The genetic variant SLC2A1-rs1105297 is associated with the differential analgesic response to a glucose-based treatment in newborns

Neonatal pain is a critical issue in clinical practice. The oral administration of glucose-based solutions is currently one of the most common and effective nonpharmacologic strategies for neonatal pain relief in daily minor procedures. However, a varying degree of analgesic efficacy has been reported for this treatment. Environmental, maternal, and genetic factors may explain this variability and potentially allow for a personalized analgesic approach, maximizing therapeutic efficacy and preventing side effects. We investigated the exposome (ie, the set of clinical and anthropometric variables potentially affecting the response to the therapy) and the genetic variability of the noradrenaline transporter gene (solute carrier family 6 member 2 [SLC6A2]) and 2 glucose transporter genes (solute carrier family 2 member 1 [SLC2A1] and 2 [SLC2A2]) in relation to the neonatal analgesic efficacy of a 33% glucose solution. The study population consisted in a homogeneous sample of more than 1400 healthy term newborns. No association for the exposome was observed, whereas a statistically significant association between the G allele of SLC2A1-rs1105297 and a fourfold decreased probability of responding to the therapy was identified after multiple-testing correction (odds ratio of 3.98, 95% confidence interval 1.95-9.17; P = 4.05 × 10-4). This allele decreases the expression of SLC2A1-AS1, causing the upregulation of SLC2A1 in the dorsal striatum, which has been suggested to be involved in reward-related processes through the binding of opioids to the striatal mu-opioid receptors. Altogether, these results suggest the involvement of SLC2A1 in the analgesic process and highlight the importance of host genetics for defining personalized analgesic treatments

Improvement of Fatty Acid Profile in Durum Wheat Breads Supplemented with Portulaca oleracea L. Quality Traits of Purslane-Fortified Bread

The addition of functional ingredients to breads could have effects on preventing cardiovascular diseases, cancers and inflammation. The incorporation of 0–5–10–15% of three populations of dried purslane flour on the rheological, sensorial and nutritional quality of fortified durum wheat breads were evaluated. The increase in dried purslane (up to 15%) caused an increase in the resistance to the mixture and a consequent reduction in its extensibility. The “panel test” gave a largely positive evaluation in 10% of enrichment. The fatty acids in breads resulted higher with the 5% substitution. Contrary to what has been imagined, the increase in percentage of substitution to 10 and 15% did not lead to an increase in linoleic (omega-3) and α-linolenic (omega-6) acid and probably the cause is in the cooking. The total phenols content and the antioxidant potential, evaluated by ferric reducing antioxidant potential (FRAP) and 2,20 -azinobis (3-ethylbenzothiazoline-6-sulfonic acid) (ABTS) assays of the enriched breads increased with the percentage of the dry purslane substitution. The enrichment of the durum wheat flour with 5% purslane resulted in a good compromise to obtain good rheological characteristics of loaves and breads with decreased omega-6/omega-3 ratio and good antioxidant properties

SIAMOC position paper on gait analysis in clinical practice: General requirements, methods and appropriateness. Results of an Italian consensus conference

Gait analysis is recognized as a useful assessment tool in the field of human movement research. However, doubts remain on its real effectiveness as a clinical tool, i.e. on its capability to change the diagnostic-therapeutic practice. In particular, the conditions in which evidence of a favorable cost-benefit ratio is found and the methodology for properly conducting and interpreting the exam are not identified clearly. To provide guidelines for the use of Gait Analysis in the context of rehabilitation medicine, SIAMOC (the Italian Society of Clinical Movement Analysis) promoted a National Consensus Conference which was held in Bologna on September 14th, 2013. The resulting recommendations were the result of a three-stage process entailing i) the preparation of working documents on specific open issues, ii) the holding of the consensus meeting, and iii) the drafting of consensus statements by an external Jury. The statements were formulated based on scientific evidence or experts' opinion, when the quality/quantity of the relevant literature was deemed insufficient. The aim of this work is to disseminate the consensus statements. These are divided into 13 questions grouped in three areas of interest: 1) General requirements and management, 2) Methodological and instrumental issues, and 3) Scientific evidence and clinical appropriateness. SIAMOC hopes that this document will contribute to improve clinical practice and help promoting further research in the field

Outcomes of elective liver surgery worldwide: a global, prospective, multicenter, cross-sectional study

Background: The outcomes of liver surgery worldwide remain unknown. The true population-based outcomes are likely different to those vastly reported that reflect the activity of highly specialized academic centers. The aim of this study was to measure the true worldwide practice of liver surgery and associated outcomes by recruiting from centers across the globe. The geographic distribution of liver surgery activity and complexity was also evaluated to further understand variations in outcomes. Methods: LiverGroup.org was an international, prospective, multicenter, cross-sectional study following the Global Surgery Collaborative Snapshot Research approach with a 3-month prospective, consecutive patient enrollment within January–December 2019. Each patient was followed up for 90 days postoperatively. All patients undergoing liver surgery at their respective centers were eligible for study inclusion. Basic demographics, patient and operation characteristics were collected. Morbidity was recorded according to the Clavien–Dindo Classification of Surgical Complications. Country-based and hospital-based data were collected, including the Human Development Index (HDI). (NCT03768141). Results: A total of 2159 patients were included from six continents. Surgery was performed for cancer in 1785 (83%) patients. Of all patients, 912 (42%) experienced a postoperative complication of any severity, while the major complication rate was 16% (341/2159). The overall 90-day mortality rate after liver surgery was 3.8% (82/2,159). The overall failure to rescue rate was 11% (82/ 722) ranging from 5 to 35% among the higher and lower HDI groups, respectively. Conclusions: This is the first to our knowledge global surgery study specifically designed and conducted for specialized liver surgery. The authors identified failure to rescue as a significant potentially modifiable factor for mortality after liver surgery, mostly related to lower Human Development Index countries. Members of the LiverGroup.org network could now work together to develop quality improvement collaboratives

Polimorfismi genetici dei recettori del gusto TAS1R1, TAS1R2 e TAS1R3 e accrescimento nei primi anni di vita

RIASSUNTO ANALITICO Introduzione Il concetto di “Salute” è stato definito, per la prima volta, nel 1948 dall'Organizzazione Mondiale della Sanità (Oms), come uno stato di completo benessere fisico, mentale e sociale. Tale stato viene a determinarsi fin dal concepimento e dalla vita intrauterina e successivamente, in particolar modo, nei primi 1000 giorni di vita. Un adeguato e fisiologico accrescimento, inteso come insieme di processi che riguardano la crescita staturo-ponderale e la maturazione scheletrica dell’individuo e che caratterizzano la trasformazione progressiva dell'organismo, può essere influenzato da diversi fattori (genetici, ormonali, nutrizionali, ambientali, culturali, ecc…). L’aspetto nutrizionale, in particolar modo, può esser considerato un importante “determinante di salute”, poiché, se alterato, può rappresentare un fattore di rischio alla base dello sviluppo di disordini metabolici della vita adulta. Esso dipende, in gran parte, dalle scelte alimentari che sembrerebbero esser correlate, secondo le ultime ricerche, non soltanto alle diete materne in gravidanza ed ai diversi contesti culturali, ma anche alla genetica della percezione del gusto ed in particolare ai polimorfismi del recettore dell’umami e del dolce. Materiali e Metodi Per la selezione della coorte dello studio sono stati presi in considerazione neonati a termine nati presso la U.O Neonatologia dell’Azienda Ospedaliero-Universitaria Pisana, reclutati nel periodo compreso tra Novembre 2015 e Luglio 2019. I neonati reclutati sono stati 1542 ,795 maschi e 720 femmine. Per ciascun paziente sono stati presi in considerazione fattori prenatali, fattori neonatali, fattori materni, variabili auxologiche alla nascita, 1 anno (270 soggetti), 2 anni di vita (220 soggetti), 3 anni (103 soggetti), 4 anni (57 soggetti), fattori nutrizionali e fattori genetici, in particolare vari genotipi dei polimorfismi genetici dei recettori del gusto (TAS1R1 e TAS1R2, TAS1R3). Risultati Dalla valutazione dei fattori associati all’accrescimento ponderale nei primi quattro anni di vita sono state confermate diverse associazioni significative precedentemente emerse, tra le quali quella col peso alla nascita, soprattutto nei primi due anni di vita e quella con il BMI pre-gravidico materno, la cui significatività della correlazione permane anche discostandosi dalla nascita e dai primi 1000 giorni di vita. Per quanto concerne i polimorfismi, invece: -TAS1R1-rs4908932 (P-value di 0,002 per il modello dominante e codominante), TAS1R2-rs12033832 (P-value = 0,06), TAS1R2-rs9701796 codominante (p-value=0,04) e recessivo(p-value=0,01) sono correlati ad una variazione di peso alla nascita rispetto alla media; -ad 1 anno sembra svolgere un ruolo rilevante il polimorfismo TAS1R3- rs3813210 (aggiustato per peso alla nascita), con un P-value che si aggira intorno a 0,05 per il modello dominante e codominante, determinando un peso di circa 400 grammi superiore rispetto alla media dei rispettivi controlli; -a 2 anni di vita, invece, sono stati individuati due polimorfismi genetici del recettore del gusto umani: TAS1R3-rs3813210, secondo analisi non aggiustata, e TAS1R1-rs4908932, anche per analisi corretta (P-value=0,005) per peso alla nascita e BMI- pregravidico, per quanto concerne il modello recessivo, determinando un peso di circa 2000g superiore rispetto alla media dei rispettivi controlli; -a 3 anni, il polimorfismo che presenta una influenza statisticamente significativa, corretta per BMI- Pregravidico, è TAS1R3-rs139522421, con un P-value intorno a 0,01 per il modello codominante, determinando un peso di circa 1500 grammi inferiore rispetto alla media dei rispettivi controlli; -a 4 anni, infine, risulta significativo il polimorfismo TAS1R2-rs3955570, per analisi non corretta, per quanto riguarda il modello co-dominante e dominante, determinando un peso di circa 1000 grammi superiore rispetto alla media dei rispettivi controlli. Conclusioni Le analisi condotte sui nostri dati confermano che l’espressione di alcuni polimorfismi di geni recettoriali TAS1R1, TAS1R2 e TAS1R3 influenza l’accrescimento ponderale nei primi due anni di vita ed indicano che l’espressione di altri, non rilevati precedentemente, interesserebbe i due anni successivi. I polimorfismi, infatti, determinerebbero, fin dallo svezzamento, la preferenza verso alcuni cibi e quindi il consolidarsi di alcune scelte alimentari che condizionerebbero il peso e più in generale il metabolismo dell’individuo anche negli anni successivi, gettando le basi per uno status patologico dell’adulto e confermando, quindi, la teoria di Baker. Approfondire le ricerche in tale direzione, ampliando il numero di campioni, soprattutto per gli anni tre e quattro, permetterebbe di ottenere risultati più certi; stratificare, inoltre, secondo l’etnia permetterebbe di ottenere risultati circoscritte alle diverse popolazioni e di oggettivare, così, eventuali fattori confondenti, quali, ad esempio, quelli socio-culturali. Indagare maggiormente il ruolo dell’Epigenetica, delineare una medicina di precisione al fine di promuovere il benessere psico-fisico e l’integrazione sociale del bambino di oggi e dell’adulto di domani, ridurre l’incidenza dell’Obesità ed i costi da sostenere per il Sistema Sanitario Nazionale, preservando risorse da investire nella Ricerca, potrebbero essere gli obiettivi da perseguire nel prossimo futuro

Rheological and nutritional profile of spaghetti and bread fortified with hemp flours

In recent years, the demands of food consumers have changed considerably. Food today is not only intended to satisfy hunger and provide the necessary nutrients, but also to prevent food-related diseases and improve the physical and mental well-being of consumers. Functional foods are formulated to contain healthy components, which when consumed daily as part of the diet, can have beneficial health effects. Cereal-based products, especially pasta and bread, are well suited for adding nutrients. Both bread and pasta, traditionally produced using durum wheat flour, can be prepared also using "non-wheat flours" in variable percentages or by incorporating food by-products, capable of increasing their nutritional value [1]. Unfortunately, fortification often affects the quality of cereal-based products, in terms of texture, color, cooking quality and sensory properties. Therefore, one of the main challenges of the food industry is to increase the healthiness of foods without sacrificing sensory attributes. In this study the rheological and chemical qualities of spaghetti and bread samples were evaluated, obtained by using a durum wheat cultivar, called "Ciclope", fortified with different percentages of hemp flour, called "Futura 75". The hemp flours, obtained after grinding the seeds and the subsequent separation of the oil, were sieved at 0.530 mm (Hemp -1) and 0.236 mm (Hemp -2)

The role of baseline HIV-1 RNA, drug resistance, and regimen type as determinants of response to first-line antiretroviral therapy

The factors influencing virological response to first-line combined antiretroviral therapy (cART) in an Italian cohort of HIV-1-infected patients were examined. Eligible patients were those enrolled in a national prospective observational cohort (Antiretroviral Resistance Cohort Analysis), starting first-line cART between 2001 and 2011 and who had at least one follow-up of HIV-1 RNA. The primary endpoint was virological success, defined as the first viral load 100,000 copies/ml, virologic success was only associated with the use of integrase inhibitors in the first cART regimen. Independent predictors of immunological success were baseline CD4+ cell count and wGSS <3. High baseline HIV-1 RNA, predicted activity of the first-line regimen based on genotypic resistance testing, gender, and use of new agents were found to predict time to achieve virological success. The type of initial nucleoside analog backbone was not found to predict virological response

"Delirium Day": A nationwide point prevalence study of delirium in older hospitalized patients using an easy standardized diagnostic tool

Background: To date, delirium prevalence in adult acute hospital populations has been estimated generally from pooled findings of single-center studies and/or among specific patient populations. Furthermore, the number of participants in these studies has not exceeded a few hundred. To overcome these limitations, we have determined, in a multicenter study, the prevalence of delirium over a single day among a large population of patients admitted to acute and rehabilitation hospital wards in Italy. Methods: This is a point prevalence study (called "Delirium Day") including 1867 older patients (aged 65 years or more) across 108 acute and 12 rehabilitation wards in Italian hospitals. Delirium was assessed on the same day in all patients using the 4AT, a validated and briefly administered tool which does not require training. We also collected data regarding motoric subtypes of delirium, functional and nutritional status, dementia, comorbidity, medications, feeding tubes, peripheral venous and urinary catheters, and physical restraints. Results: The mean sample age was 82.0 ± 7.5 years (58 % female). Overall, 429 patients (22.9 %) had delirium. Hypoactive was the commonest subtype (132/344 patients, 38.5 %), followed by mixed, hyperactive, and nonmotoric delirium. The prevalence was highest in Neurology (28.5 %) and Geriatrics (24.7 %), lowest in Rehabilitation (14.0 %), and intermediate in Orthopedic (20.6 %) and Internal Medicine wards (21.4 %). In a multivariable logistic regression, age (odds ratio [OR] 1.03, 95 % confidence interval [CI] 1.01-1.05), Activities of Daily Living dependence (OR 1.19, 95 % CI 1.12-1.27), dementia (OR 3.25, 95 % CI 2.41-4.38), malnutrition (OR 2.01, 95 % CI 1.29-3.14), and use of antipsychotics (OR 2.03, 95 % CI 1.45-2.82), feeding tubes (OR 2.51, 95 % CI 1.11-5.66), peripheral venous catheters (OR 1.41, 95 % CI 1.06-1.87), urinary catheters (OR 1.73, 95 % CI 1.30-2.29), and physical restraints (OR 1.84, 95 % CI 1.40-2.40) were associated with delirium. Admission to Neurology wards was also associated with delirium (OR 2.00, 95 % CI 1.29-3.14), while admission to other settings was not. Conclusions: Delirium occurred in more than one out of five patients in acute and rehabilitation hospital wards. Prevalence was highest in Neurology and lowest in Rehabilitation divisions. The "Delirium Day" project might become a useful method to assess delirium across hospital settings and a benchmarking platform for future surveys

SICOB-endorsed national Delphi consensus on obesity treatment optimization: focus on diagnosis, pre-operative management, and weight regain/insufficient weight loss approach

PurposeOverweight and obesity affects 60% of adults causing more than 1.2 million deaths across world every year. Fight against involved different specialist figures and multiple are the approved weapons. Aim of the present survey endorsed by the Italian Society of Bariatric Surgery (SICOB) is to reach a national consensus on obesity treatment optimization through a Delphi process.MethodsEleven key opinion leaders (KOLs) identified 22 statements with a major need of clarification and debate. The explored pathways were: (1) Management of patient candidate to bariatric/metabolic surgery (BMS); (2) Management of patient not eligible for BMS; (3) Management of patient with short-term (2 years) weight regain (WR) or insufficient weight loss (IWL); (4) Management of the patient with medium-term (5 years) WR; and (5) Association between drugs and BMS as WR prevention. The questionnaire was distributed to 65 national experts via an online platform with anonymized results.Results54 out of 65 invited panelists (83%) respond. Positive consensus was reached for 18/22 statements (82%); while, negative consensus (s20.4; s21.5) and no consensus (s11.5, s17) were reached for 2 statements, respectively (9%).ConclusionThe Delphi results underline the importance of first-line interdisciplinary management, with large pre-treatment examination, and establish a common opinion on how to properly manage post-operative IWL/WR