BNT162B2 mRNA COVID-19 vaccine in heart and lung transplanted young adults: is an alternative SARS-CoV-2 immune response surveillance needed?

[no abstract available

Analisi diacronica della linea di riva del litorale agrigentino (San Leone)

Nello spazio costiero interagiscono le componenti suolo, atmosfera e mare tramite processi che unificano i domini terrestre e marino. Tali attività si svolgono con un continuo adeguamento al ciclo delle stagioni e al ripetersi dei fenomeni fisici. Per questo si parla di "equilibrio dinamico" delle coste, che dipende da un complesso di fattori naturali e antropici. Le spiagge come tutti i sistemi costieri, vivono un equilibrio dinamico nel quale gli arretramenti o gli avanzamenti della linea di riva, anche di qualche decina di metri, possono avvenire a scale temporali differenti. In questo studio sono stati analizzati i fenomeni fisici legati all'erosione costiera, considerando in una spiaggia a debole pendenza del mediterraneo. La spiaggia di San Leone ha un'estensione di circa 5,5 km, in direzione NO-SE e costituisce una località turistica molto rinomata nell'isola. Nel tempo ha subito una forte pressione antropica, che in qualche caso ha obliterato le antiche morfologie della costa. Per analizzare la spiaggia di San Leone è stato applicato un metodo interdisciplinare che ha analizzato la costa integrando diverse tecniche di differenti discipline. Dopo un inquadramento generale sulla morfologia costiera e stato condotto studio idraulico-marittimo volto a stimare gli effetti che hanno l'azione del moto ondoso e delle maree sulla posizione della linea di riva. Infatti quest'ultima viene solitamente identificata attraverso l’uso di immagini aeree e/o satellitari e utilizzata per la ricostruzione dell’evoluzione storica dei litorali. Tuttavia, le informazioni estratte da tali immagini, permettono l’individuazione della linea di riva solo come limite asciutto/bagnato presente al momento della ripresa. Lo studio geomorfologico e idraulico-marittimo integrati tra loro hanno permesso l'identificazione delle incertezze legate alla posizione della linea di riva. Note tali incertezze, attraverso l'uso di un metodo statistico, è stata delineata l'evoluzione storica del litorale e quindi ricostruiti anche gli effetti dovuti all'azione antropica. A tale analisi e seguito l'avvio di un monitoraggio per il controllo dei processi morfodinamici sia a lungo termine sia a breve termine. Il sistema di video- sorveglianza implementato permetterà di: a) valutare i processi morfodinamici con maggior risoluzione spaziale, b) avere un'acquisizione dei dati "in continuo", e c) ridurre gli errori interpretativi

Evoluzione della linea di riva: un approccio idraulico per il caso studio della spiaggia di Lido Signorino (Marsala)

L’evoluzione della linea di riva, limite tra terra e mare, è causata dall’interazione fra l’energia del moto ondoso e l’assorbimento di questa da parte della spiaggia. Il moto ondoso e le correnti che evolvono lungo il litorale, e in particolare il frangimento e la risalita delle onde sulla spiaggia, hanno un ruolo determinante nei processi fisici costieri più rilevanti. L'obiettivo di questo studio è stato quello di analizzare le variazioni della posizione della linea di riva di una spiaggia, dissipativa e a debole pendenza localizzata nella costa occidentale siciliana. Tale spiaggia, con un’estensione N-S di circa 3,5 km, ricade a sud della città di Marsala, tra due promontori sui quali si trovano due torri di avvistamento del XVI sec., in particolare Torre Tunna e Torre Sibilliana. Lo studio si è basato sull'analisi e il georiferimento di immagini aeree e satellitari con le quali sono stati ricostruiti fotomosaici dell'intera area in studio, ciascuno dei quali, corrisponde ad un diverso anno di osservazione. La linea di riva è stata riconosciuta e mappata, attraverso l'identificazione del limite asciutto/bagnato (linea di massimo run-up) e solo dopo tale operazione è stato possibile ricostruire l'evoluzione storica del litorale, in termini di arretramenti e avanzamenti annuali, applicando il metodo statistico della U.S. Geological Survay. Tale metodo oltre a tenere conto delle incertezze sulla posizione della linea di riva, dovute all'analisi delle immagini, considera anche le incertezze relative all'azione del moto ondoso e delle maree. Quindi al fine di conoscere queste incertezze, è stato svolto uno studio idraulico-marittimo. Partendo dai parametri d'onda registrati dalla vicina boa di Mazara del Vallo, sono state propagate le onde (modello spettrale SWAN) da largo a sotto costa e una volta note le caratteristiche dell'onda in acque basse è stato calcolato il run-up attraverso un modello alla Boussinesq. Infine, l’analisi delle misure mareali registrate in un porto vicino alla spiaggia in studio (Porto Empedocle), ha permesso, la stima delle incertezze dovute alle fluttuazioni di marea. L'analisi idraulica-marittima integrata al metodo statistico, ha permesso di stimare incertezze della posizione della linea di riva tra 1,9 m e 8,6 m. Comunque lo studio ha messo in luce che il bilancio sedimenti della spiaggia è praticamente invariato, e la superficie totale di costa in accrescimento è leggermente più grande dell'area in arretramento

C-reactive protein in water leakage from gas exhaust of polypropylene oxygenators

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Results of a study on high-sensitivity cardiac troponin I in a stable hemodialysis patient population

Although cardiac troponin (cTn) assay is highly specific for myocardial injury, an elevated cTn level above the 99th percentile can be found in extra-cardiac diseases, such as Chronic Kidney Disease (CKD). The aim of the present study is to quantify hs-cTnI (high sensitivity cardiac troponin I) level in Hemodialysis (HD) patients, in order to define its basal value and to identify predictive factors associated with increased hs-cTnI levels after HD. Methods. 55 stable HD patients followed for at least 3 months at “Città di Lecce Hospital” and without cancer disease were studied. Troponin was determined before and after HD (pre/post HD) by VIDAS bioMérieux cTnI assay, based on ELFA method. Statistical analysis of pre/post HD values was conducted by permutation test based on Student’s t-test. The pre/post HD 99th percentiles of the population were determined by 3 methods according to CLSI C28-A3 and compared to the 99th percentile of healthy population (19 ng/L) in order to identify predictive factors for the cTnI increase by logistic binary regression. Differences were considered statistically significant at p < 0.05. Results. Values above the 99th percentile were found in 17 pre-HD patients (31%) and in 18 post-HD patients (33%). Differences between pre/post HD values were not statistically significant (p=0.218). The 99th percentiles pre-HD (104.05 ng/L) and post-HD (116.78 ng/L) were both statistically significant (p < 0.001), when compared with the 99th percentile of healthy population. Among predictive factors associated with increased hs-cTnI levels in HD patients (age, sex, diabetes, hypertension, hypercholesterolemia, smoking, BMI, previous cardiac diseases, creatininemia, e-GFR, CRP, hemoglobin and albumin levels), a weak but significant correlation was found in pre-HD as well as in post-HD only for male sex (p = 0.047; p = 0.049) and hypercholesterolemia (p = 0.040; p = 0.048). Conclusions. Our study demonstrates that, by using VIDAS cTnI assay, the pre/post HD 99th percentiles of stable HD patients are higher than the cTn values of healthy population and that the cTnI values are not significantly modified by HD treatment. Moreover, our data confirm the Fourth Universal Definition of Myocardial Infarction approach for the evaluation of ischemic damage during HD, based on a pre/post HD comparison of cTn values rather than on the increase above a pre-determined 99° percentile. Weak predictive factors of a cTnI increase are male sex and hypercholesterolemia

Assessment of malnutrition in community-dwelling elderly people: Cooperation among general practitioners and public health

Background: Malnutrition, a very common condition in the elderly, is known to increase their vulnerability to adverse health events. This study aimed to estimate the prevalence of malnutrition in the over 75-yr-old community-dwelling population in the “Chiavarese” Local Health Unit district (North West Italy). Methods: The short version of the Mini Nutritional Assessment (MNA-SF) was used by General Practitioners (GP) as a screening tool to investigate the nutritional status of elderly people (1039 subjects). The study was conducted in 2012- 2013 in the Local Health Unit of Chiavari (Liguria Region), Italy. The malnutrition was subsequently confirmed by means of biochemical parameters. Subjects at risk of malnutrition or malnourished (n=22) received personalized dietary counseling by the GP. Results: The MNA-SF recognized 21% of the elderly people being at risk of malnutrition and biochemical tests confirmed a malnutrition prevalence of 3.5%. The dietary counseling improved the MNA-SF score and biochemical parameters, but the difference was statistically significant only for the MNA-SF score (P=0.00613). Conclusion: Malnutrition can be evaluated with a simple tool such as the MNA-SF, recognized at the earliest stage and successfully treated by the GP

Humoral and cellular response following vaccination with the BNT162b2 mRNA COVID-19 vaccine in patients affected by primary immunodeficiencies

Mass SARS-Cov-2 vaccination campaign represents the only strategy to defeat the global pandemic we are facing. Immunocompromised patients represent a vulnerable population at high risk of developing severe COVID-19 and thus should be prioritized in the vaccination programs and in the study of the vaccine efficacy. Nevertheless, most data on efficacy and safety of the available vaccines derive from trials conducted on healthy individuals; hence, studies on immunogenicity of SARS-CoV2 vaccines in such populations are deeply needed. Here, we perform an observational longitudinal study analyzing the humoral and cellular response following the BNT162b2 mRNA COVID-19 vaccine in a cohort of patients affected by inborn errors of immunity (IEI) compared to healthy controls (HC). We show that both IEI and HC groups experienced a significant increase in anti-SARS-CoV-2 Abs 1 week after the second scheduled dose as well as an overall statistically significant expansion of the Ag-specific CD4+CD40L+ T cells in both HC and IEI. Five IEI patients did not develop any specific CD4+CD40L+ T cellular response, with one of these patients unable to also mount any humoral response. These data raise immunologic concerns about using Ab response as a sole metric of protective immunity following vaccination for SARS-CoV-2. Taken together, these findings suggest that evaluation of vaccine-induced immunity in this subpopulation should also include quantification of Ag-specific T cells

Evaluation of the cardiovascular risk in patients undergoing major non-cardiac surgery: role of cardiac-specific biomarkers. A consensus document by the Inter-Society Study Group on Cardiac Biomarkers of the Italian Societies of Clinical Biochemistry: European Ligand Assay Society (ELAS), Italian section; Societa Italiana di Biochimica Clinica e Biologia Molecolare Clinica (SIBioC); Societa Italiana di Patologia Clinica e Medicina di Laboratorio (SIPMel)

Major adverse cardiovascular events are frequently observed in patients undergoing major non-cardiac surgery during the peri-operative period. At this time, the possibility to predict cardiovascular events remains limited, despite the introduction of several algorithms to calculate the risk of adverse events, mainly death and major adverse cardiovascular events (MACE) based on the clinical history, risk factors (sex, age, lipid profile, serum creatinine) and non-invasive cardiac exams (electrocardiogram, echocardiogram, stress tests). The cardiac-specific biomarkers natriuretic peptides (NPs) and cardiac troponins (cTn) have been proposed as additional tools for risk prediction in the peri-operative period, particularly for the identification of myocardial injury in patients undergoing major non-cardiac surgery. The prognostic information from the measurement of BNP/NT-proBNP and hs-cTn is independent and complementary to other important indicators of risk, also including ECG and imaging techniques. Elevated levels of cardiac-specific biomarkers before surgery are associated with a markedly higher risk of MACE during the peri-operative period. BNP/NT-proBNP and hs-cTn should be measured in all patients during the clinical evaluation before surgery, particularly during intermediate- or high-risk surgery, in patients aged &gt;65 years and/or with comorbidities. Several questions remain to be assessed in dedicated clinical studies, such as how to optimize the management of patients with raised cardiac specific biomarkers before surgery, and whether a strategy based on biomarker measurement improves patient outcomes and is cost-effective

Hs-ctn Poct:state-of-art and clinical-organizational perspectives

The rationale for the Point-of-care testing (POCT) of troponin (cTn) lies in the reduction of the Turnaround Time (TAT) and therefore of the length-of-stay (LOS) in the Emergency Department (ED), and in the diagnosis of heart injury in isolated areas. However, cTn POCTs are less sensitive and not comparable with laboratory methods (LAB). Their data cannot be used in the troponin curve with the LAB method and the rise and fall curve with POCT must be followed for more than 6 hours. Furthermore, there are few primary evidence and no meta-analyses on the role of cTn POCTs. Nevertheless, POCTs with hs-cTn (high-sensitivity troponin) method have recently appeared on the market and can overcome the above-described issues: PATHFAST hs-cTn, Quiedel/Alere TriageTrue, Atellica VTLi Patient-side. The Review describes the data and evidence of these devices, evaluating their adequacy for the diagnostic objectives, and their perspectives

Regret affects the choice between neoadjuvant therapy and upfront surgery for potentially resectable pancreatic cancer

Background: When treating potentially resectable pancreatic adenocarcinoma, therapeutic decisions are left to the sensibility of treating clinicians who, faced with a decision that post hoc can be proven wrong, may feel a sense of regret that they want to avoid. A regret-based decision model was applied to evaluate attitudes toward neoadjuvant therapy versus upfront surgery for potentially resectable pancreatic adenocarcinoma. Methods: Three clinical scenarios describing high-, intermediate-, and low-risk disease-specific mortality after upfront surgery were presented to 60 respondents (20 oncologists, 20 gastroenterologists, and 20 surgeons). Respondents were asked to report their regret of omission and commission regarding neoadjuvant chemotherapy on a scale between 0 (no regret) and 100 (maximum regret). The threshold model and a multilevel mixed regression were applied to analyze respondents' attitudes toward neoadjuvant therapy. Results: The lowest regret of omission was elicited in the low-risk scenario, and the highest regret in the high-risk scenario (P &lt; .001). The regret of the commission was diametrically opposite to the regret of omission (P ≤ .001). The disease-specific threshold mortality at which upfront surgery is favored over the neoadjuvant therapy progressively decreased from the low-risk to the high-risk scenarios (P ≤ .001). The nonsurgeons working in or with lower surgical volume centers (P&nbsp;= .010) and surgeons (P&nbsp;= .018) accepted higher disease-specific mortality after upfront surgery, which resulted in the lower likelihood of adopting neoadjuvant therapy. Conclusion: Regret drives decision making in the management of pancreatic adenocarcinoma. Being a surgeon or a specialist working in surgical centers with lower patient volumes reduces the likelihood of recommending neoadjuvant therapy