Evaluation of Humoral Response following SARS-CoV-2 mRNA-Based Vaccination in Liver Transplant Recipients Receiving Tailored Immunosuppressive Therapy.

Background: The role of tailored immunosuppression (IS) in the development of the humoral response (HR) to SARS-CoV-2 mRNA-based vaccination in liver transplant (LT) recipients is unknown. Methods: This is a single-centre prospective study of patients who underwent LT between January 2015 and December 2021 and who have received three doses of mRNA-based SARS-CoV-2 vaccination. Patients undergoing Tacrolimus-based immunosuppression (TAC-IS) were compared with those undergoing Everolimus-based immunosuppression (EVR-IS). Patients receiving the TAC-EVR combination were divided into two groups based on trough TAC concentrations, i.e., above or below 5 ng/mL. HR (analysed with ECLIA) was assessed at 30 to 135 days after vaccination. The primary outcome was the presence of a positive antibody titre (≥0.8 U/mL). Secondary outcomes were the presence of a highly protective antibody titre (≥142 U/mL), median antibody titre, and incidence of COVID-19. Results: Sixty-one participants were included. Twenty-four (40%) were receiving TAC-IS and thirty-seven (60%) were receiving EVR-IS. At the median follow-up of 116 (range: 89-154) days, there were no significant differences in positive antibody titre (95.8% vs. 94.6%; p = 0.8269), highly-protective antibody titre (83.3% vs. 81.1%; p = 0.8231), median antibody titre (2410 [IQ range 350-2500] vs. 1670 [IQ range 380-2500]; p = 0.9450), and COVID-19 incidence (0% vs. 5.4%; p = 0.5148). High serum creatinine and low estimated glomerular filtration rate were risk factors for a weak or absent HR. Conclusions: Three doses of mRNA-based SARS-CoV-2 vaccination yielded a highly protective HR in LT recipients. The use of TAC or EVR-based IS does not appear to influence HR or antibody titre, while renal disease is a risk factor for a weak or null HR.

Modeling cell populations metabolism and competition under maximum power constraints.

Ecological interactions are fundamental at the cellular scale, addressing the possibility of a description of cellular systems that uses language and principles of ecology. In this work, we use a minimal ecological approach that encompasses growth, adaptation and survival of cell populations to model cell metabolisms and competition under energetic constraints. As a proof-of-concept, we apply this general formulation to study the dynamics of the onset of a specific blood cancer-called Multiple Myeloma. We show that a minimal model describing antagonist cell populations competing for limited resources, as regulated by microenvironmental factors and internal cellular structures, reproduces patterns of Multiple Myeloma evolution, due to the uncontrolled proliferation of cancerous plasma cells within the bone marrow. The model is characterized by a class of regime shifts to more dissipative states for selectively advantaged malignant plasma cells, reflecting a breakdown of self-regulation in the bone marrow. The transition times obtained from the simulations range from years to decades consistently with clinical observations of survival times of patients. This irreversible dynamical behavior represents a possible description of the incurable nature of myelomas based on the ecological interactions between plasma cells and the microenvironment, embedded in a larger complex system. The use of ATP equivalent energy units in defining stocks and flows is a key to constructing an ecological model which reproduces the onset of myelomas as transitions between states of a system which reflects the energetics of plasma cells. This work provides a basis to construct more complex models representing myelomas, which can be compared with model ecosystems.

Liver-Specific Contrast-Enhanced Magnetic Resonance Cholangio-Pancreatography (Ce-MRCP) in Non-Invasive Diagnosis of Iatrogenic Biliary Leakage.

Current non-invasive diagnostic modalities of iatrogenic bile leak (BL) are not particularly sensitive and often fail to localise the BL origin. Percutaneous transhepatic cholangiography (PTC) and endoscopic retrograde cholangiopancreatography (ERCP) are considered the gold standard, yet are invasive studies with potential complications. Ce-MRCP has been not comprehensively studied in this setting but may prove particularly helpful given its non-invasive nature and the anatomical dynamic detail. This paper reports a monocentric retrospective study of BL patients referred between January 2018 and November 2022 submitted to Ce-MRCP followed by PTC. The primary outcome was the accuracy of Ce-MRCP in detecting and localising BL compared to PTC and ERCP. Blood tests, coexisting cholangitis features and time for leak resolution were also investigated. Thirty-nine patients were included. Liver-specific contrast-enhanced MRCP detected BL in 69% of cases. The BL localisation was 100% accurate. Total bilirubin above 4 mg/dL was significantly associated with false negative results of Ce-MRCP. Ce-MRCP is highly accurate in detecting and localising BL, but sensitivity is significantly reduced by a high bilirubin level. Ce-MRCP may be very useful in early BL diagnosis and in accurate pre-treatment planning, but can only be reliably used in selected patients with TB < 4 mg/dL. Non-surgical techniques, both radiological and endoscopic, are proven to be effective in terms of leak resolution.

[Continuing medical education for the quality of the profession]. / Quale formazione in Sanità? Un confronto basato sulle evidenze. L'Educazione continua in medicina per la qualità della professione.

Doctors are obliged by law, for the duration of their professional career, to keep up to date their skills and knowledge base, by following developments in medical science and improvements in health technologies. This is important to build a patient/doctor relationship based on trust, in agreement with the detailed laws regulating the medical profession. The experimental stage of the national program of continuing medical education (CME) has revealed some areas which need to be developed; with the objective of guarantying healthcare workers effective training to improve the health of the patients. CME should favour the capacity of health professionals to always critically incorporate new knowledge; refine methodological skills and combine them in their everyday professional work; allowe human and professional growth.

[Nursing workload in Day Surgery]. / Il carico di lavoro infermieristico in Day surgery.

The "workload" is defined as the whole of the activities completed by a group of professionals in a period of time. The different conceptualization of nursing workload has determined different methods and tools of evaluation. The aim of this study is to evaluate the nursing workload in a Day Surgery Unit with a quantitative (time in activities) and qualitative approach (perceived complexity). We want analyze also every correlation with the time in the activities. The study design is observational. We have analyzed 147 patients admitted to the Day Surgery Unit of a University Hospital in Italy. The nurses have dedicated the average of 164,8 minutes in care. The nursing care time is correlated to anesthesiological risk class and to the general surgery procedure. The patients in specialistic surgery are considered more complexes from the nurses then the general surgery patients. Another indicator associated to the high perceived complexity is the "comorbidity management". This study will help to manage nursing resources and the admission of the patients.

[The perception of anxiety and stress in day surgery: a comparison among patients, family members and nurses]. / La percezione dell'ansia e dello stress in day surgery: comparazione tra pazienti, familiari e infermieri.

The purpose of this study was to assess anxiety and stress in day surgery patients, and to compare anxiety and stress as perceived by patients, family members and nurses. A descriptive design involving a convenience sample of 40 patients was used. Patients were waiting for ambulatory procedures of varicectomy, inguinal hernia and breast biopsy. Researchers conducted 120 interviews (40 on patients; 40 on family members and 40 on nurses) with a Questionnaire based on 25 stress factors. The mean intensity of patients' anxiety, measured with a Numerical Rating Scale, was 5,15 (median 5, SD 2,63). Family members and nurses overestimated patients anxiety. When nurses were caring for the same patient more times measured anxiety and stress more accurately. The following stressing factors emerged from this study: a) Fear due to the consequences of the surgery; b) losing one self autonomy in ADL; c) pain; d) anaesthesia. The majority of these factors could be reduce through adequate education and information strategies.