Syringa vulgaris is a new host for Cucumber mosaic virus

Virus-like symptoms consisting of light mosaic, chlorotic spots and oak chlorotic line patterns were observed on lilac plants (Syringa vulgaris L.) growing in a public garden in Imola (Emilia Romagna region, Italy). The causal agent was identified as cucumber mosaic virus (CMV) on the basis of biological, serological and nucleotide sequence properties of partial coat protein and movement protein genes, and the isolate was designated SYV. The CMV-SYV isolate caused mosaic symptoms on indicator plants of Nicotiana tabacum cv. Xanthi-nc, N. rustica and Cucumis sativus, while symptoms of local necrotic spots or pin points were observed on inoculated leaves of Vigna unguiculata and Vicia faba. To assess genetic differences between CMV-SYV and other known CMV isolates, phylogenetic analyses were carried out using 16 nucleotide sequences of coat protein and movement protein genes, including for SYV. The CMV-SYV isolate was most related to CMV subgroup IA isolates, and had 85.1-100% nucleotide sequence similarity to subgroup I isolates. This is the first report of CMV infecting S. vulgaris

Tomato Leaf Curl New Delhi Virus Found Associated with Eggplant Yellowing Disease in Italy

Tomato leaf curl New Delhi virus (ToLCNDV), a bipartite begomovirus (genus Begomovirus, family Geminiviridae), was originally described in tomato in India in 1995 (Padidam et al. 1995). The virus apparently remained confined to the Asian continent for about 20 years and has only recently been discovered in Europe. In Italy, ToLCNDV was detected for the first time in 2015 in zucchini squash in Sicily (Panno et al. 2016) and later on in other regions of continental Italy (Panno et al. 2019). Recently, epiphytotics of ToLCNDV were reported in central and south Italy, associated with yellowing and leaf curling symptoms in pepper crops (Luigi et al. 2019). In 2016, a large-scale survey was conducted to assess the distribution and the genetic diversity of the viral isolates spreading in Italy. Samples collected at that time included cucurbits and solanaceous plants, including five leaf samples from five distinct eggplant (Solanum melongena L.) plants of cultivar Violetta di Napoli that showed yellowing and light curling of the apical leaves and noticed in a cultivation located in Campania region (Castel Volturno municipality). A few Bemisia tabaci individuals were noticed associated to the cultivation. All five leaf samples tested positive for ToLCNDV with ImmunoStrip (Agdia, Elkhart, IN). These results were confirmed by PCR using ToLCNDV-specific primers TLCNDVCP1/TLCNDVCP2 (Parrella et al. 2018) on the total DNA extracted from each sample using an E.Z.N.A. Plant DNA kit (Omega Bio-tek, Norcross, GA). Amplicons of the expected size (∼1.0 kb) were obtained only from the five symptomatic plants, and the nucleotide sequences of these isolates were identical. One representative sample (Som-166/16) was selected for full-length amplification of the genome (DNA-A and DNA-B-like sequences) using the rolling circle amplification (RCA) method with an Illustra TempliPhi amplification kit (GE Healthcare, Piscataway, NJ), in accordance with the manufacturer's instructions. RCA products were digested with different restriction endonucleases to obtain a 2.8-kb linear DNA fragment. Among the different enzymes tested, BamHI resulted in a maximum DNA fragment length of 2.8 kb, which was cloned into a BamHI-linearized pUC19 plasmid. The ligated products were transformed into a competent DH5α strain of Escherichia coli, and the positive clones were sequenced in both orientations at Microsynth Seqlab (Gottingen, Germany). The obtained full-length DNA-A (2,738 nt; GenBank MN782303) and DNA-B (2,686 nt; GenBank MN782304) sequences showed the highest percentage of nucleotide identity with the ToLCNDV Italian isolates Caa-164/16 (GenBank MK732932) for the DNA-A (99.82%) and Cum-45/16 (GenBank MF688671) for the DNA-B (99.48%). Eggplant leaf yellowing caused by a ToLCNDV variant has been previously described in India (HQ264185 for DNA-A and HQ264186 for DNA-B) (Pratap et al. 2011), but the Italian and the Indian isolates exhibited only 90.20 and 79.00% nucleotide identity with respect to the nucleotide sequences of DNA-A and DNA-B. The Som-166/16 isolate was very similar at the molecular level to previously reported isolates from Mediterranean countries and belonged to the European strain ToLCNDV-ES, because the percentage of nucleotide identity was 98.83% for DNA-A with the ToLCNDV-ES strain A-MU.13.ME/4.3 (GenBank MH577751) and 97.88% for DNA-B with the ToLCNDV-ES strain B-AL.15.ZU/2.1 (GenBank MH577658) (Moriones et al. 2017; Panno et al. 2019). The ToLCNDV-ES strain evolved from ToLCNDV isolates of Asian origin and adapted to infect cucurbits (Moriones et al. 2017). Nevertheless, this report presents further evidence, in addition to a previous report (Luigi et al. 2019), that ToLCNDV-ES isolates can potentially pose a threat not only to cucurbits but also to solanaceous crops as well, because this is the first finding of ToLCNDV in eggplant in Italy. Control measures against ToLCNDV are limited and mainly based on vector control, cultivation in protected environments, and the prompt elimination of infected materials

Inferior peroneal retinaculum tear with isolated peroneus longus tendon dislocation: A case report of an extremely rare injury, with the proposal of an innovative repair technique

Peroneus longus tendon (PLT) dislocation associated with inferior peroneal retinaculum (IPR) tear is an extremely rare injury. Only 6 cases are described in English literature to date, and its diagnosis is always delayed from the initial trauma. Swelling at the lateral face of the heel and a snapping during the movement of the foot and ankle are typical signs that can induce the suspect of this injury. Operative treatment is required as it typically affects young adults with high functional demands and tendon instability causes pain and functional limitation; also, a neglected dislocated or instable PTL may eventually end up with a rupture. In the few cases reported in literature, different operative techniques have been described, all with excellent results. A case of an initially overlooked dynamic dislocation of the PLT due to IPR tear in a young professional soccer player is described. The lesion was treated with a not yet described operative technique that consists in groove deepening and subsequent IPR repair through transosseous sutures, instead of peroneal tubercle resection as mostly advocated. Final follow up at 15 months showed complete recovery, with a Foot and Ankle Outcome Score of 100%

Assessing the Benefit Produced by Marine Protected Areas: The Case of Porto Cesareo Marine Protected Area (Italy)

The article focuses on the integrated environmental accounting model called ‘eValue’, developed for protected areas and applied in the research programme coordinated by the Italian Ministry of the Environment and aimed at implementing an environmental accounting system for Italian Marine Protected Areas (MPAs). eValue adopts a cost-benefit analysis approach. Financial accounting based on costs and revenues is integrated with environmental accounting, which reflects environmental costs and environmental revenues, i.e., environmental benefits. The environ-mental costs assess the impacts related to human activities in the MPA expressed by calculating the carbon footprint and the environmental benefits of the marine ecosystem services calculated by applying monetary valuation techniques. The values thus estimated flow into the annual flow account, where the value produced (or consumed) by the MPA is estimated by difference. The eValue model was applied to the Porto Cesareo MPA (Italy). eValue showed that the annual benefit-cost ratio reaches a value of 3.4. Furthermore, the ratio of net benefit to public funding is 3.7, completely covering the number of public transfers and thus summarizing the MPA overall value for money

RANKL-RANK-OPG Pathway in Charcot Diabetic Foot: Pathophysiology and Clinical-Therapeutic Implications

Charcot Foot (CF), part of a broader condition known as Charcot Neuro-Osteoarthropathy (CNO), is characterized by neuropathic arthropathy with a progressive alteration of the foot. CNO is one of the most devastating complications in patients with diabetes mellitus and peripheral neuropathy but can also be caused by neurological or infectious diseases. The pathogenesis is multifactorial; many studies have demonstrated the central role of inflammation and the Receptor Activator of NF-kappa B ligand (RANKL)-Receptor Activator of NF-kappa B (RANK)-Osteoprotegerin (OPG) pathway in the acute phase of the disease, resulting in the serum overexpression of RANKL. This overexpression and activation of this signal lead to increased osteoclast activity and osteolysis, which is a prelude to bone destruction. The aim of this narrative review is to analyze this signaling pathway in bone remodeling, and in CF in particular, to highlight its clinical aspects and possible therapeutic implications of targeting drugs at different levels of the pathway. Drugs that act at different levels in this pathway are anti-RANKL monoclonal antibodies (Denosumab), bisphosphonates (BP), and calcitonin. The literature review showed encouraging data on treatment with Denosumab, although in a few studies and in small sample sizes. In contrast, BPs have been re-evaluated in recent years in relation to the high possibility of side effects, while calcitonin has shown little efficacy on CNO

The impact of endometriosis on dietary choices and activities of everyday life: a cross-sectional study

IntroductionEndometriosis is characterized by ectopic endometrial tissue and severe pain; frequently, women afflicted by this condition resort to non-medical interventions, such as dietary modifications. The aim of this study is to assess the impact of endometriosis on dietary patterns and quality of life.MethodsAn online survey was conducted among Italian women with endometriosis to gather self-reported demographic, clinical, dietary habit, and daily life data post-diagnosis.ResultsA total of 4,078 participants were included. Following an endometriosis diagnosis, 66% reported changes in eating habits, and 92% experienced a decline in daily life. Respondents chose dietary interventions: gluten-free (15%), anti-inflammatory (8%), Mediterranean (7.1%), or ketogenic (4%) diets, to improve health and reduce symptoms. The study revealed a shift in eating habits, with increased consumption of vegetables, fruits (10%), cereals, legumes (6.6%), and fish (4.5%), while reducing dairy products (18.4%), soy-containing foods (6.7%), and high saturated fats (8%). Eating habit changes correlated with endometriosis stages and worsened daily life. Educational level, endometriosis stages, years of symptoms, and eating habit changes linked to changes in daily life.ConclusionOur findings emphasize the importance of monitoring eating behaviors to prevent unhealthy habits and malnutrition in women with endometriosis. Further studies are needed to evaluate how different diets impact symptoms and enhance daily life for these individuals

Direct analysis of thymic function in children with Down's syndrome

BACKGROUND: Down's syndrome (DS) is characterized by several immunological defects, especially regarding T cell compartment. DS is considered the best example of accelerated ageing in humans. Direct observations of the thymus have shown that in DS this organ undergoes severe histological and morphological changes. However, no data on its capacity to generate T cells are present in the literature. Here, using a new technology based upon real time PCR, we have investigated the capacity of the thymus to produce and release newly generated T lymphocytes (the so called "recent thymic emigrants", RTE) in children with DS. METHODS: We studied 8 children affected by DS, aged 2–7 years, compared with 8 age- and sex-matched healthy controls. Flow cytometry was used to determine different lymphocytes subsets. Real time PCR with the Taqman system was used to quantify the amount of RTE, i.e. peripheral blood lymphocytes that express the T cell receptor rearrangement excision circles (TREC). RESULTS: In comparison with control children, those with DS had a significant lower number of TREC+ peripheral blood cells. Moreover, in DS children but not in controls, a strong negative correlation between age and the levels of TREC+ cells was found. CONCLUSIONS: The direct measure of thymic output indicates that the impairment of the organ results in a reduced production of newly generated T cells. This observation could suggest that cytokines able to modulate thymic function, such as interleukins, could be useful to improve the functionality of the organ and to treat the immunodeficiency present in DS subjects

The impact of pictorial health warnings (PHW) on tobacco packages: the first quasi-experimental field trial after the implementation of the law in Italy

Background. The aim of the study was to evaluate in the Italian smokers, the effects of implementation of the law about Pictorial Health Warnings (PHWs) on tobacco products. Methods. A quasi-experimental longitudinal design was conducted between 2016 and 2017. The data were collected before (pre-PHW/Wave 1) and after (post-PHW/Wave 2) the implementation of the law. The adopted questionnaire included impact of advertisement (Label Impact Index, LII), quitting behavior and knowledge of tobacco related diseases.Results. 455 respondents completed both the Waves. 7.7% of smokers declared to have stopped smoking in Wave 2 and 29% of these declared the PHWs as one of the reasons to quit. The knowledge of tobacco related diseases was significantly (p <0.001) increased from Wave 1 to Wave 2 (58% versus 72%), similarly the LII (mean = 26.9, SD = 16.7 and mean = 40.4, SD = 16.2).Conclusion. Tobacco addiction is a problem that needs to be addressed from different angles. PHWs confirm their complementary role as a support for smokers along with other strategies such as text warnings and the tobacco quit line of the Istituto Superiore di Sanità (Italian National Institute of Health) reported on the packages. Nonetheless, over the years these measures have been not enough and policy makers should consider more strategies synergistically acting in the fight against tabagism.

Infected pancreatic necrosis: outcomes and clinical predictors of mortality. A post hoc analysis of the MANCTRA-1 international study

: The identification of high-risk patients in the early stages of infected pancreatic necrosis (IPN) is critical, because it could help the clinicians to adopt more effective management strategies. We conducted a post hoc analysis of the MANCTRA-1 international study to assess the association between clinical risk factors and mortality among adult patients with IPN. Univariable and multivariable logistic regression models were used to identify prognostic factors of mortality. We identified 247 consecutive patients with IPN hospitalised between January 2019 and December 2020. History of uncontrolled arterial hypertension (p = 0.032; 95% CI 1.135-15.882; aOR 4.245), qSOFA (p = 0.005; 95% CI 1.359-5.879; aOR 2.828), renal failure (p = 0.022; 95% CI 1.138-5.442; aOR 2.489), and haemodynamic failure (p = 0.018; 95% CI 1.184-5.978; aOR 2.661), were identified as independent predictors of mortality in IPN patients. Cholangitis (p = 0.003; 95% CI 1.598-9.930; aOR 3.983), abdominal compartment syndrome (p = 0.032; 95% CI 1.090-6.967; aOR 2.735), and gastrointestinal/intra-abdominal bleeding (p = 0.009; 95% CI 1.286-5.712; aOR 2.710) were independently associated with the risk of mortality. Upfront open surgical necrosectomy was strongly associated with the risk of mortality (p &lt; 0.001; 95% CI 1.912-7.442; aOR 3.772), whereas endoscopic drainage of pancreatic necrosis (p = 0.018; 95% CI 0.138-0.834; aOR 0.339) and enteral nutrition (p = 0.003; 95% CI 0.143-0.716; aOR 0.320) were found as protective factors. Organ failure, acute cholangitis, and upfront open surgical necrosectomy were the most significant predictors of mortality. Our study confirmed that, even in a subgroup of particularly ill patients such as those with IPN, upfront open surgery should be avoided as much as possible. Study protocol registered in ClinicalTrials.Gov (I.D. Number NCT04747990)

Utilizzo di una piattaforma informatica su Cloud per la lettura centralizzata di esami TC eseguiti in un trial clinico multicentrico internazionale

Il carcinoma colon-rettale rappresenta una delle principali cause di morbosità e mortalità per neoplasia a livello globale con oltre 1,4 milioni di nuovi casi e 695.000 morti stimati nel 2012. È gravato da una mortalità elevata, con una sopravvivenza a 5 anni di circa il 60%, poiché almeno il 50% dei pazienti presenta malattia metastatica, dei quali la metà già alla diagnosi. Un ruolo di sempre maggior importanza, nell’ambito della malattia avanzata, sta acquisendo la terapia sistemica con l’impiego di agenti chemioterapici in varie combinazioni (oxaliplatino, irinotecan, TAS-102) e farmaci a bersaglio molecolare (antiangiogenetici e anticorpi monoclonali anti-EGFR). Molti studi di fase II e III hanno supportato l’uso del cetuximab in combinazione con chemioterapia evidenziandone i benefici principalmente nella sottopopolazione con tumori RAS e BRAF non mutati. Considerando che questi benefici sembrano essere correlati alla capacità del trattamento di indurre una rapida riduzione della massa tumorale, si può supporre che, una volta raggiunto l’obiettivo della riduzione tumorale, un’ulteriore esposizione al trattamento antineoplastico esiterebbe solo in un incremento degli effetti collaterali. Nell’ottica di avere un buon controllo di malattia limitando gli effetti collaterali, il Policlinico Agostino Gemelli ha sviluppato il trial clinico ERMES (ERbitux MEtastatic colorectal Strategy) al quale contribuiscono 86 centri italiani e 10 spagnoli con l’obiettivo di arruolare 600 pazienti. Lo studio di fase III di non inferiorità, multicentrico e internazionale, randomizzato, in due bracci in pazienti con carcinoma colon-rettale metastatico con RAS e BRAF wild type ha come obiettivo principale dimostrare la non inferiorità del trattamento sperimentale (FOLFIRI + cetuximab per 8 cicli, seguito da solo cetuximab fino a progressione) rispetto a quello standard (FOLFIRI + cetuximab fino a progressione), e l’eventuale riduzione delle tossicità di grado 3 e 4 di tipo ematologico e non. Se si dovessero constatare una più rapida progressione nel braccio sperimentale o una maggiore tossicità, associabile all’utilizzo del solo cetuximab, il braccio standard verrà considerato più efficace. Tali risultati si potranno raggiungere grazie al contributo dell’Azienda Ospedaliero-Universitaria Pisana che riveste il ruolo di Central Radiology Imaging Centre, ovvero centro di seconda lettura in cieco delle immagini radiologiche. Considerando che le dimensioni del campione da analizzare sono notevoli e il numero dei centri coinvolti ampio, e che tradizionalmente la trasmissione delle immagini avviene tramite invio di CD o DVD, il centro pisano ha sviluppato una “piattaforma IT ERMES”, che sfrutta la tecnologia Cloud. Questo consente una rapida gestione dei dati, sia dai centri periferici (Local Radiology Imaging Centre) verso il Central Radiology Imaging Centre, sia da quest’ultimo al Policlinico Agostino Gemelli, che ricopre il ruolo di Clinical Trial Centre, ovvero il sito in cui in ultima analisi dovranno pervenire tutti i dati raccolti nell’ambito della sperimentazione. Essendo il polo pisano anche un Local Radiology Imaging Centre abbiamo verificato la semplicità procedurale di impiego della piattaforma caricando i dati dei nostri pazienti. Nel complesso, abbiamo constatato come la piattaforma consenta un’immediata disponibilità e rapida gestione dei dati, un agevole confronto delle immagini, una diminuzione degli errori umani e della variabilità, un risparmio di tempo e costi, e quindi una veloce attività di second read. Abbiamo anche messo in evidenza alcune criticità, la più importante delle quali è rappresentata da una problematica di tipo “sociologico”: l’abitudine radicata dei medici all’impiego della metodica tradizionale (CD e DVD) per l’invio delle immagini potrebbe diminuire l’aderenza dei centri periferici all’utilizzo della piattaforma IT