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Lipotoxicity refers to the harmful effects of excess fatty acids on metabolic health, and it can vary depending on the type of fatty acids involved. Saturated and unsaturated fatty acids exhibit distinct effects, though the precise mechanisms behind these differences remain unclear. Here, we investigated the lipotoxicity of palmitic acid (PA), a saturated fatty acid, compared with oleic acid (OA), a monounsaturated fatty acid, in the hepatic cell line HuH7. Our results demonstrated that PA, unlike OA, induces lipotoxicity, endoplasmic reticulum (ER) stress, and autophagy inhibition. Compared with OA, PA treatment leads to less lipid droplet (LD) accumulation and a significant reduction in the mRNA and protein level of diacylglycerol acyltransferase 1 (DGAT1), a key enzyme of triacylglycerol synthesis. Using modulators of ER stress and autophagy, we established that DGAT1 downregulation by PA is closely linked to these cellular pathways. Notably, the ER stress inhibitor 4-phenylbutyrate can suppress PA-induced DGAT1 downregulation. Furthermore, knockdown of DGAT1 by siRNA or with A922500, a specific DGAT1 inhibitor, resulted in cell death, even with OA. Both PA and OA increased the oxygen consumption rate; however, the increase associated with PA was only partially coupled to ATP synthesis. Importantly, treatment with GW7647 a specific PPARα agonist mitigated the lipotoxic effects of PA, restoring PA-induced ER stress, autophagy block, and DGAT1 suppression. In conclusion, our study highlights the crucial role of DGAT1 in PA-induced lipotoxicity, broadening the knowledge of the mechanisms underlying hepatic lipotoxicity and providing the basis for potential therapeutic interventions., Competing Interests: Conflict of interests The authors declare that they have no conflicts of interest with the contents of this article., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: The Chronic Hypertension and Pregnancy Study demonstrated that a target blood pressure of <140/90 mm Hg during pregnancy is associated with improved perinatal outcomes. Outside of pregnancy, pharmacologic therapy for patients with diabetes and hypertension is adjusted to a target blood pressure of <130/80 mm Hg. During pregnancy, patients with both diabetes and chronic hypertension may also benefit from tighter control with a target blood pressure <130/80 mm Hg., Objective: We compared perinatal outcomes in patients with hypertension and diabetes who achieved blood pressure <130/80 vs 130 to 139/80 to 89 mm Hg., Study Design: This was a secondary analysis of a multcenter randomized controlled trial. Participants were included in this secondary analysis if they had diabetes diagnosed prior to pregnancy or at <20 weeks of gestation and at least 2 recorded blood pressure measurements prior to delivery. Average systolic and diastolic blood pressure were calculated using ambulatory antenatal blood pressures. The primary composite outcome was preeclampsia with severe features, indicated preterm birth <35 weeks, or placental abruption. Secondary outcomes were components of the primary outcome, cesarean delivery, fetal or neonatal death, neonatal intensive care unit admission, and small for gestational age. Comparisons were made between those with an average systolic blood pressure <130 mm Hg and average diastolic blood pressure <80 mm Hg and those with an average systolic blood pressure 130 to 139 mm Hg or diastolic blood pressure 80 to 89 mm Hg using Student's t test and chi-squared tests. Multivariable log-binomial regression models were used to evaluate risk ratios between blood pressure groups for dichotomous outcomes while accounting for baseline covariates., Results: Of 434 participants included, 150 (34.6%) had an average blood pressure less than 130/80 mm Hg. Participants with an average blood pressure less than 130/80 were more likely to be on antihypertensive medications at the start of pregnancy and more likely to have newly diagnosed diabetes mellitus prior to 20 weeks. Participants with an average blood pressure less than 130/80 mm Hg were less likely to have the primary adverse perinatal outcome (19.3% vs 46.5%, adjusted relative risk 0.43, 95% confidence interval 0.30-0.61, P<.01), with decreased risks specifically of preeclampsia with severe features (adjusted relative risk 0.35, 95% confidence interval 0.23-0.54) and indicated preterm birth prior to 35 weeks (adjusted relative risk 0.44, 95% confidence interval 0.24-0.79). The risk of neonatal intensive care unit admission was lower in the lower blood pressure group (adjusted relative risk 0.74, 95% confidence interval 0.59-0.94). No differences were noted in cesarean delivery (adjusted relative risk 1.04, 95% confidence interval 0.90-1.20), fetal or neonatal death (adjusted relative risk 0.59, 95% confidence interval 0.12-2.92). Small for gestational age less than the 10th percentile was lower in the lower blood pressure group (adjusted relative risk 0.37, 95% confidence interval 0.14-0.96)., Conclusion: In those with chronic hypertension and diabetes prior to 20 weeks, achieving an average goal blood pressure of <130/80 mm Hg may be associated with improved perinatal outcomes., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Temporal fluctuations of the electricity grid generation composition, variability of electricity consumption in building operation over the year and of the on-site renewable energy systems are factors that should be properly considered, using high-resolution data in the building energy and environmental performance assessment. In this study a methodological framework is developed to model high-resolution electricity mixes in building operation and to assess the related energy and environmental impacts over the year, by means of a life cycle approach. For most impact categories, the imported electricity generation mixes, to meet the residual building demand, show impact variations not higher than +20 % and not lower than -38 % at seasonal and daily time compared with the annual average values. Temporal variations are even more relevant in building consumption electricity mixes, which are significantly characterized by self-consumption and show noticeable reductions compared to the annual electricity generation mix in both assessed scenarios. As an example, summer and spring energy generation mixes show the best results for climate change (0.09 kgCO 2eq /kWh) compared to the annual ones, while in winter and autumn mixes the contribution to climate change overcomes the respective annual results. Both summer day-mixes contribute to climate change for about 0.12 kgCO 2eq /kWh, with a reduction of nearly 30 % if compared the annual data. Conversely, in the winter day-mixes the contribution to climate change is about 0.20 kgCO 2eq /kWh and comes mostly from the grid. The results highlight that assessed temporal variations are significant through the year for the most assessed environmental indicators. Furthermore, the use of high-resolution electricity generation mixes allows to optimize efficiently the temporal use of electricity in buildings, in sight of energy and environmental impact reduction also thanks to the employment of life cycle oriented approaches. The results also highlight the relevance of the storage system in fulfilling periods of peak demand or low renewable generation., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

The development of solar technologies requires increased efficiency in converting solar radiation to energy, as well as innovative materials and structure to go beyond the conventional power conversion ratio. In line with these innovations, there are concerns about greenhouse gas emissions of the solar cells, materials for the solar technologies and other relevant environmental impacts of the manufacturing processes. This review is conducted on life cycle assessments of solar cells, considering the climate change and natural resource shortage context. It is identified that the majority of existing life cycle assessments on solar cells take into account four typical environmental impacts: energy consumption, greenhouse gas emissions, material depletion, and toxicity. Though the diverse methodological aspects make it difficult to directly compare these environmental impacts among various types of solar cells, the obtained results hinder that emerging solar cells such as perovskite solar cells or tandem solar cells are likely to have better environmental profiles than conventional silicon based and thin film solar cells, in terms of energy consumption, greenhouse gas emissions and material consumption. However, the emerging solar cells may utilize toxic materials in which their eco-toxicity and human toxicity should be further considered during the design of the technologies. Moreover, it is identified that the energy and environmental hotspot lies in the manufacturing process, regardless of impact indicators and types of solar cells., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 The Authors. Published by Elsevier B.V. All rights reserved.)

Introduction: Glypican-3 (GPC3) is an oncofetal protein involved in cellular signaling, strongly expressed in the placenta, absent or diminished in postnatal life, but often increased in human malignancies. Germline loss-of-function variants of GPC3 gene are associated with Simpson-Golabi-Behmel syndrome type 1 (SGBS1), a rare recessive X-linked overgrowth disease characterized by typical facial features, congenital abnormalities, and an increased risk of developing childhood cancers., Methods: A clinical suspicion of SGBS1 was postulated for a newborn with prenatal history of overgrowth and polyhydramnios, presenting with neonatal weight and length >99th percentile, coarse facies, iris and retinal coloboma, supernumerary nipples, and splenomegaly. While waiting for whole-genome sequencing (WGS) results, we investigated placental GPC3 immunohistochemical expression in the proband, in three additional cases of SGBS1, and disorders commonly associated with fetal macrosomia and/or placentomegaly., Results: WGS in the proband identified a likely pathogenic maternally inherited missense variant in GPC3: c.1645A > G, (p.Ile549Val), and GPC3 immunohistochemistry demonstrated full-thickness loss of stain of the placental parenchyma. The same pattern ("null") was also present in the placentas of three additional cases of SGBS1, but not in those of unaffected controls., Discussion: Immunohistochemical expression of GPC3 in the placenta is highly reproducible. Our findings showed that a "null pattern" of staining is predictive of SGBS1 and represents a valuable aid in the differential diagnosis of fetal macrosomias, allowing targeted genetic testing and earlier diagnosis., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Wood is a hygroscopic, multi-scale and anisotropic natural material composed of pores with different size and differently oriented. In particular, archaeologically excavated wood generally is waterlogged wood with very high moisture content (400%-800%) that need to have a rapid investigation at the microstructural level to obtain the best treatment with preservative agents. Time-dependent diffusion coefficient D(t) quantified by Pulse Field Gradient (PFG) Nuclear Magnetic Resonance (NMR) techniques provides useful information about complex porous media, such as the tortuosity (τ) describing pore connectivity and fluid transport through media, the average-pore size, the anisotropic degree (a n ). However, diffusion NMR is intrinsically limited since it is an indirect measure of medium microstructure and relies on inferences from models and estimation of relevant diffusion parameters. Therefore, it is necessary to validate the information obtained from NMR diffusion parameters through complementary investigations. In this work, the structures of five waterlogged wood species were studied by PFG of absorbed water. D(t) and τ of water diffusing along and perpendicular to vessels/tracheids main axes together with relaxation times and a n were quantified. From these parameters, the pore sizes distribution and the wood microstructure characterization were obtained. Results among wood species were compared, validated and integrated by micro-imaging NMR (μ-MRI), environmental-scanning electron-microscope (ESEM) images, wood dry density and imbibition times measurement of all woods. The work suggests that a n vs τ rather than the estimated pore size diversifies and characterize the different wood species. As a consequence diffusion-anisotropy vs tortuosity could be an alternative method to characterize and differentiate wood species of waterlogged wood when high resolution images (μ-MRI and ESEM) are not available. Moreover, the combined use of D(t) and micro-MRI expands the scale of dimensions observable by NMR covering all the interesting length scales of wood., (Copyright © 2021 Elsevier Inc. All rights reserved.)

In response to the disruptive changes brought upon our society by the COVID-19 pandemic, most work activities and service providers had to resort to remote working. This is credited to reduce emissions for transportation, however the role of forced confinement within dwellings, especially if not designed for hosting working stations, deserves to be properly evaluated in terms of both user acceptance and long-term environmental impact. In this work, a dedicated survey campaign is used for investigating the potential pros and cons of remote working. In more detail, logistic regression and generalized linear models are used for capturing the effect of several independent variables on user acceptance of remote working. At a later stage, the main greenhouse gas emissions produced by each participant before and during remote working are assessed. According to the obtained results, the greater the distance between their home and workplace, the higher the acceptance score declared by the survey participants about remote working. Additionally, higher incomes and better-quality lifestyles with larger devotion to leisure activities also provide higher acceptance. Finally, the existence of a comfortable room to be used for work activities plays a crucial role on the declared acceptance. From an environmental point of view, remote working is always sustainable in case of long commuting distances (above 10 km) are avoided on a daily routine. In conclusion, a sensible use of remote working could reduce the environmental impact of any organization employing desk-workers as well as improve their work satisfaction and lifestyle., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2021 Published by Elsevier B.V. on behalf of Institution of Chemical Engineers.)

Background: Placental pathologic lesions suggesting maternal or fetal vascular malperfusion are common among pregnancies complicated by intrauterine growth restriction. Data on the relationship between pathologic placental lesions and subsequent infant neurodevelopmental outcomes are limited., Objective: This study aimed to assess the relationship between placental pathologic lesions and infant neurodevelopmental outcomes at 2 years of age in a cohort of pregnancies complicated by intrauterine growth restriction., Study Design: An observational cohort study included singleton intrauterine growth restriction pregnancies delivered at ≤34 weeks' gestation and with a birthweight of ≤1500 g at a single institution in the period between 2007 and 2016. Maternal and neonatal data were collected at discharge from the hospital. Infant neurodevelopmental assessment was performed every 3 months during the first year of life and every 6 months in the second year. Penalized logistic regression was used to test the association of maternal vascular malperfusion and fetal vascular malperfusion with infant outcomes adjusting for confounders., Results: Of the 249 pregnancies enrolled, neonatal mortality was 8.8% (22 of 249). Severe and overall maternal vascular malperfusion were 16.1% (40 of 249) and 31.7% (79 of 249), respectively. Severe maternal vascular malperfusion was associated with an increased risk of neonatal mortality (adjusted odds ratio, 3.3; 95% confidence interval, 1.2-9.5). Among the 198 survivors after a 2-year neurodevelopmental follow-up evaluation, the rate of major and minor neurodevelopmental sequelae was 57.1% (4 of 7) among severe fetal vascular malperfusion (adjusted odds ratio, 24.5; 95% confidence interval, 4.1-146), 44.8% (13 of 29) among overall fetal vascular malperfusion (adjusted odds ratio, 5.8; 95% confidence interval, 5.1-16.2), and 7.1% (12 of 169) in pregnancies without fetal vascular malperfusion. Infants born from pregnancies with fetal vascular malperfusion also had lower 2-year general quotient, personal-social, hearing and speech, and performance subscales scores than those without fetal vascular malperfusion. Finally, in the presence of fetal vascular malperfusion, the likelihood of a 2-year infant survival with normal neurodevelopmental outcomes was reduced by more than 70% (adjusted odds ratio, 0.29; 95% confidence interval, 0.14-0.63). Noticeably, 10 of the 20 subjects with a 2-year major neurodevelopmental impairment (3 of 4 with severe fetal vascular malperfusion) had little or no abnormal neurologic findings at discharge from neonatal intensive care unit., Conclusion: In preterm intrauterine growth restriction, placental fetal vascular malperfusion is correlated with an increased risk of abnormal infant neurodevelopmental outcomes at 2 years of age even in the absence of brain lesions or neurologic abnormalities at discharge from the neonatal intensive care unit. In the case of a diagnosis of fetal vascular malperfusion, pediatricians and neurologists should be alerted to an increased risk of subsequent infant neurodevelopmental problems., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Case Presentation: A 62-year-old man presented with a 3-month history of shortness of breath and a dry cough. He had a medical history of hypertension (without use of angiotensin-converting enzyme inhibitors), hyperlipidemia, depression, and 10-pack-years of cigarette smoking several decades ago. He was a limousine driver and denied any history of occupational high-risk exposures. The patient denied significant weight gain or weight loss, night sweats, fevers, hemoptysis, chest pain, or palpitations. He had a normal physical examination. Pulmonary function studies with a hemoglobin level of 12.9 gm/dL revealed normal spirometry, normal lung volumes, and moderately low diffusion capacity (56% of predicted). A 6-minute walk test showed mild desaturation (97% to 92% after 432 m). Stress echo revealed ejection fraction of 60% with no regional wall motion abnormalities, no evidence of impaired diastolic filling, estimated peak pulmonary artery pressure 35 to 40 mm Hg, and no valvular abnormalities with desaturation to 87% during the test. Extensive rheumatologic, infectious disease, and hypercoagulability workup were unremarkable. BAL was negative for malignancy, infection, or eosinophilic lung disease., (Copyright © 2021 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.)

Case Presentation: A 38-year-old African American woman with a history of menometrorrhagia on previous estrogen therapy and a previously biopsied benign thyroid nodule with recent interval enlargement presented with symptoms of shortness of breath on exertion, an intermittent nonproductive cough, and right upper quadrant abdominal pain for 1 year. She denied wheezing, hemoptysis, fevers, night sweats, or unintentional weight loss. Socially, the patient was a lifelong nonsmoker and denied alcohol or drug use. Travel history was not significant, and she had no contributory occupational, environmental, or animal exposures. Recent cancer screening that included Papanicolaou smear and mammography were negative for neoplasia. Vital signs were normal, and ambulatory pulse oximetry did not demonstrate evidence of oxygen desaturation. Physical examination demonstrated normal respiratory effort, diffuse vesicular breath sounds, and a soft abdomen without hepatomegaly or right upper quadrant tenderness., (Copyright © 2020 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.)

Charcot-Marie Tooth type 2B (CMT2B) is a rare inherited peripheral neuropathy caused by five missense mutations in the RAB7A gene, which encodes a small GTPase of the RAB family. Currently, no cure is available for this disease. In this study, we approached the disease by comparing the lipid metabolism of CMT2B-derived fibroblasts to that of healthy controls. We found that CMT2B cells showed increased monounsaturated fatty acid level and increased expression of key enzymes of monounsaturated and polyunsaturated fatty acid synthesis. Moreover, in CMT2B cells a higher expression of acetyl-CoA carboxylase (ACC) and fatty acid synthase (FAS), key enzymes of de novo fatty acid synthesis, with a concomitantly increased [1- 14 C]acetate incorporation into fatty acids, was observed. The expression of diacylglycerol acyltransferase 2, a rate-limiting enzyme in triacylglycerol synthesis, as well as triacylglycerol levels were increased in CMT2B compared to control cells. In addition, as RAB7A controls lipid droplet breakdown and lipid droplet dynamics have been linked to diseases, we analyzed these organelles and showed that in CMT2B cells there is a strong accumulation of lipid droplets compared to control cells, thus reinforcing our data on abnormal lipid metabolism in CMT2B. Furthermore, we demonstrated that ACC and FAS expression levels changed upon RAB7 silencing or overexpression in HeLa cells, thus suggesting that metabolic modifications observed in CMT2B-derived fibroblasts can be, at least in part, related to RAB7 mutations., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2020 The Authors. Published by Elsevier B.V. All rights reserved.)

Biomasses and bio-waste have an important role in decarbonizing the European energy mix, the latter contributing to the transition towards a circular economy. In particular, Refuse Derived Fuel (RFD) - a biofuel obtained from dry residue of waste - appears a really interesting energy option. In this framework this study aims at assessing the environmental profile of electricity generation from RDF in Italy, comparing two different kinds of RDF production and combustion plants. The functional unit is 1 kWh of net electricity from RDF delivered to the grid. Two Italian plants are examined: one located in Ravenna (RDF is produced in a direct flow treatment plant) and the other one in Bergamo (RDF is produced in a unique flow treatment plant and electricity is generated in a cogenerator). Results show that, comparing the plants, it is not possible to identify an option for RDF production or electricity generation characterized by lowest impacts for all the examined impact categories. However, cogeneration process and the avoided burdens due to the valorisation of ferrous metals and dry fractions during RDF production can reduce most of the environmental impacts. A dominance analysis reveals that chimney direct emissions generated during RDF combustion significantly contribute to some impact categories, as well as electricity consumption during RDF production. Furthermore, disposal of incineration wastes is a relevant contributor to human toxicity and freshwater eutrophication. The eco-profile of electricity from RDF is compared with electricity from the Italian grid and from multi-Si PV. The comparison highlights that electricity from RDF performs worse for relevant environmental impact categories such as climate change, human toxicity and photochemical oxidant formation. On the other hand, electricity from RDF performs better than electricity from the grid and from photovoltaic for resource depletion, an impact category of growing importance in the framework of circular economy., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2020 The Authors. Published by Elsevier B.V. All rights reserved.)

Background and Aims: Sleep disturbances may promote glucose abnormalities and inflammatory burden among shift workers. Therefore, precocious subclinical atherosclerotic process might develop in healthy shift workers even without known metabolic and cardiovascular risk factors., Methods and Results: We measured anthropometric parameters, glucose, lipids, inflammation and common carotid Intimal Medial Thickness (cIMT) in rotating-night shift workers (r-NSW, n = 88, age = 40.3 ± 7.8 y) in comparison with former-night shift workers (f-NSW, n = 35, age = 44.2 ± 6.4 y) and with day-only workers (DW, n = 64, age = 44.1 ± 8.9 y). R-NSW and f-NSW showed significantly higher cIMT and high sensitivity C-Reactive Protein (hs-CRP) respect to DW (p = 0.043 and p = 0.025, respectively). IL-1β levels were higher in r-NSW than in DW and f-NSW (p = 0.043) and significantly correlated with IL6 (r = 0.365, p < 0.001). In addition, r-NSW and f-NSW had higher HbA1c levels in comparison with DW (p = 0.047). Carotid-IMT was significantly related to night shift work (p = 0.023), with age (p < 0.001), with HOMA IR (p = 0.009), with insulin (p = 0.006) with HbA1c (p = 0.002), with LDL cholesterol (p < 0.001), with diastolic BP (p < 0.001), with WBC (p = 0.002) and with IL6 (p = 0.004). After performing a multivariate analysis night shift work remained statistically related to cIMT (B = 2.633, 95%CI = 0.489-4.776, p = 0.016)., Conclusions: Our result described a possible link bridging night shift work, inflammation and carotid Intimal Medial Thickness. Future studies are warranted to understand if carotid atherosclerosis process should be mainly driven by the IL1β/IL6 citokine axis connected to sleep disturbances., Competing Interests: Declaration of Competing Interest All the authors declare no conflict of interest., (Copyright © 2020 The Italian Diabetes Society, the Italian Society for the Study of Atherosclerosis, the Italian Society of Human Nutrition and the Department of Clinical Medicine and Surgery, Federico II University. Published by Elsevier B.V. All rights reserved.)

Background: Although in 2013 the American College of Obstetricians and Gynecologists recommended early screening for gestational diabetes in obese women, no studies demonstrate an improvement in perinatal outcomes with this strategy., Objective: We sought to determine whether early screening for gestational diabetes improves perinatal outcomes in obese women., Materials and Methods: Randomized controlled trial comparing early gestational diabetes screening (14-20 weeks) to routine screening (24-28 weeks) in obese women (body mass index ≥30 kg/m 2 ) at 2 tertiary care centers in the United States. Screening was performed using a 50-g, 1-hour glucose challenge test followed by a 100-g, 3-hour glucose tolerance test if the initial screen was ≥135 mg/dL. Gestational diabetes was diagnosed using Carpenter-Coustan criteria. Women not diagnosed at 14 to 20 weeks were rescreened at 24 to 28 weeks. Exclusion criteria were pre-existing diabetes, major medical illness, bariatric surgery, and prior cesarean delivery. The primary outcome was a composite of macrosomia (>4000 g), primary cesarean delivery, hypertensive disease of pregnancy, shoulder dystocia, neonatal hyperbilirubinemia, and neonatal hypoglycemia (assessed within 48 hours of birth)., Results: A total of 962 women were randomized, and outcomes were available for 922. Of these 922 women, 459 (49.8%) were assigned to early screen and 463 (50.2%) to routine screen. Baseline characteristics were balanced between groups. In the early screening group, 69 (15.0%; 95% confidence interval, 11.9-18.6%) were diagnosed with gestational diabetes: 29 (6.3%; 95% confidence interval, 4.3-8.9%) at <20 weeks and 40 (8.7%; 95% confidence interval, 6.3-11.7%) at >24 weeks. Of those randomized to routine screening, 56 (12.1%; 95% confidence interval, 9.3-15.4%) had gestational diabetes. Early screening did not reduce the incidence of the primary outcome (56.9% in the early screen versus 50.8% in the routine screen, P = .07; relative risk, 1.12; 95% confidence interval, 0.99-1.26)., Conclusion: Early screening for gestational diabetes in obese women did not reduce the composite perinatal outcome., (Copyright © 2019 Elsevier Inc. All rights reserved.)

The development and use of composite indexes has exploded in the last 15 years as a tool to summarise the large amount of information available nowadays. To ensure that composite indicators reflect faithfully the purpose of evaluation and are widely accepted and used, the users must understand the relationship between individual sub-indicators and the result (transparency) and the evaluation should not depend on weights, lack of information, etc. (robustness). It is proposed here for the first time a composite index to measure energy efficiency in a wastewater treatment plant, from the definition of the individual sub-indicators to the assignation of an energy label, easy to communicate to a broad public. Using as a demonstration real data from 44 wastewater treatment plants, the index robustness is tested and improved by uncertainty and sensitivity analysis results, finally achieving a robust algorithm which can be used by the large majority of wastewater treatment plants., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Background and Aims: Atherosclerosis and cancer share several risk factors suggesting that at least in part their pathogenesis is sustained by common mechanisms. To investigate this relation we followed a group of subjects with carotid atherosclerosis at baseline up for malignancy development., Methods and Results: we carried out an observational study exploring cancer incidence (study endpoint) in subjects with known carotid atherosclerosis at baseline (n = 766) without previous cancer or carotid vascular procedures. During the follow-up (160 ± 111 weeks) 24 cancer occurred, corresponding to an overall annual incidence rate of 0.11%. 10 diagnosis of cancer occurred in individuals with a carotid stenosis >50% (n = 90) whereas 14 in patients with a carotid stenosis <50% patients (n = 676) (p < 0.001). Respect to patients without cancer, diabetes was markedly more common in subjects with cancer diagnosis during the FU (37.3%vs75.0%, p < 0.001). After controlling for classic risk factors, carotid stenosis >50% (HR = 2.831, 95%CI = 1.034-5.714; p = 0.036) and diabetes (HR = 4.831, 95%CI = 1.506-15.501; p = 0.008) remained significantly associated with cancer diagnosis., Conclusions: to our knowledge this is the first study reporting a significant risk of cancer development in subjects with diabetes and high risk of cerebrovascular events, highlighting the need of a carefully clinical screening for cancer in diabetic patients with overt carotid atherosclerosis., Competing Interests: Declaration of Competing Interest All the authors declare no conflict of interest., (Copyright © 2019 The Italian Society of Diabetology, the Italian Society for the Study of Atherosclerosis, the Italian Society of Human Nutrition, and the Department of Clinical Medicine and Surgery, Federico II University. Published by Elsevier B.V. All rights reserved.)

Dispersal patterns of lichen species in monumental and archaeological sites and their relationships with spatial population structure are almost unknown, hampering predictions on colonization dynamics that are fundamental for planning conservation strategies. In this work, we tested if the local abundance and distribution pattern of some common lichen species on carbonate stones of heritage sites may be related to their patterns of propagule dispersal. We combined analyses of the spatial population structure of eight species on the calcareous balustrade of a heritage site in Torino (NW Italy) with aerobiological analyses. In situ and laboratory analyses were mainly focused on the ejection of ascospores and their air take-off and potential dispersal at short and long distance. Results indicate that the spatial distribution of lichens on the stone surfaces is influenced by both species-specific patterns of propagule dispersal and microenvironmental requirements. In particular, apotheciate species that have a higher ejection of ascospores with higher potential for long range dispersal are candidate for a much aggressive spreading on the monumental surfaces. Moreover, their occurrence on natural or artificial stone surfaces in the surroundings of the stone monumental surface may easily support recolonization dynamics after cleaning interventions, as an effective supply of propagules is expected. On the other hand, species with a lower dispersal rate have a more clustered distribution and are less effective in rapid recolonization, thus representing a minor threat for cultural heritage conservation. These results support the idea that information on the reproductive strategy and dispersal patterns of lichens should be coupled with traditional analyses on stone bioreceptivity and microclimatic conditions to plan effective restoration interventions of stone surfaces., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Fuel cells are considered one of the key technologies to reach the ambitious European goal of a low carbon economy, by reducing CO 2 emissions and limiting the production of other pollutants. The manuscript presents an assessment of the life cycle energy and environmental performances of a solid oxide fuel cell system for household applications using primary data from the manufacturing phase and experimental data for the start-up and operation phases. The Life Cycle Assessment methodology is applied, based on a functional unit of 1 MJ of exergy and includes the life cycle steps from the raw materials extraction to the maintenance. The results show a particular relevance of the operation stage on the impacts (about 98% of cumulative energy demand and more than 63% of about half of the examined environmental impacts), mainly due to the fuel supply and, focusing on climate change, to the CO 2 emissions during the conversion of chemical energy into electricity. Manufacturing step is the main responsible of the remaining half of the impacts, with a contribution higher than 38%, mainly imputable to the stacks production. For almost half of the examined impact, a contribution of 20-30% is caused by the maintenance step, with a relevant contribution of the stacks and DC/DC booster substitutions. The analysis highlights that eco-design solutions of the assessed system can be traced in the improvement of the energy system efficiency and reduction of emissions during the operation, and in the increase of the durability of the system components, thus reducing the number of their substitutions. The results of a sensitivity analysis on the selection of the functional unit also clarified the importance of the recovery of the thermal energy generated by the fuel cells, in order to avoid concurrent energy generation from conventional sources., (Copyright © 2019 Elsevier B.V. All rights reserved.)

During pregnancy, a percentage of the cell-free DNA circulating in the maternal blood is represented by the cell-free fetal DNA (cffDNA), constituting an accessible source for noninvasive prenatal genetic screening. The coexistence of the maternal DNA, the dominant fraction of cell-free DNA, together with the cffDNA component and the scarcity of the cffDNA itself make applying traditional methods of genetics and molecular biology impossible. Next-generation sequencing methods are widely used to study fetal aneuploidies. However, in monogenic disorders, there have been relatively few studies that analyzed single mutations. We present a method for the analysis of an extended group of gene variants associated with recessive and dominant autosomal disorders using next-generation sequencing. The proposed test should allow a complete analysis of common genetic disorders and pathogen-associated variants for diagnostic use. The analysis of cffDNA for single gene disorders may replace invasive prenatal diagnosis methods, associated with the risk of spontaneous abortion and psychological stress for patients. The proposed test should assess reproductive risk for both genetic family disorders and de novo occurrences of the disease. The application of this method to a case of beta-thalassemia is also discussed., (Copyright © 2019 American Society for Investigative Pathology and the Association for Molecular Pathology. Published by Elsevier Inc. All rights reserved.)

Introduction: Cardiac mortality among patients diagnosed with mental disorders is higher compared to the general population. Some authors suggest that cardiovascular risk is related to intrinsic factors specific to psychiatric disease. Nevertheless, the interpretation of these results is limited by the concomitant prescription of antipsychotics which have a cardiovascular effect. Studies evaluating the hemodynamic and electrocardiographic profile of drug naïve or drug-free patients suffering from mental disorders remain few., Aims: The aims of this work were to study the electrocardiographic and hemodynamic profile of drug naïve or drug-free patients with mental disorders and to determine clinical and biological factors associated with any electrocardiographic abnormalities., Subjects and Methods: It was a descriptive and evaluative cross-sectional study. We enrolled drug naïve or drug-free patients for at least two months. All subjects were inpatients and had at admission clinical, biological and electrocardiographic evaluation., Results: Forty-four percent of the sample had asymptomatic electrocardiographic abnormalities. These subjects had lower serum thyroid hormone levels compared to healthy group (P=0.066). Hemodynamic profile showed that 12% of the population had orthostatic hypotension., Conclusion: Electrocardiographic and hemodynamic abnormalities are common among drug-free or drug naïve patients diagnosed with psychotic disorders. The association of electrocardiographic abnormalities with low levels of thyroxin requires more investigation., (Copyright © 2019 Elsevier Masson SAS. All rights reserved.)

Aqueous solutions of amphiphilic molecules are characterized by the competition between hydrophilic and hydrophobic interactions. These interactions have a different energetic dependence with the temperature. Whereas hydrophilic interactions have been well characterized, a complete theory for the hydrophobic ones is still lacking as well as the comprehension of the effect that the solvent exerts on the solute and vice versa. In this paper from the measured relaxation time, we evaluated the thermodynamic state functions of water-methanol solutions in the frame of the transition state theory. In particular we study the behavior of the Gibbs free energy, enthalpy and entropy of water, methanol and some of their solutions as a function of both temperature and water molar fraction. Our results indicate that the temperature of about 280 K represents a crossover between two regions dominated by hydrophobicity (high T) and hydrophilicity (low T)., (Copyright © 2018 Elsevier B.V. All rights reserved.)

During the archaeological excavations conducted in the Hellenistic necropolis discovered in Messina (Sicily, Italy) dating back to the 3rd century BC., a skeleton showing evidence of cranial traumas and surgical intervention was found. The skull, belonging to a young adult male, presented signs of 4 head injuries produced by both blunt and sharp-edged instruments. The first 2 lesions, located on the frontal bone, were produced by blunt blows and showed signs of long-term survival. The third lesion, located on the inferior portion of the right parietal, suggests a perimortem nonpenetrating linear cut likely caused by a blade instrument. Finally, a rectangular bone loss is visible on the left parietal bone, involving the full cranial thickness with well-delimited cutting edges and no sign of a reparative process. This injury can be interpreted as the result of a trepanation, performed with the technique defined as "linear cutting" and obtained through 4 linear incisions in parallel pairs intersecting at the right angles. The trepanation is likely related to the multiple head injuries exhibited by the patient, who unfortunately did not survive the surgical intervention. Trepanation in Italy has been largely attested since Prehistoric times, but the case from Messina represents the first evidence of neurosurgical intervention performed through the linear cutting technique in the Italian context and the second case in the whole of Europe. This technique might have been imported in Sicily during the Hellenistic period from the Near East, where it is clearly attested., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Addressing climate change is one of the greatest environmental challenges. Due to the impact of cities to energy consumption, the involvement of the local authorities in environmental policies is rapidly increasing. The Covenant of Mayors (CoM), launched by the European Commission, is an urban initiative aimed at reducing CO 2 emissions. The signatories have to compile the greenhouse gas emissions (GHG) balance of their territory and, to do so, they can use the Intergovernmental Panel on Climate Change (IPCC) or the Life Cycle Assessment (LCA). Moreover, the signatories have to define strategies to reduce the GHG emissions. In this context, authors estimate the GHG balance of an Italian municipality using both methodologies in order to compare the results. In detail, the first application is the IPCC, the second one is the LCA approach for which two cases are analysed: i) LCA with fossil fuels and electricity GHG emission factors based on the European Reference Life Cycle Database, LCA (I); and ii) LCA with a site - specific GHG emissions for electricity generation, LCA (II). They propose energy strategies in order to quantify the achievable GHG emissions reduction by the exploitation of the renewable energy resources. The study shows that the GHG emissions results obtained with the LCA approach are higher by 20% than those calculated with the IPCC approach. This difference is relevant and it could be significant in identifying effective climate strategies. The LCA methodology ensures a systemic accounting of emissions, then, it can be more effective in order to achieve GHG emissions reduction at global level. The examined energy strategies allow for reducing the GHG emissions of about 7% of the total reduction required by the CoM. This confirms that a preliminary evaluation of the strategies is useful for the allocation of the financial resources to the environmental policies., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Fat-soluble vitamins and antioxidants are of relevance in health and disease. Current methods to extract these compounds from biological fluids mainly need use of multi-steps and multi organic solvents. They are time-consuming and difficult to apply to treat simultaneously large sample number. We here describe a single-step, one solvent extraction of fat-soluble vitamins and antioxidants from biological fluids, and the chromatographic separation of all-trans-retinoic acid, 25-hydroxycholecalciferol, all-trans-retinol, astaxanthin, lutein, zeaxanthin, trans-β-apo-8'-carotenal, γ-tocopherol, β-cryptoxanthin, α-tocopherol, phylloquinone, lycopene, α-carotene, β-carotene and coenzyme Q 10 . Extraction is obtained by adding one volume of biological fluid to two acetonitrile volumes, vortexing for 60s and incubating for 60min at 37°C under agitation. HPLC separation occurs in 30min using Hypersil C18, 100×4.6mm, 5μm particle size column, gradient from 70% methanol+30% H 2 O to 100% acetonitrile, flow rate of 1.0ml/min and 37°C column temperature. Compounds are revealed using highly sensitive UV-VIS diode array detector. The HPLC method suitability was assessed in terms of sensitivity, reproducibility and recovery. Using the present extraction and chromatographic conditions we obtained values of the fat-soluble vitamins and antioxidants in serum from 50 healthy controls similar to those found in literature. Additionally, the profile of these compounds was also measured in seminal plasma from 20 healthy fertile donors. Results indicate that this simple, rapid and low cost sample processing is suitable to extract fat-soluble vitamins and antioxidants from biological fluids and can be applied in clinical and nutritional studies., (Copyright © 2017 Elsevier B.V. All rights reserved.)

Force (F) reduction is reported with myotendinous junction (MTJ) manipulation. Autogenic inhibition reflex (AIR) activation is supposed to be the main mechanism. Still, its role remains unclear. The study aimed at assessing the effects of MTJ direct inhibitory pressure (DIP) on neuromuscular activation and F in the elbow flexor (agonist) and extensor (antagonist) muscles. After maximum voluntary contraction (MVC) assessment, thirty-five participants randomly performed submaximal contractions at 20, 40, 60, and 80% MVC. Electromyographic (EMG), mechanomyographic (MMG), and F signals were recorded. Protocol was repeated under (i) DIP (10-s pressure on the biceps brachii MTJ) with the elbow at 120° (DIP 120 ), (ii) DIP with the elbow at 180° (DIP 180 ), and (iii) without DIP (Ctrl). Electromechanical delay (EMD) components, EMG and MMG root mean square (RMS), and rate of force development (RFD) were calculated. Independently from the angle, DIP induced decrements in MVC, RFD, and RMS of EMG and MMG signals and lengthened the EMD components in agonist muscles (P<0.05). The DIP-induced decrease in F output of the agonist muscles seems to be possibly due to a concomitant impairment of the neuromuscular activation and a transient decrease in stiffness. After DIP, the antagonist muscle displayed no changes; therefore, the intervention of AIR remains questionable., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Background and Aims: Malnutrition is frequent in heart failure (HF). However, the best tool for evaluating malnutrition in geriatric patients with HF with reduced ejection fraction (HFrEF) is unknown. This study aimed to evaluate the incremental prognostic value of the geriatric nutritional risk index (GNRI) in stable geriatric outpatients with HFrEF compared with a clinical/laboratory prognostic model., Methods and Results: A total of 143 outpatients with HFrEF, aged >65 years, a LVEF <40%, and who were stable and on optimal therapy were studied. Follow-up lasted 3 years. The outcome was all-cause death. The GNRI was calculated as follows: [(1.489 × serum albumin (g/L)) + (41.7 × (current body weight/ideal weight)]. The 3-year death rate was 36.4% and 16 (11.2%) patients were at risk of malnutrition (GNRI ≤98). Deceased patients had a lower GNRI (113.6 ± 9.1 vs. 105.6 ± 9.2; p < 0.001) than did survivors. Greater values of the GNRI (hazard ratio = 0.93, 95% confidence interval [CI] = 0.90-0.95; p < 0.001) and GNRI >98 (hazard ratio = 0.29, 95% CI 0.15-0.57; p < 0.001) were associated with better survival. These factors remained significant after adjustment of significant confounders. The GNRI was a better discriminator of death than weight and albumin. Adding the GNRI to the clinical/laboratory predictor survival model significantly increased the c-statistics from 0.93 to 0.95 (p < 0.001) and the chi-square likelihood ratio test from 106.15 to 119.9., Conclusion: The risk of malnutrition, as assessed by the GNRI, in stable geriatric outpatients with HFrEF is a strong independent predictor of survival. The GNRI adds significant prognostic information to the clinical/laboratory model., (Copyright © 2017 The Italian Society of Diabetology, the Italian Society for the Study of Atherosclerosis, the Italian Society of Human Nutrition, and the Department of Clinical Medicine and Surgery, Federico II University. Published by Elsevier B.V. All rights reserved.)

The study was aimed at assessing possible correlations of the electromechanical delay components during muscle contraction (Delay TOT ) and relaxation (R-Delay TOT ), with muscle-tendon unit (MTU), muscle, and tendon stiffness before and after static stretching (SS). Plantarflexor muscles' maximum voluntary torque (T max ) was measured in 18 male participants (age 24±3yrs; body mass 76.4±8.9kg; stature 1.78±0.09m; mean±SD). During T max , surface electromyogram (EMG), mechanomyogram, and force signals were detected. Delay TOT and R-Delay TOT with their electrochemical and mechanical components were calculated. Passive torque and myotendinous junction displacement were assessed at 0°, 10° and 20° of dorsiflexion to determine MTU, muscle and tendon stiffness. The same protocol was repeated after SS. Delay TOT , R-Delay TOT and their mainly mechanical components correlated with MTU, muscle and tendon stiffness, both before (R 2 from 0.562 to 0.894; p<0.001) and after SS (R 2 from 0.726 to 0.955; p<0.001). SS decreased T max (-14%; p<0.001) and lengthened almost all the Delay TOT and R-Delay TOT components (from +5.9% to +30.5%; p<0.05). Correlations were found only between stiffness and the mechanical components of Delay TOT and R-Delay TOT . Correlations persisted after SS but delays increased to a higher extent than stiffness, indicating a complexity of the relationship between stiffness and delays that will be discussed in the manuscript., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Recent studies report that 35% of women are either overweight or obese at reproductive age. The placenta continuously releases exosomes across gestation and their concentration is higher in pregnancy complications. While there is considerable interest in elucidating the role of exosomes during gestation, important questions remain to be answered: i) Does maternal BMI affect the exosomal profile across gestation? and ii) What is the contribution of placenta-derived exosomes to the total number of exosomes present in maternal plasma across gestation? Plasma samples were classified according to the maternal BMI into three groups (n = 15 per group): Lean, overweight, and obese. Total exosomes and specific placenta-derived exosomes were determined by Nanoparticle Tracking Analysis (NanoSight™) using quantum dots coupled with CD63 or PLAP antibodies. The effect of exosomes on cytokine (IL-6, IL-8, IL-10 and TNF-α) release from endothelial cells was established by cytokine array analysis (Bioplex-200). The total number of exosomes present in maternal circulation was strongly correlated with maternal BMI. Between ∼12% and ∼25% of circulating exosomes in maternal blood are of placental origin during gestation, and the contribution of placental exosomes to the total exosomal population decreases with higher maternal BMI across gestation. Exosomes increase IL-6, IL-8 and TNF-α release from endothelial cells, an effect even higher when exosomes were isolated from obese women compared to lean and overweight. This study established that maternal BMI is a factor that explains a significant component of the variation in the exosomes data. Exosomes may contribute to the maternal systemic inflammation during pregnancy., (Copyright © 2016. Published by Elsevier Ltd.)

Background & Aims: Safety and growth adequacy of infant formulae enriched by functional ingredients need stringent evaluation by means of randomized controlled trials (RCTs), therefore we performed a double-blind RCT to evaluate an infant formula enriched with galacto-oligosaccharides, beta-palmitate, and acidified milk vs. a standard infant formula., Methods: Weight, length, head circumference and fecal bacteria (Bifidobacteria, BIF/Clostridia, CLO) were measured in healthy full term infants, at baseline - as before 21 days of life - at 60 and 135 days thereafter. A group of 51 neonates received the enriched formula (ENR), 59 the standard one (ST). Parents were trained to daily register gastrointestinal diseases., Results: All the infants grew homogeneously increasing the anthropometric parameters and complying with WHO and Italian standards: the mean (SD) difference in daily weight between ENR and ST groups was -0.74 (1.13) g/day, corresponding to a 90% CI of -2.62 to 1.13 g/day, well within the postulated interval of equivalence of -3.9 to +3.9 g/day. A statistical improvement in BIF concentration in the microbiota of infants fed by ENR was recorded. There was no between-group change in log 10 CLO, but log 10 BIF increase was higher at T2 vs. T0 in ENR (treatment × time interaction = 0.71, 95% CI 0.08-1.34, p = 0.028) than in ST neonates. This corresponds to estimated mean (95% CI) values of 8.37 (8.04-8.69) log 10 -units for ENR vs. 8.08 (7.77-8.39) log 10 -units for ST neonates. Gastrointestinal effects were mild and similar, with no statistical difference between two groups., Conclusion: Safety and growth ability of the enriched formula has been confirmed. A positive effect on neonatal gut microbiota, consisting of increased fecal BIF counts at T2 vs. baseline has been shown too. Nonetheless, larger RCTs are needed to estimate with greater precision the effective potential attributable to the enriched formula on neonatal microbiota, with particular reference to the mode of delivery., (Copyright © 2015 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.)

Background: Obstructive sleep apnea (OSA) may lead to myocardial preconditioning by increasing coronary collateral vessel recruitment in patients with acute coronary occlusion., Aim: To determine the relationship between the severity of obstructive sleep apnea and coronary collaterality during acute myocardial infarction., Methods: This study prospectively included 71 patients with an inaugural myocardial infarction who had undergone a coronary angiography within 24h of onset. All patients underwent an overnight polygraph before discharge and were classified according to the apnea-hypopnea index (AHI). Coronary collaterals were scored by visual analyses and according to the Rentrop grading system., Results: Mean age was 59±11years and 83% of patients were men. All patients had complete or subtotal occlusion of the infarct-related artery. After the sleep study, patients were divided into two groups: 25 were suffering from OSA (AHI>15/h). Patients with OSA showed better collateral vessel development (Rentrop score≥1) compared to non-OSA patients (68 vs. 41%, P=0.032). AHI was significantly higher in patients with developed coronary collaterals (Rentrop≥1) compared to those without collaterality (17.74±13.2 vs. 12.24±10.9, P=0.025)., Conclusion: Coronary collateral development may be increased in OSA patients who are presenting with a first myocardial infarction., (Copyright © 2015 Elsevier Masson SAS. All rights reserved.)

Atrial fibrillation can expose to thrombo-embolic complications. Many biomarkers have been tested to refine the stratification of thrombo-embolic risk. The study aim was to assess the interest of the d-dimer testing in this pathology. We conducted a prospective observational study including 50 cases and 19 controls, enrolled at the cardiology department of the Mongi Slim Hospital, from July to November 2012. The d-dimer assay was performed on mini-VIDAS(®) and analyzed according to clinical, echocardiographic and biological data. The mean age of patients was 61.8±10.6years. The mean CHA2DS2-VASc score was 2.58±1.31. The average of D-dimer levels was 590±506ng/ml in patients and 225.26±112.95ng/ml in controls (P=0.02). No significant difference has been found between the d-dimer level and age, sex, type and etiology of atrial fibrillation, the CHA2DS2-VASc score, the left atrial surface. Among patients on acenocoumarol, d-dimer levels was significantly higher in patients with an INR<2 compared to those with an INR≥2 (P=0.004). We identified a positive d-dimer threshold (300ng/ml) in patients distinguishing them significantly with controls (P<0.001). In conclusion, the measurement of d-dimers could help clinicians to identify patients with atrial fibrillation having an increased coagulability and, therefore, an increased thrombo-embolic risk. It could be complementary to the determination of INR in monitoring anticoagulation therapy: d-dimers level refines the thrombo-embolic risk and INR measurement assesses the level of anticoagulation and the bleeding risk., (Copyright © 2015 Elsevier Masson SAS. All rights reserved.)

The study aimed to evaluate the stretch-induced changes in muscle architecture in different portions of the gastrocnemius medialis (GM) and lateralis (GL) muscles. The reliability and sensitivity of the measurements were also assessed. Fascicle length (FL) and pennation angle (PA) were calculated in the middle and distal portions of GM and GL at 0°, 10° and 20° of ankle dorsiflexion. At the same angles, passive torque (Tpass), peak torque (pT) and myotendinous junction displacement of GM were determined. Stiffness was calculated at muscle-tendon unit (MTU), muscle and tendon level. After static stretching administration, Tpass, pT and MTU stiffness decreased by 22%, 12% and 16%, respectively (p<0.05). Muscle and tendon stiffness decreased by 15% and 16% (p<0.05). Nevertheless, no changes in FL and PA occurred. The reliability of the approach was always very high (intraclass correlation coefficient>0.90), with an adequate level of sensitivity. pT after static stretching was related to decreases in MTU, muscle and tendon stiffness, but not to alterations in muscle architecture., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

The incidence of neonatal early-onset group B streptococcus (GBS EOS) sepsis has declined during the last decade since the implementation of intrapartum antibiotic prophylaxis endorsed by Centers for Disease Control and Prevention (CDC) guidelines. All the CDC guidelines versions provide recommendations for neonatal management. The neonatal algorithm of CDC has not been universally accepted and hence different algorithms have been suggested. Since all approaches to disease prevention are still imperfect, an optimal algorithm for GBS EOS prevention is still lacking; the development of improved diagnostic methods of distinguishing at-risk infants may contribute to improve the clinician's approach., (Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.)

Intra-uterine growth retardation (IUGR) is usually defined as impaired growth and development of the fetus and/or its organs during gestation. Infants are defined small for gestational age (SGA), following IUGR, when the birth weight is below the 10th percentile. Pre-natal congenital infections caused by T. gondii, rubella, cytomegalovirus (CMV), herpes simplex virus (HSV), varicella-zoster virus (VZV), and Treponema are associated with, and account for, approximately 5 to 15% of IUGR. On the other hand, SGA preterm infants are at increased risk of post-natal infection compared to their age-matched appropriately grown controls, in particular nosocomial infection, irrespective of the responsible pathogen. One possible mechanism is the retarded development in the immune system which has been described in association with IUGR. Indeed, SGA infants have a disproportionately small thymus and low leukocyte, lymphocyte and macrophage counts. However, immune therapies, including prophylactic intravenous immunoglobulins and GM-CSF have not proven to be effective in reducing the incidence of sepsis, and further research is required., (Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.)

Fungal particulates are a dominant component of the bioaerosol, but aerobiological studies traditionally focused on a limited set of fungi having relevance as allergens or plant pathogens. This study first analyzes the occurrence of lichen meiospores in the mycoaerosol, quantitatively evaluating in the atmosphere of an alpine environment the occurrence of polar diblastic spores, unequivocally attributable to the lichen family Teloschistaceae. The analysis of air-samples collected one week per month for one year with a Hirst-type sampler displayed a low percentage occurrence of polar-diblastic spores (<0.1%) with respect to the whole mycoaerosol, dominated by Cladosporium. Spearman's correlation tests on aerobiological and climatic data highlighted a strong relationship between the detection of Teloschistaceae spores and rainfall events, excluding seasonal patterns or daily rhythms of dispersion. The fact that all the air-sampled spores were attributable to the species of Teloschistaceae occurring in the site, together with laboratory observations of predominant short range dispersal patterns for polar diblastic and other lichen spores, indicated that sexual reproduction is mostly involved in the local expansion of colonization, dispersal from a long distance appearing a less probable phenomenon. These findings indicated that responses of lichen communities to climate factors, usually related to physiological processes, also depend on their influence on meiospore dispersal dynamics. Spatial limitations in dispersal, however, have to be taken into account in evaluating lichen distributional shifts as indicators of environmental changes., (Copyright © 2013 Elsevier B.V. All rights reserved.)

Background Aims: The umbilical cord (UC) is a promising source of mesenchymal stromal cells (MSCs). UC-MSCs display very similar in vitro characteristics to bone marrow-MSCs and could represent a valuable alternative for cell-based therapies. However, it is still unclear whether UC-MSCs are prone or not to the acquisition of genomic imbalances during in vitro expansion., Methods: With the use of array-comparative genomic hybridization, we compared copy number variations of early (P2-P3) and late (>P5) passages of in vitro-expanded UC-MSCs., Results: In two of 11 long-term UC-MSCs cultures, we observed the appearance of clones carrying genomic imbalances, which generated genetic mosaicism at intermediate passages. Although still able to reach the senescence phase, the cells carrying the genomic imbalance acquired a proliferative advantage, as demonstrated by the increase in frequency during long-term culture., Conclusions: Altogether, our results suggest that UC-MSC-based clinical protocols should be designed with caution; their clinical use should be preceded by array-comparative genomic hybridization screening for the acquisition of genomic imbalances during in vitro expansion., (Copyright © 2013 International Society for Cellular Therapy. Published by Elsevier Inc. All rights reserved.)

Pulmonary valve replacement is rarely performed and is usually done with biological prostheses or grafts. The use of mechanical prostheses is still a debated issue. We analyzed the outcome of 4 patients at 11 years after pulmonary valve replacement with a mechanical prosthesis. During follow-up, all patients remained asymptomatic, with no arrhythmias and good anticoagulation. An echocardiogram showed preserved ventricular contraction and normal function of the prostheses, with low pressure gradients. No infective endocarditis occurred. Mechanical prostheses appear to be a good choice for pulmonary valve replacement. Surgical and clinical results were satisfactory with no complications, acceptable pressure gradients, and good ventricular function after more than 10 years. Lifelong anticoagulation is mandatory, but this is usually well tolerated., (2010 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)

Embryonic heart and limb development are closely related with >100 known inherited disorders affecting both. Common limb defects include duplication, deficiencies, and hypoplasia. Ventricular septal defects and atrial septal defects are the commonest associated cardiac conditions. A positive association exists between heart defects and limb disorders when these disorders are analyzed separately. Closer associations exist between heart defects and upper limb defects compared with lower limb defects. The majority of limb defects occur in the more distal parts of the affected limb. Genes expressed in both the heart and limb development include TGF-beta, BMP4, Msx transcription factor, HAND gene, retinoic acid receptor, and sonic hedgehog gene. Radial ray-heart syndromes are better described than ulnar ray-hand syndromes. There is significant variability of malformations. Partial phenocopies that are not genetically linked are well documented. An appreciation of ulnar anomalies should always provoke an evaluation of the heart for potential abnormalities. Although heart-hand syndromes are rare, valvular abnormalities and aortic aneurysms can lead to significant complications unless identified in time. The presence of radial or ulnar ray anomalies merit a detailed cardiac examination and a low threshold for cardiac imaging.

Asbestos-cement roofs, the most widespread sources of airborne, toxic and carcinogenic asbestos fibres, are often colonized by lichens. Since these latter are physical and chemical weathering agents, they have been often considered as significant responsible of disaggregation processes increasing fibre dispersion. Consequently, official guidelines for the management of asbestos often suggest their removal. Weathering and/or covering effects of lichens on asbestos-cement, however, have never been deeply investigated and available procedures to evaluate asbestos-cement aging do not take the biological colonization into account. In this study we show that a 25% lichen cover modifies physical and chemical properties of asbestos-cement sheets containing chrysotile and crocidolite fibres. By innovatively coupling pull up tests and image analysis of linear structures, we show that fibre loss is significantly lower ( approximately 30%) where lichens develop and offer a physical barrier to the fibre detachment. Below the most covering lichens (Acarospora cervina, Candelariella ssp.), chrysotile and crocidolite undergo a partial incongruent dissolution, which in laboratory assays generally determined a reduction of their surface reactivity. Because of their biocovering and bioweathering effects, lichens on asbestos-cement play a role which differs from the current public opinion and the assumptions of some official regulations, acting as effective spontaneous bioattenuation agents.

Aims: Conductive disorders following open-heart valvular surgery represent serious complications that may require definitive pacemaker implantation. The natural history of these troubles is not well established thus, controversy persist concerning the timing of pacemaker implantation. In this study we identify the predictive factors of permanent conductive disorders in order to assess the optimal time of pacing., Methods and Results: Two hundred thirty valvular replacements were done between 1993 and 2003. The mean age of our patients was 42 +/- 13.4 years. Rheumatic valvulopathies accounted for 76% of cases, with 54% of multiple valvulopathies. Twenty-two patients (9,5%) had an early postoperative conductive disorder, 9 of them (4%) were definitively implanted after a mean delay of 31.8 days. Preoperative bifascicular bloc and early installation of postoperative high-grade conduction disturbances and its persistence for more than 48 hours are significantly associated with permanent postoperative conductive disorders (respectively P = 0.04 and = 0.03). Aortic valve surgery and infective endocarditis were more frequent in the implanted group but the difference was not significant., Conclusion: After open-heart valvular surgery; predictive factors of definitive conductive troubles justify an earlier pacemaker implantation. This attitude may accelerate the hospital discharge and decrease the disease cost effectiveness.

Introduction: Hereditary breast cancer has been partly attributed to germline mutations in the BRCA1 gene that are deleterious for BRCA1 protein activity. This paper analyzes the incidence and characteristics of detectable BRCA1 mutations and polymorphisms in a hospital-based consecutive series of breast cancer patients from southern Italy to investigate the incidence and the association of these molecular alterations with breast cancer biology and family history., Methods: One hundred cases with familial characteristics were selected from a consecutive series of 511 patients with a first diagnosis of breast cancer. DNA from peripheral blood was screened for whole BRCA1 gene mutations utilizing dHPLC as a pre-screening analysis and automatic DNA sequencing for the identification of specific alterations., Results: In the overall series of 511 patients, 100 had a family history of breast cancer and were investigated for BRCA1 mutations. Two types of BRCA1 mutations were identified, 5382insC in six cases and 4566delA in one case. The 5382insC mutation was present in two out of six cases with ovarian cancer while 4566delA in one case of male cancer. The most frequent missense polymorphisms were E1038G, P871L, K1183R in exon 11, S1613G, M1652I in exon 16 and D1778G in exon 22. Confirming what found in previous studies, patients in whom pathological BRCA1 mutations were detected had early-onset breast cancer (p=0.05), positive nodal status (p=0.05), lower ER (p=0.02) and PgR (p=0.01) content. Interestingly, the K1183R polymorphism and, less strongly, S1613G polymorphism were associated to mutational risk (K1183R: OR 0.1 p=0.03; S1613G: OR 2.7 p=0.08)., Conclusion: Mutations in the BRCA1 gene are frequent also in our consecutive series of patients from southern Italy. An association between two detected single nucleotide polymorphisms (SNPs) and BRCA1 mutational risk was ascertained. Finally, we confirm the fact that peculiar clinical-pathological features seem to characterize patients with a family history of breast cancer and BRCA1 alterations.

Background: The use of indwelling central venous catheters (CVCs) has become commonplace in the management of children undergoing anticancer treatment. Several types of CVC are available, while information on complications observed in children is scarce. We describe the experience of two tertiary care centers in Italy that prospectively followed up three types of CVC used at both institutions over a 30-month period., Patients and Methods: Between January 2000 and May 2002, double-lumen (DL) or single-lumen (SL) Hickman-Broviac (HB) catheters, and single-lumen pressure-activated safety valve (PASV) catheters were used and prospectively evaluated. Four types of possible complication were defined a priori: mechanical, thrombotic, malfunctioning and infectious., Results: Four hundred and eighteen CVCs (180 SL-HB, 162 DL-HB and 76 PASV) were inserted in 368 children, for a total of 107 012 catheter days at risk of complication. At least one complication occurred while using 169 of the devices (40%): 46% of the DL-HB, 46% of the PASV and 33% of the SL-HB (P=0.02) catheters. Subjects with hematological malignancies or non-malignant diseases had significantly more complications than those with solid tumors (P <0.0001). Overall, 234 complications were documented: 93 infectious [complication rate per 1000 catheter days at risk (CR)=0.87], 84 malfunctioning (CR=0.78), 48 mechanical (CR=0.45) and nine thrombotic (CR=0.08). SL-HB had statistically fewer infectious complications, while PASV had more mechanical complications. In a multivariate regression model, the most significant risk factors for having a CVC complication were hematological disease [relative risk (RR)=3.0; 95% confidence interval (CI) 1.8-4.8] and age <6 years at CVC insertion (RR=2.5; 95% CI 1.5-4.1). As for the type of CVC, compared with SL-HB, the DL-HB catheter had a statistically significant two-fold increased risk of any complication (RR=2.1; 95% CI 1.2-3.6), while the PASV catheter had a borderline RR of 1.8 (95% CI 1.0-3.6). Analysis by tumor type showed a higher risk of any kind of complication in patients with solid malignancies who had received a DL-HB catheter as compared with an SL-HB catheter (RR=7.2; 95% CI 2.8-18.7)., Conclusions: CVCs may cause complications in up to 40% of patients, with type of CVC, underlying disease and patient age being the three main factors that affect the incidence of CVC-related complications. SL-HB catheters have the best performance.

High degree atrioventricular block complicates inferior wall acute myocardial infarction in 10 to 15% of cases. Its significance is still controversial. In this study, we have analysed 152 observations of acute inferior wall myocardial infarction during hospitalisation period. The mean age of our patients is 60 years, 48.7% of them have received fibrinolytic treatment. Second or third degree atrioventricular block was detected in 33 cases (21.7%). Mortality is higher in inferior wall myocardial infarctions with atrioventricular block than in those without atrioventricular block (12% versus 2.5%, p < 0.05). Hemodynamic complications like cardiogenic shock due to the extension of the infarction to the right ventricle and left ventricle insufficiency are more frequent (18% versus 3.4%, p < 0.01 and 12% versus 3.5%, p < 0.01 respectively). It appears that the infracted mass of myocardium is larger in case of atrioventricular block, this is assessed by comparing the average value of the peak of creatine Kinase in the two groups with and without atrioventricular block (1534 IU versus 1096 IU, p < 0.02) and by considering the rate of low ejection fraction (EF < 40%) in each group (44.6% versus 16%, p < 0.01). In our study, we note that thrombolysis does not affect the incidence of atrioventricular block (19% and 24% in thrombolyed and not thrombolyzed patients respectively) but it seems that thrombolysis improves the outcome of these patients. The occurrence of atrioventricular block in acute inferior wall myocardial infarction is related to the presence of an important right coronary artery that is occluded, the recanalisation of this vessel leads often to rapid regression of the block that is no longer pejorative.