Qualitative analysis of determinants of measles, mumps, rubella vaccine uptake in European parents

Background Parental concerns about measles, mumps and rubella (MMR) vaccination negatively influence decision to vaccinate their children, this leading to the recently reported vaccine coverage drop in Europe. The ESCULAPIO project, funded by the Italian National Centre for Disease Prevention and Control of the Ministry of Health (CCM), is investigating the main factors underlying decisions on vaccinations, in order to implement targeted campaigns and plan effective strategies. Methods A systematic literature review was carried out on studies describing the determinants underlying MMR vaccination uptake in European parents. Results A total of 45 studies were included in the analysis. The most common factors related with MMR vaccine uptake were knowledge, beliefs, perceptions on vaccines and diseases, reported in 44,4% of the articles. Parents showed doubts on vaccine efficacy, safety, side effects, while in other studies positive beliefs and perceptions were reported. Attitudes/ behaviours were often determinants of the uptake as well as demographic factors (40%). While higher no. of children in the household, lower income, temporary or lacking employment, and non-regular marital status were generally a barrier for vaccination, education level and house tenure were contradictory. Information source/advice and influence or trust of other people, institutions, media were often reported (31,1% and 17,8% respectively), but a clear direction was not showed. Conclusions These preliminary findings showed that communication strategies should provide parents with clear messages on vaccines and preventable infectious diseases, in order to build right knowledge and create correct beliefs and behaviours. Communication should be addressed mainly to more disadvantaged, larger and non-regular families. A quantitative analysis is been currently carrying out and will provide more information on the direction of the effect of the different factor

Lupus vasculitis: An overview

Lupus vasculitis (LV) is one of the secondary vasculitides occurring in the setting of systemic lupus erythematosus (SLE) in approximately 50% of patients. It is most commonly associated with small vessels, but medium-sized vessels can also be affected, whereas large vessel involvement is very rare. LV may involve different organ systems and present in a wide variety of clinical manifestations according to the size and site of the vessels involved. LV usually portends a poor prognosis, and a prompt diagnosis is fundamental for a good outcome. The spectrum of involvement ranges from a relatively mild disease affecting small vessels or a single organ to a multiorgan system disease with life-threatening manifestations, such as mesenteric vasculitis, pulmonary hemorrhage, or mononeuritis multiplex. Treatment depends upon the organs involved and the severity of the vasculitis process. In this review, we provide an overview of the different forms of LV, describing their clinical impact and focusing on the available treatment strategies

Valuation of ecological retrofitting technology in existing buildings: A real-world case study

The world’s existing buildings are aged, in a state of deterioration and in need of inter-ventions. When selecting the type of possible intervention to be applied, the choice falls between two alternatives: simple unsustainable ordinary maintenance versus ecological retrofitting i.e., an increase in the quality of the indoor environment and building energy saving using local bio-natural materials and products. The present research seeks to respond to the requests of recent comprehen-sive reviews which ask for the retrofitting of the world’s huge existing building stocks and portfolios by proposing an approach and testing it in a specific case study (at the unit, building and urban block level) which can then be carried out and repeated in the future on a larger urban scale. The real-world experimentation in the provided case study achieved the important outcome and goal of a Green Building strategy and post-carbon city framework i.e. the significant enhancement of the thermal performance of the buildings as a result of a few targeted key external works and the con-sequent saving of energy in those already existing (but not preserved and not included in the state national register or record of monuments) Liberty-style constructions. All the above show that these important existing buildings can be ecologically retrofitted at an affordable cost, although initially slightly more expensive than the cost of ordinary unsustainable maintenance. However, this difference is offset by the favorable pay-back period, which is fast, acceptable and of short duration. The tried and tested approach, the positive proposed case study and the experimental database-GIS joint platform (the details of which can be found in an additional supplementary research which is currently being carried out) are the bases on which a future decision support system will be proposed. This support system can be carried out as a tailor-made solution for the ecological retrofitting of the enormous existing building stocks and portfolios which must be considered on a larger scale i.e., at ward, quartier, city, regional and country level

Drug resistance in multiple myeloma: Soldiers and weapons in the bone marrow niche

Multiple myeloma (MM) is still an incurable disease, despite considerable improvements in treatment strategies, as resistance to most currently available agents is not uncommon. In this study, data on drug resistance in MM were analyzed and led to the following conclusions: resistance occurs via intrinsic and extrinsic mechanisms, including intraclonal heterogeneity, drug efflux pumps, alterations of drug targets, the inhibition of apoptosis, increased DNA repair and interactions with the bone marrow (BM) microenvironment, cell adhesion, and the release of soluble factors. Since MM involves the BM, interactions in the MM-BM microenvironment were examined as well, with a focus on the cross-talk between BM stromal cells (BMSCs), adipocytes, osteoclasts, osteoblasts, endothelial cells, and immune cells. Given the complex mechanisms that drive MM, next-generation treatment strategies that avoid drug resistance must target both the neoplastic clone and its non-malignant environment. Possible approaches based on recent evidence include: (i) proteasome and histone deacetylases inhibitors that not only target MM but also act on BMSCs and osteoclasts; (ii) novel peptide drug conjugates that target both the MM malignant clone and angiogenesis to unleash an effective anti-MM immune response. Finally, the role of cancer stem cells in MM is unknown but given their roles in the development of solid and hematological malignancies, cancer relapse, and drug resistance, their identification and description are of paramount importance for MM management

IFMIF suitability for evaluation of fusion functional materials

The International FusionMaterials Irradiation Facility (IFMIF) is a future neutron source based on the D-Li stripping reaction, planned to test candidate fusionmaterials at relevant fusion irradiation conditions. During the design of IFMIF special attention was paid to the structural materials for the blanket and first wall, because they will be exposed to the most severe irradiation conditions in a fusion reactor. Also the irradiation of candidate materials for solid breeder blankets is planned in the IFMIF reference design. This paper focuses on the assessment of the suitability of IFMIF irradiation conditions for testing functionalmaterials to be used in liquid blankets and diagnostics systems, since they are been also considered within IFMIF objectives. The study has been based on the analysis and comparison of the main expected irradiation parameters in IFMIF and DEMO reactor

ProNGF Is a Cell-Type-Specific Mitogen for Adult Hippocampal and for Induced Neural Stem Cells

The role of proNGF, the precursor of Nerve Growth Factor (NGF), on the biology of adult neural stem cells (aNSCs) is still unclear. Here I analyzed adult hippo-campal neurogenesis in AD11 transgenic mice, in which the constitutive expression of anti-NGF antibody leads to an imbalance of proNGF over mature NGF. I found in-creased proliferation of progenitors but a reduced neurogenesis in the AD11 DG- hippocampus (HP-DG). Also in vitro, AD11 hippocampal neural stem cells (NSCs) pro-liferated more but were unable to differentiate into morphologically mature neu-rons. By treating wild-type (WT) hippocampal progenitors with the uncleavable form of proNGF (proNGF-KR) I demonstrated that proNGF acts as mitogen on aNSCs at low concentration. The mitogenic effect of proNGF was specifically addressed to the radial glia-like (RGL) neural stem cells through the induction of cyclin D1 expression. These cells express high level of p75NTR, as demonstrated by immunofluorescence analyses performed ex vivo on RGL cells isolated from freshly-dissociated HP-DG or selected in vitro from NSCs by LIF (leukemia inhibitory factor). Clonogenic assay per-formed in the absence of mitogens showed that RGLs respond to proNGF-KR by re-activating their proliferation and thus leading to neurospheres formation. The mito-genic effect of proNGF was further exploited in the expansion of mouse induced Neural Stem Cells (iNSCs). Chronic exposure of iNSCs to proNGF-KR increased their proliferation. Altogether, I demonstrated that proNGF acts as mitogen on hippo-campal and induced neural stem cells.The role of proNGF, the precursor of nerve growth factor (NGF), in the biology of adult neural stem cells (aNSCs) is still unclear. Here, we analyzed adult hippocampal neurogenesis in AD11 transgenic mice, in which the constitutive expression of anti-NGF antibody leads to an imbalance of proNGF over mature NGF. We found increased proliferation of progenitors but a reduced neurogenesis in the AD11 dentate gyrus (DG)-hippocampus (HP). Also in vitro, AD11 hippocampal neural stem cells (NSCs) proliferated more, but were unable to differentiate into morphologically mature neurons. By treating wild-type hippocampal progenitors with the uncleavable form of proNGF (proNGF-KR), we demonstrated that proNGF acts as mitogen on aNSCs at low concentration. The mitogenic effect of proNGF was specifically addressed to the radial glia-like (RGL) stem cells through the induction of cyclin D1 expression. These cells express high levels of p75NTR, as demonstrated by immunofluorescence analyses performed ex vivo on RGL cells isolated from freshly dissociated HP-DG or selected in vitro from NSCs by leukemia inhibitory factor. Clonogenic assay performed in the absence of mitogens showed that RGLs respond to proNGF-KR by reactivating their proliferation and thus leading to neurospheres formation. The mitogenic effect of proNGF was further exploited in the expansion of mouse-induced neural stem cells (iNSCs). Chronic exposure of iNSCs to proNGF-KR increased their proliferation. Altogether, we demonstrated that proNGF acts as mitogen on hippocampal and iNSCs. Stem Cells 2019;37:1223–1237

Lower limb deep vein thrombosis in COVID-19 patients admitted to intermediate care respiratory units

COVID-19 has been associated with an increased risk of thrombotic events; however, the reported incidence of deep vein thrombosis varies depending, at least in part, on the severity of the disease. Aim of this prospective, multicenter, observational study was to investigate the incidence of lower limb deep vein thrombosis as assessed by compression ultrasound in consecutive patients admitted to three pulmonary medicine wards designated to care for patients with COVID-19 related pneumonia, with or without respiratory failure but not requiring admission to an intensive care unit. Consecutive patients admitted between March 27 and May 6, 2020 were enrolled. Patients were excluded if they were less than 18-year-old or if compression ultrasound could not be performed for any reason. Patients were assessed at admission (t0) and after 7 days (t1). Major and non-major clinically relevant bleedings were recorded. Sixty-eight patients were enrolled. Two were excluded due to anatomical abnormalities that prevented compression ultrasound; sixty patients were retested at (t1). All patients were started on antithrombotic prophylaxis, unless therapeutic anticoagulation was required. Deep vein thrombosis as assessed by compression ultrasound was observed in 2 patients (3%); one of them was later deemed to represent a previous episode. No new episodes were detected at t1. One major and 2 non-major clinically relevant bleedings were observed. In the setting of patients with COVID-related pneumonia not requiring admission to an intensive care unit, the incidence of deep vein thrombosis is low and our data support not screening asymptomatic patients

Exhaled nitric oxide in patients with PiZZ Phenotype-related α 1-anti-trypsin deficiency

AbstractThere is no report of exhaled NO (eNO) in subjects with different phenotypes ofα1 -anti-trypsin (AAT) deficiency.Exhaled nitric oxide was evaluated by means of single-breath chemiluminescence analysis (fractional exhaled concentration at the plateau level [plFENO]) in 40 patients with AAT deficiency. Patients were divided according to the protease inhibitor (Pi) phenotype: PiMZ/MS, n=25; PiSZ n=6; PiZZ, n=9. Nineteen healthy subjects served as controls. Levels of eNO in PiZZ patients were also compared with those of subjects, without AAT deficiency (PiMM), matched for diagnosis, sex, age, smoking habit and forced expiratory volume in 1 sec (FEV1). In AAT deficiency subjects airway hyper-responsiveness to methacholine (PD20FEV1) was also assessed.plFENOwas significantly lower in the PiZZ group (4·5±1·4 ppb) than in matched PiMM subjects (8·2±3·8 ppb), in healthy controls (9·3±2·8 ppb) and in patients of other phenotypes. Dynamic lung volumes and DLCOwere significantly lower in PiZZ than in other AAT-deficient patients. Bronchial hyper-responsiveness was not different among AAT phenotypes.These results suggest that eNO may be significantly reduced in PiZZ as compared to healthy control subjects and to AAT subjects with other phenotypes, independent of the level of airway obstruction. Whether, at least potentially, eNO may be considered as an early marker of lung involvement in AAT deficiency must be confirmed with studies on larger number of subjects

Antibiotics or no antibiotics, that is the question: An update on efficient and effective use of antibiotics in dental practice

The antimicrobial resistance (AMR) phenomenon is an emerging global problem and is induced by overuse and misuse of antibiotics in medical practice. In total, 10% of antibiotic prescriptions are from dentists, usually to manage oro-dental pains and avoid postsurgical complications. Recent research and clinical evaluations highlight new therapeutical approaches with a reduction in dosages and number of antibiotic prescriptions and recommend focusing on an accurate diagnosis and improvement of oral health before dental treatments and in patients’ daily lives. In this article, the most common clinical and operative situations in dental practice, such as endodontics, management of acute alveolar abscesses, extractive oral surgery, parodontology and implantology, are recognized and summarized, suggesting possible guidelines to reduce antibiotic prescription and consumption, maintaining high success rates and low complications rates. Additionally, the categories of patients requiring antibiotic administration for pre-existing conditions are recapitulated. To reduce AMR threat, it is important to establish protocols for treatment with antibiotics, to be used only in specific situations. Recent reviews demonstrate that, in dentistry, it is possible to minimize the use of antibiotics, thoroughly assessing patient’s conditions and type of intervention, thus improving their efficacy and reducing the adverse effects and enhancing the modern concept of personalized medicine