Molecular Mechanism Involved in the Pathogenesis of Early-Onset Epileptic Encephalopathy

Recent studies have shown that neurologic inflammation may both precipitate and sustain seizures, suggesting that inflammation may be involved not only in epileptogenesis but also in determining the drug-resistant profile. Extensive literature data during these last years have identified a number of inflammatory markers involved in these processes of "neuroimmunoinflammation" in epilepsy, with key roles for pro-inflammatory cytokines such as: IL-6, IL-17 and IL-17 Receptor (IL-17R) axis, Tumor-Necrosis-Factor Alpha (TNF-α) and Transforming-Growth-Factor Beta (TGF-β), all responsible for the induction of processes of blood-brain barrier (BBB) disruption and inflammation of the Central Nervous System (CNS) itself. Nevertheless, many of these inflammatory biomarkers have also been implicated in the pathophysiologic process of other neurological diseases. Future studies will be needed to identify the disease-specific biomarkers in order to distinguish epilepsies from other neurological diseases, as well as recognize different epileptic semiology. In this context, biological markers of BBB disruption, as well as those reflecting its integrity, can be useful tools to determine the pathological process of a variety of neurological diseases. However; how these molecules may help in the diagnosis and prognostication of epileptic disorders remains yet to be determined. Herein, authors present an extensive literature review on the involvement of both, systemic and neuronal immune systems, in the early onset of epileptic encephalopathy

From social infrastructure to civic center. The school as laboratory of collaborative governance models / Du service public au centre civique. À Turin, les écoles deviennent des condensateurs sociaux d’expérimentations urbaines

In the second half of the last century, after World War II, the Italian government defined an important period of public policies and projects to build a national welfare system in order to bridge the social and cultural gaps of a country with many different territorial situations. Half a century later, the complexification of the social and economic organization, which has transformed mass society into a plural society, has brought with it a multiplication and fragmentation of spatial and social needs for which the universal welfare system appears ineffective. The role of the public administration and its relationship to communities and the third sector have changed: increasingly often, alliances are defined to build projects that are closer to different social and cultural demands. This paper will focus on processes in which public service is enriched and regenerated by the care of reference communities: we seem to recognize the premises for a new way of administering public services, in which the public and the private collaborate on an equal level. We will adopt this perspective in observing what happens inside schools, which seems particularly interesting for at least two reasons. First of all, as the symbol of a public welfare service in crisis, it is simultaneously possible to recognize a certain habit of school communities taking part in the redevelopment of this service, through actions to care for the school building and its pertinent spaces. Secondly, the school also plays the role of a territorial actor, coming out of its own enclosures to take over urban space (that is, public gardens, parks, libraries, museums, cycle workshops, etc.) with educational projects at various levels. Turin represents an interesting case study, as a city where both public policies and social practices have integrated themselves, from education to urban regeneration, through institutional actors and local communities

Avoiding zero probability events when computing Value at Risk contributions

This paper is concerned with the process of risk allocation for a generic multivariate model when the risk measure is chosen as the Value-at-Risk (VaR). We recast the traditional Euler contributions from an expectation conditional on an event of zero probability to a ratio involving conditional expectations whose conditioning events have stricktly positive probability. We derive an analytical form of the proposed representation of VaR contributions for various parametric models. Our numerical experiments show that the estimator using this novel representation outperforms the standard Monte Carlo estimator in terms of bias and variance. Moreover, unlike the existing estimators, the proposed estimator is free from hyperparameters

Improving sustainable mobility in university campuses. The case study of Sapienza University

The pursue of sustainable mobility is one of the greatest environmental challenges nowadays. It requires a people mind shift, where the use of private vehicles give way to different modes of public transport like buses, bicycles, car sharing, electric cars, and walking lanes. This new call to make mobility sustainable has already been undertaken by policymakers and public managers in many urban contexts around the world, as well as, more recently, by the managers of university systems. The paper shows the work developed in 2018 for the Sapienza Sustainable University Mobility Plan (SUMP). The study stems from the need to understand and improve, in the sustainability direction, modes of travel for the students and staff of one of the oldest universities in the world, and one of the largest in Europe (112,142 students enrolled and 23,101 between academic staff and no academic staff), with its premises located in a complex and challenging urban context such as the city of Rome. The SUMP has been developed in two phases. The first one investigated travel patterns and the reasons for the modal shift and highlighted the main issues. The second phase defined strategies and interventions to be implemented in the short, medium, and long term to make students and staff's mobility more environmentally sustainable. The methodology used in the fact-finding stage was the online survey that was carried out through the use of a diversified questionnaire for staff and students of the University. The sample of students who participated in the survey amounted to 14,719 units, while the sample of faculty and staff was 9,403. The main questionnaire outcomes showed that the attitudes recorded were largely different between faculty and staff and students. While for the first ones the choice of private vehicles is the first option (36%), for students public transport is the prevailing preference (78%). According to the critical aspects found in this first stage, the SUMP objectives were defined, leading to the identification of macro-areas of intervention and specific actions. At a policy and strategic level, the attention was focused on the guidelines issued by the United Nations, the European Commission, and the Network of Universities for Sustainable Development, of which Sapienza University is a member. For this reason, the identification of strategies and interventions results from the combination of the first phase analysis, the Sapienza Governance objectives, and the national and international context in which the SUMP was drafted. Five macro-areas of intervention have been identified: Smart Strategies, Pedestrian Mobility, Cycling, Local Public Transport, Private Transport, and for each one specific intervention to be implemented in different time frames have been defined

Human toxocariasis: a report of nine cases

Aim: Human toxocariasis is caused by infection with the larval stage of nematode parasites of dogs and cats, Toxocara canis or Toxocara cati. These helminths are not able to complete their life cycle in undefinitive hosts and so undergo aberrant migrations in the tissues causing a wide spectrum of signs and symptoms. Eosinophilia is often severe and sometimes represents the only sign of infection, except in ocular and neurological forms. Methods: We describe the clinical features of nine children affected by toxocariasis admitted to our Infectious Diseases department from 2004 to 2006. Results: Fever and hepatomegaly were the most common clinical findings. In two cases eosinophilia was not present. Diagnosis was performed by enzyme-linked immunosorbent assay employing excretory–secretory antigens of Toxocara. canis larvae. All patients were successfully treated with oral albendazole with no side effects

Use of Cepheid Xpert Carba-R\uae for Rapid Detection of Carbapenemase-Producing Bacteria in Abdominal Septic Patients Admitted to Intensive Care Unit.

Abstract Early institution of effective antibiotic therapy and source control are pivotal to improve survival of abdominal septic patients. Xpert\uae Carba-R is a real time polymerase chain reaction assay for rapid detection and differentiation of five genes (blaKPC, blaVIM, blaOXA-48, blaIMP-1, blaNDM) responsible for carbapenem resistance. We performed an observational study investigating the clinical usefulness and applicability of Xpert\uae Carba-R to detect carbapenem resistance in abdominal septic patients admitted to intensive care unit. We compared the results of Xpert\uae Carba-R with standard microbiological culture. We collected a set of two rectal/stomia swabs and two swabs from abdominal drainage fluid for each patient. We included 20 patients for a total of 45 comparisons between the two methods. In our clinical setting, the overall performance of Xpert\uae Carba-R for detection of carbapenem resistance in the presence of genes detectable and non-detectable by the method was: sensitivity 50% (95% CI 24.6-75.3); specificity 93.1% (95% CI 77.2-99.1); positive predictive value (PPV) 80% (95% CI 44.4-97.5); negative predictive value (NPV) 77.1% (95% CI 56.9-89.6). The inter-rater agreement was 0.47 (SE 0.14; 95% CI 0.20-0.74). When considering the only 5 mechanisms of resistance detected by both methods, the overall diagnostic performance was: sensitivity 100% (95% CI 69.1-100), specificity 94.2 (95% CI 80.8-99.3), PPV 83.3 (95% CI 59.6-97.9) and NPV 100% (95% CI 89.4-100). The inter-rater agreement was 0.88 (SE 0.08; 95% CI 0.71-1). Xpert\uae Carba-R may be considered an additional diagnostic tool for early diagnosis of carbapenem resistance in abdominal septic patients. Clinicians should be aware of their epidemiology before its introduction in the diagnostic protocol of their intensive care units

Successful control of an outbreak of colonization by Klebsiella pneumoniae carbapenemase-producing K.\ua0pneumoniae sequence type 258 in a neonatal intensive care unit, Italy

This article reports an outbreak of colonization by Klebsiella pneumoniae carbapenemase-producing K. pneumoniae (KPC-Kp) sequence type (ST) 258 in a neonatal intensive care unit (NICU) in Palermo, Italy. KPC-Kp ST258 was detected by an active surveillance culture programme. Between 18th September and 14th November 2012, KPC-Kp was isolated from 10 out of 54 neonates admitted in the outbreak period. No cases of infection were recorded. Male sex was associated with colonization, whereas administration of ampicilline-sulbactam plus gentamicin was protective. Infection control interventions interrupted the spread of KPC-Kp without the need to close the NICU to new admissions. (C) 2013 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved