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Many studies have reported that early interventions on language and early literacy skills are important for preventing later reading difficulties at primary school. The aim of the study is to assess the effectiveness of a 12-week intervention programme focused on enhancing pre-schoolers' language and early literacy skills. Two groups of children (ages 5-6) were involved in the study: the "Talk-group", who participated in the intervention programme, and the "Play-group", who followed the standard preschool curriculum. The children's early literacy skills were tested in two sessions six months apart, at the beginning and at the end of the last year of preschool. Data analysis showed that children achieved significantly higher scores in nonword repetition and lexical comprehension at the second assessment; however, only the children in the Talk-group produced significantly higher phonological awareness scores at the second session, i.e. after the intervention. Additional tests showed that the intervention programme was effective only in the case of more basic phonological awareness skills. The programme's potential for supporting early literacy development in preschool and for preventing long-term difficulties in reading are discussed.

Background: Proxy quality of life (QoL) evaluation has been reported to be influenced by many factors. The present study was designed to investigate the impact that the presence of severe intellectual disability (ID) may have on proxy attribution of QoL in the instrumental assessment. Methods: The "other person" form (proxy questionnaire) of the Italian adaptation of the Quality of Life Instrument Package (QoL-IP), the BASIQ [BAtteria di Strumenti per l'Indagine della Qualità di Vita] was administered to 20 first-line operators to assess their perceptions of the QoL of 92 subjects with severe ID and 34 volunteers without ID. The 54-item BASIQ measures three psychological domains (Being; Belonging; Becoming) and nine sub-domains, with each item also assessed across four dimensions (Importance; Satisfaction; Decision-making; and Opportunities). Results: Subjects with ID (as rated by proxies) had higher scores on BASIQ domains than those of non-ID subjects except for the sub-domain of Psychological Being. People with ID also received lower scores from proxies on the Decision-making dimension but higher scores on the Opportunities dimension. Differences between groups were statistically significant for most variables. Conclusions: Findings suggest that prejudicial attitudes towards the QoL of people with severe ID may be either absent in proxies or contained within the scope of the excercise. Previous research indicating that non-integrated QoL assessment may give paradoxical results was also supported.

Background: Actinomycosis represents a challenging and under-reported complication of vascular surgery. Optimal management of Actinomyces spp. prosthetic vascular graft infection (PVGI) is highly uncertain because of the paucity of reports on this disease. Methods: We conducted a retrospective case-series of Actinomyces-PVGI that occurred in the last five years in two major university hospitals in northern Italy. We searched for previously published cases in the scientific literature. Results: We report five original cases of Actinomyces spp. prosthetic vascular graft infection following aortic aneurysm repair. Our literature review retrieved eight similar cases. Most patients were immunocompetent males. Most infections were polymicrobial (11/13 cases), with a prevalence of A. odontolyticus involvement (3/13 cases were associated with. Salmonella spp. infection). All cases had a late presentation (≥4 months from graft placement), with 61% associated with an aorto-enteric fistula. All patients received antibiotic therapy, but the duration was highly heterogeneous (from two weeks to life-long antibiotics). The patients without surgical revision experienced septic recurrences (2/13), permanent dysfunction (1/13), or a fatal outcome (2/13), while of the remainder who underwent vascular graft explant, six recovered completely and one developed a periprosthetic abscess. In two cases follow-up was not available. Conclusions: This case-series aims to raise the diagnostic suspicion and to describe the current management of Actinomyces-PVGIs. We highlight a high heterogeneity in antibiotic duration, choice of the antibiotic regimen, and surgical management. Higher reporting rate is advisable to produce better evidence and optimize management of this rare complication of vascular surgery. [ABSTRACT FROM AUTHOR]

Livestock manure management, especially related to soil-fertilisation practice, is responsible for most of the emissions in agriculture, and in particular the ammonia emissions (NH3), which play a key role in environmental problems, affecting water, soil and air quality. Within the digital agricultural framework, EO data contribute to agricultural-practices monitoring such as manure spreading, to mitigate pollutant emissions. This study presents a GIS-based tool on an open-source platform, developed for susceptibility estimation of sewage spreading occurrence in agricultural areas of Italy. The tool is based on the analysis of multispectral and hyperspectral satellite time series in synergy with field data and ancillary information collected from regional repositories, to produce a series of classified and prioritised spatially explicit information. Spectral analysis of satellite acquisitions enabled the identification of manure spreading with the precision of about 83%. Field campaigns from October to March were carried out to validate the spreading event. The case study demonstrates the ability of the proposed GIS-based tool in supporting the monitoring of manure spreading. [ABSTRACT FROM AUTHOR]

SPAID (Psychiatric Instrument for the Intellectually Disabled Adult) is the first Italian tool-package for carrying out psychiatric diagnosis in adults with Intellectual Disabilities (ID). It includes the "G" form, for general diagnostic orientation, and specific checklists for all groups of syndromes stated by the available classification systems. SPAID was established to provide an easy and quick tool for daily practice of the personnel working with ID. The present study was aimed at evaluating psychometric and psychodiagnostic characteristics of the SPAID-G and at supplying new data on the prevalence rate of psychiatric disorders in a multicentric Italian sample of people with ID living in different settings. The SPAID-G was randomly applied to 304 participants with ID attending residential facilities or assessment services across Italy. A part of the sample was also consecutively assessed through the use of DASH, PDD-MRS and by the clinical application of the DSM-IV TR criteria. The correlation between SPAID-G scores and those provided by other evaluation tools was over 60%. Additionally, the internal consistency and inter-rater reliability resulted to be good. Psychopathological symptoms were detected in approximately 40% of the sample. Respectively, autistic spectrum disorders, impulse control disorders, mood disorders, and dramatic personality disorders were the diagnostic orientations providing the most prevalent over-threshold scores. SPAID-G seems to be a valid diagnostic tool, quick and easy to use in psychiatric disorders assessment within the Italian population with ID. (Contains 2 tables and 1 figure.)

Background: There is substantial literature investigating quality of life (QoL) of individuals with intellectual disability (ID). QoL of families of people with ID is emerging as an important field of research. Despite this, there is a lack of studies regarding their relationship. Aim: The present paper aimed to study the relationship between QoL scores of individuals with ID and members of their families. Methods: Twenty-seven parents or relatives of 27 adults with ID were recruited by four different research centres across Tuscany (Italy) to be interviewed through the Italian adaptation of the "Family Quality of Life Survey-2006" ("FQoLS-2006"), a tool developed for use in a multiple-country study on family QoL. The "FQoLS-2006" was translated and adapted to Italian through three revisions. The last was submitted to the authors of the original version, who also maintain an electronic data file and data archive for statistical evaluations in various countries. QoL of persons with ID was assessed through the administration of the "Quality of Life-Instrument Package". QoL scores were analysed to describe population characteristics and to examine the relationships among measures of individual and family QoL using correlations (Pearson and Spearman). Results: Findings showed that family ratings of QoL were generally low. Families interviewed reported a low level of QoL in "Support from Others" and "Community Interaction", while "Family Relationships" and "Health of the Family" rated higher. For individual QoL, individuals had the lowest scores in the area of "Spiritual being" and higher scores in the area of "Physical being". Correlations examining possible relationships among Importance, Satisfaction and Opportunities found some statistically significant correlation coefficients between some aspects of the three main areas of individual QoL (Being, Belonging and Becoming) and the nine family domains. Most of these correlations regarded family "Financial Well-Being", "Family Relationships", "Support from Service" and "Support from Others" areas. Conclusions: The results of this study suggest that QoL is perceived somewhat differently by individuals with ID and by members of their families. This difference could negatively impact QoL of people with ID, if their views are not taken into account when planning for family support. The relationships between individual and family QoL appear to be quite complex, and such complexity needs to be clarified in future research.

This study compared mother-infant interaction and childrearing patterns across Romanian families in Romania, first-generation Romanian immigrant families in Italy, and Italian families. The relations between acculturation and maternal beliefs and behaviors were also examined. Ninety-five mothers and their infants aged between 0 and 12 months participated. Mothers were videotaped interacting with their infants during free play, and were interviewed about their childrearing beliefs and practices. Results showed that Romanian mothers placed more emphasis on values and behaviors related to interdependence/sociocentrism, whereas Italian mothers more highly valued socialization goals and interactive behaviors consonant with an individualistic/independent orientation. The migrant mothers more closely resembled Italian mothers in the importance attributed to stimulating children's cognitive competence, autonomy, and self-fulfillment, but no homogeneous pattern for maternal behaviors was found. Maternal beliefs and behaviors were not related in either group. While the migrant mothers were significantly more oriented towards participating in the host culture than towards maintaining their own heritage culture, no association between acculturation attitudes, maternal beliefs and behaviors emerged.

Intellectual Disability (ID) shows a high comorbidity with psychiatric disorders with a great variability in the prevalence rates. An important subgroup is represented by subjects with ID and autism or other autistic spectrum disorders (PDD). The purpose of the present study was to assess PDD with specific screening tools in a population of people with ID and compare the groups with or without PDD through the administration of a psychopathological scale in order to verify the differences of psychiatric disorders' rates. The study was conducted on 90 subjects attending daily centres or residential centres in Florence, Italy. In order to assess the presence of PDD, the PDD-MRS was administrated, while for the assessment of the psychopathological aspects we have used the DASH-II. The presence of a psychiatric disorder has a significant effect on anxiety, depression and organic syndromes and statistically significant differences have been registered in many DASH-II subscales. The statistical comparison between the two groups shows that PDD was clearly correlated with an increased presence of psychiatric disorders. The variable PDD could be considered as a vulnerability factor for psychiatric disorders. However there was still the need to focus on categorical diagnoses, in order to increase our knowledge about the concept of vulnerability in people with ID.

Background: Klebsiella pneumoniae is a common species in the gut of mammals and is widely distributed in the environment. However, the environmental source of hvKp that precedes gut colonization is unclear, but once that it reaches the gut there is a possible generalized spread y fecal-oral transmission especially in endemic areas. Liver abscess might develop when the bacteria, using its virulence factors, cross the intestinal barrier and invade the liver by the portal circulation. This syndrome, prevalent mostly in Asian countries, is increasingly reported in Western Countries and leaves open questions about the source of infection. Case: Here we describe for the first time in Italy, a case of pyogenic liver abscess caused by a hypervirulent Klebsiella pneumoniae (HvKp) complicated by endophthalmitis and other metastatic infections in lung and prostate in an immunocompetent Chinese healthy individual with no recent travel in Asia. Conclusion: This case underlines the need for increased awareness of hypervirulent K. pneumoniae, even in settings where it occurs infrequently and where there are not evident epidemiological links. [ABSTRACT FROM AUTHOR]

The incidence of psychopathology was studied in 176 Italian adults with mental retardation. Prevalence of answers relating to anxiety, tendency to live apart, and body complaints in individuals with mild mental retardation was documented. For people with severe intellectual impairments, mood disturbance with inconsistent behaviors was more prevalent. (Author/CR)

Background: ARDS in patients with coronavirus disease 2019 (COVID-19) is characterized by microcirculatory alterations in the pulmonary vascular bed, which could increase dead-space ventilation more than in non-COVID-19 ARDS. We aimed to establish if dead-space ventilation is different in patients with COVID-19 ARDS when compared with patients with non-COVID-19 ARDS. Methods: A total of 187 subjects with COVID-19 ARDS and 178 subjects with non-COVID-19 ARDS who were undergoing invasive mechanical ventilation were included in the study. The association between the ARDS types and dead-space ventilation, compliance of the respiratory system, subjects' characteristics, organ failures, and mechanical ventilation was evaluated by using data collected in the first 24 h of mechanical ventilation. Results: Corrected minute ventilation (VE), a dead-space ventilation surrogate, was higher in the subjects with COVID-19 ARDS versus in those with non-COVID-19 ARDS (median [interquartile range] 12.6 [10.2-15.8] L/min vs 9.4 [7.5-11.6] L/min; P < .001). Increased corrected VE was independently associated with COVID-19 ARDS (odds ratio 1.24, 95% CI 1.07-1.47; P = .007). The best compliance of the respiratory system, obtained after testing different PEEPs, was similar between the subjects with COVID-19 ARDS and the subjects with non-COVID-19 ARDS (mean ± SD 38 ± 11 mL/cm H2O vs 37 ± 11 mL/cm H2O, respectively; P = .61). The subjects with COVID-19 ARDS received higher median (interquartile range) PEEP (12 [10-14] cm H2O vs 8 [5-9] cm H2O; P < .001) and lower median (interquartile range) tidal volume (5.8 [5.5-6.3] mL/kg vs 6.6 [6.1-7.3] mL/kg; P < .001) than the subjects with non-COVID-19 ARDS, being these differences maintained at multivariable analysis. In the multivariable analysis, the subjects with COVID-19 ARDS showed a lower risk of anamnestic arterial hypertension (odds ratio 0.18, 95% CI 0.07-0.45; P < .001) and lower neurologic sequential organ failure assessment score (odds ratio 0.16, 95% CI 0.09-0.27; P < .001) than the subjects with non-COVID-19 ARDS. Conclusions: Indirect measurements of dead space were higher in subjects with COVID-19 ARDS compared with subjects with non-COVID-19 ARDS. The best compliance of the respiratory system was similar in both ARDS forms provided that different PEEPs were applied. A wide range of compliance is present in every ARDS type; therefore, the setting of mechanical ventilation should be individualized patient by patient and not based on the etiology of ARDS. [ABSTRACT FROM AUTHOR]

Purpose: Persons with intellectual disability and/or low-functioning autism spectrum didorder are with high support need (ID/ASD-HSN) are among the people who are most vulnerable to the COVID-19 pandemic. The specific vulnerability and the protective factors for persons with ID/LF-ASD attending residential and rehabilitative facilities have however received little attention. This paper aims to describe how two facilities located in the Italian COVID-19 red zone faced the risks associated with the spread of the pandemic and the results they have achieved so far. Design/methodology/approach: Interventions to contrast the spread of the pandemic and preserve clients' health conditions have been systematically monitored and recorded since the very beginning of the pandemic. Findings: 26/138 clients had to undergo clinical screening and laboratory tests for COVID-like symptomatology, but only one resulted affected by COVID-19 and survived. Considering that Lombardy had 89,595 cases and 16,262 deaths (January–May 2020), one COVID-19 case/138 clients is a good result. Temporarily limiting physical contacts with friends/family in favor of reducing the burden of risk and adopting a system of prevention/safety strategies directed for persons with ID/LF-ASD attending and their caregivers have been useful measures. Research limitations/implications: Structured or semi-structured interviews (using professional caregivers as informant) to confirm behavioral and emotional changes in the clients could not be carried out because of lack of time and resources (which were captured by the management of the pandemic) and could be the next goal for our residential facilities to implement the management of epidemic acute phases in a research-oriented view. Originality/value: This study is a service evaluation report about facing COVID-19 pandemic. Only few such studies are present in medical literature about ID/ASD. [ABSTRACT FROM AUTHOR]

BACKGROUND: The ratio of dead space to tidal volume (VD/VT) is associated with mortality in patients with ARDS. Corrected minute ventilation (...) is a simple surrogate of dead space, but, despite its increasing use, its association with mortality has not been proven. The aim of our study was to assess the association between ... and hospital mortality. We also compared the strength of this association with that of estimated VD/VT and ventilatory ratio. METHODS: We performed a retrospective study with prospectively collected data. We evaluated 187 consecutive mechanically ventilated subjects with ARDS caused by novel coronavirus disease (COVID-19). The association between ... and hospital mortality was assessed in multivariable logistic models. The same was done for estimated VD/VT and ventilatory ratio. RESULTS: Mean 6 SD ... was 11.8 6 3.3 L/min in survivors and 14.5 6 3.9 L/min in nonsurvivors (P < .001) and was independently associated with mortality (adjusted odds ratio 1.15, P 5 .01). The strength of association of ... with mortality was similar to that of VD/VT and ventilatory ratio. CONCLUSIONS: ... was independently associated with hospital mortality in subjects with ARDS caused by COVID-19. ... could be used at the patient's bedside for outcome prediction and severity stratification, due to the simplicity of its calculation. These findings need to be confirmed in subjects with ARDS without viral pneumonia and when lung-protective mechanical ventilation is not rigorously applied. [ABSTRACT FROM AUTHOR]

In this study, we show a seven-individual cluster belonging to the SARS-CoV-2 B.1.621 lineage, imported into Italy by travelers from abroad. All sera efficiently neutralized the SARS-CoV-2 B.1.621 isolate (Figure 1C), demonstrating that this VOI is not a concern for vaccine efficacy. (A) Maximum likelihood phylogenetic tree including the seven SARS-CoV-2 B.1.621 lineage whole genomes from Brescia and 3176 whole-genome sequences which are representative of the globally circulating SARS-CoV-2 strains until April 2021 retrieved from GISAID database. [Extracted from the article]

Objective: To evaluate whether the diagnosis of pediatric type 1 diabetes or its acute complications changed during the early phase of the coronavirus disease 2019 (COVID-19) pandemic in Italy.Research Design and Methods: This was a cross-sectional, web-based survey of all Italian pediatric diabetes centers to collect diabetes, diabetic ketoacidosis (DKA), and COVID-19 data in patients presenting with new-onset or established type 1 diabetes between 20 February and 14 April in 2019 and 2020.Results: Fifty-three of 68 centers (77.9%) responded. There was a 23% reduction in new diabetes cases in 2020 compared with 2019. Among those newly diagnosed patients who presented in a state of DKA, the proportion with severe DKA was 44.3% in 2020 vs. 36.1% in 2019 (P = 0.03). There were no differences in acute complications. Eight patients with asymptomatic or mild COVID-19 had laboratory-confirmed severe acute respiratory syndrome coronavirus 2.Conclusions: The COVID-19 pandemic might have altered diabetes presentation and DKA severity. Preparing for any "second wave" requires strategies to educate and reassure parents about timely emergency department attendance for non-COVID-19 symptoms. [ABSTRACT FROM AUTHOR]

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BACKGROUND: Properly titrated opiates decrease respiratory rate but do not affect tidal volume or induce respiratory acidosis. OBJECTIVE: To determine whether remifentanil improves breathing pattern or reduces inspiratory effort in patients with acute respiratory failure and tachypnea or rapid shallow breathing. METHODS: We studied 14 patients who developed tachypnea and/or rapid shallow breathing if the pressure support level was reduced. During pressure support ventilation, each patient received 30-min infusions, separated by 30 min, of remifentanil and placebo. Measurements were obtained before commencing and before stopping each infusion, and after 3 min of unassisted breathing. The main outcomes were rapid shallow breathing index and change in pressure-time product. RESULTS: Remifentanil did not significantly affect tidal volume. During pressure support ventilation, remifentanil infusion reduced respiratory rate, pressure-time product, and cardiovascular double product (heart rate × systolic arterial pressure) without modifying the sedation score. Mean PaCO2 showed a small and clinically negligible increase during remifentanil, but PaCO2 increased more in the hypercapnic patients than in the normocapnic patients. Remifentanil reduced the rapid shallow breathing index after 3 min of unassisted breathing. CONCLUSIONS: Remifentanil improved respiratory pattern and decreased inspiratory muscles effort in patients with tachypnea or rapid shallow breathing, but did not affect oxygenation or sedation. Though the acid-base balance did not show clinically relevant changes on average, we cannot exclude the possibility that remifentanil might prolong weaning in hypercapnic patients. [ABSTRACT FROM AUTHOR]

Aggressive behaviour represents a frequent symptom in people with intellectual disability (PWID). Despite uncertain evidence of effectiveness, the use of antipsychotics (APs) drugs to treat aggressive behaviour is very common. Antipsychotic medication of aggressivity in PWID has recently become one of the most debated issues in mental health and the need of further research is persistently stressed by most researchers. The present study was firstly aimed at evaluating the effectiveness (efficacy on target behaviour, safety and persistence on treatment) of new generation APs, in particular, olanzapine and risperidone in treating aggressive behaviour in PWID for who previous medication with first generation APs (FGAs) were not effective. 62 subjects with intellectual disability underwent to a 2-arm, parallel group pragmatic trial of olanzapine and risperidone with balanced randomisation and blind assessment of outcome at 4, 8, 12, 16, 20 and 24 weeks after a switch (cross-tapering) from a 24-week treatment with FGAs. Aggressive behaviours were assessed by Overt Aggression Scale (OAS) and clinical outcome by Clinical Global Impression Scale. Side effects were assessed with Dosage Record and Treatment Emergent Symptoms Scale, other symptom-specific scales, laboratory and instrumental tests. Both risperidone and olanzapine resulted to be more effective than FGAs in reducing aggressive behaviour. Repeated-measures analysis of covariance revealed that treatment groups differed for cumulative number of aggressive episodes during the FGAs treatment, which was higher for olanzapine. Our findings seem to confirm that olanzapine and risperidone can be effective in reducing aggressive behaviour in PWID. Both compounds resulted to be well tolerated, with side effects similar to those encountered in other patient populations. [ABSTRACT FROM AUTHOR]

Background: Vitiligo is a depigmentation disorder resulting from destruction of cutaneous melanocytes that affects 0.1-2% of the world's population, irrespective of sex and race. Objective: To investigate the clinical and immunopathologic characteristics of a series of Italian vitiligo patients. Methods: We examined clinical and immunopathologic data of 204 patients affected by vitiligo at a university-based dermatology outpatient hospital (second clinic) between January 1998 and March 2008. In particular, the clinical-epidemiologic characteristics of our patients, serologic parameters suggestive of immune/autoimmune activity (autoantibodies, immune complexes, complement, immunoglobulins), and the association between vitiligo and HLAs were investigated. Results: Upon comparison of our results with control and literature values, the following aspects appeared to be in complete agreement: the frequency of clinical subtypes of vitiligo, an earlier onset of segmental compared with non-segmental vitiligo, the association of familial vitiligo with other autoimmune diseases, the greater association of non-segmental vitiligo than segmental vitiligo with autoimmune diseases, and some features of pediatric vitiligo. Other data were partially consistent with the literature, such as the association between vitiligo and autoimmune diseases/autoantibody activities, and the association between vitiligo and HLAs. Finally, a portion of our data did not concur with the literature, including the sex distribution and mean age of onset, the lack of association between halo nevi and autoimmune diseases, and some aspects of pediatric vitiligo. Conclusions: This study provides novel information regarding clinical features and serologic parameters in different subgroups of vitiligo, namely a significant association between active vitiligo and autoantibody activities, and significant clinical differences (i.e. activity of disease, age of onset, and coexistence of other autoimmune diseases) between vitiligo associated with autoantibodies and vitiligo negative for autoantibodies. [ABSTRACT FROM AUTHOR]

The article discusses Libertine writers and societies in Italy in the 16th and 17th centuries. Topics discussed include the friendship between writer Pietro Aretino and aristocrat Lorenzo Venier, as well as Aretino's writing, the Infiammati academy in Padua, and the writings of priest Antonio Rocco, "Alcibiade fanciullo a scuola."

Wolf–ungulate interactions were studied in a mountainous region of the western Alps (Italy) from December 1999 to November 2002. Analysis of 848 scats of wolves Canis lupus showed that their most important prey was wild ungulates (87.2%). Cervids were the preferred prey (74.2%) and constituted predominant food items both in winter (84.2%) and summer (54.3%). Wolves preyed most intensively upon young ungulates. Presence of domestic ungulates on high-altitude pastures during summer (May–October) influenced wolf diet (summer 19.0%, winter 0.3%), but, despite the major density of domestic livestock, wolves still preferred wild ungulates. A strong trophic relationship between wolves and red deer Cervus elaphus emerged from the present study. During three winters, 177 ungulate carcasses were recorded. Excluding hunting, the most important cause of death in red deer was predation by wolves (51.5%), followed by disease and starvation (36.4%) and traffic accidents (12.1%). The majority of red deer killed were hinds (58.8%) and calves (29.4%); stag kills represented only 11.8%. For roe deer Capreolus capreolus, starvation and diseases were the lowest factor (11.5%), slightly higher than wolf predation (10.8%), while traffic accidents were the main cause of mortality (77.7%). Chamois Rupicapra rupicapra seemed to be less important than red deer and roe deer in the diet of wolves. The high susceptibility of red deer to wolf predation could be a result of the strong overlap of habitat and altitude use with the wolf, and to their more conspicuous herding. [ABSTRACT FROM AUTHOR]

Genotype screening was implemented in Italy and showed a significant prevalence of new SARS-CoV-2 mutants carrying Q675H mutation, near the furin cleavage site of spike protein. Currently, this mutation, which is expressed on different SARS-CoV-2 lineages circulating worldwide, has not been thoughtfully investigated. Therefore, we performed phylogenetic and biocomputational analysis to better understand SARS-CoV-2 Q675H mutants' evolutionary relationships with other circulating lineages and Q675H function in its molecular context. Our studies reveal that Q675H spike mutation is the result of parallel evolution because it arose independently in separate evolutionary clades. In silico data show that the Q675H mutation gives rise to a hydrogen-bonds network in the spike polar region. This results in an optimized directionality of arginine residues involved in interaction of spike with the furin binding pocket, thus improving proteolytic exposure of the viral protein. Furin was predicted to have a greater affinity for Q675H than Q675 substrate conformations. As a consequence, Q675H mutation could confer a fitness advantage to SARS-CoV-2 by promoting a more efficient viral entry. Interestingly, here we have shown that Q675H spike mutation is documented in all the VOCs. This finding highlights that VOCs are still evolving to enhance viral fitness and to adapt to the human host. At the same time, it may suggest Q675H spike mutation involvement in SARS-CoV-2 evolution. [ABSTRACT FROM AUTHOR]

• In Italy, recent regulation has updated the post-mortem body disposition. • Body donation is admitted for study, training and scientific research purposes. • Unsolved issues concern the grantees of teaching and training activities. • The Italian College of Anatomists has made constructive criticisms to the law. • Suggestions are provided to manage the donation process and use of the body. In Italy, recent legislation (Law No. 10/2020) has tuned regulations concerning the donation of one's postmortem body and tissues for study, training, and scientific research purposes. This study discusses several specific issues to optimise the applicability and effectiveness of such an important, novel regulatory setting. Critical issues arise concerning the learners, the type of training and teaching activities that can be planned, the position of academic anatomy institutes, the role of family members in the donation process, the time frame of the donation process, the eligibility of partial donation, or the simultaneous donation of organs and tissues to patients awaiting transplantation. In particular, a universal time limit for donations (i.e., one year) makes it impossible to plan the long-term use of specific body parts, which could be effectively preserved for the advanced teaching and training of medical students and surgeons. The abovementioned conditions lead to the limited use of corpses, thus resulting in the inefficiency of the whole system of body donation. Overall, the donors' scope for the donation of their body could be best honoured by a more flexible and tuneable approach that can be used on a case-by-case basis. Furthermore, it is deemed necessary to closely monitor the events scheduled for corpses in public nonacademic institutions or private enterprises. This paper presents useful insights from Italian anatomists with the hope of providing inspiration for drafting the regulations. In conclusion, this paper focuses on the critical issues derived from the recently introduced Italian law on the donation and use of the body after death and provides suggestions to lawmakers for future implementations. [ABSTRACT FROM AUTHOR]

Introduction: COVID-19 pandemic and lockdown greatly impact on mental health, especially on individuals with pre-existing psychiatric conditions. Objectives: To explore the prevalence of specific psychiatric symptoms across a sample of patients with Eating Disorder (ED), compared to a group of healthy controls (HC), during the lockdown period in Italy, and to assess whether patients' symptoms improved, persisted or worsened with the easing of the lockdown measures. Methods: Study 1: 59 ED patients and 43 HC were recruited and completed, at the beginning of May 2020(t0), an online survey including: the Depression, Anxiety and Stress Scale - 21 items (DASS-21), the Impact of Event Scale-Revised (IES-R), the Perceived Stress Scale (PSS), and few ad-hoc questions extracted from the Eating Disorder Examination Questionnaire (EDE-Q). Study 2: 40 ED patients from Study 1 completed the same survey two months after t0 (t1). Results: Study 1: ED patients scored significantly higher thanHCat the DASS-21 (Total Score and subscales), the IES-R (Total Score and subscales) and the PSS. Moreover, they showed higher distress specifically related to food and their body. Study 2: at t1, levels of stress, anxiety and depression were not different than at t0, but symptoms related to post-traumatic stress disorder (PTSD) improved, together with patients' reported level of psychological wellbeing and specific ED symptomatology. Conclusions: During lockdown, ED patients presented significantly higher levels of stress, anxiety, depression, PTSD-related symptoms, and ED-related symptoms than HC. With the easing of lockdown, PTSD-related and ED-related symptoms ameliorated, but high levels of stress, anxiety and depression persisted. [ABSTRACT FROM AUTHOR]

Background: Bardet–Biedl syndrome (BBS) is a rare inherited multisystemic disorder with autosomal recessive or complex digenic triallelic inheritance. There is currently no treatment for BBS, but some morbidities can be managed. Accurate molecular diagnosis is often crucial for the definition of appropriate patient management and for the development of a potential personalized therapy. Methods: We developed a next-generation-sequencing (NGS) protocol for the screening of the 18 most frequently mutated genes to define the genotype and clarify the mutation spectrum of a cohort of 20 BBS Italian patients. Results: We defined the causative variants in 60% of patients; four of those are novel. 33% of patients also harboured variants in additional gene/s, suggesting possible oligogenic inheritance. To explore the function of different genes, we looked for correlations between genotype and phenotype in our cohort. Hypogonadism was more frequently detected in patients with variants in BBSome proteins, while renal abnormalities in patients with variations in BBSome chaperonin genes. Conclusions: NGS is a powerful tool that can help understanding BBS patients' phenotype through the identification of mutations that could explain differences in phenotype severity and could provide insights for the development of targeted therapy. Furthermore, our results support the existence of additional BBS loci yet to be identified. [ABSTRACT FROM AUTHOR]

Abstract: Background: We retrospectively reviewed our experience in combined liver–kidney (L-KT) and heart–kidney (H-KT) transplantations. Patients and Methods: Between January 1997 and April 2007, we performed 25 L-KT and 5 H-KT. Patient mean age was 51 ± 8 years in L-KT and 43 ± 11 years in H-KT. The main cause of liver failure was chronic viral hepatitis (14 cases). Etiology of heart failure was dilated cardiomyopathy and hypertrophic cardiomyopathy (4 and 1 patients, respectively). The main causes of renal failure in L-KT were chronic glomerulonephritis (n = 8) and polycystic disease (n = 7). Etiology of renal failure in H-KT was interstitial nephropathy (n = 2), vascular nephropathy (n = 2), and chronic glomerulonephritis (n = 1). Results: Mean follow-up was 32 ± 26 months in L-KT and 24 ± 17 months in H-KT. Immunosuppression was cyclosporine-based (n = 4) or tacrolimus-based (n = 21) in L-KT and cyclosporine-based in H-KT. Acute rejection rate was 8% for both liver and kidney in L-KT; 80% (mild) for heart and 40% for kidney in H-KT. In the L-KT group, there was no primary graft nonfunction (PGNF). Two patients experienced liver delayed graft function (DGF); 1 patient required postoperative dialysis. One-year graft and patient survivals were both 84% and overall graft and patient survival was 76%. In the H-KT group, 3 patients needed postoperative dialysis and 1 required a cardiac assistance device for 48 hours; overall graft and patient survival was 100% with good cardiac and renal functions. Conclusion: Our experience confirmed that H-KT and L-KT are safe procedures, offering good long-term results. [Copyright &y& Elsevier]

[Display omitted] • 51 polyphenols were identified by UHPLC-HRMS in M. alba fruits from 13 cvs. • PCA suggested how polyphenols are synthesized during ripening. • 1-DNJ and anthocyanins were quantified for the first time on M. alba Italian cvs. • Fruits revealed different antioxidant and α-glucosidase inhibition activity. • Supervised models indicated which compounds are involved in biological activities. Morus alba L. fruits are considered functional foods with an important nutritional value for their high content of polyphenols. Therefore, the type and level of phytochemicals of the soroses from 13 M. alba cultivars grown in Italy were characterized due to the lack of data available about their nutraceutical properties. Mature M. alba fruits exhibited variable polyphenol, flavonoid, anthocyanin, proanthocyanins, and 1-deoxynojirimycin contents which resulted in different antioxidant and α-glucosidase inhibitory activities. Regression models built on UHPLC-HRMS results revealed a strong correlation between the expression of quercetin derivatives, cyanidin 3- O -glucoside, caffeoyl methyl quinates, and 5,5′-dehydrodivanillic acid, and the biological activity of each fruit. On another note, principal component analysis revealed that the quantity of caffeoyl/dicaffeoyl methyl quinate, caffeoylquinic acids, and quercetin derivatives decreased during ripening. The results on the compositional and functional characterization of mature M. alba fruits might improve their consumption and economic value in Italy. [ABSTRACT FROM AUTHOR]

Introduction Although several new measurements for female sexual dysfunction ( FSD) have recently been developed, the Female Sexual Function Index ( FSFI) remains the gold standard for screening and one of the most widely used questionnaires. The Italian translation of the FSFI has been used in several studies conducted in Italy, but a linguistic validation of the Italian version does not exist. Aim The aim of this study was to perform a linguistic validation of the Italian version of the FSFI. Methods A multicenter cross-sectional study conducted in 14 urological and gynecological clinics, uniformly distributed over Italian territory. We performed all steps necessary to determine the reliability and the test-retest reliability of the Italian version of the FSFI. The study population was a convenience sample of 409 Italian women. Main Outcome Measures The reliability of the questionnaire was calculated using Cronbach's alpha, which was considered weak, moderate, or high if its value was found less than 0.6, between 0.6 and 0.8, or equal to or greater than 0.8, respectively. The test-retest reliability was assessed for all women in the sample by calculating Pearson's concordance correlation coefficient for each domain and for the total score, both at baseline and after 15 days (r range between −1.00 to +1.00, where +1.00 indicates the strongest positive association). Results Cronbach's alpha coefficents for total and domain score were sufficiently high, ranging from 0.92 to 0.97 for the total sample. The test-retest procedure revealed that the concordance correlation coefficient was very high both for FSFI- I total score ( Pearson's P = 0.93) and for each domain ( Pearson's P always >0.92). Conclusion For the first time in the literature, our study has produced a validated and reliable Italian version of the FSFI questionnaire. Consequently, the Italian FSFI can be used as a reliable tool for preliminary screening for female sexual dysfunction for Italian women. Filocamo MT, Serati M, Li Marzi V, Costantini E, Milanesi M, Pietropaolo A, Polledro P, Gentile B, Maruccia S, Fornia S, Lauri I, Alei R, Arcangeli P, Sighinolfi MC, Manassero F, Andretta E, Palazzetti A, Bertelli E, Del Popolo G, and Villari D. The Female Sexual Function Index (FSFI): Linguistic validation of the Italian version. J Sex Med 2014;11:447-453. [ABSTRACT FROM AUTHOR]

Abstract: In the three-year period 2010–2012, 80 public swimming facilities in the metropolitan area of Bologna (Emilia Romagna Region, Italy), including 144 pools (69 indoor, 75 outdoor), were monitored to assess the microbiological and chemical water quality, after about ten years of implementing the new Italian guidance which introduced the principles of internal safety plans in the surveillance of swimming pools. According to the Italian guidance, water samples were collected from supply water (370 samples), pool water (645), and recirculating water entering the pool (307). The samples of supply water always conformed to the microbiological limits for drinking water. The pool water did not conform to the Italian legal requirements in around 16% of indoor pools and 25% of outdoor pools. In 65% of non-compliant samples, only one parameter exceeded the required standards. The microorganisms of faecal origin were isolated very rarely (Enterococci in less than 2% of samples) and pH and residual chlorine showed good compliance in pool water, implying an efficient management of the internal control. The inlet water exceeded the required standards in about 36% and 50% of samples, respectively in indoor and outdoor pools. However, 83.6% of the corresponding samples of pool water met the required limits. The microbiological incongruities were prevalently due to high levels of total heterotrophic counts (THCs) and Pseudomonas aeruginosa, and were indicative of bacterial colonization of the filters. The sampling of inlet water can thus be indicated as a critical control point for checking the correct functioning of the filters. The non-conformity of samples led to pool closure only in 1.5% of cases. In the other cases, the operators were officially invited to perform the corrective measures previously established in the plan of risk assessment. On the whole, the approach based on internal safety plans produced satisfactory results in terms of pool water quality, demonstrating the effective working of the internal system of analysis and management of risks. [Copyright &y& Elsevier]

Background: Currently available guidelines suggest that hypolipidemic drugs should be used in subjects at high risk for coronary heart disease (CHD). Very often, however, physicians fail to comply with the targets (total or LDL cholesterol) that are proposed by the Consensus Panels. The aim of this survey was to evaluate the efficacy of a hypocholesterolemic treatment in achieving the therapeutic target according to Adult Treatment Panel II guidelines in a sample of general practitioners from Lombardy, a region of northern Italy., Methods: Eighty-five general practitioners reported in a standardized manner data on the presence of major and minor coronary risk factors from at least 15 patients from their database for a total of 1275 patients. Treatment targets for LDL cholesterol were 100 mg/dl in patients with existing cardiovascular disease (class I), 130 mg/dl for patients with > or = 2 CHD risk factors (class II), and 160 mg/dl for the others (class III). Results on the efficacy of the therapy were divided into the following categories: 1) to target, 2) failure to reach the target by < or = 30 mg/dl, 3) failure to reach the target by > 30 mg/dl. Data were analyzed by means of the CSS statistical software., Results: Overall 58.2% of the patients were males and the average age of the population was 59.2 +/- 10.1 years; 20.4% were diabetics, 34.5% smokers, 48.8% hypertensives, 16.9% had a previous myocardial infarction, 14.9% were suffering of stable angina, and 8.1% had undergone coronary artery bypass grafting and/or coronary angioplasty. Moreover 33.9% had a positive family history for CHD. Class I patients were 31.7% of the population, class II 52.9%, and class III 15.4%. Plasma lipid levels before treatment were on average 294 +/- 37 mg/dl for total cholesterol, 211 +/- 37 mg/dl for LDL cholesterol, 45 +/- 16 mg/dl for HDL cholesterol, and 195 +/- 104 mg/dl for plasma triglycerides. Of the patients 78.8% received dietary counseling, while 94.7% received hypolipidemic treatment (89.9% were only on statins). The average post-treatment value for total cholesterol was 225 +/- 33 mg/dl (-23%), LDL cholesterol 145 +/- 34 mg/dl (-31%), HDL cholesterol 50 +/- 15 (+15%), and plasma triglycerides 151 +/- 55 (-17%). When patients were stratified according to their LDL cholesterol target, 29.9% were on target, 34.0% missed it by < or = 30 mg/dl, and 36.1% by > 30 mg/dl. In class I only 14.9% achieved the target, in class II 31.2%, in class III 61.8%., Conclusions: These data show that general practitioners do not aim at an aggressive lipid lowering in patients at high risk, perhaps because of the limited knowledge of the need for modulating treatment according to the global CHD risk.

This paper reports on the results of a survey conducted on the organization of bone marrow transplant (BMT) centers in Italy, with particular attention to the measures routinely adopted for the prevention of infectious complications in BMT patients. In 1997, a questionnaire containing 53 questions with multiple-answers and 15 with single-answer was sent to the 65 Italian BMT centers. The topics addressed in the questionnaire were the following: general structural organization of the BMT center; personnel organization; type of transplants (autologous, allogenic, both); type of protective environment; hygiene measures and food; management of central venous catheters; microbiological surveillance. Fifty questionnaires out of 65 (77%) were available. The analysis of data indicated that most centers (more than 60%) use complex and multiple measures for the prevention of infections. These are mainly represented by careful personal hygiene of the patient, protective isolation of the patient from other patients and relatives; careful washing of personnels' hands before entering patients room; extensive microbiological surveillance. Furthermore, 52% of BMT centers adopt additional measures, such as filtered air, while 22% of centers, on the contrary, lack any air-conditioning apparatus. Overall, the results of the survey indicate that there is a substantial variability in the adoption and evaluation of the impact of such different measures on the incidence of infectious complications after BMT.

The insertion of a central venous catheter (CVC) is a compulsory invasive technique for bone marrow transplant patients. CVC are in fact used for the administration of treatments (chemotherapy, Total Parenteral Nutrition) and patients monitoring (blood samplings). The study reports on the results of a retrospective analysis on 213 CVCs implanted on 203 patients undergoing bone marrow transplantation in the Bone Marrow Transplant Unit (BMT) in Florence, from 1992 to 1996. Sixty-one per cent of implanted catheters were maintained in situ until the completion of the treatments, while 5% patients needed the CVC replacement. The major cause of CVC loss was spontaneous deiscence (7% of all implanted CVCs). The 80% of implanted CVCs had a satisfactory performance; in 14% a local infusion of urokinase was required to re-establish patency and in 6% of patients a peripheral venous line had to be started. Only 2% catheters had to be removed due to an infection.