Ultrasound Lung Comets versus cardiac natriuretic peptides in patients with acute dyspnoea

Background: Acute shortness of breath as a presenting symptom is a frequent challenge for physicians. The main differential diagnosis is between cardiac and non-cardiac origin of dyspnoea. Natriuretic peptides levels have been used to successfully aid in the diagnosis of congestive heart failure (CHF) in patients presenting with dyspnoea. Ultrasound lung comets (ULCs) are a useful chest sonography sign of increased extravascular lung water. Aim: To assess the concordance rate between ULCs and cardiac natriuretic peptides. Methods: 275 patients (87 females; age 70?14 yrs) admitted with dyspnoea (NYHA class II, III or IV) to a Cardiology-Pneumology or Emergency Department were evaluated. Cardiac peptides assessment and chest sonography, scanning along the intercostal spaces, were performed in all (within 3 hours) and independently analyzed. NT-proBNP values &#8805;157 ng/l, BNP &#8805;100 ng/l and ULCs &#8805;5 were considered abnormal, according to pre-determined cut-offs. Results: Abnormal values of natriuretic peptides were found in 251 patients, while ULCs were present in 220 patients. The total number of discordant cases was 36 (13%), with a concordance rate of 87%. The dominant source of discordance was due to abnormal natriuretic peptides and absence of ULCs (34 patients, see figure): in these patients the mean hospitalization time was significantly lower than in patients with abnormal cardiac peptides and presence of ULCs (7.8?3.7 vs 10.9?6 days, p<.001). Conclusions: ULCs findings are in broad concordance with natriuretic peptides values. Being natriuretic peptides analysis not always available, especially in peripheral Emergency Departments, ULCs assessment could be a plausible alternative to identify CHF in patients with acute dyspnoea

Ultrasound lung comets for serial assessment of pulmonary congestion in heart failure

Background: Serial chest radiographs are too insensitive and therefore NOT recommended for monitoring pulmonary congestion in heart failure patients (AHA/ACC guidelines 2006). Ultrasound lung comets (ULCs) are a simple, quantitative chest sonography sign of pulmonary congestion, originating from water-thickened interlobular septa, and might represent a convenient alternative to chest x-ray in this clinical setting. Aim: To assess whether dynamic changes in ULCs could mirror variations in clinical status and natriuretic peptides. Methods: 104 patients (28 females; age 70?11 years) admitted with dyspnoea (NYHA class &#8805;II) to a Cardiology or Emergency Department were evaluated. NT-proBNP assessment and ULC were independently performed at admission and again before discharge. A patient ULC score was obtained by summing the number of comets from each of the scanning spaces from second to fifth intercostal spaces on anterior chest. Patients were considered "responders" to therapy when NYHA class decreased &#8805;1 grade at discharge. Results: Responders (group I, n=90) and non-responders (group II, n=14) had similar NT-proBNP (I=5560?6643 vs II=5470?4047 ng/l, p=.313), and ULCs number (I=27?34 vs II=34?24, p=.133) at admission. At discharge, responders had lower NT-proBNP (I=3633?5194 vs II=4654?3366 ng/l, p<.05) and ULCs (I=11?12 vs II=28?32, p<.01, see figure) when compared to non-responders. Variation in NT-proBNP somewhat mirrored variations in ULCs (r=.322, p<0.0001). Conclusions: ULC variations mirror changes in clinical functional class and natriuretic peptides in patients hospitalized with acute dyspnoea. ULCs represent an objective parameter of clinical improvement, useful for serial assessment of extra-vascular lung water in patients admitted with acute dyspnoea

Prognostic value of p27(Kip1 )expression in Basaloid Squamous Cell Carcinoma of the larynx

BACKGROUND: Very few reports have investigated the role of cell cycle regulators as biomarkers in Basaloid Squamous Cell Carcinoma (BSCC) of the larynx, a definite morphologic, uncommon, very aggressive variant of squamous cell carcinoma. Lower expression of Ki67/Mib-1, a proliferation marker highly expressed in the majority of tumours, and p53, a tumour suppressor protein that can induce an arrest of the G1-S transition, was related to a better prognosis in laryngeal BSCC. In the head and neck, p27(kip1), a member of the Cip1/Kip1 family of cyclin-dependent kinase inhibitors, has emerged as an independent prognostic factor, able to identify low-expressing tumours with unfavourable course. Up to date the role of this protein was never studied in BSCC. Aim of our study was to investigate the potential prognostic value of p27(kip1 )levels and their correlation with Ki67/Mib-1 and p53 expression in BSCC of the larynx. METHODS: The retrospective study group consisted of 15 male and 1 female patients, affected by laryngeal BSCC, ranging in age from 44 to 69 years (mean 58). The tumour originated from the supraglottis in thirtheen cases and from the glottis in the remaining three. Ten patients had metastatic cervical lymph nodes at presentation and were classified as N+. Post surgical stage was IV in four patients, III in nine, II in two cases and I in the remaining one. Follow-up ranged from a minimum of 5 months up to 9 years. Paraffin-embedded tissue sections of each laryngeal tumour were analyzed for p27(kip), Ki67/Mib-1 and p53 expression by immunohistochemistry. RESULTS: The immunohistochemical study showed p27(kip1 )expression in 40% of the patients with no evidence of disease (NED) and in none (0%) of the patients dead of disease (DOD), whilst p53 was expressed in 60% of patients in NED status and in 90% of patients in DOD status. Ki67/Mib-1 was positive in 80% of NED patients and in 100% of DOD patients. At multivariate analysis, performed by means of Discriminant analysis, low levels of p27(kip1 )expression significantly correlated with poor prognosis (P < 0.05). CONCLUSION: p27(kip1 )protein has been shown to be a significant independent prognostic factor in laryngeal SCC. In our series of laryngeal BSCC the resulting data seem to confirm the clinical prognostic relevance of p27(kip1 )low expression, which directly correlated with biological aggressiveness and consequent shortened survival

Efficacy of the New Inotropic Agent Istaroxime in Acute Heart Failure

: Current therapeutic strategies for acute heart failure (AHF) are based on traditional inotropic agents that are often associated with untoward effects; therefore, finding new effective approaches with a safer profile is dramatically needed. Istaroxime is a novel compound, chemically unrelated to cardiac glycosides, that is currently being studied for the treatment of AHF. Its effects are essentially related to its inotropic and lusitropic positive properties exerted through a dual mechanism of action: activation of the sarcoplasmic reticulum Ca2+ ATPase isoform 2a (SERCA2a) and inhibition of the Na+/K+-ATPase (NKA) activity. The advantages of istaroxime over the available inotropic agents include its lower arrhythmogenic action combined with its capability of increasing systolic blood pressure without augmenting heart rate. However, it has a limited half-life (1 hour) and is associated with adverse effects including pain at the injection site and gastrointestinal issues. Herein, we describe the main mechanism of action of istaroxime and we present a systematic overview of both clinical and preclinical trials testing this drug, underlining the latest insights regarding its adoption in clinical practice for AHF

Species authentication of canned mackerel: Challenges in molecular identification and potential drivers of mislabelling

The market for canned mackerel is growing, due to their competitive price and to the excellent properties of the meat. However, the weak rules of current legislation, coupled with the loss of discrimination power due to being obliged to use short barcode regions, open up new challenges for traceability in processed products. In this study, for the first time, we applied a two-step mini-barcoding approach to identify canned mackerel sold in Italian markets and make assumptions on the potential drivers of mislabelling. Preliminary identification was performed using mini-barcode universal primers targeting a COI-fragment; then, in order to discriminate within the complex Scomber colias/S. japonicus/S. australasicus, we applied a second step, using new specific primers designed in the mitochondrial control region (D-loop). Comparison between labels and molecular identifications highlighted that the chance of mislabelling could be either 45% or 0%, depending on the interpretation of the generic terms used on the labels. Therefore, the study revealed that the ambiguous use, in the ingredient list, of ‘umbrella’ terms for naming fish species, such as ‘sgombro’ could be related to geographic origin of products and creates opportunities for fraudulent activities, but also misleads consumers. In light of this pattern, an urgent update of European legislation is needed to face current and future challenges for full chain traceability

Valutazione dell’influenza dello stordimento sul benessere animale durante lemacellazioni religiose

Il cortisolo plasmatico e i suoi metaboliti sono indicatori fisiologici di stress, cosiddetti animal-based. Il metodo di macellazione può influenzare i loro livelli, giocando un ruolo importante nella corretta acidificazione della carne al termine delle procedure di macellazione. Lo scopo dello studio era determinare e confrontare i valori di cortisolo plasmatico in bovini macellati attraverso le normali procedure, che includono lo stordimento con pistola a proiettile captivo, e quelli degli animali macellati usando il metodo Halal, che non comporta alcun tipo di stordimento. Un secondo obiettivo era confrontare i dati ottenuti dagli animali macellati mediante rito islamico con i risultati di uno studio analogo che prevedeva il confronto tra macellazione tradizionale e rito religioso ebraico. Lo studio è stato condotto su un totale di sessanta bovini maschi di razza Charolaise di otto mesi di età, allevati in paddock outdoor. Gli animali sono stati suddivisi in due gruppi sperimentali sulla base del metodo di macellazione adottato (tradizionale e Halal), costituiti ognuno da trenta animali. Il sangue è stato raccolto in due momenti diversi della produzione: (i) in allevamento, una settimana prima della macellazione (T0) e (ii) durante la iugulazione (T1). Quindi, la concentrazione del cortisolo plasmatico è stata rilevata mediante ELISA test. Lo studio ha evidenziato che durante le due fasi considerate nel modello sperimentale, la variazione più rilevante dei livelli di cortisolo plasmatico è stata osservata durante la fase di iugulazione. I trenta bovini macellati con metodo tradizionale presentavano valori di cortisolo plasmatico, in allevamento, pari a 4,06±1,94 nmol/l, mentre i valori medi riscontrati nei trenta soggetti macellati con metodo Halal erano pari a 3,26±1,01 nmol/l (p=0,049). Viceversa, i valori medi rilevati durante la fase di iugulazione erano pari a 43,72±12,09 e 88,81±41,02 nmol/l, rispettivamente negli animali macellati previo stordimento con pistola a proiettile captivo e in quelli macellati con metodo Halal (p=0.000). Inoltre, i valori di cortisolo plasmatico ottenuti durante la macellazione Halal erano più elevati rispetto a quelli rilevati nello studio precedente in cui si valutava l’andamento del cortisolo plasmatico durante la macellazione con rito religioso ebraico (68.70±30.61 nmol/l). Il diverso andamento del cortisolo plasmatico, rilevato nelle due tipologie di macellazione rituale, potrebbe essere spiegato sulla base delle procedure più o meno restrittive adottate dai responsabili delle comunità religiose. Peraltro lo studio solleva questioni riguardanti il benessere degli animali e le possibili influenze del cortisolo plasmatico sulla qualità delle carni

Microbiome-based study in wild-caught Scomber scombrus fish products at the end of the supply chain

Fresh fish remain the dominant seafood forms and preservation technologies have enabled them to access ever more distant markets. In this study, we used metabarcoding of the 16S rRNA gene to generate gill microbiomes from Scomber scombrus bought at fishmonger’s stores as fresh products but whose labels showed they had been harvested in the Atlantic or Mediterranean FAO fishing areas. Microbial data were analysed with the aim of evaluating their ability to maintain signals from their different geographical origins and the presence of taxa which can potentially act as spoilers, foodborne pathogens, or histamine producers. Results revealed that microbiota, at the end of the wild fish supply chain, had differences related to the two FAO fishing areas (Atlantic vs Mediterranean). Despite the presence of microbial genera potentially associated with spoilage, histamine- production or foodborne pathogens, their patterns confirmed that low-temperature storage is a traditional but effective method of preservation. However, the ongoing spoilage processes were more evident in fresh non-local specimens, dominated by psychrophilic Gram-negative bacteria, whereas fresh local specimens contained Planctomycetes taxa. Therefore, despite the current limitations mainly related to time and cost of the method, our study highlighted that microbiome-based applications are an emergent tool for food system transformation

Evaluation of the animal welfare during religious slaughtering

Plasma cortisol and its metabolites are physiological indicators for stress assessment and slaughtering method may affect their levels, playing an important role in the correct acidification of meat. The aim of the study was to determine and compare plasma cortisol values in animals slaughtered using traditional procedures, which include stunning (using captive bolt pistol), with those in animals slaughtered using Halal method, which does not involve stunning. The study was carried out on a total of 60 Charolais male beef cattle of eight months of age, bred in free paddock outdoors. The animals were divided into two experimental groups, each consisting of 30 individuals, on the basis of the slaughtering method, i.e. traditional or Halal, to verify the whole production chain and to ensure that the product conformed to Muslim rules. Plasma cortisol levels (detected by Elisa test) were evaluated at two different times of animal productive life: on the farm, one week before slaughter (T0) and during bleeding (T1). The 30 calves slaughtered after stunning showed plasma cortisol values of 4.06±1.94 and 43.72±12.09 nmol/L, respectively on the farm and during exsanguination. Conversely, the average values found in the 30 calves subjected to ritual slaughter were 3.26±1.01 and 88.81±41.02 nmol/L. The study demonstrated that throughout the animal’s productive life (from pasture to slaughter) the greatest variation between slaughter with and without stunning was observed during bleeding

DNA metabarcoding for identification of species used in fish burgers

The absence of morphological identification characters, together with the complexity of the fish supply chain make processed seafood vulnerable to cases of species substitution. Therefore, the authentication and the traceability of such products play a strategic role in ensuring quality and safety. The aim of the present study was to detect species used in the production of multi-species fish burgers and to evaluate mislabelling rates, using a DNA metabarcoding approach by sequencing a fragment of the 16S rRNA mitochondrial gene. The study highlighted the presence of 16 marine and 2 mammalian taxa with an overall mislabelling rate of 80%, including cases of species substitution, the undeclared presence of molluscs and of taxa whose use is not permitted by current Italian legislation. The presence of swine DNA as well as the inclusion of undeclared taxa potentially causing allergies raise concerns regarding consumer safety and protection regarding ethical or religious issues. Overall, the study shows that the application of DNA metabarcoding is a promising approach for successfully enforcing traceability systems targeting multi-species processed food and for supporting control activities, as a guarantee of an innovative food safety management system.Peer reviewe