Search

Abstract Background The effect of plasma hepcidin concentrations on the long-term risk of developing adverse cardiovascular outcomes in people with type 2 diabetes mellitus (T2DM) is unclear. Methods We followed for a median of 55.6 months 213 outpatients with established T2DM (45.5% women, mean age 69 ± 10 years; BMI 28.7 ± 4.7 kg/m2; median diabetes duration 11 years). Baseline plasma ferritin and hepcidin concentrations were measured with an electrochemiluminescence immunoassay and mass spectrometry-based assay, respectively. The primary study outcome was a composite of all-cause mortality or incident nonfatal cardiovascular events (inclusive of myocardial infarction, permanent atrial fibrillation, ischemic stroke, or new hospitalization for heart failure). Results 42 patients developed the primary composite outcome over a median follow-up of 55.6 months. After stratifying patients by baseline hepcidin tertiles [1st tertile: median hepcidin 1.04 (IQR 0.50–1.95) nmol/L, 2nd tertile: 3.81 (IQR 3.01-4-42) nmol/L and 3rd tertile: 7.72 (IQR 6.37–10.4) nmol/L], the risk of developing the primary composite outcome in patients in the 3rd tertile was double that of patients in the 1st and 2nd tertile combined (unadjusted hazard ratio [HR] 2.32, 95%CI 1.27–4.26; p = 0.007). This risk was not attenuated after adjustment for age, sex, adiposity measures, smoking, hypertension, statin use, antiplatelet medication use, plasma hs-C-reactive protein and ferritin concentrations (adjusted HR 2.53, 95%CI 1.27–5.03; p = 0.008). Conclusions In outpatients with T2DM, higher baseline hepcidin concentrations were strongly associated with an increased long-term risk of overall mortality or nonfatal cardiovascular events, even after adjustment for established cardiovascular risk factors, plasma ferritin concentrations, medication use, and other potential confounders.

Seafood is a crucial global food source, but its role as a reservoir for antibiotic-resistant pathogens is concerning. This study focuses on the prevalence of antibiotic resistance in retail seafood, using Enterococcus spp. as an indicator. Seven categories of raw seafood were collected from retail markets in Central Italy. Out of 422 samples, 288 tested positive for Enterococcus spp., resulting in a prevalence rate of 68.25% (CI95%: 63.66%-72.51%). The most common species were E. faecalis (48%) and E. faecium (17.4%). Enterococcus spp. was most frequently found in cephalopods, salmon, bivalves, and crustaceans than in sea bass and bream. The odds of Enterococcus spp. recovery were higher in frozen than in fresh samples, while there was no difference between farm-raised and wild-caught seafood. A subset of 102 isolates was selected for antibiotic resistance testing, showing the highest resistance rates to quinupristin/dalfopristin (52.94%) and tetracycline (27.45%). Over 70% of isolates were multidrug-resistant. Additionally, strains resistant to vancomycin and oxazolidinones, two last-resort antimicrobials, were detected. Vancomycin resistance was observed in E. casseliflavus and E. gallinarum, which are naturally resistant due to the vanC chromosomal cluster. The optrA gene, responsible for resistance to oxazolidinones and phenicols, was found in E. thailandicus and E. faecium, where it was located on to a transferable plasmid. In conclusion, this study confirms the widespread presence of Enterococcus spp. in retail seafood. The detection of multi-resistant isolates and resistance to last-resort antimicrobials highlights significant human health risks, stressing the importance of including Enterococcus spp. in seafood antibiotic resistance surveillance.

There is an increasing trend among food business operators to use natural flavorings in meat preparation to reduce microbial spoilage and extend the shelf life. The objective of this study was to evaluate the prevalence of the use of natural flavoring mixtures in meat preparation, the possible presence of additives in natural flavorings, and the assessment of any transfer of additives contained in natural flavorings into experimentally prepared beef burgers. Based on a preliminary survey conducted as part of the study, approximately 87% of establishments used natural flavoring mixtures in meat preparation. The same natural mixtures used by local industries were added to minced meat in order to produce experimental hamburgers. Citric acid was found in both natural flavoring mixtures ranging from 1760 mg/kg to 92,731 mg/kg and experimental burgers ranging from 57 mg/kg to 2248 mg/kg. Ascorbic acid was present in all natural flavoring mixtures from 260 mg/kg to 98,858 mg/kg but was recovered in three burgers up to 1075 mg/kg. Acetic acid was found in three flavoring mixtures (range 23,539-77,421 mg/kg) and transferred to three treated burgers (range 3063-3202 mg/kg). Nitrite was never found in hamburgers and only once in a natural flavoring mixture at a dose of 26 mg/kg, whereas nitrate was found in some natural flavoring mixtures up to 788 mg/kg but never in hamburgers. The study has raised some critical issues about the appropriate and conscious use of natural flavorings and the possible inadequate meat preparation labeling in the Umbria region.

Abstract Intra-abdominal infections (IAIs) are common surgical emergencies and are an important cause of morbidity and mortality in hospital settings, particularly if poorly managed. The cornerstones of effective IAIs management include early diagnosis, adequate source control, appropriate antimicrobial therapy, and early physiologic stabilization using intravenous fluids and vasopressor agents in critically ill patients. Adequate empiric antimicrobial therapy in patients with IAIs is of paramount importance because inappropriate antimicrobial therapy is associated with poor outcomes. Optimizing antimicrobial prescriptions improves treatment effectiveness, increases patients’ safety, and minimizes the risk of opportunistic infections (such as Clostridioides difficile) and antimicrobial resistance selection. The growing emergence of multi-drug resistant organisms has caused an impending crisis with alarming implications, especially regarding Gram-negative bacteria. The Multidisciplinary and Intersociety Italian Council for the Optimization of Antimicrobial Use promoted a consensus conference on the antimicrobial management of IAIs, including emergency medicine specialists, radiologists, surgeons, intensivists, infectious disease specialists, clinical pharmacologists, hospital pharmacists, microbiologists and public health specialists. Relevant clinical questions were constructed by the Organizational Committee in order to investigate the topic. The expert panel produced recommendation statements based on the best scientific evidence from PubMed and EMBASE Library and experts’ opinions. The statements were planned and graded according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) hierarchy of evidence. On November 10, 2023, the experts met in Mestre (Italy) to debate the statements. After the approval of the statements, the expert panel met via email and virtual meetings to prepare and revise the definitive document. This document represents the executive summary of the consensus conference and comprises three sections. The first section focuses on the general principles of diagnosis and treatment of IAIs. The second section provides twenty-three evidence-based recommendations for the antimicrobial therapy of IAIs. The third section presents eight clinical diagnostic-therapeutic pathways for the most common IAIs. The document has been endorsed by the Italian Society of Surgery.

There is a gap in literature on comparisons between different MPC optimal control formulations and solver choices for the same building HVAC system. Mixed Integer Nonlinear (MINL) formulations are rarely considered, despite being the most physically accurate way to represent HVAC systems. This work compares several MPC formulations, including Quadratic, Nonlinear, and MINL, applied to a case study building and investigates benefits and challenges of MINL MPCs from practical perspectives. Ten different MPC formulations were developed and implemented using Pyomo. Then, a detailed emulator model was developed using open-source Modelica libraries and used with BOPTEST to assess the performance of each MPC. Results show that convergence and control switching behaviours of MINL MPCs are sensitive to formulations, initialization approaches, solver selections, and solver parameters. Thus, they require significant effort for tuning. However, a very well-tuned MINL MPC performed similarly to successful Nonlinear MPC formulations.

Summary: Cognitive fatigue (CF) increases accident risk reducing performance, especially during complex tasks such as driving. We evaluated whether transcranial random noise stimulation (tRNS) could mitigate CF and improve driving performance. In a double-blind study, thirty participants performed a virtual reality truck driving task during real (n = 15) or sham (n = 15) tRNS applied bilaterally on the “anti-fatigue network”. They completed two 30-min driving sessions while their driving performances were constantly monitored; heart rate was also monitored to evaluate arousal (Root-Mean-Square of successive R-R difference). tRNS was applied only during the first driving session to evaluate both online and offline stimulation effects. The primary outcome was CF reduction and performance improvement in the second (non-stimulated) driving session. Real tRNS significantly improved driving performances in the second driving session and reduced perceived CF. These results might also lead to the use of tRNS in those neurological disorders characterized by fatigue.

The P2Y12 receptor plays a central role in platelet activation, secretion, and procoagulant activity. The CURE (clopidogrel in unstable angina to prevent recurrent events) trial, conducted in 2001, was the first to effectively demonstrate the benefit of dual anti-aggregation therapy with aspirin and clopidogrel in patients with acute coronary syndromes (ACS) undergoing invasive treatment. Since then, the field of interventional cardiology has changed considerably. The introduction of drug-eluting stents (DES) and the development of new, potent P2Y12 inhibitors such as ticagrelor, prasugrel and cangrelor have revolutionized the treatment of ACS. Nevertheless, ST-elevation myocardial infarction (STEMI) remains a critical condition that requires rapid and effective intervention. The use of P2Y12 receptor antagonists as part of the pretreatment strategy is an interesting topic to optimize outcomes in STEMI patients. This review summarizes the existing evidence on the efficacy and safety of pretreatment with P2Y12 receptor antagonists in STEMI, and emphasizes the importance of making pretreatment decisions based on individual clinical characteristics. The review also looks to the future, pointing to the potential role of artificial intelligence (AI) in improving STEMI diagnosis and treatment decisions, suggesting a future where technology could improve the accuracy and timeliness of care for STEMI patients.

Consumption of raw or undercooked wild boar (WB) meat is considered an important risk factor for hepatitis E virus (HEV) infection in humans. The possibility of HEV contamination during the slaughtering practices may pose an additional risk. Based on these assumptions, we evaluated HEV contamination of WB meat hunted in Umbria (central Italy) during the 2022–2023 hunting season by real-time RT-PCR. Herein, we show that 10.8% of livers from slaughtered WB were positive for HEV RNA, thus providing an estimate of HEV infection in WB in the Umbria region. Then, by evaluating paired liver–muscle samples from both HEV-positive and HEV-negative animals, we found evidence of muscle HEV contamination in 33% and 14% of cases, respectively. This is the first report on the detection of HEV in WB meat in Umbria, an Italian region with diffuse WB hunting and consumption. The evidence of contamination provided by our study underscores the importance of adopting good hygienic practices in the processing stages of hunted WB carcasses to significantly reduce meat contamination and the risk posed for the final consumer.

None.

Endorsed by the current clinical practice guidelines, the indication to perform percutaneous coronary intervention (PCI) of intermediate coronary stenosis should be guided by either fractional flow reserve (FFR) or instantaneous wave-free ratio (iFR) if evidence of ischemia is lacking.1 Despite these clear recommendations, the uptake of physiology in clinical practice remains low supporting the development of new non-invasive tools that no longer mandate the need for dedicated coronary guidewires or microcatheters along with the need to administer hyperemic agents in case of FFR.1 Advances in computational power and three-dimensional quantitative coronary angiography has facilitated the development of angiography-based-FFR indices, thus allowing easy, online physiological lesion assessments. Besides anatomical and angiographic exclusion criteria like severe tortuosity, aorto-ostial lesions or overlapping vessels, pivotal studies demonstrated that with angiography-based-FFR indices the need for invasive coronary artery instrumentation and hyperemic agents can, in most cases, be avoided.2 Currently, 4 angiography-based-FFR indices have emerged and are currently commercially available.1 Despite workflow differences and embedded simplified computational fluid dynamics models, these indices demonstrated to have a good diagnostic performance with pressure guidewire based FFR as a reference.1 Among these, vessel fractional flow reserve (vFFR, CAAS Workstation 8.5 Pie Medical Imaging, Netherlands) uses a computational fluid dynamic approach based on...

Avalada por las guías de práctica clínica actuales, la indicación de realizar intervenciones coronarias percutáneas (ICP) para tratar estenosis coronarias intermedias ha de estar guiada por la reserva fraccional de flujo (RFF) o por el índice diastólico instantáneo sin ondas (iFR) si no hay evidencias de isquemia1. A pesar de estas claras recomendaciones, el uso de índices fisiológicos en la práctica clínica sigue siendo bajo, lo cual ha fomentado el desarrollo de nuevas técnicas de imágenes no invasivas que ya no necesitan guías coronarias dedicadas, microcatéteres ni la administración de agentes hiperémicos en el caso de la RFF1. Gracias a todo lo que han avanzado la potencia de computación y la angiografía coronaria cuantitativa en 3D se han podido desarrollar índices RFF angiográficos con los que realizar fáciles valoraciones fisiológicas online de las lesiones. Además de los criterios anatómicos y angiográficos de exclusión tales como una acentuada tortuosidad, lesiones aorto-ostiales o vasos solapados, importantes estudios demuestran que con los índices RFF angiográficos se puede evitar, en la mayoría de los casos, el uso de métodos e instrumentos invasivos en las coronarias y agentes hiperémicos2. En la actualidad, contamos con 4 índices de RFF derivados de la angiografía disponibles1. A pesar de las...