All the probiotics used were superior to placebo for side effect prevention, but were not associated with better compliance with antibiotic therapy. The effect of probiotic supplementation on side effects during anti-H. pylori regimens seemed to be independent of the probiotic species used.

O rthotopic liver transplantation (OLT) is the ideal treatment for hepatocellular carcinoma (HCC) emerging in liver cirrhosis since both the tumor and the underlying cirrhosis can be cured. 1 According to Mazzaferro et al., 2 OLT should be restricted to patients with single HCC lower than 5 cm or with no more than 3 nodules, each smaller than 3 cm, in order to achieve an acceptable rate of tumor recurrence. Several studies confirmed a 5-year survival of 57 to 74% if these selection criteria are taken into account. 3 -8 However, progressive tumor enlargement, occurrence of new nodules or of vascular invasion may take place precluding transplantation in HCC patients awaiting for OLT. Adjuvant treatments such as transarterial chemoembolization (TACE), percutaneous ethanol injection (PEI), and radiofrequency ablation (RFA) have been used to prevent tumor progression in HCC patients listed for OLT, but a clear confirmation of their usefulness is still lacking. 1 The efficacy evaluation of percutaneous ablation techniques is usually made using imaging techniques such as multiphasic computed tomography (CT) and magnetic resonance imaging, assessing the presence of residual arterial vascularization within the nodule. Based upon imaging techniques, the rate of short-term complete necrosis of small HCCs lower than 3 cm has been shown to be 70 to 80% after PEI 9,10 and 90 to 93% after RFA. 10,11 The model of the explanted liver provides an unique opportunity to validate the ablation techniques allowing to evaluate their efficacy result from a pathological point of view. However, there are

The aim of the present study was to describe the clinical presentation of patients aged ≥80 years with coronavirus disease 2019 , and provide insights regarding the prognostic factors and the risk stratification in this population.Methods: This was a single-center, retrospective, observational study, carried out in a referral center for COVID-19 in central Italy. We reviewed the clinical records of patients consecutively admitted for confirmed COVID-19 over a 1-month period (1-31 March 2020). We excluded asymptomatic discharged patients. We identified risk factors for death, by a uni-and multivariate Cox regression analysis. To improve model fitting and hazard estimation, continuous parameters where dichotomized by using Youden's index.Results: Overall, 69 patients, aged 80-98 years, met the inclusion criteria and were included in the study cohort. The median age was 84 years (82-89 years is interquartile range); 37 patients (53.6%) were men. Globally, 14 patients (20.3%) presented a mild, 30 (43.5%) a severe and 25 (36.2%) a critical COVID-19 disease. A total of 23 (33.3%) patients had died at 30 days' follow up. Multivariate Cox regression analysis showed that severe dementia, pO 2 ≤90 at admission and lactate dehydrogenase >464 U/L were independent risk factors for death. Conclusions:The present data suggest that risk of death could be not age dependent in patients aged ≥80 years, whereas severe dementia emerged is a relevant risk factor in this population. Severe COVID-19, as expressed by elevated lactate dehydrogenase and low oxygen saturation at emergency department admission, is associated with a rapid progression to death in these patients.

Aims To identify the most accurate early warning score (EWS) for predicting an adverse outcome in COVID-19 patients admitted to the emergency department (ED). Methods In adult consecutive patients admitted (March 1-April 15, 2020) to the ED of a major referral centre for COVID-19, we retrospectively calculated NEWS, NEWS2, NEWS-C, MEWS, qSOFA, and REMS from physiological variables measured on arrival. Sensitivity, specificity, positive (PPV) and negative predictive value (NPV), and the area under the receiver operating characteristic (AUROC) curve of each EWS for predicting admission to the intensive care unit (ICU) and death at 48 h and 7 days were calculated. Results We included 334 patients (119 [35.6%] females, median age 66 [54-78] years). At 7 days, the rates of ICU admission and death were 56/334 (17%) and 26/334 (7.8%), respectively. NEWS was the most accurate predictor of ICU admission within 7 days (AUROC 0.783 [95% CI, 0.735-0.826]; sensitivity 71.4 [57.8-82.7]%; NPV 93.1 [89.8-95.3]%), while REMS was the most accurate predictor of death within 7 days (AUROC 0.823 [0.778–0.863]; sensitivity 96.1 [80.4-99.9]%; NPV 99.4[96.2–99.9]%). Similar results were observed for ICU admission and death at 48 h. NEWS and REMS were as accurate as the triage system used in our ED. MEWS and qSOFA had the lowest overall accuracy for both outcomes. Conclusion In our single-centre cohort of COVID-19 patients, NEWS and REMS measured on ED arrival were the most sensitive predictors of 7-day ICU admission or death. EWS could be useful to identify patients with low risk of clinical deterioration.