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Objective: COVID-19 pandemic has seriously affected Italy. Radical changes occurred in the Italian NHS and thus in GI departments, as only urgent endoscopies were guaranteed. The study aimed to report how the demand for urgent endoscopy changed during the COVID-19 pandemic in Italy and to evaluate the appropriateness of urgent referrals in the Endoscopy Unit.Material and methods: Nation-wide, cross-sectional survey study in 54 Italian GI Units. Data were collected regarding urgent endoscopies (EGD, CS, ERCP) in two different time periods: March 2019 and March 2020.Results: Thirty-five (64.8%) GI endoscopy Units responded to the survey. The entity of reduction of overall urgent EGDs and CSs performed in March 2020 versus March 2019 was statistically significant: 541 versus 974 (-80%), p < .001 for EGD and 171 versus 265 (-55%), p < .008, for CS, respectively. No statistically significant reduction of urgent ERCP performed in March 2020 versus March 2019 was found. The increase in overall diagnostic yield for urgent EGD in March 2020 versus March 2019 was 7.3% (CI [0.028-0.117], p = .001). No statistically significant difference in diagnostic yield for CS between 2019 and 2020 was found.Conclusion: The study showed a statistically significant reduction of urgent EGD and CS performed during the SARS-CoV-2 pandemic, in March 2020, compared to March 2019. The diagnostic yield of urgent EGD performed in March 2020 was significantly higher than that of March 2019. No statistically significant difference was found in terms of diagnostic yield of urgent CS between March 2020 and March 2019.

Background: Sofosbuvir (SOF)-based regimens have been associated with renal function worsening in HCV patients with estimated glomerular filtration rate (eGFR) ≤ 45 ml/min, but further investigations are lacking. Aim: To assess renal safety in a large cohort of DAA-treated HCV patients with any chronic kidney disease (CKD). Methods: All HCV patients treated with DAA in Lombardy (December 2014–November 2017) with available kidney function tests during and off-treatment were included. Results: Among 3264 patients [65% males, 67% cirrhotics, eGFR 88 (9–264) ml/min], CKD stage was 3 in 9.5% and 4/5 in 0.7%. 79% and 73% patients received SOF and RBV, respectively. During DAA, eGFR declined in CKD-1 (p < 0.0001) and CKD-2 (p = 0.0002) patients, with corresponding rates of CKD stage reduction of 25% and 8%. Conversely, eGFR improved in lower CKD stages (p < 0.0001 in CKD-3a, p = 0.0007 in CKD-3b, p = 0.024 in CKD-4/5), with 33–45% rates of CKD improvement. Changes in eGFR and CKD distribution persisted at SVR. Baseline independent predictors of CKD worsening at EOT and SVR were age (p < 0.0001), higher baseline CKD stages (p < 0.0001) and AH (p = 0.010 and p < 0.0001, respectively). Conclusions: During DAA, eGFR significantly declined in patients with preserved renal function and improved in those with lower CKD stages, without reverting upon drug discontinuation.

Behcet syndrome (BS) is a multisystemic perivasculitis whose genetic susceptibility is linked to HLA region. We first meta-analysed all HLA class I and II genes involved in BS susceptibility in all ethnic groups worldwide. We identified 1141 articles and finally included 31 case-control studies after multiple rounds of selection. We analysed frequencies for 24 HLA-A alleles (3 alleles for HLA-A∗26 at four digits), 50 HLA-B alleles (11 alleles for HLA-B∗51 at four digits), 15 HLA-C alleles, 16 HLA-DRB1 alleles, 6 HLA-DQB1 alleles, and 15 HLA-DPB1 alleles. We meta-analysed only HLA allelic frequencies from at least three studies; therefore, we investigated 21 alleles out of 140. Going from 7.00 to 1.6 OR, we found 11 class I alleles conferring risk for BS: B∗51:08, B∗51, B∗51:01, B∗51:02, DQB1∗03, A∗26:01, Cw∗14, Cw∗15, Cw∗16, B∗15, and A∗26. Overall, the studies included populations from Europe (Greece, Spain, Italy, Germany, and Ireland), Asia (Korea, China, China Han, and Thailand), Middle East (Israel, Saudi Arabia, and Iran), and Morocco (as no other North-African population was included). We collected a number of ethnical groups sufficient to conduct an ethnic-specific meta-analysis where Europeans showed 11.25 OR for B∗51:08 and Japan 3.50 OR for A∗26:01. A remarkable result was that the most frequent HLA−B∗51 two-digit alleles associated with BS were different among populations: HLA−B∗51:08 in Europe, HLA−B∗51:01 in Turkey, and HLA−B∗51:02 in Japan. Overall, we discussed our real-world results with other imputation studies.

Toxoplasma gondii (T. gondii) and cytomegalovirus (CMV) infections are typically asymptomatic infections, but they can have serious consequences mainly in newborns and immunocompromised patients. In many parts of the world, these infections are routinely screened during pregnancy (toxoplasmosis) and, in others, high-risk individuals are tested using fully automated screening assays. In this study, we investigated the performance of the three fully automated immunoassays, LIAISON® XL DiaSorin, Abbott Architect and Roche Cobas®, for the determination of specific IgG antibodies to Cytomegalovirus and Toxoplasma gondii in human serum or plasma samples in terms of prevalence of CMV and Toxo IgG detected, and both sensitivity and specificity. Performance of the LIAISON® assays was investigated compared to two other assays, ARCHITECT (CMV IgG and Toxo IgG assays) and Cobas® (CMV IgG and Toxo IgG assays). Discrepant anti CMV IgG and anti Toxoplasma IgG samples were tested for IgM to CMV and Toxoplasma to exclude early acute infection where IgG could be detected differently by the methods. Overall, for both CMV IgG and Toxo IgG, the LIAISON® assay was better than both the Cobas® and ARCHITECT assays in terms of CMV and Toxo IgG detected, and both diagnostic sensitivity and specificity performance although the difference is statistically significant only compared to Cobas®.

Each year, all the Scientific Institutes of Medical Research in Italy communicate the complete list of scientific publications in their research areas to a central database at the Ministry of Health (MoH), which is necessary for funding allocation. With FileMaker 11 software, we have created a dedicated database that collect citations and Altmetrics of all research articles produced by our researchers at the Foundation sent to the Ministry. The DOI (Digital Object Identifier) and Web of Science Accession Number and Scopus EID Identifier have been inserted for each article. Launching the update, the system is able to connect to both Web of Science, through the Accession Number, to Scopus , by EID identifier, and to Altmetric.com through API codes based on DOI. Data can then be broken down by year, department, or unit. The system included data from year 2011 to 2016 (for a total of n.3.756 articles). We plan to assess the correlation between Altmetrics, citation counts and traditional indexes, by Spearman’s rank correlation coefficient, by department and by author. Also, we plan to analyse trend over time of both Altmetrics and traditional indexes, to assess whether a temporal lag exist between paper publication and actual impact. Furthermore, the possibility to have the citations of all articles from the two traditional databases (Scopus and Wos) will allow us to study the differences in the h-indices between them. Here our experience !

OBJECTIVE: Provocative stimulation tests for growth hormone (GH) assessment have poor reproducibility and can often elicit false positive results in normal children. The aim of our study was to confirm the capability of pegvisomant as an enhancer of GH secretion in unmasking false-positive results in short children (height

L’evidenza che alcuni pazienti con glaucoma possono continuare a peggiorare nonostante una riduzione significativa della pressione intraoculare (PIO) suggerisce che altri fattori siano co-responsabili per l’incidenza e la progressione della neuropatia ottica glaucomatosa. Poiché si ritiene che fattori vascolari sistemici e locali siano molto importanti, abbiamo arruolato 16 volontari sani per testare la riproducibilità del color Doppler imaging (CDI) nella nella valutazione del flusso ematico dei vasi retrobulbari prima di realizzare uno studio su pazienti glaucomatosi. In questo studio quattro operatori mascherati hanno utilizzato due differenti macchine ecografiche. La concordanza intraoperatore nell’arteria oftalmica (AO) è risultata essere buona o molto buona per il peak systolic velocity (PSV), end-diastolic velocity (EDV) e indice di resistività (IR) in entrambi le macchine. Le differenze nella concordanza fra macchine e/o operatori sono risultate maggiori per l’arteria centrale della retina e per le arterie ciliari posteriori. Abbiamo anche testato la riproducibilità interoperatore ma una scarsa concordanza è stata trovata fra le misure., Bollettino della Società Medico Chirurgica di Pavia, Vol 125, N° 4 (2012)

Ginkgo biloba (Gb) has demonstrated antioxidant and vasoactive properties as well as clinical benefits in several conditions such as ischemia, epilepsy, and peripheral nerve damage. Additionally, Gb is supposed to act as potential cognitive enhancer in dementia. So far, several trials have been conducted to investigate the potential effectiveness of Gb in neuropsychiatric conditions. However, the results of these studies remain controversial. We conducted a systematic review and a meta-analysis of three randomised controlled trials in patients with schizophrenia and eight randomised controlled trials in patients with dementia. Gb treatment reduced positive symptoms in patients with schizophrenia and improved cognitive function and activities of daily living in patients with dementia. No effect of Gb on negative symptoms in schizophrenic patients was found. The general lack of evidence prevents drawing conclusions regarding Gb effectiveness in other neuropsychiatric conditions (i.e., autism, depression, anxiety, attention-deficit hyperactivity disorder, and addiction). Our data support the use of Gb in patients with dementia and as an adjunctive therapy in schizophrenic patients.

Psoriasis is a chronical dermatosis with a prevalence among 0.5 and 4.6%. The interest for its comorbidities is a current matter, especially because of the negative impact on some of the most important therapeutical options. The most common comorbidities are: psoriatic arthritis, depression, alcohol and tobacco abuse, obesity, hypertension, dyslipidemia, type 2 diabetes mellitus and cardiovascular pathologies (metabolic syndrome). The aim of this study is comparing different sub-populations of patients affected by psoriasis to point out different profiles of comorbidities among them and then determine those at higher risk by sex, age and severity of psoriasis. The study involves 203 patients affected by psoriasis (71 women and 132 men). Data about Psoriasis Area Severity Index (PASI), Body Mass Index (BMI), comorbidities, alcohol, tobacco and drugs consumption were collected from each patient. The results point out that patients affected by hypertension, hypertrigliceridemia, type 2 diabetes mellitus and psoriatic arthritis such as drinkers and obeses show higher PASIs, namely a more severe psoriasis. The influence of sex and age on comorbidities has also been evaluated. These results could support the hypothesis about a connection between psoriasis and comorbidities based on the pro-inflammatory cytokine network, which has a role on lipidic a glucidic metabolism, too. The most important cytokine in this network is TNFα. High levels of Angiotensin Converting Enzyme (ACE) in patients affected by psoriasis could explain, moreover, the link between psoriasis and hypertension. Finally the core of the interest about comorbidities is the question of therapeutical troubles that emerge when most severe patients are found to be the most affected by comorbidites. Comorbidites can prevent the use of systemic agents (which could be otherwise suitable in case of moderate-severe psoriasis) and the therapies for the comorbidities can also interact with the ones for psoriasis., Bollettino della Società Medico Chirurgica di Pavia, Vol 122, N° 3 (2009)

The purpose of this clinical retrospective study is the evaluation of HBV infection prevalence among a population of patients affected by psoriasis, in order to compare this prevalence with the general population; in this study the HBV infection positivity was related to PASI value of psoriasis in order to evaluate a possible pathogenic association between HBV infection and psoriasis. The study is composed by 221 patients affected by psoriasis. The psoriatic patients positive for HBV infection are 35, whereas the psoriatic patients negative for HBV infection are 186 (HBV infection prevalence: 15.8%); the control group of blood donors shows a HBV infection prevalence of 13.3% (506/3791 HBV infection positive patients), which is not statistically different to the percentage of psoriatic group. On the contrary the HBsAg prevalence was higher in psoriatic patients (3.2%) than in blood donor control group (0%). In HBV infected patients group the prevalence of severe psoriasis (evaluated with PASI score) is higher than the one of moderate psoriasis. Finally this study underlines the possible HBV infection role in triggering, manteining or esacerbating Psoriasis and also the importance of evaluating the serological HBV infection markers profile in psoriasis patients., Bollettino della Società Medico Chirurgica di Pavia, Vol 122, N° 3 (2009)

Background Pediatric anesthesia nowadays requires specific knowledge and expertise. The Anesthesia PRactice In Children Observational Trial (APRICOT) was a European multicenter study designed for the identification of perioperative severe critical events and management. We aimed at analyzing the Italian database in an attempt to determine the practice of anesthesia and the incidence of severe critical events in Italy. Methods Secondary analyses of the database consisted in extracting the raw data from the 25 Italian centers that participated to APRICOT. Descriptive statistics and comparison with the reference data were made for all the variables collected. Results The study analyzed 2087 children. The Italian cohort represents 6.7% of the overall study population. Most of the children were ASA 1-2 (90.6%) and underwent a surgical procedure (62.8%). In more than 84% of the cases, anesthesia management was performed by an expert with main or frequent activity in pediatric anesthesia with on an average 15 years of experience. The overall incidence of severe critical events was 3% (95% CI: 2.2-3.8). The most frequently reported severe critical incidents were of respiratory (2%; CI: 1.4-2.6) and cardiovascular origin (0.7%; CI. 0.3-1), while drug error, anaphylaxis and bronchial aspiration were very rare. There were no reports of perioperative cardiac arrest or patients with neurological damage. Conclusions This secondary analysis demonstrates that the incidence of severe critical incidence was lower in Italy in comparison to that reported for Europe. This low rate of critical events may be related to the high expertise and experience of the anesthesiologists in charge of the children in the Italian centres that participated to APRICOT.

Background: Statins and sildenafil have been shown to exert beneficial effects in cardiac injury. We hypothesized that antenatal maternal administration of simvastatin and/or sildenafil might also promote benefits in cardiac remodeling of congenital diaphragmatic hernia (CDH). Therefore, we performed micro-CT image analysis and histology of the heart after antennal treatment in experimental nitrofen-induced CDH. Methods: At 9.5 days post conception (dpc), pregnant rats were exposed to nitrofen. At 16 and 20 dpc fetuses were treated with simvastatin and/or sildenafil. At 21 dpc postmortem micro-CT and autopsy were performed. Results: All nitrofen-treated fetuses had a lower birth weight compared to controls; in the simvastatin-treated group, a significant improvement in CDH was noted. Impairment of the lung and liver was also noted in CDH. Compared to controls, CDH rats showed lower ventricular mass, with greater left ventricular thickness; simvastatin decreased the ventricular mass and improved wall thickness. CDH rats exhibited myocardial hypotrophy, severe vascular depression in the left ventricle, and intense interstitial edema compared to controls and nitrofen-exposed animals without CDH. In CDH, the cardiac morphology appeared deformed with left ventricular wall verticalization. Simvastatin improved cardiac myocyte appearance and heart morphology. Conclusion: The potential to treat CDH with antenatal simvastatin may improve the management of this malformation.

Introduction: We assessed the post-mortem micro-CT utility to evaluate fetal cardiac impairment in nitrofen-induced congenital diaphragmatic hernia (CDH). Methods: At 9.5d postconception (dpc), pregnant rats were exposed to nitrofen. At +18 and +21dpc, fetuses were harvested by cesarean section. Postmortem micro-CT and autopsy were performed. Fetuses were assigned to three experimental groups: Control group (C), Nitrofen group (N, exposition to nitrofen without CDH), CDH group. Cardio-pulmonary indices were evaluated. Results: An accurate morphological evaluation of the lung and heart was obtained. Early cardiac impairment was present in the N and CDH groups. At term pregnancy, an increased maximum diameter and decreased minimum diameter of the ventricles and increased interventricular septal thickness were noted in CDH. Histology showed a myocardial “disarray” and an high density of mitotic myocytes in CDH at midgestation. Conclusions: The potential utility of post-mortem fetal micro-CT examination in CDH was introduced. The results highlighted the presence of cardiac adaptation in affected fetuses.

Objective Prenatal heart adaptations to congenital diaphragmatic hernia (CDH) could help define postnatal outcome. Methods We retrospectively analyzed post-mortem tissues from fetuses with severe CDH (n = 7). Histology and immunohistochemical distribution of desmin, muscle actin [HHF35], endothelin-1 [ET-1] and TGF-β were evaluated. Results In the atrium, desmin, HHF35, ET-1, TGF-β were found expressed only in preterm CDH. Dishomogeneous ventricular distribution of cardiac growth factors were detected in term CDH. The cardiomyocyte nucleus/cytoplasmatic ratio in CDH was higher compared with controls (p = 0.01). Small intramyocardial artery density and vascular wall thickness was increased in CDH compared with controls (p = 0.03 and p < 0.01). In comparison with the ventricles, the interventricular septum showed a greater vessel density (p = 0.01) and a greater vascular wall thickness, particularly compared with the CDH right ventricle (p = 0.02). Conclusion Left ventricle immaturity seems to be a cardiac adaptive response of severe CDH in utero.