How Does SARS-CoV-2 Affect the Central Nervous System? A Working Hypothesis

Interstitial pneumonia was the first manifestation to be recognized as caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2); however, in just a few weeks, it became clear that the coronavirus disease-2019 (COVID-19) overrun tissues and more body organs than just the lungs, so much so that it could be considered a systemic pathology. Several studies reported the involvement of the conjunctiva, the gut, the heart and its pace, and vascular injuries such as thromboembolic complications and Kawasaki disease in children and toddlers were also described. More recently, it was reported that in a sample of 214 SARS-CoV-2 positive patients, 36.4% complained of neurological symptoms ranging from non-specific manifestations (dizziness, headache, and seizures), to more specific symptoms such hyposmia or hypogeusia, and stroke. Older individuals, especially males with comorbidities, appear to be at the highest risk of developing such severe complications related to the Central Nervous System (CNS) involvement. Neuropsychiatric manifestations in COVID-19 appear to develop in patients with and without pre-existing neurological disorders. Growing evidence suggests that SARS-CoV-2 binds to the human Angiotensin-Converting Enzyme 2 (ACE2) for the attachment and entrance inside host cells. By describing ACE2 and the whole Renin Angiotensin Aldosterone System (RAAS) we may better understand whether specific cell types may be affected by SARS-CoV-2 and whether their functioning can be disrupted in case of an infection. Since clear evidences of neurological interest have already been shown, by clarifying the topographical distribution and density of ACE2, we will be able to speculate how SARS-CoV-2 may affect the CNS and what is the pathogenetic mechanism by which it contributes to the specific clinical manifestations of the disease. Based on such evidences, we finally hypothesize the process of SARS-CoV-2 invasion of the CNS and provide a possible explanation for the onset or the exacerbation of some common neuropsychiatric disorders in the elderly including cognitive impairment and Alzheimer disease

Compulsory treatments in eating disorders: a systematic review and meta-analysis

Introduction: The aims of this systematic review and meta-analysis are to provide a summary of the current literature concerning compulsory treatments in patients with eating disorders (ED) and to understand whether compulsorily and involuntarily treated patients differ in terms of baseline characteristics and treatment outcomes. Methods: Relevant articles were identified following the PRISMA guidelines by searching the following terms: “treatment refusal”, “forced feeding”, “compulsory/coercive/involuntary/forced treatment/admission”, “eating disorders”, “feeding and eating disorders”, “anorexia nervosa”, “bulimia nervosa”. Research was restricted to articles concerning humans and published between 1975 and 2020 in English. Results: Out of 905 articles retrieved, nine were included for the analyses allowing the comparisons between 242 compulsorily and 738 voluntarily treated patients. Mean body mass index (BMI) was slightly lower in patients compelled to treatments. Mean illness duration, BMI at discharge and BMI variation showed no significant differences between the two groups. Average length of hospitalization was 3 weeks longer among compulsory-treated patients, but this did not result in a higher increase in BMI. No significant risk difference on mortality was estimated (three studies). Conclusions: Compulsory treatments are usually intended for patients having worse baseline conditions than voluntary ones. Those patients are unlikely to engage in treatments without being compelled but, after the treatments, albeit with longer hospitalisations, they do achieve similar outcomes. Therefore, we can conclude that forcing patients to treatment is a conceivable option. Level of evidence: Level I, systematic review and meta-analysis

Co-precipitation synthesis of stable iron oxide nanoparticles with NaOH: New insights and continuous production via flow chemistry

Co-precipitation is by far the most common synthesis for magnetic iron oxide nanoparticles (IONPs), as cheap and environmentally friendly precursors and simple experimental procedures facilitate IONP production in many labs. Optimising co-precipitation syntheses remains challenging however, as particle formation mechanisms are not well understood. This is partly due to the rapid particle formation (within seconds) providing insufficient time to characterise initial precipitates. To overcome this limitation, a flow chemistry approach has been developed using steady-state operation to “freeze” transient reaction states locally. This allowed for the first time a comprehensive analysis of the early stages of co-precipitation syntheses via in-situ Small Angle X-ray Scattering and in-situ synchrotron X-Ray Diffraction. These studies revealed that after mixing the ferrous/ferric chloride precursor with the NaOH base solution, the most magnetic iron oxide phase forms within 5 s, the particle size changes only marginally afterwards, and co-precipitation and agglomeration occur simultaneously. As these agglomerates were too large to achieve colloidal stability via subsequent stabiliser addition, co-precipitated IONPs had to be de-agglomerated. This was achieved by adding the appropriate quantity of a citric acid solution which yielded within minutes colloidally stable IONP solutions around a neutral pH value. The new insights into the particle formation and the novel stabilisation procedure (not requiring any ultra-sonication or washing step) allowed to design a multistage flow reactor to synthesise and stabilise IONPs continuously with a residence time of less than 5 min. This reactor was robust against fouling and produced stable IONP solutions (of ~1.5 mg particles per ml) reproducibly via fast mixing ( 500 ml/h) for low materials cost

Antimicrobial photodynamic therapy alone or in combination with antibiotic local administration against biofilms of Fusobacterium nucleatum and Porphyromonas gingivalis

Antimicrobial photodynamic therapy (aPDT) kills several planktonic pathogens. However, the susceptibility of biofilm-derived anaerobic bacteria to aPDT is poorly characterized. Here, we evaluated the effect of Photodithazine (PDZ)-mediated aPDT on Fusobacterium nucleatum and Porphyromonas gingivalis biofilms. In addition, aPDT was tested with metronidazole (MTZ) to explore the potential antimicrobial effect of the treatment. The minimum inhibitory concentration (MIC) of MTZ was defined for each bacterial species. Single-species biofilms of each species were grown on polystyrene plates under anaerobic conditions for five days. aPDT was performed by applying PDZ at concentrations of 50, 75 and 100 mg/L, followed by exposure to 50 J/cm2 LED light (660 nm) with or without MTZ. aPDT exhibited a significant reduction in bacterial viability at a PDZ concentration of 100 mg/L, with 1.12 log10 and 2.66 log10 reductions for F. nucleatum and P. gingivalis in biofilms, respectively. However, the antimicrobial effect against F. nucleatum was achieved only when aPDT was combined with MTZ at 100× MIC. Regarding P. gingivalis, the combination of PDZ-mediated aPDT at 100 mg/L with MTZ 100× MIC resulted in a 5 log10 reduction in the bacterial population. The potential antimicrobial effects of aPDT in combination with MTZ for both single pathogenic biofilms were confirmed by live/dead staining. These results suggest that localized antibiotic administration may be an adjuvant to aPDT to control F. nucleatum and P. gingivalis biofilms

A preliminary approach for swimming performance analysis of FISDIR elite athletes with intellectual impairment using an inertial sensor

People with intellectual impairment show low performances in motor control, especially in complex movements. Performance analysis methods, based on wearable inertial sensor, are often used in typical developed swimmers but have never been used in swimmers with intellectual impairment, for whom the use of quantitative systems would be even more important. This paper presents a case study conducted on freestyle swimmers from the functional evaluation project of the Italian Sport Federation for athletes with Intellectual Impairment (FISDIR). The tests were conducted by five Italian elite swimmers with intellectual impairment using a structured experimental protocol which foresees an inertial sensor located on the wrist. Key freestyle temporal and kinematic parameters were assessed. A high-speed camera was used as a benchmark to validate the inertial-based parameters. The preliminary results indicate that the proposed inertial-based approach correlates over 90% with the performance indices obtained with the camera-based approach, and therefore it could represent a useful tool for monitoring and improving the training

Chitin and Its Derivatives: Nanostructured Materials from Different Marine and Terrestrial Sources

Chitin is a very abundant polysaccharide that can be obtained from well-known marine sources (crustaceans), but also from terrestrial sources (mushrooms and insects). In the case where animal sources are considered, the material can be obtained by much abundant food or feeding waste. The extraction methodologies were not developed with similar technical readiness levels considering the different sources and the further conversion to chitin nanofibrils and chitosan is also under study, enabling the production of products differentiated for their macromolecular structures and morphology.Chitin nanofibrils from sea food sources were used in sanitary, cosmetic and packaging applications, where their anti-microbial properties and good biocompatibility were very useful. Chitin from mushrooms and sea food was used as starting material in possible coatings for cellulosic and bioplastic substrates. Currently chitin from insects (Hermetia Illucens) is also under study as well as the methodologies for extracting derivatives from it. Infrared analysis is an interesting technique to compare chitins, chitin nanofibrils and chitosan from different sources as well as electron microscopy for studying their morphology. The derivatives of chitin, such as chitosan and chitin nanofibrils, show anti-microbial properties. Hence, their use in several applications, ranging from packaging to sanitary and cosmetics, can conjugate high performance novel products with a reduced environmental concern. The comparison between chitin derivatives from different sources is very useful to address the biopolymers to specific applications, including the agricultural sector. While more and more applications for chitin derivatives will be developed, differences between them should be clarified and correlated to the sources, the methodologies of their production and their physical-chemical properties

Characterization of chitin and chitosan derived from Hermetia illucens, a further step in a circular economy process

Due to their properties and applications, the growing demand for chitin and chitosan has stimulated the market to find more sustainable alternatives to the current commercial source (crustaceans). Bioconverter insects, such as Hermetia illucens, are the appropriate candidates, as chitin is a side stream of insect farms for feed applications. This is the first report on production and characterization of chitin and chitosan from different biomasses derived from H. illucens, valorizing the overproduced larvae in feed applications, the pupal exuviae and the dead adults. Pupal exuviae are the best biomass, both for chitin and chitosan yields and for their abundance and easy supply from insect farms. Fourier-transform infrared spectroscopy, X-ray diffraction and scanning electron microscope analysis revealed the similarity of insect-derived polymers to commercial ones in terms of purity and structural morphology, and therefore their suitability for industrial and biomedical applications. Its fibrillary nature makes H. illucens chitin suitable for producing fibrous manufacts after conversion to chitin nanofibrils, particularly adults-derived chitin, because of its high crystallinity. A great versatility emerged from the evaluation of the physicochemical properties of chitosan obtained from H. illucens, which presented a lower viscosity-average molecular weight and a high deacetylation degree, fostering its putative antimicrobial properties

COVID-19 and vertical transmission: assessing the expression of ACE2 / TMPRSS2 in the human fetus and placenta to assess the risk of SARS-CoV-2 infection

Background: While pregnant women have been identified as a potentially at-risk group concerning COVID-19 infection, little is known regarding the susceptibility of the fetus to infection. Co-expression of ACE2 and TMPRSS2 has been identified as a pre-requisite for infection, and expression across different tissues is known to vary between children and adults. However, the expression of these proteins in the fetus is unknown. Methods: We performed a retrospective analysis of single cell data repositories. This data was then validated at both gene and protein level by performing qRT-PCR and two-colour immunohistochemistry on a library of second-trimester human fetal tissues. Findings: TMPRSS2 is present at both gene and protein level in the predominantly epithelial fetal tissues analysed. ACE2 is present at significant levels, only in the fetal intestine and kidney and is not expressed in the fetal lung. The placenta is also negative for the two proteins both during development and at term. Interpretation: This dataset indicates that the lungs are unlikely to be a viable route of SARS-CoV2 fetal infection. The fetal kidney, despite presenting both the proteins required for the infection, is anatomically protected from the exposure to the virus. However, the GI tract is likely to be susceptible to infection due to its high co-expression of both proteins, as well as its exposure to potentially infected amniotic fluid