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The aim of this research is to develop a multiparametric downscaling analysis for the detection of abandoned waste in the environment. This methodology, using a multi-technological approach, involves the adoption VHR satellite images, Unmanned Aircraft System (UAS) and Unmanned Ground Vehicles (UGV). The identified Warning Areas (WA) will be investigated through an in-situ analysis with air quality measurement devices based on advanced sensors mounted on drones. The creation of a Cadastre Accumulation of Abandoned Materials (CAMA) and the related APP will allow the administrations to monitor the phenomenon. Finally, the waste product analysis, retrieved by means of UAS dataset computation, allows to retrieve some interesting prospects regarding Waste to Energy framework. Here, preliminary results obtained by the on-going INTESA Project are presented.

Objective This study was performed to evaluate the prognostic meaning of volumetric and semi-quantitative parameters measured using [18F]FDG PET/CT and somatostatin receptor (SSTR) imaging in patients with typical lung carcinoid (TC), and their relationship with proliferative index (Ki67). Methods We retrospectively reviewed 67 patients (38–94 years old, mean: 69.7) with diagnosis of TC who underwent [18F]FDG PET/CT and/or SSTR scintigraphy/SPECT with [111In]DTPA-Octreotide plus contrast-enhanced CT (CECT) at staging evaluation. All patients had Ki67 measured and a follow-up (FU) of at least 1 year. SSTR density (SSTRd) was calculated as the percentage difference of tumor/non-tumor ratio at 4 and 24 h post-injection. At PET/CT, metabolic activity was measured using SUVmax and SUVratio; volumetric parameters included MTV and TLG of the primary tumor, measured using the threshold SUV41%. ROC analysis, discriminant analysis and Kaplan–Meier curves (KM) were performed. Results 11 patients died during FU. Disease stage (localized versus advanced), SUVratio, SUVmax, Ki67, MTV and TLG were significantly higher in non-survivors than in survivors. ROC curves resulted statistically significant for Ki67, SUVratio, SUVmax, MTV and TLG. On multivariate analysis, stage of disease and TLG were significant independent predictors of overall survival (OS). In KM curves, the combination of disease stage and TLG identified four groups with significantly different outcomes (p In patients with advanced and localized disease, SSTRd proved to be the best imaging prognostic factor for progression and for disease-free survival (DFS), respectively. In localized disease, SSTRd 31.5% identified two subgroups of patients with significant different DFS distribution and in advanced disease, a high cutoff value (58.5%) was a significant predictor of adverse prognosis. Conclusion Volumetric and semi-quantitative parameters measured using [18F]FDG PET/CT and SSTR imaging combined with Ki67 may provide a reference for prognosis evaluation of patients with TC, to better stratify risk groups with the goal of developing individualized therapeutic strategies.

Aging, a time-dependent loss of physiological function, and its drivers are turning into a significant topic of research as the population's mean age increases. Epigenetic alterations, telomere shortening or dysfunction, mitogenic stress, oxidative stress, or accumulation of DNA damage can drive the cell to senescence: a permanent cell cycle arrest sometimes associated with a secretory phenotype and inflammatory consequences in the surrounding tissue. The amount of senescent cells grows over time in older organisms and may induce tissue inflammation and threaten overall tissue homeostasis, favoring aging. Senolytic and senomorphic therapeutics are an emerging approach to eliminate senescent cells or to block their secretory phenotypes respectively. Given that people living with HIV suffer non-AIDS comorbidities in a higher prevalence than the general population, aging is accentuated among them. Inflammation biomarkers may be helpful to assess prognosis or act as surrogate endpoints for studies of strategies focused on reversal of HIV-associated accelerated aging. This review summarizes the latest findings in aging and its major drivers, under the light of HIV infection. Since the number of older PLWH is currently rising, it will be of great importance to address and treat their age-related conditions, as well as to better decipher their biological mechanisms.

This review collects initiatives and legal decisions designed to mitigate discrimination in pretrial decision making, jury selection, jury unanimity, and jury deliberations. It also reviews initiatives to interrupt implicit racial biases. Among these, Washington's new rule for jury selection stands alone in treating racism as the product of both individual actors’ decisions and long-standing legal structures. Washington's rule shows the limits of recent US Supreme Court decisions addressing discrimination in cases with unusual and clearly problematic facts. The court presents these cases as rare remediable aberrations, ignoring the well-documented history of racism in jury selection. The final section juxtaposes limited reforms with the contemporary prison abolitionist movement to illuminate boundaries of incremental reforms. Reforms must reflect cognizance of the extent to which racism exists at multiple levels. Reforms that do not are less likely to make change, because they are either narrow in scope or focused on discrimination by individuals.

Background The European Network of Medical Residents in Public Health (EuroNet MRPH) is a non-profit, international, independent and non-governmental network of national associations of public health residents around Europe. Objectives To describe the results accomplished by EuroNet MRPH and to show networking opportunities provided to medical residents in public health (MRPH) from 2011 to 2021. Results EuroNet's mission is to improve and facilitate connection between MRPH, to promote pan-European Research, and to facilitate international mobility. Digital and quarterly face-to-face meetings are used as a way of communication. Since 2011, 10 European MRPH associations and 4 individual members have joined the network, representing the UK, France, Spain, Italy, Portugal, Ireland, the Netherlands, Croatia, Slovenia, Turkey, Malta, Poland, Bosnia and Herzegovina, and Austria. In this period, 27 face-to-face meetings have been organised, promoting cooperation and exchanging of ideas between MRPH. Moreover, three working groups (WG) have been established, focusing on research, internships, and communication. Regarding research, studies about e-cigarettes, conflicts of interest, and the impact of COVID-19 on mental health of MRPH have been conducted. When it comes to internships, more than 20 possible destinations and an online form are available on our website, providing MRPH information and support. Finally, thanks to the communication WG, 20 newsletters have been published, sharing experiences and thoughts from members of the network. Moreover, EuroNet has an established presence in social media, with active accounts in Twitter, Instagram and Facebook, where public health information and opportunities for young professionals are promoted. Conclusions In the last ten years, EuroNet MRPH has actively promoted networking opportunities among European Medical Residents in Public Health. Key messages Enhancing international cooperation among young public health professionals is fundamental in order to face current and future public health challenges. EuroNet MRPH represents a useful tool to promote collaboration among young public health professionals.

The Eighth Amendment's “narrowing” requirement for capital punishment eligibility has challenged states since it was recognized in Furman v. Georgia in 1972. This article examines whether California's death penalty scheme complies with this requirement by empirically analyzing 27,453 California convictions for first‐degree murder, second‐degree murder, and voluntary manslaughter with offense dates between January 1978 and June 2002. Using a 1,900‐case sample, we examine whether California's death penalty statute fails to comply with the Eighth Amendment's narrowing test. Our findings support two conclusions. First, the death‐eligibility rate among California homicide cases is the highest in the nation during that period and in the ensuing decade. We find that 95 percent of all first‐degree murder convictions and 59 percent of all second‐degree murder and voluntary manslaughter convictions were death eligible under California's 2008 statute. Second, a death sentence is imposed in only a small fraction of the death‐eligible cases. The California death sentencing rate of 4.3 percent among all death‐eligible cases is among the lowest in the nation and over two‐thirds lower than the death‐sentencing rate in pre‐Furman Georgia.

This study of individualized jury selection for 792 potentialjurors across 12 North Carolina capital cases, selected with purposive case selection, analyzes the conversations that occur during voir dire to examine the process that produces decisions about who serves on juries. Lawyers question prospective jurors in voir dire partly to gather information about prospective jurors' ability to decide a case without prejudice.Jury selection, however, suffers from what social scientists call demand characteristics. Demand characteristics provide a respondent with clues about the expected response and interfere with effective information gathering. We identified two characteristics that bear on the presence and strength of demand characteristics: the form and tone of the question. We sorted all 8,583 general legal opinion questions along a four-step scale by combining these characteristics. We then used tine-series analyses to examine responses to these questions in sequence. Juror responses were longest and most likely to include an affective utterance when the demand characteristics were weaker, and that loquaciousness and affect fell at each step of the scale. An independent qualitative study replicated these findings, and supported the assertion that length and form are valid measures of quality in this context.

Social media could be considered as an interesting complementary tool to the public health domain. Although the literature has studied in detail the efficacy of some of these platforms, it is unclear whether Instagram® can play a role in the adoption of long-term healthy habits. A healthy food Instagram account called the "ChefTaste" was created to assess both the impact of this platform and the time needed for it to exert influence on its followers. After six months, a cross-sectional study was conducted. Out of 493 candidates, 171 did not follow any healthy food account, 204 followed "ChefTaste" account and 118 fol-lowed other healthy food accounts. Users who followed any healthy food account had a higher probability of not just eating better [OR=1.50 (1.03,2.18) p=0.036] but also indulging in more exercise [OR=1.46 (1.00,2.13) p=0.048] and were more cautious about what they were eating [OR=1.67 (1.13, 2.46) p=0.01]. Furthermore, on comparing the results of "ChefTaste" followers with those of other healthy accounts, we found there were no statistically significant differences with respect to healthy eating and weekly exercise. These findings demonstrate the effectiveness of Instagram® which could be explained by its social support and simplicity. Authors, therefore, believe that Instagram® could play a potential tool in improving the lifestyle of individuals.

Background: Understanding the risk factors associated with hospital burden of COVID-19 is crucial for healthcare planning for any future waves of infection. Methods: An observational cohort study is performed, using data on all RT-PCR confirmed cases of COVID-19 in Regione Lombardia, Italy, during the first wave of infection from February-June 2020. A multi-state modelling approach is used to simultaneously estimate risks of progression through hospital to final outcomes of either death or discharge, by pathway (via critical care or not) and the times to final events (lengths of stay). Logistic and time-to-event regressions are used to quantify the association of patient and population characteristics with the risks of hospital outcomes and lengths of stay respectively. Findings: Risks of severe outcomes such as ICU admission and mortality have decreased with month of admission and increased with age. Care home residents aged 65+ are at increased risk of hospital mortality and decreased risk of ICU admission. Being a healthcare worker appears to have a protective effect on mortality risk and length of stay. Lengths of stay decrease with month of admission for survivors, but do not appear to vary with month for non-survivors. Interpretation: Improvements in clinical knowledge, treatment, patient and hospital management and public health surveillance, together with the waning of the first wave after the first lockdown, are hypothesised to have contributed to the reduced risks and lengths of stay over time. Funding: This work has been funded by the Medical Research Council (De Angelis, Jackson, Presanis: Unit programme number MC UU 00002/11; Kunzmann: Unit programme number MC_UU_00002/10); and the UKRI-MRC COVID-19 Rapid Call (Presanis, De Angelis, grant no MC_PC_19074). Declaration of Interests: None to declare.

The pandemic character of coronavirus disease-19 (COVID-19) requires strategy changes designed to guarantee the safety of patients and health-care professionals. We are greatly concerned by the limitations in the operation of pulmonary function test (PFT) laboratories, since there is a high risk of disease progression in patients with chronic pulmonary diseases, and we are now faced by the influx of a new group of individuals in the recovery phase of post-COVID-19-syndrome that requires evaluation and follow-up of their respiratory function. To reestablish the operation of PFT laboratories limiting the risk of cross-contamination, we herein present the consensus reached by a group of experts in respiratory physiology, most of whom work in PFT laboratories in several Latin American countries, on the applicable recommendations for severe acute respiratory syndrome coronavirus 2 pneumonia survivors when undergoing PFT. We present the safety and hygiene measures that must be adopted in laboratories or centers where PFT is conducted in adults and/or children. These recommendations answer the following questions: which PFT is most recommended in subjects that have recovered from COVID-19; what quality control and safety measures should PFT laboratories implement during this pandemic? And how should we approach non-COVID-19 patients requiring PFT?

El objetivo de este trabajo es estudiar las características del xilema de las raíces de Arachis hypogaea L. en suelos con horizontes densificados y distinta condición hídrica. Este trabajo se llevó a cabo en dos parcelas de la región subhúmeda seca del Opto. Río Cuarto, con suelos Haplustoles típicos. Las raíces de ambas parcelas no presentan diferencias significativas en el área total transversal y área xilemática, sin embargo, cuando la humedad media del suelo es mayor y la resistencia mecánica menor, se observa mayor diámetro, espesor de pared y frecuencia de elementos conductores xilemáticos. En la otra parcela se observa que las ralees presentan un área xilemática similar pero menores valores en las características mencionadas de los miembros de vaso, por lo tanto, debe necesariamente presentar mayor proporción de tejido parenquimático. Este aporte demuestra como pequeños cambios en el contenido hídrico del suelo afectan la estructura del xilema.

BackgroundHuman SARS-CoV-2 infection can induce a wide spectrum of organ dysfunctions, including microvascular impairment [1]. S1 subunit of viral receptor-binding domain binds to the angiotensin-converting enzyme 2 receptor on endothelium and S2 subunit allows the virus to enter endothelial cells. The resulting breakdown of barrier integrity drives a cascade of inflammatory and thrombotic events, that aggravate the course of COVID-19 together with other risk factors [2-4]. Up to date, a lower capillary density has been reported in several distinct body districts, using sublingual video microscopy, ocular optical coherence tomography angiography, skin functional laser Doppler perfusion imaging and nailfold videocapillaroscopy (NVC) [5-8]. NVC examination has been performed in adult COVID-19 patients, however, without a control group [8].ObjectivesTo confirm the statistical significance of the reduction in capillary density per linear millimeter evaluated by NVC in comparison with primary Raynaud’s phenomenon (PRP) patients and control subjects (CNT) and to evaluate the impact of an aggressive therapy against COVID-19 on the sparing in the number of capillaries.MethodsSixty-one COVID-19 survivors, thirty-one PRP patients and thirty CNT age and sex-matched underwent NVC analysis. Demographic and clinical data of COVID-19 survivors were collected with special regard to concomitant therapies, that included antivirals, antibiotics, anticoagulants and anti-inflammatory/immunomodulant drugs (glucocorticoids, hydroxychloroquine, IL-6 receptor antagonist). COVID-19 survivors were divided in two subgroups according to the severity of the active infection: thirty-four survivors with past mild-moderate disease (either unneedy for oxygen supplementation or need for Venturi mask) and twenty-seven survivors with past severe disease (need for Continuous Positive Airways Pressure and/or mechanical ventilation). The same Rheumatologist performed NVC evaluations in all patients and controls, using an optical probe, equipped with a 200x magnification lens and connected to a picture analysis software (Videocap, DS Medica, Milan, Italy). Absolute capillary number per linear millimeter was counted.ResultsCOVID-19 survivors underwent NVC examination after a mean period of 126±53 days from the disease onset. Multivariate analysis showed differences in absolute capillary number per linear millimeter (pConclusionSARS-CoV-2 infection seems associated to a significant capillary loss as distinctive NVC feature and data concerning the comparison of capillary density pre COVID-19 and post COVID-19 are desirable to reinforce this observation. The positive trend in saving the number of capillaries induced by aggressive anti-inflammatory therapies in COVID-19 survivors needs larger cohorts of patients.References[1]Rovas A et al. Angiogenesis. 2021;24:145-157.[2]Raghavan S et al. Front Cardiovasc Med. 2021;8:687783.[3]Cutolo M et al. RMD Open. 2020;6:e001454.[4]Sulli A et al. Nutrients. 2021;13(3):717.[5]Kanoore Edul VS et al. J Crit Care. 2021;61:73-75.[6]Teo KY et al. Am J Ophtalmol. 2021;235:98-110.[7]Sabioni L et al. Microvasc Res. 2021;134:104119.[8]Natalello G et al. Microvasc Res. 2021;133:104071.Disclosure of InterestsEmanuele Gotelli: None declared, Alberto Sulli Grant/research support from: Laboratori Baldacci S.p.a., Pietro Francesco Bica: None declared, Irene Schiavetti: None declared, Teresita Aloe’: None declared, Marco Grosso: None declared, Emanuela Barisione: None declared, Carmen Pizzorni: None declared, Sabrina Paolino: None declared, Vanessa Smith Grant/research support from: Boehringer Ingelheim, Janssen-Cilag, Maurizio Cutolo Grant/research support from: Bristol-Myers Squibb, Celgene, Pfizer, Boehringer Ingelheim

BackgroundSarcoidosis (S) is a granulomatous disease with multi-organ involvement displaying a mixed immune-mediated pathophysiology. Raynaud’s phenomenon (RP) has been occasionally reported in S patients [1] and serum positivity for autoantibodies has been detected in S patients but their significance is debated [2].ObjectivesWe described nailfold videocapillaroscopy (NVC) findings and estimated the prevalence of serum anti-nuclear (ANA) and extractable nuclear antigen autoantibodies (ENA-Abs) in S patients, comparing them with age- and sex- matched healthy controls (HCs) and patients with primary Raynaud’s phenomenon (PRP). Secondarily, we analysed potential correlations between NVC findings with the occurrence of autoantibodies, immunomodulatory treatment, laboratory parameters, variables of pulmonary function and whole-body imaging.MethodsTwenty-seven (27) S patients, classified according to WASOG criteria[3], were assessed through NVC examination, laboratory parameters (including serum concentrations of angiotensin-converting enzyme [ACE], C-reactive protein [CRP], calcium, phosphorus, albumin, 25-hydroxyvitamin D, parathormone, ANA and ENA), pulmonary function tests (PFTs), chest-X ray and positron emission tomography/computerized tomography (PET/CT).Among NVC parameters, we analysed capillary dilations, giant capillaries, haemorrhages, nonspecific abnormalities, and capillary absolute number for mm [4].Pulmonary involvement was classified by X-ray Scadding staging system (SSS) scoring S patients in 4 grades [5]. From PET data, the maximum standard uptake value (SUVmax) was quantified as a variable of tissue 18-fluorodeoxyglucose hyper-uptake: consequently, S patients were defined PET-positive when SUV value ≥ 2.5. NVC parameters and ANA/ENA dosage were recorded also in 30 PRPs and 30 HCs.ResultsWe excluded, among the cohort of S patient, one participant having a systemic sclerosis in overlap with S. The remaining 26 S patients (mean age 56.5 ± 12.5 years, 53.8 % of females, disease duration 28.4 ± 55.1 months, 27% glucocorticoid-naïve) showed a significant higher rate of dilations and nonspecific abnormalities and a lower mean capillary absolute number than PRPs and HCs (p < 0.01 for all comparisons). (Figure 1)The prevalence of ANA positivity was significantly higher in S patients compared with PRPs and HCs (p < 0.02 for both). Among the whole cohort of patients only one S patient displayed a positive ENA-Ab (Ro52).In the analysis of S patients’ subgroup, a significant negative correlation was detected between serum ACE levels with the presence of capillary dilations (rho = -0.45, p = 0.04), between CRP and mean capillary absolute number (rho = -0.49, p = 0.02) and a positive correlation was also detected between the mean capillary absolute number and the forced vital capacity percentage (FVC%) (rho = 0.40, p = 0.04).ConclusionOur findings suggest a microvascular involvement in sarcoidosis whose investigation by NVC could be useful for the detection of an overlapping connective tissue disease and for the monitoring of the phenotypes of S patients displaying RP.The positivity for autoantibodies in S patients is in line with literature data suggesting, at least partially, autoimmune features of the disease or the production of autoantibodies reactive to tissue damage.The correlations between NVC findings with ACE levels and lung function variables generate hypotheses of a potential partial vascular impairment in sarcoidosis disease activity and lung involvement.References[1]Nigro A et al. Reumatismo 2004; 56: 278-81.[2]Kobak S et al. Autoimmune Diseases 2014[3]Judson M.A et al. Clin Rev Allergy Immunol 2015; 49: 63-78.[4]Smith V et al. Autoimmun Rev 2020; 19: 102458.[5]Scadding J.G. Br Med J 1961; 2: 1165-72.Disclosure of InterestsNone declared

To enhance the positive predictive value (PPV) of chest digital tomosynthesis (DTS) in the lung cancer detection with the analysis of radiomics features. The investigation was carried out within the SOS clinical trial (NCT03645018) for lung cancer screening with DTS. Lung nodules were identified by visual analysis and then classified using the diameter and the radiological aspect of the nodule following lung-RADS. Haralick texture features were extracted from the segmented nodules. Both semantic variables and radiomics features were used to build a predictive model using logistic regression on a subset of variables selected with backward feature selection and using two machine learning: a Random Forest and a neural network with the whole subset of variables. The methods were applied to a train set and validated on a test set where diagnostic accuracy metrics were calculated. Binary visual analysis had a good sensitivity (0.95) but a low PPV (0.14). Lung-RADS classification increased the PPV (0.19) but with an unacceptable low sensitivity (0.65). Logistic regression showed a mildly increased PPV (0.29) but a lower sensitivity (0.20). Random Forest demonstrated a moderate PPV (0.40) but with a low sensitivity (0.30). Neural network demonstrated to be the best predictor with a high PPV (0.95) and a high sensitivity (0.90). The neural network demonstrated the best PPV. The use of visual analysis along with neural network could help radiologists to reduce the number of false positive in DTS. • We investigated several approaches to enhance the positive predictive value of chest digital tomosynthesis in the lung cancer detection. • Neural network demonstrated to be the best predictor with a nearly perfect PPV. • Neural network could help radiologists to reduce the number of false positive in DTS.

Background:Vitamin D regulates the innate and adaptive immune system responses and low vitamin D levels have been associated with the increased risk of respiratory tract infections (1). Vitamin D deficiency has been recently reported to interfere with the prognosis of COVID-19 (2,3).Objectives:The aim of this study was to correlate the 25OH-vitamin D serum levels with lung involvement and disease severity, in a cohort of elderly patients hospitalized for SARS-CoV-2 infection.Methods:Sixty-five COVID-19 patients (mean age 76±13 years) and sixty-five sex- and age-matched control subjects (CNT) were included in the study. Respiratory parameters (PaO2, SO2, PaCO2, PaO2/FiO2), clinical and laboratory parameters (including 25OH-vitamin D, D-dimer, C-reactive protein) and type of radiological pulmonary involvement were collected at hospital admission. Statistical analysis was performed by non-parametric tests.Results:Vitamin D sufficiency (>30 ng/ml), insufficiency (between 20 and 30 ng/ml), deficiency (between 10 and 20 ng/ml) and severe deficiency (2 (p=0.05), PaO2 (p=0.03), PaO2/FiO2 (p=0.02). A statistically significant negative correlation was found between vitamin D serum levels and severity of radiologic pulmonary involvement: vitamin D was significantly lower in COVID-19 patients with either diffuse/severe interstitial lung involvement (p=0.05) or multiple lung consolidations (p=0.0001) than in those with mild radiological lung involvement. Significantly lower vitamin D serum levels were found in COVID-19 patients who died during hospitalization, compared to those who survived (median 3 vs 8 ng/ml, p=0.05). Finally, a statistically significant negative correlation was found between vitamin D serum levels and D-dimer (p=0.04), C-reactive protein (p=0.04) and disease duration (p=0.05).Conclusion:This study confirms that severe vitamin D deficiency is associated with more severe lung involvement, longer disease duration and risk of death in elderly COVID-19 patients.References:[1]Cutolo M, et al. RMD Open. 2020; 6(3):e001454.[2]Bilezikian JP, et al. Eur J Endocrinol. 2020; 183(5):R133-R147.[3]Weir EK, et al. Clin Med (Lond). 2020; 20:e107-e108.Disclosure of Interests:None declared

Background:COVID-19 is a multifaceted condition with a wide range of clinical manifestations, including microvascular/endothelial dysfunction, that starts in the early phase of the disease and may become dramatically harmful in the late stage, causing a massive pro-thrombotic state. Nailfold videocapillaroscopy (NVC) is the most used tool to identify microvascular status in a large spectrum of diseases [1]. Recently, non-specific NVC abnormalities have been described in a cohort of COVID-19 patients (no controls used) [2].Objectives:To assess microvascular damage in recovered COVID-19 patients (range of 40-270 days from recovery) by considering the previous severity of the disease, and, as mandatory, the comparison with matched individuals suffering from primary Raynaud’s phenomenon (PRP) and healthy volunteers (HV).Methods:NVC investigations were performed during standard clinical assessments in forty-four recovered COVID-19 patients (mean age 58±14 years, mean days from disease onset 129±54, mean days from disease recovery 106±52), twenty-two patients with PRP (mean age 60±15 years, mean years from disease onset 11±10) and twenty-two HV (mean age 60±14 years). COVID-19 patients were divided into two subgroups, according to the need of oxygen supplementation: twenty-two patients with severe lung involvement (need of Continuous Positive Airways Pressure and/or mechanical ventilation, mean age 57±12 years) vs twenty-two patients with mild-moderate lung involvement (need of Venturi mask or no need of oxygen supplementation, mean age 59±15 years). Clinical and demographic data of all the enrolled subjects were collected, during NVC examination. The following capillaroscopic parameters were evaluated: capillary number, dilated capillaries, giant capillaries, microhemorrhages, angiogenesis, disorganization of the microvascular array. A validated semiquantitative scoring (0-3) was adopted for NVC abnormalities [3-5]. Statistical analysis was carried out by non-parametric tests.Results:After COVID-19 recovery, no statistically significant difference was observed between COVID-19 patients and control groups of subjects concerning the score for the following NVC parameters: dilated capillaries, giant capillaries, disorganization of the microvascular array, angiogenesis. However, the capillary number per linear millimeter was significantly lower in COVID-19 patients (8.3±0.9) than in PRP (8.8±0.7, p=0.05) and HV (9.3±0.6, pConclusion:COVID-19 doesn’t seem to significantly induce, in short-term, specific alterations in peripheral microvascular array as evaluated by NVC, despite the severity of the disease, except for a significant reduction of the absolute number of nailfold capillaries. The topic needs longer time of evaluation and larger number of COVID-19 recovered cases to also assess the role of concomitant therapies.References:[1]Ingegnoli F et al. Curr Rheumatol Rev. 2018;14:5-11.[2]Natalello G et al. Microvasc Res. 2021;133:104071.[3]Smith V et al. Autoimmun Rev 2020;19:102458.[4]Cutolo M et al. Clin Rheumatol. 2019;38:2293-2297.[5]Sulli A et al. Ann Rheum Dis. 2008;67:885-7.Disclosure of Interests:None declared

In Batson v. Kentucky (1986), the US Supreme Court sought to eradicate racial discrimination in jury selection by prohibiting the exercise of peremptory strikes based on race. This chapter reviews the evidence that Batson has failed to protect jurors from race-based strikes and the reasons for this failure. The test for establishing racial discrimination set forth in Batson suffers from design flaws that make its enforcement difficult given common psychological mechanisms at work in the decision-making process and which may be exacerbated by the jury selection process itself. Batson seeks to remedy only intentional discrimination. Moreover, its capacity to ensure diverse juries is limited by the stages of jury selection that precede its application. Enforcing Batson effectively is critical to the system’s integrity, but no simple solutions exist to remedy the stubborn persistence of racial bias in jury selection. All of this suggests that measures are needed to strengthen Batson’s protections.

Despite intensive studies of the Trichophyton mentagrophytes species complex, its taxonomy still causes confusion. In this study, more than 70 dermatophytes were analyzed based on nuc rDNA ITS1-5.8S-ITS2 (ITS), D1–D2 domains of nuc 28S rDNA (D1D2), and β-tubulin gene (TUBB) sequences to clarify phylogenetic relationships in the complex. This demonstrated that strains of the complex were divided into three major lineages with high statistical support: (i) T. benhamiae and related species; (ii) T. simii and two related species, T. quinckeanum and T. schoenleinii; and (iii) T. mentagrophytes, T. interdigitale, and related species. The major lineages could be further divided into 18 phylogroups, representing either individual species or phylogenetically distinct groups within species. Among strains of T. benhamiae, African isolates American Type Culture Collection (ATCC) 28064 and 28065 formed a phylogenetically distinct phylogroup from their type strain and were considered a distinct species. Strains of T. mentagrophytes were divided into at least four phylogroups based on combined sequence analysis, but some phylogroups showed closer relationships to T. interdigitale, T. equinum, and T. tonsurans when compared by individual genes. This indicates that identifying those species with one gene could lead to incorrect results. For rapid identification of those dermatophytes, each phylogroup was tested by matrix-assisted laser desorption/ionization–time-of-flight (MALDI-TOF) mass spectrometry using a database with customized reference spectra of each phylogroup. This system was able to identify all the tested strains to species level with higher than 91% accuracy, except for strains of T. interdigitale. The three phylogroups of T. benhamiae were well distinguished from one another with high identification accuracy, whereas phylogroups of T. mentagrophytes were often cross-identified to one another or to T. interdigitale. Further research should improve identification accuracy for some species, but the results suggested that MALDI-TOF MS could be a rapid and efficient identification tool for closely related dermatophytes in the T. mentagrophytes species complex.

Trichosporon dermatis is a causative agent of several mycoses in immunocompromised patients but is often misidentified as Trichosporon mucoides due to their phenotypic resemblance. In order to evaluate the current identification keys for these species and to develop a rapid and reliable identification method, 11 strains of these yeasts were fully characterized in this study by traditional and advanced technologies. DNA sequences of the internal transcribed spacer (ITS), IGS1, and D1/D2 regions identified six of the yeasts as T. dermatis that were previously known as T. mucoides, including ATCC 204094 that has been used as the quality-control strain of T. mucoides for the VITEK 2 system and other commercial yeast identification kits. These two species could not be differentiated reliably by any previously known phenotypic keys for the species, such as growth patterns on ethylamine, phloroglucinol and tyramine, or by the VITEK 2 system. On the other hand, matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) proved to be a rapid and reliable identification tool for the two closely related yeasts. With newly added superspectra from fully authenticated reference strains, the VITEK MS system using MALDI-TOF MS successfully separated strains of T. dermatis and T. mucoides at a similarity level of approximately 67 % for the mass spectra data, and could identify these strains at the species level with 100 % accuracy in repeated tests. Furthermore, the in vitro susceptibility results indicated that itraconazole, posaconazole and voriconazole were more effective against both T. mucoides and T. dermatis than the other antifungal agents tested in this study.

This work focuses on the experimental study about the influence of microwave radiation (at 2.45 GHz of frequency) on the enzyme catalyzed hydrolysis of sucrose in aqueous solutions, in order to detect possible modifications in the whole reaction rate, and to identify the inhibition effect due to sucrose and/or to the hydrolysis product D-fructose. For comparison purposes, the same experimental conditions were applied both in the presence and in the absence of irradiation. The experimental concentrations were estimated from spectrophotometer acquisitions in the UV wavelengths, and data were fitted with proper kinetic models, taking into account the main reaction pathway and inhibition phenomena. The obtained results show a modification in the reaction kinetics due to the microwave application.

In this work, the bacterial consortium Bulab 5738 was used to simultaneously remove pyrene, phenanthrene and catechol from aqueous solutions. The bacterial population growth was estimated by means of optical density measurements while HPLC was used to quantify the pollutant concentration in the solution. The obtained data were used to model the systems, in term of biomass population and substrate concentration. The effects of pollutant concentration values were analysed using the outputs of a full factorial experimental design.

This work aims to develop a control system capable to maintain the viscosity curve measured in-line during the continuous production of a non-Newtonian fluid inside a range of values of viscosity which represent the target. Rheological models capable of relating the viscosity curve of the final product to the input variables were introduced to mimic changes in the production of a non-Newtonian fabric. A one-point control has been developed that acts modifying the mass flows of ingredients injected in the production plant to reject disturbances or track set-point changes. The developed controller is capable to maintain the viscosity curve inside the desired confidence range of viscosities. The methodology is easy to implement in similar continuous production processes by adjusting the model for other ingredients.

Background: Little is known about the variation in complication rates among U.S. hospitals that perform elective total hip arthroplasty (THA) and total knee arthroplasty (TKA) procedures. The purpose of this study was to use National Quality Forum (NQF)-endorsed hospital-level risk-standardized complication rates to describe variations in, and disparities related to, hospital quality for elective primary THA and TKA procedures performed in U.S. hospitals. Methods: We conducted a cross-sectional analysis of national Medicare Fee-for-Service data. The study cohort included 878,098 Medicare fee-for-service beneficiaries, sixty-five years or older, who underwent elective THA or TKA from 2008 to 2010 at 3479 hospitals. Both medical and surgical complications were included in the composite measure. Hospital-specific complication rates were calculated from Medicare claims with use of hierarchical logistic regression to account for patient clustering and were risk-adjusted for age, sex, and patient comorbidities. We determined whether hospitals with higher proportions of Medicaid patients and black patients had higher risk-standardized complication rates. Results: The crude rate of measured complications was 3.6%. The most common complications were pneumonia (0.86%), pulmonary embolism (0.75%), and periprosthetic joint infection or wound infection (0.67%). The median risk-standardized complication rate was 3.6% (range, 1.8% to 9.0%). Among hospitals with at least twenty-five THA and TKA patients in the study cohort, 103 (3.6%) were better and seventy-five (2.6%) were worse than expected. Hospitals with the highest proportion of Medicaid patients had slightly higher but similar risk-standardized complication rates (median, 3.6%; range, 2.0% to 7.1%) compared with hospitals in the lowest decile (3.4%; 1.7% to 6.2%). Findings were similar for the analysis involving the proportion of black patients. Conclusions: There was more than a fourfold difference in risk-standardized complication rates across U.S. hospitals in which elective THA and TKA are performed. Although hospitals with higher proportions of Medicaid and black patients had rates similar to those of hospitals with lower proportions, there is a continued need to monitor for disparities in outcomes. These findings suggest there are opportunities for quality improvement among hospitals in which elective THA and TKA procedures are performed. Level of Evidence: Therapeutic Level III. See Instruction to Authors for a complete description of levels of evidence.

Purpose The aim of this work was to optimize the Video Assisted Thoracoscopic Surgery (VATS) procedure through a new rotational geometry avoiding also the interference of the flat panel with infusion lines, vital monitoring equipment and intubation instrumentation. Methods The VATS technique was performed in the Hybrid Room environment that can be used at the same time as a diagnostic room and a surgical room. The C-Arm robotic angiography acquires cone beam CT with reduced angle rotation around the patient permitting the lateral decubitus access to thoracic surgeons with two different protocols: 12sDCTLargeVolume (12s) and 5sDRBODYCARE (5s). The first one allows to scan large volumes by twisting twice around the patient. The second protocol allows to shrink the field to the region of interest with a single pass. Organ dose and REID (Risk of Exposure-Induced Death) were estimated with Monte Carlo methods in PCXMC. Results The initial and final positions of the C-Arm rotation were changed from −170, +30 to −100, +100 in the 5s protocol reducing the risk of collision in case of critical cases (external lesions), wherever the bed is located. After optimization we reduced the dose of 80% in the 12s protocol and of 8.5 times in the 5s. the organ dose and REID are shown in the table. Conclusions VATS is a rapidly emerging surgical technique for the excision of lung nodules that permits to perform radical surgery of lung cancers to a larger cohort of patients and with a longer expectancy of life respect to conventional surgery. We optimized the protocol by changing rotational departure and arrival position avoiding collisions and reducing the dose.

IntroductionIn the Phase 3 ORACLE-MS trial in 616 subjects with a first demyelinating event at high risk of converting to multiple sclerosis (MS), treatment with cladribine tablets 10 mg (3.5 mg/kg or 5.25 mg/kg cumulative dose over 2 years [CT3.5 and CT5.25, respectively]) significantly delayed time to conversion to clinically definite multiple sclerosis (CDMS) according to Poser criteria (67% or 62% risk reduction [RR], respectively) and time to conversion to 2005 McDonald MS (50% or 57% RR, respectively), versus placebo. The objective was to analyze the effect of cladribine tablets vs placebo on converstion to CDMS and McDonald MS across ORACLE-MS patient subgroups based on baseline characteristics.MethodsIn this post-hoc analysis, time-to-conversion to CDMS or McDonald MS over the double-blind period was analyzed for patients treated with CT5.25 (N=204), CT3.5 (N=206) or placebo (N=206) across different subgroups. Subgroups were defined by baseline characteristics which have been investigated as potential predictors of CDMS conversion (age [ResultsTreatment with CT3.5 or CT5.25 was consistently efficacious across the subgroups examined on conversion to CDMS versus placebo for most comparisons (RR range: CT3.5, 39%–72%; CT5.25, 36%–79%). Similarly, treatment effect of both doses on conversion to 2005 McDonald MS was consistent across subgroups (CT3.5,40%–59%;CT5.25,42%–79%).ConclusionsThe effect of cladribine tablets on delaying the time-to-conversion to CDMS, or to McDonald MS, is consistent across subgroups.

Aims To evaluate the comparative efficacy (50% reduction in seizure frequency) and tolerability (premature withdrawal due to adverse events) of anti-epileptic drugs (AEDs) for refractory epilepsy. Methods We searched Cochrane Central Register of Controlled Trials (Cochrane Library 2009, issue 2) including Epilepsy Group's specialized register, MEDLINE (1950 to March 2009), EMBASE (1980 to March 2009), and Current Contents Connect (1998 to March 2009) to conduct a systematic review of published studies, developed a treatment network and undertook a network meta-analysis. Results Forty-three eligible trials with 6346 patients and 12 interventions, including placebo, contributed to the analysis. Only three direct drug comparator trials were identified, the remaining 40 trials being placebo-controlled. Conventional random-effects meta-analysis indicated all drugs were superior in efficacy to placebo (overall odds ratio (OR] 3.78, 95% CI 3.14, 4.55) but did not permit firm distinction between drugs on the basis of the efficacy or tolerability. A Bayesian network meta-analysis prioritized oxcarbazepine, topiramate and pregabalin on the basis of short term efficacy. However, sodium valproate, levetiracetam, gabapentin and vigabatrin were prioritized on the basis of short-term efficacy and tolerability, with the caveat that vigabatrin is recognized as being associated with serious visual disturbance with chronic use. Conclusion Of the wide range of AEDs licensed for the treatment of refractory epilepsy, sodium valproate, levetiracetam and gabapentin demonstrated the best balance of efficacy and tolerability. Until regulators mandate greater use of active comparator trials with longer term follow-up, network meta-analysis provides the only available means to quantify these clinically important parameters.

ZNF224 is a member of the Kruppel-associated box zinc finger proteins (KRAB-ZFPs) family. It was originally identified as a transcriptional repressor involved in gene-specific silencing through the recruitment of the corepressor KAP1, chromatin-modifying activities, and the arginine methyltransferase PRMT5 on the promoter of its target genes. Recent findings indicate that ZNF224 can behave both as a tumor suppressor or an oncogene in different human cancers. The transcriptional regulatory properties of ZNF224 in these systems appear to be complex and influenced by specific sets of interactors. ZNF224 can also act as a transcription cofactor for other DNA-binding proteins. A role for ZNF224 in transcriptional activation has also emerged. Here, we review the state of the literature supporting both roles of ZNF224 in cancer. We also examine the functional activity of ZNF224 as a transcription factor and the influence of protein partners on its dual behavior. Increasing information on the mechanism through which ZNF224 can operate could lead to the identification of agents capable of modulating ZNF224 function, thus potentially paving the way to new therapeutic strategies for treatment of cancer.

Scholarship about racial disparities in jury selection is extensive, but the data about how parties examine potential jurors in actual trials is limited. This study of jury selection for 792 potential jurors across twelve randomly selected North Carolina capital cases uses conversation analysis to examine the process that produces decisions about who serves on juries. To examine how race influences conversations in voir dire, we adapted the Roter Interaction Analysis System, a widely used framework for understanding the dynamics of patient–clinician communication during clinical encounters, to the legal setting for the first time. This method allows us to document the conversational dynamics of actual questioning of potential jurors that precedes the decision to seat or strike a juror, or to excuse her for cause. Our preliminary analysis of this uniquely rich archival data suggests ways in which the discourse of jury selection varies by race, and provides the foundation for future work looking at the ways in which the evaluation of fitness for jury service itself is skewed and contributes to racial disparities in jury selection.

Microalgae are a promising renewable energy source because of their capability to produce a large amount of oil, which can be directly used as a fuel or converted into biodiesel through transesterification processes. Microalgae growth needs a certain amount of nutrients such as nitrogen and phosphorus and, with this regard, the wastewater arising from aquaculture and many others agro-industrial processes can be a suitable and cheap source of these elements. Moreover, nitrogen and phosphorus are responsible for the eutrophication of the waters basins, therefore microalgae can be proficiently used to remove these pollutants. In this work Nannochloropsis oculata was tested to verify the nitrogen removal capability from a synthetic wastewater. The medium was composed of marine water added with appropriate macro and micronutrients mixtures. The experiments were carried out by means of lab-scale, completely mixed bubble-columns, photo-bioreactors. A Design of Experiments (DoE) approach was here used in order to assess whether the input factors (i) light intensity, (ii) different nitrogen concentration sources and (iii) carbon dioxide have a statistically significant impact on the microalgae growth. It was demonstrated that the only factors statistically significant are the light intensity and its interaction with the nitrate concentration, at least for the parameter ranges here investigated. As a final remark, it was found that nitrate removal were completed from 3 to 5 days depending on the medium composition, whereas urea and phosphates needed more time.

Polycyclic aromatic hydrocarbons (PAHs) are considered priority pollutants because they have potentially dangerous effects on the environment and human health. Bioremediation has recently become attractive to restore polluted sites, because it is not expensive and fulfils the most important properties required by the current regulations. In this work the capability of a white-rot fungi, Pleurotus sajor-caju, was assessed for degradation of pyrene and chrysene. The main objective was to investigate the effects of pollutant concentration on the mycelium growth and find the conditions that can enhance the microorganism tolerance when exposed to pyrene and chrysene. The tests carried out in Petri dishes showed that chrysene inhibited mycelium growth, whereas pyrene was well tolerated. Experiments in liquid medium evidenced that the mycelium was able to degrade pyrene with a removal efficienty greater than 90%.

Background— Variation in outcomes after percutaneous coronary interventions (PCI) may reflect differences in quality of care. To date, however, we lack a methodology to monitor and improve national hospital 30-day mortality rates among patients undergoing PCI. Methods and Results— We developed hierarchical logistic regression models to calculate hospital risk-standardized 30-day all-cause PCI mortality rates. Due to differences in risk, patients were divided into 2 cohorts: those with ST-segment elevation myocardial infarction or cardiogenic shock, and those with no ST-segment elevation myocardial infarction and no cardiogenic shock. The models were derived using 2006 data from the CathPCI Registry linked with administrative claims data, and validated using comparable 2005 data. In the derivation cohort of the ST-segment elevation myocardial infarction or shock model (n=15 123), the unadjusted 30-day mortality rate was 9.2%. The final model included 13 variables with the observed mortality rates ranging from 1.4% to 40.3% across deciles of the predicted patient mortality rates. The 25th and 75th percentiles of the risk-standardized mortality rate were 8.5% and 9.7%, with 5th and 95th percentiles of 7.6% and 11.0%. In the derivation cohort of the no ST-segment elevation myocardial infarction and no shock model (n=110 529), the unadjusted 30-day mortality rate was 1.4%. The final model included 16 variables with the observed predicted mortality rates ranging from 0.1% to 7.0% across deciles of the predicted patient mortality rates. The 25th and 75th percentiles of the risk-standardized mortality rate across 612 hospitals were 1.3% and 1.6%, with 5th and 95th percentiles of 1.0% and 2.0%. Conclusions— These National Quality Forum endorsed registry-based models produce estimates of hospital risk-standardized mortality rates for patients undergoing PCI.

The randomized double-blind controlled clinical trial (RCT) is the undisputed gold-standard for assessing drug efficacy. However the RCT is usually insufficiently powered, or too brief, to detect rare but serious adverse effects or modest but important increases in the risk of common disease outcomes (such as coronary heart disease events) that can have a major population impact in absolute terms. Pooling individual trials via meta-analyses sometimes helps but the reporting of information on adverse effects in clinical trials is often incomplete or poorly quantified, particularly when compared to the efficacy endpoints. Clinically significant and unexpected abnormal laboratory values may not be detected as not all are routinely included in trial protocols. Most RCTs also tend to exclude the elderly, patients with co-morbidity or pregnancy, and this reduces the generalisability of these data. Therefore, at the time of product launch, there are often limited safety data of any new drug, in both the short- and longer-term which is directly applicable to that of the target population. Drugs in use therefore need to remain under constant surveillance (pharmacovigilance) and study by observation (pharmacoepidemiology) Pharmacovigilance systems identify safety signals (signal detection) and thus serve to generate hypothesis. Pharmacoepidemiology tests such hypothesis (signal validation) and quantifies the risk. Both pharmacovigilance and pharmacoepidemiology have limitations, are complementary and only partially overlap.

Aim: To establish the cost-effectiveness of screen-A ing and treating meticillin-sensitive Staphylococcus aureus (MSSA) carriers, potentially reducing both financial and clinical burdens of managing healthcare-acquired infections. Methods: A decision health economic model analysed the impact of a ‘screen and treat’ strategy for Hospital inpatients from the perspective of the UK National Health Service. Results: Cost savings in excess of £600k and around 840 potential infections could be avoided in a 70,000 patient cohort, at a nasal carriage prevalence of 30%. For 2000 high infection risk cardiothoracic surgery patients, cost savings could reach £8,636 per annum. The dominance of the ‘screen and treat’ strategy holds for plausible variations in the model parameter values and simple modelling of secondary transmission. Conclusion: Adopting rapid screening and treating MSSA nasal carriers should be clinically and financially advantageous, compared to current strategies of not screening, even under conservative assumptions for costs and probabilities of managing infections.

Purpose The aim of this work was to optimize technical and dosimetric aspects of Prostate Artery Embolization (PAE) for Benign Prostatic Hyperplasia (BPH). Methods The radiological procedures in PAE consist of an angio-CT on a Brillance64 (Philips, Eindhoven, The Netherlands) to define the anatomical vascular structure of pelvis and of prostatic arteries and the angiographic procedure on the Integris Allura system (Philips, Eindhoven, The Netherlands) or in the hybrid room with the Zeego system (Siemens, Forchheim, Germany). The latter performs rotational acquisition that permits 3D CT-like reconstructions. Combining the angiographic acquisition with the anatomical 3D reconstruction of CT permits to map the prostatic artery during the procedure. An evaluation of the ESD, pESD, and effective dose was performed based on the dose-area product (DAP), weighting contributions of all the different projections. Results 21 consecutive patients with a mean age of 75.5 (range 56–93) years were studied: 12 with Allura and 9 with Zeego. Effective doses were 54 (range 25–81) mSv during imaging and 46 (range 16–85) mSv during fluoroscopy with Allura and 37 (8–68) mSv during imaging and 80 (33–175) mSv during fluoroscopy with Zeego. Zeego permits a decrease in latero-lateral, contralateral and PA projections, compensated by the rotational acquisition. The effective dose in angio-CT was 7.9 (3.4–18.9) mSv. Optimization by reducing the number of frames per projection and the size of the field in the district of interest pemitted to lower the dose of 35%. Average ESD and pESD were respectively 0.62 Gy and 1.02 Gy on Zeego and respectively 0.44 Gy and 1.49 Gy on Zeego. The rotational dose for Zeego was evaluated 6.8% of the total dose. The angio-CT contributed to the 6.7% of the total dose. Conclusions In this work we gave a first report on the effective dose delivered during PAE on two different generations angiographics system. More patient are needed to understand the advantage of the different technologies.

Background Administrative-claims data enable comparative effectiveness assessment using large numbers of patients treated in real-world settings. Objective To evaluate real-world relapses, healthcare costs and resource use in patients with MS newly initiating subcutaneous interferon beta-1a (sc IFNβ-1a) v. oral disease-modifying drugs (DMDs: dimethyl fumarate, fingolimod, teriflunomide). Methods Patients from an administrative claims database (1 Jan 2012–31 Dec 2015) were selected if they: were 18–63 years old; had an MS diagnosis; had newly initiated sc IFNβ-1a, dimethyl fumarate, fingolimod, or teriflunomide (first claim = index); had no evidence of DMD 12-months pre-index; and had 12-month eligibility pre- and post-index. Relapse was defined as an MS-related inpatient stay, emergency room visit, or outpatient visit with a corticosteroid prescription ± 7 days. Outcomes were evaluated using logistic regression and generalized linear models. Results A total of 4475 patients met inclusion criteria: 21.9% sc IFNβ-1a, 51.0% dimethyl fumarate, 19.7% fingolimod, 7.4% teriflunomide. Teriflunomide patients had 1.357 (95% CI 1.000, 1.831; p = 0.0477) greater odds of 1-year relapse than sc IFNβ-1a patients. Estimated mean all-cause 1-year costs were higher after fingolimod (US$72,376) v. sc IFNβ-1a initiation (US$65,408; p Conclusion Patients initiating sc IFNβ-1a had better relapse outcomes v. teriflunomide, and lower all-cause costs v. fingolimod.

WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT • Conflicting studies have raised uncertainty over the vascular effects of the long-acting anticholinergic, tiotropium bromide. WHAT THIS STUDY ADDS • Our results show no increased risk of stroke with tiotropium bromide, or with inhaled anticholinergics in general. AIMS A recent communication from the United States Food and Drug Administration highlighted a possible increased risk of stroke associated with use of the relatively new inhaled anticholinergic drug, tiotropium bromide. Using the United Kingdom General Practice Research Database, we set out to assess the risk of stroke in individuals exposed to inhaled tiotropium bromide and two other inhaled treatments for airways disease. METHODS We used the self-controlled case-series that reduces confounding and minimizes the potential for biases in the quantification of risk estimates. RESULTS Of 1043 people with a diagnosis of incident stroke who had had at least one prescription for tiotropium bromide, 980 satisfied inclusion criteria. The age-adjusted incidence rate ratio for all-cause stoke in individuals exposed to tiotropium bromide (n= 980), ipratropium bromide (n= 4181) and fluticasone propionate/salmeterol xinafoate (n= 1000) was 1.1 [95% confidence interval (CI) 0.9, 1.3], 0.8 (95% CI 0.7, 0.9) and 1.0 (95% CI 0.9, 1.2), respectively. CONCLUSIONS We found no evidence of an increased risk of all-cause stroke for individuals exposed to commonly prescribed inhaled treatments for chronic obstructive pulmonary disease.

Cancer/testis Antigens (CTAs) are immunogenic proteins with a restricted expression pattern in normal tissues and aberrant expression in different types of tumors being considered promising candidates for immunotherapy. We used the alignment between EST sequences and the human genome sequence to identify novel CT genes. By examining the EST tissue composition of known CT clusters we defined parameters for the selection of 1184 EST clusters corresponding to putative CT genes. The expression pattern of 70 CT gene candidates was evaluated by RT-PCR in 21 normal tissues, 17 tumor cell lines and 160 primary tumors. We were able to identify 4 CT genes expressed in different types of tumors. The presence of antibodies against the protein encoded by 1 of these 4 CT genes (FAM46D) was exclusively detected in plasma samples from cancer patients. Due to its restricted expression pattern and immunogenicity FAM46D represents a novel target for cancer immunotherapy.

Data from the slaughter of 24,001 chickens that were part of a selection program for the production of commercial broilers were used to estimate genetic trend for absolute carcass (CW), breast meat (BRW), and leg (LW) weights, and relative carcass (CY), breast meat (BRY), and leg (LY) weights. The components of (co)variance and breeding values of individuals were obtained by the restricted maximum likelihood method applied to animal models. The relationship matrix was composed of 132,442 birds. The models included as random effects, maternal additive genetic and permanent environmental for CW, BRW, LW, CY, and BRY, and only maternal permanent environmental for LY, besides the direct additive genetic and residual effects, and as fixed effects, hatch week, parents' mating group and sex. The estimates of genetic trend were obtained by average regression of breeding value on generation, and the average genetic trend was estimated by regression coefficients. The genetic trends for CW (+6.0336 g/generation), BRW (+3.6723 g/generation), LW (+1.5846 g/generation), CY (+0.1195%/generation), and BRY (+0.1388%/generation) were positive, and they were in accordance with the objectives of the selection program for these traits. The genetic trend for LY (-0.0019%/generation) was negative, possibly due to the strong emphasis on selection for BRY and the negative correlations between these two traits.