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Smartphone apps for self-management are valuable tools to help manage low back pain (LBP) patients. The purposes of this systematic review were to (a) summarize the available studies on the efficacy of smartphone apps for self-management of LBP and (b) identify free applications available in Italy that offer strategies for LBP self-management and provide a qualitative assessment using the Mobile Application Rating Scale (MARS). According to the Prisma Checklist, six bibliographic databases were searched with the keywords 'low back pain', 'mobile application', 'smartphone', and 'telemedicine'. In total, 852 records were screened, and 16 were included in the systematic review. Of the six RCTs included, four reported a statistically significant decrease in pain in favor of the app group, and two RCTs did not. Only in a non-RCT was there an increase in the disability score. In the application research conducted on mobile stores, we identified and rated 25 applications through MARS. The overall scores ranged from 1.93 to 3.92 for the IOS app and 1.73 to 4.25 for the Play Store app. The findings suggest that few apps meet satisfying quality, content, and functionality criteria for LBP self-management. [ABSTRACT FROM AUTHOR]

Abstract: Background and aim: To explore associations between serum 25-hydroxyvitamin D3 [25(OH)D] concentrations and liver histology in patients with non-alcoholic fatty liver disease (NAFLD). Methods and results: We studied 60 consecutive patients with biopsy-proven NAFLD, and 60 healthy controls of comparable age, sex and body mass index (BMI). NAFLD patients had a marked decrease in winter serum 25(OH)D concentrations (51.0±22 vs. 74.5±15nmol/L, P <0.001) compared with controls. Metabolic syndrome (MetS; as defined by the Adult Treatment Panel III criteria) and its individual components occurred more frequently among NAFLD patients. The marked differences in 25(OH)D concentrations observed between the groups were little affected by adjustment for age, sex, BMI, creatinine, calcium, homeostasis model assessment (HOMA)-insulin resistance, and the presence of the MetS. Interestingly, among NAFLD patients, decreased 25(OH)D concentrations were closely associated with the histological severity of hepatic steatosis, necroinflammation and fibrosis (P <0.001 for all) independent of age, sex, BMI, creatinine, calcium, HOMA-insulin resistance, and presence of the MetS. Conclusions: Compared with controls, NAFLD patients have a marked decrease in serum 25(OH)D concentrations, which is closely associated with histopathological features of NAFLD. Further investigation into whether vitamin D3 may play a role in the development and progression of NAFLD appears to be warranted. [Copyright &y& Elsevier]

The clinical manifestations of SARS-CoV-2 infection vary widely among patients, from asymptomatic to life-threatening. Host genetics is one of the factors that contributes to this variability as previously reported by the COVID-19 Host Genetics Initiative (HGI), which identified sixteen loci associated with COVID-19 severity. Herein, we investigated the genetic determinants of COVID-19 mortality, by performing a case-only genome-wide survival analysis, 60 days after infection, of 3904 COVID-19 patients from the GEN-COVID and other European series (EGAS00001005304 study of the COVID-19 HGI). Using imputed genotype data, we carried out a survival analysis using the Cox model adjusted for age, age2, sex, series, time of infection, and the first ten principal components. We observed a genome-wide significant (P-value < 5.0 × 10−8) association of the rs117011822 variant, on chromosome 11, of rs7208524 on chromosome 17, approaching the genome-wide threshold (P-value = 5.19 × 10−8). A total of 113 variants were associated with survival at P-value < 1.0 × 10−5 and most of them regulated the expression of genes involved in immune response (e.g., CD300 and KLR genes), or in lung repair and function (e.g., FGF19 and CDH13). Overall, our results suggest that germline variants may modulate COVID-19 risk of death, possibly through the regulation of gene expression in immune response and lung function pathways. [ABSTRACT FROM AUTHOR]

As already shown in a newly published article (Autelli/Caria 2022b), the phraseological studies on the Catalan of Alghero are still in their infancy, and there is an urgent need for documenting more phrasemes in this diatopic variety. One can already find some of them in dictionaries and amatorial collections. The aim of this paper is to give a brief overview of the written sources and dictionaries of Algherese, then to analyse the terminology used in the latter in reference to phrasemes and, most importantly, to find out what kind of phrasemes are provided, trying to pinpoint their main morphosyntactic, semantic and cultural features. [ABSTRACT FROM AUTHOR]

Background: Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) is a novel coronavirus that caused an ongoing pandemic of a pathology termed Coronavirus Disease 19 (COVID-19). Several studies reported that both COVID-19 and RTEL1 variants are associated with shorter telomere length, but a direct association between the two is not generally acknowledged. Here we demonstrate that up to 8.6% of severe COVID-19 patients bear RTEL1 ultra-rare variants, and show how this subgroup can be recognized. Methods: A cohort of 2246 SARS-CoV-2-positive subjects, collected within the GEN-COVID Multicenter study, was used in this work. Whole exome sequencing analysis was performed using the NovaSeq6000 System, and machine learning methods were used for candidate gene selection of severity. A nested study, comparing severely affected patients bearing or not variants in the selected gene, was used for the characterisation of specific clinical features connected to variants in both acute and post-acute phases. Results: Our GEN-COVID cohort revealed a total of 151 patients carrying at least one RTEL1 ultra-rare variant, which was selected as a specific acute severity feature. From a clinical point of view, these patients showed higher liver function indices, as well as increased CRP and inflammatory markers, such as IL-6. Moreover, compared to control subjects, they present autoimmune disorders more frequently. Finally, their decreased diffusion lung capacity for carbon monoxide after six months of COVID-19 suggests that RTEL1 variants can contribute to the development of SARS-CoV-2-elicited lung fibrosis. Conclusion: RTEL1 ultra-rare variants can be considered as a predictive marker of COVID-19 severity, as well as a marker of pathological evolution in pulmonary fibrosis in the post-COVID phase. This notion can be used for a rapid screening in hospitalized infected people, for vaccine prioritization, and appropriate follow-up assessment for subjects at risk. Trial Registration NCT04549831 (www.clinicaltrial.org) [ABSTRACT FROM AUTHOR]

Background: Traditional cardiac rehabilitation (CR) is effective in improving physical performance and prognosis after myocardial infarction (MI). Anyway, it is not consistently recommended to older adults, and its attendance rate is low. Previous studies suggested that alternative, early and tailored exercise interventions are feasible and effective in improving physical performance in older MI patients. Anyway, the demonstration that they are associated also with a significant reduction of hard endpoints is lacking. Aim: To describe rationale and design of the "Physical activity Intervention in Elderly patients with myocardial Infarction" (PIpELINe) trial. Methods: The PIpELINe trial is a prospective, randomized, multicentre study with a blinded adjudicated evaluation of the outcomes. Patients aged ≥ 65 years, admitted to hospital for MI and with a low physical performance one month after discharge, as defined as short physical performance battery (SPPB) value between 4 and 9, will be randomized to a multi-domain lifestyle intervention (including dietary counselling, strict management of cardiovascular and metabolic risk factors, and exercise training) or health education. The primary endpoint is the one-year occurrence of the composite of cardiovascular death or re-hospitalization for cardiovascular causes. Results: The recruitment started in March 2020. The estimated sample size is 456 patients. The conclusion of the enrolment is planned for mid-2023. The primary endpoint analysis will be available for the end of 2024. Conclusions: The PIpELINe trial will show if a multi-domain lifestyle intervention is able to reduce adverse events in older patients with reduced physical performance after hospitalization for MI. Trial registration: ClinicalTrials.gov NCT04183465. [ABSTRACT FROM AUTHOR]

The vowel system of Catalan has been the focus of many studies, though work on the varieties spoken on the island of Eivissa (Ibiza) are scarce, with a single mention of the possible merger of the mid back vowels /o, ɔ/ (Torres Torres, Marià. 1983. Aspectes del vocalisme tònic eivissenc. Eivissa 14. 22–23). The present article provides the first acoustic analysis of the vowel inventory of 25 young native speakers of Eivissan Catalan, with a focus on the realisations of stressed /ə, ɛ/, and the back mid vowels /o, ɔ/. We employed Pillai scores (Hay, Jennifer, Paul Warren & Katie Drager. 2006. Factors influencing speech perception in the context of a merger-in-progress. Journal of Phonetics 34. 458–484) to compare the possibly merged pairs /ə, ɛ/ and /o, ɔ/ to the fully-contrasting neighbouring pairs /e, ɛ/ and /o, u/. Our results show that all participants had considerable overlap of stressed /ə/ and /ɛ/, and all but one had considerable overlap of the back mid vowels, while the fully contrastive pairs (/e, ɛ/ and /o, u/) showed almost no overlap. [ABSTRACT FROM AUTHOR]

We employed a multifaceted computational strategy to identify the genetic factors contributing to increased risk of severe COVID-19 infection from a Whole Exome Sequencing (WES) dataset of a cohort of 2000 Italian patients. We coupled a stratified k-fold screening, to rank variants more associated with severity, with the training of multiple supervised classifiers, to predict severity based on screened features. Feature importance analysis from tree-based models allowed us to identify 16 variants with the highest support which, together with age and gender covariates, were found to be most predictive of COVID-19 severity. When tested on a follow-up cohort, our ensemble of models predicted severity with high accuracy (ACC = 81.88%; AUCROC = 96%; MCC = 61.55%). Our model recapitulated a vast literature of emerging molecular mechanisms and genetic factors linked to COVID-19 response and extends previous landmark Genome-Wide Association Studies (GWAS). It revealed a network of interplaying genetic signatures converging on established immune system and inflammatory processes linked to viral infection response. It also identified additional processes cross-talking with immune pathways, such as GPCR signaling, which might offer additional opportunities for therapeutic intervention and patient stratification. Publicly available PheWAS datasets revealed that several variants were significantly associated with phenotypic traits such as "Respiratory or thoracic disease", supporting their link with COVID-19 severity outcome. A multifaceted computational strategy identifies 16 genetic variants contributing to increased risk of severe COVID-19 infection from a Whole Exome Sequencing dataset of a cohort of Italian patients. [ABSTRACT FROM AUTHOR]

Background: Although a satisfactory disease control is nowadays achievable in most patients with JIA, a substantial proportion of them still do not respond adequately or reach long-term drug-free remission. According to current recommendations, treatment should be escalated in subsequent steps. A different approach is based on the assumption that the initial start of an aggressive therapy may take advantage of the "window of opportunity" and could alter the biology of the disease, leading to an improvement of long-term outcomes, including the prevention of cumulative joint damage. Objectives: This randomised clinical trial aims to compare the effectiveness of a conventional therapeutic regimen, based on treatment escalation and driven by the treat-to-target approach, with that of an early aggressive intervention based on the initial start of a combination of conventional and biological DMARDs. Methods: JIA patients with oligoarthritis or RF negative polyarthritis aged more than 2 years and with less than 4 months of disease course will be included in the study. Children will be randomised into two arms: patients in Step-up arm with less severe oligoarthritis will undergo an intra-articular corticosteroid injection (IACI) in all affected joints; patients with polyarthritis or severe oligoarthritis will receive IACI and methotrexate. Subsequent treatment will follow a standardised protocol based on the patients' level of disease activity measured with the JADAS, according to a treat-to-target strategy. Patients in Step-down arm will receive a 6-month early combined treatment (methotrexate plus IACI for less severe oligoarthritis, methotrexate plus etanercept for severe oligoarthritis and polyarthritis). The primary endpoint is the frequency of achievement of the status of clinical remission (i.e. persistence of inactive disease for at least 6 months) at the 12-month visit. Safety events, physician-centred measures and parent/patient-reported outcomes will be collected through the Paediatric Rheumatology International Trials Organisation on line database. Expected results: The STARS trial aims to provide important evidence supporting the first-line treatment choices in the care of children with oligoarticular and polyarticular JIA. If the superiority of an early aggressive therapy will be demonstrated, this will demand further studies on the biological definition of the window of opportunity for JIA. Trial registration: The Trial is registered on the ClinicalTrials.gov registry (NCT03728478) on the 31st October 2018 and EU Clinical Trials Register on the 14th May 2018 (EudraCT Number: 2018–001931-27). [ABSTRACT FROM AUTHOR]

This article provides both a diachronic and synchronic account of the generalization of perfective auxiliary be in specific irrealis modal contexts across numerous Romance varieties spoken in Italy and more widely within the Romània, which has essentially gone unnoticed in the descriptive and theoretical literature. In some cases (southern Calabrian, Latin American Spanish, Portuguese), the distribution of be is to be interpreted as a residue of an original unaccusative syntax which was exceptionally preserved under higher V-movement in irrealis contexts, whereas in others (person-driven dialects of central and southern Italy, southern peninsular Spanish, Romanian) this original unaccusative signal has been reanalysed as a specialized marker of irrealis (lexicalizing a high Mood head) and extended to all verb classes. In the case of Alguerès, by contrast, the generalization of irrealis be is argued to be the result of language contact with surrounding Sardinian dialects where a specific pattern of dedicated irrealis marking of Mood° has been replicated. Finally, the reverse pattern with generalization of irrealis have, the reanalysis of an aspectual distinction between resultative and experiential perfects found in early Romance varieties (Neapolitan, Sicilian, Spanish, Catalan), is shown to involve a similar pattern of dedicated irrealis marking in Mood°. [ABSTRACT FROM AUTHOR]

Healthcare delivery reorganization during the COVID-19 emergency may have had a significant impact on access to care for older adults with chronic conditions. We investigated such impact among all adults with chronic conditions aged ≥ 65 years, identified through the electronic health databases of two local health agencies—ATS Brianza and ATS Bergamo—from the Lombardy region, Italy. We considered hospitalizations for 2020 compared to the average 2017–2019 and quantified differences using rate ratios (RRs). Overall, in 2017–2019 there were a mean of 374,855 older adults with ≥ 1 chronic condition per year in the two ATS and 405,371 in 2020. Hospitalizations significantly decreased from 84,624 (225.8/1000) in 2017–2019 to 78,345 (193.3/1000) in 2020 (RR 0.86). Declines were reported in individuals with many chronic conditions and for most Major Diagnostic Categories, except for diseases of the respiratory system. The strongest reductions were observed in hospitalizations for individuals with active tumours, particularly for surgical ones. Hospitalization rates increased in individuals with diabetes, likely due to COVID-19-related diseases. Although determinants of the decrease in demand and supply for care among chronic older adults are to be further explored, this raises awareness on their impacts on chronic patients' health in the medium and long run. [ABSTRACT FROM AUTHOR]