Direct Anterior versus Lateral Approach for Femoral Neck Fracture: Role in COVID-19 Disease

Background: During the COVID-19 emergency, the incidence of fragility fractures in elderly patients remained unchanged. The management of these patients requires a multidisciplinary approach. The study aimed to assess the best surgical approach to treat COVID-19 patients with femoral neck fracture undergoing hemiarthroplasty (HA), comparing direct lateral (DL) versus direct anterior approach (DAA). Methods: A single-center, observational retrospective study including 50 patients affected by COVID-19 infection (30 males, 20 females) who underwent HA between April 2020 to April 2021 was performed. The patients were allocated into two groups according to the surgical approach used: lateral approach and anterior approach. For each patient, the data were recorded: age, sex, BMI, comorbidity, oxygen saturation (SpO2), fraction of the inspired oxygen (FiO2), type of ventilation invasive or non-invasive, HHb, P/F ratio (PaO2/FiO2), hemoglobin level the day of surgery and 1 day post operative, surgical time, Nottingham Hip Fractures Score (NHFS) and American Society of Anesthesiologists Score (ASA). The patients were observed from one hour before surgery until 48 h post-surgery of follow-up. The patients were stratified into five groups according to Alhazzani scores. A non-COVID-19 group of patients, as the control, was finally introduced. Results: A lateral position led to a better level of oxygenation (p < 0.01), compared to the supine anterior approach. We observed a better post-operative P/F ratio and a reduced need for invasive ventilation in patients lying in the lateral position. A statistically significant reduction in the surgical time emerged in patients treated with DAA (p < 0.01). Patients within the DAA group had a significantly lower blood loss compared to direct lateral approach. Conclusions: DL approach with lateral decubitus seems to preserved respiratory function in HA surgery. Thus, the lateral position may be associated with beneficial effects on gas exchange

DNA hydroxymethylation levels are altered in blood cells from Down syndrome persons enrolled in the MARK-AGE project

Down syndrome (DS) is caused by the presence of part or an entire extra copy of chromosome 21, a phenomenon that can cause a wide spectrum of clinically defined phenotypes of the disease. Most of the clinical signs of DS are typical of the ageing process including dysregulation of immune system. Beyond the causative genetic defect, DS persons display epigenetic alterations, particularly aberrant DNA methylation patterns that can contribute to the heterogeneity of the disease. In the present work we investigated the levels of 5-hydroxymethylcytosine (5hmC) and of the TET dioxygenase enzymes, which are involved in DNA demethylation processes and are often deregulated in pathological conditions as well as in ageing. Analyses were carried out on peripheral blood mononuclear cells of DS volunteers enrolled in the context of the MARK-AGE study, a large-scale cross-sectional population study with subjects representing the general population in eight European countries. We observed a decrease of 5hmC, TET1 and other components of the DNA methylation/demethylation machinery in DS subjects, indicating that aberrant DNA methylation patterns in DS, which may have consequences on the transcriptional status of immune cells, may be due to a global disturbance of methylation control in DS

Treinamento auditivo cognitivo em sujeitos após COVID-19 : uma análise dos efeitos da intervenção em adultos

To analyze the effectiveness of a therapeutic intervention plan through an existing cognitive auditory training program, adapted for adults, after one year of COVID-19 infection. Methods: 13 subjects, between 18 and 59 years old, four males and nine females participated in the study. All underwent anamnesis, visual inspection of the external acoustic meatus, pure tone audiometry, speech audiometry and acoustic immitance measurements as selection procedures. For the research, the following procedures were carried out in the evaluation and reassessment: evaluation of central auditory processing, brief neuropsychological evaluation - NEUPSILIN, Speech, Spatial and Qualities of Hearing Scale and the Cognitive Potential - P300 with speech stimulus. Cognitive auditory training was carried out in six consecutive sessions, in an open field, lasting approximately 50 minutes. In all analyses, a significance level of 5% (p≤0.05) was considered. Results: When comparing the variables between the periods, pre and post intervention, there was a statistically significant difference in the Dichotic Digit Test (p = 0.009), in the Frequency Pattern Test (p = 0.020) and in Speech, Spatial and Qualities of Hearing Scale (p = 0.001). And a tendency to significance (p < 0.10) in the Gap in Noise test and Total Attention. Conclusion: Cognitive auditory training proved to be an effective therapeutic strategy for the treatment of adults with speech comprehension and cognition complaints after COVID-19 infection.Objetivo: analisar a eficácia de um plano de intervenção terapêutica por meio de um programa de treinamento auditivo cognitivo já existente, adaptado para adultos, após um ano de infecção por COVID-19. Métodos: participaram do estudo 13 sujeitos, entre 18 e 59 anos de idade, quatro do gênero masculino e nove do gênero feminino. Todos foram submetidos a um questionário, inspeção visual do meato acústico externo, audiometria tonal liminar, logoaudiometria e medidas de imitância acústica, como procedimentos de seleção. Foram realizados, na avaliação e na reavaliação, os seguintes procedimentos: avaliação do processamento auditivo central, avaliação neuropsicológica breve-NEUPSILIN, Speech, Spatial and Qualities of Hearing Scale e o Potencial Cognitivo - P300, com estímulo de fala. O treinamento auditivo cognitivo foi realizado em seis sessões consecutivas, em campo aberto, com duração de, aproximadamente, 50 minutos. Em todas as análises foi considerado o nível de significância de 5% (p≤0,05). Resultados: na comparação das variáveis entre os períodos, pré e pós-intervenção, houve diferença estatisticamente significativa no Teste Dicótico de Dígitos (p = 0,009), no Teste Padrão de Frequência (p = 0,020) e no Speech, Spatial and Qualities of Hearing Scale (p = 0,001). Houve tendência à significância (p < 0,10) no teste Gap in Noise e na Atenção Total. Conclusão: o treinamento auditivo cognitivo demonstrou ser uma estratégia terapêutica eficaz para o tratamento de adultos com queixas de compreensão de fala e de cognição após infecção por COVID-19

Analysis of the machinery and intermediates of the 5hmC-mediated DNA demethylation pathway in aging on samples from the MARKAGE Study

Gradual changes in the DNA methylation landscape occur throughout aging virtually in all human tissues. A widespread reduction of 5-methylcytosine (5mC), associated with highly reproducible site-specific hypermethylation, characterizes the genome in aging. Therefore, an equilibrium seems to exist between general and directional deregulating events concerning DNA methylation controllers, which may underpin the age-related epigenetic changes. In this context, 5mC-hydroxylases (TET enzymes) are new potential players. In fact, TETs catalyze the stepwise oxidation of 5mC to 5-hydroxymethylcytosine (5hmC), 5-formylcytosine (5fC) and 5-carboxylcytosine (5caC), driving the DNA demethylation process based on thymine DNA glycosylase (TDG)-mediated DNA repair pathway. The present paper reports the expression of DNA hydroxymethylation components, the levels of 5hmC and of its derivatives in peripheral blood mononuclear cells of age-stratified donors recruited in several European countries in the context of the EU Project ‘MARK-AGE’. The results provide evidence for an age-related decline of TET1, TET3 and TDG gene expression along with a decrease of 5hmC and an accumulation of 5caC. These associations were independent of confounding variables, including recruitment center, gender and leukocyte composition. The observed impairment of 5hmC-mediated DNA demethylation pathway in blood cells may lead to aberrant transcriptional programs in the elderly

Age-dependent expression of DNMT1 and DNMT3B in PBMCs from a large European population enrolled in the MARK-AGE study

Aging is associated with alterations in the content and patterns of DNA methylation virtually throughout the entire human lifespan. Reasons for these variations are not well understood. However, several lines of evidence suggest that the epigenetic instability in aging may be traced back to the alteration of the expression of DNA methyltransferases. Here, the association of the expression of DNA methyltransferases DNMT1 and DNMT3B with age has been analysed in the context of the MARK-AGE study, a large-scale cross-sectional study of the European general population. Using peripheral blood mononuclear cells, we assessed the variation of DNMT1 and DNMT3B gene expression in more than two thousand age-stratified women and men (35-75 years) recruited across eight European countries. Significant age-related changes were detected for both transcripts. The level of DNMT1 gradually dropped with aging but this was only observed up to the age of 64 years. By contrast, the expression of DNMT3B decreased linearly with increasing age and this association was particularly evident in females. We next attempted to trace the age-related changes of both transcripts to the influence of different variables that have an impact on changes of their expression in the population, including demographics, dietary and health habits, and clinical parameters. Our results indicate that age affects the expression of DNMT1 and DNMT3B as an almost independent variable in respect of all other variables evaluated

A multidisciplinary approach for monitoring the conservation state of the sandstones of the Palazzo Ducale in Camerino (MC)

While negative impacts of climate-related and other hazards on urban areas are widely discussed in the scientific literature, their impact on historic buildings is still understudied (Bigio et al., 2014). In this regard, the 2016-2017 seismic sequence in Central Italy, which represents the second major disastrous event in the last decade on the Apennines, caused heavy damage of tens of municipalities, thousands of buildings and mostly important, life losses. These events highlighted the need to involve innovative non-invasive techniques to preserve the existing architectural heritage, carrying out studies on both the structural and decorative elements of historic buildings (e.g., columns, capitals and other stone elements such as architraves or facade adornment). This is the case of the Palazzo Ducale, one of the main historic buildings in the town of Camerino (Central Italy) protected by the Superintendent for cultural heritage of Marche Region (peripheral body of the current MiBAC Ministero per i Beni e le Attività Culturali), where a multidisciplinary study on the sandstone columns was carried out for its restoration. In this regard, the use of Equotip hardness tester was proposed to implement a new approach for non-destructive evaluation of both the superficial and the internal hardness of the sandstone columns, useful to understand the rule that weathering plays on the mechanical rock properties (Mammoliti et al., 2021). In addition, a sedimentological study coupled with mineralogical-petrographic analyses (thin sections and XRD) were used to assess the extraction site of the sandstone columns, investigating an outcrop at the Botanical Garden of the city, just beneath the building of Palazzo Ducale. This aspect was essential to find a suitable site to extract rock samples for the Uniaxial Compressive test. In this way, the impossibility of using invasive techniques that could damage historical structures was overcome and a comparison of the mechanical properties was possible. Eventually, a conservative treatment on the surface was proposed and Equotip has been also tested to verify the effective improvement of rock hardness after the intervention

Defining a Non-Destructive In Situ Approach for the Determination of Historical Mortar Strength Using the Equotip Hardness Tester

The determination of mechanical parameters of historical mortars is a crucial aspect in the analysis of masonry in ancient buildings, especially for evaluating their quality and planning the appropriate restoration interventions. Due to conservation reasons, creating a comprehensive database is generally not possible because cutting out masonry specimens relates to damaging historical structures. This study starts with the need to characterize the mortar quality of different buildings in the town of Camerino (Central Italy) which has been strongly damaged by the 2016–2017 seismic sequence. A non-destructive collecting data strategy based on the use of the Equotip hardness tester (EQ) has been set up by evaluating the most appropriates impact strategy (single or repeated) and the range of measurements to calculate the basic statistics. The seismic damage suffered by the buildings allowed the rare opportunity to take samples from several walls and carry out laboratory tests to determine their Uniaxial Compressive Strength (UCS). The comparison between the results of the two types of tests made it possible to calibrate a relationship between the EQ values and the UCS. The Pearson’s coefficient of determination derived from an exponential interpolation (R2 = 0.81) confirmed a strong relationship between the EQ values derived from the tests on the specimens and the UCS. Moreover, comparing the in situ EQ measurements with the ones performed on the specimens prepared for the compressive tests, a general underestimation of the in situ EQ values has been observed, possibly due to the presence of a superficial alteration layer of the exposed mortar. From these results, we propose a correction of the in situ measurements able to obtain a more appropriate strength estimate of the historical mortars

Pleistocene slope, shallow-marine and continental deposits of eastern central Italy wedge-top basin: a record of sea-level changes and mountain building

This guidebook to Pleistocene sediments exposed in eastern central Italy has been prepared for the PRE-3 geological field trip accompanying the XXI INQUA Congress held in Rome, Italy, in July 2023. It is designed to provide an overview of the sedimentological features, stratigraphic architecture and basin evolutionary steps during the Pleistocene of the central portion of the Periadriatic basin (Central Periadriatic Basin), a N-S oriented foreland basin system associated to the Central Apennine Outer Orogenic Wedge. The Central Periadriatic Basin stretches along the Marche and Abruzzo regions and is an excellent example of an evolving mountain chain and associated deep-marine to fluvial-alluvial foredeep and wedge-top basin system. By integrating surface and subsurface datasets, this field trip affords a fine west to east transect through the Pleistocene basin-fill in southern Marche, where exposures allow a close examination of sedimentary facies and architecture of depositional systems. The basin fill succession includes coarse-grained submarine canyon-fills encased in slope mudstones, mixed beachface-shoreface conglomerates and sandstones, and alternating conglomerate and mudstone bodies interpreted as fluvial-channel and floodplain deposits, respectively. The analysis of facies architecture and discontinuity surfaces will allow the attendees to understand the relative role of sea-level changes, sediment supply, and thrust front propagation inside the foreland basins system as several factors controlling the stratigraphic record