Impact of a nurse led telephone intervention on satisfaction and health outcomes of children with inflammatory rheumatic diseases and their families: a crossover randomized clinical trial.

Children suffering from rheumatic disease are faced with multidimensional challenges that affect their quality of life and family dynamics. Symptom management and monitoring of the course of the disease over time are important to minimize disability and pain. Poor disease control and anticipation of the need for treatment changes may be prompted by specialist medical follow-up and regular nurse-led consultations with the patient and families, in which information and support is provided. The purpose of this study was to evaluate the impact of a nurse-led telephone intervention or Telenursing (TN) compared to standard care (SC) on satisfaction and health outcomes of children with inflammatory rheumatic diseases and their parents. A multicentered, randomized, longitudinal, crossover trial was conducted with pediatrics outpatients newly diagnosed with inflammatory rheumatic diseases. Participants were randomly assigned to two groups TN and SC for 12 months and crossed-over for the following 12 months. TN consisted of providing individualized affective support, health information and aid to decision making. Satisfaction (primary outcome) and health outcomes were assessed with the Client Satisfaction Questionnaire-8 and the Juvenile Arthritis Multidimensional Assessment Report, respectively. A mixed effect model, including a group x time interaction, was performed for each outcome. Satisfaction was significantly higher when receiving TN (OR = 7.7, 95% CI: 1.8-33.6). Morning stiffness (OR = 3.2, 95% CI: 0.97-7.15) and pain (OR = 2.64, 95% CI: 0.97-7.15) were lower in the TN group. For both outcomes a carry-over effect was observed with a higher impact of TN during the 12 first months of the study. The other outcomes did not show any significant improvements between groups. TN had a positive impact on satisfaction and on morning stiffness and pain of children with inflammatory rheumatic diseases and their families. This highlights the importance of support by specialist nurses in improving satisfaction and symptom management for children with inflammatory rheumatisms and their families. ClinicalTrial.gov identifier: NCT01511341 (December 1st, 2012)

Virological surveillance of SARS-CoV-2 in an Italian northern area: Comparison of real time RT PCR cycle threshold (CT) values in three epidemic periods

Aim of the study was to investigate the differences in Ct values in nasopharingeal swabs collected in three SARS-CoV-2 epidemic periods: first one from February 23 to March 25 (14 days from lockdown started on March 11); the second one from March 26 to May 18 (14 days from the end of strict lockdown on May 4) and the third one from May 19 until June 15. Viral RNA was detected in nasopharyngeal swabs obtained both from inpatients and outpatients. COVID-19 infection was confirmed according to the Ct values for N1 and N2 genes ascertained by Real-Time RT-PCR assay as described by the CDC. We calculated the prevalence of nasopharyngeal swabs tested positive for SARS-CoV-2, the mean and median of the Cts and the percentage of samples equal or below the Ct value of 25 in the 3 periods considered. The average value of Ct increased, going from 24.80 in the first epidemic period to 26.64 in the second period to 28.50 in the third period (p <0.001). The percentage of samples with Ct lower than or equal to 25 also decreased sharply from 54.7% to 20.0%. These findings need to be integrated with epidemiological and clinical data. (www.actabiomedica.it)

Neurocognitive impact of metal exposure and social stressors among schoolchildren in Taranto, Italy

BACKGROUND: Metal exposure is a public health hazard due to neurocognitive effects starting in early life. Poor socio-economic status, adverse home and family environment can enhance the neurodevelopmental toxicity due to chemical exposure. Disadvantaged socio-economic conditions are generally higher in environmentally impacted areas although the combined effect of these two factors has not been sufficiently studied. METHODS: The effect of co-exposure to neurotoxic metals including arsenic, cadmium, manganese, mercury, lead, selenium, and to socio-economic stressors was assessed in a group of 299 children aged 6-12\u2009years, residing at incremental distance from industrial emissions in Taranto, Italy. Exposure was assessed with biological monitoring and the distance between the home address and the exposure point source. Children's cognitive functions were examined using the Wechsler Intelligence Scale for Children (WISC) and the Cambridge Neuropsychological Test Automated Battery (CANTAB). Linear mixed models were chosen to assess the association between metal exposure, socio-economic status and neurocognitive outcomes. RESULTS: Urinary arsenic, cadmium and hair manganese resulted inversely related to the distance from the industrial emission source (\u3b2 -\u20090.04; 95% CI -0.06, -\u20090.01; \u3b2 -\u20090.02; 95% CI -0.05, -\u20090.001; \u3b2 -\u20090.02 95% CI -0.05, -\u20090.003) while the WISC intellectual quotient and its sub-scores (except processing speed index) showed a positive association with distance. Blood lead and urinary cadmium were negatively associated with the IQ total score and all sub-scores, although not reaching the significance level. Hair manganese and blood lead was positively associated with the CANTAB between errors of spatial working memory (\u3b2 2.2; 95% CI 0.3, 3.9) and the reaction time of stop signal task (\u3b2 0.05; 95% CI 0.02, 0.1) respectively. All the other CANTAB neurocognitive tests did not show to be significantly influenced by metal exposure. The highest socio-economic status showed about five points intellectual quotient more than the lowest level on average (\u3b2 4.8; 95% CI 0.3, 9.6); the interaction term between blood lead and the socio-economic status showed a significant negative impact of lead on working memory at the lowest socio-economic status level (\u3b2 -\u20094.0; 95% CI -6.9, -\u20091.1). CONCLUSIONS: Metal exposure and the distance from industrial emission was associated with negative cognitive impacts in these children. Lead exposure had neurocognitive effect even at very low levels of blood lead concentration when socio-economic status is low, and this should further address the importance and prioritize preventive and regulatory interventions

Procedure in sala dialisi durante l’emergenza Covid-19

Scopo Scopo del presente documento \ue8 definire modalit\ue0 omogenee di gestione del paziente dializzato a partire dalla comparsa di casi accertati nella popolazione italiana di infezione da nuovo Coronavirus 2019-nCoV (Covid-19). Applicabilit\ue0 Il presente documento si applica alle attivit\ue0 di sala dialitica di seguito descritte. Il documento \ue8 attualmente in applicazione presso i due presidi ospedalieri dell\u2019ASST Santi Paolo e Carlo e relativi CAL Mompiani e Rozzano. Descrizione Questo documento espone le misure di prevenzione e di controllo della diffusione dell\u2019infezione da nuovo Coronavirus, attuate dal giorno 24/02/2020 dal personale dell\u2019unit\ue0 operativa dialisi al fine di limitare la trasmissione da persona a persona. Le indicazioni che seguono hanno quindi l\u2019obiettivo di garantire l\u2019uniformit\ue0 di comportamento degli operatori sanitari nel confronto dei pazienti afferenti al centro, al fine di identificare e gestire i casi sospetti, probabili e confermati da infezione da Coronavirus. Tutti i pazienti che giungono in ospedale per eseguire la seduta emodialitica vengono considerati \u201cpotenzialmente\u201d infetti da Covid-19 e, pertanto, tutti gli operatori e tutti i pazienti devono seguire le indicazioni del protocollo sui dispositivi di protezione individuale (DPI): l\u2019igiene delle mani, l\u2019utilizzo della cuffia, mascherina chirurgica occhiali o visiera, guanti e camice come da procedure

EFFICIENCY OF VIRAL CONCENTRATION IN FOOD SAMPLES: COMPARISON BETWEEN PEG AND ULTRAFILTRATION TECHNIQUES

Norovirus is the most prevalent causative agent of foodborne diseases. However, the detection of this virus in foods other than shellfish is often time-consuming and unsuccessful. The objective of this study is to compare PEG and ultrafiltration techniques for viral concentration in bivalve molluscs. An experiment with Coxsackie B5 and feline Calicivirus strain F is conduct to determine the efficiency of each virus concentration. Ultrafiltration technique is the most indicated

Associations of a metal mixture measured in multiple biomarkers with IQ: Evidence from italian adolescents living near ferroalloy industry

BACKGROUND: Research on the health effects of chemical mixtures has focused mainly on early life rather than adolescence, a potentially important developmental life stage. OBJECTIVES: We examined associations of a metal mixture with general cognition in a cross-sectional study of adolescents residing near ferromanga-nese industry, a source of airborne metals emissions. METHODS: We measured manganese (Mn), lead (Pb), copper (Cu), and chromium (Cr) in hair, blood, urine, nails, and saliva from 635 Italian adolescents 10–14 years of age. Full-scale, verbal, and performance intelligence quotient (FSIQ, VIQ, PIQ) scores were assessed using the Wechsler Intelligence Scale for Children-III. Multivariable linear regression and Bayesian kernel machine regression (BKMR) were used to estimate associations of the metal mixture with IQ. In secondary analyses, we used BKMR’s hierarchical variable selection option to inform biomarker selection for Mn, Cu, and Cr. RESULTS: Median metal concentrations were as follows: hair Mn, 0:08 lg=g; hair Cu, 9:6 lg=g; hair Cr, 0:05 lg=g; and blood Pb, 1:3 lg=dL. Adjusted models revealed an inverted U-shaped association between hair Cu and VIQ, consistent with Cu as an essential nutrient that is neurotoxic in excess. At low levels of hair Cu (10th percentile, 5:4 lg=g), higher concentrations (90th percentiles) of the mixture of Mn, Pb, and Cr (0:3 lg=g, 2:6 lg=dL, and 0:1 lg=g, respectively) were associated with a 2.9 (95% CI: −5:2, −0:5)–point decrease in VIQ score, compared with median concentrations of the mixture. There was suggestive evidence of interaction between Mn and Cu. In secondary analyses, saliva Mn, hair Cu, and saliva Cr were selected as the biomarkers most strongly associated with VIQ score. DISCUSSION: Higher adolescent levels of Mn, Pb, and Cr were associated with lower IQ scores, especially at low Cu levels. Findings also support fur-ther investigation into Cu as both beneficial and toxic for neurobehavioral outcomes

CRIPTO and its signaling partner GRP78 drive the metastatic phenotype in human osteotropic prostate cancer

CRIPTO (CR-1, TDGF1) is a cell surface/secreted oncoprotein actively involved in development and cancer. Here, we report that high expression of CRIPTO correlates with poor survival in stratified risk groups of prostate cancer (PCa) patients. CRIPTO and its signaling partner glucose-regulated protein 78 (GRP78) are highly expressed in PCa metastases and display higher levels in the metastatic ALDHhigh sub-population of PC-3M-Pro4Luc2 PCa cells compared with non-metastatic ALDHlow. Coculture of the osteotropic PC-3M-Pro4Luc2 PCa cells with differentiated primary human osteoblasts induced CRIPTO and GRP78 expression in cancer cells and increases the size of the ALDHhigh sub-population. Additionally, CRIPTO or GRP78 knockdown decreases proliferation, migration, clonogenicity and the size of the metastasis-initiating ALDHhigh sub-population. CRIPTO knockdown reduces the invasion of PC-3M-Pro4Luc2 cells in zebrafish and inhibits bone metastasis in a preclinical mouse model. These results highlight a functional role for CRIPTO and GRP78 in PCa metastasis and suggest that targeting CRIPTO/GRP78 signaling may have significant therapeutic potential.Oncogene advance online publication, 10 April 2017; doi:10.1038/onc.2017.87

Automatically Segmenting the Left Atrium from Cardiac Images Using Successive 3D U-Nets and a Contour Loss

International audienceRadiological imaging offers effective measurement of anatomy, which is useful in disease diagnosis and assessment. Previous study has shown that the left atrial wall remodeling can provide information to predict treatment outcome in atrial fibrillation. Nevertheless, the segmentation of the left atrial structures from medical images is still very time-consuming. Current advances in neural network may help creating automatic segmentation models that reduce the workload for clinicians. In this preliminary study, we propose automated, two-stage, three-dimensional U-Nets with convolutional neural network, for the challenging task of left atrial segmentation. Unlike previous two-dimensional image segmentation methods, we use 3D U-Nets to obtain the heart cavity directly in 3D. The dual 3D U-Net structure consists of, a first U-Net to coarsely segment and locate the left atrium, and a second U-Net to accurately segment the left atrium under higher resolution. In addition, we introduce a Contour loss based on additional distance information to adjust the final segmentation. We randomly split the data into training datasets (80 subjects) and validation datasets (20 subjects) to train multiple models, with different augmentation setting. Experiments show that the average Dice coefficients for validation datasets are around 0.91 - 0.92, the sensitivity around 0.90-0.94 and the specificity 0.99. Compared with traditional Dice loss, models trained with Contour loss in general offer smaller Hausdorff distance with similar Dice coefficient, and have less connected components in predictions. Finally, we integrate several trained models in an ensemble prediction to segment testing datasets