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• A link between consciousness state and decannulation has been suggested. • 144 patients with prolonged disorders of consciousness after severe acquired brain injury. • Almost all decannulated patients improved their consciousness before decannulation. • No decannulated patient had unresponsive wakefulness syndrome. • Consciousness may influence swallowing skills involved in decannulation. To prospectively investigate the evolution of the consciousness state and the cannula-weaning progression in patients with prolonged disorders of consciousness. Nonconcurrent cohort study. A rehabilitation unit. Adult patients (N=144) with prolonged disorders of consciousness after a severe acquired brain injury admitted between June 2020 and September 2022. Not applicable. Consciousness state was assessed by repeated Coma Recovery Scale-Revised (CRS-R) questionnaire administration at admission and weekly afterward. The dates of the first improvement of consciousness state and the achievement of decannulation were recorded. Decannulation followed an internal protocol of multiprofessional rehabilitation. One hundred forty-four patients were included: age, 69 years; 64 (44.4%) with hemorrhagic etiology; time post onset, 40 days, CRS-R score at admission, 9, median length of stay, 90 days. Seventy-three (50.7%) patients were decannulated. They showed a significantly higher CRS-R (P <.001) and states of consciousness (P <.001) at admission, at the first improvement of the consciousness state (P =.003), and at discharge (P <.001); a lower severity in the Cumulative Illness Rating Scale at admission (P =.01); and a lower rate of pulmonary infections with recurrence (P =.021), compared with nondecannulated patients. Almost all decannulated patients (97.3%) improved their consciousness before decannulation. Consciousness states at decannulation were as follows: unresponsive wakefulness syndrome, 0 (0%); minimally conscious state (MCS) minus, 4 (5.5%); MCS plus, 7 (9.6%); and emergence from MCS, 62 (84.9%). Kaplan-Meier analysis showed a significant divergence between the curves with a higher probability of decannulation in patients who improved consciousness (P <.001). This study showed that the presence of signs of consciousness, even subtle, is a necessary condition for decannulation, suggesting that consciousness may influence some of the components implied in the decannulation process. [ABSTRACT FROM AUTHOR]

Studies have linked daily pollen counts to respiratory allergic health outcomes, but few have considered allergen levels. We sought to assess associations of grass pollen counts and grass allergen levels (Phl p 5) with respiratory allergic health symptoms in a panel of 93 adults with moderate-severe allergic rhinitis and daily asthma hospital admissions in London, United Kingdom. Daily symptom and medication scores were collected from adult participants in an allergy clinical trial. Daily counts of asthma hospital admissions in the London general population were obtained from Hospital Episode Statistics data. Daily grass pollen counts were measured using a volumetric air sampler, and novel Phl p 5 levels were measured using a ChemVol High Volume Cascade Impactor and ELISA analyses (May through August). Associations between the 2 pollen variables and daily health scores (dichotomized based on within-person 75th percentiles) were assessed using generalized estimating equation logistic models and with asthma hospital admissions using Poisson regression models. Daily pollen counts and Phl p 5 levels were each positively associated with reporting a high combined symptom and medication health score in separate models. However, in mutually adjusted models including terms for both pollen counts and Phl p 5 levels, associations remained for Phl p 5 levels (odds ratio [95% CI]: 1.18 [1.12, 1.24]), but were heavily attenuated for pollen counts (odds ratio [95% CI]: 1.00 [0.93, 1.07]). Similar trends were not observed for asthma hospital admissions in London. Grass allergen (Phl p 5) levels are more consistently associated with allergic respiratory symptoms than grass pollen counts. [ABSTRACT FROM AUTHOR]

• The whole world is plagued by the problem of missing persons. • The recovery of a missing person can benefit from the use of forensic science. • Age progression can help in the search of missing person. • The Italian Missing Children association realizing age progression for Missing Children Organization: the collaboration with Missing Child Kenya. The age progression technique allows to update identification photos of individuals who have been missing for years. This method is based on the study of the facial variation and on the dynamics of facial growth. Knowledge about changes in the distribution of facial fat and the tone of the cartilage allows realistic predictions of the facial appearance after many years. Beside these elements, age progression is also supported by similar characters between family members. This is why photos of the missing and family members are used to create an age progression, making the new identikit accurate. Non-profit associations are crucial for the dissemination of information on the problem of missing persons. In Italy, the Italian Missing Children association provides for free an age progression service with the support of forensic anthropology. With the activation of a protocol, consisting of guidelines, and a form for the request for age progression by family members, the Italian Missing Children has started a collaboration with Missing Child Kenya. It allowed to disseminate up-to-date photos of the presumed current appearance of the missing children in Kenya. Thus, in the present study some cases are reported, in which age progression technique was applied. The photos provided by Italian Missing Children were shown in video documentaries made by Missing Child Kenya, allowing to continue the dissemination of age progression photo during the Covid quarantines and to keep the population active in the search for the missing. [ABSTRACT FROM AUTHOR]

• Trained on 80% data and tested on the remaining 20% data of 3262 impacts from 6 different impact types, a random forest kinematics classifier reached a median accuracy of 96% over 1000 random dataset partitions. • By interpreting the important classification features, the spectral characteristics of various head impact types are investigated. • With the classifier, type-specific nearest-neighbor regression models were developed for 3 injury risk metrics: 95th percentile maximum principal strain, 95th percentile maximum principal strain in corpus callosum, and cumulative strain damage. These type-specific models with classification showed higher R 2 values than the baseline model without subtyping. Traumatic brain injury can be caused by head impacts, but many brain injury risk estimation models are not equally accurate across the variety of impacts that patients may undergo, and the characteristics of different types of impacts are not well studied. We investigated the spectral characteristics of different head impact types with kinematics classification. Data were analyzed from 3262 head impacts from lab reconstruction, American football, mixed martial arts, and publicly available car crash data. A random forest classifier with spectral densities of linear acceleration and angular velocity was built to classify head impact types (e.g., football, car crash, mixed martial arts). To test the classifier robustness, another 271 lab-reconstructed impacts were obtained from 5 other instrumented mouthguards. Finally, with the classifier, type-specific, nearest-neighbor regression models were built for brain strain. The classifier reached a median accuracy of 96% over 1000 random partitions of training and test sets. The most important features in the classification included both low- and high-frequency features, both linear acceleration features and angular velocity features. Different head impact types had different distributions of spectral densities in low- and high-frequency ranges (e.g., the spectral densities of mixed martial arts impacts were higher in the high-frequency range than in the low-frequency range). The type-specific regression showed a generally higher R 2 value than baseline models without classification. The machine-learning-based classifier enables a better understanding of the impact kinematics spectral density in different sports, and it can be applied to evaluate the quality of impact-simulation systems and on-field data augmentation. [Display omitted] [ABSTRACT FROM AUTHOR]

A smartphone 12-Lead ECG that enables layman ECG screening is still lacking. We aimed to validate D-Heart ECG device, a smartphone 8/12 Lead electrocardiograph with an image processing algorithm to guide secure electrode placement by non-professional users. One-hundred-fourty-five patients with HCM were enrolled. Two uncovered chest images were acquired using the smartphone camera. An image with virtual electrodes placement by imaging processing algorithm software was compared to the 'gold standard' electrode placement by a doctor. D-Heart 8 and 12-Lead ECG were obtained, immediately followed by 12‑lead ECGs and were assessed by 2 independent observers. Burden of ECG abnormalities was defined by a score based on the sum of 9 criteria, identifying four classes of increasing severity. A total of 87(60%) patients presented a normal/mildly abnormal ECG, whereas 58(40%) had moderate or severe ECG alteration. Eight(6%) patients had ≥1 misplaced electrode. D-Heart 8-Lead and 12‑lead ECGs concordance according to Cohen's weighted kappa test was 0,948 (p < 0,001, agreement of 97.93%). Concordance was high for the Romhilt–Estes score (k w = 0,912; p < 0.01). Concordance between D-Heart 12-Lead ECG and standard 12-Lead ECG was perfect (k w = 1). PR and QRS intervals measurements comparison with Bland-Altman method showed good accuracy (95% limit of agreement ±18 ms for PR and ± 9 ms for QRS). D-Heart 8/12-Lead ECGs proved accurate, allowing an assessment of ECG abnormalities comparable to the standard 12‑lead ECG in patients with HCM. The image processing algorithm provided accurate electrode placement, standardizing exam quality, potentially opening perspectives for layman ECG screening campaigns. [ABSTRACT FROM AUTHOR]

Individuals with Down syndrome (DS) show growth trajectories which deviate from standard ones due to variations in the growth of facial structures. Studying the effect of aging on the faces of DS individuals is necessary to obtain an accurate result through age progression, a technique based on the study of physiognomic features and used in cases of missing persons. Here we present scientific publications that delve into the rhythms of aging and morphological characteristics of facial features in DS individuals to enable appropriate age progression in cases of missing DS individuals. The scientific literature considered in this review studies the growth of soft tissue and bone substrate by comparing standard growth values with those measured through anthropometric measurements of individuals with DS. Growth trajectories are described by considering morphological trends both by comparing standard values with those found in individuals with DS and by observing individual physiognomic traits. When a young individual with DS goes missing, the realization of an age progression requires knowledge of the aging dynamics peculiar to the DS face. Therefore, physical, cognitive, and clinical factors must be considered. Delayed physical development and early aging, such as the onset of puberty and weight gain, have an important impact on the realization of age progression. In fact, depending on the life period to be considered, the effects of aging must be calibrated based on the knowledge gathered from scientific research. [ABSTRACT FROM AUTHOR]

Aortic dissection confers high mortality and morbidity rates despite advances in treatment, impacts quality of life, and contributes immense burden to the healthcare system globally. Efforts to prevent aortic dissection through screening and management of modifiable risk factors and early detection of aneurysms should incorporate genomic information, as it is integral to stratifying risk. However, effective integration of genomic-guided risk assessment into clinical practice will require addressing implementation barriers that currently permeate our healthcare systems. The Aortic Dissection Collaborative was established to define aortic dissection research priorities through patient engagement. Using a collaborative patient-centered feedback model, our Genomic Medicine Working Group identified related research priorities that could be investigated by pragmatic interventional studies aimed at aortic dissection prevention, utilization of genomic information to improve patient outcomes, and access to genomic medicine services. Further research is also needed to identify the genomic, lifestyle, and environmental risk factors that contribute to aortic dissection so these data can be incorporated into future comparative effectiveness studies to prevent aortic dissection. [ABSTRACT FROM AUTHOR]

Social capital plays an essential role in resilience building and disaster risk reduction, as it makes resources available in disaster situations. However, there is still a gap in the literature regarding the relationship between social capital, resilience, and disaster risk reduction. This research aims to understand and explain the role of social capital as a resource mobilizer during times of shock and the potential implications of this for DRR and resilience building. To do so, we develop and apply a framework that integrates the concepts of resilience (specifically the adaptive cycle theory), social capital (in terms of social relationships), and the disaster risk reduction cycle. We apply the framework to the case of rice smallholder farming in flood-prone areas in Ecuador. We find that households' resources are critical to sustaining other dimensions of resilience through different forms of social capital. The availability of resources (canoes, food, water, and others) that households can exchange or share within the community (bonding social capital) sets the conditions for other levels of social capital. Bridging social capital is relevant for accessing temporary refuge for animals, water, food, and loans when resources at the local level become scarcer. The lack of resources creates conditions that strengthen unhealthy social relationships at the bridging social capital level. The use of this framework helped us to systematize our data and provide an overview of how the coping strategies of rice smallholders contribute to and inhibit their resilience during a flood and their transition to recovery. [ABSTRACT FROM AUTHOR]

To identify the effect of some clinical characteristics of severe acquired brain injury (sABI) patients on decannulation success during their intensive rehabilitation unit (IRU) stay. Nonconcurrent cohort study. Don Gnocchi Foundation Institute. Patients (N=351) with sABI and tracheostomy were retrospectively selected from the database of the IRU of the Don Gnocchi Foundation Institute. Potential predictors of decannulation were screened from variables collected at admission during clinical examination, conducted by trained and experienced examiners. The association between clinical characteristics and decannulation status was investigated through a Cox regression model. Kaplan-Meier curves were then created for time-event analysis. Among the patients (mean age, 64.1±15.5y), 54.1% were decannulated during their IRU stay. Absence of pulmonary infections (P <.001), sepsis (P =.001), tracheal alteration at the fibrobronchoscopy examination (P =.004) and a higher Coma Recovery Scale-Revised (CRS-R) score (P <.001) or a better state of consciousness at admission (P =.001) were associated with a higher probability of decannulation. Fibrobronchoscopy assessment of patency of airways and accurate evaluation of the state of consciousness using the CRS-R are relevant in this setting of care to better identify patients who are more likely to have the tracheostomy tube removed. These results may help clinicians choose the appropriate timing and intensity of rehabilitation interventions and plan for discharge. [ABSTRACT FROM AUTHOR]

Objectives: Recent reports have demonstrated a risk of concussion and subconcussive head impacts in collegiate varsity and international elite water polo. We sought to characterize patterns of head impact exposure at the collegiate club level of water polo.Design: Prospective cohort study.Methods: Head impact sensors (SIM-G, Triax Technologies) were worn by men's (n=16) and women's (n=15) collegiate club water polo players during 11 games. Peak linear acceleration (PLA) and peak rotational acceleration (PRA) of head impacts were recorded by the sensors. Two streams of competition video were used to verify and describe the nature of head impacts.Results: Men's players sustained 52 verified head impacts of magnitude 39.7±16.3g PLA and 5.2±3.2 krad/s2 PRA, and women's players sustained 43 verified head impacts of magnitude 33.7±12.6g PLA and 4.0±2.8krad/s2 PRA. Impacts sustained by men had greater PLA than those sustained by women (p=.045). Athletes were impacted most frequently at the offensive center position, to the back of the head, and by an opponent's torso or limb.Conclusions: Our cohort of male and female athletes sustained relatively infrequent head impacts during water polo competitions played at the collegiate club level. The amount of head impact exposure in our cohort was dependent on player position, with offensive centers prone to sustaining the most impacts. Head impact sensors are subject to large amounts of false positives and should be used in conjunction with video recordings to verify the validity of impact data. [ABSTRACT FROM AUTHOR]

Les maladies allergiques sont le résultat d'interactions entre de multiples facteurs génétiques et environnementaux et seuls des changements environnementaux récents peuvent expliquer leur augmentation au cours des dernières décennies. Le concept d'exposome englobe l'ensemble des facteurs d'exposition à l'environnement extérieur, spécifiques et non spécifiques, auxquels un sujet donné est soumis dès la préconception et les conséquences de ces expositions au niveau des cellules et des organes (exposome interne) à l'origine des processus pathologiques. L'étude de l'exposome contribue de manière significative à la compréhension de l'établissement, du développement et de l'exacerbation de l'asthme et des maladies allergiques qui sont des maladies complexes. Un nombre croissant de preuves scientifiques confirme que les polluants atmosphériques interagissent avec les aéroallergènes, augmentant le risque de sensibilisation allergique et l'apparition et le développement d'une allergopathie chez les sujets sensibilisés. Les facteurs socioéconomiques et le mode de vie sont également des aspects cruciaux dans le développement de l'exposition extérieure et dans l'identification des individus à risque. L'hypothèse de la perte de la biodiversité affirme que le contact avec la nature enrichit le microbiome humain et favorise le bon équilibre du système immunitaire, protégeant ainsi contre le développement de problèmes inflammatoires ; au contraire, la perte de biodiversité en termes de plantes, d'animaux et de microorganismes entraîne des phénomènes d'immuno-dérégulation et d'inflammation chronique avec une augmentation conséquente des maladies chroniques, y compris de l'asthme et des maladies allergiques. Allergic diseases are the result of interactions between multiple genetic and environmental factors and only recent environmental changes can explain their increase over the last few decades. The concept of the exposome encompasses all the factors of exposure to the external environment, both specific and non-specific, to which a given subject is subjected from preconception and the consequences of these exposures at the level of cells and organs (internal exposome) at the origin of pathological processes. The study of the exposome contributes significantly to the understanding of the establishment, development and exacerbation of asthma and allergic diseases, which are complex diseases. A growing body of scientific evidence confirms that air pollutants interact with aeroallergens, increasing the risk of allergic sensitization and the onset and development of allergic disease in sensitized subjects. Socioeconomic and lifestyle factors are also crucial aspects in the development of outdoor exposure and in the identification of individuals at risk. The biodiversity loss hypothesis states that contact with nature enriches the human microbiome and promotes the proper balance of the immune system, thus protecting against the development of inflammatory problems; on the contrary, the loss of biodiversity in terms of plants, animals and microorganisms leads to phenomena of immuno-deregulation and chronic inflammation with a consequent increase in chronic diseases, including asthma and allergic diseases. [ABSTRACT FROM AUTHOR]

Although pelvic floor muscle training is widely recommendedin the literature as the gold standard for the treatment of pelvic floor dysfunctions, such as urinary incontinence, interest in other exercise regimens is increasing. However, it is unknown whether other exercise regimens increase pelvic floor muscle strength. This was a systematic review of randomized clinical trials found in PEDro, tridatabase, Cochrane and PubMed on the efficacy of nonspecific exercises, such as Pilates, the Paula method, and hypopressive exercises, in strengthening pelvic floor muscles in adults without underlying neurological disorders and with or without pelvic floor dysfunction. Seven studies were analyzed, and the results demonstrated that Pilates, the Paula method, and hypopressive exercises are ineffective in increasing pelvic muscle strength unless they are performed in conjunction with pelvic floor muscle training. The protocol was registered in the PROSPERO database (www.crd.york.ac.uk/prospero/) under the number CRD42019123396. Considering the available studies, we have concluded that Pilates, the Paula method and hypopressive exercises performed alone do not increase pelvic floor muscle strength. Pelvic floor muscle training continues to be the gold standard for increasing pelvic muscle strength. [ABSTRACT FROM AUTHOR]

• Despite the SoC, women with aPL still experience pregnancy complications. • The Global AntiphosPholipid Syndrome Score is a risk stratification tool. • GAPSS might be a valuable tool for stratifying patients that will likely respond to SoC. The current treatment to prevent pregnancy morbidity (PM) associated with antiphospholipid antibodies (aPL) is based on the use of low dose aspirin and low molecular weight heparin (henceforth defined as standard of care (SoC) treatment). Despite the SoC, up to 30% of women with aPL continue to have pregnancy complications. The global antiphospholipid syndrome (APS) score (GAPSS) is a tool to quantify the risk for the aPL-related clinical manifestations. In this study, we investigated the individual clinical response to SoC in women with aPL after stratifying them according to their GAPSS. One-hundred-fourty-three women (352 pregnancies) with aPL ever pregnant treated with SoC therapy were included. The patients GAPSS was then grouped according to the patients' GAPSS into low risk (< 6), medium risk (6–11), and high risk (≥12). The live birth rate was 70.5% (248 out of the 352 pregnancies), 45 patients (31%) experienced at least one event of PM, defined as early or late. Patients were stratified according to GAPSS values, in order to identify a low risk group (GAPSS <6, n = 72), a medium risk group (GAPSS 6–11, n = 66) and a high risk group (GAPSS ≥12, n = 5). When considering patients who ever experienced any PM while treated with SoC, all patients in the high risk group experienced PM, while patients in the medium group had a significant higher rate of PM when compared to the low risk group [29 (43.9%) patients V.s. 11 (15.3%), respectively; p < 0.001]. When analysing the number of pregnancies in the three groups, patients in the high risk group had significantly lower live birth rates, when compared to the other groups [11 (40.7%) live births vs. 100 (62.1%) and 137 (82.5%), respectively; p < 0.05]. Furthermore, patients with medium risk group also had significantly lower live birth rates, when compared to the lower risk group (p < 0.001). GAPSS might be a valuable tool for to identify patients with a higher likelihood of response to SoC. [ABSTRACT FROM AUTHOR]

To assess developmental disturbances through the analysis of linear enamel hypoplasia (LEH) frequency and to infer environmental stress and life history within Neolithic communities from Liguria (Italy). 43 unworn/minimally worn permanent anterior teeth of 13 individuals recovered from nearby caves and dated to c. 4800−4400 cal. BCE. LEH defects were identified with high-resolution macrophotos of dental replicas, age at LEH was calculated via perikymata counts. LEH defects matched between two or more teeth were considered as systemic disturbances. LEH frequency by age classes was analyzed via GLZ and Friedman ANOVA. Number of matched defects per individual range between 2–12. The mean LEH per individual was highest in the 2.5–2.99 age category, with a significant increase relative to earlier growth stages, followed by a decline. LEH may reflect life-history in the local ecology of Neolithic Liguria, where several individuals with osteoarticular tuberculosis have been recorded. Disease burden may have triggered developmental disturbances around the time of weaning. Age at first defect was negatively correlated with age at death and positively with the total number of defects, suggesting that early stress may have affected survivorship. The study contributes to the reconstruction of ecological pressures among Neolithic people of Liguria, and informs on environmental challenges during the Neolithic adaptive expansion. The visual examination of macrophotos is prone to observer error; mid-crown tends to display more visible LEH due to tooth architecture. Apply different quantitative methods to examine severity and duration of disturbances. [ABSTRACT FROM AUTHOR]

This study evaluates patterns of human growth in the Neolithic to make inferences about environmental correlates of developmental disturbances. 33 children/adolescents from the Neolithic of Liguria (Italy), 29 of which date between 4,800-4,400 cal BCE. Neolithic patterns of growth are compared with a modern sample (the Denver Growth Study; DGS). Dental development was used to determine age at death. Proxies for postcranial maturation are femoral length and proportion of mean adult femoral length attained. Ligurian children show growth faltering compared to DGS, especially between 4 and 9 years of age. Between 1 and 2 years, and in later childhood and adolescence, values are more similar or higher than DGS, when using the proportion of adult femoral length attained. The pattern of growth in Ligurian Neolithic children may reflect a deprived and highly-infectious environment: three individuals show skeletal lesions consistent with tuberculosis. The relatively faster growth in infancy may result from the buffering provided by maternal milk. Older children and adolescents may exhibit catch-up growth. This study contributes to our understanding of Neolithic selective pressures and possible biocultural adaptive strategies. The cross-sectional nature of the data and the small sample size make it unclear whether the observed pattern is representative of the growth patterns in the living population. The possibility that adults are stunted undermines the interpretation of optimal growth in the first years. Refine age estimates, increase sample size through the study of other bone elements. [ABSTRACT FROM AUTHOR]

Several acquired and congenital disease conditions and many cardiac and noncardiac drugs affect ventricular repolarization and increase susceptibility to ventricular arrhythmias. Abnormal ventricular repolarization can be reflected on the surface ECG by prolonged or shortened QT interval, early repolarization, and abnormal T-wave configuration. Reduced outward K+ currents and abnormal or increased sodium or calcium currents increase the vulnerability to ventricular arrhythmias. Multiple mechanisms give rise to ventricular arrhythmias in conditions of congenital or acquired abnormal ventricular repolarization. Ventricular arrhythmias associated with abnormalities of ventricular repolarization typically are rapid, usually polymorphic, ventricular tachycardia or torsades de pointes, often degenerating into ventricular fibrillation. [ABSTRACT FROM AUTHOR]

The aim of this study was to collect all available data from 2009 to 2016 focusing on the epidemiological, clinical and pharmacological issues only related to acute intoxication fatalities in the Unit of Legal Medicine of the Department of Medicine and Surgery at the University of Parma. All death certificates and autopsy reports were retrieved from the archives and evaluated to identify cases in which only acute intoxication from xenobiotics could be defined as the cause of death, however statistical and descriptive analyses were applied to all the data. A more comprehensive analysis on all causes of death showed that out of 1005 total cases the most common is haemorrhagic shock/traumatic shock (36.5%), followed by cardiogenic shock with 27.4%; asphyxia ranks as the third cause of death (11.8%); concerning encephalic injuries, our data show 10.9% of cases, while acute intoxication by xenobiotics accounts for 5.7%. Data show that the majority of subjects are poly-abuser (75.4%); people not enrolled within a preventive treatment (59.4%) were more likely to commit suicide (28.1%), whereas only 6.2% in the sub-population in treatment (40.6%) committed suicide: therefore, data strongly suggest the evidence that joining a preventive programme can decrease the probability of extreme action. Access to a full case history may indeed save considerable time and expense in carrying out tests, but also valuable targeted samplings. The investigating officer should, therefore, submit as much information as possible about the case, as this may influence the type and extent of analysis undertaken, as well as the interpretation of analytical results. [ABSTRACT FROM AUTHOR]

Abstract Objectives To investigate the long-term effect of B-cell depletion therapy with Rituximab (RTX) alone as rescue therapy in primary antiphospholipid syndrome (PAPS) patients with severe thrombocytopenia. Methods We retrospectively retrieved data from patients who met the following inclusion criteria: (a) persistent antiphospholipid antibodies (aPL) positivity and fulfilled the Sydney criteria for PAPS (b) presented with severe thrombocytopenia (platelets <50,000/mm3) (c) were treated with RTX as a rescue therapy (d) had at least 1 year of follow-up after B-cells depletion therapy. Results This retrospective study included 6 consecutive female PAPS patients [median age 49.5 (range 38–66)] who presented with severe thrombocytopenia (platelets <50,000/mm3, mean value 31,000 ± 9000/mm3). We observed a full response (defined as >150,000 platelets/mm3) after treatment with RTX in 5 out of 6 patients (83.3%). Among responders, after a median follow-up of more than 4 years, we observed a median time free from relapse of 43 months (range 12–97). One patient did not respond to the B-cell depletion therapy and was treated with a splenectomy 1 month after RTX therapy and platelets levels normalized after 3 months. No adverse events were reported, no patients developed significant infections. Importantly, the patients required no further maintenance therapy for the thrombocytopenia. Conclusion In one of the longest-term observational (median 43 months) studies, sustained clinical remission of severe thrombocytopenia without immunosuppressive maintenance therapy was obtained by RTX alone in patients with PAPS and severe thrombocytopenia intolerant or refractory to conventional therapy. [ABSTRACT FROM AUTHOR]

• The issue of missing persons is an international drama. • Age progression is used for the identification of missing person. • The possibility to recognize a person after years of missing represents a highly objective in forensic field. [ABSTRACT FROM AUTHOR]

Abstract During the Second World War, on 24th March 1944, 335 Italians were massacred near Rome by the occupying forces of Nazi Germany. Four months later forensic examination led to the identification of 323 out of 335 victims. After approximately 60 years, the identification of the remaining unidentified twelve victims began with anthropological and genetic analysis carried out by a team of Italian forensic experts. Anthropological analysis was performed in field in order to confirm the sex of each victim and verify the presence of only one individual in each grave for a correct sampling. Selected bone fragments for each individual were then collected and transferred to the laboratory for genetic analysis. Although the anthropological ante mortem information was limited, morphological and metrical data was collected for a possible future identification of the victims. Subsequently, the typing of autosomal loci, Y-STR and mtDNA D-loop region of all bone and available reference samples was conducted. LR and cumulative LRs obtained from autosomal STR and Y-STR results confirmed the alleged relationship between three victims and their relatives with values over 104 (one sample) and 106 (two samples). Therefore, the genetic analysis offered the families the possibility of replacing the number of the grave with the name of the victim. Highlights • During the Second World War, 335 civilians and Italian military personnel were killed near Roma. • Some months later forensic examination led to the identification of 323 out of 335 victims. • After about 60 years, the identification of the unidentified twelve victims began with anthropological and genetic analysis. • The analyses offered the families the possibility of replacing the number of three graves with the name of the martyr. [ABSTRACT FROM AUTHOR]

Abstract On the premise that a system's resilience is partially a function of its capability to manage risk, this paper systematically presents a step-by-step process to develop and apply a participatory risk assessment as an approximate way to better understand livelihood resilience from a local perspective, specifically within the context of rice smallholders located in flood-prone areas in Ecuador. This process is characterized mainly by (i) approaching smallholders to ascertain the livelihood assets that are relevant to them, how they could be understood as being at risk, and how their at-risk situation should be measured and interpreted; and (ii) using drawings and stories as a combined research tool for refreshing memory in the process of data collection. The differentiated research process showed that (i) including local knowledge and interpretation of risk from the beginning of the assessment tool construction results in an easier application in the field; (ii) drawing and storytelling as a combined tool on the one hand helped participants to provide detailed information about facts, feelings, and social dynamics, and on the other hand allowed us to indirectly assess their willingness to collaborate and the strategies to do so; and (iii) popular or innovative strategies, involving tangible and intangible resources, identified through every step, proved to be a link between local resilience and risk management capabilities. [ABSTRACT FROM AUTHOR]

Pâté is a new olive mill by-product potentially suitable for human consumption. This work aimed to characterize the phenolic profile of pâté samples from four crop seasons (2013–2016) in fresh, dried and stored samples, applying HPLC-DAD-MS-TOF, and to evaluate the antiaging effect in a cell senescence model. The dried pâté contains high levels of hydroxytyrosol, oleuropein derivatives and other phenolic compounds and is stable for several months. A diluted hydroalcoholic extract showed antiaging effects in vitro, comparable to those of pure hydroxytyrosol. Pâté can thus be proposed as an additional economical and environment-friendly source of olive bioactive phenolic compounds, particularly hydroxytyrosol: 1 g of pâté provides a daily intake comparable to that derived from 200 g of a typical virgin olive oil. This work lays the basis for a possible use of this food by-product as a natural ingredient for innovative foods or food supplements, contributing to a healthier lifestyle. [ABSTRACT FROM AUTHOR]

Background and Aim: Adherence to the Mediterranean Diet (MD) has been associated with a longer and better life. The aim of this study was to examine the effects of adherence to the MD, and of nutritional habits on endothelial progenitor (EPCs) and circulating progenitor (CPCs) cells in a cohort of nonagenarians enrolled within the Mugello Study, an epidemiological study aimed at investigating both clinically relevant geriatric items and various health issues, including those related to nutritional status.Methods and Results: Four hundred twenty-one nonagenarians (306 F, 115 M, mean age: 93.1 ± 3.2 years) were evaluated. Adherence to MD was assessed through the Mediterranean Diet Score. Elderly subjects who were in the fourth quartile of the Mediterranean diet score showed significantly higher EPCs than subjects grouped into the other three quartiles. After adjustment for confounders, elderly subjects who were in the highest quartile of adherence to the MD score reported to have EPCs' levels significantly higher than those who reported lower values of adherence to the MD. Furthermore, by analyzing different food categories, it was reported that daily consumption of olive oil and a higher consumption of fruit and vegetables showed higher CPCs CD34+ and EPCs CD34+/KDR+ than subjects with not daily or lower consumption.Conclusion: Our results support the hypothesis that the adherence to MD, as well as a daily consumption of olive oil and fruit and vegetables, characteristics of MD, may protect against the development of endothelial dysfunction through increasing EPCs and CPCs in older age. [ABSTRACT FROM AUTHOR]

Aspergillus sydowii is a cosmopolitan fungus that has been responsible for the mass destruction of coral in the Caribbean Sea over the last 15 years. To our knowledge, this study has found the first case of A. sydowii in the Mediterranean Sea, in marine-bottom sediments, water and calcareous shells of bivalve molluscs sampled during a campaign to characterise the mycobiota in the Port of Genoa (Italy). The area is characterised by adverse environmental conditions (high turbidity, organic pollution and high concentrations of phosphorus and nitrogen compounds). These parameters, in combination with a rising temperature, could contribute to A. sydowii bloom and dispersal. This fungal strain may have been imported into the Port of Genoa in the bilge water of vessels or by torrent input. This work represents the first step in the implementation of a monitoring programme to safeguard calcareous sponges and sea fan corals endemic in the Mediterranean Sea. [ABSTRACT FROM AUTHOR]

Fungi include a vast group of eukaryotic organisms able to colonise different natural, anthropised and extreme environments, including marine areas contaminated by metals. The present study aims to give a first multidisciplinary characterisation of marine bottom sediments contaminated by metals (Cd, Co, Cr, Cu, Ni, and Zn), originating in the water leakage from an abandoned Fe-Cu sulphide mine (Libiola, north-western Italy), and evaluate how the chemical and physical parameters of water and sediments may affect the benthic fungal communities. Our preliminary results showed the high mycodiversity of the marine sediments studied (13 genera and 23 species of marine fungi isolated), and the great physiological adaptability that this mycobiota evolved in reaction to the effects of the ecotoxic bottom sediment contamination, and associated changes in the seawater parameters. [ABSTRACT FROM AUTHOR]

Today, Alzheimer’s disease (AD) diagnosis is carried out using subjective mental status examinations assisted in research by scarce and expensive neuroimaging scans and invasive laboratory tests; all of which render the diagnosis time-consuming, geographically confined and costly. Driven by these limitations, quantitative analysis of electroencephalography (EEG) has been proposed as a non-invasive and more convenient technique to study AD. Published works on EEG-based AD diagnosis typically share two main characteristics: EEG is manually selected by experienced clinicians to discard artefacts that affect AD diagnosis, and reliance on EEG devices with 20 or more electrodes. Recent work, however, has suggested promising results by using automated artefact removal (AAR) algorithms combined with medium-density EEG setups. Over the last couple of years, however, low-density, portable EEG devices have emerged, thus opening the doors for low-cost AD diagnosis in low-income countries and remote regions, such as the Canadian Arctic. Unfortunately, the performance of automated diagnostic solutions based on low-density portable devices is still unknown. The work presented here aims to fill this gap. We propose an automated EEG-based AD diagnosis system based on AAR and a low-density (7-channel) EEG setup. EEG data was acquired during resting-awake protocol from control and AD participants. After AAR, common EEG features, spectral power and coherence, are computed along with the recently proposed amplitude-modulation features. The obtained features are used for training and testing of the proposed diagnosis system. We report and discuss the results obtained with such system and compare the obtained performance with results published in the literature using higher-density EEG layouts. [ABSTRACT FROM AUTHOR]

Tumor associated macrophages (TAMs) are critical stromal components intimately involved with the progression, invasion, and metastasis of cancer cells. To address the need for an in vitro system that mimics the clinical observations of TAM localizations and subsequent functional performance, a cancer cell/macrophage spheroid model is described. The central component of the model is a triple negative breast cancer spheroid embedded in a three-dimensional collagen gel. Macrophages are incorporated in two different ways. The first is a heterospheroid, a spheroid containing both tumor cells and macrophages. The heterospheroid mimics the population of TAMs infiltrated into the tumor mass, thus being exposed to hypoxia and metabolic gradients. In the second model, macrophages are diffusely seeded in the collagen surrounding the spheroid, thus modeling TAMs in the cancer stroma. The inclusion of macrophages as a heterospheroid changes the metabolic profile, indicative of synergistic growth. In contrast, macrophages diffusely seeded in the collagen bear the same profile regardless of the presence of a tumor cell spheroid. The macrophages in the heterospheroid secrete EGF, a cytokine critical to tumor/macrophage co-migration, and an EGF inhibitor decreases the metabolic activity of the heterospheroid, which is not observed in the other systems. The increased secretion of IL-10 indicates that the heterospheroid macrophages follow an M2/TAM differentiation pathway. Lastly, the heterospheroid exhibits resistance to paclitaxel. In summary, the collagen embedded heterospheroid model promotes TAM-like characteristics, and will be of utility in cancer biology and drug discovery. Statement of Significance Two in vitro collagen-embedded multicellular spheroid models are described that mimic the clinical observations of macrophage localization within a tumor. Incorporation of macrophages within a breast cancer spheroid emphasizes cell-cell interactions with subsequent differentiation toward a tumor-promoting TAM phenotype. In contrast, macrophages seeded around the tumor spheroid display decreased interaction with cancer cells and no indication of a TAM phenotype. Finally, the presence of macrophages in the heterospheroid increases resistance to paclitaxel. This study demonstrates that cell-cell interactions and 3D collagen matrix direct macrophage activity, and, thus, highlights the important role the local environment itself plays in macrophage behavior. [ABSTRACT FROM AUTHOR]

Growth hormone (GH) deficiency is characterized by impaired growth and development, and is currently treated by repeated administration of recombinant human GH (hGH). Encapsulated cell therapy (ECT) may offer a less demanding treatment-strategy for long-term production and release of GH into circulation. We used PiggyBac-based (PB) transposon delivery for engineering retinal pigment epithelial cells (ARPE-19), and tested a series of viral and non-viral promoters as well as codon-optimization to enhance transgene expression. Engineered cells were loaded into TheraCyte macrocapsules and secretion was followed in vitro and in vivo. The cytomegalovirus (CMV) promoter supports strong and persistent transgene expression, and we achieved clonal cell lines secreting over 6 µg hGH/106 cells/day. Codon-optimization of the hGH gene did not improve secretion. ARPE-19 cells endured encapsulation in TheraCyte devices, and resulted in steady hormone release for at least 60 days in vitro. A short-term pilot experiment in immunodeficient SCID mice demonstrated low systemic levels of hGH from a single 40 µL capsule implanted subcutaneously. No significant increase in weight increase or systemic hGH was detected after 23 days in the GH-deficient lit/SCID mouse model using 4.5 µL capsules loaded with the highest secreting clone of ARPE-19 cells. Our results demonstrate that PB-mediated engineering of ARPE-19 is an efficient way to generate hormone secreting cell lines compatible with macroencapsulation, and our CMV-driven expression cassette allows for identification of clones with high level and long-term secretory activity without addition of insulator elements. Our results pave the way for further in vivo studies of encapsulated cell therapy. • PiggyBac-mediated engineering of ARPE-19 efficiently generates hormone secreting cell lines. • ARPE-19 cells are compatible with microencapsulation in TheraCyte devices. • The cytomegalovirus promoter supports strong and persistent transgene expression in ARPE-19 cells. [ABSTRACT FROM AUTHOR]

• EEG-derived symmetry indexes are markers of recovery for patients with acquired brain injury. • Machine learning algorithms can be crossvalidated to automatically extract symmetry index. • The solution detected asymmetry with a test accuracy of 85% (sensitivity 92%, specificity 80%) • It can speed up analysis and improve quality of care in settings lacking skilled staff. Lateral brain symmetry indexes, detected by electroencephalography (EEG), are markers of rehabilitative recovery widely used in patients with severe acquired brain injury (sABI). In this study, Machine Learning algorithms were cross-validated to detect consistent asymmetries, starting from a completely automated features extraction pipeline in the EEG recordings of 54 patients with sABI, classified by two expert neurophysiologists. Raw data were filtered and segmented in two-seconds non-overlapping epochs. Low data quality in frontal electrodes caused up to 40% of epochs rejection, whilst central and posterior electrodes contributed with the greatest number of artefacts-free epochs. Out of more than 3000 extracted features, ∼300 significantly differentiated symmetric and asymmetric EEG recordings, most of them extracted from pairs and lines of electrodes. The best performing solution (nested-cross-validated and optimized Support Vector Machine classifier) detected asymmetry with a test accuracy of 85% (sensitivity 92%, specificity 80%). The application of the proposed approach to our sample size supports the generalizability of our model and its translation to clinical practice. The algorithm, heading to automatic EEG analysis, has the potential to speed up analysis of long recordings and, to improve quality of care in settings lacking skilled staff. [ABSTRACT FROM AUTHOR]

The aim of this research is to gain insights on the progression timeline of osteoarticular tuberculosis (TB) in people from the Neolithic period by using skeletal traits that are independent of the bony lesions. The body proportions and postcranial mechanical strength of bones from two individuals from Liguria in northwestern Italy (Arene Candide 5, adolescent, and Arma dell’Aquila 1, adult), were compared with the rest of the Ligurian Neolithic skeletal series (45 individuals). If TB led to wasting of the skeleton and lack of normal function that endured for years, as often happens today, a clear signature of postcranial gracility and disruption of development should be apparent. Conversely, rapid progress of the disease would leave little systemic macroscopic change in the skeleton, except for the bony lesions directly caused by the TB pathogen, suggesting a different level of bacterial virulence in the past. The extreme biomechanical gracility observed in the lower limb of Arene Candide 5 suggests a period of compromised diaphyseal periosteal apposition during ontogeny due to metabolic disturbances likely linked to TB. Results suggest that, in Neolithic Liguria, TB in humans saw a slow, chronic progression, which is characteristic of diseases with long histories of host-pathogen co-evolution. [ABSTRACT FROM AUTHOR]

Unlabelled: Efficacy and safety of antibiotic prophylaxis (AP) for prevention of infective endocarditis (IE) in patients with predisposing cardiac condition (PCC) undergoing invasive procedures is still debated. We sought to assess the prevalence of PCC, the type of interventional procedures preceding the onset of symptoms, and the usefulness of AP in a large cohort of consecutive patients with definite IE.Methods: We examined 677 (median age 65.34 years; male 492 [73%]) consecutive patients with IE enrolled from July 2007 through 2010 into the Italian Registry of Infective Endocarditis.Results: Predisposing cardiac condition was present in 341 patients (50%).Thirty-two patients (4.7%) underwent dental procedures. Of 20 patients with PCC undergoing dental procedure, 13 had assumed AP. Viridans group streptococci were isolated from blood cultures in 8 of 20 patients with PCC and prior dental procedure. Nondental procedures preceded IE in 139 patients (21%). They were significantly older and had more comordibities compared with patients undergoing dental procedures. Predisposing cardiac condition was identified in 91 patients. Perioperative antimicrobial prophylaxis was administered to 67 patients. Staphylococcus aureus was the most frequent causative agent. Cardiac surgery was necessary in 85 patients (20 with prior dental and 65 with nondental procedure). Surgical mortality (12% vs 0%, P = .03) and hospital mortality (23% vs 3%, P = .001) were significantly larger among patients with nondental procedures.Conclusions: In a large unselected cohort of patients with IE, the incidence of preceding dental procedures was minimal. The number of cases potentially preventable by means of AP was negligible. Nondental procedures were more frequent than dental procedures and were correlated with poorer prognosis. [ABSTRACT FROM AUTHOR]

Dinoflagellate proliferation is common in coastal waters, and trophic strategies are often advanced to explain the success of these organisms. The Biguglia lagoon is a Mediterranean brackish ecosystem where eutrophication has long been an issue, and where dominance of dinoflagellates has persisted for several years. Monthly monitoring of fluorescence-based properties of phytoplankton communities carried out in 2010 suggested that photosynthesis alone could not support the observed situation all year round. Contrasting food webs developed depending on the hydrological season, with a gradual shift from autotrophy to heterotrophy. Progressively, microphytoplankton assemblages became unequivocally dominated by a Prorocentrum minimum bloom, which exhibited very weak effective photosynthetic performance, whereas paradoxically its theoretical capacities remained fully operational. Different environmental hypotheses explaining this discrepancy were examined, but rejected. We conclude that P. minimum bloom persistence is sustained by mixotrophic strategies, with complex compromises between phototrophy and phagotrophy, as evidenced by fluorescence-based observations. [ABSTRACT FROM AUTHOR]

This paper focuses on an energy and economic analysis of a mineral carbonation process developed to treat raw flue gas issued from an industrial plant. The process uses Serpentinite based mining residues available in very large quantities close to an industrial center in southern Quebec. A model based on a mass balance obtained from laboratory scale experiments allowed the evaluation of the energy requirements of the process. The integration of these results to the particular situation of the Québec province showed the process feasibility. In addition, economic investigations illustrated the profitability of such plant because of the high potential sale value of the carbonates produced. This work aims to give a particular focus on a technology developed for a niche problem but also gives valuable information for the development of other potential mineral carbonation processes elsewhere in the world. Results show that 7.8 GJ/t CO 2 is required to sequester 234 kg of CO 2 per tonne of rocks. Calculations showed that a plant with a capacity of 200 t of rocks treated per hour, using biomass for the heat requirements and train for the rock transportation would treat 387 000 tCO 2 per year. The global process cost is estimated at 144 $/tCO 2 (146 $/tCO 2 avoided). Based on the incomes generated by the by-product sale and the carbon credit tax, revenues of 644 $/tCO 2 are generated, giving a profitable balance. With a payback period of 1.4 years the process is highly beneficial from an economic point of view. [ABSTRACT FROM AUTHOR]

The Biguglia lagoon is a shallow Mediterranean coastal ecosystem where eutrophication is increasing for years. A channel supplying freshwater was cleared in 2009 to enhance lagoon water circulation and alleviate dystrophic crises. Monthly monitoring was started in 2010 to document the impacts of this action on abiotic characteristics and phytoplankton communities. Three stations were surveyed (by microscopy and HPLC). Evidence suggests that this operation had an unexpected outcome. Salinity footprints indicated the succession of three main hydrological sequences that depended on rainfall and circulation pattern. Diatoms and dinoflagellates dominated the first sequence, characterized by heavy rainfall, while Prorocentrum minimum became progressively the dominant species in the second period (increasing salinities) with extensive bloom over the whole lagoon (5.93 × 10- 5 cells·L − 1 ) during the third period. These phytoplankton successions and community structures underline the risk of pernicious effects arising from remediation efforts, in the present case based on increasing freshwater inputs. [ABSTRACT FROM AUTHOR]

Parenteral nutrition constitutes a life-saving therapeutic tool in patients unable to ingest/absorb oral or enteral delivered nutrients. Liver function tests abnormalities are a common therapy-related complication, thus configuring the so-called Parenteral Nutrition Associated Liver Disease (PNALD) or cholestasis (PNAC). Although the damage is frequently mild, and resolves after discontinuation of parenteral nutrition, in some cases it progresses into cirrhotic changes, especially in neonates and infants. We present a literature review focusing on the pathogenetic mechanisms-driven prevention and therapies for the cases where parenteral nutrition cannot be discontinued. Ursodeoxycholic acid has been proposed in patients with cholestatic hepatopathy, but its efficacy needs to be better established. Little evidence is available on efficacy of anti-oxidants, antibiotics, probiotics and anti TNFα. Lipid emulsions based on fish oil with a high content of long-chain polyunsaturated fatty acids ω-3 appear effective both in decreasing intrahepatic inflammation and in improving biliary flow. Most recent promising variations such as soybean/MCT/olive/fish oil emulsion [third generation lipid emulsion (SMOFlipid)] are under investigation. In conclusion, we remark the emergence of a number of novel pathomechanisms underlying the severe liver impairment damage (PNALD and PNAC) in patients treated with parenteral nutrition. Only few traditional and innovative therapeutic strategies have hitherto been shown promising. [ABSTRACT FROM AUTHOR]

Non-viral transfer of the growth hormone gene to different muscles of immunodeficient dwarf (lit/scid) mice is under study with the objective of improving phenotypic correction via this particular gene therapy approach. Plasmid DNA was administered into the exposed quadriceps or non-exposed tibialis cranialis muscle of lit/scid mice followed by electroporation, monitoring several growth parameters. In a 6-month bioassay, 50 μg DNA were injected three times into the quadriceps muscle of 80-day old mice. A 50% weight increase, with a catch-up growth of 21%, together with a 16% increase for nose-to-tail and tail lengths (catch-up = 19–21%) and a 24–28% increase for femur length (catch-up = 53–60%), were obtained. mIGF1 serum levels were ~ 7-fold higher than the basal levels for untreated mice, but still ~ 2-fold lower than in non-dwarf scid mice. Since treatment age was found to be particularly important in a second bioassay utilizing 40-day old mice, these pubertal mice were compared in a third bioassay with adult (80-day old) mice, all treated twice with 50 μg DNA injected into each tibialis cranialis muscle, via a less invasive approach. mIGF1 concentrations at the same level as co-aged scid mice were obtained 15 days after administration in pubertal mice. Catch-up growth, based on femur length (77%), nose-to-tail (36%) and tail length (39%) increases was 40 to 95% higher than those obtained upon treating adult mice. These data pave the way for the development of more effective pre-clinical assays in pubertal dwarf mice for the treatment of GH deficiency via plasmid-DNA muscular administration. [ABSTRACT FROM AUTHOR]

Background: Subcutaneous implantable cardioverter-defibrillator (S-ICD) is a promising option for patients with hypertrophic cardiomyopathy (HCM). Patients with HCM can present markedly abnormal electrocardiograms (ECGs), and there are no data on what percentage of patients with HCM fail the prerequisite S-ICD vector screening.Objective: The purpose of this study was to determine the failure rate of the prerequisite vector screening using 1 or 2 acceptable vectors stratified for risk profile for sudden cardiac death and predictors of failure.Methods: ECG recordings from consecutive patients with HCM simulating the S-ICD sensing vectors were analyzed with the S-ICD screening tool. Eligibility was defined by 1 or 2 appropriate vectors. Medical history, ultrasound characteristics, and 12-lead ECG characteristics were analyzed and the individual arrhythmic risk at 5 year was determined to study potential predictors of failure.Results: One hundred sixty-five (118 men; mean age 51 ± 16 years) patients were analyzed. Twenty-two patients (13%) had a high risk of sudden cardiac death, 33 (20%) had intermediate to high risk, and 110 (67%) had low risk. Twenty-six patients (16%) had no suitable vector, including 8 of 22 high-risk patients (36%). The primary cause of failure was high T-wave voltages in 25% of the vectors analyzed. T-wave inversions in >2 leads on the surface 12-lead ECG (odds ratio 15.6; 95% confidence interval 4.9-50.3; P < .001) and prior myectomy (odds ratio 8.4; 95% confidence interval 2.1-33.1; P = .002) were significantly associated with screening failure in a multivariable model.Conclusion: Currently available preimplant screening algorithms recommended by the manufacturer are associated with a significant failure rate in patients with HCM, particularly in the high-risk subgroup. [ABSTRACT FROM AUTHOR]

To assess predicting factors that might influence systemic lupus erythematosus (SLE) disease activity in women in an extended follow-up period of two years after giving birth with clinical assessments every three months. The study was design as an international retrospective study, enrolling 119 women with a first birth and with a two years follow-up. Joint involvement was present in 80% of patients, acute cutaneous in 64%, haematological in 54%, renal in 41% and 75% of patients were positive for anti-dsDNA. The mean SLE disease activity index 2000 (SLEDAI-2K) at diagnosis was 13.5±6.8 and at first birth was 2.8±4.4. At follow-up, 51.3% of patients had at least one flare after a mean time after birth of 9±6.3 months (mean flare per patient 0.94±1.1). The most frequent flare manifestations were joint involvement (48%), renal (33%), cutaneous (28%) and haematologic (20%). Patients with remission of disease (SLEDAI-2K=0; no clinical or laboratory manifestations of SLE) at conception had significantly lower rates of flares (18/49–37% vs. 43/70–61%; p=0.008). Patients who experienced a flare during pregnancy (17 patients) had higher rates of flares during follow-up (76% vs. 47%; p=0.019), lower time for first flare (4.4±2.3 months vs. 10.3±6.5; p<0.001), lower rate of remission of disease at conception (12% vs. 46%; p<0.001), lower rates of SLEDAI-2K at conception (5.9±5.6 vs. 2.3±4; p<0.001) and lower rates of exclusive breastfeeding (24% vs. 57%: p=0.009). Results were confirmed after performing multivariate analysis. Remission at conception can influence SLE disease positively, even at long-term. Planned pregnancy counseling is fundamental when managing SLE patients. [ABSTRACT FROM AUTHOR]

This paper will report on the development of a prototype of actively controlled facade module, which is capable of adapting its solar transmittance to changeable solar gains. Hence this new facade offers additional features with respect to the most popular currently used glass facades, which have fixed solar transmittance indeed. The novel technology is made possible by the creation of an additional 1.5-mm-thick sliding shielding liquid, which flows internally, in order to dynamically adapt the window's solar transmittance. As compared with competitive technologies, this shielding system has low manufacturing costs, is durable, is completely reversible and always transparent, irrespective of its transmittance state. Specifically, the manufacture of a full size window prototype and the engineering of the window was carried out; moreover, glass pane bending when subject to hydrostatic pressure was eventually assessed. All this information has been used to set up the industrial process needed for its manufacturing. [ABSTRACT FROM AUTHOR]

Objective: The management of arterial pathology in individuals with vascular Ehlers-Danlos syndrome (vEDS) remains a challenge. Here we describe the correlation between COL3A1 gene mutation type and the clinical phenotype in individuals with vEDS. Methods: Individuals with confirmed molecular diagnoses of vEDS were enrolled in a multi-institutional natural history study. Data collected included demographics, clinical and family histories, arterial pathology (aneurysm, dissection, and rupture), operative details, and autopsy reports. Individuals were classified into two cohorts by the type of COL3A1 mutations and their effect on the amount of normal collagen produced: those with mutations that lead to minimal (MIN) production (10%-15%) of normal type III collagen and those with haploinsufficiency (HI) mutations that lead to production of 50% of the normal type III collagen. Results: A cohort of 68 individuals (72%) from 56 families had arterial pathology (44% male) with 13% HI. The HI group was older at the time of their first vascular event (mean, 42 [range, 26-58] years vs 33 [range, 8-62] years; P = .016) and had a higher incidence of aortic pathology than the MIN group (56% vs 21%; P = .025). Visceral arterial pathology was seen in 43 arteries in 23 individuals in the MIN group vs only one artery in five individuals in the HI group. Emergency surgical procedures were more likely to be undertaken when vEDS diagnosis was not known (81% vs 41%; P = .005), and 81% of these procedures were open surgical repair compared with 19% endovascular repairs (P = .019). Open and endovascular repairs were equally used in the elective setting. Postoperative complications were highest when the diagnosis of vEDS was not known (62% vs 14%; P < .001) and when procedures were undertaken in an emergency setting (5% vs 55% P < .001). Mortality due to arterial complications was 0% in the HI cohort and 21% in the MIN cohort (P = .132). Conclusions: Arterial pathology in vEDS individuals is related to the underlying COL3A1 mutation type. The arterial pathology in individuals with HI mutations occurs at later ages with a higher incidence of aortic disease compared with other COL3A1 mutation types. Molecular diagnosis is recommended because diagnosis confirmation, appropriate surveillance, and prophylactic interventions in an elective setting improve surgical outcomes. [Copyright &y& Elsevier]

Background and purpose: Although several studies reported that drug-eluting stents (DES) are able to reduce restenosis incidence without increasing mortality, concerns still exist about their safety in ST-segment elevation myocardial infarction (STEMI) patients mainly for a possible higher rate of in-stent thrombosis. Recent evidence suggests a better safety profile of second-generation DES, but data on their outcome in STEMI are still poor. In this study we evaluated the impact on mortality and target lesion revascularization (TLR) of DES or bare metal stent (BMS) implantation in STEMI patients submitted to primary angioplasty. Methods and subjects: We analyzed mortality and TLR in 1150 STEMI patients during a mean 43-month follow-up after DES (44.6%) or BMS (55.4%) implantation. A propensity score method was used to minimize bias. During follow-up, 223 deaths occurred. Essential results: Unadjusted for potential confounders, DES implantation was associated with a significant reduction in all-cause mortality [hazard ratio (HR) 0.40; 95% CI 0.30-0.54] and TLR (HR 0.55; 95% CI 0.36-0.86); this latter was confirmed after propensity score analysis (HR 0.39; 95% CI 0.21-0.67). Second-(n = 179) vs. first- (n = 337) generation DES showed a further reduction in TLR (HR 0.17; 95% CI 0.05-0.57). Adjusted analyses showed a significant reduction in the combined end-point of all-cause mortality or TLR after both first- and second-generation DES vs. BMS implantation with a trend to a lower risk for second- vs. first-generation DES. Principal conclusions: DES implantation in STEMI patients showed a significant reduction in TLR and in the combined endpoint of TLR or mortality. Second-generation DES showed a more protective effect on the combined endpoint, suggesting that they would be preferred in this setting. [ABSTRACT FROM AUTHOR]