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Background: Limited and heterogeneous literature data necessitate a focused examination of the learning curve in robotic liver resections. This study aims to assess the learning curve of two surgeons from the same team with differing laparoscopic backgrounds., Methods: Since February 2021, San Raffaele Hospital in Milan has implemented a robotic liver surgery program, performing 250 resections by three trained console surgeons. Using cumulative sum (CUSUM) analysis, the learning curve was evaluated for a Pioneer Surgeon (PS) with around 1200 laparoscopic cases and a New Generation Surgeon (NGS) with approximately 100 laparoscopic cases. Cases were stratified by complexity (38 low, 74 intermediate, 85 high)., Results: Both PS and NGS demonstrated a learning curve for operative time after 15 low-complexity and 10 intermediate-complexity cases, with high-complexity learning curves apparent after 10 cases for PS and 18 cases for NGS. Conversion rates remained unaffected, and neither surgeon experienced increased blood loss or postoperative complications. A "team learning curve" effect in terms of operative time emerged after 12 cases, suggesting the importance of a cohesive surgical team., Conclusion: The robotic platform facilitated a relatively brief learning curve for low and intermediate complexity cases, irrespective of laparoscopic background, underscoring the benefits of team collaboration., (Copyright © 2024 International Hepato-Pancreato-Biliary Association Inc. Published by Elsevier Ltd. All rights reserved.)

Background: Hypertrophic synovium (HS) is a marker of disease activity in persons with hemophilia (PwH). Although some recommendations suggest intensifying prophylaxis in PwH with HS, no validated schedules are available., Objectives: We explored the efficacy of intensive factor VIII (FVIII) replacement treatment in PwH with HS., Methods: In a randomized, open-label study, PwH with HS were randomized to receive pharmacokinetics-driven prophylaxis targeting a FVIII trough level of 8% to 12% (intensive treatment arm [ITA]) or 3% to 5% (standard treatment arm [STA]). The primary outcome was HS reduction/resolution in the 2 treatment arms., Results: A total of 39 PwH were randomized to ITA and 36 to STA. During the study, we found a lower annual bleeding rate and a higher rate of annual bleeding rate zero in the ITA than in the STA. HS reduction/resolution was reported in 35.9% of cases in the ITA and 8.4% in the STA. In detail, in the ITA ,10.3% achieved HS reduction and 25.6% complete HS resolution, as compared to 5.6% and 2.8% in the STA. Cox regression showed that ITA was associated with HS reduction/resolution (hazard ratio: 4.75; 95% CI: 1.36-16.57; P = .014) and HS complete resolution (hazard ratio: 10.79; 95% CI: 1.38-84.45; P = .023). The analysis of the 127 joints with HS (54 elbows, 41 knees, and 32 ankles) consistently confirmed similar results., Conclusion: In this randomized study, we found a ∼5-fold higher rate of HS reduction/resolution and a ∼10-fold higher rate of HS resolution in the ITA than in the STA., Competing Interests: Declaration of competing interests Matteo Nicola Dario Di Minno has acted as consultant/advisor and/or speaker for Bayer Healthcare, CSL Behring, Novo Nordisk, Pfizer, Roche, Sobi, Biomarin, and Takeda, outside the submitted work. Ilenia Calcaterra has acted as consultant/advisor and/or speaker for Bayer Healthcare, CSL Behring, Novo Nordisk, Pfizer, Roche, Sobi, Biomarin, and Takeda, outside the submitted work. Erminia Baldacci has acted as consultant/advisor and/or speaker for Bayer Healthcare, CSL Behring, Novo Nordisk, Pfizer, Roche, Sobi, and Takeda, outside the submitted work. Renato Marino has acted as consultant/advisor and/or speaker for Bayer Healthcare, CSL Behring, Novo Nordisk, Roche, Sobi, and Takeda, outside the submitted work. Federica Valeri has received honoraria for attending advisory boards and/or for speaking from Bayer Healthcare, Novo Nordisk, Pfizer, Sobi, and Takeda, outside the submitted work. Rita Carlotta Santoro has acted as consultant/advisor and/or speaker for Bayer Healthcare, CSL Behring, Novo Nordisk, Pfizer, Roche, Sobi, Biomarin, and Takeda, outside the submitted work. Gianluigi Pasta has received honoraria for attending symposia/congresses and/or for speaking and/or consulting, and/or has received research funding from Bayer, Novo Nordisk, Pfizer, Roche, Sobi, and Takeda. Carlo Martinoli has acted as paid consultant for Pfizer, and received speaker fees from Pfizer, Sobi, Takeda, Novartis, and Novo Nordisk, outside the submitted work., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

Background & Aims: The use of immune checkpoint inhibitors (ICIs) in patients with advanced hepatocellular carcinoma (HCC) has become widespread with encouraging outcomes in the neoadjuvant setting. Safety and intention-to-treat (ITT) outcomes in the peri-transplant setting are currently based on small and heterogenous single-center reports., Methods: This first multiregional US study (2016-2023) included 117 consecutive patients with HCC assessed for liver transplantation (LT) and treated preoperatively with ICIs. ITT and survival analyses were conducted with evaluation of post-LT rejection rates., Results: In total, 86 (73.5%) patients exceeded Milan criteria (MC) and 65 (75.6%) were successfully downstaged within a median of 5.6 months; 43 (36.7%) underwent transplantation, including 18 (15.4%) within MC and 23 (19.7%) who were initially beyond but were downstaged. Overall, 94% of the cohort received concurrent ICIs and locoregional therapies. No grade 4-5 adverse events occurred on the waiting list. The 3-year cumulative probability of dropout was 28% for those within MC and 48% for those beyond. Independent predictors of dropout included being beyond MC (p <0.001), alpha-fetoprotein doubling from baseline (p = 0.014) and radiographic responses (p <0.001). The 3-year ITT survival rate was 71.1% (73.5% within MC vs. 69.7% beyond MC, p = 0.329), with a 3-year post-LT survival rate of 85%. Post-LT rejection occurred in seven patients, six received their last dose of ICI less than 3 months prior to LT, resulting in one graft loss., Conclusions: The first multicenter evaluation of patients with HCC receiving ICIs pre-LT demonstrates favorable survival and safety outcomes, justifying continued utilization and further evaluation of this strategy in clinical practice. High tumor burden, doubling of alpha-fetoprotein levels, and radiographic response were identified as predictors of unfavorable oncologic outcomes., Impact and Implications: Herein, we report results from the first multicenter evaluation of pretransplant immune checkpoint inhibitors in hepatocellular carcinoma to show promising intention-to-treat survival, safety and rejection rates. Immune checkpoint inhibitors, either alone or combined with locoregional therapy, demonstrate reliable efficacy. This preoperative strategy could be particularly beneficial for high-risk patients, including those requiring downstaging or with elevated alpha-fetoprotein levels despite locoregional treatment. These findings fill current knowledge gaps and offer reassuring evidence for the feasibility of pretransplant use of immune checkpoint inhibitors, pending results from ongoing trials., (Copyright © 2024. Published by Elsevier B.V.)

Introduction: Incidental Gallbladder Cancer (IGBC) following cholecystectomy constitutes a significant portion of gallbladder cancer diagnoses. Re-exploration is advocated to optimize disease clearance and enhance survival rates. The consistent association of residual disease (RD) with inferior oncologic outcomes prompts a critical examination of re-resection's role as a modifying factor in the natural history of IGBC., Methods: All patients diagnosed with gallbladder cancer between 2012 and 2022 were included. An elastic net regularized regression model was employed to profile high-risk predictors of RD within the IGBC group. Survival outcomes were assessed based on resection margins and RD., Results: Among the 181 patients undergoing re-exploration for IGBC, 133 (73.5 %) harbored RD, while 48 (26.5 %) showed no evidence. The elastic net model, utilizing a selected λ = 0.029, identified six coefficients associated with the risk of RD: aspiration from cholecystectomy (0.141), hepatic tumor origin (1.852), time to re-exploration >8 weeks (1.879), positive margin status (2.575), higher T stage (1.473), and poorly differentiated tumors (2.241). Furthermore, the study revealed a median overall survival of 44 months (CI 38-60) for IGBC patients with no evidence of RD, compared to 31 months (23-42) for those with RD (p < 0.001)., Conclusion: Re-resection revealed a high incidence of RD (73.5 %), significantly correlating with poorer survival outcomes. The preoperative identification of high-risk features provides a reliable biological disease profile. This aids in strategic preselection of patients who may benefit from re-resection, underscoring the need to consolidate outcomes with tailored chemotherapy for those with unfavorable characteristics., 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. Published by Elsevier Ltd.)

Objective: We sought to answer the question of how adolescents (ages 12-17 years old) with opioid-related presentations are currently managed in the ED. The two main outcomes were the proportion of visits where naloxone and buprenorphine were both used and prescribed, and the rate of revisits to the emergency department in the six months following ED presentation., Methods: This was a multi-center retrospective cross-sectional study. We studied patients presenting to the ED who were 12-17 years old with an opioid-related presentation., Results: Two-hundred and thirty-one patients were identified out of 571 encounters screened. Of these presentations, 77/231 (33%) were girls and 154/231 (67%) were boys. The majority of patients were Latino (64%; n=147); 26% were white (n=59), 6% were middle eastern or Arab (14), and 4% were black (10). Incidence of opioid use disorder per 100,000 presentations increased by 2800% from 2014 to 2022 (21/100,000 +/- 10 [2014] to 600/100,000 +/- 50 [2022]). A plurality of cases was related to opioid withdrawal (42%; 97). On discharge from the ED, 29% of patients received naloxone. For patients in withdrawal, 4% received a prescription for buprenorphine. Twenty-nine percent of patients had a return to the ED in the six months following initial visit., Conclusions: Adolescent opioid-related presentations to the ED are rapidly increasing. Increasing ED presentations, compounded by a high 6-month revisit rate, pose a management challenge amid limited outpatient resources for this population. Opioid agonist therapy and naloxone are not routinely provided. Increasing the use of both are two ways to improve the quality of care for this population., 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 Elsevier B.V. All rights reserved.)

Background: Major surgery, along with preoperative cholestasis-related complications, are responsible for the increased risk of morbidity and mortality in perihilar cholangiocarcinoma (pCCA). The aim of the present survey is to provide a snapshot of current preoperative management and optimization strategies in Europe., Methods: 61 European centers, experienced in hepato-biliary surgery completed a 59-questions survey regarding pCCA preoperative management. Centers were stratified according to surgical caseload (<5 and ≥ 5 cases/year) and preoperative management protocols' application., Results: The overall case volume consisted of 6333 patients. Multidisciplinary discussion was routinely performed in 91.8% of centers. Most respondents (96.7%) recognized the importance of a well-structured preoperative protocol. The preferred method for biliary drainage was percutaneous transhepatic biliary drainage (60.7%) while portal vein embolization was the preferred technique for liver hypertrophy (90.2%). Differences in preoperative pathologic confirmation of malignancy (35.8% vs 28.7%; p < 0.001), number of mismanaged referred patients (88.2% vs 50.8%; p < 0.001), biliary drainage (65.1% vs 55.6%; p = 0.015) and liver function evaluation (37.2% vs 5.6%; p = 0.001) were found between centers according to groups' stratification., Conclusion: The importance of a correct preoperative management is recognized. Nevertheless, the current lack of guidelines leads to wide heterogeneity of behaviors among centers. This survey can provide recommendations to improve pCCA perioperative outcomes., Competing Interests: Conflict of interest None to declare., (Copyright © 2023 International Hepato-Pancreato-Biliary Association Inc. Published by Elsevier Ltd. All rights reserved.)

Objective: Endovascular aortic aneurysm repair (EVAR) has lower rates of postoperative mortality and morbidity when compared with open repair. However, endovascular repair still carries the risk of postoperative dialysis, paralysis, and stroke. This study examined the rates of postoperative mortality and morbidity stratified by type of endovascular aortic aneurysm repair., Methods: All patients who underwent EVAR in the Vascular Quality Initiative registry from January 2011 to May 2022 were identified. Patients were stratified by repair type: infrarenal EVAR, complex EVAR, thoracic endovascular aortic repair (TEVAR), extent I to III thoracoabdominal aortic aneurysm (TAAA) repair, or aortic arch repair. The primary outcome was postoperative thoracoabdominal aortic aneurysm life-altering events (TALE) across the different treatment groups. TALE was defined as a composite outcome of postoperative mortality, dialysis, paralysis, and/or stroke. Mixed effect logistic regression modeling was used to identify procedural and anatomic factors that were independently associated with TALE., Results: A total of 52,592 EVARs, 3768 complex EVARs, 3899 TEVARs, 1139 extent I to III TAAA repairs, and 479 arch repairs were identified. TALE was observed in 1.2% of EVARs, 4.8% of complex EVARs, 6.0% of TEVARs, 10% of extent I to III TAAA repairs, and 14% of arch repairs. More proximal landing zone was associated with higher odds of TALE after complex EVAR (odds ratio [OR], 1.9; 95% confidence interval [CI], 1.2-3.1; P = .008), TEVAR (OR, 2.2; 95% CI, 1.4-3.5; P = .001), and extent I to III TAAA repair (OR, 2.7; 95% CI, 1.5-4.9; P = .001). Aortic diameter >65 mm was associated with higher odds of TALE after infrarenal EVAR (OR, 1.8; 95% CI, 1.4-2.3; P < .001), complex EVAR (OR, 1.6; 95% CI, 1.1-2.3; P = .010), TEVAR (OR, 2.7; 95% CI, 2.0-3.8; P < .001), and arch repair (OR, 2.4; 95% CI, 1.3-4.4; P = .007). The use of parallel grafting technique (chimney/snorkel/periscope) during extent I to III TAAA repair was also associated with higher odds of TALE (OR, 1.8; 95% CI, 1.1-3.2; P = .032). Preoperative chronic kidney disease was also associated with higher odds of TALE after infrarenal EVAR (OR, 4.3; 95% CI, 3.0-5.7; P < .001), complex EVAR (OR, 5.2; 95% CI, 3.3-8.2; P < .001), TEVAR (OR, 4.5; 95% CI, 2.8-7.1; P < .001), and extent I to III TAAA repair (OR, 3.2; 95% CI, 1.6-6.7; P = .001)., Conclusions: Although TALE was originally described for TAAA repairs, TALE may occur after complex EVAR, TEVAR, and arch repairs as well. Therefore, TALE and its component parts should be used to evaluate the efficacy of all aortic repairs and for preoperative counseling. Additionally, surgeons should be aware of anatomic and procedural characteristics that are associated with higher odds of TALE. The anticipated need for such interventions during aortic repair should be factored into preoperative risk assessment of patients., (Copyright © 2023 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.)

The aim of this paper is to investigate purchase intention (PI) for meat obtained through a tenderization process based on a treatment with exogenous proteolytic enzymes. Particularly, perceived risks and perceived benefits on the consumer acceptance of tender meat produced through this emerging technology have been evaluated. In order to achieve the stated objective, a survey was conducted on a national representative sample of Italian consumers (N = 1006), who received information about the traditional and the emerging tenderization processes. Principal Component Analysis and Structural Equation Model were applied to the collected data. Results show that consumer purchase intention for meat treated with exogenous proteolytic enzymes was strongly influenced by perceived benefits and weakly influenced by perceived risks. Another important result is that perceived benefits are mainly affected by trust in science. Finally, a Cluster Analysis was performed to distinguish consumer segments with different response patterns., Competing Interests: Declaration of Competing Interest The authors declare no conflict of interest., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

The impact of papain and/or ultrasound treatments on tenderization of semitendinosus muscle through a proteomic approach was studied. Sixteen bovine muscles were submitted to the following treatments: aging at 3 °C (Control), papain injection (PI), ultrasound (US), PI followed by US (PIUS) and US followed by PI (USPI). pH, myofibrillar fragmentation indices (MFI), soluble collagen, texture profile and changes of myofibrillar proteins were investigated after 2, 24, 48 and 96 h of storage. The highest MFI and soluble collagen content were found in PI, PIUS and USPI samples while control samples showed the lowest values. PI samples showed the lowest WBSF and hardness values until 48 h of storage while at 96 h meat from USPI treatment showed WBSF value comparable to PI treatment. The lowest values of cohesiveness, gumminess and chewiness were found in PI samples during all storage times. Proteomic analysis revealed a different quantity and expression of proteins among tenderization treatments. US treatment did not exhibit a significant ability to degrade muscle proteins, while, all treatments containing papain, showed a greater ability to hydrolyse and degrade myofibrillar proteins. PI promoted intense proteolysis leading to an early tenderization process; on the contrary, in PIUS and USPI treatments the sequence of treatments was relevant on meat tenderization. Particularly, USPI treatment, after 96 h, reached the same improvement in tenderness of enzymatic treatment but with slower hydrolysing rate; this could be determinant to preserve textural structure., Competing Interests: Declaration of Competing Interest The authors declare no conflict of interest., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Background: Type 3 von Willebrand disease (VWD) is the most severe form of this disease owing to the almost complete deficiency of von Willebrand factor (VWF). Replacement therapy with plasma-derived products containing VWF or recombinant VWF rarely cause the development of alloantibodies against VWF that may be accompanied by anaphylactic reactions., Objective: The objective of this study was to assess the prevalence of anti-VWF alloantibodies in subjects with type 3 VWD enrolled in the 3WINTERS-IPS., Methods: An indirect in-house enzyme-linked immunosorbent assay has been used to test all the alloantibodies against VWF. Neutralizing antibodies (inhibitors) have been tested with a Bethesda-based method by using a VWF collagen binding (VWF:CB) assay. Samples positive for anti-VWF antibodies were further tested with Bethesda-based methods by using the semiautomated gain-of-function glycoprotein-Ib binding (VWF:GPIbM) and a VWF antigen (VWF:Ag) enzyme-linked immunosorbent assay., Results: In total, 18 of the 213 (8.4%) subjects tested positive for anti-VWF antibodies and 13 of 213 (6%) had VWF:CB inhibitors. These 13 were among the 18 with anti-VWF antibodies. Of the 5 without VWF:CB inhibitors, 3 had non-neutralizing antibodies, 1 only inhibitor against VWF:GPIbM, and one could not be tested further. Ten of the 13 subjects with VWF:CB inhibitors also had VWF:GPIbM inhibitors, 6 of whom also had VWF:Ag inhibitors. Subjects with inhibitors were homozygous for VWF null alleles (11/14), homozygous for a missense variant (1/14), or partially characterized (2/14)., Conclusions: Anti-VWF antibodies were found in 8.4% of subjects with type 3 VWD, whereas neutralizing VWF inhibitors were found in 6%, mainly in subjects homozygous for VWF null alleles. Because inhibitors may be directed toward different VWF epitopes, their detection is dependent on the assay used., Competing Interests: Declaration of competing interest statement J.E. received research support from CSL Behring outside the scope of this project and fees for educational activities from Roche and Celgene, which fees go to the institution. J.G. in the last 3 years received fees for lectures or consultancy from LFB outside the scope of this work. F.L. received unrestricted research grants from CSL Behring, Takeda, SOBI, and uniQure. He is a consultant for CSL Behring, Takeda, BioMarin, and uniQure, of which the fees go to the University. He has been a DSMB member of a study sponsored by Roche. P.M.M. is member of the scientific board for the Bayer Awards. Speaker fee from Bayer and Kedrion, Roche for lectures at educational symposia. C.S., in the last 3 years, has received honoraria for consulting or speaker bureau from Bayer, CSL Behring, Takeda, Novonordisk, Sobi, Novartis, Pfizer, Amgen, and Roche. A.T. received research support or honoraria for lectures or consultancy from CSL Behring, Octapharma, and Takeda outside of this work. F.P. reported participation at advisory board of Sanofi, Sobi, Takeda, Roche, and BioMarin. A.B.F. reported advisory board participation of CSL Behring, Grifols, Takeda, Octapharma, LFB, and Kedrion. J.O. has received research funding from Bayer, Biotest, CSL Behring, Octapharma, Pfizer, Swedish Orphan Biovitrum, and Takeda; consultancy, speakers bureau, honoraria, scientific advisory board, and travel expenses from Bayer, Biogen Idec, BioMarin, Biotest, Chugai Pharmaceutical Co., Ltd., CSL Behring, Freeline, Grifols, Novo Nordisk, Octapharma, Pfizer, F. Hoffmann-La Roche Ltd., Sanofi, Spark Therapeutics, Swedish Orphan Biovitrum, and Takeda. GC reported advisory board participation/speaker fee of CSL Behring, Grifols, Takeda, LFB, and Kedrion. The remaining authors declare no competing financial interests., (Copyright © 2023 International Society on Thrombosis and Haemostasis. Published by Elsevier Inc. All rights reserved.)

This study aimed to evaluate the effect of hazelnut skin by-product supplementation on lamb meat quality characteristics and plasma and muscle proteomes. Twenty-two Valle del Belice male lambs were divided into two experimental groups: control (C), fed a maize-barley diet and hazelnut (H), fed hazelnut skin by-product as maize partial replacer in the concentrate diet. The meat of lambs fed hazelnut skin showed greater values of lightness, redness, yellowness, and chroma color parameters together with the highest myofibril fragmentation index. Two-dimensional electrophoresis and mass spectrometry applied on plasma proteome identified 20 protein spots corresponding to 18 unique gene names to be differently expressed due to hazelnut skin by-product substitution. For the early post-mortem muscle, 23 protein spots (42 unique gene names) were significantly up-regulated due to hazelnut skin by-product supplementation. Four proteins these being APOA1, PHB, ACTG1 and ALB, were found to be common to the two proteomes suggesting that these proteins could be candidate biomarkers to monitor in vita and post-mortem lamb meat quality traits. This study evidenced the main mechanisms involved in the supplementation of hazelnut skin by-product in lambs' diet and confirmed the possibility of using plasma proteome as a non-invasive way to predict lamb meat quality. SIGNIFICANCE: Maximizing the use of agro-industrial by-products as replacers of traditional feedstuff for improving animal products is one of the important challenges to preserving natural resources and guaranteeing environmental sustainability. Hazelnut (Corylus avellana L.) skin, obtained as a results of hazelnut roasting, represents a valuable by-products due to its high content in unsaturated fatty acids, tannins, and vitamins. Thus, including hazelnut skin by-product in small ruminant nutrition could reduce the costs of animal feedings for farmers as well as improve meat nutritional and sensorial characteristics. Additionally, monitoring the meat quality characteristics with fast, accurate, and non-invasive tools to find, before slaughter, animals with desired quality characteristics is of growing interest in the last years. In this regard, the objectives of this study were to assess i) the effect of hazelnut skin supplementation on lamb meat quality characteristics and plasma and muscle proteomes, and ii) whether analyzing plasma proteome by using a gel-based proteomic approach could effectively offer a more readily available option for determining lamb meat quality. Taken together, the proteomic approach applied to plasma and muscle proteomes, allowed us to reveal the pathways and the potential candidate plasma biomarkers to predict lamb meat production in the pre-slaughter phase., Competing Interests: Declaration of Competing Interest The authors declare no competing financial interest., (Copyright © 2022 Elsevier B.V. All rights reserved.)

Purpose: We report the first prospective, international, natural history study of the ultra-rare genetic disorder fibrodysplasia ossificans progressiva (FOP). FOP is characterized by painful, recurrent flare-ups, and disabling, cumulative heterotopic ossification (HO) in soft tissues., Methods: Individuals aged ≤65 years with classical FOP (ACVR1 R206H variant) were assessed at baseline and over 36 months., Results: In total, 114 individuals participated; 33 completed the study (mean follow up: 26.8 months). Median age was 15.0 (range: 4-56) years; 54.4% were male. During the study, 82 (71.9%) individuals reported 229 flare-ups (upper back: 17.9%, hip: 14.8%, shoulder: 10.9%). After 84 days, 14 of 52 (26.9%) imaged flare-ups had new HO at the flare-up site (mean new HO volume: 28.8 × 10 3 mm 3 ). Mean baseline low-dose whole-body computed tomography (excluding head) HO volume was 314.4 × 10 3 mm 3 ; lowest at 2 to <8 years (68.8 × 10 3 mm 3 ) and increasing by age (25-65 years: 575.2 × 10 3 mm 3 ). The mean annualized volume of new HO was 23.6 × 10 3 mm 3 /year; highest at 8 to <15 and 15 to <25 years (21.9 × 10 3 and 41.5 × 10 3 mm 3 /year, respectively) and lowest at 25 to 65 years (4.6 × 10 3 mm 3 /year)., Conclusion: Results from individuals receiving standard care for up to 3 years in this natural history study show the debilitating effect and progressive nature of FOP cross-sectionally and longitudinally, with greatest progression during childhood and early adulthood., Competing Interests: Conflict of Interest R.J.P. is a research investigator at Clementia Pharmaceuticals/Ipsen and Regeneron Pharmaceuticals, Inc and is part of the advisory board as President of the International Clinical Council on Fibrodysplasia Ossificans Progressiva. G.B. is part of the advisory boards of Clementia Pharmaceuticals/Ipsen, FOP European Consortium, and International Clinical Council on FOP and is a speaker at Clementia Pharmaceuticals/Ipsen. M.A.B. is part of the advisory boards of AbbVie, Janssen, Pfizer, UCB Pharma, and Novartis; receives grant support from AbbVie; is a research investigator at AbbVie, Clementia Pharmaceuticals/Ipsen, Janssen, Novartis, Pathios Therapeutics Ltd, and Regeneron Pharmaceuticals, Inc; and is a speaker at AbbVie, United States, Janssen, Novartis, Switzerland, Pfizer, United States, Regeneron Pharmaceuticals, Inc, United States, and UCB Pharma, United Kingdom. C.D.C. is a research investigator at Clementia Pharmaceuticals/Ipsen and is a speaker at Novartis. E.C.H. is part (all voluntary) of the Fibrous Dysplasia Foundation Advisory Board, International Fibrodysplasia Ossificans Progressiva Association (IFOPA), United States Registry Medical Advisory Board, and International Clinical Council on FOP Advisory Board; receives clinical research support from Clementia Pharmaceuticals/Ipsen, France, Neurocrine Biosciences Inc, United States, and Regeneron Pharmaceuticals, Inc; and is a research investigator at Clementia Pharmaceuticals/Ipsen. R.K. is a research investigator at Clementia Pharmaceuticals/Ipsen, Kyowa Kirin, and Regeneron Pharmaceuticals, Inc and is part of the IFOPA Fibrodysplasia Ossificans Progressiva Registry Medical Advisory Board and International Clinical Council on Fibrodysplasia Ossificans Progressiva Advisory Board. M.A.M. receives research support from Clementia Pharmaceuticals/Ipsen and Regeneron Pharmaceuticals, Inc; is a non-paid consultant for BioCryst Pharmaceuticals, Inc, United States, Blueprint Medicines, Daiichi Sankyo, Incyte, and Keros Therapeutics; is part (all voluntary) of the IFOPA Registry Medical Advisory Board, Incyte Advisory Board, and International Clinical Council on FOP Advisory Board; and receives non-restricted educational fund from Excel and Catalyst sponsored by Ipsen. K.-H.L.Q.S. is a coordinator of Ipsen FOP-program and multiple osteochondromas-trial. A.W., R.M., and A.S. are employees of Ipsen. F.S.K. is a research investigator at Clementia/Ipsen and Regeneron Pharmaceuticals, Inc, is part of the IFOPA Medical Advisory Board, is a Founder and immediate past President of the International Clinical Council on FOP, and is the Chair of the Publications Committee of the International Clinical Council. In April 2019, Ipsen acquired Clementia Pharmaceuticals., (Copyright © 2022 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: Type 3 von Willebrand disease (VWD) is a severe bleeding disorder caused by the virtually complete absence of von Willebrand factor (VWF). Pathophysiological mechanisms of VWD like defective synthesis, secretion, and clearance of VWF have previously been evaluated using ratios of VWF propeptide (VWFpp) over VWF antigen (VWF:Ag) and factor (F)VIII coagulant activity (FVIII:C) over VWF:Ag., Objective: To investigate whether the VWFpp/VWF:Ag and FVIII:C/VWF:Ag ratios may also be applied to understand the pathophysiological mechanism underlying type 3 VWD and whether VWFpp is associated with bleeding severity., Methods: European and Iranian type 3 patients were enrolled in the 3WINTERS-IPS study. Plasma samples and buffy coats were collected and a bleeding assessment tool was administered at enrolment. VWF:Ag, VWFpp, FVIII:C, and genetic analyses were performed centrally, to confirm patients' diagnoses. VWFpp/VWF:Ag and FVIII:C/VWF:Ag ratios were compared among different variant classes using the Mann-Whitney test. Median differences with 95% confidence intervals (CI) were estimated using the Hodges-Lehmann method. VWFpp association with bleeding symptoms was assessed using Spearman's rank correlation., Results: Homozygosity/compound heterozygosity for missense variants showed higher VWFpp level and VWFpp/VWF:Ag ratio than homozygosity/compound heterozygosity for null variants ([VWFpp median difference, 1.4 IU/dl; 95% CI, 0.2-2.7; P = .016]; [VWFpp/VWF:Ag median difference, 1.4; 95% CI, 0-4.2; P = .054])., Fviii: C/VWF:Ag ratio was similarly increased in both. VWFpp level did not correlate with the bleeding symptoms (r = .024; P = .778)., Conclusions: An increased VWFpp/VWF:Ag ratio is indicative of missense variants, whereas FVIII:C/VWF:Ag ratio does not discriminate missense from null alleles. The VWFpp level was not associated with the severity of bleeding phenotype., (© 2022 The Authors. Journal of Thrombosis and Haemostasis published by Wiley Periodicals LLC on behalf of International Society on Thrombosis and Haemostasis.)

The study investigates the changes in meat organoleptic characteristics and sarcoplasmic proteins of 3 horse muscles during aging. Longissimus lumborum (LL), semimembranosus (SM) and semitendinosus (ST) muscles, were removed from 12 Italian Heavy Draft Horse carcasses and aged for 1, 3, 6, 9 and 14 days. The lowest values of hardness and chewiness were found in LL muscle. During aging, a decrease of hardness was observed in ST muscle reaching the lowest value at 14 days. 2DE revealed a decrease of 15 sarcoplasmic protein spots in all muscles. Muscle-differences were found at 14 days. An increase of tropomyosin spots was found in LL muscle while, ST was characterized by a rise of superoxide dismutase, phosphoglucomutase-1 and two isoforms of myoglobin. Principal component analysis applied to color, texture parameters and spots volume differentiated the muscles into three different clusters. Data revealed that myofibrillar, glycolytic and mitochondrial proteins are potential muscle-biomarkers to monitor post-mortem processes and meat quality characteristics in horse meat., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Background: Fueled by misinformation, fentanyl panic has harmed public health through complicating overdose rescue while rationalizing hyper-punitive criminal laws, wasteful expenditures, and proposals to curtail vital access to pain pharmacotherapy. To assess misinformation about health risk from casual contact with fentanyl, we characterize its diffusion and excess visibility in mainstream and social media., Methods: We used Media Cloud to compile and characterize mainstream and social media content published between January 2015 and September 2019 on overdose risk from casual fentanyl exposure., Results: Relevant content appeared in 551 news articles spanning 48 states. Misinformed media reports received approximately 450,000 Facebook shares, potentially reaching nearly 70,000,000 users from 2015-2019. Amplified by erroneous government statements, misinformation received excess social media visibility by a factor of 15 compared to corrective content, which garnered fewer than 30,000 shares with potential reach of 4,600,000 Facebook users., Conclusion: Health-related misinformation continues to proliferate online, hampering responses to public health crises. More evidence-informed tools are needed to effectively challenge misinformed narratives in mainstream and social media., Competing Interests: Declarations of Interests The authors have no conflicts of interests to declare., (Copyright © 2020. Published by Elsevier B.V.)

A hyperinflammatory syndrome (HIS) may cause a life-threatening acute respiratory distress syndrome (ARDS) in patients with COVID-19 pneumonia. A prospective series of 100 consecutive patients admitted to the Spedali Civili University Hospital in Brescia (Italy) between March 9th and March 20th with confirmed COVID-19 pneumonia and ARDS requiring ventilatory support was analyzed to determine whether intravenous administration of tocilizumab (TCZ), a monoclonal antibody that targets the interleukin 6 (IL-6) receptor, was associated with improved outcome. Tocilizumab was administered at a dosage of 8 mg/kg by two consecutive intravenous infusions 12 h apart. A third infusion was optional based on clinical response. The outcome measure was an improvement in acute respiratory failure assessed by means of the Brescia COVID Respiratory Severity Score (BCRSS 0 to 8, with higher scores indicating higher severity) at 24-72 h and 10 days after tocilizumab administration. Out of 100 treated patients (88 M, 12 F; median age: 62 years), 43 received TCZ in the intensive care unit (ICU), while 57 in the general ward as no ICU beds were available. Of these 57 patients, 37 (65%) improved and suspended noninvasive ventilation (NIV) (median BCRSS: 1 [IQR 0-2]), 7 (12%) patients remained stable in NIV, and 13 (23%) patients worsened (10 died, 3 were admitted to ICU). Of the 43 patients treated in the ICU, 32 (74%) improved (17 of them were taken off the ventilator and were discharged to the ward), 1 (2%) remained stable (BCRSS: 5) and 10 (24%) died (all of them had BCRSS≥7 before TCZ). Overall at 10 days, the respiratory condition was improved or stabilized in 77 (77%) patients, of whom 61 showed a significant clearing of diffuse bilateral opacities on chest x-ray and 15 were discharged from the hospital. Respiratory condition worsened in 23 (23%) patients, of whom 20 (20%) died. All the patients presented with lymphopenia and high levels of C-reactive protein (CRP), fibrinogen, ferritin and IL-6 indicating a HIS. During the 10-day follow-up, three cases of severe adverse events were recorded: two patients developed septic shock and died, one had gastrointestinal perforation requiring urgent surgery and was alive at day 10. In conclusion, our series showed that COVID-19 pneumonia with ARDS was characterized by HIS. The response to TCZ was rapid, sustained, and associated with significant clinical improvement., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Fractal analysis can be properly applied to complex structures, like physical and chemical networks formed by particles or polymers, when they exhibit self-similarity over an extended range of length scales and, hence, can be profitably used not only for their morphological characterization but also for individuating possible relationships between morphology and mechanisms of aggregation and crosslinking, as well as between morphology and physical properties. Several experimental methods are available to determine the fractal dimension of gel networks, including various scattering techniques and microscopies, permeability measurements and rheology. The present study regards the self-assembly kinetics of High Methoxyl Pectin (HMP) solutions with different pectin and sucrose concentrations investigated by rheological measurements to highlight the effects of pectin and sucrose concentrations on the gel point and to evaluate the degree of compactness of the incipient gel networks through an interpretation of the viscoelastic response at the sol-gel transition., Competing Interests: Declaration of competing interest The authors declare no conflict of interest., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Objectives: The assessment of loss of tissue autofluorescence (LAF) has been proposed as an adjunct to comprehensive oral examination to enhance the detection of mucosal lesions harbouring dysplasia or carcinoma. The assessment of LAF is not based on completely objectified parameters therefore intraobserver and interobserver variability cannot be neglected alongside the issue of correct interpretation of LAF. The present study evaluated intraobserver and interobserver variability in the clinical assessment of LAF as performed by oral medicine practitioners (OMPs) or general dental practitioners (GDPs)., Materials and Methods: Couples of clinical pictures, acquired under white incandescent dental operatory light and during the assessment of LAF performed by VELscope were retrieved. Four OMPs and eight GDPs were asked to assess the pictures and to score the LAF. Kappa statistics allowed the assessment of intra- and inter-observer related variability., Results: Pictures of 109 lesions representative of all oral mucosal sites and clinical appearances were selected. OMPs had a better intraobserver agreement than GDPs (substantial versus moderate). The moderate (k = 0.506) interobserver agreement observed among both OMPs and GDPs in a 2-score model (positive versus negative), lowered down to poor values only among GDPs when a 3-score or 4-score model (including uncertain judgements) was applied., Conclusions: A good agreement (k>0.8) was never observed and the present results are similar to previously reported data about conventional oral examination. Irrespective of the diagnostic accuracy, the assessment of AF seems not to be able to improve observer-related variability in the clinical assessment of oral mucosal lesions., (Copyright © 2019 Elsevier B.V. All rights reserved.)

The aim of this study was to evaluate the effect of post-mortem aging on tenderness development and proteolysis of myofibrillar proteins in 3 different horse muscles. Warner-Bratzler shear force decreased during aging in all muscles, showing the lowest values in longissimus lumborum (LL) in all sampling points. Myofibril fragmentation index significantly increased in LL and semimembranosus (SM) muscles throughout aging time whereas in semitendinosus (ST) it increased after 14 days of aging. Proteomics analysis revealed the major content of intact myofibrillar proteins with high molecular weight in ST muscle in the first phase of aging, while, after 14 days a higher accumulation of TnT-derived polypeptides and spots isoforms ascribed to MLC2 and MLC1 proteins were found. Data highlight that aging affects the meat tenderness and proteolysis with different intensities in each muscle and suggest that a more extensive post-mortem proteolysis occurred in ST muscle., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Background: Percutaneous endoscopic gastrostomy (PEG) is the most common endoscopic procedure used to provide nutritional support., Aim: To prospectively evaluate the mortality and complication incidences after PEG insertion or replacement., Methods: All patients who underwent PEG insertion or replacement were included. Details on patient characteristics, ongoing therapies, comorbidities, and indication for PEG placement/replacement were collected, along with informed consent form signatures. Early and late (30-day) complications and mortality were assessed., Results: 950 patients (47.1% male) were enrolled in 25 centers in Lombardy, a region of Northern Italy. Patient mean age was 73 years. 69.5% of patients had ASA status 3 or 4. First PEG placement was performed in 594 patients. Complication and mortality incidences were 4.8% and 5.2%, respectively. The most frequent complication was infection (50%), followed by bleeding (32.1%), tube dislodgment (14.3%), and buried bumper syndrome (3.6%). At multivariable analysis, age (OR 1.08 per 1-year increase, 95% CI, 1.0-1.16, p = 0.010) and BMI (OR 0.86 per 1-point increase, 95% CI, 0.77-0.96, p = 0.014) were factors associated with mortality. PEG replacement was carried out in 356 patients. Thirty-day mortality was 1.8%, while complications occurred in 1.7% of patients., Conclusions: Our data confirm that PEG placement is a safe procedure. Mortality was not related to the procedure itself, confirming that careful patient selection is warranted., (Copyright © 2019 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.)

Background: It is estimated that, as of 2010, there were 32 million orphaned children in India. There is little published information on the oral health of children in orphanages in India., Aim: To determine caries status and associated risk factors among children in orphanages in Kerala, India., Methods: This cross-sectional study assessed caries using World Health Organization (WHO) criteria, and caries experience was reported as decayed, missing and filled primary or secondary teeth (dmft or DMFT, respectively). A brief questionnaire captured information on child oral health behaviours. Mean [standard deviation (SD)] and median [interquartile range (IQR)] scores were used to describe caries rates. Multivariable logistic regression analysis was conducted to identify independent disease predictors. Study design complexities, such as clustering by orphanage and stratification by district, were accounted for in the multivariable regression analysis. This was carried out using the survey commands in STATA 13. A value of P<0.05 was considered as statistically significant., Results: Overall, 1,137 children residing in 31 orphanages across the State of Kerala were recruited to the study. Female children made up 82% of the sample. In 6-year-old children the prevalence of caries was 77% and the mean dmft score was 3.60 (SD= 3.50); in 12-year-old children the prevalence of caries was 44% and the mean DMFT score was 1.35 (SD = 1.96). Among 12-year-old children, those who reported being shown how to clean their teeth were less likely to have caries (odds ratio = 0.62; 95% confidence interval: 0.38-0.95)., Conclusion: Caries rates among children in orphanages were much higher than among children in the general population in Kerala. There is an urgent need for evidence-based and sustainable primary prevention strategies to reduce the burden of caries in this highly vulnerable population., (© 2018 FDI World Dental Federation.)

Diet supplementation with oilseeds is known to improve the fatty acid profile of meat, but few studies have been carried out to determine the time required for the incorporation of a significant quantity of n-3 polyunsaturated fatty acids (PUFA) into meat from steers. Therefore, the present study aimed to assess the effects of linseed supplementation and feeding duration on the fatty acid profile, cholesterol and bioactive compounds of bovine meat. In total, 54 Friesian steers were randomly allocated during the finishing period into six experimental treatments following a 2×3 factorial design. The six treatments consisted of two diets, the control diet (CO) with no supplemental fat and the linseed diet (LS) containing 10% whole linseed, fed 40, 75 or 120 days before slaughter. At the end of each finishing period, steers from the CO and LS groups were slaughtered. After 8 days of ageing chemical analysis, the fatty acid profile, cholesterol content and bioactive compounds were determined from the longissimus thoracis muscle. Including linseed in the diet increased the content of monounsaturated fatty acids, CLA and n-3 PUFA, and reduced the proportion of saturated fatty acids and n-6 PUFA. The percentage of myristic fatty acid increased with the duration of feeding, regardless of diet and a decrease in PUFA and n-6 PUFA was observed in the CO and LS diets, respectively. Furthermore, meat from steers fed linseed showed an increased percentage of n-3 PUFA, linolenic acid, and EPA from 40 to 75 days of feeding, whereas vaccenic acid, CLA 9c,11t, and total CLA increased from 40 and 75 days but declined at 120 days. Beef from the linseed group had a higher content of bioactive substances such as creatine, carnosine and anserine than beef from the control group. The duration of feeding significantly affected the creatine concentrations, with an increase in the LS group from 40 to 75 days of feeding. Feeding linseed did not modify the cholesterol content, on average and the lowest cholesterol content was found in meat after 75 days of linseed administration. This study demonstrates that a short-term diet manipulation is sufficient to improve the nutritional properties of meat, including n-3 PUFA and bioactive compounds.

Several natural and synthetic polysaccharides are able to form, under appropriate conditions, supramolecular structures, typically physical hydrogels, and, together with their biocompatibility, this explains their wide use in food, pharmaceutical and biomedical sectors. In the case of high methoxyl pectins (HMP) the gel formation is promoted by the presence of cosolutes (sugars or polyols) and low pH. The present investigation mainly regards the structuring kinetics of aqueous HMP solutions at acid pH (3.1) with the same pectin concentration (0.2% w/w) and different sucrose concentrations (from 56 to 65% w/w). Preliminary viscosity tests were performed to individuate the threshold of the sol region. A sequence of consecutive frequency sweeps was applied to each sample immediately after its preparation. The time evolution of the linear viscoelastic behavior is described by the sigmoidal profiles of both moduli at each applied frequency and more thoroughly defined through the change of the mechanical spectrum, i.e. the variation of the parameters of the generalized Maxwell model or the Friedrich-Braun model which are both suitable to provide a satisfactory data fitting. In particular, the equilibrium modulus G e offers a significant description of the gelation kinetics and its sucrose dependence., (Copyright © 2018 Elsevier B.V. All rights reserved.)

This work aimed to evaluate the effect of suckling technique and slaughter age on Martina Franca donkey meat quality. Twenty Martina Franca male foals were involved in the trial. Foals naturally assumed colostrum within 4h from birth. Afterwards, 10 foals were partially artificially suckled (AS), and 10 foals were naturally suckled (NS). All the foals were weaned at 180d, then housed indoors and fed the same diet. Ten donkeys were slaughtered at 12months and the other 10 at the age of 18months. Samples of Longissimus thoracis et lumborum (LTL) were taken from each foal for chemical analysis, then rheological parameters, oxidative profile, colorimetric parameters and fatty acid profile were assessed. Older donkeys (18months) fed with natural milk presented the highest intramuscular fat (IMF) and meat protein content. From a dietary view point, IMF acid composition showed a more favourable profile in meat from artificially-reared donkeys compared to naturally-suckled ones., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

The aim of this study was to evaluate the effect of dietary supplementation of linseed and/or quinoa on tenderness and on proteome of lamb meat. Thirty-two Italian Merino lambs were distributed into 4 groups with different diet: control (CO) with no supplemental fat, linseed (LS), quinoa (QS) and QS+LS diets. Meat obtained by lamb fed linseed showed the lowest values of WBSF (P<0.001), hardness (P<0.01), gumminess (P<0.01) and chewiness (P<0.01). Proteomic changes of myofibrillar and sarcoplasmic proteins were estimated with SDS-PAGE, Western Blot and Two-Dimensional Gel Electrophoresis. In linseed group proteomic analysis revealed a degradation of desmin and TnT proteins complex and a major number of spots and phosphorylation isoforms of fast MLC2 patterns. Meat obtained by lamb fed quinoa showed a minor effect on the instrumental evaluation of meat tenderness and a major number of spots ascribed to sarcoplasmic proteins and fMHC. Data suggest that dietary supplementation may act on meat tenderness and on proteolytic pattern of myofibrillar fraction., (Copyright © 2017. Published by Elsevier Ltd.)

Background: Critically ill patients often present with hyperglycemia, regardless of previous history of diabetes mellitus (DM). Hyperglycemia has been associated with adverse outcome in acute myocardial infarction and acute heart failure. We investigated the association of admission blood glucose level with the clinical picture and short-term mortality in cardiogenic shock (CS)., Methods: Consecutively enrolled CS patients were divided into five categories according to plasma glucose level at the time of enrolment: hypoglycemia (glucose <4.0mmol/L), normoglycemia (4.0-7.9mmol/L), mild (8.0-11.9mmol/L), moderate (12.0-15.9mmol/L), and severe (≥16.0mmol/L) hyperglycemia. Clinical presentation, biochemistry, and short-term mortality were compared between the groups., Results: Plasma glucose level of 211 CS patients was recorded. Glucose levels were distributed equally between normoglycemia (26% of patients), mild (27%), moderate (19%) and severe (25%) hyperglycemia, while hypoglycemia (2%) was rare. Severe hyperglycemia was associated with higher blood leukocyte count (17.3 (5.8) E9/L), higher lactate level (4.4 (3.3-8.4) mmol/L) and lower arterial pH (7.23 (0.14)) compared with normoglycemia or mild to moderate hyperglycemia (p<0.001 for all). In-hospital mortality was highest among hypoglycemic (60%) and severely hyperglycemic (56%) patients, compared with 22% in normoglycemic group (p<0.01). Severe hyperglycemia was an independent predictor of in-hospital mortality (OR 3.7, 95% CI 1.19-11.7, p=0.02), when adjusted for age, gender, LVEF, lactate, and DM., Conclusions: Admission blood glucose level has prognostic significance in CS. Mortality is highest among patients with severe hyperglycemia or hypoglycemia. Severe hyperglycemia is independently associated with high in-hospital mortality in CS. It is also associated with biomarkers of systemic hypoperfusion and stress response., (Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.)

Introduction: Device related distress negatively affects the quality of life of cardiac device recipients mostly of women. A submammary approach has been proposed to reduce the physical impact of the implantation. Our aim was to assess the safety of this approach and to evaluate the patients' acceptance of the device., Methods: We enrolled 42 patients who underwent a submammary device. The primary endpoint was the need for implant revision that was assessed in the study group compared with the overall control group of 72 standard cardiac device recipients (29 females and 43 males)and with the female group (29 females of controls). In the female population (42 women of the submammary group and 29 of controls) patients' acceptance was calculated with the Florida Patient Acceptance Survey (FPAS)., Results: The rate of implant revision was similar in the two groups and the revision-free survival was comparable with a median follow-up of about six years (Log rank test p=0.949). Similar results were found when considering only the female population. Patients' acceptance was greater in the submammary group [total FPAS 85 (95%CI 83-86) vs 74.5 (95%CI 70.2-77.3) p<0,001] and a strongly significant superiority of the submammary group was found regarding body image concerns [10 (95%CI 10-10) vs 8 (95%CI 8-8) p<0.001) and device related distress [23 (95%CI 22-23) vs 1 (95%CI 1-1) p<0.001]., Conclusions: Submammary device implantation is safe and more accepted than standard approach. Our results should encourage cardiologists to suggest this approach to their patients for a better acceptance of the therapy., (Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.)

Nutritional properties and consumer evaluation were performed in bresaola and salami from donkey meat compared with respective conventional products. Donkey bresaola and salami showed higher content of protein and lower content of fat than beef bresaola and pork salami. Significant differences in the unsaturation level of fatty acids were found. Particularly, donkey meat products showed lower saturated fatty acids, higher polyunsatured fatty acid content and better nutritional indices than conventional beef bresaola and pork salami. Furthermore, donkey meat products, especially bresaola, showed the highest content of essential amino acids. Both donkey meat products resulted to be more tender than conventional products, in addition donkey bresaola showed also higher consumer acceptability. Our investigation demonstrates the possibility of processing donkey meat into products comparable to traditional ones with a high nutritional value., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

The effects of breed and aging time (1, 7, 14, 21d) were evaluated on physical meat properties and on sarcoplasmic protein changes in 24 young bulls from Romagnola×Podolian, Podolian and Friesian breeds. Aging affects lightness showing an increase in all breeds while changes in redness varied according to the breed. Podolian breed showed meat with the darkest and the reddest color and the lowest drip loss compared to the other breeds. Extending aging to 21d reduced drip loss from meat. SDS-PAGE and 2DE showed that many changes in the sarcoplasmic proteins occurred among breeds and during aging. During post-mortem some sarcoplasmic proteins decline in intensity after 21d highlighting that they were susceptible to aging. Protein identification and western blotting showed the presence of myosin light chains, Troponin T and tropomyosin proteins during aging, suggesting a degradation of myofibers and a more intense proteolysis especially in the Podolian breed., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

The effects of breed and aging time (1, 7, 14, 21 days) were evaluated on meat tenderness and on proteolysis in 24 young bulls from Romagnola×Podolian crossbreed, Podolian and Friesian breed. Shear force decreased with aging in all breeds and showed the highest values at 1 and 7 days in Podolian meat. Myofibrillar fragmentation index significantly increased in Podolian meat throughout aging whereas in Friesian and in Crossbreed meat it increased only in the first week. Proteolysis was investigated by SDS-PAGE and 2-dimensional electrophoresis showing a different quantity and expression profile of myofibrillar proteins among breeds. In all breeds a decrease of troponin-T and an increase of troponin-T derived polypeptides during aging were observed. The highest decrease of troponin-T together with the presence of fragments of MHC in Podolian meat during aging was an outcome of a more extensive proteolysis in this breed. Data suggest that tenderness and proteolytic changes during aging are related to animal's breed., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

This experiment was conducted to determine the influence of low voltage electrical stimulation (ES) on the tenderness development of beef round muscles. Eight steers were slaughtered, and ES applied to one side of each carcass within 90 min of exsanguination. Steaks from M. longissimus dorsi, semimembranosus, adductor, and gracilis were vacuum packaged and aged at 4 °C for 9 d. Star probe, sensory evaluation, Western blot assays of troponin-T and μ-calpain autolysis and 2D-DIGE were conducted. ES resulted in accelerated (P<0.05) pH decline of the longissimus in the first 24h postmortem. ES did not influence (P>0.05) proteolysis and tenderness, but did alter the predominance of metabolic proteins in the soluble fraction of muscle. Aging for 9 d improved tenderness (P<0.05). The data confirmed that low voltage ES at 90 min of exsanguination had no effect on proteolysis and tenderness development in the longissimus dorsi, semimembranosus, adductor or gracilis in beef., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

Transplantation of whole bone marrow (BMT) as well as ex vivo-expanded mesenchymal stromal cells (MSCs) leads to striking clinical benefits in children with osteogenesis imperfecta (OI); however, the underlying mechanism of these cell therapies has not been elucidated. Here, we show that non-(plastic)-adherent bone marrow cells (NABMCs) are more potent osteoprogenitors than MSCs in mice. Translating these findings to the clinic, a T cell-depleted marrow mononuclear cell boost (> 99.99% NABMC) given to children with OI who had previously undergone BMT resulted in marked growth acceleration in a subset of patients, unambiguously indicating the therapeutic potential of bone marrow cells for these patients. Then, in a murine model of OI, we demonstrated that as the donor NABMCs differentiate to osteoblasts, they contribute normal collagen to the bone matrix. In contrast, MSCs do not substantially engraft in bone, but secrete a soluble mediator that indirectly stimulates growth, data which provide the underlying mechanism of our prior clinical trial of MSC therapy for children with OI. Collectively, our data indicate that both NABMCs and MSCs constitute effective cell therapy for OI, but exert their clinical impact by different, complementary mechanisms. The study is registered at www.clinicaltrials.gov as NCT00187018.

This study was undertaken to assess the effect of milk replacer (MR) containing Lactobacillus acidophilus and a mix of Bifidobacterium animalis subsp. lactis and Bifidobacterium longum subsp. longum on lamb immune response and on lamb meat quality. A 6-week-trial was conducted on 40 male Comisana lambs, divided into four groups, fed maternal milk (MM), MR, MR with L. acidophilus supplementation (MRL) and MR with a mix (1 : 1) of B. animalis subsp. lactis and B. longum subsp. longum supplementations (MRB). Lambs fed MR containing a mix of bifidobacteria showed the highest in vivo cellular immune response to phytohemagglutinin, whereas MM and MRB showed the highest antibody response to ovalbumin. At day 11 of the trial, MRL displayed the highest value of Interleukin-10; differences disappeared among groups subsequently. Blood cholesterol levels in lambs fed MR containing L. acidophilus was almost halved compared with that found in MM and MR groups. Meat from artificially reared lambs was characterized by trans-11 18:1 and total conjugated 18:2n-6, whereas meat from the dam-suckled lambs was characterized by 14:0, cis-9 14:1 and 16:0. Polyunsaturated to saturated fatty acid ratio was higher in meat of MR, MRL and MRB than in MM lambs. Meat from artificially reared lamb fed MR containing probiotics showed an improved fatty acid profile for human diet.

In the present research, the X-ray microtomography (muCT) technique was used to quantify intramuscular fat content and to study fat distribution in different breeds and commercial meat joints. Two different breeds, Podolian vs. Charolaise, chosen to exhibit variability in terms of visible structure of fat, were used. High Pearson correlation coefficients (r=0.92-0.99, P<0.001) were found between fat content, expressed as percentage object volume (POV) determined by muCT and fat content analysed by an official method. Useful information was provided from quantitative three-dimensional parameters describing the fat structure, such as the structure model index (SMI), the object structure/ volume ratio (OSVR) and the structure separation (SS). Charolaise breed showed higher POV and SS (P<0.01) values than Podolian. X-ray microtomography allows a rapid estimation of intramuscular fat of meat and provides a more accurate description of the fat microstructure and meat quality., (Copyright 2010 Elsevier Ltd. All rights reserved.)

In this work the possibility to substitute pork backfat with extra virgin olive oil (EVOO), adsorbed on whey protein-based crumb or white bread crumb, in typical Italian salami is addressed. Five types of salami were manufactured, under the usual commercial conditions, by replacing 0 (Control), 60% and 100% of pork backfat with whey protein-based crumb (WP60-WP100) and white pan bread (PB60-PB100), respectively, soaked in EVOO. Results highlighted that pH, weight loss, colour parameters and microbial counts did not show statistically significant differences between the Control and the modified salami. On the other hand, malonaldehyde was slightly lower in PB100, PB60, WP100 and WP60, compared to the Control. Chemical composition was significantly affected by formulations. Modified salami presented a better fatty acid profile showing lower saturated and higher monounsaturated fatty acids than control. Furthermore in all modified salami atherogenic and thrombogenic indices displayed the lowest values. The Control showed the highest values for Warner-Bratzler Shear, hardness, cohesiveness, gumminess and chewiness. Sensory evaluation of WP60 did not show significant differences compared to the Control, whereas PB100 and WP100 were unacceptable for taste.

The use of SNPs in combination with Bayesian statistics for the geographic traceability of cattle was evaluated using a dataset comprising 24 breeds from Italy, France, Spain, Denmark, the Netherlands, Switzerland and UK genotyped with 90 polymorphic markers. The percentage of correct assignment of the individuals to their Country of origin was 90%, with an average assignment probability of 93% and an average specificity of 92%. The higher value was observed for UK breeds (97% of correct assignment) while Swiss animals were the most difficult to allocate (77% of correct assignment). Tracing of Protected Geographic Indication (PGI) products, the approach correctly assigned 100% of Guaranteed Pure Highland Beef; 97% of "Vitellone dell'Appennino Centrale" breeds; 84% of Ternera de Navarra, and 80% of Boeuf de Chalosse. Methods to verify Products of Designated Origin (PDO) and Protected Geographic Indication (PGI) products will help to protect regional foods and promote the economic growth of marginal rural areas by encouraging the production of high quality niche market foods.

In principle, bone marrow transplantation should offer effective treatment for disorders originating from defects in mesenchymal stem cells. Results with the bone disease osteogenesis imperfecta support this hypothesis, although the rate of clinical improvement seen early after transplantation does not persist long term, raising questions as to the regenerative capacity of the donor-derived mesenchymal progenitors. We therefore studied the kinetics and histologic/anatomic pattern of osteopoietic engraftment after transplantation of GFP-expressing nonadherent marrow cells in mice. Serial tracking of donor-derived GFP(+) cells over 52 weeks showed abundant clusters of donor-derived osteoblasts/osteocytes in the epiphysis and metaphysis but not the diaphysis, a distribution that paralleled the sites of initial hematopoietic engraftment. Osteopoietic chimerism decreased from approximately 30% to 10% by 24 weeks after transplantation, declining to negligible levels thereafter. Secondary transplantation studies provided evidence for a self-renewing osteopoietic stem cell in the marrow graft. We conclude that a transplantable, primitive, self-renewing osteopoietic cell within the nonadherent marrow cell population engrafts in an endosteal niche, like hematopoietic stem cells, and regenerates a significant fraction of all bone cells. The lack of durable donor-derived osteopoiesis may reflect an intrinsic genetic program or exogenous environmental signaling that suppresses the differentiation capacity of the donor stem cells.

C-type lectins play an important role in the immune system and are part of a large superfamily that includes C-type lectin-like domain (CTLD)-containing proteins. Divergent evolution, acting on the CTLD fold, has generated the Ca2+-dependent carbohydrate-binding lectins and molecules, as the lectin-like natural killer (NK) receptors that bind proteins, rather than sugars, in a Ca(2+)-independent manner. We have studied ciCD94-1, a CTLD-containing protein from the tunicate Ciona intestinalis, which is a homolog of the CD94 vertebrate receptor that is expressed on NK cells and modulates their cytotoxic activity by interacting with MHC class I molecules. ciCD94-1 shares structural features with the CTLD-containing molecules that recognize proteins, suggesting that it could be located along the evolutionary pathway leading to the NK receptors. ciCD94-1 was up-regulated in response to inflammation induced by lipopolysaccharide (LPS) acting on a blood cell type present in both the tunic and circulating blood. Furthermore, an anti-ciCD94-1 antibody specifically inhibited the phagocytic activity of these cells. ciCD94-1 was also expressed during development in the larva and in the early stages of metamorphosis in structures related to the nervous system, and loss of its function affected the correct differentiation of these territories. These findings suggest that ciCD94-1 has different roles in immunity and in development, thus strengthening the concept of gene co-option during evolution and of an evolutionary relationship between the nervous and the immune systems.

Nanos gene encodes for zinc-finger protein with putative RNA-binding activity which shows an evolutionary conserved function in germ cell development. In the mouse, three Nanos homologs have been identified: Nanos1, Nanos2 and Nanos3. The Nanos3 ortholog is expressed in both male and female gonads of early embryo and, after birth, it is found only in the testis. Nanos3 targeted disruption results in the complete loss of germ cells in both sexes; however the role of Nanos3 in the testis during the postnatal period has not been explored yet. In this study, we show that, in prepuberal testis, Nanos3 is expressed in undifferentiated spermatogonia and that its up-regulation causes accumulation of cells in the G1 phase, indicating that this protein is able to delay the cell cycle progression of spermatogonial cells. This is in line with the observation that the cell cycle length of the undifferentiated germ cells is longer than in differentiating spermatogonia. We also demonstrate a conserved mechanism of action of Nanos3, involving the interaction with the murine RNA-binding protein Pumilio2 and consisting of a potential translational repressor activity. According to the possible role of Nanos3 in inhibiting spermatogonia cell differentiation, we show that treatment with the differentiating factor all-trans retinoic acid induces a dramatic down-regulation of its expression. These results allow to conclude that, in the prepuberal testis, Nanos3 is important to maintain undifferentiated spermatogonia via the regulation of their cell cycle.

The present study was aimed to assess the effect of information about the farming system and welfare of artificially (AR) and ewe-reared lambs (ER) on meat acceptability. An 84-consumer panel was asked to give three types of evaluation for both products: tasting without information (perceived liking); information without tasting (expected liking); tasting with information (actual liking). For both products, the expected liking was significantly different from the perceived liking (P<0.001), thus indicating that a disconfirmation occurred. The consumers found ER meat worse than expected (negative disconfirmation) and AR meat better than expected (positive disconfirmation). No significant difference between perceived and actual liking was observed for ER lamb (P>0.05), whereas, for the meat produced by AR lambs actual liking was lower than perceived liking (P<0.001). However, consumers did not completely assimilate their liking in the direction of expectations, as indicated by the fact that expectancy for AR lamb was significantly lower than actual acceptability (P<0.001). Mean scores of perceived liking were higher for the meat produced by AR animals as compared to ER lambs (P<0.05). Conversely, expected and actual liking scores were higher for meat from ER lambs than for meat from AR animals (P<0.001 and P<0.05, respectively). These results show that information about animal welfare, expressed in terms of rearing conditions, can be a major determinant of animal-based food acceptability, thus providing a potential tool for meat differentiation.

Mesenchymal stromal cells (MSCs) have enormous potential for the regeneration of bone, cartilage, and other tissues derived from primitive mesoderm. Despite extensive research, there is still no single marker that reliably identifies MSCs within the bone marrow. Using immunocytochemistry and flow cytometry, we demonstrate here that the neural ganglioside GD2 is expressed by MSCs either newly isolated from bone marrow or expanded in tissue culture; this finding was supported by reverse transcriptase-polymerase chain reaction (RT-PCR) analysis showing expression of the mRNA for GD2 synthase, an essential enzyme for GD2 biosynthesis. GD2 was also expressed on MSCs isolated from adipose tissue, but not on foreskin fibroblasts. Importantly, MSCs were the only cells within normal marrow that expressed this marker. Thus, GD2 appears to be the first reported single surface marker that uniquely distinguishes MSCs from other marrow elements. GD2 may prove valuable to study MSC biology and for the preparation of MSCs for clinical applications.