Season and altitude effects on milk fatty acid profile in Sarda dairy sheep flocks

Diet plays a major role in modulating the fatty acid composition of ruminant milk. It is also well known that the intake of fresh forages has a positive influence on polyunsaturated fatty acid (PUFA), particularly CLA and omega- 3, compared with diets based on dry forage and concentrates. Altitude influences, directly, grass availability and botanical composition of the pasture, and, indirectly, the amount of concentrate supplemented to the diet. Therefore, the altitude where farms are located at may give indirect information about the type of feeding system trough analysis of milk fat. The objective of this survey was to investigate variations in the milk fatty acid profile, focusing on the content of vaccenic acid (VA), conjugated linoleic acid (CLA) and n-3 fatty acid (FA), of Sarda dairy ewes flocks located at different altitudes throughout Sardinia. Bulk milk samples were collected in spring (April) and in summer (July) from 36 flocks located at different altitudes: 3 flocks in the lowlands (Low), 3 flocks in the hills (Hill) and 3 in the highlands (High) in 4 provinces (Sassari, Nuoro, Oristano and Cagliari) of Sardinia (Italy). Milk fatty acid profile was analyzed by gas-chromatography. Data were analyzed with a linear model with altitude (A), season (S), province (P) and altitude x season as fixed factors. The interaction was never significant. The season influenced significantly almost all fatty acids analyzed. The proportion of short chain FA (C4-C10) decrease (10.0 vs 7.0 mg/100 mg FA; P<0.01) and that of medium chain FA increase (43.2 vs 45.5 mg/100 mg FA; P<0.10) from spring to summer. The long chain FA did not vary between spring and summer but the concentration of oleic acid (C18:1 cis9) increased significantly from spring to summer (22.3 vs 25.1 mg/100 mg FA; P<0.01). The proportion of n-3 FA was higher in spring than summer (1.2 vs 0.7 for n- 3 FA; P<0.01). The variation in n-3 FA in milk fat was mainly due to the variation in a-linolenic acid (ALA; 18:3n- 3) which decrease from 1.0 to 0.5 mg/100 mg FA from spring to summer. The same pattern was showed by vaccenic acid (VA; trans-11 18:1) that decrease from 1.6 vs 0.8 mg/100 mg FA. No variation in cis9, trans11 CLA has been observed between spring and summer (1.0 vs 0.8 mg/100 mg FA). A reduction of PUFA (5.64 vs 5.10; P<0.10), n3/n6 ratio (0.38 vs 0.21) and content of C20:5 n-3 (0.13 vs 0.07 mg/100 mg FA) from spring to summer has been observed. Unexpectedly, the milk FA profile was not affected by altitude, except for C18:1 c9, probably because of the low number of samples analyzed

Willingness to pay for one-stop anesthesia in pediatric day surgery

<p>Abstract</p> <p>Background</p> <p>This study assesses the parents' Willingness To Pay (WTP) for One Stop Anesthesia (OSA). OSA is part of a free screening procedure that determines the timing of the anesthesiological assessment. In OSA-positive patients, the preoperative assessment is carried out on the same day as the surgery. The OSA allows patients who have to undergo surgery in a pediatric day surgery to avoid accessing the pre-admission clinic.</p> <p>Method</p> <p>This is a descriptive cohort study. A sample of 106 parents were interviewed directly by means of a questionnaire. The questionnaire builds a hypothetical scenario where the interviewee has a chance to buy the OSA health service with the WTP. The WTP values are distributed in classes and are contingent to the market built in the questionnaire. The Chi Square and Cramer's V tests evaluate the WTP dependence on the parents' place of origin and occupation.</p> <p>Results</p> <p>The approximate average of the WTP classes is €87.21 per family. The Chi Square test relative to the WTP classes and the places of origin is statistically significant (p < 0.05). The Cramer's V test is 0.347 and points to a positive association between the two demographics. The Cramer's V test of the WTP classes and the types of job is 0.339 and indicates a positive association.</p> <p>Conclusion</p> <p>Nearly 90% of pediatric patients who were screened for timing the preoperative assessment are true positives to OSA. This allows doing away with the pre-hospitalization, with definite advantages for the families. This screening is a health service that families would be hypothetically willing to pay.</p

PCR-based methods to discriminate Bacillus thuringiensis strains

Bacillus thuringiensis is a Gram positive bacterium that is used for the production of biopesticides. The toxic action of different strains and serovars ofB. thuringiensis can be extremely selective towards specific pests, or, in contrast, it can affect a wide variety of non-target organisms such as insects, vertebrates or humans. A reliable characterization of the cultivated strains is of primary importance for the biopesticide industry, in order to assess the contamination of the final product with strains with different pesticide actions or that might be dangerous for human health. The aim of this study was to develop useful methods for the typing of differentB. thuringiensis strains using two PCR-based methods, RAPD and Rep-PCR with BOXA1R and ERIC2 primers. The molecular fingerprints obtained using ERIC2-PCR showed a reliable ability to discriminateBacillus thuringiensis strains

optimizing patient referral and center capacity in the management of chronic hepatitis c lessons from the italian experience

Abstract Aims In 2017 the Italian Drug Agency (Agenzia Italiana del Farmaco, AIFA) revised the criteria for access to therapy for patients with chronic hepatitis C as part of a three-year plan to eradicate HCV. We conducted a Delphi study to determine strategies to identify and treat patients with HCV and to develop through a shared pathway, a model to manage patient referral and optimize prescription center capacity with the overall aim of increasing access to therapy. Methods The process took place in two phases – Phase I (January 2017), before the criteria for treatment of HCV were revised and Phase II (May 2017) when AIFA developed a framework for the eradication of HCV infection in Italy. Two questionnaires were devised with Q1 administered in Phase I and Q2 in Phase II. Results Q1 was sent to 823 hepatitis specialists working in 235 Italian HCV centers authorized to prescribe direct-acting antiviral drugs (DAAs). Overall, 167 centers (71%) participated with a good geographical representativeness (North 69%, Centre 74%; South and islands 70%). 548 prescribers (68.8%) provided responses to Q1 and 443 (80%) specialists who responded to Q1 completed Q2. Over 70% considered that to meet the new therapy targets local/regional networks need to be consolidated and reinforced with GPs providing the 'missing link' in current regional networks. Adherence to therapy was considered important by 75% of clinicians with reduction in follow-up intervals/length considered important by 65% – to free up staff/resources to manage increasing numbers of new patients. About 80% of respondents stated that medical personnel were principally involved in follow-up with follow-up having a significant impact on center capacity. Conclusion Enhancing patient referral, the need for an increased role of GPs, increasing center capacity in particular medical personnel in outpatient centers and greater liaison between Hub centers and healthcare professionals currently managing high-risk groups as yet untreated, were factors that need to be streamlined in order to meet treatment targets for eradication of HCV

Tissue expression of Squamous Cellular Carcinoma Antigen (SCCA) is inversely correlated to tumor size in HCC

<p>Abstract</p> <p>Background</p> <p>This study aimed to investigate squamous cellular carcinoma antigen (SCCA) in serum and in tumoral and paired peritumoral tissues. We studied 27 patients with liver cirrhosis (LC) and 55 with HCC: 20 with a single nodule < 3 cm (s-HCC) and 35 with a single nodule > 3 cm or multifocal (l-HCC).</p> <p>Methods</p> <p>Serum SCCA was measured by the ELISA kit, and in frozen tissues by immunohistochemistry, quantified with appropriate imaging analysis software and expressed in square microns. Continuous variables are reported as means and 95% confidence intervals. Comparisons between independent groups were performed with a generalized linear model and Tukey grouping. Pearson's correlation coefficients were determined to evaluate relations between markers. Qualitative variables were summarized as count and percentage. Statistical significance was set at p-value < 0.05.</p> <p>Results</p> <p>Serum SCCA values in LC patients were 0.41 (0.31–0.55) ng/ml and statistically different from both HCC groups: 1.6 (1.0–2.6) ng/ml in s-HCC, 2.2 (1.28–2.74) ng/ml in l-HCC. SCCA in hepatic tissue was 263.8 (176.6–394.01) μm²in LC patients, statistically different from values in s-HCC: 1163.2 (863.6–1566.8) μm²and l-HCC: 625.8 (534.5–732.6). All pairwise comparisons between groups yielded statistically significant differences. Tumoral SCCA resulted linearly related with nodule size, showing a statistically significant inverse relation between the two variables (b = -0.099, p = 0.024).</p> <p>Conclusion</p> <p>There was no statistically significant correlation between tissue and serum levels of SCCA. The significantly stronger expression of SCCA in smaller compared to larger HCC could be important for early HCC detection. However, the increased expression in peritumoral tissue could affect the significance of serological detection.</p

Microbiologia e valutazione igienico-sanitaria della salsiccia sarda

In this study we evaluated the microbiological status of the Salsiccia sarda with special emphasis on the microbial indicators of the hygienic and sanitary conditions. Moreover, the evolution of the autochthonous microflora has been monitored during the entire production process. For these aims, microbiological analyses were carried out on different samples of minced meat and sausages at different ripening times. Despite the results showed some critical points in the hygienic and sanitary conditions, substantiated by a significant presence of Escherichia coli, Salmonella and Listeria spp. were not found in any sample. The dominant microflora of Salsiccia sarda was composed by Lactobacillus curvatus, L. plantarum, Staphylococcus xylosus and Debaryomyces hansenii. The knowledge of the microbial ecology of this typical sardinian food-stuff is a significant baseline for the development of autochthonous starter cultures to be employed in the production process. The use of such cultures may allow a better management of the process and guarantee suitable qualitative traits of this traditional ripened sausage. Nel presente lavoro sono stati valutati i microrganismi di interesse igienico-sanitario e l'evoluzione della microflora della Salsiccia sarda. Prelievi e analisi microbiologiche sono stati effettuati sulla carne macinata e sulla salsiccia a tempi diversi di maturazione. I risultati hanno mostrato che, nonostante le criticità inerenti le condizioni igienico-sanitarie rilevate in alcune fasi tecnologiche e confermate dalla presenza di Escherichia coli, non sono stati ritrovati batteri ascrivibili ai generi Salmonella e Listeria. Le specie microbiche risultate predominanti sono state Lactobacillus curvatus, L. plantarum, Staphylococcus xylosus e Debaryomyces hansenii. La conoscenza dell'ecologia microbica di questo prodotto tipico costituisce un punto di partenza per la messa a punto di colture starter autoctone da impiegare nei processi di trasformazione. L'utilizzo di tali colture consentirebbe una migliore gestione del processo garantendo adeguati standard qualitativi ad un prodotto tradizionale come la Salsiccia sarda

Selection of folate-producing lactic acid bacteria for improving fermented goat milk

Goat milk is a complete food but its low level of folic acid diminisches its nutritional efficacy. In this study, Streptococcus thermophilus, Lactobacillus delbrueckii subsp. bulgaricus, Lb. delbrueckii subsp. lactis and Lb. helveticus strains were selected for folate production in goat milk to improve its quality. A suitable HPLC method was developed to directly determine both total folate and its biologically active derivatives such as 5-methyl-tetrahydrofolate (5- CH3-H4-PteGlu), tetrahydrofolate (H4-PteGlu) and 5 formyl-tetrahydrofolate (5-CHO-H4-PteGlu). Results showed that S. thermophilus, Lb. delbrueckii subsp. lactis and Lb. helveticus strains produced higher amounts of total folate than Lb. delbrueckii subsp. bulgaricus, especially 5-CH3-H4-PteGlu and H4-PteGlu. Moreover the use of selected S. thermophilus strains in association with Lb. delbrueckii subsp. bulgaricus resulted in yoghurt with a significant quantity of folate and good organoleptic features

Effectiveness of a Hospital-Based Computerized Decision Support System on Clinician Recommendations and Patient Outcomes: A Randomized Clinical Trial.

IMPORTANCE: Sophisticated evidence-based information resources can filter medical evidence from the literature, integrate it into electronic health records, and generate recommendations tailored to individual patients. OBJECTIVE: To assess the effectiveness of a computerized clinical decision support system (CDSS) that preappraises evidence and provides health professionals with actionable, patient-specific recommendations at the point of care. DESIGN, SETTING, AND PARTICIPANTS: Open-label, parallel-group, randomized clinical trial among internal medicine wards of a large Italian general hospital. All analyses in this randomized clinical trial followed the intent-to-treat principle. Between November 1, 2015, and December 31, 2016, patients were randomly assigned to the intervention group, in which CDSS-generated reminders were displayed to physicians, or to the control group, in which reminders were generated but not shown. Data were analyzed between February 1 and July 31, 2018. INTERVENTIONS: Evidence-Based Medicine Electronic Decision Support (EBMEDS), a commercial CDSS covering a wide array of health conditions across specialties, was integrated into the hospital electronic health records to generate patient-specific recommendations. MAIN OUTCOMES AND MEASURES: The primary outcome was the resolution rate, the rate at which medical problems identified and alerted by the CDSS were addressed by a change in practice. Secondary outcomes included the length of hospital stay and in-hospital all-cause mortality. RESULTS: In this randomized clinical trial, 20 563 patients were admitted to the hospital. Of these, 6480 (31.5%) were admitted to the internal medicine wards (study population) and randomized (3242 to CDSS and 3238 to control). The mean (SD) age of patients was 70.5 (17.3) years, and 54.5% were men. In total, 28 394 reminders were generated throughout the course of the trial (median, 3 reminders per patient per hospital stay; interquartile range [IQR], 1-6). These messages led to a change in practice in approximately 4 of 100 patients. The resolution rate was 38.0% (95% CI, 37.2%-38.8%) in the intervention group and 33.7% (95% CI, 32.9%-34.4%) in the control group, corresponding to an odds ratio of 1.21 (95% CI, 1.11-1.32; P < .001). The length of hospital stay did not differ between the groups, with a median time of 8 days (IQR, 5-13 days) for the intervention group and a median time of 8 days (IQR, 5-14 days) for the control group (P = .36). In-hospital all-cause mortality also did not differ between groups (odds ratio, 0.95; 95% CI, 0.77-1.17; P = .59). Alert fatigue did not differ between early and late study periods. CONCLUSIONS AND RELEVANCE: An international commercial CDSS intervention marginally influenced routine practice in a general hospital, although the change did not statistically significantly affect patient outcomes. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT02577198

Linee guida per la redazione del progetto di fattibilità tecnica ed economica da porre a base dell’affidamento di contratti pubblici di lavori del PNRR e del PNC (Art. 48, comma 7, del decreto-legge 31 maggio 2021, n. 77, convertito nella legge 29 luglio 2021, n. 108)

Nel quadro dell’innovazione normativa e procedurale introdotta dal PNRR e dal decreto-legge 31 maggio 2021, n. 77, le Linee Guida sono volte a definire il contenuto essenziale dei documenti, degli eventuali modelli informativi digitali e degli elaborati occorrenti alle Stazioni Appaltanti per l’affidamento sulla base del Progetto di Fattibilità Tecnico-Economica - PFTE, secondo quanto stabilito dall’art. 48, comma 7

The Italian Rare Pancreatic Exocrine Cancer Initiative

INTRODUCTION: Exocrine pancreatic cancers include common type pancreatic ductal adenocarcinoma and cystic neoplasms, which account for 85% and 10% of cases, respectively. The remaining 5% are rare histotypes, comprising adenosquamous carcinoma, acinar cell carcinoma, signet ring cell carcinoma, medullary carcinoma, pancreatoblastoma, hepatoid carcinoma, undifferentiated carcinoma and its variant with osteoclast-like giant cells, solid pseudopapillary carcinoma, and carcinosarcoma. Due to their low incidence, little knowledge is available on their clinical and molecular features as well as on treatment choices. The national initiative presented here aims at the molecular characterization of series of rare histotypes for which therapeutic and follow-up data are available. METHODS: A nationwide Italian Rare Pancreatic Cancer (IRaPaCa) task force whose first initiative is a multicentric retrospective study involving 21 Italian cancer centers to retrieve histologic material and clinical and treatment data of at least 100 patients with rare exocrine pancreatic cancers has been created. After histologic revision by a panel of expert pathologists, DNA and RNA from paraffin tissues will be investigated by next-generation sequencing using molecular pathway-oriented and immune-oriented mutational and expression profiling panels constructed availing of the information from the International Cancer Genome Consortium. Bioinformatic analysis of data will drive validation studies by immunohistochemistry and in situ hybridization, as well as nanostring assays. CONCLUSIONS: We expect to gather novel data on rare pancreatic cancer types that will be useful to inform the design of therapeutic choices