthcare workers. CONCLUSION: The proposed questionnaire revealed effective in approaching the assessment of RS-risk; the findings were also useful in prioritizing and implementing strategic interventions aimed to moderate the occupational risk related to RS.


Subject(s)
Occupational Health , Personnel, Hospital/statistics & numerical data , Risk Assessment/methods , Work Schedule Tolerance , Hospital Departments/organization & administration , Humans , Italy , Risk Factors , Surveys and Questionnaires , Time Factors
13.
Ann Ig ; 30(6): 482-489, 2018.
Article in English | MEDLINE | ID: mdl-30614497

ABSTRACT

BACKGROUND: To date there is a lack of evidence about the impact of shiftwork on the occurrence of acute low back pain among registered nurses working non-traditional shifts, including nights and 12-hour shifts. The objectives of the present study were: 1) to investigate the impact of shiftwork, physical activity and body mass index on the occurrence of acute low back pain among female shift-registered nurses; 2) to suggest preventive interventions. METHODS: The author conducted a cross-sectional nested case-control analysis of data concerning acute low back pain and staffing data for female registered nurses employed in hospital wards. RESULTS: The analysis found a relationship between acute low back pain and nightshift, extended shifts, obesity; the adoption of forward rotating schedules proved to be effective in minimizing the frequency of acute low back pain. CONCLUSIONS: The findings showed that the prevention of acute low back pain should consider interventions aimed at minimizing not only physical ergonomic factors, but also organizational risks and lifestyle factors.


Subject(s)
Body Mass Index , Exercise , Low Back Pain/epidemiology , Nursing Staff, Hospital/statistics & numerical data , Occupational Diseases/epidemiology , Shift Work Schedule/adverse effects , Case-Control Studies , Chi-Square Distribution , Cross-Sectional Studies , Female , Humans , Italy , Logistic Models , Low Back Pain/prevention & control , Middle Aged , Occupational Diseases/prevention & control , Shift Work Schedule/statistics & numerical data , Time Factors
14.
Eur J Surg Oncol ; 43(9): 1617-1621, 2017 Sep.
Article in English | MEDLINE | ID: mdl-28292628

ABSTRACT

Cholangiocarcinoma (CC) is the second most common type of primary liver cancer after hepatocellular carcinoma. Surgical resection is considered the only curative treatment for CC. In general, laparoscopic liver surgery (LLS) is associated with improved short-term outcomes without compromising the long-term oncological outcome. However, the role of LLS in the treatment of CC is not yet well established. In addition, CC may arise in any tract of the biliary tree, thus requiring different types of treatment, including pancreatectomies and extrahepatic bile duct resections. This review presents and discusses the state of the art in the laparoscopic and robotic surgical treatment of all types of CC. An electronic search was performed to identify all studies dealing with laparoscopic or robotic surgery and cholangiocarcinoma. Laparoscopic resection in patients with intrahepatic CC (ICC) is feasible and safe. Regarding oncologic adequacy, as R0 resections, depth of margins, and long-term overall and disease-free survival, laparoscopy is comparable to open procedures for ICC. An adequate patient selection is required to obtain optimal results. Use of laparoscopy in perihilar CC (PHC) has not gained popularity. Further studies are still needed to confirm the benefit of this approach over conventional surgery for PHC. Laparoscopic pancreaticoduodenectomy for distal CC (DCC) represents one of the most advanced abdominal operations owing to the necessity of a complex dissection and reconstruction and has also had small widespread so far. Minimally invasive surgery seems feasible and safe especially for ICC. Laparoscopy for PHC is technically challenging notably for the caudate lobectomy. Not least as for the LLR, the robotic approach for DCC appears technically achievable in selected patients.


Subject(s)
Bile Duct Neoplasms/surgery , Bile Ducts, Intrahepatic , Cholangiocarcinoma/surgery , Laparoscopy , Disease-Free Survival , Hepatectomy/methods , Humans , Laparoscopy/adverse effects , Margins of Excision , Neoplasm, Residual , Pancreaticoduodenectomy/methods , Robotic Surgical Procedures/adverse effects , Survival Rate
16.
Eur J Radiol ; 86: 119-126, 2017 Jan.
Article in English | MEDLINE | ID: mdl-28027737

ABSTRACT

OBJECTIVES: To compare Apparent Diffusion Coefficient (ADC) measurements in rectal neoplastic lesions before and after lumen distension obtained with sonography transmission gel. METHODS: From January 2014 to July 2016, 25 patients (average age 63.7, range 41-85, 18 males) were studied for pre-treatment rectal cancer staging using a 1.5T MRI. Diffusion MRI was obtained using echo-planar imaging with b=800 value; all patients were studied acquiring diffusion sequences with and without rectal lumen distension obtained using sonography transmission gel. In both diffusion sequences, two blinded readers calculated border ADC values and small ADC values, drawing regions of interest respectively along tumour borders and far from tumour borders. Mean ADC values among readers - for each type of ADC measurement - were compared using Wilcoxon matched pairs signed rank test. Correlation was assessed using Pearson analysis. RESULTS: Border ADC mean value for diffusion MR sequences without endorectal contrast was 1.122mm2/sec, with 95% Confidence Interval (CI)=1.02-1.22; using gel lumen distension, higher border ADC mean value of 1.269mm2/s (95% CI=1.16-1.38) was obtained. Wilcoxon matched pairs signed rank test revealed statistical difference (p<0.01); a strong Pearson correlation was reported, with r value of 0.69. Small-ADC mean value was 1.038mm2/s (95% CI=0.91-1.16) for diffusion sequences acquired without endorectal distension and 1.127mm2/s (95% CI=0.98-1.27) for diffusion sequences obtained after endorectal gel lumen distension. Wilcoxon analysis did not show statistical difference (p=0.13). A very strong positive correlation was observed, with r value of 0.81. CONCLUSIONS: ADC measurements are slightly higher using endorectal sonographic transmission gel; ROI should be traced far from tumour borders, to minimize gel filled-pixel along the interface between lumen and lesion. Further studies are needed to investigate better reliability of ADC in rectal cancer MRI using sonographic gel intraluminal distension.


Subject(s)
Rectal Neoplasms/pathology , Adult , Aged , Aged, 80 and over , Diffusion Magnetic Resonance Imaging/methods , Dilatation/methods , Echo-Planar Imaging/methods , Female , Gels , Humans , Male , Middle Aged , Neoplasm Staging , Prospective Studies , Rectum/pathology , Reproducibility of Results
17.
Occup Med (Lond) ; 66(8): 678-680, 2016 Nov 01.
Article in English | MEDLINE | ID: mdl-27481860

ABSTRACT

BACKGROUND: Needlestick injuries (NSIs) represent a major concern for the safety of health care workers involved in clinical care. The percentage of health workers reporting these injuries varies between 9 and 38% and the occurrence of NSI is most frequent among employees having close clinical contact with patients or patient specimens. These injuries appear to occur most frequently where organizational factors contribute to the risk. AIMS: To investigate the interactions between organizational level interventions focused on work-related stress (WRS) and the occurrence of NSIs among nurses employed in hospital departments, and to determine the impact of such interventions on the safety budget. METHODS: Comparison of NSI occurrence among nurses employed in hospital health care departments in two 3-year periods, before and after interventions aimed at minimizing WRS. The economic cost of NSIs occurrence was calculated. RESULTS: The study group consisted of 765 nurses. The cumulative 3-year incidence of NSIs after the implementation of management stress interventions was significantly lower than the cumulative 3-year incidence observed before implementation (OR 0.60; 95% CI 0.43-0.83). A cost saving from managing fewer NSIs than during the first study period was found. CONCLUSIONS: This study found a reduction in NSI occurrence and associated costs following an intervention to bring about proactive, integrated and comprehensive management of stress in the workplace.

19.
Transplant Proc ; 48(2): 386-90, 2016 Mar.
Article in English | MEDLINE | ID: mdl-27109962

ABSTRACT

BACKGROUND: Clinical practice requires an accurate psychological assessment of subjects with clinical history of alcohol abuse and/or substance abuse (abuse history [AH]) for therapeutic choice. This study aims to identify significant correlations between the Minnesota Multiphasic Personality Inventory (MMPI)-2 scales in patients awaiting liver transplantation. METHODS: We evaluated a personality questionnaire containing MMPI-2 scales in the sample of 308 patients (81.8% males and 18.2% females) awaiting liver transplantation. The AH group composed 44.49% of patients and in the abuse free (AF) group, 55.51%. Scales were compared using Shapiro-Wilk test and Mann-Whitney U test. Interrelationships were examined using Spearman's correlation. RESULTS: This analysis found 27 scales of the MMPI-2 that were statistically different between 2 groups (AF and AH). In the AH group, we found a significant correlation between the following pairs of scales: Schizophrenia Scale (Sc) with the Addictions Potential Scale, Social Introversion scale (Si) with the Psychopathic Deviate scale (Pd), and Social Discomfort scale with Pd; the ES scale was negatively correlated with the Sc and Si scales. This interim study showed that the understanding of these indicators is crucial both for the assessment accuracy and for a prediction of the degree of therapy compliance after the transplantation. CONCLUSIONS: The scales of the MMPI-2 indicated a marked tendency to emotional rigidity, a lack of self-esteem and susceptibility judgment. Social introversion and social discomfort trends lead to impulsive behavior and deviant actions that combine poorly with good compliance with treatment.


Subject(s)
Alcoholism/psychology , Liver Transplantation , Patient Compliance/psychology , Personality , Alcoholism/therapy , Female , Humans , MMPI , Male , Middle Aged , Substance-Related Disorders/psychology , Substance-Related Disorders/therapy , Surveys and Questionnaires , Waiting Lists
20.
Clin Microbiol Infect ; 22(5): 462.e1-3, 2016 May.
Article in English | MEDLINE | ID: mdl-26812446

ABSTRACT

Association between hepatitis C virus (HCV) infection and diabetes has been widely postulated. Little is known about the effect of direct-acting antiviral agents (DAAs) on glycaemic control. The aim of our study was to evaluate the glycaemic control modifications in a case series of HCV-positive diabetic patients receiving DAAs. We retrospectively evaluated 149 HCV-positive patients in two different institutions affiliated with Sapienza University: Policlinico Umberto I of Rome and Ospedale Santa Maria Goretti of Latina. We were able to identify 29 patients with type 2 diabetes mellitus (19% of total population) who were receiving different interferon-free regimens. During-treatment fasting glucose (FG) values were available for 21 patients, and analysis revealed a statistically significant reduction (p 0.007); reduction mean value was -52.86 mg/dL. A glycated haemoglobin (A1C) value during treatment (at weeks 4, 8 and/or 12) was available for ten patients, and the analysis revealed a statistically significant reduction (p 0.021) with a reduction mean value of -1.95%. Six patients (23%) needed to reduce hypoglycaemic drugs, eight of ten patients showed reduction of A1C and 14 (67%) of 21 patients showed reduced FG during treatment. FG and A1C reductions values were independent from which DAA was present in the regimen, HCV genotype, body mass index and HIV status. In order to avoid hypoglycaemic events, diabetic patients receiving DAAs should be closely monitored for reduction of hypoglycaemic drugs. Furthermore, in our opinion, diabetes could be considered as an element to prioritize treatment in those patients with no apparent liver disease.


Subject(s)
Antiviral Agents/adverse effects , Blood Glucose/drug effects , Diabetes Mellitus, Type 2/complications , Glycated Hemoglobin/analysis , Hepatitis C, Chronic/complications , Hepatitis C, Chronic/drug therapy , Adult , Aged , Female , Humans , Male , Middle Aged , Retrospective Studies , Rome
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