Anxiety is Prevailing in Non-Cardiac Chest Pain Subjects, while Somatisation is Not A Comparative Study in the Emergency Department

Objective: The main purpose of this study was to verify if non-cardiac chest pain (NCCP) subjects recruited in an Emergency Department were more anxious, depressive or burdened by somatoform symptoms as compared with cardiac chest pain (CCP) subjects, and with subjects without chest pain (WOCP). Methods: We included patients with chest pain not attributable to a gastro-oesophageal reflux disorder. NCCP subjects were negative at ECG examination and at troponin test at baseline and after three months. A number of instruments were administered, measuring anxiety and depression (HADS), somatisation (somatisation scale of SCL- 90, TAS-20), and the health-related QoL (SF-12), along with other scales measuring the social and experiential profile. Results: We recruited 435 subjects (of which NCCP were 44.8%) in the Emergency Department, while other 147 subjects were recruited in a primary care clinic. The logistic regression showed that the levels of HADS anxiety in the three groups were dissimilar, even when adjusted for confounding variables: taking NCCP as reference category, adjusted ORs were 0.64 for CCP (IC95% 0.42 \u2013 0.96) and 0.23 for WOCP (IC95% 0.13 \u2013 0.40). When considering the somatisation construct, CCP and NCCP subjects reported similar somatic symptom complaints, higher than WOCP subjects. Moreover, even if NCCP subjects showed higher TAS-20 scores than WOCP subjects, these scores were below the range of a possible alexithymia. As for the physical health-related QoL (SF-12, subscale PCS-12), regression analyses showed that the PCS-12 mean score of NCCP was higher than that of CCP ( f -2.31; IC95% -4.14 to -0.48) and lower than that of WOCP ( f 2.24; IC95% 0.12 \u2013 4.37). Conclusion : NCCP subjects are characterised from an elevated anxiety, together with a better physical well-being, when compared with subjects who have a cardiac failure. The somatisation construct seems less useful to distinguish NCCP from CCP subjects. Consequently, anxiety should be the major target of our mental-health intervention when treating subjects with chest pain

COVID-19-induced neuropsychiatric symptoms can persist long after acute infection: a 2-year prospective study of biobehavioral risk factors and psychometric outcomes

Objectives: To assess the prevalence of neuropsychiatric symptoms 2 years after the COVID-19 acute phase and to identify biobehavioral risk factors. Methods: This 2-year prospective study assessed adult individuals with COVID-19 via face-to-face interview and laboratory testing at onset, and via telephone interview at 2-year follow-up. Data collected included COVID-19 severity and management at onset, as well as depression, anxiety, insomnia, cognitive failure, and fatigue at follow-up using standardized assessment tools. Results: Out of 1,067 screened COVID-19 patients, 230 completed the 2-year follow-up (female, 53.5%; aged>40, 80.9%; native Italian, 94.9%; medical comorbidity, 53.5%; chronic medication, 46.3%; moderate to severe COVID-19, 24.9%; hospital admission, 28.7%; ICU, 5.2%). At follow-up, 9.1% had anxiety, 11.3% depression, 9.1% insomnia, 18.3% cognitive failure, and 39.1% fatigue, of clinical relevance. Headache (OR = 2.49, 95% CI = 1.01-6.16, p = 0.048), dyspnea (OR = 2.55, 95% CI = 1.03-6.31, p = 0.043), and number of symptoms (OR = 1.23, 95% CI = 1.01-1.51, p = 0.047) at onset were associated with anxiety at follow-up; dyspnea at onset was associated with depression at follow-up (OR = 2.80, 95% CI = 1.22-6.41, p = 0.015); number of comorbidities at onset was associated with insomnia at follow-up (OR = 1.48, 95% CI = 1.06-2.08, p = 0.022); female gender (OR = 2.39, 95% CI = 1.14-5.00, p = 0.020) and number of symptoms (OR = 1.20, 95% CI = 1.02-1.42, p = 0.026) at onset was associated with cognitive failure at follow-up; number of comorbidities (OR = 1.33, 95% CI = 1.03-1.73, p = 0.029) and symptoms (OR = 1.19, 95% CI = 1.04-1.37, p = 0.013) and raised interleukin 6 levels (OR = 4.02, 95% CI = 1.42-11.36, p = 0.009) at onset was associated with fatigue at follow-up. Conclusions: COVID-19 survivors, especially if female, with preexisting health problems, and with a more severe acute phase, may present with long-lasting neuropsychiatric sequalae, urging interventions to sustain recovery particularly in these higher risk individuals

Características geoquímicas de las cuñas de hielo en Puerto Deseado (Santa Cruz, Argentina): implicancias paleoambientales y cronológicas

Ground wedge structures of cryogenic origin are common in the Quaternary sediments along the coast of the Patagonia, and their formation is related to climatic cold events experienced by this area in the Late Quaternary. The infilling sediments of two wedges generations were analyzed in the area of Puerto Deseado. Bulk chemistry (major elements), X-ray diffraction (XRD), morphoscopic observations with Scanning Electronic Microscope (SEM) and chemical analyses of volcanic glass shards were undertaken to provide indications about infilling sediment provenience, along with chronological constraint for wedge formation. Bulk chemistry and XRD patterns indicate a significant SiO2- enriched composition of the sediment infilling compared to the most of the loess deposits of the North Argentina and the present day dust originated in Patagonia. This was interpreted as due to the nature of the bedrock present over the Deseado Massif. SEM morphoscopic characteristics of glass shards evidence typical aeolian reworking features, with impact structures and indented edges of the volcanic fragments. Chemical analyses of the glass shards indicate that they were probably generated by the H0 eruption (17,300-17,400 cal yr BP) of the Hudson volcano. Volcanological data indicate that H0 eruption dispersed toward NE, but volcanic glasses were available for reworking due to a WNW component in the western wind direction. Over the Deseado Massif structural high the glass shards mixed with sediments enriched in SiO2, and were eventually deflated further to SE reaching the present coastal area and infilling the frost cracks. The age of the glass shards (17,300-17,400 cal yr BP) and that of the sandy layer affected by cryogenic structures (14,670±750 yr BP) well constrain to the Late Glacial both wedge generations.Las cuñas de hielo son estructuras comunes en sedimentos cuaternarios a lo largo de la costa patagónica, y su formación está relacionada con eventos climáticos fríos experimentados en esta área en el Cuaternario Tardío. Se analizaron sedimentos que rellenan dos generaciones de cuñas de hielo en la zona de Puerto Deseado. Análisis químicos de elementos mayores, difractometría de rayos X (DRX), observaciones con microscopio electrónico de barrido (SEM) y análisis químico de fragmentos de vidrio volcánico contenidos en el sedimento que rellena las cuñas proporcionaron información sobre la precedencia del relleno, además de inferir antecedentes cronológicos sobre su formación. La composición química del sedimento y la difracción de rayos X indican una composición enriquecida en SiO2 en comparación con la mayoría de los depósitos de loess del norte de Argentina y el polvo actual originado en la Patagonia. Esto fue interpretado como producto de la influencia de las rocas que constituyen el macizo del Deseado. Las características morfológicas de los fragmentos de vidrio evidencian rasgos típicos de retrabajo eólico, con presencia de estructuras de impacto y bordes dentados. Los análisis químicos de los fragmentos de vidrio son compatibles con un origen en la erupción H0 (17.300-17.400 cal yr BP) del volcán Hudson. Datos volcanológicos indican que la erupción H0 originó una pluma de dispersión hacia el NE. El material volcánico dispersado por esta erupción quedó disponible para ser retrabajado por una componente WNW de los vientos del W dominantes en la zona. Sobre el macizo del Deseado, los fragmentos de vidrio se mezclaron con sedimentos ricos en SiO2 y fueron adicionalmente, enriquecidos en este elemento hasta alcanzar el área de costa actual, rellenando las cuñas de hielo. La edad de los fragmentos de vidrio (17.300-17.400 cal yr BP) y de la capa arenosa afectada por las estructuras criogénicas (14.670±750 años BP) limitan al glacial tardío la formación de ambas generaciones de cuñas.Centro de Estudios Integrales de la Dinámica Exógen

Risk Factors and Outcomes of Infections by Multidrug-Resistant Gram-Negative Bacteria in Patients Undergoing Hematopoietic Stem Cell Transplantation

Abstract The objective of this study was to determine risk factors and outcomes of infections by multidrug-resistant gram-negative (MDR GN) bacteria in 241 recipients of hematopoietic stem cell transplantation (HSCT). The cumulative incidence of infections was 10.5% (95% CI, 12.0% to 25.8%), with 57% of infections occurring during the period of severe neutropenia (neutrophil count  6 /L). In multivariate analysis, allogeneic transplant and colonization with MDR GN bacteria at admission to the transplant unit were significantly associated with an increased risk of infection. Although we observed neither transplant-related mortality (TRM) nor deaths due to infections by MDR GN bacteria after autologous transplant, in the allogeneic setting a significant difference was reported in terms of overall survival (OS) and TRM between patients who developed infections and those who did not (1-year OS, 39% versus 68%; 1-year TRM, 42% versus 19%). In multivariate analysis, refractory disease and development of grades III to IV graft-versus-host disease (GVHD) were factors that affected both TRM and OS, whereas occurrence of infections by MDR GN pathogens significantly reduced OS. We conclude that eligibility to allogeneic HSCT in MDR GN bacteria carriers should be carefully evaluated together with all other factors that independently influence outcome (disease status, donor, and GVHD risk)

Brain-reactive autoantibodies in neuropsychiatric systemic lupus erythematosus

IntroductionThe pathogenesis of neuropsychiatric systemic lupus erythematosus (NPSLE) is widely unknown, and the role of autoantibodies is still undetermined. MethodsTo identify brain-reactive autoantibodies possibly related to NPSLE, immunofluorescence (IF) and transmission electron microscopy (TEM) on rat and human brains were performed. ELISA was used to reveal the presence of known circulating autoantibodies, while western blot (WB) was applied to characterize potential unknown autoantigen(s). ResultsWe enrolled 209 subjects, including patients affected by SLE (n=69), NPSLE (n=36), Multiple Sclerosis (MS, n=22), and 82 age- and gender-matched healthy donors (HD). Autoantibody reactivity by IF was observed in almost the entire rat brain (cortex, hippocampus, and cerebellum) using sera from NPSLE and SLE patients and was virtually negative in MS and HD. NPSLE showed higher prevalence (OR 2.4; p = 0.047), intensity, and titer of brain-reactive autoantibodies than SLE patients. Most of the patient sera with brain-reactive autoantibodies (75%) also stained human brains. Double staining experiments on rat brains mixing patients' sera with antibodies directed against neuronal (NeuN) or glial markers showed autoantibody reactivity restricted to NeuN-containing neurons. Using TEM, the targets of brain-reactive autoantibodies were located in the nuclei and, to a lesser extent, in the cytoplasm and mitochondria. Given the high degree of colocalization between NeuN and brain-reactive autoantibodies, we assumed NeuN was a possible autoantigen. However, WB analysis with HEK293T cell lysates expressing or not expressing the gene encoding for NeuN protein (RIBFOX3) showed that patients' sera carrying brain-reactive autoantibodies did not recognize the NeuN corresponding band size. Among the panel of NPSLE-associated autoantibodies (e.g., anti-NR2, anti-P-ribosomal protein, antiphospholipid) investigated by ELISA assay, only the anti-& beta;2-glycoprotein-I (a & beta;2GPI) IgG was exclusively found in those sera containing brain-reactive autoantibodies. ConclusionIn conclusion, SLE and NPSLE patients possess brain-reactive autoantibodies but with higher frequency and titers found in NPSLE patients. Although many target antigens of brain-reactive autoantibodies are still undetermined, they likely include & beta;2GPI

Brain-reactive autoantibodies in neuropsychiatric systemic lupus erythematosus

IntroductionThe pathogenesis of neuropsychiatric systemic lupus erythematosus (NPSLE) is widely unknown, and the role of autoantibodies is still undetermined.MethodsTo identify brain-reactive autoantibodies possibly related to NPSLE, immunofluorescence (IF) and transmission electron microscopy (TEM) on rat and human brains were performed. ELISA was used to reveal the presence of known circulating autoantibodies, while western blot (WB) was applied to characterize potential unknown autoantigen(s).ResultsWe enrolled 209 subjects, including patients affected by SLE (n=69), NPSLE (n=36), Multiple Sclerosis (MS, n=22), and 82 age- and gender-matched healthy donors (HD). Autoantibody reactivity by IF was observed in almost the entire rat brain (cortex, hippocampus, and cerebellum) using sera from NPSLE and SLE patients and was virtually negative in MS and HD. NPSLE showed higher prevalence (OR 2.4; p = 0.047), intensity, and titer of brain-reactive autoantibodies than SLE patients. Most of the patient sera with brain-reactive autoantibodies (75%) also stained human brains. Double staining experiments on rat brains mixing patients’ sera with antibodies directed against neuronal (NeuN) or glial markers showed autoantibody reactivity restricted to NeuN-containing neurons. Using TEM, the targets of brain-reactive autoantibodies were located in the nuclei and, to a lesser extent, in the cytoplasm and mitochondria. Given the high degree of colocalization between NeuN and brain-reactive autoantibodies, we assumed NeuN was a possible autoantigen. However, WB analysis with HEK293T cell lysates expressing or not expressing the gene encoding for NeuN protein (RIBFOX3) showed that patients’ sera carrying brain-reactive autoantibodies did not recognize the NeuN corresponding band size. Among the panel of NPSLE-associated autoantibodies (e.g., anti-NR2, anti-P-ribosomal protein, antiphospholipid) investigated by ELISA assay, only the anti-β2-glycoprotein-I (aβ2GPI) IgG was exclusively found in those sera containing brain-reactive autoantibodies.ConclusionIn conclusion, SLE and NPSLE patients possess brain-reactive autoantibodies but with higher frequency and titers found in NPSLE patients. Although many target antigens of brain-reactive autoantibodies are still undetermined, they likely include β2GPI

In patients with metastatic breast cancer the identification of circulating tumor cells in epithelial-to-mesenchymal transition is associated with a poor prognosis

Background: Although recent models suggest that the detection of Circulating Tumor Cells (CTC) in epithelial-to-mesenchymal transition (EM CTC) might be related to disease progression in metastatic breast cancer (MBC) patients, current detection methods are not efficient in identifying this subpopulation of cells. Furthermore, the possible association of EM CTC with both clinicopathological features and prognosis of MBC patients has still to be demonstrated. Aims of this study were: first, to optimize a DEPArray-based protocol meant to identify, quantify and sort single, viable EM CTC and, subsequently, to test the association of EM CTC frequency with clinical data. Methods: This prospective observational study enrolled 56 MBC patients regardless of the line of treatment. Blood samples, depleted of CD45(pos) leukocytes, were stained with an antibody cocktail recognizing both epithelial and mesenchymal markers. Four CD45(neg) cell subpopulations were identified: cells expressing only epithelial markers (E CTC), cells co-expressing epithelial and mesenchymal markers (EM CTC), cells expressing only mesenchymal markers (MES) and cells negative for every tested marker (NEG). CTC subpopulations were quantified as both absolute cell count and relative frequency. The association of CTC subpopulations with clinicopathological features, progression free survival (PFS), and overall survival (OS) was explored by Wilcoxon-Mann-Whitney test and Univariate Cox Regression Analysis, respectively. Results: By employing the DEPArray-based strategy, we were able to assess the presence of cells pertaining to the above-described classes in every MBC patient. We observed a significant association between specific CD45(neg) subpopulations and tumor subtypes (e.g. NEG and triple negative), proliferation (NEG and Ki67 expression) and sites of metastatic spread (e.g. E CTC and bone; NEG and brain). Importantly, the fraction of CD45(neg) cells co-expressing epithelial and mesenchymal markers (EM CTC) was significantly associated with poorer PFS and OS, computed, this latter, both from the diagnosis of a stage IV disease and from the initial CTC assessment. Conclusion: This study suggests the importance of dissecting the heterogeneity of CTC in MBC. Precise characterization of CTC could help in estimating both metastatization pattern and outcome, driving clinical decision-making and surveillance strategies

How future surgery will benefit from SARS-COV-2-related measures: a SPIGC survey conveying the perspective of Italian surgeons

COVID-19 negatively affected surgical activity, but the potential benefits resulting from adopted measures remain unclear. The aim of this study was to evaluate the change in surgical activity and potential benefit from COVID-19 measures in perspective of Italian surgeons on behalf of SPIGC. A nationwide online survey on surgical practice before, during, and after COVID-19 pandemic was conducted in March-April 2022 (NCT:05323851). Effects of COVID-19 hospital-related measures on surgical patients' management and personal professional development across surgical specialties were explored. Data on demographics, pre-operative/peri-operative/post-operative management, and professional development were collected. Outcomes were matched with the corresponding volume. Four hundred and seventy-three respondents were included in final analysis across 14 surgical specialties. Since SARS-CoV-2 pandemic, application of telematic consultations (4.1% vs. 21.6%; p < 0.0001) and diagnostic evaluations (16.4% vs. 42.2%; p < 0.0001) increased. Elective surgical activities significantly reduced and surgeons opted more frequently for conservative management with a possible indication for elective (26.3% vs. 35.7%; p < 0.0001) or urgent (20.4% vs. 38.5%; p < 0.0001) surgery. All new COVID-related measures are perceived to be maintained in the future. Surgeons' personal education online increased from 12.6% (pre-COVID) to 86.6% (post-COVID; p < 0.0001). Online educational activities are considered a beneficial effect from COVID pandemic (56.4%). COVID-19 had a great impact on surgical specialties, with significant reduction of operation volume. However, some forced changes turned out to be benefits. Isolation measures pushed the use of telemedicine and telemetric devices for outpatient practice and favored communication for educational purposes and surgeon-patient/family communication. From the Italian surgeons' perspective, COVID-related measures will continue to influence future surgical clinical practice

Mitochondrial physiology

As the knowledge base and importance of mitochondrial physiology to evolution, health and disease expands, the necessity for harmonizing the terminology concerning mitochondrial respiratory states and rates has become increasingly apparent. The chemiosmotic theory establishes the mechanism of energy transformation and coupling in oxidative phosphorylation. The unifying concept of the protonmotive force provides the framework for developing a consistent theoretical foundation of mitochondrial physiology and bioenergetics. We follow the latest SI guidelines and those of the International Union of Pure and Applied Chemistry (IUPAC) on terminology in physical chemistry, extended by considerations of open systems and thermodynamics of irreversible processes. The concept-driven constructive terminology incorporates the meaning of each quantity and aligns concepts and symbols with the nomenclature of classical bioenergetics. We endeavour to provide a balanced view of mitochondrial respiratory control and a critical discussion on reporting data of mitochondrial respiration in terms of metabolic flows and fluxes. Uniform standards for evaluation of respiratory states and rates will ultimately contribute to reproducibility between laboratories and thus support the development of data repositories of mitochondrial respiratory function in species, tissues, and cells. Clarity of concept and consistency of nomenclature facilitate effective transdisciplinary communication, education, and ultimately further discovery