Sources and Transmission Routes of Carbapenem-Resistant Pseudomonas aeruginosa: Study Design and Methodology of the SAMPAN Study

Background/Objectives: The global spread of carbapenem-resistant Pseudomonas aeruginosa (CRPA) warrants collaborative action. Guidance should come from integrated One Health surveillance; however, a surveillance strategy is currently unavailable due to insufficient knowledge on the sources and transmission routes of CRPA. The aim of the SAMPAN study (“A Smart Surveillance Strategy for Carbapenem-resistant Pseudomonas aeruginosa”) is to develop a globally applicable surveillance strategy. Methods: First, an international cross-sectional study will be conducted to investigate CRPA in clinical and environmental settings in Rotterdam (The Netherlands), Rome (Italy), and Jakarta (Indonesia). Screening cultures and risk factor questionnaires will be taken from healthy individuals and patients upon hospital admission. Clinical CRPA isolates will also be included. Additionally, samples will be taken twice from wet hospital environments and monthly from the hospitals’ (drinking) water system, hospital and municipal wastewater treatment plants, and receiving rivers. Whole-genome sequencing will be performed to characterize CRPA isolates and determine the genetic relatedness among the isolates from different reservoirs. Findings from the cross-sectional study, combined with expert elicitation using a Delphi method, will serve as the input for the surveillance strategy. Conclusions: The SAMPAN study will provide a broader understanding of the sources and transmission routes of CRPA. Therewith, the development of a globally applicable smart surveillance strategy will be made possible, delivering information that is needed to guide actions against the spread of CRPA

Le produzioni animali, 2024

The livestock sector in Lombardy during 2023 remains a cornerstone of the region’s agriculture, reaching €6.15 billion in value, up 8.4% from 2022, growth mainly driven by rising prices rather than increased volumes. Milk production, the leading component of the sector, has remained generally stable with slight growth in 2023. However, farm profitability is under pressure due to rising production costs, particularly energy and feed. The meat sector grew by 10.2% in value despite lower quantities; beef production is declining, driven by a structural reduction in the number of farms and weak domestic demand. The pig farming sector is experiencing greater difficulties: increased costs and disruptions in the processing industry have led to a drop in the number of farms. In contrast, the poultry sector is performing well, supported by strong demand and stable prices, both for meat and eggs. Minor sectors like horsemeat and honey remain in decline, with honey production falling sharply due to climate and bee health issues. Overall, Lombardy’s livestock system, during 2023, remains strong but vulnerable to market volatility, regulatory changes, and environmental pressures. Adaptation and innovation are becoming increasingly essential to ensure the long-term sustainability of the sector

Planar Schrodinger-Poisson system with steep potential well: supercritical exponential case

We study a class of planar Schrodinger-Poisson system

From food-to-human microplastics and nanoplastics exposure and health effects: A review on food, animal and human monitoring data

This review figures out the overall status on the presence of microplastics (MPs) and nanoplastics (NPs) in food and their bioaccumulation in animal and human tissues, providing critical insights into possible human health impacts. Data are discussed on both in-vivo and ex-vivo animal and human studies, and the role of physicochemical properties in determining the biological fate and toxicological effects of MPs and NPs. Particular attention is given to dietary exposure assessments, specifically evaluating daily intake through the consumption of contaminated food items. The current limitations in the body of knowledge and some considerations for future assessments are also reported. Overall, there is a pressing need to establish more robust biomarker research and develop standardized methodologies, for a better understanding of MPs and NPs fate and associated effects in more realistic scenarios for their safe consumption. The review underscores the importance of integrating the human biomonitoring into monitoring programs and interdisciplinary research to ultimately inform on MPs and NPs real burden in the human body

Letture social del meme: stereotipi e fraintendimenti di un umorismo sui generis

Il concetto di trash viene qui analizzato tramite i meccanismi del social listening (ascolto della rete). In un periodo di ricerca annuale, ci si propone di interrogarsi sulla percezione delle audience della satira usata, sui social, per ironizzare su tematiche quotidiane. Interessante sarà considerare il caso dei Meme Award, ma prima di procedere con questo esempio, pare opportuno riflettere sul concetto di trash in generale. Lo si potrebbe descrivere come un processo di etichettamento diffusissimo nelle culture mediali della contemporaneità che però, nonostante la sua crescente pervasività, non è descrivibile tramite un’univoca definizione. In senso generale, si potrebbe provare a dire che esso ha a che fare con la rinegoziazione del valore di prodotti culturali che occupano il gradino più basso di una gerarchia estetica condivisa e viene spesso molto semplicisticamente associato ai contenuti spazzatura. Data questa breve premessa, l’ambizione di questo lavoro è quindi dimostrare come il trash sui social spopoli molto in quanto strumento di satira, applicato a moltissimi ambiti, sottolineando come in realtà gode anche (ma non solo) di considerazione positiva

Timing and morbidity of loop ileostomy closure after rectal cancer resection: a prospective observational multicentre snapshot study from Multidisciplinary Italian Study group for STOmas (MISSTO)

Purpose: Time to closure and morbidity are significant issues associated with ileostomy reversal after rectal cancer resection. This study aimed to investigate the rate, time, and morbidity associated with ileostomy closure procedure. Methods: Between February and December 2022, patients who underwent protective ileostomy after rectal cancer surgery across 45 Italian surgical centres were prospectively included. Data on ileostomy closure times, surgical methods, and complications were collected and analyzed. Both univariate and multivariate statistical tests were employed to assess stoma closure rates and the occurrence of post-operative complications. Results: A total of 287 patients participated in the study. Ileostomy closure was achieved in 241 patients, yielding overall and 6-month closure rates of 84% and 62%, respectively. The median time for ileostomy closure was 146 days. Direct sutures were used to close approximately 70% of skin defects, while purse-string sutures were applied in around 20%. The overall morbidity rate was 17%, with complications including skin suture dehiscence (7%), small bowel obstruction (6%), and anastomotic leakage (2%). Multivariate analysis revealed that an American Society of Anesthesiologists (ASA) score > 2 (p = 0.028), advanced age (p = 0.048), and previous stoma complications (p = 0.048) were independently linked to failure of stoma closure; hypertension (p = 0.036) was found to be a significant independent risk factor for post-operative complications. Conclusion: This study demonstrated that a delay and a significant no-closure rate exist in ileostomy reversal after rectal cancer surgery. Post-operative complications remain high but can be prevented with adequate pre-operative assessment and post-operative care

Long-term clinical impact of angiographic complexity in left main trifurcation percutaneous coronary interventions

Background: Current evidence on the long-term outcome and its determinants in patients with unprotected left main trifurcation (LMT) treated with percutaneous coronary intervention (PCI) is based on small-sized studies. We aimed to assess the clinical, anatomical and procedural factors impacting long-term clinical outcomes of patients with LMT treated by PCI. Methods: We conducted a multicenter retrospective study on consecutive patients with unprotected LMT in stable or acute coronary settings who underwent PCI with drug-eluting-stent implantation. Primary endpoint was major adverse cardiovascular events (MACE), defined as composite of all-cause death, myocardial infarction, and target lesion revascularization. LMT lesions complexity was graded according to a modified Medina LMT score, which, together with standard criteria of >50% stenosis in any of the branches, included the presence of disease extent >5 mm in the two major side-branches. Results: A total of 103 patients were analyzed, mean age 67.5 years, 37.9% with diabetes mellitus, 47.6% presenting with acute coronary syndrome, 8.7% in cardiogenic shock, with a mean SYNTAX Score of 28.1. Procedural success (angiographic success without in-hospital MACE) was achieved in 99 patients (96.1%). During 3-year follow-up, 18 patients (17.9%) experienced MACE, mainly due to target lesion revascularization (TLR), which occurred in 12 patients (11.9%). At multivariable analysis, modified Medina LMT score was the only independent predictor of MACE (HR 1.538 [1.081-2.189], P=0.017). Conclusions: PCI in patients with LMT is associated with a high procedural success rate and acceptable long-term clinical outcomes. Baseline LMT lesion complexity, assessed by an original modified Medina LMT score, is an independent driver of long-term clinical outcomes

Exploring language-related episodes (LREs) in English-medium instruction (EMI) from a translanguaging and multimodal perspective

With the expansion of English-medium Instruction (EMI) programmes in European universities, studies have begun to point at the linguistic challenges faced by lecturers and students and suggest the need to increase the focus on language in English-taught content lectures. Language-related episodes (LREs), intended as brief transitory shifts of the topic of the discourse from content to language, could be a way of focusing on language within content-based activities. The present study aims to identify the occurrence of LREs in engineering lectures at a Spanish multilingual university and explore their construction from a translanguaging and multimodal perspective. For this purpose, a series of videotaped and verbatim transcribed lectures were analysed following previous frameworks for Multimodal Discourse Analysis (MDA). Results indicate that LREs do occur, with a highly variant frequency rate across lectures. Furthermore, multiple semiotic resources and translanguaging practices are used and play a major contribution to the meaning-making process of the LREs. The outcome of this study calls for a multimodal reconceptualization of LREs and shows instances of good practices that can be potentially included in professional training programmes to develop EMI lecturer awareness

Global, regional, and national prevalence of adult overweight and obesity, 1990–2021, with forecasts to 2050: a forecasting study for the Global Burden of Disease Study 2021

Background: Overweight and obesity is a global epidemic. Forecasting future trajectories of the epidemic is crucial for providing an evidence base for policy change. In this study, we examine the historical trends of the global, regional, and national prevalence of adult overweight and obesity from 1990 to 2021 and forecast the future trajectories to 2050. Methods: Leveraging established methodology from the Global Burden of Diseases, Injuries, and Risk Factors Study, we estimated the prevalence of overweight and obesity among individuals aged 25 years and older by age and sex for 204 countries and territories from 1990 to 2050. Retrospective and current prevalence trends were derived based on both self-reported and measured anthropometric data extracted from 1350 unique sources, which include survey microdata and reports, as well as published literature. Specific adjustment was applied to correct for self-report bias. Spatiotemporal Gaussian process regression models were used to synthesise data, leveraging both spatial and temporal correlation in epidemiological trends, to optimise the comparability of results across time and geographies. To generate forecast estimates, we used forecasts of the Socio-demographic Index and temporal correlation patterns presented as annualised rate of change to inform future trajectories. We considered a reference scenario assuming the continuation of historical trends. Findings: Rates of overweight and obesity increased at the global and regional levels, and in all nations, between 1990 and 2021. In 2021, an estimated 1·00 billion (95% uncertainty interval [UI] 0·989–1·01) adult males and 1·11 billion (1·10–1·12) adult females had overweight and obesity. China had the largest population of adults with overweight and obesity (402 million [397–407] individuals), followed by India (180 million [167–194]) and the USA (172 million [169–174]). The highest age-standardised prevalence of overweight and obesity was observed in countries in Oceania and north Africa and the Middle East, with many of these countries reporting prevalence of more than 80% in adults. Compared with 1990, the global prevalence of obesity had increased by 155·1% (149·8–160·3) in males and 104·9% (95% UI 100·9–108·8) in females. The most rapid rise in obesity prevalence was observed in the north Africa and the Middle East super-region, where age-standardised prevalence rates in males more than tripled and in females more than doubled. Assuming the continuation of historical trends, by 2050, we forecast that the total number of adults living with overweight and obesity will reach 3·80 billion (95% UI 3·39–4·04), over half of the likely global adult population at that time. While China, India, and the USA will continue to constitute a large proportion of the global population with overweight and obesity, the number in the sub-Saharan Africa super-region is forecasted to increase by 254·8% (234·4–269·5). In Nigeria specifically, the number of adults with overweight and obesity is forecasted to rise to 141 million (121–162) by 2050, making it the country with the fourth-largest population with overweight and obesity. Interpretation: No country to date has successfully curbed the rising rates of adult overweight and obesity. Without immediate and effective intervention, overweight and obesity will continue to increase globally. Particularly in Asia and Africa, driven by growing populations, the number of individuals with overweight and obesity is forecast to rise substantially. These regions will face a considerable increase in obesity-related disease burden. Merely acknowledging obesity as a global health issue would be negligent on the part of global health and public health practitioners; more aggressive and targeted measures are required to address this crisis, as obesity is one of the foremost avertible risks to health now and in the future and poses an unparalleled threat of premature disease and death at local, national, and global levels. Funding: Bill & Melinda Gates Foundation

Management, Flow, and Outcomes of Patients with Aortic Stenosis Followed by a Heart Valve Clinic: The Untold "Behind the Scene" from a High-Volume, Real-World Experience

Background: According to current guidelines, patients with heart valve disease should be followed by Heart Valve Clinics (HVCs). Regular quality analysis is a major prerequisite of an HVC’s program, but few data have been reported so far. Methods: We retrospectively collected patients with isolated, native aortic valve stenosis who had been visited in our HVC at least once between 2021 and 2024. For each outpatient visit, symptoms, physical examination, echocardiographic data, complementary tests, and indications were acquired. Also, adverse events (hospitalization, unplanned procedures, and death) were retrieved. Results: A total of 320 patients were included. Mean visits/patient ratio was 1.2. At the first visit, 69.7% already had severe aortic stenosis, and severe symptoms (NYHA ≥ III) were evident in 24.4%. In addition, 26.5%, 59.1%, 12.8%, and 1.6% were in Généreux stage I, II, III, and IV, respectively. Overall, 197 (78.5%) and 54 (21.5%) patients received an indication for transcatheter AVR and surgical AVR, respectively. AVR-free survival was 46%, 23%, and 6% at 6, 12, and 24 months, respectively (mean 8.8 months CI95% 7.7–9.9). Adverse event-free survival was 97.2%, 95.5%, and 85% at 3, 6, and 12 months, respectively. Conclusions: Patients referred to our HVC already had an advanced disease with cardiac damage. Transcatheter AVR was mostly indicated, and it showed excellent short-term results. A low rate of adverse events was seen among patients in follow-up, but the odds of receiving AVR were high and driven by Généreux’s stage. Despite these favorable results, further efforts to sensitize earlier patient referral should be made