The high-pathogenicity island (HPI) promotes flagellum-mediated motility in extraintestinal pathogenic Escherichia coli

The key of success of extraintestinal pathogenic Escherichia coli (ExPEC) to colonize niches outside the intestinal tract and to establish infection is the coordinated action of numerous virulence and fitness factors. The so-called high-pathogenicity island (HPI), responsible for synthesis, secretion and uptake of the siderophore yersiniabactin, proved to be an important virulence determinant. In this study we investigated the interaction of the flagellum-mediated motility and the HPI. The impairment of yersiniabactin production by deletion of irp2 or ybtA affected significantly motility. The gain of yersiniabactin production improved motility in both pathogenic and non-pathogenic E. coli strains. The loss of flagella expression had no adverse effect on the HPI. Strikingly, external iron abundance was not able to suppress activation of the HPI during motility. The HPI activity of swarming bacteria was comparable to iron deplete conditions, and could even be maximized by supplementing excessive iron. This fact is the first description of a regulatory mechanism, which does not follow the known hierarchical regulation of siderophore systems. Transcriptional reporter fusions of the ybtA promoter demonstrated that the entire promoter region with all YbtA binding sites is necessary for complete induction in both HPI-positive and HPI-negative strains. Altogether, these results suggest that the HPI is part of a complex regulatory network, which orchestrates various virulence mechanisms to optimize the overall fitness of ExPEC

Real and perceived physical functioning in Italian elderly population: associations with BADL and IADL

This study aimed to identify the key physical abilities (aerobic endurance, gait speed, balance, strength) and psychological variables associated with the level of basic (BADL) and instrumental (IADL) activities of daily living in an autonomous community-dwelling elderly population in Italy. 135 elderly people (63% women; mean age = 73.3, SD = 5.5) were included in the study. Stepwise regression was performed to verify the association between these variables and the level of BADL and IADL in the elderly participants. Results showed that balance (β = −0.21, p < 0.01) and perception of physical functioning (β = 0.32, p < 0.0001) were the key individual variables related to BADL scores, and IADL score was associated with perception of physical functioning (β = 0.30, p < 0.0001) and upper limb strength (β = 0.21, p < 0.05). The results demonstrate a relationship between physical functioning and ADL, both real physical functioning and perceived physical functioning

Visceral adiposity index and DHEAS are useful markers of diabetes risk in women with polycystic ovary syndrome

Objective: On the basis of the known diabetes risk in polycystic ovary syndrome (PCOS), recent guidelines of the Endocrine Society recommend the use of an oral glucose tolerance test (OGTT) to screen for impaired glucose tolerance (IGT) and type 2 diabetes (T2DM) in all women with PCOS. However, given the high prevalence of PCOS, OGTTwould have ahigh cost-benefit ratio. In this study, we identified, through a receiver operating characteristic analysis, simple predictive markers of the composite endpoint (impaired fasting glucose (IFG) or IGT or IFGCIGT or T2DM) in women with PCOS according to the Rotterdam criteria.Design: We conducted a cross-sectional study of 241 women with PCOS in a university hospital setting.Methods: Clinical, anthropometric, and metabolic (including OGTT) parameters were evaluated. The homeostasis model assessment of insulin resistance (HOMA2-IR), the Matsuda index of insulin sensitivity, and the oral dispositional index and visceral adiposity index (VAI) were determined.Results: Out of 241 women included in this study, 28 (11.6%) had an IFG, 13 (5.4%) had IGT, four (1.7%) had IFGCIGT, and four (1.7%) had T2DM. Among the anthropometric variables examined, the VAI had a significantly higher C-statistic compared with BMI (0.760 (95% CI: 0.70-0.81) vs 0.613 (95% CI: 0.54-0.67); PZ0.014) and waist circumference (0.760 (95% CI: 0.70-0.81) vs 0.619 (95% CI: 0.55-0.68); PZ0.028). Among all the hormonal and metabolic serum variables examined, DHEAS showed the highest C-statistic (0.720 (95% CI: 0.65-0.77); P<0.001).Conclusions: In addition to fasting glucose, the VAI and DHEAS may be considered useful tools for prescreening in all women with PCOS without the classical risk factors for diabetes

Diffuse post-traumatic calcification of the anterior longitudinal ligamentum of cervical and dorsal spine

Among the different conditions causing inflammation and calcification/ossification of the soft tissues of the spinal cord, single or recurrent traumatic events are included. Within the international literature, the involvement of the posterior longitudinal ligament, following spinal cord injuries is frequently reported, especially in the elders. The Authors describe here an uncommon calcification/ossification of the anterior longitudinal ligament occurred after a double traumatic event in a young man, followed clinically and radiologically for a long-term period. On the basis of clinical, laboratory and radiological findings, the differential diagnosis with other possible aetiologies, especially DISH (Diffuse idiopathic skeletal hyperostosis) and ankylosing spondylitis, is discussed

Effects of 1 year of lifestyle intervention on institutionalized older adults

The socio-economic and health consequences of our ageing population are well documented, with older adults living in long-term care facilities amongst the frailest possessing specific and significant healthcare and social care needs. These needs may be exacerbated through the sedentary behaviour which is prevalent within care home settings. Reducing sedentary time can reduce the risk of many diseases and improve functional health, implying that improvements in health may be gained by simply helping older adults substitute time spent sitting with time spent standing or in light-intensity ambulation. This study identified the impact of 1 year of lifestyle intervention in a group of older adults living in a long-term care setting in Italy. One hundred and eleven older adults (mean age, 82.37 years; SD = 10.55 years) participated in the study. Sixty-nine older adults were in the intervention group (35 without severe cognitive decline and 34 with dementia) and 42 older adults were in the control group. Data on physical functioning, basic activities of daily living (BADL) and mood were collected 4 times, before, during (every four months) and after the 1 year of intervention. The lifestyle intervention focused on improving the amount of time spent every week in active behaviour and physical activity (minimum 150 min of weekly activities). All participants completed the training program and no adverse events, related to the program, occurred. The intervention group showed steady and significant improvements in physical functioning and a stable situation in BADL and mood following the intervention in older adults with and without dementia, whilst the control group exhibited a significant decline over time. These results suggest that engagement in a physical activity intervention may benefit care home residents with and without dementia both physically and mentally, leading to improved social care and a reduced burden on healthcare services

TOpic: rare and special cases, the real "Strange cases"

Introduction: The bladder hernia represents approximately 1-3% of all inguinal hernias, where patients aged more than 50 years have a higher incidence (10%). Many factors contribute to the development of a bladder hernia, including the presence of a urinary outlet obstruction causing chronic bladder distention, the loss of bladder tone, pericystitis, the perivesical bladder fat protrusion and the obesity

Modest agreement between magnetic resonance and pathological tumor regression after neoadjuvant therapy for rectal cancer in the real world.

Magnetic resonance imaging (MRI) is routinely used for preoperative tumor staging and to assess response to therapy in rectal cancer patients. The aim of our study was to evaluate the accuracy of MRI based restaging after neoadjuvant chemoradiotherapy (CRT) in predicting pathologic response. This multicenter cohort study included adult patients with histologically confirmed locally advanced rectal adenocarcinoma treated with neoadjuvant CRT followed by curative intent elective surgery between January 2014 and December 2019 at four academic high-volume institutions. Magnetic resonance tumor regression grade (mrTRG) and pathologic tumor regression grade (pTRG) were reviewed and compared for all the patients. The agreement between radiologist and pathologist was assessed with the weighted k test. Risk factors for poor agreement were investigated using logistic regression. A total of 309 patients were included. Modest agreement was found between mrTRG and pTRG when regression was classified according to standard five-tier systems (k = 0.386). When only two categories were considered for each regression system, (pTRG 0-3 vs pTRG 4; mrTRG 2-5 vs mrTRG 1) an accuracy of 78% (95% confidence interval [CI] 0.73-0.83) was found between radiologic and pathologic assessment with a k value of 0.185. The logistic regression model revealed that "T3 greater than 5 mm extent" was the only variable significantly impacting on disagreement (OR 0.33, 95% CI 0.15-0.68, P = .0034). Modest agreement exists between mrTRG and pTRG. The chances of appropriate assessment of the regression grade after neoadjuvant CRT appear to be higher in case of a T3 tumor with at least 5 mm extension in the mesorectal fat at the pretreatment MRI

Rabbia, alessitimia, impulsività in pazienti affetti da schizofrenia e autori di reato: uno studio trasversale

Background: Anger, alexithymia, impulsivity are clinical variables underlying aggression/crimes, therefore their evaluation with specific instruments in psychiatric patients samples could give the clinician deeper knowledge and useful information aimed to the rehabilitative work and the prevention of recidivism. Materials and Methods: 53 people with Schizofrenia, sectioned at the Barcellona Pozzo di Gotto Forensic Hospital – before its dismissing -, have completed STAXI-2, TAS-20, BIS-11 questionnaires.Exclusion criteria: Intellectual Disability. Pearson linear correlations have been performed to test associations between the three variables of anger, alexithymia, impulsivity and between a single variable and crimes. Logistic regressions have been used to further investigate links between clinical variables and crimes. Results: Correlations between variables: a) 17 alexithymic patients (TAS&gt;60), mean score BIS-11: 58. Positive Pearson correlation between alexithymia and impulsivity; b) STAXI-2 RS/S, R/T, RT/T, RT/R, ER/IN are positively related to alexithymia; CR/IN e CR/OUT in a negative way; c) Impulsivity is related to STAXI-2 RT/T, ER/IN in a significant way. Correlations between variables and crimes: d) As TAS-20 scores increase, there is lower probability to commit a crime inside the family; e) As BIS-11 scores increase, there is lower probability to commit homicide; f) STAXI-2 RS/S is positively related to robbery. Discussion and conclusions: Our results about alexithymia and impulsivity, alexithymia and anger, and impulsivity and anger correlations go along with the literature about aggression/violence antecedents. Alexithymic subjects would commit crimes outside the family and murderers – in our sample – would have committed “low level of impulsivity” homicides, as far as the premeditation factor is concerned. Robbery is related to RS/S (feeling anger), to indicate how anger is manifested in such crimes.Background: Rabbia, alessitimia, impulsività sono variabili cliniche sottese ad agiti aggressivi/reati, pertanto il loro studio e rilevazione con strumenti testali in campioni di soggetti affetti da malattia mentale può consentire al clinico una conoscenza psicopatologica più approfondita e fornire informazioni utili per la riabilitazione e prevenzione delle recidive. Materiali e Metodi: 53 persone affette da Schizofrenia, internate presso l’Ospedale Psichiatrico Giudiziario di Barcellona Pozzo di Gotto prima dellasua chiusura hanno svolto i questionari STAXI-2, TAS-20, BIS-11. Criterio di esclusione: diagnosi di Disabilità Intellettiva. Sono state svolte correlazioni lineari di Pearson per testare possibili associazioni tra le variabili rabbia, alessitimia, impulsività e tra le singole variabili e le tipologie di reati commessi. Ulteriori approfondimenti per il legame tra stati emotivi e reati sono stati svolti con regressione logistica (reato commesso/non commesso). Risultati: Correlazioni tra variabili: a) 17 soggetti alessitimici (TAS&gt;60), punteggio medio BIS-11: 58. Correlazione di Pearson positiva e statisticamente significativa tra alessimia e impulsività; b) Le sottoscale STAXI-2 RS/S, R/T, RT/T, RT/R, ER/IN si correlano in modo statisticamente significativo all’alessitimia, CR/IN e CR/OUT in modo negativo; c) Impulsività si correla in modo statisticamente significativo alle sottoscale STAXI-2 RT/T, ER/IN. Correlazioni variabili-reati: d) All’aumento di punteggi di TAS-20, vi è una minore probabilità di commettere reati in famiglia; e) All’aumento di punteggi di BIS-11, vi è una minore probabilità di commettere omicidio; f) La sottoscala STAXI-2 RS/S è correlata positivamente con la rapina. Discussione e conclusioni: I risultati ottenuti in merito alle correlazioni tra alessitimia e impulsività, alessitimia e rabbia, impulsività e rabbia sono concordi con la letteratura esistente rispetto agli antecedenti di comportamenti aggressivi e violenti. Soggetti alessitimici tenderebbero a commettere reati al di fuori della famiglia e i soggetti autori di omicidio – nel campione in esame – avrebbero commesso omicidi “a basso livello di impulsività”, per componente di premeditazione. Il reato rapina si correla con la sottoscala “sentire rabbia” (RS/S), ad indicare come la componente rabbiosa si slatentizzi in questo tipo di reati.

Optimized management of urolithiasis by coloured stent-stone contrast using dual-energy computed tomography (DECT)

Background We analysed in vitro the appearance of commonly used ureteral stents with dual-energy computed tomography (DECT) and we used these characteristics to optimize the differentiation between stents and adjacent stone. Methods We analysed in vitro a selection of 36 different stents from 7 manufacturers. They were placed in a self-build phantom model and measured using the SOMATOM® Force Dual Source CT-Scanner (Siemens, Forchheim, Germany). Each sample was scanned at various tube potentials of 80 and 150 peak kilovoltage (kVp), 90 and 150 kVp and 100 and 150 kVp. The syngo Post-Processing Suite software program (Siemens, Forchheim, Germany) was used for differentiation based on a 3–material decomposition algorithm (UA, calcium, urine) according to our standard stone protocol. Results Stents composed of polyurethane appeared blue and silicon-based stents were red on the image. The determined appearances were constant for various peak kilovoltage (kVp) values. The coloured stent-stone-contrast displayed on DECT improves monitoring, especially of small calculi adjacent to indwelling ureteral stents. Conclusion Both urinary calculi and ureteral stents can be accurately differentiated by a distinct appearance on DECT. For the management of urolithiasis patients can be monitored more easily and accurately using DECT if the stent shows a different colour than the adjacent stone

Age-related decrements in dual-task performance: comparison of different mobility and cognitive tasks. A cross sectional study

This cross-sectional study investigated the age-related differences in dual-task performance both in mobility and cognitive tasks and the additive dual-task costs in a sample of older, middle-aged and young adults. 74 older adults (M = 72.63±5.57 years), 58 middle-aged adults (M = 46.69±4.68 years) and 63 young adults (M = 25.34±3.00 years) participated in the study. Participants performed different mobility and subtraction tasks under both single- and dual-task conditions. Linear regressions, repeated-measures and one-way analyses of covariance were used, The results showed: significant effects of the age on the dual and mobility tasks (p<0.05) and differences among the age-groups in the combined dual-task costs (p<0.05); significant decreases in mobility performance under dual-task conditions in all groups (p<0.05) and a decrease in cognitive performance in the older group (p<0.05). Dual-task activity affected mobility and cognitive performance, especially in older adults who showed a higher dual-task cost, suggesting that dual-tasks activities are affected by the age and consequently also mobility and cognitive tasks are negatively influenced