La sorveglianza della tubercolosi in Sicilia

Obiettivi. Descrivere l’andamento dei casi di tubercolosi (TB) in Sicilia negli anni 2010-2013. Disegno e partecipanti. Indagine osservazionale delle notifiche di TB relative agli anni 2010-2013 mediante l’analisi dei dati del Sistema informativo delle malattie infettive (SIMI) e indagine epidemiologico-molecolare mediante tipizzazione spoligo- e 24- loci mycobacterial interspersed repetitive units-variable number of tandem repeats (MIRU-VNTR) dei ceppi di Mycobacterium tuberculosis complex (MTBC) isolati a Palermo negli anni 2012-2013. Risultati. Negli anni 2010-2013 sono stati notificati in Sicilia 876 casi di TB con un tasso medio annuale di notifica pari a 4,4 casi per 100.000 abitanti. La proporzione di casi di TB in soggetti nati all’estero è crescente e nel 2012 e 2013 supera quella nella popolazione autoctona. L’età mediana dei pazienti stranieri è risultata significativamente inferiore agli italiani (30,5 vs. 51,2 anni, p <0,001). La distribuzione per classi di età è stata significativamente differente nelle due subpopolazioni, con la proporzione più elevata di casi nelle fascia di età 15-44 anni tra gli stranieri e, al contrario, una distribuzione uniforme dei pazienti italiani tra le fasce di età 15-44, 45-64 e >64 anni. Nell’82,5% dei casi è stata diagnosticata una localizzazione polmonare. La tipizzazione molecolare è stata effettuata su 151 ceppi di MTBC. Mediante spoligotyping essi sono stati attribuiti a 14 differenti lineage e 33 sublineage rappresentati con frequenza diversa tra le due subpopolazioni di pazienti. Soltanto nove ceppi (6,2%) sono stati inclusi in quattro cluster. Sono stati identificati, infine, due ceppi multiresistenti. Conclusioni. L’epidemiologia della TB in Sicilia è complessa e in rapida evoluzione, con una crescente proporzione di casi in soggetti non italiani e una grande eterogeneità dei ceppi di MTBC circolanti. L’integrazione di strumenti convenzionali e molecolari è necessaria per una sorveglianza efficace e un’interpretazione accurata dell’epidemiologia della TB in Sicilia

Macroscopic characteristics of the umbilical cord in Standardbred, Thoroughbred and Warmblood horses

The umbilical cord (UC), the connection between mother and fetus via the umbilical vessels, carries nutrients and oxygenated blood to the fetus through the umbilical vein and removes deoxygenated blood and waste products via the umbilical arteries. It is designed to protect blood flow to the fetus during pregnancy. In equine medicine, only a few studies have described the UC, and most of these involved Thoroughbreds. The present study describes and compares the macroscopic features of the equine umbilical cord in three different breeds and in relation to the foal's gender. In addition, a possible correlation between UC features and maternal and perinatal factors is investigated. One hundred and twenty four healthy mares with normal pregnancies were enrolled in the study and were divided into three groups according to their breed: 70 Standardbreds (STB), 38 Thoroughbreds (THB) and 16 Warmbloods (WAB). The following data were recorded: mare's age and parity, gestation length, placental weight, presence of fetal membrane alterations, UC length and number of coils in the amniotic and allantoic portions, and the Umbilical Coiling Index (UCI), which is the ratio between total coils and total UC length. The UCI has not been investigated previously in veterinary medicine. Furthermore, immediately after foaling, APGAR score, foal's weight and sex were recorded. All the STB and WAB were housed in Italy and the THB were housed in New Zealand. Mares\ue2\u80\u99 mean age was higher in WAB than in THB and STB; the latter had a significantly shorter gestation length. The foal's weight was positively correlated with placental weight in all breeds; and in STB, foal weight was positively related to parity and gestation length. Mean total UC length was comparable to previous reports in THB, STB and WAB. The lengths of the two UC portions were statistically different between STB and THB, where the amniotic portion was longer than the allantoic one. In each breed, total UC length was correlated with total number of coils (THB and STB = 5 \uc2\ub1 1; WAB = 6 \uc2\ub1 1), the UC amniotic length was positively correlated with the number of amniotic coils and the allantoic length was positively correlated with the number of allantoic coils. The UCI values were 0.09 in STB and THB and 0.1 in WAB. This study provides reference values for UCI that could be included in the gross placental evaluation if its clinical importance were demonstrated

Knowledge and material analysis for conservation actions related to the Maida castle in Calabria (Italy)

[EN] The Maida castle is located in a hill site in historical center of the Maida City, facing two sea gulfs: Squillace gulf on the east side and Sant’Eufemia gulf on the west side. The position is strategic moreover because the castle is located in the center of Calabria between the Tyrrhenian and the Ionian Seas. Hidden in an inner area, the castle was erected on a rock which has a wide perspective view, giving the ability to control a stretch of territory between the two coasts and allowing to make an easier defense. Although today the fortress appears mainly as a ruin, it is still possible to distinguish one of the quadrangular towers as used as district prison, some inaccessible underground spaces and part of the walls. The state of degradation is evident, caused by the time action and, unfortunately, by inadequate maintenance activity. Most of the external surfaces have evident signs of deterioration, caused by bad weather conditions, but above all by weed vegetation. To better understand the role of the factors as biological aggression, a study has been carried out focusing on most common and widespread biological degradation present on the external surfaces of the castle. Samples of biological materials were taken and examined in the laboratory in order to acquire useful information about the state of the monument. This knowledge is necessary because it provides a first picture of the main causes of degradation of the castle and useful information for developing more aware and respectful restorations of its identity.Gattuso, C.; Palermo, A.; Castagnaro, I.; Ruberto, F. (2020). Conoscenza e analisi dei materiali per la conservazione del castello di Maida in Calabria (Italia). Editorial Universitat Politècnica de València. 1201-1208. https://doi.org/10.4995/FORTMED2020.2020.11437OCS1201120

Diagnostics for the knowledge: the case of the tower of Palazzo Termine Pietragliata in Palermo (Italy)

[EN] Developing a methodological approach is crucial to assess the state of conservation of a monument, starting from the overall analysis, progressively moving from small to medium scale and reaching the grand scale at the end. Considering the territory, causes are investigated in order to understand the propensities, as well as considering a single monument, evidences are carefully read to assess the overall conditions, that will be lately detailed by the analysis on materials and their degradation. The object of this study is the tower of the Palazzo Pietragliata in Palermo, one of the most important examples of the late Gothic civil architecture in Sicily. The Palace, built in 1473 by Prince of Baucina, possesses an imposing crenellated tower, whose two levels are connected by an original internal staircase “cargol” like, an extraordinary example of the influence of Catalan Gothic architecture in Sicily. Some micro samples were taken from the tower structure, made entirely of blocks of biocalcarenite, on which diagnostic investigations were performed in the laboratory. In the context of a more comprehensive interdisciplinary study, this paper illustrates the specific results of the micro analysis conducted in the laboratory and particularly those made through the use of the SEM and biological investigations, also paying attention to the pathologies detected on the battlements of the tower. These forms of decay, for their variety, represent a significant example that allows to properly illustrate the adopted study method.Gattuso, C.; Fernandez, F.; Pecoraro, MM.; Palermo, AM. (2015). Diagnostics for the knowledge: the case of the tower of Palazzo Termine Pietragliata in Palermo (Italy). En Defensive architecture of the mediterranean: XV to XVIII centuries. Vol. I. Editorial Universitat Politècnica de València. 389-396. https://doi.org/10.4995/FORTMED2015.2015.1760OCS38939

Aurora kinases are expressed in medullary thyroid carcinoma (MTC) and their inhibition suppresses in vitro growth and tumorigenicity of the MTC derived cell line TT

International audienceBACKGROUND: The Aurora kinase family members, Aurora-A, -B and -C, are involved in the regulation of mitosis, and alterations in their expression are associated with cell malignant transformation. To date no information on the expression of these proteins in medullary thyroid carcinoma (MTC) are available. We here investigated the expression of the Aurora kinases in human MTC tissues and their potential use as therapeutic targets. METHODS: The expression of the Aurora kinases in 26 MTC tissues at different TNM stages was analyzed at the mRNA level by quantitative RT-PCR. We then evaluated the effects of the Aurora kinase inhibitor MK-0457 on the MTC derived TT cell line proliferation, apoptosis, soft agar colony formation, cell cycle and ploidy. RESULTS: The results showed the absence of correlation between tumor tissue levels of any Aurora kinase and tumor stage indicating the lack of prognostic value for these proteins. Treatment with MK-0457 inhibited TT cell proliferation in a time- and dose-dependent manner with IC50 = 49.8 ± 6.6 nM, as well as Aurora kinases phosphorylation of substrates relevant to the mitotic progression. Time-lapse experiments demonstrated that MK-0457-treated cells entered mitosis but were unable to complete it. Cytofluorimetric analysis confirmed that MK-0457 induced accumulation of cells with ≥ 4N DNA content without inducing apoptosis. Finally, MK-0457 prevented the capability of the TT cells to form colonies in soft agar. CONCLUSIONS: We demonstrate that Aurora kinases inhibition hampered growth and tumorigenicity of TT cells, suggesting its potential therapeutic value for MTC treatment

Population-level benefits of increasing influenza vaccination uptake among Italian older adults: results from a granular panel model

BackgroundThe impact of seasonal influenza vaccination (SIV) on mortality is still controversial; some studies have claimed that increasing vaccination coverage rates is beneficial, while others have found no significant association. This study aimed to construct a granular longitudinal dataset of local VCRs and assess their effect on pneumonia- and influenza-related (P&amp;I) mortality among Italian adults aged ≥ 65 years.MethodsNUTS-3 (nomenclature of territorial units for statistics) level data on SIV coverage were collected via a survey of local data holders. Fixed- and random-effects panel regression modeling, when adjusted for potential confounders, was performed to assess the association between local SIV coverage rates and P&amp;I mortality in older adults.ResultsA total of 1,144 local VCRs from 2003 to 2019 were ascertained. In the fully adjusted fixed-effects model, each 1% increase in vaccination coverage was associated (P &lt; 0.001) with a 0.6% (95% CI: 0.3–0.9%) average over-time decrease in P&amp;I mortality. With an annual average of 9,293 P&amp;I deaths in Italy, this model suggested that 56 deaths could have been avoided each year by increasing SIV coverage by 1%. The random-effects model produced similar results. The base-case results were robust in a sensitivity analysis.ConclusionOver the last two decades, Italian jurisdictions with higher SIV uptake had, on average, fewer P&amp;I deaths among older adults. Local policy-makers should implement effective strategies to increase SIV coverage in the Italian senior population

Clinical features and outcomes of elderly hospitalised patients with chronic obstructive pulmonary disease, heart failure or both

Background and objective: Chronic obstructive pulmonary disease (COPD) and heart failure (HF) mutually increase the risk of being present in the same patient, especially if older. Whether or not this coexistence may be associated with a worse prognosis is debated. Therefore, employing data derived from the REPOSI register, we evaluated the clinical features and outcomes in a population of elderly patients admitted to internal medicine wards and having COPD, HF or COPD + HF. Methods: We measured socio-demographic and anthropometric characteristics, severity and prevalence of comorbidities, clinical and laboratory features during hospitalization, mood disorders, functional independence, drug prescriptions and discharge destination. The primary study outcome was the risk of death. Results: We considered 2,343 elderly hospitalized patients (median age 81&nbsp;years), of whom 1,154 (49%) had COPD, 813 (35%) HF, and 376 (16%) COPD + HF. Patients with COPD + HF had different characteristics than those with COPD or HF, such as a higher prevalence of previous hospitalizations, comorbidities (especially chronic kidney disease), higher respiratory rate at admission and number of prescribed drugs. Patients with COPD + HF (hazard ratio HR 1.74, 95% confidence intervals CI 1.16-2.61) and patients with dementia (HR 1.75, 95% CI 1.06-2.90) had a higher risk of death at one year. The Kaplan-Meier curves showed a higher mortality risk in the group of patients with COPD + HF for all causes (p = 0.010), respiratory causes (p = 0.006), cardiovascular causes (p = 0.046) and respiratory plus cardiovascular causes (p = 0.009). Conclusion: In this real-life cohort of hospitalized elderly patients, the coexistence of COPD and HF significantly worsened prognosis at one year. This finding may help to better define the care needs of this population

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

Severe senile osteoporosis: synergism of action between PTH 1-34 and rehabilitation

An analysis of the data shows that the PTH 1-34 in association with specific rehabilitation treatment is effective in reducing early pain borne by the dorsal-lumbar spine, to avoid the risk of new fractures, improve balance and gait to correct a good quality of life. Even taking into account the small number of patients, we emphasize the absence of new osteoporotic fractures in women who have also physical therapy and therapeutic exercise

Tecniche alternative di risoluzione dei conflitti in materia penale

Il volume raccoglie i contributi del Seminario internazionale su \u201cLe tecniche alternative di risoluzione dei conflitti in materia penale e l\ub4esperienza italiana del giudice di pace da un punto di vista internazionale\u201d svoltosi nella Facolt\ue0 di Giurisprudenza di Verona 18 marzo 2009, avente ad oggetto temi di grande attualit\ue0 del dibattito sulla \u201cgiustizia conciliativa\u201d e \u201cripartiva\u201d in campo penale. Rilevanti sono non solo le concrete ricadute sulla prassi, ma anche il pi\uf9 generale confronto teorico che rinvia ai fondamenti ed alle funzioni della pena. Per l\u2019ordinamento italiano si tratta di una prospettiva recente, in cui convergono pragmatiche esigenze di alleggerimento del carico giudiziario e di superamento delle difficolt\ue0 di \u201cgestione\u201d delle pene detentive brevi, con la necessit\ue0 di differenziare le risposte a reati e tipologie delinquenziali di minor gravit\ue0, senza lasciarle al \u201cvuoto\u201d indulgenziale della sospensione condizionale (priva di concreti contenuti rieducativi) o della prescrizione. Importante \ue8 dunque la comparazione con l\u2019esperienza tedesca, in cui il risarcimento e le condotte riparatorie da tempo consentono di archiviare il processo o di \u201csostituire\u201d la condanna, previa o meno mediazione fra autore e vittima