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Objective heart transplant (HT) patients need to be strictly monitored, especially within the first months after surgery by advanced and sensitive techniques, in order to rule out possible acute or subacute cellular rejection (CR) and hinder poor outcomes. This includes frequently repeated endomyocardial biopsy (EMB) and biomarkers. Echocardiography has emerged as an easily available and powered technique able to detect morphofunctional changes in various clinical settings. More recently, speckle tracking ultrasound and left ventricular (LV) strain have been documented as more accurate tools for detecting early myocardial dysfunction in most cardiac diseases. This study aimed at recognizing whether strain echocardiography can improve early diagnosis of subclinical CR. Methods We studied 32 patients, mean aged 52±4 years, who had undergone heart transplantation over the last 3 years at IRCCS ISMETT-UPMC (Palermo, Italy). They were scheduled for EMBs on a regular basis, and multisite biopsy specimens served to make diagnosis of CR. Conventional and advanced ultrasound measurements were performed on the same day of EMB. LV ejection fraction (LVEF) was assessed by using the Simpson rule biplane method and global longitudinal strain (GLS) by speckle tracking. Diastolic function was achieved by PW-Doppler/TDI sampling, as the E/E’ ratio. Echocardiographic findings were also related to anti-HLA antibodies (HAb). Results Multiple EMBs and ultrasound studies were performed in each patient. Echocardiographic findings from those likely to be healthy (CR- group) or with possible CR (CR+ group) are summarized in Table underneath (numbers are the average values of the various appraisals). Overall, 300 EMBs were negative (score 0-1) and 94 were positive (score 2-3). Global longitudinal strain and E/E’ ratio were significantly impaired in the first group, despite preserved LVEF. Tacrolimus therapeutic levels were similar between the groups, whereas a higher title of HAb was recognized in the CR+ group (13.3% vs 10.8%, p=0.012). Conclusions Cardiac ultrasound was confirmed to be a useful technique for monitoring HT patients over time. In those likely to have CR as by EMB specimens and HAb title, GLS and diastolic indices were significantly impaired irrespective of LVEF, suggesting speckle tracking echocardiography as a choice modality for detecting subclinical LV dysfunction in patients at risk of CR.

Background The number of patients with end stage heart failure (HF) which requires a ventricular assist devices (VADs) implantation is constantly increasing. Gastrointestinal bleeding (GIB) represents one of the most common complications that occur in this patient population. GIB risk assessment could have important implications for candidate selection and postimplant therapeutic strategies. A recent model, called UTAH bleeding risk score (UBRS), was created with the aim of predicting the risk of GIB during LVAD support, but its use does not yet have a worldwide validation. The two most popular bleeding risk (BR) scores available, the ARC-HBR and the HAS-BLED scores, have been validated respectively in the setting of percutaneous coronary intervention and atrial fibrillation but their use in VAD patients is limited. Aims to describe clinical outcome and gastrointestinal bleeding complications of patients underwent LVAD implantation at a single tertiary referral hospital for heart transplant. Furthermore, to explore possible correlation among clinical, echocardiographic, hemodynamic parameters and the development of gastrointestinal bleeding complications has been evaluated. Finally, to evaluate the predictive value of UBRS, ARC-HBR and HAS-BLED scores in this population and to propose possible new parameters capable of predicting the risk of GIB in VAD patients. Methods Between November 2010 and December 2021, 75 consecutive patients with end stage heart failure who underwent LVAD implantation have been enrolled in this monocentric retrospective registry. Univariable and multivariable Cox regression analysis were performed to identify factors independently associated with GI bleeding in the study population. Results Patient's mean age was 57,8 ± 8,8 years. Thirty-six patients (48%) died at mean time of 579 ± 481 days after implant of VAD. The overall patient survival was 66,6% at two years. To the mean follow-up time of 737 ± 593 days, a total of 44 bleeding (incidence of 58,7%) occurred in 30 patients. Nineteen patients (25%) experienced 21 GIB events. Mean time to first GIB was 469 ± 520 days and only one event occurred within 30 days.The patient survival at two years did not differ significantly between patients who experienced GIB and those who did not (58% vs 69,6%; p=0,3). While, considering the total bleedings, overall mortality was significantly higher in patients who developed any bleeding event, than in those who did not bleed (67 vs 35%; p= 0,008).The clinical characteristics of patient with and without gastrointestinal bleeding were similar with regard to age, INTERMACS profile, etiology of heart failure and VAD implant indication.The subgroup analysis demonstrated that low cardiac output (P< 0,001), right ventricular disfunction (P=0,01) and severe mitral regurgitation (P= 0,01) were all associated with increased risk of GIB. In our population, high risk profile UBRS was shown to be related to a higher percentage of GIB, compared to patients with a low risk profile UBRS, in which patients without GIB prevailed (p< 0,001). Instead, ARC-HBR and HAS-BLED scores, didn't prove to be effective in predicting the GIB risk of VAD patient population. Conclusions High gastrointestinal bleeding rates associated with LVAD implantation do not impact negatively with patient survival. Total bleedings are correlated with higher mortality. Reduced cardiac output, right ventricular disfunction and severe mitral regurgitation are independent GIB risk factors. UBRS was able to stratify risk, in order to predict GIB, in the population tested, while ARC-HBR and HAS-BLED did not.

BACKGROUND: The annual incidence of herpes simplex encephalitis (HSE) is 1:250–500 thousand in developed countries, which makes it the most common viral cause of encephalitis. Encephalitis caused by HSV-1 probably accounts for most of the cases in the Herpesviridae family and typically affects older children. CASE REPORT: An atypical presentation of pediatric herpetic encephalitis is reported. The child presented with recurrent seizures that were initially unresponsive to several anticonvulsant drugs. EEG and MRI of the brain were not effective for diagnosis. PCR analysis of the cerebrospinal fluid indicated positivity for HSV DNA and was crucial for the diagnosis as a highly sensitive and specific test. CONCLUSION: Based on the clinical presentation of the child, viral encephalitis was deemed to be the most likely aetiological condition.

Este trabalho apresenta resultados da parceria entre o Parque Nacional de Jericoacoara/ CE e o Centro Nacional de Pesquisa e Conservação da Sociobiodiversidade Associada a Povos e Comunidades Tradicionais para caracterização e manejo do turismo com cavalos-marinhos realizado no Parque desde 2006, com vistas ao ordenamento desta atividade e sua adequação às normativas internas do Instituto Chico Mendes de Conservação da Biodiversidade. No desenvolvimento do trabalho foi realizado o resgate histórico dessa atividade no Parque e oficinas de capacitação dos condutores de visitantes que nela atuam. Dentre os resultados alcançados estão: o diagnóstico da atividade, a capacitação dos condutores e intercâmbio de informações entre diferentes setores envolvidos, verificando-se a necessidade de sua requalificação. Conclui-se que é necessário que o ordenamento do turismo com cavalos-marinhos no Parque continue a ocorrer de forma participativa e pautado nos instrumentos de gestão da unidade, trazendo novas perspectivas para seu desenvolvimento e contribuindo para que ele ocorra de acordo com a sustentabilidade socioambiental. This work presents the results of the partnership between the National Park of Jericoacoara/CE and the National Center for Research and Conservation of Sociobiodiversity Associated with Traditional Peoples and Communities for the characterization and management of tourism with seahorses carried out in the Park since the mid-2000s, with a view to the organization of this activity and its adaptation to the internal regulations of the Chico Mendes Institute for Biodiversity Conservation. During the development of the work, the historical recovery of this activity in the Park was carried out, as well as training workshops for the conductors of visitors who work there. Among the results achieved are: the diagnosis of the activity, training of conductors and exchange of information between different sectors involved, verifying the need for their requalification. It is concluded that it is necessary that the planning of tourism with seahorses in the Park continues to occur in a participatory manner and based on the unit’s management instruments, bringing new perspectives for its development and contributing to its development in accordance with socio-environmental sustainability. Este trabajo presenta los resultados de la alianza entre el Parque Nacional Jericoacoara/ CE y el Centro Nacional de Investigación y Conservación de la Sociobiodiversidad Asociada a Pueblos y Comunidades Tradicionales para la caracterización y manejo del turismo de caballitos de mar realizado en el Parque desde 2006, con miras a organizar esta actividad y adecuarla al reglamento interno del Instituto Chico Mendes para la Conservación de la Biodiversidad. En el desarrollo del trabajo se realizó el rescate histórico de esta actividad en el Parque y talleres de capacitación a los conductores de visitantes que laboran en el mismo. Entre los resultados alcanzados están: diagnóstico de la actividad, capacitación de los conductores e intercambio de información entre los diferentes sectores involucrados, verificando la necesidad de su recualificación. Se concluye que es necesario que la planificación del turismo con caballitos de mar en el Parque continúe ocurriendo de forma participativa y con base en los instrumentos de gestión de la unidad, trayendo nuevas perspectivas para su desarrollo y contribuyendo a su ocurrencia de acuerdo con la sostenibilidad socioambiental.

Pediatric acute-onset neuropsychiatric syndrome (PANS) is a condition characterized by the abrupt, dramatic onset of obsessive&ndash, compulsive disorder (OCD) or eating restriction accompanied by equally abrupt and severe comorbid neuropsychiatric symptoms. PANDAS (pediatric autoimmune neuropsychiatric disorder associated with streptococcal infection) is a heterogeneous syndrome identified as post-Streptococcus pyogenes infection (&beta, hemolytic Streptococcus group A) complications regarding the central nervous system with specific involvement of neuropsychiatric and behavioral skills. In the first part of our study, we share our experience in the treatment of a group of extreme-grade (according to CY-BOCS severity scale) symptomatic patients with intravenous immunoglobulin (IVIG), following the most recent studies regarding the dosage of the drug. Our contribution is to share our experience made on a sample of 55 patients all in the highest level of a severity grade. In the second part of our study, we also analyze the literature on PANS/PANDAS rehabilitation therapy, since in the literature there is no discussion of union and comparison on this method. Objective: This study aims to evaluate the clinical features of the patients observed from different Italian cohorts, with the attempt at evaluating clinical response to IVIG treatment in children with an extreme severity grade of PANS/PANDAS disease. Furthermore, after having analyzed the literature, we propose rehabilitation therapy as an added value to the pharmacological treatment. Materials and Methods: A total of 55 patients with a diagnosis of PANS/PANDAS, who belonged to an extreme grade of disease, were enrolled. All patients were administered with IVIG treatment at 2 g/kg per day for two consecutive days. Results: From our study, a noticeable improvement (until complete remission) of symptoms was evident for at least one year in 47 out of 55 (85%) observed children, while 11 out of these 43 (25%) showed an evident symptoms remission in a single attempt and the remaining 32 (75%) required a second administration to notice a lasting symptomatic improvement.

Cerebral venous thrombosis is an uncommon event of stroke in childhood. Its origin is multifactorial and often it manifests with nonspecific symptoms that may overlap with underlying predisposing factors. Anti–myelin oligodendrocyte glycoprotein (MOG) antibody syndrome is a group of recently recognized acquired demyelinating diseases that occur more commonly in children, usually, with a favorable outcome. The association between cerebral venous thrombosis and demyelinating syndrome has been reported but their clinical relationship is matter of debate and various hypotheses have been advanced including intravenous (IV) steroid therapy and/or the consequence of a shared inflammatory-thrombotic process. Herein, we report the case of a child with anti-MOG antibody syndromes who developed a thrombosis of the superior sagittal sinus and of the right Trolard's vein.

Biogas plants are a widespread renewable energy technology. However, the use of digestate for agronomic purposes has often been a matter of concern. It is controversial whether biogas plants might harbor some pathogenic clostridial species, which represent a biological risk. Moreover, the inhabitance of Clostridium hard-cheese spoiling species in anaerobic digesters can be problematic for hard-cheese manufacturing industries, due to the issue of cheese blowing defects. This study investigated the effect of mesophilic anaerobic digestion processes on the Clostridium consortia distribution over time. Specifically, three lab-scale CSTRs treating agricultural biomass were characterized by considering both the whole microbial community and the cultivable clostridial spores. It is assessed an overall reduction of the Clostridium genus during the anaerobic digestion process. Moreover, it was evidenced a slight, but steady decrease of the cultivable clostridial spores, mainly represented by two pathogenic species, C. perfringens and C. bifermentans, and one hard-cheese spoiling species, C. butyricum. Thus, it is revealed an overall reduction of the clostridial population abundance after the mesophilic anaerobic digestion treatment of agricultural biomass.

Differences in gut microbiota between Parkinson's disease patients and controls seem to depend on multiple-frequently unmeasured-confounders. Monozygotic twins offer a unique model for controlling several factors responsible for interpersonal variation in gut microbiota. Fecal samples from 20 monozygotic twin pairs (n = 40) discordant for Parkinson's disease were studied (metagenomic shotgun analysis). Paired data analysis detected minimal differences in bacterial taxa abundance at species level (Bacteroides pectinophilus [p = 0.037], Bifidobacterium pseudocatenulatum [p = 0.050], and Bifidobacterium catenulatum [p = 0.025]) and in predicted metabolic pathways (primary bile acid biosynthesis [p = 0.037]). Additional studies are warranted to understand the role of gut microbiota in the pathogenesis of Parkinson's disease. ANN NEUROL 2022;92:631-636.

Lactic Acid Bacteria (LAB) could provide a valid alternative to S. cerevisiae as a starter culture for bakery products, avoiding yeast-related health problems while contributing to the technological and functional properties of bread. In this work, we evaluate the role of certain LABs (Leuconostoc citreum SB6, Weissella cibaria UC4051, Weissella confusa UC4051, and the commercial starter cultures Weissella cibaria, and Leuconostoc mesenteroides) in producing functional compounds (pro-technological, health-promoting, and postbiotic-like molecules). For this purpose, we analysed the genotypic and phenotypic features of strains, and we investigated dough fermentation from microbiological and metabolomics approaches. Results evidenced a clear discrimination between the metabolic activity of baker's yeast and LAB. The most discriminant metabolites derived from proteolysis and lipolysis, such as peptides, amino acids, and fatty acyls. Furthermore, we elucidated the different metabolism of these strains by building gene-metabolite interaction networks that pairwise compared the LAB strains of the same genus. While most of the networks showed a characteristic nucleotide metabolism, only the commercial W. cibaria exhibited an interaction network composed of amino acids and their related genes. In conclusion, our findings reveal that LAB strains under investigation, and particularly the commercial W. cibaria, can enhance the functional properties of bread.

Background Natriuretic peptides and diastolic dysfunction have prognostic value in asymptomatic subjects at risk for heart failure. Their integration might further refine the risk stratification process in this setting. Aim of this paper was to explore the possibility to predict heart failure and death combining diastolic dysfunction and natriuretic peptides in an asymptomatic population at risk for heart failure. Methods Among 4047 subjects aged ≥55/≤80 years followed by 10 general practitioners in Italy, the DAVID-Berg study prospectively enrolled 623 asymptomatic outpatients at increased risk for heart failure. Baseline evaluation included electrocardiogram, echocardiogram, and natriuretic peptides collection. Based on diastolic dysfunction and natriuretic peptides, subjects were classified in four groups: control group (no diastolic dysfunction/normal natriuretic peptides, 57%), no diastolic dysfunction/high natriuretic peptides (9%), diastolic dysfunction/normal natriuretic peptides (24%), and diastolic dysfunction/high natriuretic peptides (11%). We applied Cox multivariable and Classification and Regression Tree analyses. Results The mean age of the population was 69 ± 7 years, 44% were women, mean left ventricular ejection fraction was 61%, and 35% had diastolic dysfunction. During a median follow-up of 5.7 years, 95 heart failure/death events occurred. Overall, diastolic dysfunction and natriuretic peptides were predictive of adverse events (respectively, hazard ratio 1.91, confidence interval 1.19–3.05, padjusted = 0.007, and hazard ratio 2.25, confidence interval 1.35–3.74, padjusted = 0.002) with Cox analysis. However, considering the four study subgroups, only the group with diastolic dysfunction/high natriuretic peptides had a significantly worse prognosis compared to the control group (hazard ratio 4.48, confidence interval 2.31–8.70, padjusted Conclusions The DAVID-Berg data suggest that we look for the quite common combination of diastolic dysfunction/high natriuretic peptides to correctly identify asymptomatic subjects at greater risk for incident heart failure/death, thus more suitable for preventive interventions.

Syntaxin binding protein 1 (STXBP1), commonly known as MUNC18–1, is a member of SEC1 family membrane trafficking proteins; their function consists in controlling the soluble N-ethylmaleimide-sensitive factor attachment protein receptors complex assembly, making them essentials regulators of vesicle fusion. The precise function and molecular mechanism through which Munc18–1 contributes to neurotransmitter releasing is not entirely understood, but several evidences suggest its probable role in exocytosis. In 2008, heterozygous de novo mutations in neuronal protein Munc18–1 were first referred as a cause of Ohtahara syndrome development. Currently, a wide examination of the published data proved that 3.1% of patients with severe epilepsy carry a pathogenic de novo mutation including STXBP1 and approximately 10.2% of early onset epileptic encephalopathy is due to an aberrant STXBP1 form codified by the mutated gene. STXBP1 mutations can be associated to a wide clinical heterogeneity. All affected individuals show developmental delay and approximately the 95% of cases have seizures and early onset epileptic encephalopathy, characterized by infantile spasms as the main consistent feature. Burst suppression pattern and hypsarrhythmia are the most frequent EEG anomalies. Other neuronal disorders include Rett syndrome and behavioral and movement disorders. Mild dysmorphic features have been detected in a small number of cases. No genotype–phenotype correlation has been reported. Management of STXBP1 encephalopathy requires a multidisciplinary approach, including epilepsy control and neurological rehabilitation. About 25% of patients are refractory to standard therapy. A single or combined antiepileptic drugs may be required. Several studies described vigabatrin, valproic acid, levetiracetam, topiramate, clobazam, and oxcarbazepine as effective in seizure control. Lamotrigine, zonisamide, and phenobarbital are also commonly used. To date, it remains unclear which therapy is the most effective. Severe morbidity and high mortality are inevitable consequences in some of these patients.

A novel Gram-stain-positive, strictly aerobic, short rod-shaped bacterium, designated 2CT, was isolated from freshly packaged microfiltered milk. This strain was able to grow within the NaCl concentration range of 0–5 % (w/v), temperature range of 8–37 °C (optimally at 30 °C) and at pH 6.0–10.0. Phylogenetic analysis based on 16S rRNA gene sequences revealed that strain 2CT was closely related to species of the genus Microbacterium , with the highest sequence similarity (99.2 %) to Microbacterium lacticum DSM 20427T as well as Microbacterium flavum DSM 18909T (=YM18-098T). The phylogenetic tree based on 16S rRNA genes showed that strain 2CT clustered with M. flavum DSM 18909T. However, the phylogenetic tree based on concatenated 16S rRNA and four housekeeping genes showed that strain 2CT clustered with M. lacticum DSM 20427T. Furthermore, the phylogenomic tree showed that strain 2CT clustered with M. lacticum DSM 20427T and M. flavum DSM 18909T. The major respiratory quinones were MK-10, MK-11 and MK-12. The predominant cellular fatty acids were anteiso-C15 : 0, iso-C16 : 0 and anteiso-C17 : 0. The polar lipid composition of strain 2CT consisted of diphosphatidylglycerol, phosphatidylglycerol, three unidentified glycolipids and two unidentified lipids. The cell-wall peptidoglycan type was a variant of B1α {Gly} [l-Lys] d-Glu-l-Lys, with the amino acids lysine, glycine, alanine and glutamic acid. The whole-cell sugars consisted of galactose, glucose, ribose and minor amounts of rhamnose. In addition, strain 2CT showed a glycolyl-type cell wall. The genomic DNA G+C content was 69.8mol%, while the average nucleotide identity (ANI) and digital DNA-DNA hybridization (dDDH) values with the closely related Microbacterium species were below the recognized thresholds of 95–96 % ANI and 70 % DDH for species definition. Based on the phenotypic and genotypic data, strain 2CT (=LMG 32277T=CECT 30329T) is considered to represent a new species, for which the name Microbacterium paulum sp. nov. is proposed.

Fermentation is one of if not the oldest food processing technique, yet it is still an emerging field when it comes to its numerous mechanisms of action and potential applications. The effect of microbial activity on the taste, bioavailability and preservation of the nutrients and the different food matrices has been deciphered by the insights of molecular microbiology. Among those roles of fermentation in the food chain, biopreservation remains the one most debated. Presumably because it has been underestimated for quite a while, and only considered – based on a food safety and technological approach – from the toxicological and chemical perspective. Biopreservation is not considered as a traditional use, where it has been by design – but forgotten – as the initial goal of fermentation. The ‘modern’ use of biopreservation is also slightly different from the traditional use, due mainly to changes in cooling of food and other ways of preservation, Extending shelf life is considered to be one of the properties of food additives, classifying – from our perspective – biopreservation wrongly and forgetting the role of fermentation and food cultures. The present review will summarize the current approaches of fermentation as a way to preserve and protect the food, considering the different way in which food cultures and this application could help tackle food waste as an additional control measure to ensure the safety of the food., Perspective on the potential of food cultures for the biopreservation of food products and applications to limit food waste.

The phenotypic variety associated to mutations in dynamin 1 (DNM1), codifying the presynaptic protein DNM1 has been increasingly reported, mainly related to encephalopathy with intractable epilepsy; currently, it is known the phenotype related to DNM1 gene mutations is relatively homogeneous with developmental delay, hypotonia, and epilepsy characterized by infantile spasms and possible progression to Lennox-Gastaut syndrome. By examining all the papers published until 2020 (18 articles), we compared data from 30 patients (extrapolated from 5 papers) with DNM1 mutations, identifying 26 patients with de novo mutations in DNM1. Nine patients (33.3%) reported the recurrent mutation p.Arg237Trp. A usual phenotype observed comprises severe to deep developmental delay and muscular hypotonia in all patients with epilepsy beginning with infantile spasms, which often evolved into Lennox-Gastaut syndrome. Data about GTPase or central domains mutations, and existing structural modeling and functional suggest a dominant negative effect on DMN1 function. Generally genetic epilepsies consist of a wide spectrum of clinical features, unlike that, DNM1-related CNS impairment phenotype is quite uniform. In up to one third of patients it has been found variant p.Arg237Trp, which is one of the most frequent variant detected in epileptic encephalopathies. The understanding of DNM1 function opens up the chance that this gene would become a new therapeutic target for epilepsies.

The aim of this work is to find a possible solution to problems related to the selection of the network in heterogeneous scenarios with the demand for several different services at the same time. Currently, reputation-based network selection algorithms do not take into account different types of traffic. SMASH, addresses network selection through a reputation algorithm, network slicing and neural networks and presents a new solution to improve the exploitation of resources by controlling congestion and improving network performance in terms of QoS parameters such as the average throughput, packet loss ratio and packet delay.

Background Little is known about the coronavirus SARS-CoV-2 disease (COVID-19) in solid organ transplanted patients. We here report a series of heart transplanted patients with COVID-19 from two centers of Italy. Methods All heart transplanted patients of Transplant Centers of Bergamo and Torino with a microbiologically confirmed SARS-CoV-2 infection were enrolled. Data collection included clinical presentation, laboratory and radiological findings, treatment and outcome. Follow-up was performed by visit or phone. Results From February to March 2020 twenty-six heart transplanted patients (age 62±12 years; 77% males; time from transplant 10±10 years; 69% with comorbidities) had a microbiologically confirmed COVID-19. The most frequent symptom was fever, followed by cough. Seventeen patients had a pneumonia, 8 of them severe pneumonia. Seven patients died (27%) and 17 (65%) were hospitalized. Discontinuation of immunosuppression was associated with death (71 vs 21%, p=0.02). Conversely, all patients receiving steroids survived (p The current regimen enabled the prolonged survival and function of orthotopic cardiac xenografts in altogether 6 of 8 baboons, of which 4 were now added. These results exceed the threshold set by the Advisory Board of the International Society for Heart and Lung Transplantation. Conclusions COVID-19 has a significant impact on long term heart transplanted patients. Conversely, SARS-CoV-2 infection seems to have a limited influence on more recent transplants. Our experience may suggest that heart transplantation programs can be maintained even during the pandemic phase if specific and tailored paths to prevent and to limit virus transmission are provided.

BACKGROUND Mild asymptomatic left ventricular systolic dysfunction (ALVSD) may be associated with incident heart failure (HF). However, this gray zone group needs incremental risk refinement. We hypothesized that diastolic dysfunction (DD) may refine HF and death risk prediction in mild ALVSD. METHODS AND RESULTS Among 4047 subjects aged ≥55/≤80 years followed by 10 general practitioners in northern Italy, the DAVID-Berg study prospectively enrolled 623 asymptomatic outpatients at increased risk for HF. Baseline evaluation included clinical visit, N-terminal pro B-type natriuretic peptide, and echocardiogram. Based on left ventricular ejection fraction (LVEF) and DD, subjects were classified as: control group (normal LVEF, n = 459, 76%), mild ALVSD (LVEF ≥40%/

Cerebral palsy (CP) is a disorder of movement, muscle tone or posture that is caused by an insult to the immature...

Lactobacillus helveticus belongs to the large group of lactic acid bacteria (LAB), which are the major players in the fermentation of a wide range of foods. LAB are also present in the human gut, which has often been exploited as a reservoir of potential novel probiotic strains, but several parameters need to be assessed before establishing their safety and potential use for human consumption. In the present study, six L. helveticus strains isolated from natural whey cultures were analyzed for their phenotype and genotype in exopolysaccharide (EPS) production, low pH and bile salt tolerance, bile salt hydrolase (BSH) activity, and antibiotic resistance profile. In addition, a comparative genomic investigation was performed between the six newly sequenced strains and the 51 publicly available genomes of L. helveticus to define the pangenome structure. The results indicate that the newly sequenced strain UC1267 and the deposited strain DSM 20075 can be considered good candidates for gut-adapted strains due to their ability to survive in the presence of 0.2% glycocholic acid (GCA) and 1% taurocholic and taurodeoxycholic acid (TDCA). Moreover, these strains had the highest bile salt deconjugation activity among the tested L. helveticus strains. Considering the safety profile, none of these strains presented antibiotic resistance phenotypically and/or at the genome level. The pangenome analysis revealed genes specific to the new isolates, such as enzymes related to folate biosynthesis in strains UC1266 and UC1267 and an integrated phage in strain UC1035. Finally, the presence of maltose-degrading enzymes and multiple copies of 6-phospho-β-glucosidase genes in our strains indicates the capability to metabolize sugars other than lactose, which is related solely to dairy niches.

Aims Midwall fractional shortening (MWFS) is a measure of left ventricular (LV) systolic function that is more reliable in case of concentric LV geometry compared to LV ejection fraction (LVEF). We hypothesized that MWFS might predict heart failure (HF) and death in a high-risk asymptomatic population, beyond other echocardiographic parameters. Methods and results Among 4047 subjects aged ≥55/≤80 years followed by 10 general practitioners in northern Italy, the DAVID-Berg study prospectively enrolled 623 asymptomatic outpatients at increased risk for HF. Baseline evaluation included clinical visit, electrocardiogram, N-terminal pro-brain natriuretic peptide (NT-proBNP), and echocardiogram. Mean age of the population was 69 ± 7 years, 56% were men, 88% had hypertension, mean LVEF was 61 ± 9%, and mean MWFS 16.2 ± 3.3. During a median follow-up of 5.7 years, 95 subjects experienced HF/death events. At Cox analysis, lower MWFS was the only echocardiographic parameter, among structural/functional ones, associated with higher risk of HF/death [hazard ratio (HR) 0.89, 95% confidence interval (CI) 0.84–0.95, Padjusted < 0.001]. The risk of HF/death related to clinical data and NT-proBNP (baseline model) was reclassified by echocardiography only when MWFS was included into the model (baseline C-statistics 0.761; adding conventional structural/functional echocardiographic data 0.776, P = 0.09; adding MWFS 0.791, P = 0.007). Compared to subjects with normal LVEF and MWFS, only subjects with combined systolic dysfunction (11% of the population) were at higher risk (P = 0.001 for both abnormal; P > 0.24 for either LVEF or MWFS abnormal). Conclusion DAVID-Berg data suggest to include MWFS assessment in clinical practice, a simple and reliable echocardiographic parameter able to improve risk stratification in subjects at high risk for HF.

Due to their traditional use in food fermentation process for centuries, microbial food cultures are considered to have a safe history of use. A specific microbial risk assessment is therefore rarely conducted for fermented foods and their food cultures, inoculated or naturally present. Some of those food cultures have been also considered for their potential health effect as probiotic strain candidates, for which a specific safety demonstration process has been proposed by a joint expert report of FAO and WHO. The European Food Safety Authority (EFSA) Biohazard panel also provides an approach for evaluating the safety of a strain to be added in the food chain, the Qualified Presumption of Safety (QPS). Weissella confusa, former taxon Lactobacillus confusus, is a food culture characterized in the fermentation process of sourdough. Some strains have been recently proposed for their probiotic potential. The species is also documented in recent infection case reports. It is considered nevertheless to be opportunistic as underlying factors have been suggested to explain the infection. We report here the microbial risk assessment of the species, by studying a collection of 26 food and 17 clinical isolates of Weissella confusa. The phenotypic study, genomic characterization and bibliographical survey will allow us to conclude about the safety of the species and confirm its use for food fermentation and consider specific strains for demonstration of their respective health effects as probiotic candidates.

A short review on the clinical presentation of pediatrics cases of Bickerstaff brain encephalitis emphasizing the broad clinical spectrum of the disease. Cases of pediatric Bickerstaff’s brainstem encephalitis collected on three electronic medical databases (PubMed, Cochrane Library and Scopus Web of Science) are reviewed. The inclusion criteria of the cases were based on the clinical characteristics of the disorder in the pediatric age. We reviewed 20 articles on Bickerstaff’s brainstem encephalitis, identifying 40 pediatric cases focused on the clinical symptoms. We saw that the prevalence was higher in male subjects, and the median age at diagnosis was 8 years. The phenotype of pediatrics patients was similar to previously published literature. We identify three cases of overlapping forms between Bickerstaff brain encephalitis and Guillain-Barré Syndrome in patients with lower limbs weakness and typical signs of Bickerstaff brain encephalitis, suggesting a combined involvement of the central and peripheral nervous system. Although there is no defined data on incidence and prevalence in the literature, Bickerstaff’s brainstem encephalitis appears to be a rare disorder, especially in children. The incidence of Bickerstaff brain encephalitis and Guillain-Barré Syndrome, and Miller Fisher Syndrome has been underrated in the past, primarily due to an underestimation of the forms with a Peripheral Nervous System involvement. Bickerstaff brain encephalitis usually has a rapid and acute onset within 2–4 weeks, characterized by a typical picture of ophthalmoplegia, hyperreflexia, cerebellar symptoms as ataxia. The subsequent manifestations of hyperreflexia or consciousness disturbances as drowsiness, sleepiness, or coma, indicative of central involvement, suggest a Bickerstaff brain encephalitis clinical diagnosis.

Biogas production is a hot topic, which has globally gained interest from many researchers over the past years. This fact is mainly due to the depletion of fossil fuels and environmental concerns regarding wastes disposal. Anaerobic Digestion (AD) represents a biological way to obtain both energy (in form of biogas) and waste discard, by converting the polluting organic matter. The overall process relies on a syntrophic chain where different microbial consortia produce the feed necessary for the final methanogenic step. Cheese whey has been largely investigated for AD treatment, since is a high polluting waste derived from the cheese-making process. However, there is a less-known waste originating from the portioning and shaving phases of long-ripened hard-cheese. This study aimed to investigate the microbiome of anaerobic digesters processing dairy industry wastes, such as cattle manure, cheese whey and hard-cheese powder wastes. In particular, the effects of process parameters, reactor configurations and type of dairy wastes, on the microbial populations, have been analyzed. The goal was achieved by means of culture-independent methods and high throughput sequencing, which allowed quantifying and identifying the main species present, as well as their differential gene expression in relation to hydrogen injection for biogas upgrading purposes.

Sourdough fermentation of bakery products is a well-established and widespread technique to confer an added value to the resulting food. In recent decades, gluten-free raw materials have gained more attention due to the diffusion of food disorders such as coeliac disease, but, at the same time, they present difficult manipulation and scarce technological properties because of the absence of gluten. For this reason, the present work was aimed at selecting starter cultures for sourdough application that are isolated from fermentation of sorghum flour. Three isolates of Lactobacillus fermentum, Weissella cibaria, and Weissella confusa were selected for the following properties: exopolysaccharide synthesis, acidification, CO2 production, and amylase activity. The investigated phenotypic characteristics were confirmed by genomic analyses, which also highlighted other potentially beneficial features for use in bakery products employment. These strains, together with bakery yeast, were used for bread preparation using sorghum and wheat flour and after 24 h of fermentation the resulting dough was analyzed to assess the improvement of its characteristics. The presence of lactic acid bacteria (LAB) had a great impact on the final dough, and the best preparation, from a rheological point of view, resulted in one made of sorghum and wheat flour with added LAB and bakery yeast, whose resulting characteristics were similar to all wheat flour doughs. The results of this study suggest a potential application of the selected starters in sorghum composite bread and should be validated with data from large-scale pilot tests conducted in industrial bakeries.

Background The expansion of renewable energy produced by windmills and photovoltaic panels has generated a considerable electricity surplus, which can be utilized in water electrolysis systems for hydrogen production. The resulting hydrogen can then be funneled to anaerobic digesters for biogas upgrading (biomethanation) purposes (power-to-methane) or to produce high value-added compounds such as short-chain fatty acids (power-to-chemicals). Genome-centric metagenomics and metatranscriptomic analyses were performed to better understand the metabolic dynamics associated with H2 injection in two different configurations of anaerobic digesters treating acidic wastes, specifically cheese manufacturing byproducts. These approaches revealed the key-genes involved in methanation and carbon fixation pathways at species level. Results The biogas upgrading process in the single-stage configuration increased the CH4 content by 7%. The dominant methanogenic species responsible for the upregulation of the hydrogenotrophic pathway in this reactor was Methanothermobacter wolfeii UC0008. In the two-stage configuration, H2 injection induced an upregulation of CO2 fixation pathways producing short-chain fatty acids, mainly acetate and butyrate. In this configuration, the abundant species Anaerobaculum hydrogeniformans UC0046 and Defluviitoga tunisiensis UC0050 primarily upregulated genes related to electron transport chains, suggesting putative syntrophisms with hydrogen scavenger microbes. Interestingly, Tepidanaerobacter acetatoxydans UC0018 did not act as an acetate-oxidizer in either reactor configurations, and instead regulated pathways involved in acetate production and uptake. A putative syntrophic association between Coprothermobacter proteolyticus UC0011 and M. wolfeii UC0008 was proposed in the two-stage reactor. In order to support the transcriptomic findings regarding the hydrogen utilization routes, an advanced bioconversion model was adapted for the simulation of the single- and two-stage reactor setups. Conclusions This is the first study investigating biogas reactor metatranscriptome dynamics following hydrogen injection for biomethanation and carbon fixation to short-chain fatty acids purposes. The same microbes showed different patterns of metabolic regulation in the two reactor configurations. It was observed an effect of the specialized acidogenic reactor on the overall microbial consortium composition and activity in the two-stage digester. There were also suggested the main species responsible for methanation, short-chain fatty acids production, and electron transport chain mechanisms, in both reactor configurations. Electronic supplementary material The online version of this article (10.1186/s40168-018-0583-4) contains supplementary material, which is available to authorized users.

Neste artigo, apresentamos uma abordagem de combate à corrupção e ao comportamento desonesto baseada na economia comportamental, psicologia cognitiva e psicologia social. A economia comportamental tem sido extensivamente aplicada à criação de políticas eficazes de alteração de comportamentos na área da saúde e educação, sendo, a aplicação ao combate à corrupção uma área ainda incipiente. Neste artigo, tendo por base uma revisão da literatura científica sobre o comportamento desonesto, demonstramos que as pessoas nem sempre agem de forma racional, coerente e previsível e nem sempre incorporam análises de custo-benefício nas suas decisões, tal como é previsto pelos modelos econômicos tradicionais. Também demonstramos que existem fatores inconscientes e mais sutis que podem estar contribuindo para o comportamento desonesto. Estes fatores são: i) a cognição humana e os vieses que afetam a tomada de decisão (racionalização motivada, licença moral, dissonância cognitiva etc.); ii) as características do contexto que nos podem influenciar em direção a determinado comportamento desonesto (ambiguidade nos procedimentos, falta de clareza, distância psicológica em relação ao dinheiro etc.); iii) os fatores sociais que decorrem da interação com as outras pessoas (reciprocidade, difusão da responsabilidade, normas sociais etc.). Uma vez conhecidos estes fatores, um rol de intervenções pode ser sugerido para conduzir as pessoas a agirem de forma mais honesta. Este artigo é direcionado a atores do setor público e privado interessados na temática do combate à corrupção e tem dois objetivos: i) descrever os fatores psicológicos que influenciam o comportamento desonesto e ii) apresentar soluções de fácil implementação e baixo custo (nudges), que podem ser integradas nas políticas de integridade e combate à corrupção.

Grisel’s syndrome is a non-traumatic subluxation of the atlantoaxial joints, which is caused by an inflammatory process involving the upper neck. Torticollis, neck pain, and reduced neck mobility are the main clinical signs of presentation. Predisposing factors are trauma, hyperlaxity of the transverse and alar ligaments of the atlantoaxial joints, and surgical interventions carried out in this area. Several viral and bacterial pathogens have been reported as causative events of Grisel’s syndrome, including Epstein-Barr virus, Kawasaki disease, Streptococcus pyogenes, Staphylococcus aureus, and other infectious agents. Grisel’s syndrome linked to Mycoplasma pneumoniae infection as the trigger has not previously been reported. Mycoplasma pneumoniae is a small prokaryotic microbe and a frequent etiologic factor of respiratory tract infections and, less frequently, of extrapulmonary body organs. The recognition of the Grisel’s syndrome is based on clinical and neuroradiological investigations, and early diagnosis and specific treatment are crucial to the successful outcome of the disease. We report the case of an 8-year-old girl with Grisel’s syndrome caused by an upper respiratory tract infection due to Mycoplasma pneumoniae. Diagnostic suspicion and treatment of Grisel’s syndrome were established quickly by anamnestic and clinical data and confirmed by radiological findings. The girl was immediately treated with specific antibiotic therapy and cervical immobilization, thus preventing the most dangerous complications of the disorder. Mycoplasma pneumoniae, among the other infectious agents, may be cause of scute torticollis and Gresel's syndrome.

The present research is the first comprehensive study regarding the thermophilic anaerobic degradation of cheese wastewater, which combines the evaluation of different reactor configurations (i.e. single and two-stage continuous stirred tank reactors) on the process efficiency and the in-depth characterization of the microbial community structure using genome-centric metagenomics. Both reactor configurations showed acidification problems under the tested organic loading rates (OLRs) of 3.6 and 2.4 g COD/L-reactor day and the hydraulic retention time (HRT) of 15 days. However, the two-stage design reached a methane yield equal to 95% of the theoretical value, in contrast with the single stage configuration, which reached a maximum of 33% of the theoretical methane yield. The metagenomic analysis identified 22 new population genomes and revealed that the microbial compositions between the two configurations were remarkably different, demonstrating a higher methanogenic biodiversity in the two-stage configuration. In fact, the acidogenic reactor of the serial configuration was almost solely composed by the lactose degrader Bifidobacterium crudilactis UC0001. The predictive functional analyses of the main population genomes highlighted specific metabolic pathways responsible for the AD process and the mechanisms of main intermediates production. Particularly, the acetate accumulation experienced by the single stage configuration was mainly correlated to the low abundant syntrophic acetate oxidizer Tepidanaerobacter acetatoxydans UC0018 and to the absence of aceticlastic methanogens.