Building a local climate reference dataset: application to the Abruzzo region (Central Italy), 1930–2019

Reliable secular time series of essential climatic variables are a fundamental element for the assessment of vulnerability, impact and adaptation to climate change. Here, we implement a readily portable procedure for building an upgradable long‐term homogeneous climate dataset using monthly and daily observations of temperature and precipitation over a given area of interest, exemplified here with Abruzzo, a region in Central Italy characterized by complex orography. We process the dataset according to a preliminary ranking of stations based on data quantity and quality, and we exploit the Climatol algorithm for inhomogeneity correction. The corrected time series show trends in broad agreement with external databases (CRU, Berkeley Earth, E‐OBS), and highlight the importance of relying on a local network for a better representation of gradients and variability over the territory. We estimate that maximum (TX) and minimum temperature (TN) increased by ~1.6 and ~2.2°C/century, respectively, over the period 1930–2019, while in the recent decades 1980–2019 we found an accelerated trend of ~5.7 and ~3.9°C/century. Precipitation (RR) decreased by ~10%/century in 1930–2019, while it has been increasing at a rate of ~26%/century in 1980–2019. The Köppen–Geiger climate classification is sensitive to the increase of precipitation in the recent decades, which is attributable to decreased summer precipitation overcompensated by more rain in late spring and early autumn. The cold climate types are retreating upwards along the slopes of the mountain ranges. Over the period 1980–2019, extreme values are also displaying significant trends. Every 2 years, there is one less frost day (TN 25°C) in the Apennines area, while there is one more tropical night (TN >20°C) in the Adriatic coastal area. Precipitation extremes are increasing, especially along the coast, with rain accumulated in the rainiest days increasing at a rate of 1–2%/year

Effects of limited irrigation water volumes on near-isohydric ‘Montepulciano’ vines trained to overhead trellis system

The thermal increase, due to the changed climatic context, is leading to marked variations in the yield and quality of the grapes and causing an increase in the use of water resources in several viticultural areas. Nevertheless, in some environments, rainfalls are scarce and there is no water availability. In this study, we compared the impact of low water irrigation volumes (DI, replacement of 70% of crop evapotranspiration) with respect to non-irrigated vines (NI), on the physiological, yield and qualitative performances of near-isohydric variety ‘Montepulciano’, trained to overhead trellis system, which requires a high-water supply. The stomatal conductance and photosynthesis values, in basal and median leaves, were higher in DI vines. All NI leaves sufered water stress, showing in the youngest leaves (position 20 and 25 along the main shoot) higher carbon isotope discrimination (δ13C) (− 25.38‰ and 25–25.77‰, respectively). At harvest, DI vines showed yield higher of 30% and 33% than NI vines in 2005 and 2006, respectively, and 18% in 2007. In environments with prolonged water shortage and low water resource, near-isohydric ‘Montepulciano’ vines, trained to overhead trellis system and irrigated with limited volumes, determined a signifcant improvement of ‘vineyard efciency’ with a yield of 19.2 t/ha with respect to 13.4 t/ha of NI vines, ensuring also more sugar content (+31%), anthocyanin concentration (+13%) and polyphenolic substances (+8%) than NI vines

Vegetative development and berry growth in relation to heat accumulation in Sangiovese vines subjected to double pruning at three different times

The double pruning on Sangiovese based on pre-pruning and finishing in March, April and May applied over three years, induced a postponement of phenological phases, with repercussions on the vine vegetative and berry growth trends, with greater effects, according to the delay in the time of hand follow up during the season. The phenological development, the canopy and berry growth of Sangiovese, subjected to the three different finishing dates for the final pruning, were recorded during three years (2014-2016) and related to day of the year (DOY) and seasonal heat accumulation (growing degree days, GDD). A sigmoid growth model with high coefficient determination (R2 between 0.96 and 0.99), described shoot elongation and herbaceous berry growth, showing a temporal and thermal shift according to the finishing times. Despite the chronological delay, the vines revealed similar thermal necessities. Leaf area evolution of April and May finished vines showed 2 steps: a slow initial development followed by a rapid growth phase (91- 97cm2/GDD) beginning when shoots reached 7–10 leaves. GDD allowed to obtain simple models of vegetative development and berry growth of Sangiovese vines based on thermal evolution

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Splenic trauma : WSES classification and guidelines for adult and pediatric patients

Spleen injuries are among the most frequent trauma-related injuries. At present, they are classified according to the anatomy of the injury. The optimal treatment strategy, however, should keep into consideration the hemodynamic status, the anatomic derangement, and the associated injuries. The management of splenic trauma patients aims to restore the homeostasis and the normal physiopathology especially considering the modern tools for bleeding management. Thus, the management of splenic trauma should be ultimately multidisciplinary and based on the physiology of the patient, the anatomy of the injury, and the associated lesions. Lastly, as the management of adults and children must be different, children should always be treated in dedicated pediatric trauma centers. In fact, the vast majority of pediatric patients with blunt splenic trauma can be managed non-operatively. This paper presents the World Society of Emergency Surgery (WSES) classification of splenic trauma and the management guidelines.Peer reviewe

The open abdomen in trauma and non-trauma patients : WSES guidelines

Damage control resuscitation may lead to postoperative intra-abdominal hypertension or abdominal compartment syndrome. These conditions may result in a vicious, self-perpetuating cycle leading to severe physiologic derangements and multiorgan failure unless interrupted by abdominal (surgical or other) decompression. Further, in some clinical situations, the abdomen cannot be closed due to the visceral edema, the inability to control the compelling source of infection or the necessity to re-explore (as a "planned second-look" laparotomy) or complete previously initiated damage control procedures or in cases of abdominal wall disruption. The open abdomen in trauma and non-trauma patients has been proposed to be effective in preventing or treating deranged physiology in patients with severe injuries or critical illness when no other perceived options exist. Its use, however, remains controversial as it is resource consuming and represents a non-anatomic situation with the potential for severe adverse effects. Its use, therefore, should only be considered in patients who would most benefit from it. Abdominal fascia-to-fascia closure should be done as soon as the patient can physiologically tolerate it. All precautions to minimize complications should be implemented.Peer reviewe

An explainable model of host genetic interactions linked to COVID-19 severity

We employed a multifaceted computational strategy to identify the genetic factors contributing to increased risk of severe COVID-19 infection from a Whole Exome Sequencing (WES) dataset of a cohort of 2000 Italian patients. We coupled a stratified k-fold screening, to rank variants more associated with severity, with the training of multiple supervised classifiers, to predict severity based on screened features. Feature importance analysis from tree-based models allowed us to identify 16 variants with the highest support which, together with age and gender covariates, were found to be most predictive of COVID-19 severity. When tested on a follow-up cohort, our ensemble of models predicted severity with high accuracy (ACC = 81.88%; AUCROC = 96%; MCC = 61.55%). Our model recapitulated a vast literature of emerging molecular mechanisms and genetic factors linked to COVID-19 response and extends previous landmark Genome-Wide Association Studies (GWAS). It revealed a network of interplaying genetic signatures converging on established immune system and inflammatory processes linked to viral infection response. It also identified additional processes cross-talking with immune pathways, such as GPCR signaling, which might offer additional opportunities for therapeutic intervention and patient stratification. Publicly available PheWAS datasets revealed that several variants were significantly associated with phenotypic traits such as "Respiratory or thoracic disease", supporting their link with COVID-19 severity outcome.A multifaceted computational strategy identifies 16 genetic variants contributing to increased risk of severe COVID-19 infection from a Whole Exome Sequencing dataset of a cohort of Italian patients

Carriers of ADAMTS13 Rare Variants Are at High Risk of Life-Threatening COVID-19

Thrombosis of small and large vessels is reported as a key player in COVID-19 severity. However, host genetic determinants of this susceptibility are still unclear. Congenital Thrombotic Thrombocytopenic Purpura is a severe autosomal recessive disorder characterized by uncleaved ultra-large vWF and thrombotic microangiopathy, frequently triggered by infections. Carriers are reported to be asymptomatic. Exome analysis of about 3000 SARS-CoV-2 infected subjects of different severities, belonging to the GEN-COVID cohort, revealed the specific role of vWF cleaving enzyme ADAMTS13 (A disintegrin-like and metalloprotease with thrombospondin type 1 motif, 13). We report here that ultra-rare variants in a heterozygous state lead to a rare form of COVID-19 characterized by hyper-inflammation signs, which segregates in families as an autosomal dominant disorder conditioned by SARS-CoV-2 infection, sex, and age. This has clinical relevance due to the availability of drugs such as Caplacizumab, which inhibits vWF-platelet interaction, and Crizanlizumab, which, by inhibiting P-selectin binding to its ligands, prevents leukocyte recruitment and platelet aggregation at the site of vascular damage