Fatores de risco de transtornos alimentares: revisão guarda-chuva de metanálises publicadas

Objetivo: Graduar as evidências sobre fatores de risco de transtornos alimentares (anorexia nervosa, bulimia nervosa e transtorno de compulsão alimentar periódica) com o método de revisão guarda-chuva. Métodos: Trata-se de revisão sistemática de estudos observacionais sobre fatores de risco de transtornos alimentares publicados no PubMed, PsycInfo, e Embase até 11 de dezembro de 2019. Recalculamos metanálises de efeitos aleatórios, heterogeneidade, efeito de estudo pequeno, viés de excesso de significância e intervalo de confiança de 95% e graduamos evidências significativas (p < 0,05) de convincentes a fracas, conforme os critérios estabelecidos. A qualidade foi avaliada com a ferramenta Assessment of Multiple Systematic Reviews 2 (AMSTAR-2). Resultados: Foram incluídas 9 das 2.197 metanálises, as quais apresentavam evidências de 50 fatores de risco, 29.272 sujeitos com transtornos alimentares e 1.679.385 controles. Embora não houvesse associação com evidências convincentes, evidências altamente sugestivas apoiaram a associação entre abuso sexual infantil e bulimia nervosa (k = 29, 1.103 casos com distúrbios alimentares, 8.496 controles, RC, 2,73, IC95% 1,96-3.79, p = 2,1x10-9, qualidade AMSTAR-2 moderada) e entre vitimização por provocação relacionada à aparência e quaisquer transtornos alimentares (k = 10, 1.341 casos com transtornos alimentares, 3.295 controles, RC 2,91, IC95% 2,05-4,12, p = 1,8x10-9, qualidade AMSTAR-2 moderada). Evidências sugestivas, fracas ou nenhuma evidência sustentaram 11, 29 e 8 associações, respectivamente. Conclusões: Evidência mais confiáveis indicam que eventos traumáticos e estressantes precoces são fatores de risco de transtornos alimentares. São necessários estudos de coorte colaborativos prospectivos maiores para identificar fatores de risco de transtornos alimentares, especialmente a anorexia nervos

The ASTRI SST-2M prototype for the Cherenkov Telescope Array: opto-mechanical performance

ASTRI SST-2M is an end-to-end telescope prototype developed by the Italian National Institute of Astrophysics (INAF) in the framework of the Cherenkov Telescope Array (CTA). The CTA observatory, with a combination of large-, medium-, and small-sized telescopes (LST, MST and SST, respectively), will represent the next generation of imaging atmospheric Cherenkov telescopes. It will explore the very high-energy domain from a few tens of GeV up to few hundreds of TeV. The ASTRI SST-2M telescope structure and mirrors have been installed at the INAF observing station at Serra La Nave, on Mt. Etna (Sicily, Italy) in September 2014. Its performance verification phase began in autumn 2015. Part of the scheduled activities foresees the study and characterization of the optical and opto-mechanical performance of the telescope prototype. In this contribution we report the results achieved in terms of kinematic model analysis, mirrors reflectivity evolution, telescopes positioning, flexures and pointing model and the thermal behavior

Mount control system of the ASTRI SST-2M prototype for the Cherenkov Telescope Array

The ASTRI SST-2M telescope is an end-to-end prototype proposed for the Small Size class of Telescopes (SST) of the future Cherenkov Telescope Array (CTA). The prototype is installed in Italy at the INAF observing station located at Serra La Nave on Mount Etna (Sicily) and it was inaugurated in September 2014. This paper presents the software and hardware architecture and development of the system dedicated to the control of the mount, health, safety and monitoring systems of the ASTRI SST-2M telescope prototype. The mount control system installed on the ASTRI SST-2M telescope prototype makes use of standard and widely deployed industrial hardware and software. State of the art of the control and automation industries was selected in order to fulfill the mount related functional and safety requirements with assembly compactness, high reliability, and reduced maintenance. The software package was implemented with the Beckhoff TwinCAT version 3 environment for the software Programmable Logical Controller (PLC), while the control electronics have been chosen in order to maximize the homogeneity and the real time performance of the system. The integration with the high level controller (Telescope Control System) has been carried out by choosing the open platform communications Unified Architecture (UA) protocol, supporting rich data model while offering compatibility with the PLC platform. In this contribution we show how the ASTRI approach for the design and implementation of the mount control system has made the ASTRI SST-2M prototype a standalone intelligent machine, able to fulfill requirements and easy to be integrated in an array configuration such as the future ASTRI mini-array proposed to be installed at the southern site of the Cherenkov Telescope Array (CTA)

Considerazioni etiche, deontologiche e giuridiche sul Documento SIAARTI \u201cRaccomandazioni di etica clinica per l\u2019ammissione a trattamenti intensivi e per la loro sospensione, in condizioni eccezionali di squilibrio tra necessit\ue0 e risorse disponibili\u201d.

Il 6 marzo 2020 la Societ\ue0 Italiana di Anestesia Analgesia Rianimazione e Terapia Intensiva (SIAARTI) ha pubblicato un documento intitolato \u201cRaccomandazioni di etica clinica per l\u2019ammissione a trattamenti intensivi e per la loro sospensione, in condizioni eccezionali di squilibrio tra necessit\ue0 e risorse disponibili\u201d. Il documento, che si pone lo scopo di proporre criteri decisionali di cura a fronte di eccezionali squilibri tra esigenze di salute e risorse, ha suscitato molte reazioni, all\u2019interno della comunit\ue0 medico-scientifica, nel mondo accademico e sul piano mediatico. Il presente lavoro si propone, nel contesto di emergenza internazionale di salute pubblica per l\u2019epidemia di CoViD-19 attualmente in atto, di esplicitare le basi etiche, deontologiche e giuridiche del Documento SIAARTI e di prospettare integrazioni di natura metodologica e argomentativa utili alla comprensione e contestualizzazione dei criteri decisionali che esso propone. Il gruppo misto di lavoro che ha contribuito alla stesura di questo scritto \ue8 concorde nel ritenere opportuno che il personale sanitario, impegnato in particolare nell\u2019assistere tutti coloro che al momento necessitano di trattamenti intensivi o sub-intensivi, possa beneficiare di chiare indicazioni operative utili a orientare l\u2019azione di cura e, al contempo, che la popolazione possa conoscere in anticipo quali criteri orienteranno le scelte tragiche che potranno ricadere su ciascuno. Il presente contributo riflette quindi, preliminarmente, sulla opportunit\ue0 della presa di posizione della SIAARTI e sugli obiettivi che il Documento SIAARTI si pone, per poi procedere a dimostrare come le indicazioni in esso contenute possano trovare collocazione in una condivisa prospettiva interdisciplinare, etica, deontologica e giuridica

Considerazioni etiche, deontologiche e giuridiche sul Documento SIAARTI “Raccomandazioni di etica clinica per l’ammissione a trattamenti intensivi e per la loro sospensione, in condizioni eccezionali di squilibrio tra necessità e risorse disponibili”

Il 6 marzo 2020 la Società Italiana di Anestesia Analgesia Rianimazione e Terapia Intensiva (SIAARTI) ha pubblicato un documento intitolato “Raccomandazioni di etica clinica per l’ammissione a trattamenti intensivi e per la loro sospensione, in condizioni eccezionali di squilibrio tra necessità e risorse disponibili”. Il documento, che si pone lo scopo di proporre criteri decisionali di cura a fronte di eccezionali squilibri tra esigenze di salute e risorse, ha suscitato molte reazioni, all’interno della comunità medico-scientifica, nel mondo accademico e sul piano mediatico. Il presente lavoro si propone, nel contesto di emergenza internazionale di salute pubblica per l’epidemia di CoViD-19 attualmente in atto, di esplicitare le basi etiche, deontologiche e giuridiche del Documento SIAARTI e di prospettare integrazioni di natura metodologica e argomentativa utili alla comprensione e contestualizzazione dei criteri decisionali che esso propone. Il gruppo misto di lavoro che ha contribuito alla stesura di questo scritto è concorde nel ritenere opportuno che il personale sanitario, impegnato in particolare nell’assistere tutti coloro che al momento necessitano di trattamenti intensivi o sub-intensivi, possa beneficiare di chiare indicazioni operative utili a orientare l’azione di cura e, al contempo, che la popolazione possa conoscere in anticipo quali criteri orienteranno le scelte tragiche che potranno ricadere su ciascuno. Il presente contributo riflette quindi, preliminarmente, sulla opportunità della presa di posizione della SIAARTI e sugli obiettivi che il Documento SIAARTI si pone, per poi procedere a dimostrare come le indicazioni in esso contenute possano trovare collocazione in una condivisa prospettiva interdisciplinare, etica, deontologica e giuridica.On 6 March 2020, the Italian Society of Anaesthesia Analgesia Resuscitation and Intensive care (SIAARTI) published the document “Clinical Ethics Recommendations for Admission to and Suspension of Intensive Care in Exceptional Conditions of Imbalance between Needs and Available Resources”. The document, which aims to propose treatment decision-making criteria in the face of exceptional imbalances between health needs and available resources, has produced strong reactions, within the medical-scientific community, in the academic world, and in the media. In the current context of international public health emergency caused by the CoViD-19 epidemic, this work aims to explain the ethical, deontological and legal bases of the SIAARTI Document and to propose methodologic and argumentative integrations that are useful for understanding and placing in context the decision-making criteria proposed. The working group that contributed to the drafting of this paper agrees that it is appropriate that healthcare personnel, who is particularly committed to taking care of those who are currently in need of intensive or sub-intensive care, should benefit from clear operational indications that are useful to orient care and, at the same time, that the population should know in advance which criteria will guide the tragic choices that may fall on each one of us. This contribution therefore firstly reflects on the appropriateness of the SIAARTI standpoint and the objectives of the SIAARTI Document. It then turns to demonstrate how the recommendations it proposes can be framed within a shared interdisciplinary, ethical, deontological and legal perspective

Role of Genetic Polymorphism Present in Macrophage Activation Syndrome Pathway in Post Mortem Biopsies of Patients with COVID-19

COVID-19 is a viral disease associated with an intense inflammatory response. Macrophage Activation Syndrome (MAS), the complication present in secondary hemophagocytic lymphohistiocytosis (sHLH), shares many clinical aspects observed in COVID-19 patients, and investigating the cytolytic function of the responsible cells for the first line of the immune response is important. Formalin-fixed paraffin-embedded lung tissue samples obtained by post mortem necropsy were accessed for three groups (COVID-19, H1N1, and CONTROL). Polymorphisms in MAS cytolytic pathway (PRF1; STX11; STXBP2; UNC13D and GZMB) were selected and genotyping by TaqMan&reg; assays (Thermo Fisher Scientific, MA, USA) using Real-Time PCR (Applied Biosystems, MA USA). Moreover, immunohistochemistry staining was performed with a monoclonal antibody against perforin, CD8+ and CD57+ proteins. Histopathological analysis showed high perforin tissue expression in the COVID-19 group; CD8+ was high in the H1N1 group and CD57+ in the CONTROL group. An association could be observed in two genes related to the cytolytic pathway (PRF1 rs885822 G/A and STXBP2 rs2303115 G/A). Furthermore, PRF1 rs350947132 was associated with increased immune tissue expression for perforin in the COVID-19 group. The genotype approach could help identify patients that are more susceptible, and for this reason, our results showed that perforin and SNPs in the PRF1 gene can be involved in this critical pathway in the context of COVID-19

Treatment of eating disorders: A systematic meta-review of meta-analyses and network meta-analyses

Treatment efficacy for eating disorders (EDs) is modest and guidelines differ. We summarized findings/quality of (network) meta-analyses (N)MA of randomized controlled trials (RCTs) in EDs. Systematic meta-review ((N)MA of RCTs, ED, active/inactive control), using (anorexia or bulimia or eating disorder) AND (meta-analy*) in PubMed/PsycINFO/Cochrane database up to December 15th, 2020. Standard-ized mean difference, odds/risk ratio vs control were summarized at end of treatment and follow-up. In-terventions involving family (family-based therapy, FBT) outperformed active control in adults/adolescents with anorexia nervosa (AN), and in adolescents with bulimia nervosa (BN). In adults with BN, individual cognitive behavioural therapy (CBT)-ED had the broadest efficacy versus active control; also, antidepressants out-performed active. In mixed age groups with binge-eating disorder (BED), psychotherapy, and lisdexamfetamine outperformed active control. Antidepressants, stimulants outperformed placebo, despite lower acceptability, as did CBT-ED versus waitlist/no treatment. Family-based therapy is effective in AN and BN (adolescents). CBT-ED has the largest efficacy in BN (adults), followed by antidepressants, as well as psychotherapy in BED (mixed). Medications have short-term efficacy in BED (adults)

Immune Response Gaps Linked to SARS-CoV-2 Infection: Cellular Exhaustion, Senescence, or Both?

The COVID-19 pandemic, promoted by the SARS-CoV-2 respiratory virus, has resulted in widespread global morbidity and mortality. The immune response against this pathogen has shown a thin line between protective effects and pathological reactions resulting from the massive release of cytokines and poor viral clearance. The latter is possibly caused by exhaustion, senescence, or both of TCD8+ cells and reduced activity of natural killer (NK) cells. The imbalance between innate and adaptive responses during the early stages of infection caused by SARS-CoV-2 contributes to the ineffective control of viral spread. The present study evaluated the tissue immunoexpression of the tissue biomarkers (Arginase-1, CCR4, CD3, CD4, CD8, CD20, CD57, CD68, CD138, IL-4, INF-&alpha;, INF-&gamma;, iNOS, PD-1, Perforin and Sphingosine-1) to understand the cellular immune response triggered in patients who died of COVID-19. We evaluated twenty-four paraffin-embedded lung tissue samples from patients who died of COVID-19 (COVID-19 group) and compared them with ten lung tissue samples from patients who died of H1N1pdm09 (H1N1 group) with the immunohistochemical markers mentioned above. In addition, polymorphisms in the Perforin gene were genotyped through Real-Time PCR. Significantly increased tissue immunoexpression of Arginase, CD4, CD68, CD138, Perforin, Sphingosine-1, and IL-4 markers were observed in the COVID-19 group. A significantly lower immunoexpression of CD8 and CD57 was also found in this group. It is suggested that patients who died from COVID-19 had a poor cellular response concerning viral clearance and adaptive response going through tissue repair

The PLATO Mission

International audiencePLATO (PLAnetary Transits and Oscillations of stars) is ESA's M3 mission designed to detect and characterise extrasolar planets and perform asteroseismic monitoring of a large number of stars. PLATO will detect small planets (down to &lt;2 R_(Earth)) around bright stars (&lt;11 mag), including terrestrial planets in the habitable zone of solar-like stars. With the complement of radial velocity observations from the ground, planets will be characterised for their radius, mass, and age with high accuracy (5 %, 10 %, 10 % for an Earth-Sun combination respectively). PLATO will provide us with a large-scale catalogue of well-characterised small planets up to intermediate orbital periods, relevant for a meaningful comparison to planet formation theories and to better understand planet evolution. It will make possible comparative exoplanetology to place our Solar System planets in a broader context. In parallel, PLATO will study (host) stars using asteroseismology, allowing us to determine the stellar properties with high accuracy, substantially enhancing our knowledge of stellar structure and evolution. The payload instrument consists of 26 cameras with 12cm aperture each. For at least four years, the mission will perform high-precision photometric measurements. Here we review the science objectives, present PLATO's target samples and fields, provide an overview of expected core science performance as well as a description of the instrument and the mission profile at the beginning of the serial production of the flight cameras. PLATO is scheduled for a launch date end 2026. This overview therefore provides a summary of the mission to the community in preparation of the upcoming operational phases