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Objective: To assess and compare the inter-rater agreement of the CDC criteria and the ASEPSIS score in identifying surgical site infections after cesarean section., Methods: Prospective observational study including 110 patients subjected to a cesarean section at our institution. Surgical wounds were managed according to standard care and were photographed on the third, seventh, and thirtieth postoperative day or during any evaluation in case of complications. Three expert surgeons reviewed the prospectively gathered data and photographs and classified each wound using CDC criteria and the ASEPSIS score. The inter-rater agreements of CDC criteria and ASEPSIS score were determined with Krippendorff's Alpha with linear weights and compared with a confidence interval approach., Results: The weighted α coefficient for CDC criteria was 0.587 (95%CI, 0.411-0.763, p  < 0.001, "moderate" agreement according to Altman's interpretation of weighted agreement coefficient), while the weighted α coefficient for the ASEPSIS score was 0.856 (95%CI, 0.733-0.980, p  < 0.001, "very good" agreement)., Conclusion: ASEPSIS score presents a "very good" inter-rater agreement for surgical site infections identification after cesarean, resulting in a more objective method than CDC criteria ("moderate" inter-rater agreement). ASEPSIS score could represent an objective tool for managing and monitoring surgical site infections after cesarean section, also by photographic evaluation., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2023 Delli Carpini, Giannella, Di Giuseppe, Fioretti, Franconi, Gatti, Sabbatini, Montanari, Marconi, Tafuri, Tibaldi, Fichera, Pizzagalli and Ciavattini.)

The aim of this study was to evaluate the shelf-life of pre-packaged sheep's arrosticini produced in a factory located in northern Italy. Samples were divided into two series and packaged in modified atmosphere with specific gas mixtures: conventional (C: 35% O2/15% CO2/50% N2) and experimental (E: 30% CO2/70% N2). All the samples were stored at 4°C for 10 days and subjected, after 5, 8 and 10 days (t5, t8, t10), to triplicate microbiological and chemical- physical (pH, total volatile basic nitrogen, thiobarbituric acid reactive substances) analyses. At the same time, the colorimetric analysis and a sensorial evaluation were carried out (pack tightness, presence of color or odor alterations), assigning a discrete score from 0 to 5. The samples showed initial total bacterial counts close to 5 Log CFU/g: these values gradually increased during storage, exceeding the threshold of 8 Log CFU/g in the C series; lower values were detected in the E series. A similar trend was highlighted for Enterobacteriaceae , with initial loads of about 3 Log CFU/g and an increase until t10, reaching values higher than 6 Log CFU/g in the C series and close to 5 Log CFU/g in the E series (P=0.002). E. coli also showed a similar trend, although with values approximately 1 Log lower than Enterobacteriaceae . Pseudomonas spp. showed initial counts close to 4.5 Log CFU/g, with a different increase in the C series (6.5 Log CFU/g at t10) and the E series (4.95 Log CFU/g) (P= 0.006). The higher growth in the C series was also observed for lactic acid bacteria, with an increase from 3 to 5 Log CFU/g (3.8 Log CFU/g in the E series P=0.016). The other microbiological parameters showed very low counts and, in most cases undetectable counts (<2 Log CFU/g) for the entire period considered. The initial values obtained from the measurement of the colorimetric indices were within the norm for this type of product: however, starting from t5, lower values of red index and lightness in the E series were measured, with an evident greying of meat surface. The results of the sensory evaluation indicated that the product showed optimal sensorial characteristics up to 8 days of shelf-life in the C series, while the use of an oxygenfree atmosphere, despite having a moderate inhibiting effect on the microbial populations, has led to an early modification of the product (5 days of storage), due to the presence of superficial greyish areas. The microbiological characteristics of arrosticini strictly depend on the hygienic conditions of slaughtering and production; even in optimal situations, the product is particularly perishable, and requires careful management of storage temperatures and times, to maintain its quality characteristics., Competing Interests: Conflict of interest: the authors declare no conflict of interest., (©Copyright: the Author(s).)

Sézary syndrome (SS) is a rare and aggressive variant of cutaneous T-cell lymphoma. It is characterized by the copresence of CD4+ neoplastic lymphocytes, named Sezary cells, mainly in the blood, lymph nodes, and skin where they induce chronic inflammation that in turn impairs the patient's QOL and fuels neoplastic cells. SS is not readily cured, but immunotherapy is becoming an effective option for this lymphoma. In this study, we investigated, in a large cohort of patients with SS, the expression and function of the immune checkpoint molecule CD39, which degrades proinflammatory extracellular adenosine triphosphate. We showed that the SNP rs10748643 A/G within the ENTPD1 gene coding for the CD39 protein controls its expression level. Patients carrying the A/G‒G/G genotype showed a significantly higher frequency of clonal CD4+CD39+ SS cells than those carrying the A/A genotype. Different from other cancers, high CD39 expression correlates with a better prognosis. Comparing primary G/G with A/A lymphoma cells, we observed that G/G SS cells have a higher ability to degrade adenosine triphosphate, increased apoptotic susceptibility, and upon activation, reduced IL-2 production. Accordingly, CD39 enzymatic inhibition enhances SS cell viability and IL-2 production on activation. These results strongly suggest a special caution for SS treatment with therapeutic inhibitors of CD39., (Copyright © 2022 The Authors. Published by Elsevier Inc. All rights reserved.)

Sézary syndrome (SS) is an aggressive variant of cutaneous t-cell lymphoma characterized by the accumulation of neoplastic CD4+ lymphocytes-the SS cells-mainly in blood, lymph nodes, and skin. The tumor spread pattern of SS makes this lymphoma a unique model of disease that allows a concurrent blood and skin sampling for analysis. This review summarizes the recent studies highlighting the transcriptional programs triggered by the crosstalk between SS cells and blood-skin microenvironments. Emerging data proved that skin-derived SS cells show consistently higher activation/proliferation rates, mainly driven by T-cell receptor signaling with respect to matched blood SS cells that instead appear quiescent. Biochemical analyses also demonstrated an hyperactivation of PI3K/AKT/mTOR, a targetable pathway by multiple inhibitors currently in clinical trials, in skin SS cells compared with a paired blood counterpart. These results indicated that active and quiescent SS cells coexist in this lymphoma, and that they could be respectively treated with different therapeutics. Finally, this review underlines the more recent discoveries into the heterogeneity of circulating SS cells, highlighting a series of novel markers that could improve the diagnosis and that represent novel therapeutic targets (GPR15, PTPN13, KLRB1, and ITGB1) as well as new genetic markers (PD-1 and CD39) able to stratify SS patients for disease aggressiveness.