Is hospital admission valuable in managing syncope? Results from the STePS study

The proper way to test the usefulness of hospitalization in syncope patients would be to conduct a randomized controlled trial. However, this approach is characterized by major theoretical and ethical limitations which make this procedure unfeasible. Data from observational studies indirectly show that hospitalization might help reduce the short-term risk of death and adverse events by promptly identifying and treating life-threatening events or conditions. Future research should focus on identifying which patients will benefit from hospitalization. In this regard, we should be able both to correctly risk-stratify patients and to analyze syncope observation units and protocols, which may provide a safe alternative for the evaluation of intermediate-risk patients

Definition of input data to assess GHG default emissions from biofuels in EU legislation: Version 1c - July 2017

The Renewable Energy Directive (RED) (2009/28/EC) and the Fuel Quality Directive (FQD) (2009/30/EC), amended in 2015 by Directive (EU) 2015/1513 (so called ‘ILUC Directive’), fix a minimum requirement for greenhouse gas (GHG) savings for biofuels and bioliquids for the period until 2020, and set the rules for calculating the greenhouse impact of biofuels, bioliquids and their fossil fuels comparators. To help economic operators to declare the GHG emission savings of their products, default and typical values for a number of spefic pathways are listed in the annexes of the RED and FQD. The EC Joint Research Center (JRC) is in charge of defining input values to be used for the calculation of default GHG emissions for biofuels, bioliquids, solid and gaseous biomass pathways. An update of the GHG emissions in Annex V has been carried out for the new Proposal of a Directive on the Promotion of the Use of Energy from Renewable Sources (COM(2016)767 - RED-2), for the post-2020 framework. This report describes the assumptions made by the JRC when compiling the new updated data set used to calculate default and typical GHG emissions for the different biofuels pathways as proposed in the new RED-2 document.JRC.C.4-Sustainable Transpor

Definition of input data to assess GHG default emissions from biofuels in EU legislation

Directive EU 2018/2001 on the promotion of the use of energy from renewable sources has been officially ratified in December 2018 for the post-2020 framework. It is a new iteration of the Renewable Energy Directive RED, the so-called ‘recast’, work on which began in 2016. The Directive fixes a minimum requirement for greenhouse gas (GHG) savings for biofuels and bioliquids for the period from 2021 to 2030, and sets the rules for calculating the greenhouse impact of biofuels, bioliquids and their fossil fuels comparators. To help economic operators to declare the GHG emission savings of their products, default and typical values for a number of specific pathways are listed in the annexes of the RED-recast (Annex V). The EC Joint Research Center (JRC) is in charge of defining input values to be used for the calculation of default GHG emissions for biofuels, bioliquids, solid and gaseous biomass pathways. An update of the GHG emissions in Annex V has been carried out for the new Directive on the Promotion of the Use of Energy from Renewable Sources (Directive 2018/2001), for the post-2020 framework. This report describes the assumptions made by the JRC when compiling the new updated data set used to calculate default and typical GHG emissions for the different biofuels pathways as proposed in the new directive.JRC.C.2-Energy Efficiency and Renewable

Assessing the impact of ground ice degradation on high mountain lake environments (Lago Nero catchment, Swiss Alps)

In high mountain hydrosystems, glacial meltwater composition is potentially affected by the degradation of alpine permafrost terrains and ground ice bodies releasing atmospheric pollutants that have been stored in permafrost terrains for several decades. In this study we investigate the potential local permafrost distribution as well as the physical and chemical ground water characteristics of the periglacial environments of the Lago Nero ("Black Lake") catchment, a high alpine basin located in the Southern Swiss Alps. Our approach combines in situ geological and geomorphological mapping, potential permafrost distribution modelling, a thermal monitoring of ground surface temperatures and the study of the meltwater chemistry of an intact rock glacier (active or inactive rock glacier, i.e. containing ice) and several perennial ice patches. The comparison of elemental concentrations between the periglacial terrains and the Lago Nero outflow unveiled the presence of atmospheric chemicals in the meltwater. Considering the temporal concordance between the recorded peak of sulphur deposition between 1965 and 1980 and the last identified period of positive glacier mass balance occurred in the region (1961-1985), we argue that the enhanced melting of ground ice related to the recent severe warming is nowadays releasing "legacy" pollutants that have been stored in the cryosphere for several decades

Virulence of Mycobacterium tuberculosis affects inteleukin-8, monocyte chemoattractant protein-1 and interleukin-10 production by human mononuclear phagocytes

Microbial virulence and cytokine-mediated immune responses to Mycobacterium tuberculosis infection are important determinants of the pathogenesis of human tuberculosis. To determine the interrelationship between mycobacterial virulence and cytokine induction, human monocytes and monocyte-derived macrophages were infected with attenuated (H37Ra) and virulent (H37Rv and CH306) strains of M. tuberculosis and the amount of proinflammatory [interleukin (IL)-8 and monocyte chemoattractant protein (MCP)- 1] and inhibitory (IL- 10) cytokines was measured in the culture supernatants by enzyme-linked immunosorbent assay (ELISA). Infection with live bacilli induced de novo synthesis of IL-8, MCP-1 and IL-10, since cytokine release was abolished when cells were preincubated with the protein synthesis inhibitor cycloheximide. A differential production of antiinflammatory and inhibitory cytokines was observed. The amount of IL-8 and MCP-1 release was inversely related to strain virulence, the attenuated H37Ra strain being more prone than virulent strains to induce secretion of chemokines. In contrast, virulent strains induced greater amounts of the inhibitory cytokine IL-10. Efficient upregulation of IL-10 synthesis, but not of chemokines, required infection of cells with live bacilli, since heat killing of organisms or challenge with soluble mycobacterial products completely abrogated the effect. Moreover, cells infected with virulent strains produced IL-10 even at a very low bacillus-to-cell ratio and secreted IL-10 continuously during the 96 h that followed infection. The results suggest that the degree of virulence affects host cell responses to M. tuberculosis infection. Continued production of IL-10 may be one of the means by which M. tuberculosis downregulates acute local inflammatory reactions, favoring the development of tuberculosis

Valutazione del self-care nelle persone con diabete di tipo 2: traduzione e validazione della Summary of Diabetes Self-Care Activities

Introduzione. Il self-care rappresenta un fattore chiave nel mantenimento della qualití  di vita e nella prevenzione delle complicanze per le persone con il diabete. Gli strumenti standardizzati sono necessari per valutare e promuovere il self-care dei pazienti diabetici. La Summary of Diabetes Self-Care Activities (SDSCA) è stata ampiamente impiegata nella clinica e nella ricerca ed è stata tradotta in numerose lingue. La validití  e l'affidabilití  di questa scala self-report sono state documentate da diversi studi. Tuttavia la SDSCA non è stata ancora tradotta, adattata dal punto di vista culturale e testata nel contesto italiano. Lo scopo di questa ricerca metodologica è stato quello di tradurre e di svolgere un primo studio di validazione della SDSCA – Versione 11 item. Metodi. Allo scopo di tradurre la SDSCA in Italiano, si è attuato un processo di translation, back-translation e valutazione della concordanza semantica in collaborazione con gli autori dello strumento originale. Uno studio cross-sectional è stato condotto per testare la coerenza interna e l'affidabilití  test-retest della SDSCA su un campione di 80 pazienti con diabete di tipo 2. Obiettivo secondario, è stato quello di esplorare la validití  di criterio della SDSCA in riferimento a un insieme di outcomes clinici come l'emoglobina glicata e la presenza di complicanze. Risultati. L'articolo riporta una descrizione del livello di self-care dei partecipanti sia per il campione generale che per sottogruppi in base ad etí , sesso, livello di istruzione e di reddito. L'Alfa di Cronbach e l'Intraclass Correlation Coefficient hanno mostrato valori accettabili considerando la struttura multidimensionale della SDSCA. Elevati valori si sono riscontrati in 3 sottoclassi di item su 5. Come in precedenti studi, le sottoclassi riguardanti la dieta specifica e l'attivití  fisica hanno mostrato una limitata coerenza interna. Il Kappa di Cohen, il Concordance Correlation Coefficient e il t-test hanno evidenziato una elevata affidabilití  test-retest della SDSCA. Il punteggio totale della SDSCA non ha mostrato correlazioni significative con gli outcomes clinici in studio; tuttavia 3 singoli item sono risultati significativamente correlati all'emoglobina glicata, alla presenza o assenza di complicanze e al giudizio clinico dell'infermiera case manager. Conclusioni. Sono necessarie ulteriori ricerche su campioni più ampi per verificare le performance della SDSCA in lingua Italiana, specialmente per la validití  di costrutto e di criterio. Tuttavia, sulla base di questi risultati preliminari, la SDSCA potrebbe trovare utili applicazioni nella pratica clinica per valutare sistematicamente, comparare nel tempo e incrementare le capacití  di self-care dei pazienti con diabete.Parole Chiave: self-care, self-management, diabete, diabete mellito di tipo 2, valutazione clinica, studio di validazione, Summary of Diabetes Self-care Activities.ABSTRACT Introduction. Self-care represents a key factor for diabetes patients to maintain quality of life and to prevent serious disease complications. Self-care standardized assessment tools are needed to evaluate and to promote self-care in diabetes patients. The Summary of Diabetes Self-Care Activities Scale (SDSCA) has been widely used in clinical and research settings and has been translated in many languages. Validity and reliability of this self-report scale were reported by several studies. However, SDSCA has not yet been translated, culturally adapted and tested in the Italian context. The aim of this methodological research was to translate and to provide a first validation study of the Italian SDSCA – 11 item Version. Methods. A process of translation, back-translation and semantic concordance evaluation has been performed in order to translate the SDSCA into Italian language in collaboration with the original authors. A cross-sectional survey has been planned to test internal consistency and test –retest reliability on a convenience sample of 80 type 2 diabetes patients. As secondary objective, SDSCA criterion validity has been explored referring to a range of clinical outcomes as glicated emoglobin and presence of complications. Results. A description of respondents' self-care abilities is provided for the whole sample and for sub-groups by gender, age, instruction and income levels. Cronbach's Alfa and Intraclass Correlation Coefficient showed acceptable values considering the multidimensionality of SDSCA. High values were obtained in 3 out of 5 sub-classes of items. As in previous studies, specific diet and physical exercise sub-classes showed limited internal consistency. Cohen's Kappa Concordance Correlation Coefficient and t-test demonstrated high test-retest reliability of SDSCA. Overall SDSCA score did not show significant correlations with selected clinical outcomes; however 3 SDSCA single items significantly correlated with glicated emoglobin, complications and the clinical judgment of the diabetes case manager nurse. Conclusion. Further researches involving larger samples are needed to integrate data about Italian SDSCA performances, especially concerning construct and criterion validity. However, based on these preliminary results, SDSCA could find relevant applications in clinical settings to systematically evaluate, to compare over time and to improve specific self-care abilities of diabetes patients.Key words: self-care, self-management, diabetes, type 2 diabetes mellitus, clinical assessment, validation study, Summary of Diabetes Self-care Activities

Extracellular MicroRNA signature of human helper T cell subsets in health and autoimmunity

Upon T cell receptor stimulation, CD4 \uc3\ub4 T helper (Th) lymphocytes release extracellular vesicles (EVs) containing microRNAs. However, no data are available on whether human CD4+T cell subsets release EVs containing different pattern of microRNAs. The present work aimed at filling this gap by assessing the microRNA content in EVs released upon in vitro T cell receptor stimulation of Th1, Th17, and T regulatory (Treg) cells. Our results indicate that EVs released by Treg cells are significantly different compared with those released by the other subsets. In particular, miR-146a-5p, miR-150-5p, and miR-21-5p are enriched, whereas miR-106a-5p, miR-155-5p, and miR-19a-3p are depleted in Treg-derived EVs. The in vitro identified EV-associated microRNA signature was increased in serum of autoimmune patients with psoriasis and returned to healthy levels upon effective treatment with etanercept, a biological drug targeting the TNF pathway and suppressing inflammation. Moreover, Gene Set Enrichment Analysis showed an over-representation of genes relevant for T cell activation, such as CD40L, IRAK1, IRAK2, STAT1, and c-Myb in the list of validated targets of Treg-derived EV miRNAs. At functional level, Treg-derived (but not Th1/ Th17-derived) EVs inhibited CD4+T cell proliferation and suppressed two relevant targets of miR-146a-5p: STAT1 and IRAK2. In conclusion, our work identified the miRNAs specifically released by different human CD4+T cell subsets and started to unveil the potential use of their quantity in human serum to mark the pathological elicitation of these cells in vivo and their biological effect in cell to cell communication during the adaptive immune response

Intracellular Modulation, Extracellular Disposal and Serum Increase of MiR-150 Mark Lymphocyte Activation

<div><p>Activated lymphocytes release nano-sized vesicles (exosomes) containing microRNAs that can be monitored in the bloodstream. We asked whether elicitation of immune responses is followed by release of lymphocyte-specific microRNAs. We found that, upon activation <i>in vitro</i>, human and mouse lymphocytes down-modulate intracellular miR-150 and accumulate it in exosomes. <i>In vivo</i>, miR-150 levels increased significantly in serum of humans immunized with flu vaccines and in mice immunized with ovalbumin, and this increase correlated with elevation of antibody titers. Immunization of immune-deficient mice, lacking MHCII, resulted neither in antibody production nor in elevation of circulating miR-150. This study provides proof of concept that serum microRNAs can be detected, with minimally invasive procedure, as biomarkers of vaccination and more in general of adaptive immune responses. Furthermore, the prompt reduction of intracellular level of miR-150, a key regulator of mRNAs critical for lymphocyte differentiation and functions, linked to its release in the external milieu suggests that the selective extracellular disposal of microRNAs can be a rapid way to regulate gene expression during lymphocyte activation.</p> </div