Utilita' della tipizzazione HLA-DQ per la diagnosi di celiachia in una popolazione selezionata di pazienti con sintomi clinici e test sierologici positivi

La celiachia è definita come "un disordine sistemico immuno-mediato scatenato dall' ingestione del glutine, che insorge in soggetti geneticamente predisposti, caratterizzato da un' enteropatia associata ad una variabile combinazione di un ampio spettro di manifestazioni cliniche, specifici anticorpi e specifici aplotipi HLA" (ESPGHAN). Secondo le ultime linee guida, per la diagnosi di malattia celiaca i pazienti sintomatici con livelli di anticorpi anti-TG elevati e positività per gli anticorpi EMA, non necessitano più della biopsia duodenale come conferma diagnostica, ma solo dell' esame genetico. In questo studio abbiamo cercato allora di capire quanto sia importante la genotipizzazione HLA nella diagnosi di celiachia, e se è sempre necessaria. Sono stati valutati 370 pazienti, suddivisi in due gruppi in base alla loro positività o negatività al triplo test (presenza di segni e sintomi suggestivi di celiachia, livelli di anticorpi anti-TG > 10 vv il valore di normalità e positività per gli anticorpi EMA). Il triplo test è stato confermato con la biopsia duodenale. I risultati ci dicono che quando il triplo test è positivo ha un' accuratezza assoluta nel riconoscere tutti i celiaci, per cui i pazienti che presentano sintomi clinici e test sierologici positivi, che secondo le ultime linee guida non necessitano dell' esame istologico, potrebbero non necessitare anche dell' esame genetico

Clinical impact of the immunome in lymphoid malignancies: the role of Myeloid-Derived Suppressor Cells

The better definition of the mutual sustainment between neoplastic cells and immune system has been translated from the bench to the bedside acquiring value as prognostic factor. Additionally, it represents a promising tool for improving therapeutic strategies. In this context, myeloid-derived suppressor cells have gained a central role in tumor developing with consequent therapeutic implications. In this review, we will focus on the biological and clinical impact of the study of myeloid-derived suppressor cells in the settings of lymphoid malignancies

Adaptation of Propionibacterium freudenreichii to long-term survival under gradual nutritional shortage

1- Introduction: Propionibacterium freudenreichii is an Actinobacterium widely used in the dairy industry as a ripening culture for Swiss-type cheeses, for vitamin B12 production and some strains display probiotic properties. It is reportedly a hardy bacterium, able to survive the cheese-making process and digestive stresses. 2- Objectives : The aim of the study was to decipher metabolic adaptations of P. freudenrechii responsible for long-term survival under gradual nutritional shortage. 3- Materials & methods: For 11 days, in a non-nutrient supplemented culture medium, eight strains were monitored by measuring their optical density, counting colony-forming units (CFU) and using LIVE/DEAD staining and microscopy observation. The strain with the highest survival rate was incubated for 11 days (9 days after entry into stationary phase) in Yeast Extract Lactate medium at 30 °C under microaerophilic conditions, without any adjunct during the incubation. Its physiological adaptation was investigated by RNA-seq analysis. The carbon and free amino acids sources available in the medium, and the organic acids produced by the strain, were monitored throughout growth and survival. 4- Results: Under these conditions, the eight studied strains displayed high survival rates, their culturability reaching more than 9 log 10 CFU/ml after 2 days. After 11 days, this value ranged from 7.8 to 8.2 log 10 CFU/ml depending on the strain, and at least 50% of the P. freudenreichii population displayed an intact envelope. P. freudenreichii with the highest survival rate was CIRM-BIA 138 (alias ITG P9). Although lactate (the preferred carbon source for P. freudenreichii) was exhausted three days after inoculation, the CIRM-BIA 138 strain sustained a high population level of 9.3 log 10 CFU/mL and revealed a complete disruption of metabolism at the entry into stationary phase as compared to exponential phase. 5- Conclusions: P. freudenreichii adapts its metabolism during entry into stationary phase by down-regulating oxidative phosphorylation, glycolysis, and the Wood-Werkman cycle, by exploiting new nitrogen (glutamate, glycine, alanine) sources, by down-regulating the transcription, translation and secretion of protein. Utilization of polyphosphates was suggested

Additional file 2: Table S2. of Adaptation of Propionibacterium freudenreichii to long-term survival under gradual nutritional shortage

List of genes induced in the stationary phase (3d post-inoculation) compared to the exponential phase (1d post-inoculation) (P value adjusted ≤0.05). (XLSX 98 kb

Additional file 1: Table S1. of Adaptation of Propionibacterium freudenreichii to long-term survival under gradual nutritional shortage

List of repressed genes in stationary phase (3d post-inoculation) compared to exponential phase (1d post-inoculation) (P value adjusted ≤0.05). (XLSX 96 kb

Nationwide survey on the management of pediatric pharyngitis in Italian emergency units

Background Acute pharyngitis is a frequent reason for primary care or emergency unit visits in children. Most available data on pharyngitis management come from primary care studies that demonstrate an underuse of microbiological tests, a tendency to over-prescribe antibiotics and a risk of antimicrobial resistance increase. However, a comprehensive understanding of acute pharyngitis management in emergency units is lacking. This study aimed to investigate the frequency of rapid antigen test use to diagnose acute pharyngitis, as well as other diagnostic approaches, the therapeutic attitude, and follow-up of children with this condition in the emergency units.Methods A multicentric national study was conducted in Italian emergency departments between April and June 2022.Results A total of 107 out of 131 invited units (response rate 82%), participated in the survey. The results showed that half of the units use a scoring system to diagnose pharyngitis, with the McIsaac score being the most commonly used. Most emergency units (56%) were not provided with a rapid antigen diagnostic test by their hospital, but the test was more frequently available in units visiting more than 10,000 children yearly (57% vs 33%, respectively, p = 0.02). Almost half (47%) of the units prescribe antibiotics in children with pharyngitis despite the lack of microbiologically confirmed cases of Group A beta-hemolytic streptococcus. Finally, about 25% of units prescribe amoxicillin-clavulanic acid to treat Group A beta-hemolytic streptococcus pharyngitis.Conclusions The study sheds light on the approach to pharyngitis in emergency units, providing valuable information to improve the appropriate management of acute pharyngitis in this setting. The routinary provision of rapid antigen tests in the hospitals could enhance the diagnostic and therapeutic approach to pharyngitis

Asthma in patients admitted to emergency department for COVID-19: prevalence and risk of hospitalization

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