Pregnancy after liver transplantation: a case series and review of the literature

Objective: To evaluate maternal and perinatal outcomes in pregnant women after liver transplantation with a case series and literature systematic review. Methods: This was a single-center case-series study performed at University of Naples Federico II. All consecutive women with liver transplantation who reported pregnancy at our institution were included in a dedicated database. In addition, a systematic literature review was performed, including case series, population-based studies, and national registries, including maternal and perinatal outcomes of pregnant women with liver transplant. Studies with fewer than 10 cases and surveys were excluded. The primary outcome was perinatal death, defined as either stillbirth (defined as intrauterine fetal death after 20 weeks of gestation) or neonatal death (death of a live-born infant within the first 28 d of life). Results: During the study period, two women who underwent liver transplantation had a pregnancy in our Institution. Both of them underwent liver transplantation for biliary atresia at 1 year of age. One of them received cyclosporin as immunosuppressive regime during pregnancy, while the other one received tacrolimus. Both of them had a pregnancy with no major complications and delivered by cesarean section at term a baby with normal weight. One of them developed thrombocytopenia. Seventeen articles were included in this systematic review. Preterm birth at less than 37 weeks of gestations occurred in 279 women (33.6%). One-hundred women (14.9%) experienced preeclampsia, and 206 women (49.2%) delivered by cesarean delivery. Graft rejection related to pregnancy occurred in 73 women (8.3%). 117 women (12.9%) experienced miscarriage, and 22 (2.3%) IUFD. Fifty-two women (9.52%) underwent elective I-TOP. 195 fetuses (33.4%) were LBW. Eight neonatal deaths were recorded (1.3%). Conclusion: The maternal and perinatal outcome is usually favorable, but with an increased risk of preeclampsia, preterm birth, and perinatal morbidity and mortality. However, appropriate counseling about risks and complications is essential but women shouldn't be advised against pregnancy

Six-DOF Impedance Control of Dual-Arm Cooperative Manipulators

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Sequential development of large B cell lymphoma in a patient with peripheral T-cell lymphoma.

Lymphomas of different histologic type can occur in the same patient. Two types of lymphomas can be diagnosed in the same lymph node (composite lymphoma) or in different sites. In the latter case, terms as simultaneous and sequential have been proposed to define the detection of two lymphomas at the same time or at different times, respectively

Results of five years monitoring for Toxoplasma gondii infection in animals by the official Italian Zoonoses Informative System (SINZOO)

In order to drive effective public health preventive measures for human toxoplasmosis a scrupulous epidemiological monitoring of animal toxoplasmosis is essential. BACKGROUND AND AIM:T. gondii is the fourth most important parasite in the world and second out of 14 foodborne pathogens in the USA and in Europe. Meat-borne transmission of T. gondii causes most of food-borne infections in Europe (EFSA-European Food Safety Authority). SINZOO is part of the Veterinary Informative System of the Italian Ministry of Health. It collects and transmit data to EFSA, published in the annual EFSA/ECDC summary reports on zoonoses. The aim of this study was to evaluate the effectiveness of SINZOO for epidemiological surveillance of toxoplasmosis in Italy. METHODS:Among animal species tested in Italy between 2015 and 2019 the ones most commonly reared for human consumption (sheep, cattle, pig, goats) were selected, moreover wild boars, wild ruminants, cats. RESULTS:Infection rates ranged from 0.73% in wild boars to 45.72% in sheep. Total number of tested animals ranged from 37 pigs in 2015 to 3449 sheep in 2018. Besides a relevant incidence among wild boars in 2018 (45%) and 2019 (32%), higher infection rates were more often reported among sheep and pigs. Between 2018 and 2019 67% of the overall analyses were carried out in one region (Sardinia), mostly on one species (sheep) and emerged from targeted research or clinical investigation. In fact in 2019 83.45% of analyses were performed following clinical suspicions while only 8.43% came from official controls, highlighting toxoplasmosis underestimation by the national veterinary health system. CONCLUSIONS:Despite EFSA recognizes the relevance of toxoplasmosis, this is not included among zoonoses under mandatory notification, making animal epidemiological surveillance rather scarce and uneven. Data reported to SINZOO suggest that T. gondii is still a relevant hazard to monitor by meat inspection and in-farm survey, for effective epidemiological evaluations and appropriate public health interventions. This issue characterizes Italy and Europe, highlighting that toxoplasmosis monitoring should be made mandatory and with uniform rules

Toxoplasma gondii in animals and food: results of four-years monitoring by the official italian zoonoses informative system.

When considering human toxoplasmosis, food remains the main source of infection. Whether is meat from susceptible animals that naturally harbour Toxoplasma gondii tissue cysts or food like fresh vegetables or fishery products (mussels, fish) contaminated by environmentally derived oocysts, information about animal toxoplasmosis prevalence should continue to be under the spotlight. Directive 2003/99/EC of the European Parliament and the Council classifies toxoplasmosis and its causative agent as a class B zoonosis/agent for which monitoring depends on the epidemiological situation. Surveillance systems on animal toxoplasmosis are different across Europe and regulated by national legislation. In Italy, administrative regions are called annually to submit data on animal toxoplasmosis to SINZOO (Zoonoses Informative System) that is part of the Veterinary Informative System managed by the Italian Ministry of Health. Foodborne zoonoses data collected at the national level are then processed and summarized by EFSA to became part of the annual EFSA/ECDC joint European Union summary reports on trends and sources of zoonoses, zoonotic agents and foodborne outbreaks. No foodborne outbreaks of toxoplasmosis have been reported in Italy during 2017, the most recent year for which a report is available. Unfortunately, prevalence data are often the results of fragmented researches or clinical investigations but, nevertheless, they provide baseline data to monitor epidemiological trends for guiding public health preventive measures. Over the past four years (2014-2017), in Italy, sheep, cattle, pig, goats, wild boars and wild ruminants were the main species tested besides pet animals. Prevalence of the infection ranged: 3.49-11.10% in cattle (209 to 2289 animals tested); 11.46-34.55% in pigs (37 to 2051 animals tested); 18.01-45.72% in sheep (912 to 2682 animals tested); 5.98-23.25% in goats (234 to 432 animals tested. Positive among wildlife ranged from 0 to 10.24% for wild boars (26 to 901 animals tested) and from 0.76 to 11.25% for wild ruminants (240 to 394 animals tested). For cats, that are solely responsible for contamination with environmentally-resistant oocysts, the prevalence ranged from 19.48 to 34.77% (77 to 696 animals tested). Although these data cannot support epidemiological analyses, they suggest that pigs and small ruminants are still the major sources of meatborne toxoplasmosis. Cattle are also under a special watch list since beef consumption has been predicted as the most important source of meatborne toxoplasmosis at least in Italy and the Netherlands as resulting from quantitative risk assessment studies. Cattle are often found positive to serological screening although direct detection of T. gondii via biological assay or PCR is uncommon with lack of concordance between antibodies and parasite DNA detection. The informative system also reports very limited information on food such as fresh vegetables or fishery products that can be contaminated by T. gondii oocysts dispersed in the environment although 1 sample of mussels and 3 samples of fish resulted positive by PCR in 2017. These findings suggest that surveillance on animal toxoplasmosis and meat and other food contamination with T. gondii should be enhanced since it is one of the few effective tools to control the parasite diffusion and prevent the transmission of the zoonosis

Lansoprazole and carbonic anhydrase IX inhibitors sinergize against human melanoma cells.

AbstractContext: Proton Pump Inhibitors (PPIs) reduce tumor acidity and therefore resistance of tumors to drugs. Carbonic Anhydrase IX (CA IX) inhibitors have proven to be effective against tumors, while tumor acidity might impair their full effectiveness.Objective: To analyze the effect of PPI/CA IX inhibitors combined treatment against human melanoma cells.Methods: The combination of Lansoprazole (LAN) and CA IX inhibitors (FC9-399A and S4) has been investigated in terms of cell proliferation inhibition and cell death in human melanoma cells.Results: The combination of these inhibitors was more effective than the single treatments in both inhibiting cell proliferation and in inducing cell death in human melanoma cells.Discussion: These results represent the first successful attempt in combining two different proton exchanger inhibitors.Conclusion: This is the first evidence on the effectiveness of a new approach against tumors based on the combination of PPI and CA IX inhibitors, thus providing an alter..

Unveiling diffusion pattern and structural impact of the most invasive SARS-CoV-2 spike mutation

SARS-CoV-2 epidemics quickly propagated worldwide, sorting virus genomic variants in newly established propagules of infections. Stochasticity in transmission within and between countries or an actual selective advantage could explain the global high frequency reached by some genomic variants. Using statistical analyses, demographic reconstructions, and molecular dynamics simulations, we show that the globally invasive G614 spike variant i) underwent a significant demographic expansion in most countries not explained by stochastic effects nor by overrepresentation in clinical samples; ii) increases the spike S1/S2 furin-like site conformational plasticity (short-range effect), and iii) modifies the internal motion of the receptor-binding domain affecting its cross-connection with other functional domains (long-range effect). Our results support the hypothesis of a selective advantage at the basis of the spread of the G614 variant, which we suggest may be due to structural modification of the spike protein at the S1/S2 proteolytic site, and provides structural information to guide the design of variant-specific drugs

Suicidal ideation and suicide commitment in Health Care Workers during COVID-19 pandemic: a review of the literature

Introduction: Suicide represents an important public health concern since it leads to more annual deaths globally than violence, war and natural disasters combined. It is evident that during this pandemic year the phenomenon acquires even greater importance especially in the categories at risk, such as health care workers (HCWs). The aim of this review is to analyze literature evidence regarding health care providers' suicidal ideation (SI) and suicide commitment during the first year of the COVID-19 pandemic. Methods: International databases and digital worldwide media reports were screened between March 2020 and March 2021. The authors conducted a systematic review and described evidence using a narrative approach with some focus points based on the PICO framework. Inclusion or exclusion of literature is done according to Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) recommendations. Results: What emerged is a range of SI that varies from 4 to 8% and the main risk factors seem to be loneliness, not having children and personal history of mental disorders. Conclusion: SI, and in worst cases suicide commitment, seem mental health outcomes not to be underestimated, especially in an emergency that is protracting. They require monitoring by health surveillance systems with a goal of prevention and support