NEMO-SN1 Abyssal Cabled Observatory in the Western Ionian Sea

The NEutrinoMediterranean Observatory—Submarine Network 1 (NEMO-SN1) seafloor observatory is located in the central Mediterranean Sea, Western Ionian Sea, off Eastern Sicily (Southern Italy) at 2100-m water depth, 25 km from the harbor of the city of Catania. It is a prototype of a cabled deep-sea multiparameter observatory and the first one operating with real-time data transmission in Europe since 2005. NEMO-SN1 is also the first-established node of the European Multidisciplinary Seafloor Observatory (EMSO), one of the incoming European large-scale research infrastructures included in the Roadmap of the European Strategy Forum on Research Infrastructures (ESFRI) since 2006. EMSO will specifically address long-term monitoring of environmental processes related to marine ecosystems, marine mammals, climate change, and geohazards

Placenta Accreta: Management by Peridural Anesthesia

The incidence of placenta accreta spectrum (PAS) disorders, characterized by abnormal invasion of trophoblastic tissue through the myometrium and uterine serosa, has been growing considerably, thus exposing mothers to the risk of massive bleeding and death.The most recent guidelines suggest producing in-hospital protocols and establishing a step-by-step plan, from ultrasound-based detection of placenta previa to post-surgery management

Updates on the management of placenta accreta spectrum

Placenta accreta spectrum (PAS) disorders is a multifactorial process that encompasses a heterogeneous group of conditions characterized by an abnormal invasion of trophoblastic tissue through the myometrium and uterine serosa. PAS is associated with a high burden of adverse maternal outcomes including severe life-threatening hemorrhage, need for blood transfusion, damage to adjacent organs, and death. Prenatal screening of PAS is mandatory so that women may be counselled about the severity of this condition to plan management with a multidisciplinary team and delivery in a specialized center. Ultrasound during the second and third trimester is the primary tool in diagnosing PAS, while magnetic resonance imaging (MRI) is generally performed to confirm the diagnosis and to delineate the topography of placental invasion. Cesarean hysterectomy with placenta left in situ between 34 and 35 weeks of gestation is currently the gold standard surgical management of PAS disorders. Conservative management, such as uterine conservation with the placenta left in situ, or "Triple-P" procedure, should be restricted to a limited number of patients who desire to preserve fertility, after an extensive counselling regarding the high maternal morbidity and mortality risks. Finally, endovascular interventional radiology has been suggested to reduce the amount of blood loss, improve visualization of the operative field and reduce surgical complications, and its use is increasing in specialized centers

Sensory-Adapted Dental Environment for the Treatment of Patients with Autism Spectrum Disorder

Purpose: The importance of dental care and oral hygiene is often underestimated in people with autism spectrum disorder (ASD). Comorbidity with dental anxiety is greater in ASD subjects who also show unusual reactions to sensory stimuli. The aim of our study was to assess the efficacy for a sensory-adapted environment and targeted methods in reducing anxiety and positively influencing cooperation in children with ASD during a dental examination or specific treatments. Material and methods: The sample consisted of 50 Italian children with a diagnosis of ASD (36 males and 14 females; aged 9–10 years) presenting with mild intellectual disability (ID) and verbal language skills. The subjects enrolled in the study had at least two decayed teeth and all were treated in two different dental environments: regular dental environment (RDE) and sensory-adapted dental environment (SADE). Results: 20% of the sample was successfully treated in RDE, while 68% of subjects were successfully treated in SADE. Conclusions: Results suggest that a sensory-adapted environment positively affects the therapeutic dental treatment in patients with ASD and reaffirm that sensory dysregulation in children with ASD is a crucial factor influencing the successful outcome of oral care

First trimester detection of abnormally invasive placenta in women at risk: a systematic review and meta-analysis

OBJECTIVES: The primary aim of this systematic review was to ascertain whether ultrasound (US) signs suggestive of abnormally invasive placenta (AIP) are present in the first trimester. The secondary aims were to ascertain the strength of association and the predictive accuracy of such signs in detecting AIP in the first trimester of pregnancy. METHODS: MEDLINE, EMBASE, CINAHL and Cochrane databases (2000-2016) were searched. Only studies reporting the first trimester diagnosis of AIP that was subsequently confirmed in the third trimester either during operative delivery or by pathology were included. Meta-analysis of proportion, random-effect meta-analysis and hierarchical summary receiver operating characteristic curve (HSROC) analysis were used to compute the data. RESULTS: Seven studies (551 pregnancies at risk for AIP) were included. At least one ultrasound sign suggestive of AIP was detected in 91.4% (95% CI 85.8-95.7) of cases with confirmed AIP. The most common ultrasound feature in the first trimester of pregnancy was a low implantation of the gestational sac close to the previous uterine scar which was observed in 82.4% (95% CI 46.6-99.8) of the cases. Anechoic spaces within the placental mass (lacunae) were observed in 46.0% (95% CI 10.9-83.7) and a reduced myometrial thickness in 66.8% (95% CI 45.2-85.2) cases affected by AIP. Pregnancies with a low implantation of the gestational sac had a significantly higher risk of AIP, (OR:19.6, 95% CI 6.7-57.3), with a sensitivity and a specificity of 44.4% (95% CI 21.5-69.2) and 93.4% (95% CI 90.5-95.7) respectively. CONCLUSIONS: Ultrasound signs of AIP are already present during the first trimester of pregnancy, especially before 11 weeks of gestation. Low anterior implantation of the placenta/sac close to or within the scar was the most common early US signs suggestive of AIP, although its individual predictive accuracy is not high

Implementation of Sample Pooling Procedure Using a Rapid SARS-CoV-2 Diagnostic Real-Time PCR Test Performed Prior to Hospital Admission of People with Intellectual Disabilities

Reliability, accuracy, and timeliness of diagnostic testing for SARS-CoV-2 infection have allowed adequate public health management of the disease, thus notably helping the timely mapping of viral spread within the community. Furthermore, the most vulnerable populations, such as people with intellectual disability and dementia, represent a high-risk group across multiple dimensions, including a higher prevalence of pre-existing conditions, lower health maintenance, and a propensity for rapid community spread. This led to an urgent need for reliable in-house rapid testing to be performed prior to hospital admission. In the present study, we describe a pooling procedure in which oropharyngeal and nasopharyngeal swabs for SARS-CoV-2 detection (performed prior to hospital admission using rapid RT-PCR assay) are pooled together at the time of sample collection. Sample pooling (groups of 2–4 samples per tube) allowed us to significantly reduce response times, consumables, and personnel costs while maintaining the same test sensitivity

Role of balloon tamponade during cesarean section in women with placenta previa: a systematic review and meta-analysis

Introduction: To explore the role of balloon tamponade insertion in pregnancies complicated by placenta previa. Evidence acquisition: Medline, Embase and ClinicalTrials.gov databases were searched electronically on October 17. Inclusion criteria were women with placenta previa undergoing, compared to those not undergoing, balloon tamponade insertion at the time of the cesarean section (CS). The outcomes observed were total, intra- and post-operative estimated blood loss (EBL), need for blood transfusion, admission to intensive care unit (ICU), hysterectomy and additional surgical or medical procedures to achieve hemostasis. Results were reported as pooled odd ratios (OR) or mean difference (MD) according to the outcome investigated. Evidence synthesis: Four studies (593 women) were included. Total EBL was significantly lower in women undergoing balloon tamponade insertion during CS compared to controls (MD: -556.3, 95% CI -496 to -617.0, p=0.001). Likewise, women undergoing balloon tamponade insertion had significantly lower intra- (MD: -699.8, 95% CI -766.1 to -633.5, p=0.001) and post-operative (MD: -1162ml (95% CI -1211.1 to -1134.4, p<0.001) compared to women who did undergo such procedure. Furthermore, women undergoing balloon tamponade insertion had a significantly lower risk of requiring additional surgical (OR: 0.16, 95% CI 0.1-0.5, I2: 0%; p=0.001) or medical (OR: 0.02, 95% CI 0.003-0.1, I2: 0; p=0.001) procedures to achieve hemostasis. Conversely, there was no significant difference in either the need for blood transfusion (p= 0.071), admission to ICU (p= 0.459) or need for hysterectomy (p= 0.312) between women undergoing, compared to those not undergoing, balloon tamponade insertion during CS for placenta previa. Conclusions: Elective balloon tamponade insertion at the time of CS for placenta previa seems to be associated with a lower EBL and a reduced risk of additional medical and surgical procedures to control hemostasis. Large and adequately powered randomized controlled trials are needed to validate these results and introduce elective balloon tamponade insertion at the time of CS for placenta previa in clinical practice

Carotid Body Paragangliomas and Matrix Metalloproteinases

Paragangliomas (PGLs) are slow-growing, typically, benign tumors that arise from the extra-adrenal paraganglion of the autonomic nervous system. PGLs arising from the carotid body are relatively rare tumors but constitute the majority of head and neck PGLs (60e70%).1 Carotid body tumors (CBTs) belong to the classification of PGLs, because they originate from paraganglia in chromaffin-negative glomus cells derived from the embryonic neural crest, functioning as part of the sympathetic nervous system. These cells normally act as special chemoreceptors located along blood vessels, particularly in the carotid bodies (at bifurcation of the common carotid artery in the neck).2 CBTs are usually classified using the criteria described by Shamblin et al.3 Matrix metalloproteinases (MMPs), enzymes that regulate cell matrix composition, play a role in several clinical conditions,4,5 including embryogenesis, wound healing,6,7 inflammation, arthritis, cardiovascular diseases,8 pulmonary diseases, and cancer.9 Several studies10e15 have shown that specific MMPs are involved in cancer processes that promote metastasis.The aim of this study is to examine the levels of MMPs in patients with benign and malignant neoplastic CBTs

Novel deletion of the E3A ubiquitin protein ligase gene detected by multiplex ligation-dependent probe amplification in a patient with Angelman syndrome

Angelman syndrome (AS) is a severe neurobehavioural disorder caused by failure of expression of the maternal copy of the imprinted domain located on 15q11-q13. There are different mechanisms leading to AS: maternal microdeletion, uniparental disomy, defects in a putative imprinting centre, mutations of the E3 ubiquitin protein ligase (UBE3A) gene. However, some of suspected cases of AS are still scored negative to all the latter mutations. Recently, it has been shown that a proportion of negative cases bear large deletions overlapping one or more exons of the UBE3A gene. These deletions are difficult to detect by conventional gene-scanning methods due to the masking effect by the non-deleted allele. In this study, we have used for the first time multiplex ligation-dependent probe amplification (MLPA) and comparative multiplex dosage analysis (CMDA) to search for large deletions affecting the UBE3A gene. Using this approach, we identified a novel causative deletion involving exon 8 in an affected sibling. Based on our results, we propose the use of MLPA as a fast, accurate and inexpensive test to detect large deletions in the UBE3A gene in a small but significant percentage of AS patients