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Introduction: Conversion Total Hip Arthroplasty (cTHA) is a rescue strategy for proximal femur osteosynthesis failures. However, it is unclear whether cTHAs performed for extra-capsular fracture fixation failures (ECF) or for intra-capsular fracture fixation failures (ICF) share the same complexity and efficacy. The purpose of our study was to compare cTHAs performed on pre-existing ICFs and pre-existing ECFs, focusing on surgical complications and functional outcomes in both groups.Methods: An observational retrospective study was conducted on cTHA patients, treated between 2014 and 2018, divided into 2 groups: ICF-group and ECF-group. The main outcomes were: type of implant used, duration of surgery, need for transfusions, incidence of complications, functional outcomes.Results: 28 patients were included (15 in the ECF group and 13 in the ICF group); the average follow-up was of 31 ± 17.3 months. No significant differences were identified in terms of the type of implant used and duration of surgery. The number of transfused patients was 4 in the ICF group and 12 in the ECF group (p = 0.02); the average transfused units were 0.4 ± 0.7 in the ICF group and 1.3 ± 0.9 in the ECF group (p = 0.01). The incidence of complications - an infection and a dislocation, both of which occurred in the ICF group - and functional outcomes did not present significant differences.Conclusion: The conversion surgery on ECFs patients is technically more difficult for the surgeon and prone to greater blood loss. The outcomes are satisfactory and overlap between the two groups. [ABSTRACT FROM AUTHOR]

Background: Occurrence of hepatitis C virus (HCV) infection is reduced by effective risk management procedures, but patient-to-patient transmission continues to be reported in healthcare settings.Aim: To report the use of phylogenetic analysis in the clinical risk management of an HCV outbreak among 128 thalassaemia outpatients followed at a thalassaemia centre of an Italian hospital.Methods: Epidemiological investigation and root-cause analysis were performed. All patients with acute hepatitis and known chronic infection were tested for HCV RNA, HCV genotyping, and NS3, NS5A, and NS5B HCV genomic region sequencing. To identify transmission clusters, phylogenetic trees were built for each gene employing Bayesian methods.Findings: All patients with acute hepatitis were infected with HCV genotype 1b. Root-cause analysis, including a lookback procedure, excluded blood donors as the source of HCV transmission. The phylogenetic analysis, conducted on seven patients with acute infection and eight patients with chronic infection, highlighted four transmission clusters including at least one patient with chronic and one patient with acute HCV infection. All patients in the same cluster received a blood transfusion during the same day. Two patients with acute hepatitis spontaneously cleared HCV within four weeks and nine patients received ledipasvir plus sofosbuvir for six weeks, all achieving a sustained virological response.Conclusion: Combined use of root-cause analysis and molecular epidemiology was effective in ascertaining the origin of the HCV outbreak. Antiviral therapy avoided the chronic progression of the infection and further spread in care units and in the family environment. [ABSTRACT FROM AUTHOR]

• Similar recanalization rate is achieved in patients with and without cancer. • Active cancer is associated with higher mortality in stroke patients. • Independency is possible in patients with cancer with successful thrombectomy. • Patients with stroke and previous cancer or without cancer have similar outcome. Cancer-related coagulopathy is a known cause of stroke and can lead to formation of thrombi with a unique composition. The effectiveness of mechanical thrombectomy in cancer patients is still unknown. The aim of the study was to evaluate the rate of successful reperfusion and the clinical outcome in cancer patients with stroke treated with endovascular therapies, compared to patients without cancer. We performed a retrospective analysis of consecutive patients with ischemic stroke treated with endovascular therapies at our hospital between January 2008 and January 2016. A sub-group analysis was performed including only patients with cryptogenic stroke. We included in the final analysis 14 patients with active cancer and 267 patients without cancer. Successful reperfusion was achieved in 79% of patients without cancer, and 71% of patients with active cancer (P = 0.68). Patients with cryptogenic stroke and active cancer had a lower reperfusion rate compared to patients with cryptogenic stroke without active cancer, although not significantly so (2/4 cancer patients, 50% vs 37/50, 74%, p: 0.31). Mortality rate was higher among cancer patients. Hemorrhagic transformation occurred in similar proportions in the two groups. Endovascular treatment in cancer patients seems, thus, effective. [ABSTRACT FROM AUTHOR]

Hepatitis B virus (HBV) and Hepatitis D virus (HDV) super-infection is considered as one of the most dangerous forms of chronic viral hepatitis, but the burden of the HDV infection worldwide could be underestimated. The aim of our study is to evaluate the burden of HDV among a cohort of HBV patients with a long-term follow-up (more than 10 years). This retrospective study enrolled HBV patients from a tertiary liver centre between 1998 and 2022. We performed screening for HDV including anti-HDV antibodies at baseline and during the last year of follow-up. We estimated the prevalence of HDV infection among those patients with HBsAg positivity. Disease outcomes as progression to advanced liver disease, decompensation of liver cirrhosis, development of hepatocellular carcinoma (HCC), portal thrombosis or death were collected and estimated using Kaplan-meier curves. We evaluated a total of 616 HBsAg positive patients who attended our liver tertiary (78% males; mean age 62 years). At the end of our retrospective analysis, we identified 52 patients (8.4%) with HBV / HDV coinfection Of these forty-two were italians (80%) while ten (20%) were foreigners9 of 10 of the foreigners patients10 were Romanians. At baseline, 3 of 52 HBV-HDV coinfected patients had a chronic asymptomatic infection (5.7%), 14 had a chronic hepatitis (26.9%) and 35 had a liver cirrhosis (67.3%). In the subgroup of 35 cirrhotic patients, 19 patients (54.2%) developed at least decompensation of their iver disease and 13 patients (37.1%) developed HCC. Overall, 15 patients (28.9%) died during a mean follow up of 115 months. Our retrospective study confirms that HBV / HDV coinfection is still widespread in cohorts of patients with chronic HBV infection and that it results in severe liver disease with a high risk of developing heart failure, HCC and death. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To investigate the presence of multiple spinothalamic pathways for warmth in the human spinal cord. Methods: Laser evoked potentials to C-fiber stimulation (C-LEPs) were recorded in 15 healthy subjects after warmth stimulation of the dorsal midline at C5, T2, T6, and T10 vertebral levels. This method allowed us to calculate the spinal conduction velocity (CV) in two different ways: (1) the reciprocal of the slope of the regression line was obtained from the latencies of the different C-LEP components, and (2) the distance between C5 and T10 was divided by the latency difference of the responses at the two sites. In particular, we considered the C-N1 potential, generated in the second somatosensory (SII) area, and the late C-P2 response, generated in the anterior cingulate cortex (ACC). Results: The calculated CV of the spinal fibers generating the C-N1 potential (around 2.5m/s) was significantly different (p <0.01) from the one of the pathway producing the P2 response (around 1.4m/s). Conclusions: Our results suggest that the C-N1 and the C-P2 components are generated by two parallel spinal pathways. Significance: Warmth sensation is subserved by parallel spinothalamic pathways, one probably reaching the SII area, the other the ACC. [Copyright &y& Elsevier]

• Microfluidic platform allowing fast RT-qPCR analysis on continuously flowing droplets. • Screening of multiple combinations of samples and target genes in the same run. • The platform is optimized for both small and large number of samples. • It is perfectly suitable for diagnostic applications. • Automated system for generation and merging of pairs of droplets. RT-qPCR represents a key method in cancer diagnostic, however the constant increase in patients and cancer biomarker panels to screen requires the implementation of faster approaches allowing smaller reagents and samples volumes consumption. To fulfil these needs, we present here a fully automated droplet microfluidics platform that couples a specifically designed thermal system with a fluorescence excitation/detection module. Additionally, the droplet generation and merging approaches allows the analysis of multiple samples and genes with no risk of contamination. This platform has been initially validated by investigating HER2 overexpression in two cancer cell lines starting from total RNA samples; these results have been successfully compared with those obtained by a commercially available machine, showing no limitation in terms of number of processed samples as well as reducing of 200 times the analysis costs per patient. Finally, we have demonstrated its capability in performing fast RT-qPCR, raising the throughput of analysis to a hundred samples in less than 20 min. [ABSTRACT FROM AUTHOR]

Aim of the study was to assess the A-delta nociceptive system during the night and afternoon in idiopathic Restless Legs Syndrome (RLS) patients, by recording the Laser Evoked Potentials (LEPs). We studied 11 patients (mean age 53.40±18.59years; 6 males, 5 females) affected by idiopathic RLS. LEPs were recorded to stimulation of the right foot, hand and perioral region. LEPs were recorded at night (between 9.00 PM and 11.00 PM) and in the early afternoon (between 1.00 PM and 3.00 PM). Two consecutive averages (20 trials each) were obtained for each stimulation site. LEPs were recorded from 3 recording electrodes placed at Cz, Fz, and T3 sites of the 10–20 International System. In RLS patients, we found a significant increase of N2–P2 amplitude after foot stimulation during nighttime session (p =0.008) when compared to daytime. The N2/P2 amplitude after hand and face stimulation was not significantly different during both sessions (p >0.05). We did not find any impairment of the Adelta-fiber system. However, there is a prevailing activity of the Adelta nociceptive system of lower limbs during nighttime. These findings suggest, in idiopathic RLS, a circadian disinhibition in the central processing of the lower limb Adelta-fiber inputs. [ABSTRACT FROM AUTHOR]