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Abstract While Cystic Fibrosis is characterized by a high phenotypic variability, a correlation is reported between the pancreatic status and the CFTR genotype. Here we report an unusual case of a child with Cystic Fibrosis (F508del-duplication of exons 1–3 genotype) diagnosed at 8 years old for pancreatic insufficiency and non-pathological sweat test, in absence of respiratory symptoms and acute episodes of pancreatitis. Nasal potential differences and intestinal current measurements were normal, while the short-circuit current measured on patient-derived colonoids grown on Transwell® indicated the presence of a reduced CFTR-dependent current relative to non-CF colonoids with, a modest improvement of CFTR activity record following treatment with elexacaftor/tezacaftor/ivacaftor. This case opens the discussion on the importance of performing CFTR sequencing and the search for large gene rearrangements in cases of pancreatic insufficiency of unclear etiology, also in the presence of non-pathological sweat test. Children with CF and non-pathological sweat chloride are likely to develop higher concentrations if they truly have CF.

Abstract Background and aim Migraine is a common disabling conditions which, globally, affects 15.2% of the population. It is the second cause of health loss in terms of years lived with disability, the first among women. Despite being so common, it is poorly recognised and too often undertreated. Specialty centres and neurologists with specific expertise on headache disorders have the knowledge to provide specific care: however, those who do not regularly treat patients with migraine will benefit from a synopsis on the most relevant and updated information about this condition. This paper presents a comprehensive view on the hallmarks of migraine, from genetics and diagnostic markers, up to treatments and societal impact, and reports the elements that identify migraine specific features. Main results The most relevant hallmark of migraine is that it has common and individual features together. Besides the known clinical manifestations, migraine presentation is heterogeneous with regard to frequency of attacks, presence of aura, response to therapy, associated comorbidities or other symptoms, which likely reflect migraine heterogeneous genetic and molecular basis. The amount of therapies for acute and for prophylactic treatment is really wide, and one of the difficulties is with finding the best treatment for the single patient. In addition to this, patients carry out different daily life activities, and might show lifestyle habits which are not entirely adequate to manage migraine day by day. Education will be more and more important as a strategy of brain health promotion, because this will enable reducing the amount of subjects needing specialty care, thus leaving it to those who require it in reason of refractory condition or presence of comorbidities. Conclusions Recognizing the hallmarks of migraine and the features of single patients enables prescribing specific pharmacological and non-pharmacological treatments. Medical research on headaches today particularly suffers from the syndrome of single-disease approach, but it is important to have a cross-sectional and joint vision with other close specialties, in order to treat our patients with a comprehensive approach that a heterogeneous condition like migraine requires.

Abstract Many ecological systems dominated by stochastic dynamics can produce complex time series that inherently limit forecast accuracy. The ‘intrinsic predictability’ of these systems can be approximated by a time series complexity metric called weighted permutation entropy (WPE). While WPE is a useful metric to gauge forecast performance prior to model building, it is sensitive to noise and may be biased depending on the length of the time series. Here, we introduce a simple randomized permutation test (rWPE) to assess whether a time series is intrinsically more predictable than white noise. We apply rWPE to both simulated and empirical data to assess its performance and usefulness. To do this, we simulate population dynamics under various scenarios, including a linear trend, chaotic, periodic and equilibrium dynamics. We further test this approach with observed abundance time series for 932 species across four orders of animals from the Global Population Dynamics Database. Finally, using Adélie (Pygoscelis adeliae) and emperor penguin (Aptenodytes forsteri) time series as case studies, we demonstrate the application of rWPE to multiple populations for a single species. We show that rWPE can determine whether a system is significantly more predictable than white noise, even with time series as short as 10 years that show an apparent trend under biologically realistic stochasticity levels. Additionally, rWPE has statistical power close to 100% when time series are at least 30 time steps long and show chaotic or periodic dynamics. Power decreases to ~10% under equilibrium dynamics, irrespective of time series length. Among four classes of animal taxa, mammals have the highest relative frequency (28%) of time series that are both longer than 30 time steps and indistinguishable from white noise in terms of complexity, followed by insects (16%), birds (16%) and bony fishes (11%). rWPE is a straightforward and useful method widely applicable to any time series, including short ones. By informing forecasters of the inherent limitations to a system's predictability, it can guide a modeller's expectations for forecast performance.

The analog–mixed signal simulation environment, used for verifying non-volatile memory macrocells, is presented. It has been adopted over the last decade, providing excellent results in verification coverage, efficiency, and flexibility. This methodology ensures a smooth and effective transition from full transistor/fully analog simulations to fully digital simulations while maintaining most of the environment’s features. This allows verification designers to exchange data, stimuli, and results, thereby enhancing debugging capabilities and reducing simulation time.

Abstract Background Recurrent respiratory infections are a leading cause of morbidity and mortality in persons with Cystic Fibrosis (pwCF). Recently, the emergence of Nocardia species as a potential pathogen in CF has raised questions about its role and management, as its clinical significance and the optimal patient management remain unclear in current clinical practice. This review explores the clinical implications of Nocardia species in patients with Cystic Fibrosis (pwCF) through a comprehensive literature review. Key objectives include assessing its impact on lung function, identifying colonization risk factors, and evaluating an appropriate treatment. Methods The literature review, conducted until June 30, 2023, from databases like MEDLINE, PubMed, Embase, and Cochrane, included 16 articles involving 89 pwCF with Nocardia species isolation according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guideline recommendations. Articles reporting Nocardia prevalence and symptoms based on original data in adult and paediatric pwCF were included. All the retrieved studies were observational ones, thus, they were categorized by study type as case report and case series. Results Overall 89 pwCF and Nocardia species isolation were included: 42 children and 47 adults. Where reported, we found these main following bacterial species: Nocardia asteroides (35%, 23/64), Nocardia farcinica (21%, 14/64), Nocardia tranvalensis (13%, 8/64) and Nocardia cyriacigeorgica (11%, 7/64). A co-infection was reported in 85% of patients (61/72). Of patients whose lung function was reported before and after Nocardia isolation, 23% (16/68) showed a decline in FEV1. Above all, 82 patients were treated at least once after isolation of Nocardia strain. In 93% (77/82) of cases, treatment was started immediately upon isolation. Antibiotic treatment was performed per os or intravenously depending on the clinical condition of the individual patient. Nocardia eradication was attempted in only 32 cases out of 82, and 78% (25/32) of these patients were successfully eradicated after one or more courses of antibiotics. Death was reported in 3 patients, 2 of which were children. Conclusion In general the isolation of the bacteria does not necessarily imply therapy, but patients need to be monitored closely to assess the possible occurrence of active infection. The treatment seems to be indicated in patients showing lung involvement with the possible appearance of pneumonia, pleural effusion, fever, cough, or a decrease in FEV1, as in the case that we described, or in patients undergoing pulmonary transplantation.

Polyomaviruses (PyVs) are small double-stranded DNA viruses able to infect species across all vertebrate taxa. In cetaceans, PyVs have been reported only in short-beaked common dolphin (Delphinus delphis), common bottlenose dolphin (Tursiops truncatus) and killer whale (Orcinus orca). Herein, we surveyed PyV in 119 cetaceans (29 mysticetes and 90 odontocetes) stranded along the Brazilian coast, from 2002 to 2022, comprising 18 species. DNA extracted from the lungs was tested using a nested PCR targeting the major capsid protein gene of PyV. Polyomavirus was detected in lung samples of 1.7% (2/119) cetaceans: two juvenile female Guiana dolphins (Sotalia guianensis) stranded in Rio de Janeiro (Rio de Janeiro state) and Guriri (Espírito Santo state), in 2018. Both retrieved sequences were identical and presented 93.3% amino acid identity with Zetapolyomavirus delphini, suggesting a novel species. On histopathology, one of the PyV-positive individuals presented basophilic intranuclear inclusion bodies morphologically consistent with polyomavirus in the lungs. Other available tissues from both cases were PyV-PCR-negative; however, both individuals tested positive for Guiana dolphin morbillivirus. To our knowledge, this is the first report of PyV infection in cetaceans of the Southern Hemisphere and the first description of a co-infection with morbillivirus.

Abstract Introduction Medical thoracoscopy is a minimally invasive and safe procedure mostly performed for unexplained exudative pleural effusions but may be considered for pneumothorax (PNX). Methods This retrospective study included participants affected by PNX who underwent medical thoracoscopy with talc poudrage at a single academic hospital from 2008 to 2021. The primary endpoint was the observation of complete radiographical lung re-expansion and absence of air supply from the chest drain within 7 days of medical thoracoscopy. The secondary endpoint was achieving no recurrence of ipsilateral PNX at 24 months post-discharge. Results A total of 95 patients affected by primary spontaneous PNX (PSP), secondary spontaneous PNX (SSP), iatrogenic, and traumatic PNX were enrolled. An additional procedure was required by 17.89% of patients, and only one patient with SSP required subsequent surgery. Recurrence of PNX occurred on the same side within 24 months after discharge in 9.47% of patients, with a median time to recurrence of 13.5 months. The PSP group was significantly more likely to achieve the primary endpoint. Pleural morphology was significantly associated with reaching the primary endpoint, while receiving a cumulative dose of talc greater than or equal to 4 g during hospitalization was associated with a lower risk of meeting it. Receiving a cumulative dose of talc greater than or equal to 4 g led in all cases to the achievement of the secondary endpoint. Patients with iatrogenic and traumatic PNX had an excellent prognosis in both the short- and long-term evaluation. Conclusion Medical thoracoscopy is an effective procedure for treating PNX in the acute setting in selected cases while preventing long-term relapses. Large prospective clinical studies are needed to support and better define the role of medical thoracoscopy in current clinical practice.

Abstract Modulators of cystic fibrosis transmembrane conductance regulator (CFTR) improved cystic fibrosis (CF) patients’ outcome. The elexacaftor/tezacaftor/ivacaftor (ETI) combination was safe and effective improving lung function in patients with different CFTR genotypes, including at least one F508del mutation. However, cases with liver damage were reported. We describe 105 CF patients heterozygous for F508del in trans with another CFTR mutation, treated for 1 year with ETI. We analyzed liver biochemical parameters and cholesterol metabolism, including lathosterol and phytosterols, surrogate markers of cholesterol de-novo synthesis and absorption, respectively. The treatment significantly improved sweat chloride, body mass index and forced expiratory volume in 1 s, whereas it caused a significant increase of total and conjugated bilirubin, ALT and GGT, even if no patients developed CF liver disease. Such alterations were less relevant than those previously observed in ETI-treated F508del homozygous patients. Furthermore, ETI treatment significantly increased serum cholesterol by enhancing its absorption (correlation between serum cholesterol and phytosterols). Whereas, we observed a normalization of de-novo biosynthesis (lathosterol reduction) that was not observed in homozygous patients. These data suggest that the second mutation in trans with the F508del contributes to reduce the liver cholesterol accumulation and thus, the triggering of liver inflammation. However, no differences in the alteration of biochemical indexes were observed between CF patients with and without liver steatosis, and between patients with different mutations in trans with the F508del. Such data suggest to further investigate the effects of ETI therapy on liver function indexes and new predictive biomarkers.

Grazia Lazzari,1 Ilaria Benevento,1 Antonietta Montagna,1 Barbara D’Andrea,1 Giuseppina De Marco,2 Giovanni Castaldo,1 Antonella Bianculli,3 Raffaele Tucciariello,3 Vito Metallo,1 Angela Pia Solazzo1 1Radiation Oncology Unit, IRCCS, CROB, Rionero in Vulture, PZ, Italy; 2Radiation Oncology Unit, University Vanvitelli, Napoli, NA, Italy; 3Physic Unit, Radiation Oncology Unit, IRCCS, CROB, Rionero in Vulture, PZ, ItalyCorrespondence: Grazia Lazzari, Radiation Oncology Unit, IRCCS, CROB, Rionero in Vulture, PZ, 85028, Italy, Email lazzarigrazia@gmail.comPurpose: We administered a new breast cancer (BC) adjuvant therapy sequence that delivered postoperative radiotherapy (PORT) before chemotherapy (CT). Our aim was to assess the gain in time to start PORT and the G2–G3 acute–subacute toxicity rate of whole breast adjuvant hypofractionated radiotherapy (AH-RT) administered up-front to the third-generation adjuvant CT (A-CT) in high-risk nodal positive BC in a preliminary report at 2 years.Methods: This retrospective study analysed the duration of treatment and safety of AH-RT administered up-front to A-CT in high-risk nodal positive BC patients (pts). Data on 45 pts treated between 2022– 2023 were collected. All pts underwent the third-generation A-CT after AH-RT 15– 5 fractions with or without a boost. Acute toxicity was scored according to CTCAE v5.0 for skin, pulmonary, and cardiac adverse events. Univariate and multivariate analyses were conducted to assess significant prognosticators for skin/lung/heart acute toxicities in the AH-RT 5– 15 fractions arms and CT (p < 0.005).Results: A reduction in the time to PORT initiation and overall adjuvant treatment time was recorded. RT was initiated 5 median weeks after surgery, and A-CT was performed 9 median weeks after surgery. The median duration of the entire adjuvant treatment was 35 weeks after surgery. At 6 months mean follow-up, no significant differences in G2–G3 toxicity were noted between the different hypofractionated RT arms, irrespective of the CT schedules, irradiated volumes, or boost (SIB or sequential) in univariate and multivariate analyses. In the multivariate analysis, no significant effects in CT schedules and AH-RT 5– 15 arms for skin/lung acute toxicities (p = 0.077 and p = 0.68; 0.67 and 0.87, respectively) were recorded.Conclusion: As a new PORT approach in BC, AH-RT up-front to the third-generation A-CT appeared safe with a low acute toxicity profile, providing an advantage in shortening the time from surgery to PORT initiation and the overall adjuvant treatment time.Keywords: PORT, third-generation chemotherapy, hypofractionated radiotherapy

Abstract This paper analyses how YouTube authenticates engagement metrics and, more specifically, how the platform corrects view counts by removing “fake views” (i.e., views considered artificial or illegitimate by the platform). Working with one and a half years of data extracted from a thousand French YouTube channels, we show the massive extent of the corrections done by YouTube, which concern the large majority of the channels and over 78% of the videos in our corpus. Our analysis shows that corrections are not done continuously as videos collect new views, but instead occur in batches, generally around 5 p.m. every day. More significantly, most corrections occur relatively late in the life of the videos, after they have reached most of their audience, and the delay in correction is not independent of the final popularity of videos: videos corrected later in their life are more popular on average than those corrected earlier. We discuss the probable causes of this phenomenon and its possible negative consequences on content diffusion. By inflating view counts, fake views could make videos appear more popular than they are and unwarrantedly encourage their recommendation, thus potentially altering the public debate on the platform. This could have implications on the spread of online misinformation, but their in-depth exploration requires first-hand information on view corrections, which YouTube does not provide through its API. This paper presents a series of experimental techniques to work around this limitation, offering a practical contribution to the study of online attention cycles (as described in the “Data and methods” section). At the same time, this paper is also a call for greater transparency by YouTube and other online platforms about information with crucial implications for the quality of online debate.

Abstract Introduction Thymic epithelial tumors (TETs) are rare neoplasms often associated with immune-related disorders. Patients with Good’s syndrome (GS), an adult-acquired TET-related immunodeficiency, are at a high risk of mortality due to infectious diseases. This study aims to examine COVID-19 occurrence and severity in TET patients, with or without GS. Methods Clinical records of TET patients referred to the Regional Coordinating Center for Rare Tumors of Campania Region were retrospectively collected. During the observation period, elapsing from March 2020 to April 2023, the following data were collected: occurrence of SARS-CoV-2 infection; COVID-19 severity, according to the National Institute of Health (NIH) illness categories; COVID-19 treatment. COVID-19 occurrence and severity were assessed in the overall population and correlated with the presence of GS and/or other immune-related dysregulations. Results Overall, 47 TET patients were included in the study; 27 of these (57.4%) had GS. All participants had received a full cycle of mRNA vaccine for SARS-CoV2., Thirty-one patients (66.0%) experienced COVID-19, of whom 18 (58.0%) had previously received a diagnosis of GS. No significant association of GS and/or other immune-related dysregulations with SARS-CoV-2 infection occurrence was detected (Fisher’s exact test p = 1 and p = 0.3587, respectively). Among patients with GS, 8 (45.0%) reported a COVID-19 severity score of ≥ 3; whereas, only 1 of the 13 patients without GS (7.7%) had a severity score of ≥ 3. The correlation between presence of GS and COVID-19 severity (score 1 or 2 vs. ≥ 3) was statistically significant (p = 0.0448). No statistically significant association between COVID-19 severity and other immune-related syndromes were found (p = 1). Of note, all the hospitalized patients for NIH 4 and 5 COVID-19 had GS. Conclusions Our data suggest that TET patients, especially those with GS, require a careful multidisciplinary monitoring for SARS-CoV-2 infection, in order to establish tailored treatments and prophylactic protocols.

Abstract Background The innate immunity acts during the early phases of infection and its failure in response to a multilayer network of co-infections is cause of immune system dysregulation. Epidemiological SARS-CoV-2 infections data, show that Influenza Virus (FLU-A-B-C) and Respiratory Syncytial Virus (RSV) are co-habiting those respiratory traits. These viruses, especially in children (mostly affected by ‘multi-system inflammatory syndrome in children’ [MIS-C] and the winter pandemic FLU), in the aged population, and in ‘fragile’ patients are causing alteration in immune response. Then, bacterial and fungal pathogens are also co-habiting the upper respiratory traits (e.g., Staphylococcus aureus and Candida albicans), thus contributing to morbidity in those COVID-19 affected patients. Methods Liquid chromatography coupled with high-resolution mass spectrometry using the quadrupole orbital ion trap analyser (i.e., UHPLC-Q-Orbitrap HRMS) was adopted to measure the polyphenols content of a new nutraceutical formula (Solution-3). Viral infections with SARS-CoV-2 (EG.5), FLU-A and RSV-A viruses (as performed in BLS3 authorised laboratory) and real time RT-PCR (qPCR) assay were used to test the antiviral action of the nutraceutical formula. Dilution susceptibility tests have been used to estimate the minimum inhibitory and bactericidal concentration (MIC and MBC, respectively) of Solution-3 on a variety of microorganisms belonging to Gram positive/ negative bacteria and fungi. Transcriptomic data analyses and functional genomics (i.e., RNAseq and data mining), coupled to qPCR and ELISA assays have been used to investigate the mechanisms of action of the nutraceutical formula on those processes involved in innate immune response. Results Here, we have tested the combination of natural products containing higher amounts of polyphenols (i.e., propolis, Verbascum thapsus L., and Thymus vulgaris L.), together with the inorganic long chain polyphosphates ‘polyPs’ with antiviral, antibacterial, and antifungal behaviours, against SARS-CoV-2, FLU-A, RSV-A, Gram positive/ negative bacteria and fungi (i.e., Candida albicans). These components synergistically exert an immunomodulatory action by enhancing those processes involved in innate immune response (e.g., cytokines: IFNγ, TNFα, IL-10, IL-6/12; chemokines: CXCL1; antimicrobial peptides: HBD-2, LL-37; complement system: C3). Conclusion The prophylactic antimicrobial success of this nutraceutical formula against SARS-CoV-2, FLU-A and RSV-A viruses, together with the common bacteria and fungi co-infections as present in human oral cavity, is expected to be valuable.

IntroductionIn this work, we aim to explore numerically the behavior of beam energetic particles in the Divertor Tokamak Test (DTT), a superconductive device equipped with a Neutral Beam Injection (NBI) system capable of injecting neutrals up to 510 keV.MethodWe explore beam ionization and beam slowing down for different DTT plasma scenarios. Numerical simulations are performed using the ASCOT suite of codes, including a wide-range scan of plasma density and beam injection energy. For different plasma conditions, we estimate shine-through losses, including the heat fluxes on the first wall thanks to dedicated particle tracing simulations. Orbits of newly-born fast ions are characterized by means of the constant of motion phase space, showing how trapped energetic particles’ population and prompt losses change with plasma density and NBI energy.Results and discussionSlowing down simulations show that NBI injection at 510 keV is well coupled to DTT plasmas. DTT NBI will be one of the sources of auxiliary ion heating, with an absorbed power ratio of up to ∼50% depending on plasma and beam parameters. At low plasma densities, energetic particle confinement is less efficient, and NBI power and/or energy reduction is expected.

Abstract It is often undermined that occupational safety policies do not only displace a direct effect on work well-being, but also an indirect effect on firms’ economic performances. In such context, econometric models dominated the scenes of causality until recently while Machine Learning models were seen with skepticism. With the rise of complex datasets, an ever-increasing need for automated algorithms capable to handle complex non-linear relationships between variables has brought to uncover the power of Machine Learning for causality. In this paper, we carry out an evaluation of a public aid-scheme implemented in Italy and oriented to support investment of small and medium enterprises (SMEs) in occupational safety and health (OSH) for assessing the impact on the survival of corporations. A comparison of thirteen models is performed and the Individual Treatment Effect (ITE) estimated and validated based on the AUUC and Qini score for which best values of 0.064 and 0.407, respectively, are obtained based on the Light Gradient Boosting Machine (LightGBM). An additional in-depth statistical analysis also revealed that the best beneficiaries of the policy intervention are those firms that experience performance issues in the period just before the interventions and for which the increased liquidity brought by the policy may have prevented default.