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This document discusses the potential use of serum protein electrophoresis (SPE) as a screening tool for alpha-1 antitrypsin deficiency (AATD), a heritable condition that can lead to pulmonary and hepatic diseases. The study, conducted in four Italian hospitals, found that using the alpha1-globulin band in SPE can effectively detect AATD variants. The authors suggest that implementing SPE for population screening could lead to early intervention and improved outcomes for AATD patients. However, they note that SPE is not a diagnostic tool and cannot differentiate between different AATD variants or clinical phenotypes. Further research is needed to understand the clinical relevance of these findings. [Extracted from the article]

Background: Altered serum magnesium (Mg) levels in older persons have been hypothesized to have a role in predicting hospitalization and mortality. Hypomagnesemia and delirium are frequent problems in older patients, but no study has evaluated such an association in acute geriatric setting. Aims: We investigated the impact of hypomagnesemia on the incidence of delirium in an acute geriatric setting. Methods: This retrospective study was conducted on 209 older hospitalized patients. All subjects underwent a comprehensive geriatric assessment. Mg was measured in serum by routine laboratory methods. The presence of incident delirium was determined by the 4AT screening tool. A logistic regression model was used to assess the association between serum Mg and delirium controlling for multiple covariates. Results: 209 patients (77.9% women) were included in the study. The mean age of the participants was 85.7 ± 6.50 years (range 65–100). 27 subjects (12.9%) developed delirium during the hospitalization, with no difference between genders. Subjects with delirium had lower serum magnesium levels than those without (1.88 ± 0.34 versus 2.04 ± 0.28; p = 0.009). Delirium risk was significantly higher in patients with lower serum magnesium levels (OR 5.80 95% CI 1.450–23.222; p = 0.013), independent of multiple covariates. Conclusion: Our data show that low serum Mg level is a good predictor of incident delirium in acute geriatric settings. Present findings have relevant implications for clinical management, highlighting the need for analyzing Mg concentration carefully. Whether Mg supplementation in patients with hypomagnesemia could lead to delirium prevention and/or control needs further investigation. [ABSTRACT FROM AUTHOR]

Summary: To slow down the coronavirus disease 2019 (COVID‐19) pandemic an unequalled vaccination campaign was initiated. Despite proven efficacy and safety, a rare but potentially fatal complication of adenoviral‐vector vaccines, called vaccine‐induced immune thrombotic thrombocytopenia (VITT), has emerged the pathogenesis of which seems to be related to the development of platelet‐activating anti‐platelet factor 4 (PF4) antibodies. While a few studies have evaluated the incidence of anti‐PF4 positivity in anti‐severe acute respiratory syndrome coronavirus‐2 (SARS‐CoV‐2) vaccine recipients, to date no studies have assessed whether an antiplatelet immunological response develops and if this associates with platelet and blood clotting activation. We carried out a prospective study in healthy subjects who received the first dose of ChAdOx1 or Ad26.COV2.S or BNT162b2 vaccines to evaluate platelet‐specific and non‐specific immune response and in vivo platelet activation and blood clotting activation. Individuals receiving ChAdOx1 and, less so, Ad26.COV2.S developed with high frequency auto‐ or alloantiplatelet antibodies, increased circulating platelet‐derived microvesicles and soluble P‐selectin associated with mild blood clotting activation. Our study shows that an immunological reaction involving platelets is not uncommon in individuals receiving anti‐SARS‐CoV‐2 vaccination, especially after ChAdOx1 and Ad26.COV2.S, and that it associates with in vivo platelet and blood clotting activation. [ABSTRACT FROM AUTHOR]

The kappa index (K-Index), calculated by dividing the cerebrospinal fluid (CSF)/serum kappa free light chain (KFLC) ratio by the CSF/serum albumin ratio, is gaining increasing interest as a marker of intrathecal immunoglobulin synthesis. However, data on inter-laboratory agreement of these measures is lacking. The aim was to assess the concordance of CSF and serum KFLC measurements, and of K-index values, across different laboratories. KFLC and albumin of 15 paired CSF and serum samples were analyzed by eight participating laboratories. Four centers used Binding Site instruments and assays (B), three used Siemens instruments and assays (S), and one center used a Siemens instrument with a Binding Site assay (mixed). Absolute individual agreement was calculated using a two-way mixed effects intraclass correlation coefficient (ICC). Cohen's kappa coefficient (k) was used to measure agreement on positive (≥5.8) K-index values. There was an excellent agreement in CSF KFLC measurements across all laboratories (ICC (95% confidence interval): 0.93 (0.87–0.97)) and of serum KFLC across B and S laboratories (ICC: 0.91 (0.73–0.97)), while ICC decreased (to 0.81 (0.53–0.93)) when including the mixed laboratory in the analysis. Concordance for a positive K-Index was substantial across all laboratories (k = 0.77) and within S laboratories (k = 0.71), and very good (k = 0.89) within B laboratories, meaning that patients rarely get discordant results on K-index positivity notwithstanding the testing in different laboratories and the use of different platforms/assays. [ABSTRACT FROM AUTHOR]

Background: Cardiovascular diseases due to atherosclerosis represent the major cause of disability and mortality in old age subjects. The atherosclerotic process is linked to a low grade of systemic inflammation with the involvement of many cytokines and inflammatory proteins. Among them, evidence from animal studies suggests that IL-13 has a protective property. However, the role of IL-13 in the pathogenesis of atherosclerosis in humans is still unknown. Aims: With this study, we aim to investigate a potential association between IL-13 and carotid intima-media thickness (IMT) in old age subjects. Methods: This is a retrospective study conducted among 79 old age subjects (over 75 years old). All subjects underwent IMT assessment by high-resolution B-mode ultrasonography and IL-13 measurement in serum by ELISA. Results: Subjects (41 M/38F) had a mean age of 81.0 ± 4.5 years and were mostly overweight. Stratifying the whole cohort by IMT thickness (IMT ≤ 0.9, n = 17; IMT ≥ 1 and ≤ 1.3, n = 50; IMT ≥ 1.4, n = 12) among the main variables explored, only BMI and triglycerides differed among groups, having subjects with higher IMT significantly higher BMI and lower triglycerides. Serum IL-13 levels significantly differed among groups having subjects with IMT ≥ 1.4 lower levels as compared to other groups (p < 0.0001). In all sample population, IMT values significantly correlate with IL-13 levels (r = − 0.454, p < 0.0001). Indeed, a linear regression analysis showed that independent of age, gender, body mass index, triglycerides, systolic blood pressure, statin use and smoking habit, lower IL-13 serum levels were associated with higher IMT values. Conclusions: IL-13, an anti-inflammatory cytokine, may have a protective role in the human atherosclerotic process. It could be used as an effective and promising novel therapeutic target development. [ABSTRACT FROM AUTHOR]

Background: Elevated peripheral levels of different cytokines and chemokines in subjects with Alzheimer's disease (AD), as compared with healthy controls (HC), have emphasized the role of inflammation in such a disease. Considering the cross-talking between the central nervous system and the periphery, the inflammatory analytes may provide utility as biomarkers to identify AD at earlier stages.Objective: Using an advanced statistical approach, we can discriminate the interactive network of cytokines/chemokines and propose a useful tool to follow the progression and evolution of AD, also in light of sex differences.Methods: A cohort of 289 old-age subjects was screened for cytokine and chemokine profiling, measured in plasma, after a thorough clinical and neuropsychological evaluation. A custom algorithm based on Fisher linear discriminant analysis was applied to ascertain a classification signature able to discriminate HC from mild cognitive impairment (MCI) and AD.Results: We observed that a joint expression of three proteins (a "signature" composed by IFN-α2, IL-1α, TNFα) can discriminate HC from AD with an accuracy of 65.24%. Using this signature on MCI samples, 84.93% of them were classified as "non-HC". Stratifying MCI samples by sex, we observed that 87.23% of women were classified as "non-HC", and only 57.69% of males. Indeed, in a scatter plot of IFN-α2 and IL-1α, the HC group was better separated from MCI and AD in women as compared with men.Conclusion: These findings suggest that AD is accompanied by a peripheral inflammatory response that can already be present in MCI subjects, thus providing a mean for detecting this at-risk status and allow an anticipated intervention. [ABSTRACT FROM AUTHOR]

Flood mapping and estimation of the maximum water depth are essential elements for the first damage evaluation, civil protection intervention planning and detection of areas where remediation is needed. In this work, we present and discuss a methodology for mapping and quantifying flood severity over floodplains. The proposed methodology considers a multiscale and multisensor approach using free or low-cost data and sensors. We applied this method to the November 2016 Piedmont (northwestern Italy) flood.We first mapped the flooded areas at the basin scale using free satellite data from low- to mediumhigh- resolution from both the SAR (Sentinel-1, COSMOSkymed) and multispectral sensors (MODIS, Sentinel-2). Using very- and ultra-high-resolution images from the lowcost aerial platform and remotely piloted aerial system, we refined the flooded zone and detected the most damaged sector. The presented method considers both urbanised and nonurbanised areas. Nadiral images have several limitations, in particular in urbanised areas, where the use of terrestrial images solved this limitation. Very- and ultra-high-resolution images were processed with structure from motion (SfM) for the realisation of 3-D models. These data, combined with an available digital terrain model, allowed us to obtain maps of the flooded area, maximum high water area and damaged infrastructures. [ABSTRACT FROM AUTHOR]

Flood mapping and estimation of maximum water depth are essential elements for a first damages evaluation, civil protection interventions planning and detection of areas where remedial are more needed. In this work, we present and discuss a methodology for mapping and quantifying flood severity over plain areas. The proposed methodology considers a multiscale and multi-sensor approach using free or low-cost data/sensors. We applied this method to November 2016 Piemonte (NW Italy) flood. We first mapped flooded areas at basin scale using free satellite data from low to medium-high resolution using both SAR (Sentinel-1, Cosmo-Skymed) and multispectral sensors (MODIS, Sentinel-2). Using very- and ultra- high-resolution images from the low-cost aerial platform and Remotely Piloted Aerial System, we refined the flooded zone, and we detected the most damaged sector. The presented method considers both urbanized and not urbanized areas. Nadiral images have several limitations in particular in urbanized areas, where the use of terrestrial images solved this limitation. Very- and ultra-high resolution images have been processed with Structure from Motion (SfM) for the realization of 3-D models. These data, combined with available digital elevation model, allowed us to obtain maps of flooded area, maximum water high and damaged infrastructures. [ABSTRACT FROM AUTHOR]

Objective: To delineate thromboelastographic profiles of the premature infants with and without intracranial hemorrhage during the first 21 days of life. Methods: In this study, 49 premature infants (24 female; 25 male) were consecutively admitted at our neonatal intensive care unit during a 6 months period were subject to thromboelastography and standard coagulation assessments at birth and weekly up to 21 days. Sixteen out of 49 infants developed intracranial hemorrhage at birth. Results: The test results of 127/196 were considered eligible for analysis. Overall significant changes of the main thromboelastographic parameters were observed shortly after birth. Newborns with intracranial hemorrhage showed increased thromboelastogram-defined thrombin generation (shorter R and time to maximum amplitude times) from birth onward, suggesting a hypercoagulable state. No significant differences concerning thromboelastographic and coagulation assays parameters were found at birth between infants with and without intracranial hemorrhage, except for higher plasma D-Dimer concentration (p = 0.002) in the former infants. Finally, a positive correlation between clot lysis time and gestational age (Spearman's rho = 0.502,p = 0.002) was observed. Conclusions: Thromboelastographic profiles of the premature infants suggest an effective hemostatic function during the first post-natal weeks. Further study is needed to determine whether thromboelastography may be more useful than coagulation assays to reflect the bleeding risk of the premature infants. [ABSTRACT FROM AUTHOR]

Aim: To evaluate, in a large population, differences in HDL levels between subjects with acute phase reaction (APR) and subjects without different HDL decreases depending on disease causing APR and correlations between HDL and APR parameters. Materials & methods: In 902 patients we retrospectively evaluated alpha-2-globulins, white blood cells, C-reactive protein (CRP) and lipid profiles. APR was defined by CRP >1.5 mg/dl. Patients were reselected in seven subsets: infections, rheumatic diseases, neoplasms, cerebro-cardiovascular diseases, traumatic/mental disorders, endocrine/metabolic diseases and controls. Results: Subjects with APR showed significantly lower HDL-C (age and gender adjusted). Subset 'infections' showed the lowest HDL-C values and the highest CRP values. HDL-C had inverse significant correlation with all APR parameters. At stepwise regression analysis gender, albumin, TG and CRP were independent predictors of HDL-C. Conclusion: Our data produced the observation that subjects with APR show HDL-C levels lower than non-APR subjects to a large and heterogeneous population. HDL-C levels decrease in a different manner on the basis of the disease causing APR, maybe depending on inflammation intensity. [ABSTRACT FROM AUTHOR]

Introduction: The aim of the study was to evaluate the effects of postoperative administration of glutamine on the subjective perception of fatigue after major surgery. A prospective controlled clinical trial was conducted with a quasi-randomization method, enrolling cancer patients undergoing major elective surgery and treated with intravenous glutamine supplementation. Materials and Methods: Twenty-two well-nourished or slightly undernourished cancer patients were enrolled and divided into 2 groups. Both groups received isocaloric and protein-sparing nutritional support (1215 Kcal; 7.3 g N) by a peripheral parenteral nutrition device for 7 days after the operation. The glutamine group also received an intravenous glutamine supplement (20 g/day) on the first 6 postoperative days. We measured biochemical, clinical and anthropometric parameters including prealbumin, albumin, retinol-binding protein, transferrin, C-reactive protein, lymphocytes, fatigue (by visual analogue scale), handgrip force (by dynamometer), weight, height, mid-arm circumference and triceps skinfold thickness. Results: Each group was analyzed for significant values with Student’s t-test. A better response of transferrin and retinol-binding protein was measured in the glutamine group (p<0.05). Within each group, the time course of parameters was analyzed. The results were presented in the form of a paired t-test and showed a favorable trend for prealbumin, albumin and mid-arm circumference. A controversial result was obtained during the first postoperative days for C-reactive protein and postoperative fatigue. Conclusions: Glutamine supplementation in well-nourished or slightly undernourished cancer patients undergoing major elective surgery does not seem to improve postoperative fatigue, but ameliorates biohumoral recovery and nutritional status after major surgery [ABSTRACT FROM AUTHOR]