Long-term patient-reported outcomes after anti-reflux surgery for gastroesophageal reflux disease and hiatal hernia repair: a single-center experience.

BACKGROUND: Patients with gastroesophageal reflux disease (GERD) and hiatal hernia who are candidates for surgery should be treated with minimally invasive partial or total fundoplication. As data on long-term clinical and functional outcomes after laparoscopic surgery for GERD are limited, the aim of this study was to evaluate the long-term effectiveness of fundoplication in terms of patient-reported symptoms and proton pump inhibitor (PPI) use. METHODS: The data of 88 patients who underwent laparoscopic anti-reflux surgery for GERD between January 2007 and September 2020 were retrospectively reviewed. Preoperative and postoperative patient-reported outcomes were investigated after surgery using a 13-items Likert-Scale questionnaire based on the frequency (events/week) and severity of typical and atypical symptoms, dysphagia, and dyspepsia. Furthermore, variations in the use of PPIs were investigated as a secondary endpoint. RESULTS: A total of 76 patients participated in the questionnaire survey. The median follow-up duration was 77 (2-165) months. The postoperative rate of mild and severe typical symptoms was significantly lower than the preoperative rate (P<0.01). Similarly, the atypical symptom rates decreased after surgery (P<0.05). Dysphagia was more frequent after fundoplication (P<0.01). Before the anti-reflux surgery, 94.7% of the patients were prescribed a PPI. At the time of follow-up, this proportion had decreased to 73.7% (P<0.01). However, the PPI intake rate was 90.9% in the group of patients interviewed >10 years after surgery. CONCLUSIONS: In this cohort of patients, laparoscopic anti-reflux fundoplication reduced the rate typical and atypical symptoms of GERD. However, surgery appeared to have no impact on PPI intake over time.

Early Recurrence after Upfront Surgery for Pancreatic Ductal Adenocarcinoma.

BACKGROUND: Survival after surgery for pancreatic ductal adenocarcinoma (PDAC) remains poor, due to early recurrence (ER) of the disease. A global definition of ER is lacking and different cut-off values (6, 8, and 12 months) have been adopted. The aims of this study were to define the optimal cut-off for the definition of ER and predictive factors for ER. METHODS: Recurrence was recorded for all consecutive patients undergoing upfront surgery for PDAC at our institute between 2010 and 2017. Receiver operating characteristic (ROC) curves were utilized, to estimate the optimal cut-off for the definition of ER as a predictive factor for poor post-progression survival (PPS). To identify predictive factors of ER, univariable and multivariable logistic regression models were used. RESULTS: Three hundred and fifty one cases were retrospectively evaluated. The recurrence rate was 76.9%. ER rates were 29.0%, 37.6%, and 47.6%, when adopting 6, 8, and 12 months as cut-offs, respectively. A significant difference in median PPS was only shown between ER and late recurrence using 12 months as cut-off (p = 0.005). In the multivariate analysis, a pre-operative value of CA 19-9 > 70.5 UI/L (OR 3.10 (1.41-6.81); p = 0.005) and the omission of adjuvant treatment (OR 0.18 (0.08-0.41); p < 0.001) were significant predictive factors of ER. CONCLUSIONS: A twelve-months cut-off should be adopted for the definition of ER. Almost 50% of upfront-resected patients presented ER, and it significantly affected the prognosis. A high preoperative value of CA 19-9 and the omission of adjuvant treatment were the only predictive factors for ER.

From COVID-19 Pandemic to Patient Safety: A New "Spring" for Telemedicine or a Boomerang Effect?

During the Covid-19 health emergency, telemedicine was an essential asset through which health systems strengthened their response during the critical phase of the pandemic. According to the post-pandemic economic reform plans of many countries, telemedicine will not be limited to a tool for responding to an emergency condition but it will become a structural resource that will contribute to the reorganization of Healthcare Systems and enable the transfer of part of health care from the hospital to the home-based care. However, scientific evidences have shown that health care delivered through telemedicine can be burdened by numerous ethical and legal issues. Although there is an emerging discussion on patient safety issues related to the use of telemedicine, there is a lack of reseraches specifically designed to investigate patient safety. On the contrary, it would be necessary to determine standards and specific application rules in order to ensure safety. This paper examines the telemedicine-risk profiles and proposes a position statement for clinical risk management to support continuous improvement in the safety of health care delivered through telemedicine.

Microbiological Laboratory Diagnosis of Human Brucellosis: An Overview.

Brucella spp. are Gram-negative, non-motile, non-spore-forming, slow-growing, facultative intracellular bacteria causing brucellosis. Brucellosis is an endemic of specific geographic areas and, although underreported, represents the most common zoonotic infection, with an annual global incidence of 500,000 cases among humans. Humans represent an occasional host where the infection is mainly caused by B. melitensis, which is the most virulent; B. abortus; B. suis; and B. canis. A microbiological analysis is crucial to identifying human cases because clinical symptoms of human brucellosis are variable and aspecific. The laboratory diagnosis is based on three different microbiological approaches: (i) direct diagnosis by culture, (ii) indirect diagnosis by serological tests, and (iii) direct rapid diagnosis by molecular PCR-based methods. Despite the established experience with serological tests and highly sensitive nucleic acid amplification tests (NAATs), a culture is still considered the "gold standard" in the laboratory diagnosis of brucellosis due to its clinical and epidemiological relevance. Moreover, the automated BC systems now available have increased the sensitivity of BCs and shortened the time to detection of Brucella species. The main limitations of serological tests are the lack of common interpretative criteria, the suboptimal specificity due to interspecies cross-reactivity, and the low sensitivity during the early stage of disease. Despite that, serological tests remain the main diagnostic tool, especially in endemic areas because they are inexpensive, user friendly, and have high negative predictive value. Promising serological tests based on new synthetic antigens have been recently developed together with novel point-of-care tests without the need for dedicated equipment and expertise. NAATs are rapid tests that can help diagnose brucellosis in a few hours with high sensitivity and specificity. Nevertheless, the interpretation of NAAT-positive results requires attention because it may not necessarily indicate an active infection but rather a low bacterial inoculum, DNA from dead bacteria, or a patient that has recovered. Refined NAATs should be developed, and their performances should be compared with those of commercial and home-made molecular tests before being commercialized for the diagnosis of brucellosis. Here, we review and report the most common and updated microbiological diagnostic methods currently available for the laboratory diagnosis of brucellosis.

The Results From Up-Front Esophageal Testing Predict Proton Pump Inhibitor Response in Patients With Chronic Cough.

INTRODUCTION: The clinical management of chronic cough patients is challenging, and their response to proton pump inhibitors (PPIs) is considered as unsatisfactory. Few data concerning the association between impedance-pH variables and PPI response in these patients are available. Mean nocturnal baseline impedance (MNBI) and postreflux swallow-induced peristaltic wave (PSPW) index increase the diagnostic yield of impedance-pH in gastroesophageal reflux disease. METHODS: Demographic, clinical, and endoscopy findings; impedance-pH; and high-resolution manometry tracings from consecutive patients assessed for cough were evaluated. Univariable and multivariable regression models were generated to evaluate the association between impedance-pH and high-resolution manometry findings, endoscopic and clinical characteristics, and PPI response. RESULTS: A total of 178 patients were included. Eighty-four of 178 cough patients (47.2%) displayed grade C-D erosive esophagitis or were characterized by a pathological acid exposure time (AET) and/or positive symptom association probability/symptom index. When also considering MNBI and PSPW, 135 of 178 patients (75.8%) were characterized by the evidence of reflux disease (P < 0.001). Eighty patients (44.9%) had cough responding to PPIs, whereas 98 (55.1%) were nonresponders (P = 0.071). At the receiver operating characteristic analysis, both PSPW index and MNBI were associated to PPI responsiveness. MNBI and PSPW index showed higher sensitivity in predicting PPI response compared with AET and symptom association probability/symptom index. The area under the curves of MNBI and PSPW index were significantly higher than that of AET (P < 0.01 for both comparisons). When patients were stratified according to AET and excluding those with erosive esophagitis, pathological MNBI or PSPW index, hiatal hernia, and hypomotility features were associated to PPI response in all groups. DISCUSSION: Our results demonstrate the usefulness of an up-front esophageal testing in discriminating reflux-related cough patients and predicting PPI response.

The Role of Pathological Method and Clearance Definition for the Evaluation of Margin Status after Pancreatoduodenectomy for Periampullary Cancer. Results of a Multicenter Prospective Randomized Trial.

BACKGROUND: There is extreme heterogeneity in the available literature on the determination of R1 resection rate after pancreatoduodenectomy (PD); consequently, its prognostic role is still debated. The aims of this multicenter randomized study were to evaluate the effect of sampling and clearance definition in determining R1 rate after PD for periampullary cancer and to assess the prognostic role of R1 resection. METHODS: PD specimens were randomized to Leeds Pathology Protocol (LEEPP) (group A) or the conventional method adopted before the study (group B). R1 rate was determined by adopting 0- and 1-mm clearance; the association between R1, local recurrence (LR) and overall survival (OS) was also evaluated. RESULTS: One-hundred-sixty-eight PD specimens were included. With 0 mm clearance, R1 rate was 26.2% and 20.2% for groups A and B, respectively; with 1 mm, R1 rate was 60.7% and 57.1%, respectively (p > 0.05). Only in group A was R1 found to be a significant prognostic factor: at 0 mm, median OS was 36 and 20 months for R0 and R1, respectively, while at 1 mm, median OS was not reached and 30 months. At multivariate analysis, R1 resection was found to be a significant prognostic factor independent of clearance definition only in the case of the adoption of LEEPP. CONCLUSIONS: The 1 mm clearance is the most effective factor in determining the R1 rate after PD. However, the pathological method is crucial to accurately evaluate its prognostic role: only R1 resections obtained with the adoption of LEEPP seem to significantly affect prognosis.

Development and psychometric testing of the care dependence perception questionnaire.

OBJECTIVE: This multicentre study aimed to develop a measure of the perception of care dependence in patients diagnosed with cancer and to test its psychometric properties. METHODS: The questionnaire was developed based on findings emerged from a meta-synthesis and from qualitative studies conducted in three hospitals in Italy. The draft questionnaire was tested for face and content validity and pilot-tested with patients. The questionnaire was completed by care-dependent patients with cancer. Test-retest was conducted to verify stability. Exploratory factor analysis (EFA) was performed using a Maximum Likelihood robust estimator. RESULTS AND CONCLUSION: The Scale-Content Validity Index was 0.92. The final 15-item questionnaire was completed by 208 patients admitted to two hospitals. The EFA yielded a two-factor model including a positive and a negative perception of care dependence. Factor score determinacy coefficients, Cronbach's alpha coefficients, composite reliability coefficients and Intraclass Correlations Coefficients yielded satisfactory results confirming internal consistency and stability. The hedonic balance score is also available as a single indicator of subjective well-being. The study provides initial validation of the Care DEeP Questionnaire that can be used by cancer nurses to assess positive and negative patient experiences with care dependence and to personalise and improve their care.

Morphometric analysis of atypical glandular cells correctly classifies normal, reactive, and atypical cells in cervical smears.

The 2014 Bethesda System diagnostic criteria for atypical glandular cells (AGC) aid in the classification of atypical cells in cervical cytology. Anyway, AGC diagnosis remains challenging, due to low frequencies of this finding (approximately 0.5%-1% of Pap test results), abundance of AGC mimics, and significant interobserver variability. We developed an algorithm based on nuclear areas parameter that can help to differentiate AGC from Normal and Reactive glandular cells. Nuclear areas and perimeters were measured on 16 Pap smears with AGC and 18 with Reactive glandular cells of women aged between 30 and 77. Glandular cells from nonpathological Pap smears were used as controls. For each case, the means, medians, standard deviations, and the minimum and maximum values of both nuclear areas and perimeters of the cells of interest were calculated. The nuclear area analysis showed a 100% specificity in discriminating Normal from Altered cells (either Reactive or AGC), whereas the nuclear perimeter analysis showed a lower specificity (87.5%). Both nuclear area and perimeter variability analysis resulted in high specificity values in distinguishing Reactive cells from AGC. Therefore, a stepwise two-step algorithm using nuclear areas to discriminate Normal from Altered cells, and nuclear area variability to distinguish Reactive from AGC, allowed us to reliably classify the cells into these three categories. The morphometric analysis of nuclear area is a valuable and reliable aid in AGC diagnosis and standardization, easily integrable into common automatic algorithms.

Trans-duodenal ampullectomy for ampullary neoplasms: early and long-term outcomes in 36 consecutive patients.

BACKGROUND: Trans-duodenal ampullectomy (TDA) is a surgical option for the treatment of selected ampullary neoplasms. The aim of this study was to evaluate our experience with TDA for the treatment of ampullary neoplasms, focusing on indications, technical aspects, and short- and long-term outcomes. METHODS: All TDAs for ampullary neoplasms performed between January 2010 and December 2018 at our institution were retrospectively evaluated. Patients had ampullary neoplasms with low-grade dysplasia or in situ carcinoma (Tis) not suitable for an endoscopic approach, ampullary carcinoma unfit for pancreaticoduodenectomy (PD), or ampullary neuroendocrine G1-tumours. RESULTS: Thirty-six patients were included in the study: 9 (25.0%) with neoplasms with low-grade dysplasia, 4 (11.1%) with G1 neuroendocrine tumours and 23 (63.9%) with Tis or invasive carcinoma. Mean operative time was 252.5 min. Overall and severe (Clavien-Dindo > IIIa) morbidity rate was 44.4% and 13.9%, respectively. No 90-day mortality was observed. At follow-up, no deaths were observed and local recurrence rate was 11.1% for patients with ampullary adenomas with low-grade dysplasia. Among four patients with neuroendocrine neoplasms, only one developed recurrence (pulmonary). Tis, T1 and T2 lesions were found in 16 (69.6%), 2 (8.7%) and 5 (21.7%) patients, respectively: recurrence occurred in 3 patients with Tis lesions (one malignant), no patients with T1 neoplasms and 2 patients with T2 lesions (3 patients had a survival of > 3 years). CONCLUSIONS: TDA is a feasible and effective surgical procedure for the treatment of ampullary adenomas with low-grade dysplasia when endoscopic approach is contraindicated or has failed. For lesions with evidence of malignancy, TDA seems to be an oncological safe procedure for Tis ampullary cancer and a good palliative procedure for patients unfit for PD. Moreover, TDA may be appropriate for the treatment of G1 ampullary neuroendocrine neoplasms. A large multicentre study of TDA for early ampullary cancers is needed.

Continuity of care interventions for preventing hospital readmission of older people with chronic diseases: A meta-analysis.

BACKGROUND: Hospital readmission after discharge is a frequent, burdensome and costly event, particularly frequent in older people with multiple chronic conditions. Few literature reviews have analysed studies of continuity of care interventions to reduce readmissions of older inpatients discharged home over the short and long term. OBJECTIVE: To evaluate the effectiveness of continuity of care interventions in older people with chronic diseases in reducing short and long term hospital readmission after hospital discharge. DESIGN: Meta-analysis of randomized controlled trials. DATA SOURCES: A comprehensive literature search on the databases PubMed, Medline, CINAHL and EMBASE was performed on 27 January 2019 with no language and time limits. REVIEW METHODS: RCTs on continuity of care interventions on older people discharged from hospital having hospital readmission as outcome, were included. Two reviewers independently screened the studies and assessed methodological quality using the Cochrane Risk of Bias tool. Selected outcome data were combined and pooled using a Mantel-Haenszel random-effects model. RESULTS: Thirty RCTs, representing 8920 patients were included. Results were stratified by time of readmissions. At 1 month from discharge, the continuity interventions were associated with lower readmission rates in 207/1595 patients in the experimental group (12.9%), versus 264/1645 patients in the control group (16%) (Relative Risk [RR], 0.84 [95% CI, 0.71-0.99]). From 1 to 3 months, readmission rates were lower in 325/1480 patients in the experimental group (21.9%), versus 455/1523 patients in the control group (29.8%) (RR 0.74 [95% CI, 0.65-0.84]). A subgroup analysis showed that this positive effect was stronger when the interventions addressed all of the continuity dimensions. After 3 months this impact became inconclusive with moderate/high statistical heterogeneity. CONCLUSIONS: Continuity of care interventions prevent short term hospital readmission in older people with chronic diseases. However, there is inconclusive evidence about the effectiveness of continuity interventions aiming to reduce long term readmission, and it is suggested that stronger focus on it is needed.

[Publishing estimates of Emergency Department waiting times for low-priority patients: a tool to improve the perceived quality of services]. / Indicazione dei tempi di attesa dei pazienti a bassa priorità in un Pronto Soccorso: strumento per migliorare la qualità percepita del servizio.

Emergency Department (ED) waiting times are a relevant concern both to health care professionals and consumers, because ED crowding may affect the quality of and access to health care. This has prompted a large amount of studies in the scientific literature, addressing the problem of waiting times as an "international crisis". The causes of long waiting times are complex and multifaceted and feasible solutions must consider this and other aspects such as limitation of resources and unpredicted surges in demand. In the present article, we address the issue of modeling ED flow of patients with a low score at the triage evaluation. This study aimed to develop a model to predict expected waiting times for patients with a "green" or "white" code at triage, by analyzing the patient flow in a regional referral hospital in an Italian district. The simulation model was developed through flow analysis; moreover, input analysis was performed by using registration data collected in the ED during daily activities. The simulation results were compared to data collected through direct observation at the hospital ED and to data extracted from the existing hospital information system, which represents an online transaction system tailored for routine care and patient services in the ED as well as in other hospital departments. The applied model was shown to be able to emulate patient flow in the ED and to find key critical points of the health care process, for patients who received a low category score at the triage. To face the problem of ED waiting times, adoption of patient flow analysis and improvement strategies are recommended, together with improvement of triage evaluation procedures. Simulation models can help to manage this complex issue.

The evolution of post-operative pancreatic fistula (POPF) classification: A single-center experience.

BACKGROUND: The ISGPS classification of post-operative pancreatic fistula (POPF) was recently revised, introducing the concept of biochemical leak (BL) which replaced grade A POPF. More recently, an additional distinction on three different subclasses for grade B (B1-B3) POPF was proposed. The aim of this study was to evaluate the impact of these modifications in clinical practice. METHODS: All pancreatico-duodenectomies (PD) and distal pancreatectomies (DP) performed between 2010 and 2016 were retrospectively evaluated. Incidence and grade of POPF using the old and new ISGPS classification were evaluated. Three grade B subclasses (B1: maintenance of abdominal drain >3 weeks; B2: adoption of specific medical treatments for POPF; B3: use of radiological procedures) were evaluated for clinical severity. RESULTS: A total of 716 patients (502 PD, 214 DP) were evaluated. The new ISGPS classification reduced the reported rate of POPF (30.7% vs 35.2% for PD, p > 0.05; 28% vs 44.9% for DP, p < 0.05), due to the abolition of grade A POPF. Grade B1, B2 and B3 rates were 3.1%, 73.8% and 23.1% in PD and 12.3%, 47.4% and 40.3% in DP, respectively. Passing from B1 to B3, significant increases in wound infection (0-40%), mean length of stay in PD (14.7-22.5 days; p < 0.05) and readmission rate in DP (0-39.1%) were observed. CONCLUSIONS: The new ISGPS classification significantly reduces the reported rate of POPF, particularly after DP. The three different grade B subclasses (B1-B3) better discriminate the severity of post-operative course, especially after PD.

Palliative Care Education in Undergraduate Nursing Curriculum in Italy.

Worldwide, more than 19 million people require palliative care because of an advanced stage of disease. Undergraduate nursing education should include palliative care as the European consensus suggests. In 2004, the European Society of Palliative Care issued a guide for the development of palliative nurse education in Europe. This study aims to describe the extension and characteristics of palliative care education within all of the nursing degree curricula in Italy, as well as to what extent their topics match the European Society of Palliative Care guide. A descriptive study was conducted through the universities web pages. For each degree, the curricula of the academic years from 2010 to 2014 were analyzed. Sixty percent of the curricula had formal education in palliative care, heterogeneously distributed in different courses and provided few compulsory and mandatory teaching hours. Data on clinical training suggested that education was essentially theoretical, with poor theory and practice integration. The increasing need for palliative care in different settings corresponds to increasing attention to nursing education in palliative care from the undergraduate level. The inclusion of palliative care teaching in universities at all levels of education and research development represent the future challenges for this discipline.

Attention-deficit/hyperactivity disorder and enuresis: a study about effectiveness of treatment with methylphenidate or desmopressin in a pediatric population.

BACKGROUND: The aim of this study was to evaluate the effectiveness of treatment with methylphenidate or desmopressin (dDAVP) in patients with comorbid attention-deficit/hyperactivity disorder (ADHD) and enuresis. METHODS: We enrolled 103 patients affected by ADHD and 125 patients with monosymptomatic nocturnal enuresis (NE). Data were collected between January 2014 and December 2015. The study was carried out in compliance with the Helsinki Declaration. RESULTS: About children with ADHD, 9/103 (8.7%) were also suffering from NE; of those 8/9 followed treatment with methylphenidate and cognitive behavioral therapy. After 3 months 2/8 (25%, CI 95%: 8-65%) showed improvements, remaining 75% has been increased dosage of methylphenidate. After 6 months a response was achieved in 6/8 (75%, CI 95%: 35-96%) children and 1/8 was lost to follow-up. Furthermore the drug withdrawal showed a recurrence of symptoms both ADHD and NE in 1/7 (14.3%, CI 95%: 0.3-57%) vs. 6/7 (85.7%, CI 95%: 42-99%) that not presented recurrences. About children with NE enrolled at Campus Bio-Medico University it was found that 4/125 (3.8%) children were also suffering from ADHD; 3/4 (75%) treated with dDAVP and motivational therapy, of those 2/3 (66.7%, CI 95%: 9-99%) showed no improvements of symptoms vs. 1/3 (33.3%, CI 95%: 0.8-90%) that showed partial response with a reduction of wet-nights. CONCLUSIONS: It is important the service of recruitment of patients with NE. In fact considering NE in a Child Neuropsychiatry Service where patients belong to a diagnosis of ADHD and NE is an incidental finding, this one is not considered as the addressee of treatment, but the therapy is directed to the neuro-behavioral problem using specific drugs and therapies, which are resolutive in the enuretic disorder.

[The role of nurses in health education about vaccines: analysis of style and communication models of institutional vaccination campaigns]. / Ruolo dell'infermiere nella educazione alla salute in ambito vaccinale: analisi dello stile e dei modelli di comunicazione delle campagne vaccinali istituzionali.

Vaccine hesitancy represents an increasingly important global health issue. Nurses, together with other healthcare professionals, can play a key role in increasing vaccination uptake. The aim of this article is to analyze the main elements of positive communication styles used in vaccination campaigns and initiatives. The most important components in style, construction and contents used in several vaccination campaigns were evaluated through an original instrument, specifically developed for the present study. The most relevant aspects of nursing expertise and competencies were mixed with foundations of mass communication theory, in order to develop a framework made by 13 items, useful to evaluate different aspects of immunization campaigns. A multi-professional project was developed, to obtain a deep integration between nurse expertise in health promotion and other groups with similar public health orientation. The Authors further evaluated sociological instruments and theories from other fields, as mass communication theory and the social/behavioral approach. An integrative review was performed, about the following main themes: vaccination adherence basis; nurse role in health promotion; health education competences; multi-professionals integration in public health; positive communication style; efficacy evaluation. Key elements were collected, to prepare an original instrument to be used in evaluating several communication campaigns. The evaluation framework (13 items) was prepared and applied to vaccine communication in different institutional settings in the last five years. Main components are: elements taken from main communication models (persuasive communication models); nurse competencies in health education; public health expertise (from an expert panel). The main findings of this study regard the usefulness of evaluating main aspects of communication in the vaccine field. Nurses' knowledge and competencies in health promotion and health education add relevant meanings and cues to act against the causes for not vaccinating. It shows that is worth analyzing the main aspects of communication techniques and evaluating innovative methods to increase population confidence levels in public health.

Extraction, Analysis, and Antioxidant Activity Evaluation of Phenolic Compounds in Different Italian Extra-Virgin Olive Oils.

The analysis of phenolic compounds in extra virgin olive oils was carried out by high-performance liquid chromatography utilizing photodiode array and mass spectrometry detectors. The chromatographic profile of thirty samples from four Italian Regions highlighted the presence of secoiridoids, phenolic alcohols, flavonoids, and phenolic acid classes. A similar qualitative profile was observed with some differences in peak area and fifteen compounds were tentatively identified. Quantitative analysis was performed by UV detection considering eight standard phenolic compounds. The chromatographic method, after optimization, was validated studying some parameters, e.g., intra-day and inter-day retention time precision, limit of detection, limit of quantification, and linearity. Recovery of the method was performed achieving good results (10 and 50 g·g-1 with recovery of 72.9⁻92.1% (w/w) and 79.1⁻102.8% (w/w), respectively). In all samples secoiridoids were the main compounds ranging from 85 to more than 99% (w/w) of the total concentration of detected phenolic compounds while phenolic acids accounted for the lowest percentage (0.1⁻0.6%, w/w). Finally, total concentration of phenolic compounds and antioxidant activity were determined with different chemical assays. A good and significant correlation among total phenolic compound concentration and antioxidant activity was observed. A significant different phenolic compound concentration and antioxidant activity was determined between samples from Puglia and Sicily. This was studied performing statistical analysis by one-way analysis of variance (ANOVA) followed by Bonferroni post-hoc test.

Could Music Minimize Discomfort and Pain During Office-Based ENT Surgery?

BACKGROUND: Video-assisted endoscopic radiofrequency inferior turbinate volume reduction (RFVTR) is one of the most common surgical therapies for inferior turbinate hypertrophy (ITH). Despite all the technical and surgical advancement, it is advisable to reduce as low as possible the intraoperative discomfort. The aim of this study is to evaluate the role of music in reducing patient discomfort during RFVTR. MATERIALS AND METHODS: Twenty-three patients with chronic nasal obstruction due to ITH and candidate to RFVTR are included. Before the procedure each patient filled in a completed Italian version of the state anxiety questionnaire (State-Trait Anxiety Inventory), SNOT 22 questionnaire, VAS, and chose their favourite music to be played during RFVTR. All patients evaluate the intraoperative discomfort with a visual analog scale (VAS) and for each patient, vital parameters such as blood pressure and heart rate were recorded 15 minutes before the procedure, during and after RFVTR. RESULTS: The intraoperative VAS scores during listening to music (5.7 ± 2.42 vs 6.7 ± 1.97; p< 0.05) were significantly lower, such as systolic BP (133.5 ±17.2 vs 136.78 ±16.8; p< 0.05) and heat rate (80.3 ±14.9 vs 81.7 ±15.5; p NS). During our survey, most of the patients preferred listening to classical music and none preferred rock music. No correlation was found between STAI 1-2 and intraoperative surgical discomfort evaluated both with VAS and cardiac parameters (systolic BP and HR). CONCLUSIONS: Music can be useful as a complementary method to control anxiety and reduce perception of pain in an office-based procedure, such as the RFVTR. The patient is more relaxed and experiences less discomfort; thus the surgeon and nurse can work with more confidence.

Prevalence and clinical characteristics of refractoriness to optimal proton pump inhibitor therapy in non-erosive reflux disease.

BACKGROUND: The real size of the gastro-oesophageal reflux disease (GERD) population not responding to proton pump inhibitor (PPI) therapy has still not been fully elucidated. Causes of PPI refractoriness include incorrect diagnosis and lack of adherence to therapy, in terms of incorrect dosage and timing. AIMS: To evaluate the prevalence of refractoriness to optimal PPI therapy and the contribution of non-erosive reflux disease (NERD), reflux hypersensitivity, and functional heartburn, to PPI refractoriness. The association of functional GI symptoms in non-responders was evaluated. METHODS: Frequency and severity of GERD symptoms (heartburn, regurgitation, chest pain), dysphagia, belching, epigastric pain, postprandial distress, irritable bowel syndrome (IBS), globus, and ear nose and throat (ENT) symptoms were evaluated in patients previously classified as non-responders. Patients with at least one of the oesophageal symptoms with a frequency ≥3 /week were treated with esomeprazole 40 mg once daily for 8 weeks and then re-evaluated. Non-responders (patients with oesophageal symptoms ≥3 times per week) underwent 24 hour multichannel intraluminal impedance-pH monitoring. RESULTS: Of 573 consecutive patients, 92 with oesophageal symptoms and classified as PPI-refractory underwent the esomeprazole trial; 60 did not respond. IBS, epigastric pain, and post-prandial distress episodes were associated with a poor response on multivariate analysis. NERD, reflux hypersensitivity, and functional heartburn patients constituted 32%, 42%, and 26%, respectively of the PPI-refractory group. CONCLUSIONS: True refractoriness in patients with GERD symptoms attending a secondary care setting is lower than previously reported. Following a careful history and optimal PPI dosing, the rate of refractoriness was 20%. True NERD constitutes only a third of the PPI-refractory group.

Efficacy and economic impact evaluation of a navigation system for assisted lung biopsy.

This Letter reports on the testing and assessment of an optical computed tomography-navigation system for percutaneous lung interventional, SIRIO, showing how the lesion diameter affects the bioptic procedure. Clinical data, relating to 501 patients, were collected at the Department of Interventional Radiology of Policlinico Universitario Campus Bio-Medico. This Letter shows that the diameter of lesion affects only the procedure duration (50.91 ± 18.87 min for lesions of diameter ≤20 mm and 44.98 ± 19.43 min for lesions of diameter >20 and ≤40 mm). For the nodules with a diameter ≤20 mm, there is a significant increase in the duration of the procedure (for each mm less the time increases by 6 s). Other parameters like the mean effective radiation dose and the presence of a diagnostic or non-diagnostic specimen do not depend, instead, on the lesion size. The economic analysis based on the biopsy procedure with SIRIO shows the necessity to adopt a new reimbursement system for percutaneous biopsy performed using navigation systems to stimulate their use to get important non-economic gains such as early diagnosis, reduction of the absorbed dose of X-rays and increasing number of lung cancers in a curable early stage.

Long-term outcome of cryopreserved allograft for aortic valve replacement.

OBJECTIVE: The most efficient surgical approach to severe aortic valve disease in the young adult is still debated: cryopreserved aortic allograft offers excellent hemodynamic and avoid anticoagulation, but long-term durability is influenced by structural valve deterioration (SVD). This study aimed to describe long-term results of aortic allografts and to identify factors influencing long-term durability. METHODS: From January 1993 to August 2010, 210 patients underwent aortic allograft replacement via the free-hand subcoronary implantation technique (N = 55) or root replacement with coronary reimplantation (N = 155). Clinic and echocardiographic follow-up was updated to April 2016. RESULTS: Overall mortality and cardiac mortality occurred in 80 (38.1%) and 64 (30.5%) patients, respectively. Reoperation was required in 69 cases (32.8%), whereas SVD required reoperation in 57 cases (27.1%). No early endocarditis occurred, whereas late endocarditis occurred in 4 patients. The free-hand technique seems to be associated with improved left ventricular remodeling compared with the root-replacement technique, and smaller allograft size represents a predictor of reoperation independently on the surgical technique used. In the overall population, there were 44 women of childbearing age, and 37 patients remained pregnant during the follow-up of the study. No differences were found in the clinical outcomes among women who had children and who did not. CONCLUSIONS: Cryopreserved allograft is a valid option, especially in complex infective endocarditis and in women of childbearing age. A careful choice of allograft size and implantation technique can reduce the risk of SVD.