Hospital discharges-based search of acute flaccid paralysis cases 2007-2016 in Italy and comparison with the National Surveillance System for monitoring the risk of polio reintroduction

Background: Acute flaccid paralysis (AFP) surveillance has been adopted globally as a key strategy for monitoring the progress of the polio eradication initiative. Hereby, to evaluate the completeness of the ascertainment of AFP cases in Italy, a hospital-discharges based search was carried out. Methods: AFP cases occurring between 2007 and 2016 among children under 15 years of age were searched in the Italian Hospital Discharge Records (HDR) database using specific ICD-9-CM diagnostic codes. AFP cases identified between 2015 and 2016 were then compared with those notified to the National Surveillance System (NSS). Results: Over a 10-year period, 4163 hospital discharges with diagnosis of AFP were reported in Italy. Among these, 956 (23.0%) were acute infective polyneuritis, 1803 (43.3%) myopathy, and 1408 (33.8%) encephalitis, myelitis and encephalomyelitis. During the study period, a decreasing trend was observed for all diagnoses and overall the annual incidence rate (IR) declined from 5.5 to 4.5 per 100,000 children. Comparing NSS with HDR data in 2015-2016, we found a remarkable underreporting, being AFP cases from NSS only 14% of those recorded in HDR. In particular, the acute infective polyneuritis cases reported to NSS accounted for 42.6% of those detected in HDR, while only 0.9% of myopathy cases and 13.1% of encephalitis/myelitis/encephalomyelitis cases have been notified to NSS. The highest AFP IRs per 100,000 children calculated on HDR data were identified in Liguria (17.4), Sicily (5.7), and Veneto (5.1) Regions; regarding the AFP notified to the NSS, 11 out of 21 Regions failed to reach the number of expected cases (based on 1/100,000 rate), and the highest discrepancies were observed in the Northern Regions. Overall, the national AFP rate was equal to 0.6, therefore did not reach the target value. Conclusions: AFP surveillance data are the final measure of a country's progress towards polio eradication. The historical data obtained by the HDR have been useful to assess the completeness of the notification data and to identify the Regions with a low AFP ascertainment rate in order to improve the national surveillance system

On the mechanisms governing gas penetration into a tokamak plasma during a massive gas injection

A new 1D radial fluid code, IMAGINE, is used to simulate the penetration of gas into a tokamak plasma during a massive gas injection (MGI). The main result is that the gas is in general strongly braked as it reaches the plasma, due to mechanisms related to charge exchange and (to a smaller extent) recombination. As a result, only a fraction of the gas penetrates into the plasma. Also, a shock wave is created in the gas which propagates away from the plasma, braking and compressing the incoming gas. Simulation results are quantitatively consistent, at least in terms of orders of magnitude, with experimental data for a D 2 MGI into a JET Ohmic plasma. Simulations of MGI into the background plasma surrounding a runaway electron beam show that if the background electron density is too high, the gas may not penetrate, suggesting a possible explanation for the recent results of Reux et al in JET (2015 Nucl. Fusion 55 093013)

p53 attenuates AKT signaling by modulating membrane phospholipid composition

Analytical BioScience

Uncommon G9P[4] group A rotavirus strains causing dehydrating diarrhea in young children in Italy

Group A rotaviruses (RVA) are one of the major cause of acute gastroenteritis (AGE) in young children, being responsible for up to 250.000 deaths worldwide, mostly in developing countries. The two outer capsid proteins VP7 (glycoprotein, G-genotype) and VP4 (protease-sensitive protein, P-genotype) are the basis for the binary RVA nomenclature. Although at least 36 G-types and 51 P-types of rotavirus are presently known, most RVA infections in humans, worldwide as well as in Italy, are related to six major G/P combinations: G1P[8], G2P[4], G3P[8], G4P[8], G9P[8] and G12P[8]. In November 2016, in the framework of the Italian 2016/17 rotavirus surveillance season, a total of 22 rotavirus-positive samples from hospitalized children presenting AGE symptoms were collected in a small area of Central Italy (Ancona, Marche). After genotyping, 3 samples presented the G9P[4] genotype. In order to better understand the origin of these uncommon RVA strains causing dehydrating diarrhea in three children, the strains RVA/Human-wt/ITA/AN18/2016/G9P[4], RVA/Human-wt/ITA/AN19/2016/G9P[4] and RVA/Human-wt/ITA/AN22/2016/G9P[4] were subjected to nucleotide sequencing of all the 11 gene segments to define their genomic constellation. Nucleotide sequencing revealed that the genomic constellation of the three strains was G9-P[4]-I2-R2-C2-M2-A2-N2-T2-E2-H2, highlighting human origin for all the gene segments investigated. The molecular characterization of RVAs and the continue monitoring of their circulation is needed to better define the epidemiology of these pathogen and to detect the emergence of viral variants presenting a high spreading potential in humans in the post-vaccination era