The impact of COVID-19 restrictions and care home strategies on residents with dementia as experienced by family carers in Italy.

OBJECTIVES: The COVID-19 pandemic and public health measures caused serious consequences for several population cohorts, including people with dementia in care homes and their families. The aim of this study was to explore the impact of COVID-19 on care home residents with dementia as experienced by family carers in Italy. Specifically, strategies implemented to overcome the pandemic's constraints, their influence upon care, and consequences for everyday life of residents with dementia and carers were investigated. METHODS: Semi-structured interviews explored participants' experiences of the pandemic, its restrictions and the services' status during lockdown. Transcripts were analysed via thematic analysis. RESULTS: 26 family carers were interviewed. Three themes emerged: (1) COVID-19 restrictions negatively affected both residents with dementia and family carers, (2) Changing policies in care homes during COVID-19, and (3) Technology use in care homes during COVID-19. COVID-19 restrictions severely affected care home residents with dementia, disrupted their daily living, and accelerated their cognitive decline. Consequently carers' emotional burdens increased. Care home response strategies (safe visiting and digital solutions) were critical, though they were not enough to compensate for the lack of close in-person contacts. CONCLUSIONS: Mixed evidence emerged about the feasibility of care home strategies and their associated benefits. To meet arising needs and possible future pandemic waves, there is a need for updated health strategies. These should prioritise a continuity of therapeutic activities and minimize negative effects on residents' quality of life, whilst incorporating feasible and accessible digital solutions to provide remote communication and psychological support for family carers.

Quality of life in liver transplant recipients during the Corona virus disease 19 pandemic: A multicentre study.

BACKGROUND: Liver transplant recipients require specific clinical and psychosocial attention given their frailty. Main aim of the study was to assess the quality of life after liver transplant during the current pandemic. METHODS: This multicentre study was conducted in clinically stable, liver transplanted patients. Enrollment opened in June and finished in September 2021. Patients completed a survey including lifestyle data, quality of life (Short Form health survey), sport, employment, diet. To examine the correlations, we calculated Pearson coefficients while to compare subgroups, independent samples t-tests and ANOVAs. To detect the predictors of impaired quality of life, we used multivariable logistic regression analysis. RESULTS: We analysed data from 511 patients observing significant associations between quality of life's physical score and both age and adherence to Mediterranean diet (p < .01). A significant negative correlation was observed between mental score and the sedentary activity (p < .05). Female patients scored significantly lower than males in physical and mental score. At multivariate analysis, females were 1.65 times more likely to report impaired physical score than males. Occupation and physical activity presented significant positive relation with quality of life. Adherence to Mediterranean diet was another relevant predictor. Regarding mental score, female patients were 1.78 times more likely to show impaired mental score in comparison with males. Sedentary activity and adherence to Mediterranean diet were further noteworthy predictors. CONCLUSIONS: Females and subjects with sedentary lifestyle or work inactive seem to show the worst quality of life and both physical activity and Mediterranean diet might be helpful to improve it.

Use of technology by people with dementia and informal carers during COVID-19: A cross-country comparison.

OBJECTIVES: Considering the adverse outcomes of COVID-19, it is essential to provide adequate support and care for people with dementia and informal carers. Technology can reduce the distress associated with social distancing rules and the decreased access to in-person services. This study aimed to explore the use of technology and its perceived effects across different settings and countries. METHODS: The sample was composed of 127 informal carers and 15 people with dementia from the UK, Italy, Australia and Poland. Semi-structured interviews explored participants' experiences of using technology and their perceived effects. Transcripts were analysed by researchers in each country using an inductive approach. RESULTS: Three overarching themes were developed: (1) Technology kept us alive during COVID-19; (2) Remote care was anything but easy; (3) Perceived technology limitations. Many similarities emerged between countries supporting the role of technology for being socially engaged, having a routine, and staying active. However, the benefits of technology for health and psychosocial care were more limited. Across countries, barriers to the access and use of technology included lack of digital literacy, dementia severity, and lack of appropriate digital environments. Help and supervision from carers were also necessary and sometimes perceived as an additional burden. CONCLUSIONS: Technology can effectively reduce the shrinking world that may be amplified by the pandemic, thus preserving people with dementia's social skills and maintaining family connections. However, for more extensive and well-adapted use of technology in dementia care, actions should be taken to overcome the barriers to the access and use of technology by older and vulnerable people globally.

A qualitative 5-country comparison of the perceived impacts of COVID-19 on people living with dementia and unpaid carers.

BACKGROUND: Emerging evidence shows an impact of the COVID-19 pandemic on people living with dementia and informal carers, without any evidence-based global comparison to date. The aim of this international study was to explore and compare the perceived impact of COVID-19 and associated public health restrictions on the lives of people living with dementia and informal carers and access to dementia care across five countries. METHODS: Informal carers and people living with dementia who were residing in the community in the UK, Australia, Italy, India, and Poland were interviewed remotely between April and December 2020. Participants were asked about their experiences of the pandemic and how restrictions have impacted on their lives and care. Transcripts were analysed by researchers in each country using inductive thematic analysis. RESULTS: Fifteen people living with dementia and 111 informal carers participated across the five countries. Four themes emerged: (1) Limited access and support; (2) Technology and issues accessing remote support; (3) Emotional impact; and (4) Decline of cognitive and physical health reported by carers. Whilst variations were noted, the pandemic has indirectly affected people with dementia and carers across all five countries. The pandemic removed access to social support services and thus increased carer burden. Remote services were not always provided and were very limited in benefit and usability for those with dementia. As a result, carers appeared to notice reduced cognitive and physical health in people with dementia. Particular differences were noted between India and Poland vs. the UK, Italy, and Australia, with less impact on care provision in the former due to limited uptake of support services pre-pandemic based on cultural settings. CONCLUSIONS: The pandemic has amplified dementia as a global public health problem, and people affected by the condition need support to better access vital support services to live well.

Children and young people's experience of parental dementia: A systematic review.

OBJECTIVES: Most studies have been concerned with the experiences and needs of spouses/partners and adult children of people with dementia. In this review, children and young people's lived experience of parental dementia was investigated. Findings will inform both researchers and professionals in the area of dementia care. DESIGN: A systematic literature search was performed in CINAHL, PsychINFO, PubMed, Scopus, and Web of Science. A rigorous screening process was followed, and a checklist for qualitative and observational studies was used to evaluate the methodological quality of the studies. Narrative synthesis of the selected articles was carried out. RESULTS: Twenty-one studies were included and a synthesis of the literature revealed six themes. The first theme concerned the difficulties in dealing with the diagnosis which was often preceded by a long period characterized by uncertainty, confusion, family distress, and conflicts. The second theme discussed changes in family relationships in terms of the role of children and young people in supporting both parents and keeping family together. The third theme described the impact of caring on children and young people who struggled to balance caring tasks and developmental needs. The fourth theme showed consequences on children and young people's personal lives in terms of education/career and life planning. The fifth theme illustrated main adaptation models and coping strategies. The last theme discussed the need for appropriate support and services based on a "whole family" approach. CONCLUSIONS: The included studies provide the basis for knowledge and awareness about the experience of children and young people with a parent with dementia and the specific needs of support for this population.

Gene expression signature for early prediction of late occurring pancytopenia in irradiated baboons.

Based on gene expression changes measured in the peripheral blood within the first 2 days after irradiation, we predicted a pancytopenia in a baboon model. Eighteen baboons were irradiated with 2.5 or 5 Gy. According to changes in blood cell counts, the surviving baboons (n = 17) exhibited a hematological acute radiation syndrome (HARS) either with or without a pancytopenia. We used a two stage study design where stage I was a whole genome screen (microarrays) for mRNA combined with a qRT-PCR platform for simultaneous detection of 667 miRNAs using a part of the samples. Candidate mRNAs and miRNAs differentially upregulated or downregulated (>2-fold, p < 0.05) during the first 2 days after irradiation were chosen for validation in stage II using the remaining samples and using throughout more sensitive qRT-PCR. We detected about twice as many upregulated (mean 2128) than downregulated genes (mean 789) in baboons developing an HARS either with or without a pancytopenia. From 51 candidate mRNAs altogether, 11 mRNAs were validated using qRT-PCR. These mRNAs showed only significant differences between HARS groups and H0, but not between HARS groups with and without pancytopenia. Six miRNA species (e.g., miR-574-3p, p = 0.009, ROC = 0.94) revealed significant gene expression differences between HARS groups with and without pancytopenia and are known to sensitize irradiated cells. Hence, in particular, the newly identified miRNA species for prediction of pancytopenia will support the medical management decision making.

Pre-Exposure Gene Expression in Baboons with and without Pancytopenia after Radiation Exposure.

Radiosensitivity differs in humans and likely among primates. The reasons are not well known. We examined pre-exposure gene expression in baboons (n = 17) who developed haematologic acute radiation syndrome (HARS) without pancytopenia or a more aggravated HARS with pancytopenia after irradiation. We evaluated gene expression in a two stage study design where stage I comprised a whole genome screen for messenger RNAs (mRNA) (microarray) and detection of 667 microRNAs (miRNA) (real-time quantitative polymerase chain reaction (qRT-PCR) platform). Twenty candidate mRNAs and nine miRNAs were selected for validation in stage II (qRT-PCR). None of the mRNA species could be confirmed during the validation step, but six of the nine selected candidate miRNA remained significantly different during validation. In particular, miR-425-5p (receiver operating characteristic = 0.98; p = 0.0003) showed nearly complete discrimination between HARS groups with and without pancytopenia. Target gene searches of miR-425-5p identified new potential mRNAs and associated biological processes linked with radiosensitivity. We found that one miRNA species examined in pre-exposure blood samples was associated with HARS characterized by pancytopenia and identified new target mRNAs that might reflect differences in radiosensitivity of irradiated normal tissue.

[Herpes Zoster and its prevention in Italy. Scientific consensus statement]. / L'Herpes Zoster e la prevenzione vaccinale in Italia. Documento scientifico di consenso.

In this paper, an Italian group of experts presents a revision of the available data about epidemiology and prevention of Herpes Zoster (HZ). HZ is an acute viral diseases caused by the reactivation of Varicella Zoster Virus (VZV). HZ is characterized by neurological and dermatological symptoms with a dermatomeric localization. The reactivation of the virus from the latent status in the sensitive ganglia increases with age and failing cell mediated immunity. In Europe, more than 95% of adults presents antibodies against VZV. Incidence of HZ is similar all over the world, related to the age of the population: from 2-3/1000 persons/year in the age group 20 to 50 years to 5/1000 in the 60 years old, 6-7/1000 between 70 and 80 up to >1/100 in older than 80. In Italy, about 157,000 new cases of HZ are estimated every year with an incidence of 6.3/1000 persons/year mostly in older adults. Among the hospitalized cases, 60% are over 65 years of age. The more frequent and severe complication of HZ is post herpetic neuralgia (PHN), characterized by severe localized pain lasting at least 3 month after the beginning of the acute phase. The pain is responsible for a sharp decrease in the quality of life. In Europe, PHN is described in 2.6-27% of HZ cases. In Italy, data obtained by a network of General Practitioner show PHN in 20.6% of HZ patients, while 9.2% of the patients still presents PHN at 6 months. The more frequent localization is thoracic; when the virus reactivate at the level of the ophthalmic division of the trigeminal nerve most patients develop ocular complications. The clinical and therapeutical managements of HZ patients is difficult and the results are often poor. Prevention of HZ e PHN in the population over 50 years is possible using a live attenuated vaccine containing VZV (Oka/Merck strain, not less than 19.400 plaque forming units), available since 2006. Efficacy of anti-HZ vaccine was demonstrated in two large clinical trials that showed a 51% reduction in the incidence of HZ and a 61% decrease of the burden of illness. Incidence of PHN showed a reduction of 67% in immunized subjects. Long-term follow-up showed a persistence of the protection even if a decrease was noted in older subjects and with time. Effectiveness studies confirm the data of clinical trials and numerous pharmaco-economical evaluation show a favorable profile of HZ vaccine. The vaccine is recommended in USA, Canada and some European countries for people over 60. The expert group concluded that HZ and PHN represent an important clinical and Public Health problem in Italy and that the possibility to prevent them should be carefully evaluated.

Validation of genes for H-ARS severity prediction in leukemia patients - interspecies comparison, challenges, and promises.

PURPOSE: In a previous baboon-study, a total of 29 genes were identified for clinical outcome prediction of the hematologic, acute, radiation, syndrome (H-ARS) severity. Among them, four genes (FDXR, DDB2, POU2AF1, WNT3) appeared promising and were validated in five leukemia patients. Within this study, we sought further in-vivo validation in a larger number of whole-body irradiated patients. MATERIAL AND METHODS: Peripheral blood was drawn from 10 leukemia patients before and up to 3 days during a fractionated (2 Gy/day) total-body irradiation (TBI) with 2-12Gy. After RNA-isolation, gene expression (GE) was evaluated on 31 genes widely used in biodosimetry and H-ARS prediction employing qRT-PCR. A customized low-density-array (LDA) allowed simultanously analyzing all genes, the 96-well format further examined the four most promising genes. Fold-changes (FC) in GE relative to pre-irradiation were calculated. RESULTS: Five patients suffering from acute-lymphoblastic-leukemia (ALL) respectively non-Hodgkin-lymphoma (NHL) revealed sufficient RNA-amounts and corresponding lymphocyte and neutrophile counts for running qRT-PCR, while acute-myeloid-leukemia (AML) and one myelofibrosis patient could not supply enough RNA. Generally, 1-2µg total RNA was isolated, whereas up to 10-fold differences in RNA-quantities (associated suppressed GE-changes) were identified among pre-exposure and exposure samples. From 31 genes, 23 were expressed in at least one of the pre-exposure samples. Relative to pre-exposure, the number of expressed genes could halve at 48 and 72h after irradiation. Using the LDA, 13 genes were validated in human samples. The four most promising genes (vid. sup.) were either undetermined or too close to pre-exposure. However, they were measured using the more sensitive 96-well format, except WNT3, which wasn´t detectable. As in previous studies, an opposite regulation in GE for FDXR in leukemia patients (up-regulated) relative to baboons (down-regulated) was reconfirmed. Radiation-induced GE-changes of DDB2 (up-regulated) and POU2AF1 (down-regulated) behaved similarly in both species. Hence, 16 out of 23 genes of two species showed GE-changes in the same direction, and up-regulated FDXR as in human studies were revalidated. CONCLUSION: Identified genes for H-ARS severity prediction, previously detected in baboons, were validated in ALL but not in AML patients. Limitations related to leukemia type, associated reduced RNA amounts, suppressed GE changes, and methodological challenges must be considered as factors negatively affecting the total number of validated genes. Based on that, we propose additional controls including blood cell counts and preferably fluorescence-based RNA quantity measurements for selecting promising samples and using a more sensitive 96-well format for candidate genes with low baseline copy numbers.

Different Production Processes for Thermoplastic Composite Materials: Sustainability versus Mechanical Properties and Processes Parameter.

Up to now, fiber-reinforced composites with thermoplastic matrix have seen limited fields of use in the structural scope due to their high viscosity in the molten state, which results in poor impregnability of the reinforcement, leading to mechanical properties of the finished product that are not comparable to those of thermosets. Although the latter still dominate the various sectors of automotive, aerospace, transportation and construction, new applications involving the production of thermoplastic composites are growing rapidly, offering new approaches to the solution of this problem. The aim of this work is to study and evaluate the state of the art on the manufacturing processes of thermoplastic matrix composite, analyzing the parameters that come into play and that most influence the process and material performance. The advantages of film stacking and powder impregnation techniques are contrasted by the versatility of hybrid fabrics and, at the same time, parameters such as pressure and temperature must be carefully considered. A description of different thermoplastic composite processes such as powder impregnation, film stacking molding, hybrid woven fabric, hybrid yarn and products follows, which represent the current possibilities to move from a thermosetting matrix composite to a thermoplastic one, upon which the concept of sustainability is based. This article wants to present an overview of research that has been done in manufacturing thermoplastic reinforced composites and will serve as a baseline and aid for further research and development efforts.

Aerogel Technology for Thermal Insulation of Cryogenic Tanks-Numerical Analysis for Comparison with Traditional Insulating Materials.

The traditional choice of insulation material for liquefied natural gas (LNG) transportation with cryogenic tankers is the back-filled perlite-based system. However, aiming to further cut down the insulation cost, spare additional arrangement space, and provide safety in installation and maintenance, the requirement of looking for alternative materials still exists. Fiber-reinforced aerogel blankets (FRABs) could represent good candidates in designing insulation layers for LNG cryogenic storage because of their ability to ensure adequate thermal performance without the need to create deep vacuum conditions in the annular space of the tank. In this work, a finite element method (FEM) model was developed to study the thermal insulation performance of a commercial FRAB (Cryogel ® Z) for application in cryogenic storage/transport LNG tanks, comparing it with the performance of traditional perlite-based systems. Within the reliability limits of the computational model, the analysis proved that FRAB insulation technology gave encouraging results and might be potentially scalable for transporting cryogenic liquid. In addition to demonstrating superior performance in terms of thermal insulating efficiency and boil-off rate over the perlite-based system, as far as a perspective of cost savings and space gain, FRAB technology allows for higher levels of insulation without vacuum and with lower thickness of the outer shell, which is therefore beneficial for storing more material and lightening the weight of the LNG transportation semitrailer.

The Role of the Quality of Relationship in Couples Facing Treatment for Breast Cancer: A Qualitative Italian Study.

INTRODUCTION: Breast cancer is the leading cause of cancer death in women worldwide. Recently, the focus of research has shifted from psychiatric, psychological, and social consequences on the woman who gets sick from breast cancer to the impact on the couple. Indeed, the psychosocial perspective has developed the construct of the Quality of Relationship (QoR) that affects the quality of life of both members of the dyad. OBJECTIVE: The aim of this study was to extend knowledge in this field by identifying and analyzing what dimensions of QoR may impact couples' psychosocial adjustment to breast cancer and related treatments. PATIENTS AND METHODS: Semistructured interviews explored couples' experiences of breast cancer diagnosis and treatment. Transcripts were analyzed using inductive thematic analysis. RESULTS: Twelve couples were interviewed. Results showed how the dimensions of psychosocial support, dyadic coping, communication, and intimacy are associated and define the construct of QoR, thus affecting the couples' adjustment to breast cancer diagnosis and to the disease pathway. CONCLUSION: Assessment procedures of couple functioning since and after diagnosis could increase the appropriateness and benefits of integrating existing clinical practice in oncological settings.

Synergic Effect of Recycled Carbon Fibers and Microfibrillated Cellulose Gel for Enhancing the Mechanical Properties of Cement-Based Materials.

A new hybrid fiber blend containing microfibrillated cellulose (MFC) gel and recycled carbon short fiber (RCSF) was implemented for designing fiber-reinforced cement mortars, to further improve the mechanical properties and enhance the sustainability of cement-based materials. The individual impact of single fibrous fillers as well as the synergistic effect of a hybrid fiber system (MFC + RCSF) were investigated in terms of the rheological properties, mechanical strength, and microstructure of the mortars. The results indicated that the workability of fresh mixtures slightly increased after fiber addition. The fibers incorporated alone improved the materials' performance in different ways. The addition of RCSF led to improvements of up to 76% in flexural strength and 13% in compression strength for a fiber content of 0.75 wt.%. However, the addition of carbon fibers led to slight deteriorations in terms of porosity and water absorption. On the other hand, the use of MFC induced a less significant growth in terms of mechanical strength (+14% in flexural strength for 0.75 wt.% of cellulose) but greatly improved the microstructural quality of the mortar, significantly reducing its water permeability. Considering the optimum MFC dosage, MFC+RCSF hybrid mixtures showed positive effects on the mechanical properties and microstructure of the mortar, displaying further improvements in strength, while preserving a lower porosity and water absorption than the control mix.

Carbon-Fiber-Recycling Strategies: A Secondary Waste Stream Used for PA6,6 Thermoplastic Composite Applications.

With a view to achieving sustainable development and a circular economy, this work focused on the possibility to valorize a secondary waste stream of recycled carbon fiber (rCF) to produce a 3D printing usable material with a PA6,6 polymer matrix. The reinforcing fibers implemented in the research are the result of a double-recovery action: starting with pyrolysis, long fibers are obtained, which are used to produce non-woven fabrics, and subsequently, fiber agglomerate wastes obtained from this last process are ground in a ball mill. The effect of different amounts of reinforcement at 5% and 10% by weight on the mechanical properties of 3D-printed thermoplastic composites was investigated. Although the recycled fraction was successfully integrated in the production of filaments for 3D printing and therefore in the production of specimens via the fused deposition modeling technique, the results showed that fibers did not improve the mechanical properties as expected, due to an unsuitable average size distribution and the presence of a predominant dusty fraction ascribed to the non-optimized ball milling process. PA6,6 + 10 wt.% rCF composites exhibited a tensile strength of 59.53 MPa and a tensile modulus of 2.24 GPa, which correspond to an improvement in mechanical behavior of 5% and 21% compared to the neat PA6,6 specimens, respectively. The printed composite specimens loaded with the lowest content of rCF provided the greatest improvement in strength (+9% over the neat sample). Next, a prediction of the "optimum" critical length of carbon fibers was proposed that could be used for future optimization of recycled fiber processing.

COVID-19 and community-based care services: Experiences of people living with dementia and their informal carers in Italy.

The COVID-19 pandemic has significantly limited access to health and social care support systems for people with dementia and their carers, compounding the severe social restrictions. The aim of this study was to investigate the experiences of COVID-19 among community-dwelling people with dementia and their informal carers in Italy. Specifically, we focused on access to community-based services and adopted solutions to provide support and care during exceptional times. Informal carers, caring for someone with dementia and attending community-based services in Italy, participated in remote semi-structured interviews between October and November 2020. Participants were asked about the effects of social isolation and closure of in-person services on their daily lives as well as the challenges of dementia care. Transcripts were analysed using inductive thematic analysis. 22 informal carers were interviewed. Three themes emerged: (1) Disruptions to people with dementia's lives and health; (2) COVID-19 as an additional stressor for carers; and (3) New ways of caring for people with dementia during COVID-19. Face-to-face social care and social support services were suddenly interrupted and restrictions on social distancing were introduced, thus leading to people with dementia's impaired health and increased behavioural and psychological symptoms. Not only the amount but also the intensity of care increased, with no chance of respite for informal carers. Overall remote activities provided participants with emotional and social benefits, while allowing the continuity of relationships with services staff and users and of care. However, according to carers, a combination of virtual and face-to-face activities could better counterbalance the multiple adverse outcomes of COVID-19. Public health measures should be designed carefully to consider the safety needs and the physical, psychological and social needs of people with dementia. Within a holistic care approach, social care services need to be enabled better to guarantee high-quality care even during pandemic times.

The hemorrhoid laser procedure technique vs rubber band ligation: a randomized trial comparing 2 mini-invasive treatments for second- and third-degree hemorrhoids.

BACKGROUND: Hemorrhoid laser procedure is a new laser procedure for outpatient treatment of hemorrhoids in which hemorrhoidal arterial flow feeding the hemorrhoidal plexus is stopped by means of Doppler-guided laser coagulation. OBJECTIVE: Our aim was to compare the hemorrhoid laser procedure with rubber band ligation for outpatient treatment of symptomatic hemorrhoids with moderate mucosal prolapse. DESIGN: This was a randomized controlled trial with balanced allocation to hemorrhoid laser procedure or rubber band ligation, with stratification by study center. SETTING: This study was conducted at 2 teaching hospitals in Italy. PATIENTS: Patients with symptomatic grade II or grade III hemorrhoids with minimal mucosal prolapse were eligible for the study. INTERVENTIONS: In the hemorrhoid laser procedure operation, a Doppler probe was inserted into the anal canal through a dedicated disposable proctoscope to identify the terminal branches of superior hemorrhoidal arteries approximately 3 cm above the dentate line. Five pulsed laser shots were delivered to each identified artery through the proctoscope to close the terminal branches. The procedure was repeated for each artery through clockwise rotation of the proctoscope. Absence of a Doppler signal after treatment confirmed arterial coagulation. Rubber band ligation was performed by positioning rubber bands at the base of left lateral, right anterior, and right posterior piles. No anesthesia was given for either technique. MAIN OUTCOME MEASURES: Operative time, complications, postoperative pain (visual analog scale), postoperative downgrading of hemorrhoids, resolution of symptoms, and quality of life were evaluated. RESULTS: A total of 60 patients (35 women, 25 men; mean age, 46 years) entered the trial and were analyzed. No significant differences between rubber band ligation and hemorrhoid laser procedure were observed in operative time or intraoperative morbidity. The median postoperative pain score was 2.9 (range, 1-5) with rubber band ligation vs 1.1 (range, 0-2) for hemorrhoid laser procedure (P < .001). At 6 months, resolution of symptoms was observed in 16 patients (53%) with ligation vs 27 (90%) with hemorrhoid laser procedure (P < .001), and reduction of hemorrhoids by at least 1 grade was observed in 12 patients (40%) with ligation vs 24 (80%) with hemorrhoid laser procedure (P < .001). Significantly higher quality of life was seen in the hemorrhoid laser procedure group (P = .002). LIMITATIONS: Follow-up was not longer than 1 year (median, 6 mo). CONCLUSIONS: Despite higher cost, the hemorrhoid laser procedure technique was more effective than rubber band ligation in reducing postoperative pain, resolving symptoms, and improving quality of life in patients with grade II or III hemorrhoids with incomplete mucosal prolapse.

Doppler-guided hemorrhoidal laser procedure for the treatment of symptomatic hemorrhoids: experimental background and short-term clinical results of a new mini-invasive treatment.

BACKGROUND: According to the "vascular" theory, arterial overflow in the superior hemorrhoidal arteries would lead to dilatation of the hemorrhoidal venous plexus. A 980-nm diode laser-pulsed shot causes shrinkage of tissue. The depth of shrinkage can be regulated by the power and duration of the laser beam. Through a 1000-micron conic fiber, five laser shots generated at a power of 13 W with duration of 1.2 s each and a pause of 0.6 s caused shrinkage of tissues to the depth of approximately 5 mm. Terminal branches of the superior hemorrhoidal artery in the anal canal, if precisely identified through a Doppler signal, can be closed with the use of this laser. METHODS: A specially designed proctoscope has a small window that allows introducing a Doppler probe whose function is to identify hemorrhoidal arteries. Approximately 3 cm above the dentate line, the terminal branches of the superior hemorrhoidal artery (usually 8-12) are recognized through a clockwise rotation of the proctoscope and progressively fulgurated through a laser optic fiber. The procedure does not require anesthesia and can be performed as an ambulatory treatment. RESULTS: Thirty patients (16 men) with second to third grade symptomatic hemorrhoids have been treated with the described technique. The procedure proved to be successful at 3 months' follow-up in 92% of cases. No major adverse effects or complications were reported. Bleeding was observed in four cases. In two cases surgical hemostasis was necessary. Minor pain that required medication was reported in three cases. CONCLUSIONS: The hemorrhoidal laser procedure (HeLP) represents a new nonexcisional, mini-invasive treatment for patients suffering from second and third degree hemorrhoids without severe mucosal prolapse. Thermal occlusion of the hemorrhoidal arteries causes a progressive shrinkage of hemorrhoidal cushions. The procedure does not require anesthesia, is technically easy, repeatable, and can be performed as an office treatment.

Ground Waste Tire Rubber as a Total Replacement of Natural Aggregates in Concrete Mixes: Application for Lightweight Paving Blocks.

The use of waste materials as alternative aggregates in cementitious mixtures is one of the most investigated practices to enhance eco-sustainability in the civil and construction sectors. For specific applications, these secondary raw materials can ensure adequate technological performance, minimizing the exploitation of natural resources and encouraging the circular disposal of industrial or municipal waste. Aiming to design and develop lightweight paving blocks for pedestrian or very light-traffic purposes (parking area, garage, sidewalk, or sports surfaces), this paper presents the material characterization of rubberized cement mortars using ground waste tire rubber (0-1 mm rubber powder and 1-3 mm rubber granules) to totally replace the mineral aggregates. Considering recommended requirements for concrete paving members in terms of mechanical strength, water drainage performance, acoustic attenuation, and dynamic and energy absorption behavior, a comprehensive laboratory testing is proposed for five different formulations varying the sand-rubber replacement level and the proportion ratio between the two rubber fractions. Tests highlighted positive and promising results to convert laboratory samples into pre-cast members. The "hot" finding of the work was to prove the feasibility of obtaining totally rubberized mortars (0 v/v% of sand) with suitable engineering performance and enhanced eco-friendly features.

Relationship Dynamics among Couples Dealing with Breast Cancer: A Systematic Review.

Most studies have been concerned with the experiences and needs of women with breast cancer and spouses/partners separately. In this review, the relationship dynamics that characterize the couple's experience of breast cancer treatment were investigated. Findings will inform both researchers and professionals in the area of oncology. A systematic literature search was performed in CINAHL, PsychINFO, MEDLINE, Scopus and Web of Science. A checklist for qualitative and observational studies was used to evaluate the methodological quality of the studies. Seventeen studies were included, and the synthesis of the literature revealed five domains that characterized the dyadic process: dyadic coping strategies, psychosocial support, communication, the couple's sexual life and spirituality. The included studies provide the basis for knowledge and awareness about the experience of couples with cancer, the specific dimensions enacted during the breast cancer treatment path and the type of responses that are associated with a positive couple's adjustment to the disease.

Geopolymers vs. Cement Matrix Materials: How Nanofiller Can Help a Sustainability Approach for Smart Construction Applications-A Review.

In the direction of reducing greenhouse emissions and energy consumption related to the activities of the cement and concrete industry, the increasingly popular concept of eco-sustainability is leading to the development and optimization of new technologies and low impact construction materials. In this respect, geopolymers are spreading more and more in the cementitious materials field, exhibiting technological properties that are highly competitive to conventional Portland concrete mixes. In this paper, the mix design, mechanical properties, microstructural features, and mineralogical properties of geopolymer mixes are discussed, investigating the influence of the main synthesis parameters (curing regime, type of precursors, activator molarity, mix design) on the performance of the final product. Moreover, recent developments of geopolymer technology based on the integration of functional nanofillers are reported. The novelty of the manuscript is to provide a detailed collection of past and recent comparative studies between geopolymers and ordinary Portland concrete mixes in terms of strength properties, durability, fire resistance, and environmental impact by LCA analysis, intending to evaluate the advantages and limitations of this technology and direct research towards a targeted optimization of the material.