Molecular characterization of a phytoplasma causing phyllody in clover and other herbaceous hosts in northern Italy

Red clover (Trifolium pratense) and Ladino clover (Trifolium repens) plants showing phytoplasma-associated symptoms (yellowing/reddening, virescence and phyllody) have been recovered in Friuli-Venezia Giulia, Italy. Using AluI RFLP analysis of PCR amplified 16S rDNA we showed that the disease can be caused independently by two phylogenetically distinct phytoplasmas. One of them showed the very typical 16S rDNA RFLP pattern of the agent of Clover Phyllody in Canada (CCPh). The 16S rDNA of the other phytoplasma (Italian Clover Phyllody phytoplasma, ICPhp) has been PCR amplified, cloned and sequenced. The sequence revealed high similarity (>98%) with phytoplasmas belonging to the X disease cluster, which includes organisms not reported to cause phyllody on their hosts. The analysis by AluI RFLP of the PCR amplified pathogen 16S rDNA from other herbaceous plants (Crepis biennis, Taraxacum officinale, Leucanthemum vulgare) collected nearby with phytoplasma-associated symptoms showed similar patterns. Southern blot hybridization of their EcoRI digested total DNA revealed identical RFLP patterns, suggesting that the causative agent may be the same organism

Vertically resolved aerosol properties by multi-wavelength lidar measurements

An approach based on the graphical method of Gobbi and co-authors (2007) is introduced to estimate the dependence on altitude of the aerosol fine mode radius (<i>R</i>_f) and of the fine mode contribution (η) to the aerosol optical thickness (AOT) from three-wavelength lidar measurements. The graphical method of Gobbi and co-authors (2007) was applied to AERONET (AErosol RObotic NETwork) spectral extinction observations and relies on the combined analysis of the Ångstrom exponent (<i>å</i>) and its spectral curvature Δ<i>å</i>. Lidar measurements at 355, 532 and 1064 nm were used in this study to retrieve the vertical profiles of <i>å</i> and Δ<i>å</i> and to estimate the dependence on altitude of <i>R</i>_f and η(532 nm) from the <i>å</i>–Δ<i>å</i> combined analysis. Lidar measurements were performed at the Department of Mathematics and Physics of the Universita' del Salento, in south-eastern Italy. Aerosol from continental Europe, the Atlantic, northern Africa, and the Mediterranean Sea are often advected over south-eastern Italy and as a consequence, mixed advection patterns leading to aerosol properties varying with altitude are dominant. The proposed approach was applied to ten measurement days to demonstrate its feasibility in different aerosol load conditions. The selected days were characterized by AOTs spanning the 0.26–0.67, 0.15–0.39, and 0.04–0.27 range at 355, 532, and 1064 nm, respectively. Mean lidar ratios varied within the 31–83, 32–84, and 11–47 sr range at 355, 532, and 1064 nm, respectively, for the high variability of the aerosol optical and microphysical properties. <i>å</i> values calculated from lidar extinction profiles at 355 and 1064 nm ranged between 0.1 and 2.5 with a mean value &pm; 1 standard deviation equal to 1.3 ± 0.7. Δ<i>å</i> varied within the −0.1–1 range with mean value equal to 0.25 ± 0.43. <i>R</i>_f and η(532 nm) values spanning the 0.05–0.3 μm and the 0.3–0.99 range, respectively, were associated with the <i>å</i>–&Delta;<i>å</i> data points. <i>R</i>_f and η values showed no dependence on the altitude. 60% of the data points were in the &Delta;<i>å</i>–<i>å</i> space delimited by the &eta; and <i>R</i>_f curves varying within 0.80–0.99 and 0.05–0.15 μm, respectively, for the dominance of fine-mode particles in driving the AOT over south-eastern Italy. Vertical profiles of the linear particle depolarization ratio retrieved from lidar measurements, aerosol products from AERONET sun photometer measurements collocated in space and time, analytical back trajectories, satellite true colour images, and dust concentrations from the BSC–DREAM (Barcelona Super Computing Center-Dust REgional Atmospheric Model) model were used to demonstrate the robustness of the proposed method

Risk factors for obstructive sleep apnea syndrome in children: state of the art

The obstructive sleep apnea syndrome (OSAS) represents only part of a large group of pathologies of variable entity called respiratory sleep disorders (RSD) which include simple snoring and increased upper airway resistance syndrome (UARS). Although the etiopathogenesis of adult OSAS is well known, many aspects of this syndrome in children are still debated. Its prevalence is about 2% in children from 2 to 8 years of age, mostly related to the size of the upper airways adenoid tissue. Several risk factors linked to the development of OSAS are typical of the pediatric age. The object of this paper is to analyze the state of the art on this specific topic, discussing its implications in terms of diagnosis and management

Management of idiopathic epistaxis in adults: what's new? [Il trattamento dell’epistassi idiopatica nell’adulto: cosa c’è di nuovo?]

L’epistassi è uno dei disturbi più comuni per il quale il paziente si rivolge spesso al pronto soccorso. Questa revisione della letteratura sipropone di valutare sistematicamente e criticamente gli studi scientifici riguardo il trattamento dell’epistassi idiopatica al fine di ottenere utili spunti per la pratica clinica. La ricerca è stata eseguita nei database elettronici: PubMed, Embase, Cochrane e Central. I criteri di inclusione sono stati: studi clinici controllati retrospettivi o prospettici o randomizzati o studi su modelli animali che includevano i risultati nella gestione dell’epistassi idiopatica. Sono stati individuati 23 articoli che soddisfano i criteri di inclusione. Il tamponamento nasale rappresenta ancora l’approccio di prima linea all’epistassi, anche se è evidente dalla letteratura che sia il meno efficace ma il più associato a ricoveri ospedalieri di maggior durata rispetto alla chirurgia endoscopica basata sull’elettrocoagulazione. In conclusione appare sempre più evidente che la cauterizzazione dovrebbe essere l’approccio di prima linea per l’alto tasso di costo-efficacia e il basso rischio di complicanze. Tuttavia, ulteriori ricerche urgenti sono necessarie per validare l’efficacia dei nuovi biomateriali nel trattamento dell’epistassi.Epistaxis is one of the most common complaints presenting to emergency departments. The aim of this study is to systematically review and critically evaluate the evidence relating to treatment of idiopathic epistaxis for guiding best practice. A comprehensive review of the English language literature was performed using PubMed, Embase, Cochrane Library and Central electronic databases. The inclusion criteria were: retrospective or prospective or randomised controlled clinical trials which included outcomes in the management of idiopathic epistaxis. Twentythree articles met inclusion criteria and were reviewed. Nasal packing still represents the first-line approach to epistaxis, although, at present, it appears that there is clear evidence in the literature to suggest that it is less effective and associated with more admissions and longer hospital stays than endoscopic electrocoagulation-based management of epistaxis. In conclusion, cauterisation should be the first-line approach for its high cost-effectiveness rate and low risk of complications. Further research is urgently needed to assess the efficacy of new biomaterials

Mechanical correlates of dyspnea in bronchial asthma.

We hypothesized that dyspnea and its descriptors, that is, chest tightness, inspiratory effort, unrewarded inspiration, and expiratory difficulty in asthma reflect different mechanisms of airflow obstruction and their perception varies with the severity of bronchoconstriction. Eighty-three asthmatics were studied before and after inhalation of methacholine doses decreasing the 1-sec forced expiratory volume by ~15% (mild bronchoconstriction) and ~25% (moderate bronchoconstriction). Symptoms were examined as a function of changes in lung mechanics. Dyspnea increased with the severity of obstruction, mostly because of inspiratory effort and chest tightness. At mild bronchoconstriction, multivariate analysis showed that dyspnea was related to the increase in inspiratory resistance at 5 Hz (R 5) (r (2) = 0.10, P = 0.004), chest tightness to the decrease in maximal flow at 40% of control forced vital capacity, and the increase in R 5 at full lung inflation (r (2) = 0.15, P = 0.006), inspiratory effort to the temporal variability in R 5-19 (r (2) = 0.13, P = 0.003), and unrewarded inspiration to the recovery of R 5 after deep breath (r (2) = 0.07, P = 0.01). At moderate bronchoconstriction, multivariate analysis showed that dyspnea and inspiratory effort were related to the increase in temporal variability in inspiratory reactance at 5 Hz (X 5) (r (2) = 0.12, P = 0.04 and r (2) = 0.18, P &lt; 0.001, respectively), and unrewarded inspiration to the decrease in X 5 at maximum lung inflation (r (2) = 0.07, P = 0.04). We conclude that symptom perception is partly explained by indexes of airway narrowing and loss of bronchodilatation with deep breath at low levels of bronchoconstriction, but by markers of ventilation heterogeneity and lung volume recruitment when bronchoconstriction becomes more severe

Ventilation heterogeneity in obesity.

Obesity is associated with important decrements in lung volumes. Despite this, ventilation remains normally or near normally distributed at least for moderate decrements in functional residual capacity (FRC). We tested the hypothesis that this is because maximum flow increases presumably as a result of an increased lung elastic recoil. Forced expiratory flows corrected for thoracic gas compression volume, lung volumes, and forced oscillation technique at 5-11-19 Hz were measured in 133 healthy subjects with a body mass index (BMI) ranging from 18 to 50 kg/m(2). Short-term temporal variability of ventilation heterogeneity was estimated from the interquartile range of the frequency distribution of the difference in inspiratory resistance between 5 and 19 Hz (R5-19_IQR). FRC \% predicted negatively correlated with BMI (r = -0.72, P < 0.001) and with an increase in slope of either maximal (r = -0.34, P < 0.01) or partial flow-volume curves (r = -0.30, P < 0.01). Together with a slight decrease in residual volume, this suggests an increased lung elastic recoil. Regression analysis of R5-19_IQR against FRC \% predicted and expiratory reserve volume (ERV) yielded significantly higher correlation coefficients by nonlinear than linear fitting models (r(2) = 0.40 vs. 0.30 for FRC \% predicted and r(2) = 0.28 vs. 0.19 for ERV). In conclusion, temporal variability of ventilation heterogeneities increases in obesity only when FRC falls approximately below 65\% of predicted or ERV below 0.6 liters. Above these thresholds distribution is quite well preserved presumably as a result of an increase in lung recoil

Diagnostic and Therapeutic Approach to Children and Adolescents with Obstructive Sleep Apnea Syndrome (OSA): Recommendations in Emilia-Romagna Region, Italy

Obstructive sleep apnoea syndrome (OSA) in paediatrics is a rather frequent pathology caused by pathophysiological alterations leading to partial and prolonged obstruction (hypoventilation) and/or intermittent partial (hypopnoea) or complete (apnoea) obstruction of the upper airways. Paediatric OSA is characterised by daytime and night-time symptoms. Unfortunately, there are few data on shared diagnostic-therapeutic pathways that address OSA with a multidisciplinary approach in paediatric age. This document summarizes recommendations from the Emilia-Romagna Region, Italy, developed in order to provide the most appropriate tools for a multidisciplinary approach in the diagnosis, treatment and care of paediatric patients with OSA. The multidisciplinary group of experts distinguished two different ‘step’ pathways, depending on the age group considered (i.e., under or over two years). In most cases, these pathways can be carried out by the primary care paediatrician, who represents the first filter for approaching the problem. For this reason, it is essential that the primary care paediatrician receives adequate training on how to formulate the diagnostic suspicion of OSA and on what criteria to use to select patients to be sent to the hospital centre. The relationship between the paediatrician of the patient and her/his parents must see a synergy of behaviour between the various players in order to avoid uncertainty about the diagnostic and therapeutic decisions as well as the follow-up phase. The definition and evaluation of the organizational process and outcome indicators of the developed flow-chart, and the impact of its implementation will remain fundamental