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BackgroundHealthcare workers (HCW) are at increased risk of being infected with SARS-CoV-2, yet limited information is available on risk factors of infection.MethodsWe pooled data on occupational surveillance of 10,654 HCW who were tested for SARS-CoV-2 infection in six Italian centers. Information was available on demographics, job title, department of employment, source of exposure, use of personal protective equipment (PPE), and COVID-19-related symptoms. We fitted multivariable logistic regression models to calculate odds ratios (OR) and 95% confidence intervals (CI).FindingsThe prevalence of infection varied across centers and ranged from 3.0% to 22.0%, being strongly correlated with that of the respective areas. Women were at lower risk of infection compared to men. Fever, cough, dyspnea and malaise were the symptoms most strongly associated with infection, together with anosmia and ageusia. No differences in the risk of infection were detected between job titles, or working in a COVID-19 designated department. Reported contact with a patient inside or outside the workplace was a risk factor. Use of a mask was strongly protective against risk of infection as was use of gloves. The use of a mask by the source of exposure (patient or colleague) had an independent effect in reducing infection risk.

To evaluate the reliability of a conometric system for fixed retention of complete prostheses (CPs) on four implants after 5 years of function.Twenty-five patients with a completely edentulous mandible received four implants supporting a CP. A total of 100 implants were immediately loaded with CPs on conometric abutments. A follow-up of 5 years was observed for each patient. Outcome measures were prosthesis and implant success, complications, probing pocket depth changes, marginal bleeding and plaque changes, and patient satisfaction.One patient dropped-out. In total, 96 implants supporting the 24 CPs completed the follow-up examination at 5 years. No implant failed. Two framework fractures occurred after 4 and 5 years of function. No loss of retention was recorded for the CPs. Mucositis was recorded for two implants after 1 year of prostheses function for two patients, for one implant after 3 years and for two implants after 4 years in different patients and successfully treated with interceptive supportive therapy. No significant differences were found between Plaque Index (PI) at baseline and after 2 years (P = 1.0); similar findings were calculated between PI at baseline and after 5 years (P = 0.6) of function. At baseline, after 2 and after 5 years, respectively, 69%, 64% and 56% of implants showed a PI of 0; 31%, 36% and 44% of implants showed a PI between 1 and 3. Modify Bleeding Index (MBI) was not significantly different both between baseline and after 2 years of function (P = 1.0) and between baseline and 5 years of function (P = 0.5). At baseline, after 2 and after 5 years, respectively, 69%, 65% and 61% of implants showed a MBI of 0; 27%, 28% and 29% of implants showed a MBI of 1; and 4%, 7% and 10% of implants showed a MBI of 2. The mean probing pocket depth was 1.2 ± 0.4 mm at baseline, 1.2 ± 0.4 mm after 2 years and 1.4 ± 0.5 mm after 5 years of function. The differences were not statistically significant between baseline and 2 years (P = 1.0) and between baseline and 5 years (P = 0.1). From the patient satisfaction questionnaire, 85% percent of patients were satisfied from both aesthetic and functional points of view after 5 years of conometric prostheses function.The present implant-supported conometric retention system can be used to give fixed retention to a CP supported by four implants. An adequate metal framework should be provided to the definitive restoration in order to avoid fractures in the long term.

We assessed the influence of clinically significant mitral regurgitation (MR) on clinical-echocardiographic response and outcome in heart failure (HF) patients treated with a biventricular defibrillator (cardiac resynchronization therapy defibrillator [CRT-D]). METHODS AND RESULTS: A total of 659 HF patients underwent successful implantation of CRT-D and were enrolled in a multicenter prospective registry (median follow-up of 15 months). Following baseline echocardiographic evaluation, patients were stratified into two groups according to the severity of MR: 232 patients with more than mild MR (Group MR+: grade 2, 3, and 4 MR) versus 427 patients with mild (grade 1) or no functional MR (Group MR-). On 6- and 12-month echocardiographic evaluation, MR was seen to have improved in the vast majority of MR+ patients, while it remained unchanged in most MR- patients. On 12-month follow-up evaluation, a comparable response to CRT was observed in the two groups, in terms of the extent of left ventricular reverse remodeling and combined clinical and echocardiographic response. During long-term follow-up, event-free survival did not differ between MR+ and MR- patients, even when subpopulations of patients with ischemic heart disease and with dilated cardiomyopathy were analyzed separately. On multivariate analysis, the only independent predictor of death from any cause was the lack of β-blocker use. CONCLUSIONS: This observational analysis supports the use of CRT-D in HF patients with clinically significant MR; MR had no major influence on patient outcome.

The risk assessment for Upper Extremities Work Related Muscle skeletal Disorders (UEWMSDs) remains a complex and open question. For professionals involved in this analysis of fundamental importance appears the use of technical/good practice norms or the guide lines produced by scientific society or association, such as for our country the guide lines published on this theme by the Italian Society of Occupational Medicine and Industrial Hygiene (SIMLII). The objective of this research was to verify and validate the multiple step method suggested by above mentioned guide lines and to compare results obtained by six analysis methods adopted (Washington State Standard, OCRA, HAL, RULA, OREGE and STRAIN INDEX (SI)).439 workstation in 17 manufactures employing 4166 workers for a total of 1396 analysis by different methods were considered, by adopting the following multiple step procedure: preliminary evaluation by Washington State method and OCRA checklist in all the working stations, RULA or HAL as first level evaluation, OREGE or SI as second level evaluation when complexity of work variables or contradictory results emerged. We have also collected data, provided by occupational physicians, about the pathologies of the upper limb. A representative sample of workers was also administered a INRS OREGE questionnaire that investigates the disorders of the upper limb, the subjective perception of risk, psychosocial factors and stress-related disturbs.The preliminary evaluation resulted negative (risk absent) in the 87% of examined work stations and by using checklist OCRA optimal-acceptable condition was found in 57% (the percentage reaches more than 90% when classes of risk absent-very low-low risk classes of the method were considered all together), by HAL in 91% of analysis, by RULA in 90%, by OREGE in 58%; by SI in 67% of examined working position. Five methods have been contemporary used for 31 working position with the following results: 58% at different degree of risk by OCRA, 13% by HAL, 19% by RULA; 13% by OREGE; 10% by SI. Among the main components of the bio mechanical risk the high frequency of working task resulted at first place for 4/5 methods and for checklist OCRA also the evaluation of recovery times. Consistent with the findings from risk assessment, the majority of reports of occupational diseases by occupational physician is localized at the wrist and workers assigned to tasks at risk not always have had occupational diseases. The role of main psychosocial factors was demonstrated in about the 15-20% of working conditions and regarded in particular the working climate, the job maintenance perspective, the time pressure and errors possibility together with the difficulty of help by colleagues and managers and stress related disturbs.The preliminary evaluation by State of Washington method appears to be an adequate instrument for identify the working condition at risk. The results of this method appears well correlated with OCRA checklist and HAL. The risk conditions were always confirmed by higher complexity methods (RULA, OREGE, SI). All the adopted methods were in a good agreement in two extreme situations: high risk or absent risk. In the degree of accordance varied on the basis of their rationale and of the role of their different components. A necessary integration of biomechanical analysis appears the evaluation of working conditions and musculoskeletal and psychological disorders collected directly from the workers and the results of health surveillance programs. The recommendations of SIMLII about the critical use of biomechanical methods and about the possible use of more than one of them considering the working characteristics have been confirmed.

Aims To analyse the effectiveness of cardiac resynchronization therapy (CRT) in patients with valvular heart disease (a subset not specifically investigated in randomized controlled trials) in comparison with ischaemic heart disease or dilated cardiomyopathy patients. Methods and results Patients enrolled in a national registry were evaluated during a median follow-up of 16 months after CRT implant. Patients with valvular heart disease treated with CRT ( n = 108) in comparison with ischaemic heart disease ( n = 737) and dilated cardiomyopathy ( n = 635) patients presented: (i) a higher prevalence of chronic atrial fibrillation, with atrioventricular node ablation performed in around half of the cases; (ii) a similar clinical and echocardiographic profile at baseline; (iii) a similar improvement of LVEF and a similar reduction in ventricular volumes at 6–12 months; (iv) a favourable clinical response at 12 months with an improvement of the clinical composite score similar to that occurring in patients with dilated cardiomyopathy and more pronounced than that observed in patients with ischaemic heart disease; (v) a long-term outcome, in term of freedom from death or heart transplantation, similar to patients affected by ischaemic heart disease and basically more severe than that of patients affected by dilated cardiomyopathy. Conclusion In ‘real world’ clinical practice, CRT appears to be effective also in patients with valvular heart disease. However, in this group of patients the outcome after CRT does not precisely overlap any of the two other groups of patients, for which much more data are currently available.

Background: Few data exist on the long-term changes and the prognostic value of heart rate variability (HRV) assessed by implanted devices in heart failure (HF) patients treated with resynchronization therapy (CRT). Aims: To analyze the long-term changes in the standard deviation of 5-minute median atrial–atrial sensed intervals (SDANN), and assess its role in predicting CRT efficacy and major cardiovascular events. Methods and results: We included 509 consecutive patients implanted with CRT devices. At 12-month follow-up, 44 patients had died and 86 patients had at least one HF hospitalisation. A significant increase in SDANN occurred after 4 weeks of CRT (from 69±22 ms to 82±27 ms, p

Summary. Background: A prolonged treatment with oral anticoagulants has been claimed to reduce the incidence of newly diagnosed cancer in the long-term follow-up of patients with venous thromboembolism. Objectives: In a multicenter prospective study we assessed the incidence of newly diagnosed clinically overt cancer in patients with a first episode of idiopathic venous thromboembolism (VTE) treated with oral anticoagulants for 3 months or 1 year. Patients and methods: Consecutive patients with an idiopathic venous thromboembolism who had completed 3 months of oral anticoagulant therapy without having a recurrence, bleeding or newly diagnosed cancer were randomized to discontinue oral anticoagulant therapy or to continue it for nine additional months. Idiopathic venous thromboembolism was defined as thrombosis occurring in the absence of known cancer, known thrombophilia, or temporary risk factors for venous thromboembolism. All patients were followed up for at least 1 year after randomization. Results: A total of 429 patients, 265 patients with DVT and 164 with PE, were followed up for an average of 43.7 months after randomization. A newly diagnosed cancer occurred in 32 patients (7.5%), 13 (6.2%) of the 210 patients treated for 3 months and 19 (8.7%) of the 219 patients treated for 1 year (RR = 0.71, 95% confidence interval 0.36–1.41). Conclusions: The incidence of newly diagnosed clinically overt cancer is not reduced in patients with idiopathic venous thromboembolism treated with 1-year anticoagulant treatment compared with patients treated for 3 months.

Purpose: Generator impedance (Im) mapping with constant contact force (CF) by tip catheter at PV isolation (PVI) was assessed for a proposal of tissue characterization at PV-LA junction (PV-LAJ). Methods: In this observational, prospective, single-center study, Im mapping at constant CF = 10g (± 2g) was performed before PVI at PV-LAJ. PV in-vein, PV ostium (PVos), and antrum (PVan) contours were manually traced based on the 3D electroanatomic map (3DEAM) integrating intracardiac echocardiography and computerized tomography. PVan contour-methods based on Im mapping was defined on 3DEAM as the atrial-like Im contour closest to PVos, and its distance from anatomical PVan contour > 5mm was assumed as the non-concordance marker between contour and methods. Results: Sixty-two patients (62 ± 9years; 43 males) were enrolled, and 244 PV-LAJ were assessed. From in-vein PV to LA and, less prominently, from PVos to PVan and LA, Im showed a unidirectional decrease with highly variable individual-specific distribution and values. PVan non-concordance was found in 59/665 segments (8.8%), 18% of PV-LAJs, and 53% of pts; it prevailed in superior PV-LAJ and measured on average 7.2 ± 1.1mm. Im decrease patterns and non-concordance were not associated with any clinical or anatomical feature, including PV dimensions and shape. Conclusions: Im mapping of LA-PVJ at constant CF added to 3DEAM may consistently track the tissue transition from PV to LA. PVan identified by Im was often located more toward LA than the 3D anatomical PVan, particularly in LSPV, suggesting the potential advantage of avoiding ablation of venous-like tissue. Im mapping can deserve further investigation for target characterization at LA-PVJ.

Objectives: Solitary plasmacytoma (SP) is characterized by a single mass of clonal plasma cells. Definitive RT can result in long-term local control of the SP. Due to the small number of patients and narrow range of doses, phase III randomized trials are lacking. The aim of this study is to further support the potential use of RT for the treatment of SP. Methods: Clinical data of all patients treated for SP at our Institution between 1992 and 2018 were reviewed. A total of 42 consecutive patients were analyzed. Results: The median follow-up was 84.8months. Radiation dose did not differ significantly as a function of sex, type of SP (solitary bone plasmacytoma or as extramedullary plasmacytoma), tumor size; conversely differs significantly as a function of age (p = 0.04). The 5y-OS and 10y-OS were, respectively, 96 and 91%. Local recurrences developed in 21.4% of patients (9/42). 16 patients progressed to MM (38.1%). The 5y-progression to MM free survival (PMFS) and the 10y-PMFS were, respectively, 68.6 and 61.9%. Conclusions: Our data confirm that good results are achievable with RT to treat SP, but they don’t allow defining a dose–effect correlation; therefore, it remains uncertain which is the most effective dose and whether lower doses can guarantee adequate disease control.

We carryied out a meta-analysis of studies on exposure to polychlorinated biphenyls (PCBs) and risk of non-Hodgkin lymphoma (NHL). Through a systematic search of the literature, we identified relative risks (RRs) for PCB exposure and NHL risk in 30 populations (10 occupational exposure, seven high environmental exposure, 13 without special exposure). We performed random effects meta-analyses for exposure to all PCBs, specific PCB congeners and risk of all NHL and NHL subtypes. The meta-RR for studies of occupational exposure, high environmental exposure, and no special exposure were 0.94 [95% confidence interval (CI): 0.84-1.03], 1.05 (95% CI: 0.94-1.16), and 1.03 (95% CI: 0.72-1.34), respectively, and the cumulative meta-RR was 0.96 (95% CI: 0.85-1.07). No positive associations were found for exposure to specific congeners, nor for NHL subtypes. The meta-RR for an increase of 100 ppb serum or fat PCB level was 1.02 (95% CI: 1.00-1.04). There was weak indication of publication bias. Our meta-analysis found no association between PCB exposure and NHL risk, in particular in studies of occupational exposures. We detected a weak dose-response relation; the possibility of residual confounding and other sources of bias cannot be ruled out. PCBs are not likely to cause NHL in humans.

The aim of this study was to carry out a meta-analysis of studies on exposure to polychlorinated biphenyls (PCBs) and the risk of malignant melanoma (MM). We searched Scopus, PubMed, and reference lists; among 807 potentially relevant articles, we selected those based on 12 populations. Data were extracted according to a standardized form; the Newcastle-Ottawa Scale was used to assess study quality. Meta-analyses were carried out according to fixed-effect and random-effects models. The fixed-effect summary relative risk (RR) for MM was 0.91 [95% confidence interval (CI): 0.82-1.00]; the random-effects summary RR was 1.05 (95% CI: 0.78-1.32). The random-effects summary RR from eight occupational cohorts was 1.13 (95% CI: 0.91-1.35) and that from four community-based studies was 0.84 (95% CI: 0.36-1.31). The quality of the studies and the methods for PCB exposure assessment did not influence the RR. These results do not support the hypothesis of an association between PCB exposure and the risk of MM. © 2017 Wolters Kluwer Health, Inc. All rights reserved.

Boron neutron capture therapy (BNCT) is a radiotherapy treatment based on the accumulation in the tumor of a 10 B-containing drug and subsequent irradiation with low energy neutrons, which bring about the decay of 10 B to 7 Li and an α particle, causing the death of the neoplastic cell. The effectiveness of BNCT is limited by the low delivery and accumulation of the used boron-containing compounds. Here we report the development and the characterization of BPO 4 nanoparticles (NPs) as a novel possible alternative drug for BNCT. An extensive analysis of BPO 4 NP biocompatibility was performed using both mature blood cells (erythrocytes, neutrophils and platelets) and a model of hematopoietic progenitor cells. A time- and concentration-dependent cytotoxicity study was performed on neoplastic coloncarcinoma and osteosarcoma cell lines. BPO 4 functionalization with folic acid, introduced to improve the uptake by tumor cells, appeared to effectively limit the unwanted effects of NPs on the analyzed blood components. From the Clinical Editor Boron neutron capture therapy (BNCT) is a radiotherapy treatment modality based on the accumulation of a 10 B-containing drug and subsequent irradiation with low energy neutrons, inducing the decay of 10 B to 7 Li and an α particle, causing neoplastic cell death. This team of authors reports on a folic acid functionalized BPO 4 nanoparticle with improved characteristics compared with conventional BNCT approaches, as demonstrated in tumor cell lines, and hopefully to be followed by translational human studies.

Background Prediction of response to cardiac resynchronization therapy (CRT) is still an unsolved major issue. The interface between left ventricular mechanics, coronary sinus (CS) lead, and pacing delivery has been little investigated. Objective To investigate CS lead tip movements at baseline and during biventricular pacing (BiV) in the hypothesis that they could provide some insights into left ventricular mechanical behavior in CRT. Methods Three-dimensional reconstruction of CS lead tip trajectory throughout the cardiac cycle using a novel fluoroscopy-based method was performed in 22 patients with chronic heart failure (19 men; mean age 70 ± 10 years). Three trajectories were computed: before (T −1 ) and immediately after (T 0 ) BiV start-up and after 6 months (T 1 ). CRT response was the echocardiographic end-systolic volume reduction ≥15% at T 1 . Metrics describing trajectory at T 0 , T −1 , and T 1 were compared between 9 responders (R) and 13 nonresponders (NR). Results At T −1 trajectories demonstrated heterogeneous shapes and metrics, but at T 0 the variations in the ratio between the two main axes (S 1 /S 2 ) and in the eccentricity were statistically different between R and NR, pointing out a trajectory's change toward a significantly more circular shape at BiV start-up in R. Remarkably, R and NR could be completely separated by means of the percent variation in S 1 /S 2 from T −1 to T 0 (R: 47.5% [31.5% to 54.1%] vs NR: −25.6% [−67% to −6.5%]). This single marker computed at T 0 would have predicted CRT response at T 1 . Conclusions Preliminary data showed that CS lead tip trajectory changes induced by BiV were related to mechanical resynchronization.

Atrial fibrillation (AF) is associated with a fivefold increase in the risk of cerebrovascular events, being responsible of 15–18% of all strokes. The morphological and functional remodeling of the left atrium (LA) caused by AF favors blood stasis and, consequently, stroke risk. In this context, several clinical studies suggest that the stroke risk stratification could be improved by using hemodynamic information on the LA and the left atrial appendage (LAA). The goal of this study was to develop a personalized computational fluid dynamics (CFD) model of the LA which could clarify the hemodynamic implications of AF on a patient-specific basis. In this paper, we present the developed model and its application to two AF patients as a preliminary advancement toward an optimized stroke risk stratification pipeline.

Dental implants are installed in an increasing number of patients. Mucositis and peri-implantitis are common microbial–biofilm-associated diseases affecting the tissues that surround the dental implant and are a major medical and socioeconomic burden. By metagenomic sequencing of the plaque microbiome in different peri-implant health and disease conditions (113 samples from 72 individuals), we found microbial signatures for peri-implantitis and mucositis and defined the peri-implantitis-related complex (PiRC) composed by the 7 most discriminative bacteria. The peri-implantitis microbiome is site specific as contralateral healthy sites resembled more the microbiome of healthy implants, while mucositis was specifically enriched for Fusobacterium nucleatum acting as a keystone colonizer. Microbiome-based machine learning showed high diagnostic and prognostic power for peri-implant diseases and strain-level profiling identified a previously uncharacterized subspecies of F. nucleatum to be particularly associated with disease. Altogether, we associated the plaque microbiome with peri-implant diseases and identified microbial signatures of disease severity.