CT volume of enhancement of disease (VED) can predict the early response to treatment and overall survival in patients with advanced HCC treated with sorafenib.

OBJECTIVES: To analyse the predictive value of the volume of enhancement of disease (VED), based on the CT arterial enhancement coefficient (ΔArt%), in the evaluation of the sorafenib response in patients with advanced hepatocellular carcinoma (HCC). METHODS: Patients with sorafenib-treated advanced HCC, who underwent a multiphase contrast-enhanced CT before (T0) and after 60-70 days of starting therapy (T1), were included. The same target lesions utilised for the response evaluation according to modified Response Evaluation Criteria in Solid Tumors criteria were retrospectively used for the ΔArt% calculation ([(HUarterial phase - HUunenhanced phase) / HUunenhanced phase] × 100). ΔArt% was weighted for the lesion volume to obtain the VED. We compared VEDT0 and VEDT1 values in patients with clinical benefit (CB) or progressive disease (PD). The impact of VED, ancillary imaging findings, and blood chemistries on survival probability was evaluated. RESULTS: Thirty-two patients (25 men, mean age 65.8 years) analysed between 2012 and 2016 were selected. At T1, 8 patients had CB and 24 had PD. VEDT0 was > 70% in 8/8 CB patients compared with 12/24 PD patients (p = 0.011). Patients with VEDT0 > 70% showed a significantly higher median survival than those with lower VEDT0 (451.5 days vs. 209.5 days, p = 0.032). Patients with VEDT0 > 70% and alpha-fetoproteinT0 ≤ 400 ng/ml had significantly longer survival than all other three combinations. In multivariate analysis, VEDT0 > 70% emerged as the only factor independently associated with survival (p = 0.037). CONCLUSION: In patients with advanced HCC treated with sorafenib, VED is a novel radiologic parameter obtained by contrast-enhanced CT, which could be helpful in selecting patients who are more likely to respond to sorafenib, and with a longer survival. KEY POINTS: • To achieve the best results of treatment with sorafenib in advanced HCC, a strict selection of patients is needed. • New radiologic parameters predictive of the response to sorafenib would be essential. • Volume of enhancement of disease (VED) is a novel radiologic parameter obtained by contrast-enhanced CT, which could be helpful in selecting patients who are more likely to respond to therapy, and with a longer survival.

Characterization of raft-forming alginate suspensions formed in HCl or model food systems at varying pH levels to better simulate gastric postprandial conditions.

OBJECTIVE: Elucidate properties of raft-forming alginates in vitro with varying composition, a system in which the raft was formed (HCl solution; tomato soup; protein-rich beverage), and pH levels for a more accurate representation of postprandial gastric conditions. SIGNIFICANCE: Knowledge of the impact of the food system and pH on properties of raft-forming alginates may aid in formulation optimization. Recommendations may be made on food that is consumed prior to their consumption to optimize efficacy as a therapeutic agent. METHODS: Dispersions of sodium alginate, calcium carbonate, and sodium bicarbonate were prepared with levels similar to commercial formulations. Rafts were formed in HCl solution, tomato soup, and a protein-rich beverage at pH 1-4 to assess raft properties. RESULTS: Significant differences (p < 0.05) in raft mass, strength, resilience, and ability to buffer acid were observed depending on the system in which the rafts were formed. The highest mass was obtained in tomato soup (48.5 ± 9.8 g) compared to the protein-rich beverage and HCl solution (32.5 ± 4.5 g and 23.4 ± 4.8 g, respectively) at pH 1. Rafts formed in the protein-rich beverage exhibited the highest strength. Rafts formed in both food systems had a greater ability to buffer added acid compared to rafts formed in HCl solution. CONCLUSIONS: In vitro testing of raft forming alginates in HCl solution at low pH may not be sufficient to describe in vivo events, as a strong matrix effect was observed when rafts were formed in model meal systems at representative postprandial pH levels.

Recycling agricultural, municipal and industrial pollutant wastes into fertilizers for a sustainable healthy food production.

This work was focused on recycling different typology of pollutant wastes (olive pomace and orange residues; municipal wastes and sulphur residue of hydrocarbon refining processes) with the triple objectives of limiting wastes in landfill, reducing greenhouse gas emission and producing organic-mineral fertilizers. The environmental risks and benefits of the whole process have been considered. The specific objectives were: 1) innovation in waste management techniques by reducing the accumulation of different typology of wastes using a unique process 2) verifying efficiency of the obtained organic-mineral fertilizers on soil and plant growth 3) improving soil and crop quality relating wastes to food, economy and environment. Sulphur-based pads improved soil quality mostly when contained orange residues. Onion and Garlic grew better in presence of sulphur-based pads (+20%), and mostly when pads contained orange residues (+45%). Onion and Garlic quality, in terms of antioxidant compounds and antioxidant capacity, increased in presence of sulphur-based pads (+30%) mostly when orange residues were present in the pads (+90%). In short, in addition to the environmental advantages, numerous economic benefits coming from the decrease in the production and use of chemical fertilizers, the reduction of costs for landfilling and the gain rising from the sale of the new fertilizers produced, emerged.

Enhancing the nutritional value of sweet bell pepper through moderate NaCl salinity.

Salinity presents a significant obstacle to crop productivity, particularly in dry and semi-arid regions. Sweet bell pepper (Capsicum annuum L.), a widely grown and consumed horticultural crop, is especially vulnerable to salinity. Consequently, it is vital to determine the salinity threshold that impacts bell pepper growth and quality, enabling sustainable production in salinized areas. This study aimed to evaluate the effects of varying sodium chloride concentrations (0, 50, and 75 mM) on bell pepper growth, nutritional value, and phytochemical composition, aiming to identify the adaptable threshold in salinized environments. The results suggested that the application of 75 mM NaCl not only had no adverse impact on fruit quality in terms of biomolecules and phytochemicals but also led to significant improvements. Specifically, under these conditions, there was a remarkable increase, in respect to control, in total protein (TPRO by 50 %), total carbohydrates (TCARB by 18 %), lycopene (LIC by 68 %), total Carotenoids (TCAR by 13 %), and total phenols (TPHE by 18 %) in terms of antioxidants.In contrast, the content of ascorbic acid and antioxidant activities remained consistent. Moderate salt stress exhibited the most positive influence on sweet bell pepper quality, leading to higher concentrations of essential nutrients and nutraceutical compounds, including minerals, phenolic acids, and flavonoids.

Detection of carbapenemase- and ESBL-producing Klebsiella pneumoniae from bovine bulk milk and comparison with clinical human isolates in Italy.

Klebsiella pneumoniae is the most common Klebsiella species infecting animals and is one of the causing agents of mastitis in cows. The rise of antimicrobial resistance in K. pneumoniae, particularly in strains producing extended-spectrum ß-lactamases (ESBLs) and/or carbapenemases, is of concern worldwide. Recently (Regulation UE No 2022/1255), carbapenems and cephalosporins in combination with ß-lactamase inhibitors have been reserved only to human treatments in the European Union. The aim of this study was to investigate the role of cattle as carrier of human pathogenic carbapenem-resistant (CR) and ESBL-producing K. pneumoniae. On this purpose, a study involving 150 dairy farms in Parma province (Northern Italy) and 14 non replicate K. pneumoniae isolates from patients admitted at Parma University-Hospital was planned. Four multidrug resistant (MDR) K. pneumoniae strains were detected from 258 milk filters collected between 2019 and 2021. One carbapenemase KPC-3-positive K. pneumoniae ST307 (0.4 %; 95 % CI - 0.07 - 2.2) was detected in milk filters. The isolate also harboured OXA-9, CTX-M-15 and SHV-106 determinants, together with genes conferring resistance to aminoglycosides (aac(3')-IIa, aph (3″)-Ib, aph (6)-Id), fluoroquinolones (oqxA, oqxB, qnrB1), phosphonic acids (fosA6), sulphonamides (sul2), tetracyclines (tet(A)6) and trimethoprim (dfrA14). One KPC-3-producing K. pneumoniae ST307 was identified also among the human isolates, thus suggesting a possible circulation of pathogens out of the clinical settings. The remaining three bovine isolates were MDR ESBL-producing K. pneumoniae characterized by different genomic profiles: CTX-M-15, TEM-1B and SHV-187 genes (ST513); CTX-M-15 and SHV-145 (ST307); SHV-187 and DHA-1 (ST307). Occurrence of ESBL-producing K. pneumoniae in milk filters was 1.2 % (95 % CI 0.4-3.4). All the isolates showed resistance to aminoglycosides, 3rd-generation cephalosporins, and fluoroquinolones. Among the human isolates, two multidrug resistant ESBL-producing K. pneumoniae ST307 were found, thus confirming the circulation of this high-risk lineage between humans and cattle. Our findings suggest that food-producing animals can carry human pathogenic microorganisms harboring resistance genes against carbapenems and 3rd-generation cephalosporins, even if not treated with such antimicrobials. Moreover, on the MDR K. pneumoniae farms, the antimicrobial use was much higher than the Italian median value, thus highlighting the importance of a more prudent use of antibiotics in animal productions.

Terrestrial records of deglaciation events during terminations V and IV in the central Apennines (Italy) and insights on deglacial mechanisms.

40Ar/39Ar geochronology constraints to aggradational phases and grain size variations show that the two large gravel beds occurring in the sedimentary filling of the Liri fluvial-lacustrine basin (central Italy) recorded the occurrence of deglaciation events synchronous within uncertainties with global meltwater pulses at ca. 450 and 350 ka. In particular, we find a precise match between the ages of gravel deposition and the occurrence of moderate sea-level rise events which anticipate those more marked during the glacial termination V and IV in the Red Sea relative sea level curve, as already verified by data from the Tiber River catchment basin. Such correspondence suggests that gravel deposition is facilitated by melting of Apennine mountain range glaciers, which provide the water transport energy and a surplus of clastic input to the rivers draining the mountain regions and flowing into the Tyrrhenian Sea. Therefore, the thick gravel beds intercalated in the sedimentary filling of the catchment basins of the major rivers in central Italy may be regarded as an equivalent proxy of large deglaciation events, similar to the ice-rafted debris in northern Atlantic. Consistent with this hypothesis, we also show the close correspondence between the occurrence of particularly mild (warmer) minima of the mean summer insolation at 65° N and these early aggradational phases, as well as with other anomalous early sea-level rises occurring c. 750 ka and 540 ka at the onset of glacial termination VIII and VI, and 40 ka at the onset of the so-called Heinrich events.

Atezolizumab plus bevacizumab versus lenvatinib or sorafenib in non-viral unresectable hepatocellular carcinoma: an international propensity score matching analysis.

BACKGROUND: A growing body of evidence suggests that non-viral hepatocellular carcinoma (HCC) might benefit less from immunotherapy. MATERIALS AND METHODS: We carried out a retrospective analysis of prospectively collected data from consecutive patients with non-viral advanced HCC, treated with atezolizumab plus bevacizumab, lenvatinib, or sorafenib, in 36 centers in 4 countries (Italy, Japan, Republic of Korea, and UK). The primary endpoint was overall survival (OS) with atezolizumab plus bevacizumab versus lenvatinib. Secondary endpoints were progression-free survival (PFS) with atezolizumab plus bevacizumab versus lenvatinib, and OS and PFS with atezolizumab plus bevacizumab versus sorafenib. For the primary and secondary endpoints, we carried out the analysis on the whole population first, and then we divided the cohort into two groups: non-alcoholic fatty liver disease (NAFLD)/non-alcoholic steatohepatitis (NASH) population and non-NAFLD/NASH population. RESULTS: One hundred and ninety patients received atezolizumab plus bevacizumab, 569 patients received lenvatinib, and 210 patients received sorafenib. In the whole population, multivariate analysis showed that treatment with lenvatinib was associated with a longer OS [hazard ratio (HR) 0.65; 95% confidence interval (CI) 0.44-0.95; P = 0.0268] and PFS (HR 0.67; 95% CI 0.51-0.86; P = 0.002) compared to atezolizumab plus bevacizumab. In the NAFLD/NASH population, multivariate analysis confirmed that lenvatinib treatment was associated with a longer OS (HR 0.46; 95% CI 0.26-0.84; P = 0.0110) and PFS (HR 0.55; 95% CI 0.38-0.82; P = 0.031) compared to atezolizumab plus bevacizumab. In the subgroup of non-NAFLD/NASH patients, no difference in OS or PFS was observed between patients treated with lenvatinib and those treated with atezolizumab plus bevacizumab. All these results were confirmed following propensity score matching analysis. By comparing patients receiving atezolizumab plus bevacizumab versus sorafenib, no statistically significant difference in survival was observed. CONCLUSIONS: The present analysis conducted on a large number of advanced non-viral HCC patients showed for the first time that treatment with lenvatinib is associated with a significant survival benefit compared to atezolizumab plus bevacizumab, in particular in patients with NAFLD/NASH-related HCC.

Study of energetic properties of different tree organs in six Olea europaea L. cultivars.

Pruning is an important horticultural practice for the management of olive orchards (Olea europaea L.) that generates a considerable amount of residues every year. Olive orchards are increasingly expanding beyond the Mediterranean Basin to new growing Countries (Australia, California, Argentina, Chile and Uruguay) and this will certainly lead to larger availability of pruning material. Currently, the interest in use of olive tree pruning residues for energy purposes is increasing but unfortunately, the information on the differences among organs of the tree, in terms of calorific value and ash content, is scarce. Another unknown aspect is the effect of cultivar vigour on dry matter partition among different tree organs, these are important traits to establish the energetic quality of pruning residues. The aim of this research was to study energetic aspects of six olive cultivars, largely grown in the Sicilian olive industry and characterized by different vigour. The trees taken into consideration in the study were selected in an experimental orchard to avoid any effect due to differences in environmental conditions and management. The energetic characteristics, calorific value and ash content, were evaluated for the various tree organs particularly shoots, leaves and branches; also root system was evaluated, although the roots can only be used once the trees are uprooted. Significant differences were observed in the calorific values among the different tree organs and the cultivars. Regarding the ash, shoots and leaves showed the highest content with respect to the other organs, thus causing a possible tendency in slagging with fouling and corrosion of boiler components.

Identification of lenvatinib prognostic index via recursive partitioning analysis in advanced hepatocellular carcinoma.

BACKGROUND: After the advent of new treatment options for advanced hepatocellular carcinoma (HCC), the identification of prognostic factors is crucial for the selection of the most appropriate therapy for each patient. PATIENTS AND METHODS: With the aim to fill this gap, we applied recursive partitioning analysis (RPA) to a cohort of 404 patients treated with lenvatinib. RESULTS: The application of RPA resulted in a classification based on five variables that originated a new prognostic score, the lenvatinib prognostic index (LEP) index, identifying three groups: low risk [patients with prognostic nutritional index (PNI) >43.3 and previous trans-arterial chemoembolization (TACE)]; medium risk [patients with PNI >43.3 but without previous TACE and patients with PNI <43.3, albumin-bilirubin (ALBI) grade 1 and Barcelona Clinic Liver Cancer stage B (BCLC-B)]; high risk [patients with PNI <43.3 and ALBI grade 2 and patients with PNI <43.3, albumin-bilirubin (ALBI) grade 1 and Barcelona Clinic Liver Cancer stage C (BCLC-C)]. Median overall survival was 29.8 months [95% confidence interval (CI) 22.8-29.8 months] in low risk patients (n = 128), 17.0 months (95% CI 15.0-24.0 months) in medium risk (n = 162) and 8.9 months (95% CI 8.0-10.7 months) in high risk (n = 114); low risk hazard ratio (HR) 1 (reference group), medium risk HR 1.95 (95% CI 1.38-2.74), high risk HR 4.84 (95% CI 3.16-7.43); P < 0.0001. The LEP index was validated in a cohort of 127 Italian patients treated with lenvatinib. While the same classification did not show a prognostic value in a cohort of 311 patients treated with sorafenib, we also show a possible predictive role in favor of lenvatinib in the low risk group. CONCLUSIONS: LEP index is a promising, easy-to-use tool that may be used to stratify patients undergoing systemic treatment of advanced HCC.

Nonalcoholic steatohepatitis in hepatocarcinoma: new insights about its prognostic role in patients treated with lenvatinib.

BACKGROUND: Hepatocellular carcinoma (HCC) treatment remains a big challenge in the field of oncology. The liver disease (viral or not viral) underlying HCC turned out to be crucial in determining the biologic behavior of the tumor, including its response to treatment. The aim of this analysis was to investigate the role of the etiology of the underlying liver disease in survival outcomes. PATIENTS AND METHODS: We conducted a multicenter retrospective study on a large cohort of patients treated with lenvatinib as first-line therapy for advanced HCC from both Eastern and Western institutions. Univariate and multivariate analyses were performed. RESULTS: Among the 1232 lenvatinib-treated HCC patients, 453 (36.8%) were hepatitis C virus positive, 268 hepatitis B virus positive (21.8%), 236 nonalcoholic steatohepatitis (NASH) correlate (19.2%) and 275 had other etiologies (22.3%). The median progression-free survival (mPFS) was 6.2 months [95% confidence interval (CI) 5.9-6.7 months] and the median overall survival (mOS) was 15.8 months (95% CI 14.9-17.2 months). In the univariate analysis for OS NASH-HCC was associated with longer mOS [22.2 versus 15.1 months; hazard ratio (HR) 0.69; 95% CI 0.56-0.85; P = 0.0006]. In the univariate analysis for PFS NASH-HCC was associated with longer mPFS (7.5 versus 6.5 months; HR 0.84; 95% CI 0.71-0.99; P = 0.0436). The multivariate analysis confirmed NASH-HCC (HR 0.64; 95% CI 0.48-0.86; P = 0.0028) as an independent prognostic factor for OS, along with albumin-bilirubin (ALBI) grade, extrahepatic spread, neutrophil-to-lymphocyte ratio, portal vein thrombosis, Eastern Cooperative Oncology Group (ECOG) performance status and alpha-fetoprotein. An interaction test was performed between sorafenib and lenvatinib cohorts and the results highlighted the positive predictive role of NASH in favor of the lenvatinib arm (P = 0.0047). CONCLUSION: NASH has been identified as an independent prognostic factor in a large cohort of patients with advanced HCC treated with lenvatinib, thereby suggesting the role of the etiology in the selection of patients for tyrosine kinase treatment. If validated, this result could provide new insights useful to improve the management of these patients.

Genetic variation in carboxylesterase genes and susceptibility to isoniazid-induced hepatotoxicity.

Treatment of latent tuberculosis infection (LTBI) generally includes isoniazid (INH), a drug that can cause serious hepatotoxicity. Carboxylesterases (CES) are important in the metabolism of a variety of substrates, including xenobiotics. We hypothesized that genetic variation in CES genes expressed in the liver could affect INH-induced hepatotoxicity. Three CES genes are known to be expressed in human liver: CES1, CES2 and CES4. Our aim was to systematically characterize genetic variation in these novel candidate genes and test whether it is associated with this adverse drug reaction. As part of a pilot study, 170 subjects with LTBI who received only INH were recruited, including 23 cases with hepatotoxicity and 147 controls. All exons and the promoters of CES1, CES2 and CES4 were bidirectionally sequenced. A large polymorphic deletion was found to encompass exons 2 to 6 of CES4. No significant association was found. Eleven single-nucleotide polymorphisms (SNPs) in CES1 were in high linkage disequilibrium with each other. One of these SNPs, C(-2)G, alters the translation initiation sequence of CES1 and represents a candidate functional polymorphism. Replication of this possible association in a larger sample set and functional studies will be necessary to determine if this CES1 variant has a role in INH-induced hepatotoxicity.

Anomalous Last Interglacial Tyrrhenian sea levels and Neanderthal settling at Guattari and Moscerini caves (central Italy).

We present a geological-stratigraphical study aimed to provide chronologic constraints to the sea-level markers occurring at two coastal caves of central Italy (Grotta Guattari and Grotta dei Moscerini) and to the Neanderthal frequentation of these caves, in the light of recent archaeological and geomorphological-geochronological studies suggesting similar sea levels during MIS 5.5 and MIS 5.3, and only few m below the Present during MIS 5.1 in this region. Based on the review of previous literature data, combined with new stratigraphic observations at Grotta Guattari and re-analysis of archive material including unpublished field notes from Grotta dei Moscerini, we reconstruct a plausible sea-level history accounting for the lithological and paleoenvironmental features of their sedimentary fillings. In particular, we outline the abundant occurrence of well-rounded pumice clasts within the sedimentary deposits of Moscerini Cave, attesting for the proximity to the beach where this pumice was gathered by wave action. Through the petrographic and geochemical analysis of this pumice we evidence provenance from Phlegraean Fields and Ischia Island volcanic districts, framing their chronology in the time span 118-40 ka, consistent with literature ESR-U/Th dates providing ages ranging 101 ± 5-74 ± 7 ka for the sedimentary filling of both Moscerini and Guattari caves.

Fluoroquinolone use for uncomplicated urinary tract infections in women: a retrospective cohort study.

OBJECTIVES: The United States Food & Drug Administration released an advisory in 2016 that fluoroquinolones be relegated to second-line agents for uncomplicated urinary tract infections (UTIs) given reports of rare but serious side effects; similar warnings have followed from Health Canada and the European Medicines Agency. The objective was to determine whether alternative non-fluoroquinolone agents are as effective as fluoroquinolones in the treatment of UTIs. METHODS: We conducted a retrospective population-based cohort study using administrative health data from six Canadian provinces. We identified women (n = 1 585 997) receiving antibiotic treatment for episodes of uncomplicated UTIs (n = 2 857 243) between January 1 2005 and December 31 2015. Clinical outcomes within 30 days from the initial antibiotic dispensation were compared among patients treated with a fluoroquinolone versus non-fluoroquinolone agents. High-dimensional propensity score adjustments were used to ensure comparable treatment groups and to minimize residual confounding. RESULTS: Fluoroquinolone use for UTI declined over the study period in five of six Canadian provinces and accounted for 22.3-48.5% of treatments overall. The pooled effect across the provinces indicated that fluoroquinolones were associated with fewer return outpatient visits (OR 0.89, 95%CI 0.87-0.92), emergency department visits (OR 0.74, 95%CI 0.61-0.89), hospitalizations (OR 0.83, 95%CI 0.77-0.88), and repeat antibiotic dispensations (OR 0.77, 95%CI 0.75-0.80) within 30 days. CONCLUSIONS: Fluoroquinolones are associated with improved clinical outcomes among women with uncomplicated UTIs. This benefit must be weighed against the risk of fluoroquinolone resistance and rare but serious fluoroquinolone side effects when selecting first-line treatment for these patients.

Monti Sabatini and Colli Albani: the dormant twin volcanoes at the gates of Rome.

This multi-disciplinary work provides an updated assessment of possible future eruptive scenarios for the city of Rome. Seven new 40Ar/39Ar ages from selected products of the Monti Sabatini and Vulsini volcanic districts, along with a compilation of all the literature ages on the Colli Albani and Vico products, are used to reconstruct and compare the eruptive histories of the Monti Sabatini and Colli Albani over the last 900 ka, in order to define their present state of activity. Petrographic analyses of the dated units characterize the crystal cargo, and Advanced-InSAR analysis highlights active deformation in the MS. We also review the historical and instrumental seismicity affecting this region. Based on the chronology of the most recent phases and the time elapsed between the last eruptions, we conclude that the waning/extinguishment of eruptive activity shifted progressively from NW to SE, from northern Latium toward the Neapolitan area, crossing the city of Rome. Although Monti Sabatini is unaffected by the unrest indicators presently occurring at the Colli Albani, it should be regarded as a dormant volcanic district, as the time of 70 kyr elapsed since the last eruption is of the same order of the longest dormancies occurred in the past.

Unsupported Ni metal catalyst in hydrothermal liquefaction of oak wood: Effect of catalyst surface modification.

Hydrothermal liquefaction of oak wood was carried out in tubular micro reactors at different temperatures (280-330 °C), reaction times (10-30 min), and catalyst loads (10-50 wt%) using metallic Ni catalysts. For the first time, to enhance the catalytic activity of Ni particles, a coating technique producing a nanostructured surface was used, maintaining anyway the micrometric dimension of the catalyst, necessary for an easier recovery. The optimum conditions for non-catalytic liquefaction tests were determined to be 330 °C and 10 min with the bio-crude yield of 32.88%. The addition of metallic Ni catalysts (Commercial Ni powder and nanostructured surface-modified Ni particle) increased the oil yield and inhibited the char formation through hydrogenation action. Nano modified Ni catalyst resulted in a better catalytic activity in terms of bio-crude yield (36.63%), thanks to the higher surface area due to the presence of flower-like superficial nanostructures. Also, bio-crude quality resulted improved with the use of the two catalysts, with a decrease of C/H ratio and a corresponding increase of the high heating value (HHV). The magnetic recovery of the catalysts and their reusability was also investigated with good results.

Epidemiology and costs associated with genital warts in Canada.

BACKGROUND: Genital warts (condyloma acuminatum) remain one of the most commonly reported sexually transmitted infections (STI) worldwide. Most genital warts are caused by non-oncogenic human papilloma virus. Recurrence is common and many patients receive several rounds of treatment. There are limited data in the literature on the burden of illness and costs associated with genital warts at a population level. METHODS: Episodes of anogenital warts (AGW) were identified from the physician billing database, hospitalisation records and STI clinics from 1998 to 2006. To be included from the physician billing and STI databases, the person had to have a claim that had a diagnosis of condyloma acuminatum (078.11), viral warts (078.1), viral warts unspecified (078.10) or other unspecified warts (078.19), as well as one of the relevant fee codes associated with the treatment of AGW. To be included from the hospital database, the person could be of any age and have a diagnosis of AGW (A63.0), condyloma acuminatum (078.11), viral warts (078.1 or B07), viral warts unspecified (078.10) or other unspecified warts (078.19) in any of the diagnosis fields, as well as one of the relevant procedure codes associated with the treatment of AGW. RESULTS: A total of 39,493 people was diagnosed with AGW and during this period they had a total of 43,586 episodes. The average cost per episode of AGW was $C190 ($C176 for men; $C207 for women). The majority of treatment was with ablative therapy alone (98%). CONCLUSIONS: AGW are associated with a significant burden of illness and costs to the healthcare system.

Reliability of transient elastography for the diagnosis of advanced fibrosis in chronic hepatitis C.

BACKGROUND: Transient elastography (TE) has received increasing attention as a means to evaluate disease progression in patients with chronic liver disease. AIM: To assess the value of TE for predicting the stage of fibrosis. METHODS: Liver biopsy and TE were performed in 150 consecutive patients with chronic hepatitis C-related hepatitis (92 men and 58 women, age 50.6 (SD 12.5) years on the same day. Necro-inflammatory activity and the degree of steatosis at biopsy were also evaluated. RESULTS: The areas under the curve for the prediction of significant fibrosis (> or = F2), advanced fibrosis (> or = F3) or cirrhosis were 0.91, 0.99 and 0.98, respectively. Calculation of multilevel likelihood ratios showed that values of TE < 6 or > or = 12, < 9 or > or = 12, and < 12 or > or = 18, clearly indicated the absence or presence of significant fibrosis, advanced fibrosis, and cirrhosis, respectively. Intermediate values could not be reliably associated with the absence or presence of the target condition. The presence of inflammation significantly affected TE measurements in patients who did not have cirrhosis (p<0.0001), even after adjusting for the stage of fibrosis. Importantly, TE measurements were not influenced by the degree of steatosis. CONCLUSIONS: TE is more suitable for the identification of patients with advanced fibrosis than of those with cirrhosis or significant fibrosis. In patients in whom likelihood ratios are not optimal and do not provide a reliable indication of the disease stage, liver biopsy should be considered when clinically indicated. Necro-inflammatory activity, but not steatosis, strongly and independently influences TE measurement in patients who do not have cirrhosis.

Volcano-tectonic deformation in the Monti Sabatini Volcanic District at the gates of Rome (central Italy): evidence from new geochronologic constraints on the Tiber River MIS 5 terraces.

The accumulation of magma within the Monti Sabatini Volcanic District (MSVD), Italy, coupled with the extensional tectonics of the region, pose both volcanic and tectonic hazards to the city of Rome, located 20 km to the southeast. We combine 40Ar/39Ar geochronology of volcanic deposits and a geomorphologic/stratigraphic/paleomagnetic study of fluvial terraces to determine the recurrence interval and the time elapsed since the last eruption of the MSVD. Moreover, we provide a date for the youngest known eruption of the MSVD and assess the timing of the most recent volcanic phase. Results of this study show: (i) The most recent eruptive phase occurred between 100 ka and 70 ka; (ii) the anomalously high elevation of the MIS 5 terrace indicates that it was concurrent with 50 m of uplift in the volcanic area; (iii) the time since the last eruption (70 ka) exceeds the average recurrence interval (39 ky) in the last 300 ky, as well as the longest previous dormancy (50 ky) in that time span. (iv) the current duration of dormancy is similar to the timespan separating the major explosive phase that occurred 590-450 ka.

Intention of parents to have male children vaccinated with the human papillomavirus vaccine.

BACKGROUND: Although already approved for use in males in some jurisdictions, there is little information about parental attitudes toward having their sons receive the human papillomavirus (HPV) vaccine. The goal of this study was to ascertain parental intentions to vaccinate their sons with an HPV vaccine and to determine factors that predict this intention. METHODS: Parents of children aged 8-18 years were recruited from across Canada through random digit dialling. Participants were asked to respond to a series of questions in the context of a Grade 6 (age 11/12 years old), publicly funded school-based HPV vaccine programme, including their intention to vaccinate their sons with the HPV vaccine. Parents were also asked about a series of characteristics thought to predict intention to vaccinate as well as demographic characteristics. Backwards logistic regression was conducted to calculate adjusted odds ratios (AOR) to identify the factors that are predictive of parents' intention to vaccinate their son(s) against HPV. RESULTS: Of the 1381 respondents with male children, 67.8% (95% CI 65.3 to 70.3) intend to vaccinate their son(s) against HPV. Parents who had positive attitudes toward vaccines and the HPV vaccine in particular (AOR 41.5, 95% CI 9.5 to 181.7), parents who were influenced by subjective norms (AOR 7.8, 95% CI 5.8 to 10.5), parents who felt that the vaccine had limited influence on sexual behaviour (AOR 2.3, 95% CI 1.6 to 3.3) and parents who were aware of HPV (AOR 1.4, 95% CI 1.1 to 2.0) were significantly more likely to report an intention to vaccinate boys against HPV. In contrast, residence in British Columbia compared to Atlantic Canada (AOR 0.4, 95% CI 0.2 to 0.8) and higher education (AOR 0.7, 95% CI 0.5 to 0.9) were negatively associated with intention to vaccinate. Parents who reported an intention to vaccinate their daughters were also highly likely to report an intention to vaccinate their sons (kappa = 0.9, p<0.001). DISCUSSION: The majority of Canadian parents would intend to have their male children receive the HPV vaccine in the context of a publicly funded school-based immunisation programme. Overall attitudes toward vaccine, recommendations from health professionals and impact of the vaccine on sexual practices are important predictors of intention to have a male child receive the HPV vaccine.