Poor implementation of the EU clinical trial regulation is a major threat for pragmatic trials in European countries

The principle of pragmatism in clinical trials has been broadly recognised as a way to close the gap between research and practice. In this contribution, we argue that the conduct of pragmatic clinical trials in Europe may be hampered by poor implementation of current European Union's Clinical Trial Regulation No. 536/2014

Evaporite Dissolution Rate through an on-site Experiment into Piezometric Tubes Applied to the Real Case-Study of Quinis (NE Italy)

The present paper deals with a field experiments on evaporite rock samples and groundwater investigations in the Quinis test site, a hamlet of the Enemonzo municipality in NE Italy, were sinkholes occurred in the past and are still occurring causing severe damage to the existing infrastructures. The area is characterised by a Carnian evaporitic bedrock made of gypsum and anhydrite mantled by alluvial and colluvial deposits. In order to evaluate the loss of weight and volume of the subcropping evaporites as responsible for sinkholes, a field-experiment was carried out. Inside seven piezometers, at different depths, evaporitic rock samples were exposed to the naturally occurring variable climatic conditions such as degree of humidity, different air flow and hydrodynamic. The rock samples were installed at the beginning of April 2017 in the dry sections of piezometric tubes, in the vadose zone and in the phreatic zone. Data related to water level fluctuations were recorded by using data-logger devices and highlight significant changes in the water table. After 13 months of data recording (May 2018), rock samples were removed, reweighted and the volume loss measured. In addition, water from piezometer-experiment, representative of the groundwater circulation, were collected at different depths. The obtained results indicate that rock sample reduction is dependent on the hydrological regime and water chemistry and not on the number of days during which the samples remained submersed. In particular, the water geochemistry highlights the possible role in gypsum/anhydrite dissolution due to NaCl water admixing in a complex scenario. In additional, the geochemical data highlight the occurrence of some potentially toxic elements (As, Fe, Mn) at concentrations of concern in some water. This approach represents a novel contribution in the study of karst hazard in evaporites adding a tile to the knowledge of the fast evolutionary processes which cause sinkhole formation

Evaporite Dissolution Rate through an on-site Experiment into Piezometric Tubes Applied to the Real Case-Study of Quinis (NE Italy)

The present paper deals with a field experiments on evaporite rock samples and groundwater investigations in the Quinis test site, a hamlet of the Enemonzo municipality in NE Italy, were sinkholes occurred in the past and are still occurring causing severe damage to the existing infrastructures. The area is characterised by a Carnian evaporitic bedrock made of gypsum and anhydrite mantled by alluvial and colluvial deposits. In order to evaluate the loss of weight and volume of the subcropping evaporites as responsible for sinkholes, a field-experiment was carried out. Inside seven piezometers, at dierent depths, evaporitic rock samples were exposed to the naturally occurring variable climatic conditions such as degree of humidity, dierent air flow and hydrodynamic. The rock samples were installed at the beginning of April 2017 in the dry sections of piezometric tubes, in the vadose zone and in the phreatic zone. Data related to water level fluctuations were recorded by using data-logger devices and highlight significant changes in the water table. After 13 months of data recording (May 2018), rock samples were removed, reweighted and the volume loss measured. In addition, water from piezometer-experiment, representative of the groundwater circulation, were collected at dierent depths. The obtained results indicate that rock sample reduction is dependent on the hydrological regime and water chemistry and not on the number of days during which the samples remained submersed. In particular, the water geochemistry highlights the possible role in gypsum/anhydrite dissolution due to NaCl water admixing in a complex scenario. In additional, the geochemical data highlight the occurrence of some potentially toxic elements (As, Fe, Mn) at concentrations of concern in some water. This approach represents a novel contribution in the study of karst hazard in evaporites adding a tile to the knowledge of the fast evolutionary processes which cause sinkhole formation

Trace Elements in Soil and Urban Groundwater in an Area Impacted by Metallurgical Activity: Health Risk Assessment in the Historical Barga Municipality (Tuscany, Italy)

Trace elements were measured in soil and groundwater collected within the Fornaci di Barga urban area (Serchio River Valley, Tuscany, Italy), a territory that integrates natural assets with touristic vocation, impacted by long-lasting metallurgical activity. Epidemiological studies highlighted that the area surrounding the industrial plants is characterized by a persistent excess of diseases, attributed to heavy metal pollution. Soils were taken in school gardens, public parks, sport grounds and roadsides. The results indicate that Cu, Zn and Cd represent the main contaminants in surface soil, likely originated by deposition of airborne particulate matter from metallurgical activity. Risk assessment considering soil ingestion and dermal contact exposure routes revealed that the cadmium Hazard Quotient approaches unity for children, and the cadmium risk-based concentration obtained by combining exposure information with toxicity data is only slightly lower compared with the cadmium maximum concentration actually measured in soil. Groundwater does not show evidence of trace metal contamination, suggesting that the migration of contaminants from soil to subsurface is a slow process. However, assessment of the possible interconnections between shallow and deep-seated aquifers requires monitoring to be continued. The obtained results highlight the possible link between space clusters of diseases and metal concentration in soil

LPS-induced TNF-α factor mediates pro-inflammatory and pro-fibrogenic pattern in non-alcoholic fatty liver disease

Lipopolysaccharide (LPS) is currently considered one of the major players in non-alcoholic fatty liver disease (NAFLD) pathogenesis and progression. Here, we aim to investigate the possible role of LPS-induced TNF-α factor (LITAF) in inducing a pro-inflammatory and pro-fibrogenic phenotype of non-alcoholic steatohepatitis (NASH).We found that children with NAFLD displayed, in different liver-resident cells, an increased expression of LITAF which correlated with histological traits of hepatic inflammation and fibrosis. Total and nuclear LITAF expression increased in mouse and human hepatic stellate cells (HSCs). Moreover, LPS induced LITAF-dependent transcription of IL-1β, IL-6 and TNF-α in the clonal myofibroblastic HSC LX-2 cell line, and this effect was hampered by LITAF silencing. We showed, for the first time in HSCs, that LITAF recruitment to these cytokine promoters is LPS dependent. However, preventing LITAF nuclear translocation by p38MAPK inhibitor, the expression of IL-6 and TNF-α was significantly reduced with the aid of p65NF-ĸB, while IL-1β transcription exclusively required LITAF expression/activity. Finally, IL-1β levels in plasma mirrored those in the liver and correlated with LPS levels and LITAF-positive HSCs in children with NASH.In conclusion, a more severe histological profile in paediatric NAFLD is associated with LITAF over-expression in HSCs, which in turn correlates with hepatic and circulating IL-1β levels outlining a panel of potential biomarkers of NASH-related liver damage. The in vitro study highlights the role of LITAF as a key regulator of the LPS-induced pro-inflammatory pattern in HSCs and suggests p38MAPK inhibitors as a possible therapeutic approach against hepatic inflammation in NASH

Positron emission tomography response and minimal residual disease impact on progression-free survival in patients with follicular lymphoma. A subset analysis from the FOLL05 trial of the Fondazione Italiana Linfomi

The aim of the present study was to analyze the prognostic role of combined PET and BCL2/IGH analysis, performed at the EOT, in a subset study of the phase III trial FOLL05 (NCT00774826), in which patients with FL were randomized to R-CVP (rituximab plus cyclophosphamide, vincristine and prednisone), R-CHOP (rituximab plus cyclophosphamide, doxorubicin, vincristine and prednisone) or R-FM (rituximab plus fludarabine and mitoxantrone).6 This study was conducted in compliance with the Declaration of Helsinki, was approved by the appropriate research ethics committee, and required each patient to provide written informed consent

A rare and unusual cause of acute abdominal pain: A case of spontaneous isolated dissection of the celiac trunk

Spontaneous dissection of the celiac trunk is a rare and uncommon cause of acute abdominal pain. Risk factors, natural history and optimal treatment are still unclear due to the rarity of the disorder. Therapeutic strategies and follow-up procedures are based on limited observations, and the absence of guidelines warrants a patient-tailored approach. We report the case of a 50-year-old woman who presented to our emergency department for epigastric pain, nausea, and vomiting resulting from a spontaneous dissection of the celiac trunk, successfully treated endovascular technique

Case report: optic atrophy and nephropathy with m.13513G>A/MT-ND5 mtDNA pathogenic variant

Isolated complex I deficiency represents the most common mitochondrial respiratory chain defect involved in mitochondrial disorders. Among these, the mitochondrial DNA (mtDNA) m.13513G>A pathogenic variant in the NADH dehydrogenase 5 subunit gene (MT-ND5) has been associated with heterogenous manifestations, including phenotypic overlaps of mitochondrial encephalomyopathy with lactic acidosis and stroke-like episodes, Leigh syndrome, and Leber’s hereditary optic neuropathy (LHON). Interestingly, this specific mutation has been recently described in patients with adult-onset nephropathy. We, here, report the unique combination of LHON, nephropathy, sensorineural deafness, and subcortical and cerebellar atrophy in association with the m.13513G>A variant