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Primary sclerosing cholangitis is a cholestatic disease with a low prevalence in Italy. Indications for liver transplantation and the time of listing are not stated. We performed a national survey to investigate the listing criteria, comorbidities, and outcomes. In April 2022, we surveyed liver transplantation in primary sclerosing cholangitis nationwide for the last 15 years. From 2007 to 2021, 445 patients were included on waiting lists, and 411 had undergone liver transplants. The median age at transplantation was 46 years (males 63.9%); 262 patients (59%) presented an inflammatory bowel disease. Transplants increased over the years, from 1.8 % in 2007 to 3.0 % in 2021. Cholangitis (51%) and hepatic decompensation (45%) were the main indications for listing. The disease recurred in 81 patients (20%). Patient survival after the first transplant was 94 %, 86% and 84% at one, five, and ten years. Twenty-four died in the first year (50% surgical complications, 25% infections); 33 between one to five years (36% recurrence, 21% cholangiocarcinoma recurrence) and nine after five years (56% de novo cancer, 44% recurrence). Primary sclerosing cholangitis has been an increasing indication for transplantation in Italy. Cholangitis and decompensation were the main indications for listing. Recurrence and cancer were the leading causes of death. [ABSTRACT FROM AUTHOR]

Previous reports reveal inconsistent findings of right ventricular (RV) changes following pregnancy in subjects with repaired tetralogy of Fallot (rTOF). A two-center, retrospective cohort study which included women with rTOF who completed pregnancy that were matched to nulliparous women with rTOF by age at the time of baseline cardiac magnetic resonance (CMR), RV ejection fraction (RVEF), and indexed RV end-diastolic volume (RVEDVi). Pre-pregnancy and postpartum cardiac magnetic resonance (CMR) were analyzed and compared to sequential CMR of nulliparous subjects with rTOF. Thirty-six women with rTOF who completed pregnancy were matched to 72 nulliparous women with rTOF. Over a mean period of 3.1 years for the pregnancy group and 2.7 years for the comparison group, there was no significant change in the RVEDVi, RVEF, RV mass, pulmonary regurgitation severity, left ventricular (LV) volumes, LV ejection fraction (LVEF), or LV mass when comparing the baseline CMR and the follow-up CMR in either of the groups. There was a slight increase in RV indexed end-systolic volume (RVESVi) when comparing the baseline CMR and the follow-up CMR in the pregnancy group (68.93, SD 23.34 ml/m2 at baseline vs. 72.97, SD 25.24 mL/m2 at follow-up, P =.028). Using a mixed effects model for CMR parameters change over time; when adjusted for time between baseline and follow-up CMR there was no significant difference in rate of change between the pregnancy and comparison groups. Most ventricular remodeling parameters measured by CMR did not significantly change in subjects with rTOF who completed pregnancy or in nulliparous subjects with rTOF. In the pregnancy group, RVESVi is larger in those individuals who have undergone pregnancy without a significant change in ventricular function. These patients should be followed longitudinally to determine the long-term ventricular and clinical effects of pregnancy. [ABSTRACT FROM AUTHOR]

Guidelines on obesity management reinforce regular exercise to reduce body fat. Exercise modalities, including high-intensity interval training (HIIT), appear to produce a similar effect to continuous aerobic training (CAT) on body fat. However, they have not addressed the chronic effect of HIIT vs. CAT on body fat assessed by dual energy X-ray absorptiometry (DEXA). Thus, we compared the effectiveness of CAT vs. HIIT protocols on body fat (absolute or relative) (%BF) and abdominal visceral fat reduction, assessed by DEXA, in adults with overweight and obesity. We conducted a systematic review and meta-analysis of randomized clinical trials (RCTs) including both female or male adults with excess body weight. We performed searches in the databases MEDLINE (PubMed), EMBASE, Scopus, LILACS, Web of Science and Cochrane. In our analysis (11 RCTs), we found no greater benefit on %BF of HIIT vs. CAT (MD –0.55%, 95% CI –1.42 to 0.31; p = 0.209). As for abdominal visceral fat, no training modality was superior (SMD: −0.05, 95% CI –0.29 to 0.19; p = 0.997). Regarding secondary outcomes (body weight, BMI, VO 2 max, glycemic and lipid profiles), HIIT shows greater benefit than CAT in increasing VO 2 max and fasting blood glucose and reducing total cholesterol. HIIT is not superior to CAT in reducing %BF or abdominal visceral fat in individuals characterized by excess weight. However, HIIT showed beneficial effects on cardiorespiratory fitness, total cholesterol and fasting blood glucose when compared to CAT. [ABSTRACT FROM AUTHOR]

• In this study we survey on social media patients with a colloid cyst. • We also performed a review of the literature of familial colloid cysts and compared our two groups. • A total of 211 patients completed the survey. 25 cases were familial colloid cysts. Colloid cysts of the third ventricle are rare benign tumors, accounting for approximately 1% of all intracranial tumors. Familial colloid cysts are less common, only 25 cases have been previously reported in the literature. We aim to describe demographic and disease-specific characteristics to reduce the knowledge gap with this potentially life-threatening tumor. We conducted a retrospective cohort study of 211 colloid cyst patients from the Colloid Cyst Survivors Group who completed a survey that included demographic and clinical data and inquired about family members diagnosed with a colloid cyst. Data was collected from October 14th, 2021 to October 27th, 2021. We compared our data with previously published cases from the literature. A total of 211 responses from patients with a previous diagnosis of a colloid cyst completed our survey. 11.8 % were familial colloid cysts, of this group 60.8 % were symptomatic and 39.2 % incidental. We observed significant difference between symptom incidence between reports from the literature and our cohort: headache 75.5 % versus 49 % (p = 0.005); imbalance 13.2 % versus 31.4 % (p = 0.03); nausea 11.3 % versus 29.4 % (p = 0.02), and difficulty walking 1.9 % versus 19.6 % (p = 0.003). Additionally, we found first degree family member as the most frequent relative diagnosed with this disease. Our study involved the largest cohort of patients with familial colloid cysts. According to previous literature, siblings are the most prevalent family member affected by this disease, specifically among monozygotic twins. This suggests strong inheritance patterns and even genetic mechanism underlying the development of this disease. [ABSTRACT FROM AUTHOR]

Coagulation in cirrhosis involves a complex imbalance between procoagulant and anticoagulant factors due to liver dysfunction. This results in a delicate hemostatic equilibrium that increases the risk of both bleeding and thrombosis. To analyze the occurrence of thromboembolic events in a prospective series of patients with liver cirrhosis, and to assess patients' characteristics. We prospectively enrolled 188 patients with cirrhosis admitted to our gastrointestinal ward (December 2021-December 2022). We evaluated general and liver disease-related characteristics as well as the incidence of venous thromboembolism (VTE), and death during the first year following hospital admission. Median age was 63 years, and 72.9% were males. The primary cause of hospitalization was acute decompensation (n=101, 53.7%), followed by hepatocellular carcinoma (n=34, 18.1%) or liver-related elective diagnostic-therapeutic procedures (28, 14.9%). Twenty-five (13.3%) patients were admitted due to non-liver related events. The median length of hospitalization was 9 days (IQR 5-14). Most of patients had decompensated cirrhosis (Child-Pugh B: 41.5%; Child-Pugh C: 26.6%), with median MELD-Na=14, and clinically significant portal-hypertension (CSPH) in 148 (78.7%). Sixty-two (32.9%) patients had hepatocellular carcinoma. Thirty-one patients (16.5%) were on anticoagulants. During a 1-year follow-up, three (1.6%) patients experienced VTE while 26 (13.8%) patients had variceal bleeding. Overall mortality was 42.0% (n=79). Padua and Improve-VTE risk scores, MELD-Na, Child-Pugh class, and presence of CSPH were no different between patients with or without VTE. A competitive-risk model focused on experiencing VTE and risk of death and bleeding as competing events showed no significant association between VTE and use of anticoagulant, Charlson comorbidity index, CSPH, male gender, HCC, length of hospitalization and Improve-VTE, Padua and MELD-Na scores. VTE is a rare event in patients with cirrhosis, occurring in only 1.6% of prospectively evaluated population, and no significant association between VTE and various risk factors was identified. [ABSTRACT FROM AUTHOR]

Proton pump inhibitors (PPIs) are commonly prescribed for gastroesophageal reflux disease (GERD) or prophylaxis of non-steroidal anti-inflammatory drugs and aspirin-induced gastric damage. However, their prolonged use in cirrhotic patients has been linked to complications like spontaneous bacterial peritonitis (SBP) and hepatic encephalopathy (EE). To evaluate the appropriateness of PPI therapy in patients with cirrhosis. We reviewed medical records of 209 cirrhotic patients admitted to our gastrointestinal ward (December 2021-December 2022). Demographics, clinical characteristics, PPI use indications, and incidence of EE and SBP were assessed. The median age was 69 years, and 74.4% were males. Main reasons for hospitalization were hepatocellular carcinoma (n=63, 28.7%), elective diagnostic-therapeutic procedures (n=63, 28.7%), non-liver-related events (n=54, 24.7%), and acute decompensation (n=39, 17.7%). Etiology of liver disease was alcohol in 91 patients (41.6%), virus-related in 77 (35.1%), and metabolic-associated in 30 (13.7%). The median MELD-Na score was 10 (8-14). At admission, 145 patients (66.2%) were on PPIs: of these, 42 patients (29.0%) had confirmed GERD, 12 (8.3%) had esophagitis ≥grade B, and 27 (18.6%) were on aspirin with bleeding risk-factors. Overall, inappropriate PPI use was observed in 74 patients (44.1%). Patients on PPIs were older, with higher MELD-Na and creatinine, and lower hemoglobin and Na compared to those not on PPIs (p<0.05). Multivariate analysis showed that PPI use was independently associated with older age (OR 1.03, IC95% 1.01-1.07) and lower hemoglobin (OR 0.82, IC95% 0.70-0.97). During a median follow-up of 18 months, the incidence of EE and SBP did not differ between PPI users and non-users. A significant proportion of patients with cirrhosis is inappropriately prescribed PPIs. Although this did not correlate with major liver-related events in the short term, proper PPI prescription education is crucial to prevent potential long-term consequences. [ABSTRACT FROM AUTHOR]

The routing and spectrum allocation (RSA) problem arises in the context of flexible grid optical networks, and consists in routing a set of demands through a network while simultaneously assigning a bandwidth to each demand, subject to non-overlapping constraints. One of the most effective integer programming formulations for RSA is the DR-AOV formulation, presented in a previous work. In this work we explore a relaxation of this formulation with a subset of variables from the original formulation, in order to identify valid inequalities that could be useful within a cutting-plane environment for tackling RSA. We present basic properties of this relaxed formulation, we identify several families of facet-inducing inequalities, and we show that they can be separated in polynomial time. [ABSTRACT FROM AUTHOR]

Given a graph G = (V, E), a subset S ⊆ V is 2-dominating if every vertex in S¯ has at least two neighbors in S. The minimum cardinality of such a set is called the 2-domination number of G. Consider a process in discrete time that, starting with an initial set of marked vertices S , at each step marks all unmarked vertices having two previously marked neighbors. In such a process, the minimum number of initial vertices in S such that eventually all vertices are marked is called the P 3 -hull number of G. These parameters are relevant both as a generalization of the domination number and in the context of discrete convexities in graphs, particularly the P 3 convexity. In this work, we explore a polyhedral relation between these two parameters and, in addition, we provide new families of valid inequalities for the associated polytopes. Finally, we give explicit descriptions of the polytopes associated to these problems when G is a path, a cycle, or a complete graph. If G is a tree we give the complete description of the associated 2-domination polytope. [ABSTRACT FROM AUTHOR]

One of the most promising solutions to deal with huge data traffic demands in large communication networks is given by flexible optical networking, in particular the flexible grid (flexgrid) technology specified in the ITU-T standard G.694.1. In this specification, the frequency spectrum of an optical fiber link is divided into narrow frequency slots. Any sequence of consecutive slots can be used as a simple channel, and such a channel can be switched in the network nodes to create a lightpath. In this kind of networks, the problem of establishing lightpaths for a set of end-to-end demands that compete for spectrum resources is called the routing and spectrum allocation problem (RSA). Due to its relevance, RSA has been intensively studied in the last years. It has been shown to be NP-hard and different solution approaches have been proposed for this problem. In this paper we present several families of valid inequalities, valid equations, and optimality cuts for a natural integer programming formulation of RSA and, based on these results, we develop a branch-and-cut algorithm for this problem. Our computational experiments suggest that such an approach is effective at tackling this problem. [ABSTRACT FROM AUTHOR]

Background: Civilian studies suggest that trending Shock-Index Pediatric Adjusted(SIPA) values can prove useful in the prediction of trauma outcomes. The purpose of this study was to evaluate the relationship between trends in SIPA and outcomes in pediatric warzone trauma. Methods: Retrospective review of the Department of Defense Trauma Registry from 2008 to 2015, including all patients age ≤17years. SIPA was calculated both pre-hospital and upon arrival, then classified as "normal" or "abnormal" based upon previously validated thresholds. Patients were stratified into groups based on the trend of their SIPA (1-normal to normal, 2-normal to abnormal, 3-abnormal to normal, 4-abnormal to abnormal). Key outcomes including ICU admission, severe injury, mechanical ventilation, and mortality were then compared between groups. Results: 669 patients were included, mean ISS 12 ± 10. The most common mechanism of injury was blast (46.5%). Overall, 43% were stratified into Group 1, 13.9% into Group 2, 14.8% into Group 3, and 28.0% into Group 4. Those patients with a persistently abnormal SIPA (Group 4) had significantly increased incidence of severe injury, ICU admission, need for mechanical ventilation, and mortality. Conclusion: Trends in SIPA may be used to predict trauma outcomes for children injured in warzones, with persistently abnormal values associated with worse outcomes overall. [ABSTRACT FROM AUTHOR]

Natural arsenic (As) contamination of groundwater which provides drinking water and/or irrigation supplies remains a major public health issue, particularly in South and Southeast Asia. A number of studies have evaluated various aspects of the biogeochemical controls on As mobilization in aquifers typical to this region, however many are predicated on the assumption that key biogeochemical processes may be deduced by sampled water chemistry. The validity of this assumption has not been clearly established even though the role of sorption/desorption of As and other heavy metals onto Fe/Mn (hydr)oxides is an important control in As mobilization. Here, selective chemical extractions of sand-rich and clay-rich sediments from an As-affected aquifer in Kandal Province, Cambodia, were undertaken to explore the potential role of partial re-equilibrium through sorption/desorption reactions of As and related solutes (Fe, Mn and P) between groundwater and the associated solid aquifer matrix. In general, groundwater As is strongly affected by both pH and Eh throughout the study area. However, contrasting sorption behaviour is observed in two distinct sand-dominated (T-Sand) and clay dominated (T-Clay) transects, and plausibly attributed to differing dominant lithologies, biogeochemical and/or hydrogeological conditions. Sorption/desorption processes appear to be re-setting groundwater As concentrations in both transects, but to varying extents and in different ways. In T-Sand, which is typically highly reducing, correlations suggest that dissolved As may be sequestered by sorption/re-adsorption to Fe-bearing mineral phases and/or sedimentary organic matter; in T-Clay Eh is a major control on As mobilization although binding/occlusion of Fe-bearing minerals to sedimentary organic matter may also occur. Multiple linear regression analysis was conducted with groups categorised by transect and by Eh , and the output correlations support the contrasting sorption behaviours encountered in this study area. Irrespective of transect, however, the key biogeochemical processes which initially control As mobilization in such aquifers, may be "masked" by the re-setting of As concentrations through in-aquifer sorption/desorption processes. Image 1 • Selective chemical extractions of As, Fe, Mn & P in arsenic-prone aquifers in Cambodia. • Contrasting sorption behaviour observed in clay- and sand-dominated sediments. • Groundwater-sediment partial re-equilibration masks microbial controls on As mobility. [ABSTRACT FROM AUTHOR]

In the b-coloring problem , we aim to assign colors from a set C to the vertices of a graph G in such a way that adjacent vertices do not receive the same color, and for every c ∈ C we have a c -colored vertex v in G such that every color in C ∖ { c } is assigned to at least one of v 's neighbors. It has been shown that b-coloring is NP-complete, so we propose in this article an approach for the problem under integer programming techniques. To this end, we give an integer programming formulation and study the associated polytope. We provide several families of valid inequalities, and analyze facetness conditions for them. Finally, we show computational evidence suggesting that the given inequalities may be useful in a branch-and-cut environment. [ABSTRACT FROM AUTHOR]

Abstract Laparoscopic pyloromyotomy was completed successfully at 3 weeks of life after the full term delivery of a baby boy. A 3-week-old baby boy initially presented with a typical history and physical examination for hypertrophic pyloric stenosis that was confirmed by ultrasound. His initial recovery was uneventful and he was discharged home tolerating full feeds without emesis. However, he returned with progressively worsening projectile nonbilious emesis two months after his original operation with an upper gastrointestinal series consistent with recurrent pyloric stenosis. He was taken for a second laparoscopic pyloromyotomy and has continued to grow and thrive. Highlights • Presentation and treatment of a rare case of recurrent pyloric stenosis with surgical video. • Review of the available literature and discussion of the current clinical definitions of recurrent pyloric stenosis. • A review of the various available treatment option for recurrent pyloric stenosis. [ABSTRACT FROM AUTHOR]

Abstract A set of points X = X B ∪ X R ⊆ R d is linearly separable if the convex hulls of X B and X R are disjoint, hence there exists a hyperplane separating X B from X R. Such a hyperplane provides a method for classifying new points, according to which side of the hyperplane the new points lie. When such a linear separation is not possible, it may still be possible to partition X B and X R into prespecified numbers of groups , in such a way that every group from X B is linearly separable from every group from X R. We may also discard some points as outliers , and seek to minimize the number of outliers necessary to find such a partition. Based on these ideas, Bertsimas and Shioda proposed the classification and regression by integer optimization (CRIO) method in 2007. In this work we explore the integer programming aspects of the classification part of CRIO, in particular theoretical properties of the associated formulation. We are able to find facet-inducing inequalities coming from the stable set polytope, hence showing that this classification problem has exploitable combinatorial properties. [ABSTRACT FROM AUTHOR]

Discontinuation of hepatitis B (HBV) immune globulin (HBIG) after liver transplantation (LT) for HBV-related cirrhosis with and without hepatocellular carcinoma (HCC) represents a challenging option. The adherence to this option in real-life practice is unknown. In a contemporary cohort of patients transplanted for HBV, with and without HCC, we aimed to; 1) assess the rate of HBV recurrence (HBV-R); 2) evaluate risk factors for HBV-R; 3) evaluate the association between HBV-R and HCC recurrence (HCC-R) and patient survival. This is a multicentric, retrospective study designed by the "Permanent Transplant Commission" of the Italian Association for the Study of the Liver. All recipients who underwent LT for HBV cirrhosis were included. Exclusion criteria were: LT prior to January 1, 2010; age <18 years old; combined transplantation; HIV coinfection; duration of follow-up after LT <12 months. HBV-R was defined by positivity of HBV-DNA and/or HBsAg. Uni and multivariate linear regression analysis were used to identify predictors of HBV/HCC-R. 1115 patients were included. Indications for LT were HCC (51%), decompensated cirrhosis (41.2%), acute on chronic liver failure (ACLF) (3.4%), and acute liver failure (ALF) (4.2%). Life-long HBIG + nuclos(t)ide analogues (NA) was the most common used prophylaxis (94.4%). Overall rate of HBV-R was 2.2% (median time after LT: 7 months). Patients under life-long HBIG + NA had lower rates of HBV-R than those in whom HBIG were withdrawn and those who received NA alone (1.4% vs. 10.7% vs. 13.6%; respectively, p<0.001). HBV-R was associated with a lower survival after LT (p=0.008). In patients transplanted for HCC (n=535), the rate of HBV-R was 2.8% and of HCC-R was 10.3% (median time from LT: 17 months). Rate of HBV-R was higher in patients with vs. without HCC-R (14.6% vs. 1.2%; p<0.001). Multivariate analysis showed that HBV-R was the only parameter independently associated with HCC-R (HR: 20; CI95% 5-86; p<0.001). HCC-R was associated with a significantly reduced survival after LT (5-year survival 36% vs. 94%; p<0.001). Life-long HBIG + NA is the most commonly used scheme for HBV-R prophylaxis after LT in Italy, leading to a low risk of HBV-recurrence. In LT recipients, HBV recurrence is associated with an increased risk of death. In patients transplanted for HCC, HBV-R is independently associated with HCC recurrence. Therefore, discontinuation of HBIG in these patients should be considered only in the setting of clinical trials [ABSTRACT FROM AUTHOR]

The safety and efficacy of atezolizumab/bevacizumab in patients with hepatocellular carcinoma (HCC) and impaired liver function is not completely defined. To address safety and efficacy of atezolizumab/bevacizumab in Child-Pugh class B patients reviewing the published data and analysing them by meta-analysis. Safety and efficacy of atezolizumab/becavizumab in patients with HCC and Child-Pugh B cirrhosis were compared to the respective figures in Child-Pugh A patients. Overall, 8 retrospective, non-randomized, cohort studies were identified, including a total of 1,071 class A and 225 class B patients. Adverse events grade ≥3 were observed in 11.8% and 26.8% of class A and B patients, respectively (P=0.0001; Odds Ratio 0.43, confidence interval 0.21–0.90; P=0.02). Median overall survival was 16.8±2.0 and 6.8±3.2 months in class A and B patients, respectively (mean difference 9.06 months, 7.01–11.1, P<0.0001). Progression Free Survival at both 6- (4.90±2.08 vs 4.75±2.08 months; P=0.0004) and 12-month (8.83±2.32 vs 7.26±2.33 months; P=0.002) was lower in class B patients. A trend towards higher Objective Response Rate (ORR) (25.6% vs 18.1%, P=0.070) and a significantly greater probability of obtaining an ORR was observed in class A patients (Odds Ratio 1.79, 1.12–2.86, P=0.02). Disease Control Rate (DCR) was observed in 78.4% of class A and in 66.9% of class B patients (P=0.102), although class A had significantly higher probability of DCR than class B patients (Odds Ratio 1.73, 1.17–2.56; P=0.006). Oncological efficacy of atezolizumab/bevacizumab is moderate in Child-Pugh class B patients, and the shorter survival figures associated with a greater likelihood of experiencing treatment-related adverse events observed in these patients compared to patients with less impaired liver function suggest caution and individualization of treatment. Comparative studies with best supportive care may provide further evidence supporting treatment in these patients. [ABSTRACT FROM AUTHOR]

We propose a generalization of the k -coloring problem, namely the minimum chromatic violation problem (MCVP). Given a graph G = ( V , E ) , a set of weak edges F ⊂ E and a set of colors C , the MCVP asks for a | C | -coloring of the graph G ′ = ( V , E \ F ) minimizing the number of weak edges with both endpoints receiving the same color. We present an integer programming formulation for this problem and provide an initial polyhedral study of the polytopes arising from this formulation. We give partial characterizations of facet-inducing inequalities and we show how facets from weaker and stronger instances of MCVP (i.e., more/less weak edges) are related. We then introduce a general lifting procedure which generates (sometimes facet-inducing) valid inequalities from generic valid inequalities and we present several facet-inducing families arising from this procedure. Finally, we present another family of facet-inducing inequalities which is not obtained from the prior lifting procedure. [ABSTRACT FROM AUTHOR]

The bandwidth coloring problem (BCP) is a generalization of the well-known vertex coloring problem (VCP), asking colors to be assigned to vertices of a graph such that the absolute difference between the colors assigned to adjacent vertices is greater than or equal to a weight associated to the edge connecting them. In this work we present an integer programming formulation for BCP based on the orientation model for VCP. We present two families of valid inequalities for this formulation, show that they induce facets of the associated polytope, and report computational experience suggesting that these families are useful in practice. [ABSTRACT FROM AUTHOR]

Primary Sclerosing Cholangitis (PSC) is a rare condition with low incidence in countries of the Mediterranean Basin, such as Italy; the timing for listing and the indication for liver transplantation (LT) are not entirely stated. To investigate the Italian trend in indication, timing, and outcome for PSC LT. In April 2022, we conducted a nationwide survey of LT in PSC over the last 15 years. 85% of Italian LT Centers took part in the project. Clinical features, indications and outcomes were evaluated. From January 2007 to December 2021, 445 PSC patients have been included in the Italian LT waiting-lists, and 411 underwent LT. The median age at LT was 46 years (18-73), with a high prevalence of males (n=287, 70%). Over 15 years, the number of transplants for PSC increased from 20 to 42 per year, reaching 3.0% of all indications in 2021. Recurring cholangitis and hepatic decompensation were the main indications for listing. The dropout rate from the waiting-list was 6% (26/445), cholangiocarcinoma (CCA) not eligible for LT and being too sick were the leading causes. 71% of the LT Centers utilized induction therapy with Basiliximab. Tacrolimus+MMF was the combined therapy of choice. Overall post-LT mortality was 15% (66/441): 24 patients died in the first year (50% due to surgical complications and 25% infections); 33 patients died between 1 to 5 years (36% PSC recurrence, 21% occult CCA-recurrence) and 9 patients after 5 years (56% cancer, 44% PSC recurrence). Likewise other Countries, PSC has been an increasing indication for LT in Italy. The dropout rate from LT waiting-list was relatively low, and CCA not eligible for transplantation or being too sick for surgery were the leading causes. 5-year post-LT survival was 87%, being PSC-recurrence or neoplastic disease the main causes of death. [ABSTRACT FROM AUTHOR]

Background Cutaneous metastases represent a therapeutic challenge. An increasing body of experience suggests that electrochemotherapy (ECT) provides effective tumor control, although its evidence basis should be strengthened. Methods This prospective, multicenter, observational study enrolled patients with superficial metastases, who underwent ECT at 10 centers between 2008 and 2013. Outcomes included adherence to European Standard Operating Procedures of ECT (ESOPE), tumor response, local progression-free survival (LPFS), toxicity and patient-reported outcomes (PROs, EORTC QLQ-C30 plus an 8-item questionnaire). Results We enrolled 376 eligible patients. Tumor histotype distribution was as follows: melanoma, 56%; squamous cell carcinoma, 11%; Kaposi sarcoma, 11%; breast carcinoma, 8%; basal cell carcinoma, 6%; soft tissue sarcomas, 3%; others, 5%. We registered 1304 target tumors (median size 1 cm). Treatment adhered to ESOPE in 88% of patients as to the route of drug administration, and in 70% as to electrode application. The procedure was mainly performed under sedation (64.6%) and by using intravenous chemotherapy (93.4%). Tumor response rate at 60 days was 88% (complete, 50%). Small tumor size predicted complete response achievement (OR 2.24, p = 0.003), higher LPFS (HR 0.68, p = 0.004) and improved PROs (Global Health Status, p < 0.001; wound bleeding, p < 0.001; healing, p = 0.002; and aesthetics, p < 0.001). Skin toxicity (grade ≥3, 7.8%) was lower in patients with tumors <2 cm ( p ≤ 0.001 ). One-year LPFS was 73.7% (95%CI 68.4–78.3). Conclusions ECT represents a valuable skin-directed therapy across a range of malignancies. The most frequently applied treatment modality is intravenous chemotherapy under sedation. Small tumor size predicts durable tumor control, fewer side-effects and better PROs. [ABSTRACT FROM AUTHOR]

Despite the fact that many vertex coloring problems are polynomially solvable on certain graph classes, most of these problems are not “under control” from a polyhedral point of view. The equivalence between optimization and separation suggests the existence of integer programming formulations for these problems whose associated polytopes admit elegant characterizations. In this work we address this issue. As a starting point, we focus our attention on the well-known standard formulation for the classical vertex coloring problem. We present some general results about this formulation and we show that the vertex coloring polytope associated to this formulation for a graph G and a set of colors C corresponds to a face of the stable set polytope of a particular graph S G C . We further study the perfectness of S G C showing that when ∣ C ∣ > 2 , this graph is perfect if and only if G is a block graph, from which we deduce a complete characterization of the associated coloring polytopes for block graphs. We also derive a new family of valid inequalities generalizing several known families from the literature and we conjecture that this family is sufficient to completely describe the vertex coloring polytope associated to cacti graphs. [ABSTRACT FROM AUTHOR]

A caterpillar is a graph such that the removal of all its vertices with degree 1 results in a path. Given a graph G , a caterpillar-packing of G is a set of disjoint (not necessarily induced) subgraphs of G such that each subgraph is a caterpillar. In this work we consider the set of caterpillar-packings of a graph, which corresponds to feasible solutions of the 2-schemes strip cutting problem with a sequencing constraint (2-SSCPsc) presented by F. Rinaldi and A. Franz in 2007. We study the polytope associated with a natural integer programming formulation of this problem. We explore basic properties of this polytope, including a lifting lemma and several facet-preserving operations on the graph. These results allow us to introduce several families of facet-inducing inequalities. [ABSTRACT FROM AUTHOR]

In a previous work we have presented a procedure for generating rank and non-rank valid inequalities for the stable set polytope based on clique projection and lifting operations. In this work we propose to apply another lifting operation and give some sufficient conditions for this new procedure to generate facet defining inequalities. Computational experience shows that the proposed approach allows to obtain tighter upper bounds for the maximum stable set problem. [ABSTRACT FROM AUTHOR]

Background: The rate of acute infection after surgery for proximal humeral fractures is not known. The aims of this study were to report the incidence and to analyze the risk factors for infection after proximal humeral fracture treatment. Materials and methods: We report a retrospective multicenter study of 452 proximal humeral fractures. Data were modeled by use of univariate and/or linear regression analyses to determine the odds ratio (OR). A logistic regression analysis was used to check for demographic and other characteristics with the potential to confound a true association between risk factors and infection. Results: The mean age was 62.1 years, and 314 patients were female patients. Of the patients, 18 (4%) had an acute infection. The factors that correlated with infection were length of surgery (OR, 1.009; P = .05), preoperative skin preparation with chlorhexidine gluconate (OR, 0.13; P = .008), and prophylactic antibiotic (OR, 10.73; P = .03). The delay to surgery was close to achieving significance (OR, 1.71; P = .06). Conclusion: This study suggests that washing the shoulder with chlorhexidine gluconate and avoiding the use of first-generation cephalosporin in favor of more effective prophylactic therapy are effective at reducing the risk of infection after treatment for proximal humeral fractures. [Copyright &y& Elsevier]

• The COVID-19 crisis has uncovered critical shortages of medical supplies. • Halyard H600 respirator masks have been proposed as N95 alternatives. • Halyard H600 does not meet N95 standards. The use of surgical sterilization wrap for respirator masks during the COVID-19 crisis has become a popularized personal protective equipment alternative option due to claims supporting its ability to meet N95 standards. This study sought to assess these claims using standardized filter testing. The tested material failed to meet N95 standards and suggests its use may place medical personnel at increased risk of harm when managing COVID-19 patients. [ABSTRACT FROM AUTHOR]

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Abstract: Background: In the Western world, hepatocellular carcinoma seldom develops in patients without cirrhosis, and reports describing the characteristics of non-cirrhotic patients with hepatocellular carcinoma are rather infrequent. Methods: We evaluated the main clinical characteristics, treatment options, and survival of patients with hepatocellular carcinoma developed in non-cirrhotic liver among the 3027 consecutive cases of hepatocellular carcinoma accrued in the Italian Liver Cancer database during the last 20 years. Results: We identified 52 patients with hepatocellular carcinoma in non-cirrhotic livers (1.7% of all hepatocellular carcinomas), 42 with (80.8%) and 10 without (19.2%) chronic liver disease. In patients without chronic liver disease, median tumour diameter was greater compared to patients with chronic liver disease (7.8 versus 4.0cm, P =0.046). Curative treatment was feasible in 20 patients (38.5%). Median overall survival was 26 months and 5-year survival rate was 23.7%. Detection of hepatocellular carcinoma outside surveillance (P =0.036), advanced hepatocellular carcinoma stage (P <0.0001), and non-curative treatment (P =0.007) were associated with worse prognosis, but tumour stage was the only independent predictor of survival. Conclusions: In Italy, less than 2% of hepatocellular carcinomas develop in a non-cirrhotic liver, and almost never in a normal liver. These patients frequently present with advanced tumours, have low eligibility rates for curative treatment, and have a dismal prognosis despite their preserved liver function. [Copyright &y& Elsevier]

Abstract: In this work we study a particular way of dealing with interference in combinatorial optimization models representing wireless communication networks. In a typical wireless network, co-channel interference occurs whenever two overlapping antennas use the same frequency channel, and a less critical interference is generated whenever two overlapping antennas use adjacent channels. This motivates the formulation of the minimum-adjacency vertex coloring problem which, given an interference graph representing the potential interference between the antennas and a set of prespecified colors/channels, asks for a vertex coloring of minimizing the number of edges receiving adjacent colors. We propose an integer programming model for this problem and present three families of facet-inducing valid inequalities. Based on these results, we implement a branch-and-cut algorithm for this problem, and we provide promising computational results. [Copyright &y& Elsevier]

Abstract: Given a graph G and an integer k, the maximum edge subgraph problem consists in finding a k-vertex subset of G such that the number of edges within the subset is maximum. This NP-hard problem arises in the analysis of cohesive subgroups in social networks. In this work we study the polytope associated with a straightforward integer programming formulation of the maximum edge subgraph problem. We characterize the graph generated by and give a tight bound on its diameter. We give a complete description of , where is the star on vertices, and we conjecture a complete description of , where is the graph composed by m disjoint edges. Finally, we introduce three families of facet-inducing inequalities for , which generalize known families of valid inequalities for this polytope. [Copyright &y& Elsevier]

Abstract: One of the most challenging tasks within the planning of a demographic census is to partition each census track into sets of homes such that each census taker visits exactly one set from this partition. In this work we introduce the home segmentation problem, which consists in designing such a partition subject to specific constraints. We present an integer programming-based algorithm for this problem, and we report the application of this algorithm for the 2010 census in the main province in Argentina. [Copyright &y& Elsevier]

Abstract: We address the problem of existence of an envy-free distribution of pieces among two or more players in the cake-cutting setting with the minimum number of cuts. Our cakes are discrete in the sense that the playersʼ valuations are concentrated on atoms. These atoms are placed on an interval and no two players give positive value to atoms placed at the same position. We prove the existence of an envy-free allocation for any discrete cake and any number of players by resorting to Spernerʼs Lemma, a suitable triangulation, and moving-knife arguments. Our results also apply to pies, which are defined over circumferences instead of intervals. [Copyright &y& Elsevier]

Abstract: A coloring of a graph G is an assignment of colors to the vertices of G such that any two vertices receive distinct colors whenever they are adjacent. An acyclic coloring of G is a coloring such that no cycle of G receives exactly two colors, and the acyclic chromatic number of a graph G is the minimum number of colors in any such coloring of G. Given a graph G and an integer k, determining whether or not is NP-complete even for . The acyclic coloring problem arises in the context of efficient computations of sparse and symmetric Hessian matrices via substitution methods. In this work we study the disjunctive rank of six facet-inducing families of valid inequalities for the polytope associated to a natural integer programming formulation of the acyclic coloring problem. We also introduce the concept of disjunctive anti-rank and study the anti-rank of these families. [Copyright &y& Elsevier]

Abstract: In this work we consider the single-item single-machine lot-sizing problem with continuous start-up costs. A continuous start-up cost is generated in a period whenever there is a nonzero production in the period and the production capacity in the previous period is not saturated. This concept of start-up does not correspond to the standard (discrete) start-up considered in previous models, thus motivating a polyhedral study of this problem. We introduce a natural integer programming formulation for this problem, we study some general properties and facet-inducing inequalities of the associated polytope, and we state relationships with known lotsizing polytopes. [Copyright &y& Elsevier]

Objectives To analyze the frequency of the different clinical presentations of the disease in women with HELLP syndrome and the most important factors that can predict a different maternal and fetal outcome. Study design This is a cross-sectional, consecutive, case-series study, the subjects being all patients with HELLP syndrome admitted to our Hospital within the last decade (1999-2009). Results The rate of maternal complications was 43.0% and perinatal mortality 14.1%. The severity of the syndrome, measured by The Mississippi Classification, influenced the rate of maternal complications but not fetal mortality: the rate of maternal complications among women in class 1 HELLP syndrome was 67.6%, compared to 49.3% in class 2 and 24.0% in class 3 HELLP syndrome, p<0.0001. In a 21.8% of women, the onset of the disease was after delivery. We highlight the fact that those cases with an early puerperium onset of the disease were those with a higher number of maternal complications (odds ratio: 2.38; CI: 1.05-5.44). Conclusions These results suggest the possibility of an increased complication rate when the onset of the syndrome appears after delivery and the necessity of having a high grade of suspicion in every case to diagnose the disease, even when the gestation and delivery were normal. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: To analyze the frequency of the different clinical presentations of the disease in women with HELLP syndrome and the most important factors that can predict a different maternal and fetal outcome. Study design: This is a cross-sectional, consecutive, case-series study, the subjects being all patients with HELLP syndrome admitted to our Hospital within the last decade (1999–2009). Results: The rate of maternal complications was 43.0% and perinatal mortality 14.1%. The severity of the syndrome, measured by The Mississippi Classification, influenced the rate of maternal complications but not fetal mortality: the rate of maternal complications among women in class 1 HELLP syndrome was 67.6%, compared to 49.3% in class 2 and 24.0% in class 3 HELLP syndrome, p <0.0001. In a 21.8% of women, the onset of the disease was after delivery. We highlight the fact that those cases with an early puerperium onset of the disease were those with a higher number of maternal complications (odds ratio: 2.38; CI: 1.05–5.44). Conclusions: These results suggest the possibility of an increased complication rate when the onset of the syndrome appears after delivery and the necessity of having a high grade of suspicion in every case to diagnose the disease, even when the gestation and delivery were normal. [Copyright &y& Elsevier]

Abstract: The purpose of this study was to evaluate central (carotid) artery blood pressure (BP) in endurance athletes. Carotid-femoral (= aortic) pulse wave velocity (PWV) together with radial and carotid tonometry and pulse wave analysis were performed at rest in 30 endurance athletes and 30 sedentary controls, all males matched for age, height, brachial systolic BP (SBP), and diastolic BP. Whereas brachial BP was similar in the two groups, carotid SBP and pulse pressure (PP) were higher in endurance athletes than in controls irrespective of age (123.1 ± 2.17 vs. 110.2 ± 1.29 mm Hg, and 50.9 ± 1.95 vs. 34.1 ± 1.01 mm Hg; P < .0001 for both). PP amplification evaluated from the brachial/carotid PP ratio was lower in athletes than in controls (1.05 ± 0.04 vs. 1.40 ± 0.02; P < .0001). When compared with controls, athletes had lower PWV (7.81 ± 0.17 vs. 9.8 ± 0.23 m/second; P < .0001), higher reflected wave transit time/left ventricular ejection time ratio (P = .02), and lower heart rate (52.03 ± 1.54 vs. 68.9 ± 1.72 beats/minute; P < .0001). When matched for brachial BP, central SBP and PP were higher in endurance athletes than in sedentary controls. The possible negative pathophysiological impact of increased central BP on the overall favorable effects of training deserves further study. [Copyright &y& Elsevier]

Background & Aims: Patients with advanced liver disease often undergo invasive procedures, so the combination of thrombocytopenia, coagulopathy, and bleeding should be carefully assessed. We evaluated the prevalence of thrombocytopenia in a series of patients with liver cirrhosis who were being evaluated for orthotopic liver transplantation (OLT) and determined the number of invasive procedures and procedure-related incidences of bleeding in patients with thrombocytopenia. Methods: We studied 121 consecutive patients who were being evaluated for OLT. Thrombocytopenia was defined as a platelet count <150,000/μL and severe thrombocytopenia as a platelet count <75,000/μL. The presence of significant coagulopathy was defined as an international normalized ratio >1.5. Invasive procedures and incidences of procedure-related bleeding were recorded for each patient. Results: The prevalence of thrombocytopenia and severe thrombocytopenia were 84% and 51%, respectively. Among the 102 thrombocytopenic patients, 50 (49%) underwent an invasive procedure (32 with severe thrombocytopenia; 64%). Bleeding occurred in 10 of the patients who underwent an invasive procedure (20%). Among the 50 patients who underwent invasive procedure, 32 had severe thrombocytopenia and 18 had moderate thrombocytopenia. Bleeding occurred in 10 of the 32 patients (31%) with severe thrombocytopenia and in none of those with moderate thrombocytopenia. There was no difference in prevalence of significant coagulopathy between patients with severe thrombocytopenia who underwent invasive procedure and bled (3/10; 30%) and those who did not bleed (10/22; 45%). Conclusions: Thrombocytopenia has a high prevalence among patients with advanced liver disease. Bleeding related to invasive procedures occurs most frequently in patients with severe thrombocytopenia, whereas significant coagulopathy does not seem to be associated with bleeding. [ABSTRACT FROM AUTHOR]

Abstract: The study of cohesive subgroups is an important aspect of social network analysis. Cohesive subgroups are studied using different relaxations of the notion of clique in a graph. For instance, given a graph and an integer k, the maximum edge subgraph problem consists in finding a k-vertex subset such that the number of edges within the subset is maximum. This work proposes a polyhedral approach for this NP-hard problem. We study the polytope associated to an integer programming formulation of the problem, present several families of facet-inducing valid inequalities, and discuss the separation problem associated to these families. [Copyright &y& Elsevier]