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Closed-loop stimulation (CLS; BIOTRONIK SE & Co. KG, Berlin, Germany) is a rate-responsive algorithm that analyzes intracardiac impedance trends using a standard lead placed in the right ventricle. It is unknown whether CLS could perform adequately with His bundle (HB) lead placement, as contractility dynamics may be attenuated in this region compared to the right ventricle apex. We performed hand-grip, mental, and bicycle exercise tests in a patient with brady atrial fibrillation and permanent HB pacing. The CLS algorithm responded with an appropriate heart rate to mental and physical tests. A combination of permanent His bundle and closed-loop stimulation-driven pacing may be a valid and physiological option for atrial fibrillation patients with chronotropic incompetence. [ABSTRACT FROM AUTHOR]

The circular economy is gaining attention around the world as a sustainable approach to tackling environmental problems, promoting more responsible management of resources. The aim of this work is the valorization of grape pomace as a waste product of agrifood chain. We prepared decoction (DC), ultrasound-assisted and microwave-assisted extracts (UAE and MAE respectively) of grape pomace, determining their phytochemical profile (using HPLC-ESI-Q-TOF-MS), antioxidant activity and enzyme inhibitory effects. Then, the results were compared with those of raisins and several edible berries already present in the market. Grape pomace extracts presented the highest total phenolic content (62–68 mg gallic acid equivalents/g; mg GAE/g), whereas the concentrations in the other berries were 4–43 mg GAE/g. These results were in agreement with the higher antioxidant activity and tyrosinase inhibition observed in grape pomace compared with the other berries, except for the metal chelating activity. The main compounds in grape pomace extracts were flavonoids (particularly quercetin glycosides), followed by organic acids (citric, isocitric and gallic acids). These results open new perspectives in the development of food supplements and nutraceuticals based on grape pomace extracts. • Phytochemical characterization of grape pomace and berries extracts. • Grape pomace extracts presented the highest TPC among samples. • Grape pomace extracts show the best antioxidant activity among samples. • Grape pomace extracts exert the best inhibition on tyrosinase among samples. [ABSTRACT FROM AUTHOR]

The production of tomato products is massive in Italy resulting in a huge amount of tomato waste as seeds, peels and stems. The aim of our work is to re-utilize these matrices through the extraction of carotenoids, especially lycopene to obtain enriched extra virgin olive oil (EVOO). The extraction has been obtained by ultrasound-assisted extraction (UAE) technique using directly extra virgin olive oil as extraction solvent, due to its lipophilic nature. The quantification of lycopene has been done through HPLC-DAD, resulting in a good concentration of lycopene per gram of oil (0.9 mg/g oil). Then the lycopene enriched EVOO was evaluated in vitro to determine its antioxidant and enzyme inhibitory activity in comparison with the EVOO itself. These data were associated to the cytotoxicity assays and in vivo histological bioassays, aiming to highlight its safe and healthy profile on human normal cells. [Display omitted] [ABSTRACT FROM AUTHOR]

Telehealth (TH) services rapidly expanded during the COVID-19 pandemic. This rapid deployment precluded the opportunity for initial planning of implementation strategies. The purpose of the quality improvement project was to understand the needs of nurse practitioners and examine TH procedures and interventions designed to promote high-quality, equitable health care for pediatric patients with gastrointestinal concerns. The Plan-Do-Study-Act model was used. Survey data from providers and families were collected and analyzed. They were further illuminated through iterative dialog across the research team to determine the quality and efficiency of TH. A toolkit of strategies for promoting the quality and efficiency of TH was created according to the three domains of health equity: availability, accessibility, and acceptability. TH will be used in the postpandemic era. Institutions need to implement evidence-based strategies that ensure health equity across TH platforms to ensure excellent patient care. [ABSTRACT FROM AUTHOR]

In response to the COVID-19 pandemic, local and institutional guidelines restricted non-emergent, in-person visits in outpatient specialty clinics. Nurse practitioners (NPs) in pediatric gastroenterology clinics immediately shifted their practice to telehealth (TH). The shift to TH necessitated a change in practice. This quality improvement project was designed to define factors influencing family's perceptions of TH and secure feedback on the TH experience. TH is remaining an option for accessing care even as restrictions are being lifted. Feedback is necessary to ensure that quality of care and high patient satisfaction are maintained in a virtual environment. The Unified Theory of Acceptance and Use of Technology was used to frame the project. Surveys were collected from NPs related to services provided and complexities of each encounter. Post-visit surveys were conducted with families to assess their perceptions of the visit. Findings were discussed to identify and address gaps in service. Parent/family surveys were consistent with NP feedback. Results indicated that parents were satisfied with care provided via TH, but that these visits were limited by incomplete assessments, lacked the intimacy of in-person encounters and were often difficult to access due to technological issues. It is anticipated that TH will be used in the post pandemic era to provide routine and non-emergent acute care. Institutions and providers need to consider factors influencing the patient experience learned during the pandemic and implement evidenced-based strategies that ensure quality care that meets patients' needs. • The Unified Theory of Acceptance and Use of Technology can explain the use of TH. • Most families surveyed were highly satisfied with their telehealth encounter. • Telehealth met patient needs and was beneficial for decreased travel, cost and time. • Loss of physical exams, privacy, and technology issues limit telehealth encounters. • Patient feedback and acceptance is necessary for long-term adoption of telehealth. [ABSTRACT FROM AUTHOR]

Juvenile type granulosa cell tumor (JGCTs) are extremely rare, mainly diagnosed in young women and pre-pubertal girls at stage I disease. Literature is scanty and guidelines regarding the optimal management are still controversial. The aim of this study is to add on the experience of the MITO group (Multicenter Italian Trials in Ovarian Cancer). Clinicopathological data from patients with stage I JGCTs were retrospectively collected. Descriptive statistics were used to characterize the patient population. Clinicopathological features and treatment variables were evaluated for association with relapse. Seventeen patients were identified. Surgical approach was laparoscopic and open for 7 (41%) and 10 (59%) patients, respectively. Fertility sparing surgery (FSS) was performed in 15 patients (88%): unilateral salpingo-oophorectomy (USO) in 11 patients, cystectomy with subsequent USO in 2 patients and cystectomy alone in the remaining 2. Adjuvant chemotherapy was given in 2 cases. After a median follow up time of 80 months, no recurrences were registered. Given the available data, minimally invasive surgery is safe in stage I JGCTs. Because of the good prognosis and of the young age of patients, FSS can be chosen in most of the cases. The role of cystectomy deserves further validation. The need of adjuvant chemotherapy in stage I disease is still unclear, even if available data does not seem to support treatment over surveillance. • Minimally invasive surgery is a safe approach in JGCTs • Fertility sparing surgery should be chosen when fertility is an issue. • Available data do not seem to support the role of adjuvant chemotherapy over surveillance. [ABSTRACT FROM AUTHOR]

Naturally occurring asbestos from ophiolitic outcrops can pose a health risk to the resident population. Some studies have documented this risk of exposure in many areas around the world. The aim of the study is to estimate the possible impact on health caused by asbestos outcrops present in some areas of Calabria, a region of southern Italy. The design of the study is observational and uses routinely collected data on employment, compensations and mortality. Data from archives of mortality in the period 2005–2015 were selected. Standardized mortality ratio (SMR) for malignant mesothelioma (MM) by municipalities of residence with reference to the regional population was estimated assuming a Poisson distribution of the data. Administrative archives of companies' employment records and occupational disease compensation data were used to exclude occupational origin cases. A total of 163 cases of MM were identified. Statistically significant excess risks (P -value <0.05) were observed for several municipalities, some of which were located in areas where asbestos outcrops had previously been identified. Significant SMRs vary between 44.0 and 5.2. The mean age at death in the areas at risk of ophiolitic outcrops ranges from 65.4 to 77.1 years, and the gender ratio (male/female) ranges from 0.66 to 1.3. Monitoring of areas most involved in the risk of environmental contamination from ophiolitic outcrops is highly suggested. Full implementation of the local MM surveillance system is strongly encouraged. Further investigations are recommended to specifically identify the cause of exposure and confirm the hypothesis of a causal association with asbestos naturally occurring in these risk areas. [ABSTRACT FROM AUTHOR]

As a backup lead in right ventricle (RV) is often used in His-bundle pacing (HBP) implants, in sinus rhythm patients the His lead is connected to the left ventricular (LV) port of a CRT device. In current devices, the backup pacing will be delivered 100% of time due to cross-channel ventricular refractory periods. Beyond an impact on battery, unnecessary RV pacing could find excitable tissue and capture a portion of the myocardium tissue potentially reducing the benefits of physiological HBP as shown in this case report where the switch from biventricular to LV-only pacing improved acute and 2-month echocardiography parameters. [ABSTRACT FROM AUTHOR]

Benign prostatic hyperplasia (BPH) and prostatic cancer are aging-associated urological conditions in men. While significant advances have been made in relation to treatment, poor response, treatment resistance and adverse side-effects limit currently available therapies. The possible antiproliferative and/or ameliorative potentials of Juglans regia have been reported, however, there is a dearth of scientific information on its effect on BPH or prostatic cancer. In this study, in-vivo and in-vitro studies were used to assess the possible benefits of fresh walnut fruits extract in BPH or prostate cancer. High-performance liquid chromatography coupled with electro spray ionization and quadrupole-time-of-flight mass spectrometry (HPLC-ESI-Q-TOF) was used to assess the chemical profile of the plant extract. The anti-proliferative activity of Juglans regia extract was tested against normal and cancerous human prostate cell lines by using the iCELLigence real-time and label-free cell analysis system. The ameliorative potential of fresh fruits Juglans regia extract was assessed by administering the extract at 50 and 100 mg/kg body weight to rats with testosterone induced BPH. Analysis of phytochemicals in Juglans regia revealed a high concentration of phenolic acids and flavonoids, Juglans regia also showing time- and dose-dependent anti-proliferative activity against prostate cancer cells, and reversed biochemical and histomorphological changes induced by testosterone-induced BPH. [ABSTRACT FROM AUTHOR]

Study Objective: To investigate the correlation between endometrial polyps (EPs) and chronic endometritis (CE).Design: Single-center retrospective case-control study.Setting: Academic center.Patients: A total of 480 premenopausal women with abnormal uterine bleeding (AUB) were enrolled. Group A included 240 women suffering from EPs (diagnosed by hysteroscopy and histology), and group B included 240 patients without EPs at hysteroscopy.Interventions: In group A, 2 separate samples were obtained from the EPs (group A polyps) and endometrium (group A endometrium). In group B, a single sample of endometrial tissue was evaluated (group B endometrium). All tissue samples were subjected to immunohistochemistry for CD-138 for plasma cell identification.Measurements and Main Results: The primary study endpoint was to compare the rates of CE in group A endometrium versus group B endometrium. The secondary endpoint was to evaluate the consistency in CD-138 immunoreactivity between group A polyps and compared with group A endometrium. A higher prevalence of CE was observed in group A endometrium compared with group B endometrium (p < .0001). The total percentage of EPs showing CD-138 positivity was 76.7% (184 of 240). CE was more frequent in women with CD-138+ EPs compared to those with CD-138- EPs (p < .0001).Conclusions: EPs were commonly associated with CE in the premenopausal women suffering from AUB. Moreover, the majority of EPs were positive for CD-138 staining, suggesting a possible hidden association between chronic inflammation and EPs. [ABSTRACT FROM AUTHOR]

The pre-harvest damage of wheat by sunn pests decreases flour quality. Mixolab ® is a recent instrument that can be used to accurately describe the technological behaviour of flour dough, since it is able to evaluate both protein and starch components at the same time. Two-year field experiments were carried out to study the effect of Eurygaster maura (Heteroptera: Scutelleridae) feeding on the quality traits of common and durum wheat, recorded using different protocols, in comparison to the traditional sodium dodecyl sulphate sedimentation test (SSV). In 2012–13 growing season, a damage rate between 16% and 21% of damaged kernels led to a greater reduction in dough stability for common (−65%) than for durum wheat (−32%), while the protein strength was affected more by insect activity in durum wheat (−56%). In 2013–14 growing season, E. maura feeding (on average 32% of damaged kernels) reduced SSV by 5% and 66%, dough stability by 12% and 30%, and protein strength by 12% and 16%, for common and durum wheat, respectively. The increasing percentages of damaged kernels in both crops led to a clear decrease in dough stability and protein strength; a significant change in the rheological parameters was noticeable at a 2.5% level of damaged kernels. SSV resulted to be significantly correlated to Mixolab ® dough stability, the protein strength, the protein network wakening rate ( α ) and Change in Mixolab Consistency (CMC, “Wheatbug” protocol) for both common and durum wheat. Therefore, Mixolab ® can be considered a suitable tool for a quick detection of damage caused by sunn pests in common and durum wheat flour. [ABSTRACT FROM AUTHOR]

An agronomic improvement in grain yield and quality in winter wheat could be obtained through the application of strategies, such as application of foliar fungicides or fertilizers, that protect health of the last leaves and delay the senescence process during ripening. Only a few studies have reported the effect of these practices on barley, although these treatments could represent a new opportunity to specialize in feed and food barley markets and raise farmer profitability. The aim of this study was to compare the effect of different late-season strategies, N and S foliar fertilizers and fungicides applied at barley anthesis, on crop canopy greenness during the ripening stages and to establish the relationship between these strategies and barley yield and quality. Four field experiments have been conducted in NW Italy during 3 growing seasons, according to a full factorial design with four treatments, three barley cultivars and four replications. The following parameters were recorded: canopy greenness, grain yield, test weight (TW), thousand kernel weight (TKW), grain protein content (GPC), foliar disease incidence and severity and deoxynivalenol (DON) contamination. The collected data clearly underline the importance of prolonging canopy greenness of barley in order to increase grain yield and to improve quality. Of all the compared treatments, the application of a fungicide with an azole mixture at anthesis has shown to play the most important role in delaying the senescence process, and has resulted in a higher gran yield (+25%), TW (+1.3 kg hl −1 ) and TKW (+2.8 g). The effect of the fungicide treatment on barley grain yield was significant for all the compared cultivars and in almost all the environmental conditions, but led to a greater advantage in the cooler environments with prolonged ripening. The fungicide also led to a clear, significant control of foliar disease and a reduction in DON contamination. The use of N and S foliar fertilizers was able to prolong canopy greenness and enhance barley yield and quality but only in environments characterized by a prolonged grain filling period. [ABSTRACT FROM AUTHOR]

Diffuse Large B-cell Lymphoma (DLBCL) is the most common form of Non-Hodgkin lymphoma characterized by clinical and biological heterogeneity attributable both to the tumor cells and the complex tumor-microenvironment surrounding them. Tumor-associated macrophages (TAMs) and mast cells are two major components of the tumor inflammatory infiltrate with a definite role in enhancing tumor angiogenesis. In this study, we have investigated CD68 and tryptase expression and their relationship with microvascular density (MVD) in chemo-resistant and chemosensitive patients affected by DLBCL. CD68 and tryptase expression as well as MVD were increased in chemo-resistant patients when compared with chemosensitive patients. Tryptase expression showed a positive correlation with MVD, supporting a role for mast cell in DLBCL tumor angiogenesis, while CD68 correlation with MVD was not significant, indicating a different role for TAMs than angiogenesis in DLBCL. [ABSTRACT FROM AUTHOR]

Angiogenesis is a hallmark of tumor growth and progression in solid and hematological malignancies. Different cellular components of the tumor microenvironment such as macrophages, mast cells, circulating endothelial cells and angiogenic factors, including vascular endothelial growth factor and its receptors are involved in the maintenance of Hodgkin Lymphoma. In this review article, we highlight relevant literature focusing on the relationships between angiogenesis and Hodgkin Lymphoma as well as discussing anti-angiogenic treatments in this malignancy. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the relationship between multichannel intraluminal impedance and pH monitoring (MII/pH) values in newborns with symptoms of gastroesophageal reflux disease (GERD) and clinical history in their first 3 years of life. Study design: Sixty-four newborns with GERD symptoms who underwent MII/pH in the first weeks of life were enrolled into a clinical follow-up program. Follow-up visits were programmed at 1, 3, 6, 9, 12, 18, 24, and 36 months. Patients were divided into 3 groups according to duration of symptoms: short (1-3 months), medium (4-9 months), and long (>9 months), and MII/pH values in these groups were compared. Results: Fifty-three patients completed the 3-year follow-up. The number of patients with GERD symptoms decreased each month. A comparison of MII/pH values of the 3 lifetime symptom groups revealed differences in the impedance bolus exposure index (F = 83; P = .012) and proximal reflux frequency (F = 410; P = .022). These 2 MII variables showed an increasing trend from the short lifetime symptom group to the long lifetime symptom group. Weakly acidic reflux events, but not acidic events, were responsible for these differences. Conclusion: MII/pH in newborns has prognostic value regarding the duration of GERD symptoms and provides useful information that clinicians may give parents about the prognosis of symptomatic infants. Impedance bolus exposure index and proximal reflux frequency seem to be the variables with the highest predictive value. Weakly acidic reflux events play an important role in determining the duration of GERD symptoms in newborns. [ABSTRACT FROM AUTHOR]

Experimental studies suggest that alcohol may have protective effects similar to that of ischemic preconditioning (IPC). The acute effects of alcohol on IPC in humans, however, are poorly known. In this study, we assessed the effect of alcohol administration on the warm-up phenomenon, as an expression of IPC, in patients with stable coronary artery disease (CAD). We randomized 45 stable CAD patients with positive (ST-segment depression ≥1 mm) exercise stress test to 1 of 3 groups of 15 patients each: (1) group 1 = 60 cc of gin (18.5 g of ethanol); (2) group 2 = 180 cc of red wine (18.9 g of ethanol); and (3) group 3 = placebo (120 cc of water). A first exercise test was performed 15 minutes after beverage administration. In those with a positive exercise test (13, 14, and 14 patients in the gin, wine, and placebo groups, respectively), a second exercise test was performed 15 minutes after the end of the first one. On the first test, there were no differences among groups in rate pressure product and time of exercise at 1-mm ST-segment depression, as well as in maximal ST segment depression. Furthermore, an improvement of the ischemic exercise variables was observed in each group, without any statistically significant differences among them. In conclusion, our data show that, in stable CAD patients, the acute intake of low doses of alcohol does not significantly influence IPC, as expressed by the warm-up phenomenon on exercise stress testing. [Copyright &y& Elsevier]

Abstract: Italy was an important producer of raw asbestos until 1992 (when it was banned) and it is now experiencing severe public health consequences due to large-scale industrial use of asbestos in shipbuilding and repair, asbestos-cement production, railways, buildings, chemicals and many other industrial sectors. Latency of malignant mesothelioma generally shows a large variability and the relationship with the modality of asbestos exposure is still not fully clarified. We present an analysis of latency period among the case list collected by the Italian mesothelioma register (ReNaM) in the period of diagnosis 1993–2001 (2544 malignant mesothelioma (MM) cases with asbestos exposure history). Exposure is assessed retrospectively by interview. Statistical univariate analyses were performed to estimate median and variability measures of latency time by anatomical site, gender and diagnosis period. The role of diagnostic confidence level, the morphology of the tumour and the modalities of asbestos exposure were verified in a regression multivariate model. We found a median latency period of 44.6 years increasing in recent years with a linear trend. Anatomical site, gender and morphology were not relevant for MM latency time whereas a shorter latency period was documented among occupationally exposed subjects (43 years) with respect to environmentally and household exposed ones (48 years). [Copyright &y& Elsevier]

Abstract: Study objective: Fluid minihysteroscopy is in most cases a painless procedure. However, rarely, severe pain and side effects are reported. The goal of this study was to identify predictive factors of pain at minihysteroscopy. Design: Prospective study (Canadian Task Force classification II-2). Setting: Academic environment. Patients: Five hundred thirty-three women undergoing fluid minihysteroscopy. Interventions: Diagnostic fluid minihysteroscopy. Measurements and main results: The women were asked to score pain perception on a visual analog scale from zero (no pain) to 5 (unbearable pain). Correlation between pain at procedure and parity, previous cesarean section (PCS), menopausal status, anxiety, and chronic pelvic pain (CPP) was evaluated. Four hundred thirteen women (78%) reported no pain or discomfort (0–1 pain score, group A), while 120 (22%) experienced mild to unbearable pain (2–5 pain score, group B). Instances of PCS, CPP, anxiety, and menopause were significantly lower in group A than in group B (4% vs 82%, 0% vs 29%, 62% vs 72%, 25% vs 72%, respectively), whereas menopausal status was less frequent in group A (25.2%) than in group B (72.5%). At binary logistic regression, all the variables were independent risk factors for pain; however, when CPP was stratified for intensity, no correlation between pain at procedure and intensity of CPP was found. Conclusion: Previous cesarean section, CPP, anxiety, and menopause are predictive factors for pain perception during fluid minihysteroscopy, and history of CPP even of low intensity is predictive of pain at hysteroscopy. These patients may benefit from local anesthesia. [Copyright &y& Elsevier]

Abstract: Study objective: Chronic endometritis is a subtle condition that is difficult to detect; however, it may cause abnormal uterine bleeding and infertility. Few data exist about the appearance of chronic endometritis at fluid hysteroscopy and about the value of diagnostic fluid hysteroscopy in the detection of this condition. In our experience, at fluid hysteroscopy chronic endometritis is characterized by consistent association of stromal edema and either focal or diffuse hyperemia; in some cases, this finding is associated with endometrial micropolyps (less than 1 mm in size). This study attempted to describe diagnostic criteria for chronic endometritis at fluid hysteroscopy and assess the diagnostic accuracy of fluid hysteroscopy in the detection of this condition. Design: Retrospective Study (Canadian Task Force classification II-2). Setting: University hospital. Patients: Nine hundred-ten women in whom hysteroscopy was indicated. Interventions: Fluid hysteroscopy followed by endometrial biopsy. Measurements and main results: Sensitivity, specificity, positive and negative predictive values, and accuracy of fluid hysteroscopy in the detection of chronic endometritis, based on the association of edema; hyperemia; and, if present, micropolyps were calculated. Based on the presence of hyperemia and edema, chronic endometritis was diagnosed in 158 patients (17.4%); in 61 patients (6.7%), micropolyps also were present. Histology confirmed the diagnosis in 101 patients (63.9% of positive cases at hysteroscopy) and was positive in 9 additional cases not detected by hysteroscopy. Chronic endometritis at histology was found in approximately 30% of infertile women and 35% of cases related to abnormal uterine bleeding. The sensitivity, specificity, and positive and negative predictive values of hysteroscopy for chronic endometritis based on detection of only hyperemia and edema were 91.8%, 92.9%, 63.9%, and 98.8%, respectively; the diagnostic accuracy was 92.7 %. The combination of hyperemia, edema, and micropolyps had sensitivity, specificity, and positive and negative predictive values of 55.4%, 99.9%, 98.4%, 94.5%, respectively, with a diagnostic accuracy of 93.4%. Conclusions: Fluid hysteroscopy is very reliable in diagnosing no inflammation, while detection of micropolyps is a very reliable sign of inflammation. When performing hysteroscopy for abnormal uterine bleeding or infertility, signs of chronic endometritis should always be sought. [Copyright &y& Elsevier]

The Italian National Mesothelioma Register (ReNaM) was set up at ISPESL (the National Institute for Occupational Safety and Prevention) in 1993. Five Italian regions (Piedmont, Liguria, Emilia-Romagna, Tuscany and Puglia, with a total of approximately 17 500 000 inhabitants) agreed to record mesothelioma cases according to guidelines established by ISPESL, to define exposure to asbestos and transmit the data to ISPESL. We describe an analysis of survival of 429 mesothelioma cases—392 pleural, 34 peritoneal and 3 in the pericardium—diagnosed during 1997, with variable follow-up from June 1999 to December 2001. The Kaplan–Meier method was used to estimate survival rates, the log rank non-parametric test and Cox proportional hazard model to assess the role of prognostic factors such as age, gender, morphology, level of diagnostic certainty and modality of exposure. Median survival was 275 days (95% confidence interval (CI) 241–309) for pleural mesotheliomas and 157 days (95% CI: 118–196) for peritoneal mesotheliomas. Survival after diagnosis of malignant pleural mesothelioma showed a statistically significant linear trend for age group at diagnosis, for males and females (P=0.006 and 0.008, respectively). The Cox proportional hazard model gave an adjusted relative risk (RRadj), for the fibrous histotype, of 2.96 (95% CI: 1.28–6.81; P=0.012) compared with cases with unspecified morphology; for epithelioid and biphasic morphologies, the risk was lower than unity. There was no significant difference in survival for cases with confirmed exposure (occupational, household or environmental) or without. [Copyright &y& Elsevier]

Despite the relevance for occupational safety policies, the health effects of temperature on occupational injuries have been scarcely investigated. A nationwide epidemiological study was carried out to estimate the risk of injuries for workers exposed to extreme temperature and identify economic sectors and jobs most at risk. The daily time series of work-related injuries in the industrial and services sector from the Italian national workers' compensation authority (INAIL) were collected for each of the 8090 Italian municipalities in the period 2006–2010. Daily air temperatures with a 1 × 1 km resolution derived from satellite land surface temperature data using mixed regression models were included. Distributed lag non-linear models (DLNM) were used to estimate the association between daily mean air temperature and injuries at municipal level. A meta-analysis was then carried out to retrieve national estimates. The relative risk (RR) and attributable cases of work-related injuries for an increase in mean temperature above the 75th percentile (heat) and for a decrease below the 25th percentile (cold) were estimated. Effect modification by gender, age, firm size, economic sector and job type were also assessed. The study considered 2,277,432 occupational injuries occurred in Italy in the period 2006–2010. There were significant effects for both heat and cold temperatures. The overall relative risks (RR) of occupational injury for heat and cold were 1.17 (95% CI: 1.14–1.21) and 1.23 (95% CI: 1.17–1.30), respectively. The number of occupational injuries attributable to temperatures above and below the thresholds was estimated to be 5211 per year. A higher risk of injury on hot days was found among males and young (age 15–34) workers occupied in small-medium size firms, while the opposite was observed on cold days. Construction workers showed the highest risk of injuries on hot days while fishing, transport, electricity, gas and water distribution workers did it on cold days. Prevention of the occupational exposure to extreme temperatures is a concern for occupational health and safety policies, and will become a critical issue in future years considering climate change. Epidemiological studies may help identify vulnerable jobs, activities and workers in order to define prevention plans and training to reduce occupational exposure to extreme temperature and the risk of work-related injuries. • Health effects of extreme temperatures on occupational injuries have been scarcely investigated; • We found a significant effect of extreme temperature exposure on occupational injuries risk in Italy; • The identified pattern of susceptible workers could help regulators and governments for developing prevention measures; • Climate change scenarios suggest considering the prevention of extreme temperature occupational exposure as a priority. [ABSTRACT FROM AUTHOR]

We describe a case of osseous metaplasia into the cervical canal in a 41-year-old woman. The patient had a history of primary infertility, pelvic pain, chronic endocervicitis, and bone formation in the upper third of the cervical canal. After antibiotic therapy, we removed bone fragments by operative hysteroscopy using grasping forceps. The fragments were completely removed with no evidence of recurrence at 1-year follow-up. Chronic endocervicitis may cause endocervical ossification and should be ruled out before surgical removal of bone fragments in order to ensure definitive resolution and prevent recurrence. [Copyright &y& Elsevier]

Our understanding of the progression from clonal hematopoiesis (CH) to aggressive leukemias such as acute myelogenous leukemia enables a potential opportunity for intervention. Many mutations in CH are in genes encoding epigenetic regulators (e.g. DNMT3A, TET2 and ASXL1) presenting an opportunity for epigenetic targeted therapies to be used to prevent leukemia. However, the lack of representative human models of CH has hampered the development of effective therapeutic strategies. We have developed an in vitro competition model of TET2 loss-of-function CH that allows for chemical and genetic screening to identify key vulnerabilities. We have optimized culturing conditions to expand total CD34+ hematopoietic stem and progenitor cells (HSPCs) for up to 8-weeks. Using these culturing conditions, we knocked-out TET2 in CD34+ cells from cord blood and adult bone marrow using CRISPR-Cas9 and observed an increase in proliferation, immature phenotype (e.g. CD34+) and colony formation compared to controls. By employing distinct fluorescent markers for TET2-null (mNeonGreen) and AAVS1 control (mScarlet), we observed the competitive advantage of TET2-null cells over time by flow cytometry. We performed a chemical screen of 31 epigenetic targeting compounds using this competitive culture. This screen identified expected hits such as the known hypomethylating agents azacitidine and decitabine, as well as unique candidates that preferentially target TET2-null HSPCs. We validated two of the candidate molecules in differentiation, colony formation and in vivo murine competitive transplant assays. Furthermore, we performed a targeted CRISPR screen and identified the known target one of our candidate compounds as a top hit. This data demonstrates the feasibility of this in vitro model for scalable chemical and genetic screening to identify vulnerabilities in CH. [ABSTRACT FROM AUTHOR]

Highlights: [•] Pearling can separate the negative and positive elements of wheat kernels. [•] Pearling fractions could enrich wheat-based products of bioactive compounds. [•] Bread enriched with a 10%-pearled fraction resulted in low sanitary risk. [•] Enriched bread has shown few technological differences from the control. [Copyright &y& Elsevier]

Abstract: Objective: The study evaluates the association between subjective well-being and psychopathology in bipolar inpatients at the time of hospitalization and during a follow-up period. Method: One hundred twenty consecutive inpatients with a diagnosis of bipolar affective disorder were studied on admission (T0), at discharge (T1) and every 6 weeks for 18 weeks after hospitalization. The Young''s Mania Rating Scale (YMRS) and the Hamilton Rating Scale for Depression (HAM-D) were used to determine affective symptoms, while subjective well-being was assessed by subjective well-being under neuroleptic (SWN). Associations between SWN and HAM-D or YMRS scores and between their changes were analyzed across the different time points by using Pearson correlation coefficients. Linear regression models were constructed using SWN as the dependent variable and demographic and clinical characteristics as possible predictors. Results: At baseline, depression explained 24% and mania explained an additional 16% of baseline SWN variance. Changes in SWN and HAM-D total score displayed an inverse correlation during hospitalization and follow-up. End point severity of depression was associated with the end point SWN total score explaining additional 26% of SWN total score variance, whereas severity of mania was inversely associated with SWN total score. Conclusion: Data of this study provide further support for the need to consider the subjective well-being as a personal variable associated to psychopathological state in bipolar patients. However, results seem to be in line with authors who suggest to use other subjective quality of life scales in acute mania. [Copyright &y& Elsevier]

Early surgical intervention improves the outcome of patients with mitral regurgitation (MR) secondary to flail leaflet. Current criteria for the diagnosis of flail leaflet require a detailed definition of mitral valve anatomy, which is often challenging by transthoracic echocardiography (TTE) and, occasionally, even by transesophageal echocardiography (TEE). We studied 57 patients (mean age 63 +/- 15 years) with anatomically confirmed flail mitral leaflet and a control group of 57 patients (mean age 68 +/-14 years) with at least moderate MR but no flail leaflet. In patients with flail mitral leaflet, the mean angle formed by the axis of the MR jet and the plane of the mitral annulus was 33 +/- 11 degrees and 29 +/- 16 degrees when measured with TTE and TEE, respectively. In controls the mean angle was 66 +/- 16 degrees and 66 +/- 17 degrees by TTE and TEE, respectively (p <0.0001). Based on receiver- operating characteristic analysis, the optimal cutoff jet angle value for diagnosing flail mitral leaflet was 45 degrees with TTE (sensitivity 88%, specificity 88%), and 47 degrees by TEE (sensitivity 88%, specificity 88%). MR jet angles < or =45 degrees were also correctly identified by visual assessment of TTE images in >90% of cases, with good interobserver agreement (k = 0.76). Thus, quantitative analysis of MR jet eccentricity by color flow Doppler is highly sensitive and specific for diagnosing flail mitral leaflet. [ABSTRACT FROM AUTHOR]

Climate change is increasingly affecting human well-being and will inevitably impact on occupational sectors in terms of costs, productivity, workers' health and injuries. Among the cooling garment developed to reduce heat strain, the ventilation jacket could be considered for possible use in workplaces, as it is wearable without limiting the user's mobility and autonomy. In this study, simulations with a sweating manikin are carried out to investigate the effects of a short-sleeved ventilation jacket on human thermophysiological responses in a warm-dry scenario. Simulations were performed in a climatic chamber (air temperature = 30.1 °C; air velocity = 0.29 m/s; relative humidity = 30.0 %), considering two constant levels of metabolic rate M (M 1 = 2.4 MET; M 2 = 3.2 MET), a sequence of these two (Work), and three levels of fan velocities (l f = 0; l f = 2 ; l f = 4). The results revealed a more evident impact on the mean skin temperature (T s k ) compared to the rectal temperature (T r e) , with significant decreases (compared to fan-off) at all M levels, for T s k from the beginning and for T r e from the 61st minute. Skin temperatures of the torso zones decreased significantly (compared to fan-off) at all M levels, and a greater drop was registered for the Back. The fans at the highest level (l f = 4) were significantly effective in improving whole-body and local thermal sensations when compared to fan-off, at all M levels. At the intermediate level (l f = 2), the statistical significance varied with thermal zone, M and time interval considered. The results of the simulations also showed that the Lower Torso needs to be monitored at M 2 level, as the drop in skin temperature could lead to local overcooling and thermal discomfort. Simulations showed the potential effectiveness of the ventilation jacket, but human trials are needed to verify its cooling power in real working conditions. • Simulations on a sweating manikin to evaluate the effectiveness of a ventilation jacket. • A more evident impact on the mean skin temperature than on the rectal temperature. • Significant decrease in trunk skin temperatures: a greater drop recorded in the Back. • Significantly improved whole-body and local sensations at the highest fan velocity. • Lower Trunk temperature drop needs to be monitored: it can lead to thermal discomfort. [ABSTRACT FROM AUTHOR]

Abstract Background The World Health Organization (WHO) and the International Labour Organization (ILO) are developing a joint methodology for estimating the national and global work-related burden of disease and injury (WHO/ILO joint methodology), with contributions from a large network of experts. In this paper, we present the protocol for two systematic reviews of parameters for estimating the number of deaths and disability-adjusted life years from stroke attributable to exposure to long working hours, to inform the development of the WHO/ILO joint methodology. Objectives We aim to systematically review studies on occupational exposure to long working hours (called Systematic Review 1 in the protocol) and systematically review and meta-analyse estimates of the effect of long working hours on stroke (called Systematic Review 2), applying the Navigation Guide systematic review methodology as an organizing framework, conducting both systematic reviews in tandem and in a harmonized way. Data sources Separately for Systematic Reviews 1 and 2, we will search electronic academic databases for potentially relevant records from published and unpublished studies, including Medline, EMBASE, Web of Science, CISDOC and PsychINFO. We will also search electronic grey literature databases, Internet search engines and organizational websites; hand-search reference list of previous systematic reviews and included study records; and consult additional experts. Study eligibility and criteria We will include working-age (≥15 years) workers in the formal and informal economy in any WHO and/or ILO Member State, but exclude children (<15 years) and unpaid domestic workers. For Systematic Review 1, we will include quantitative prevalence studies of relevant levels of occupational exposure to long working hours (i.e. 35–40, 41–48, 49–54 and ≥55 h/week) stratified by country, sex, age and industrial sector or occupation, in the years 2005–2018. For Systematic Review 2, we will include randomized controlled trials, cohort studies, case-control studies and other non-randomized intervention studies with an estimate of the relative effect of a relevant level of long working hours on the incidence of or mortality due to stroke, compared with the theoretical minimum risk exposure level (i.e. 35–40 h/week). Study appraisal and synthesis methods At least two review authors will independently screen titles and abstracts against the eligibility criteria at a first stage and full texts of potentially eligible records at a second stage, followed by extraction of data from qualifying studies. At least two review authors will assess risk of bias and the quality of evidence, using the most suited tools currently available. For Systematic Review 2, if feasible, we will combine relative risks using meta-analysis. We will report results using the guidelines for accurate and transparent health estimates reporting (GATHER) for Systematic Review 1 and the preferred reporting items for systematic reviews and meta-analyses guidelines (PRISMA) for Systematic Review 2. PROSPERO registration number: CRD42017060124. Highlights • WHO and ILO are developing a joint methodology for estimating the national and global work-related burden of disease and injury • A large network of experts is contributing to this WHO/ILO joint methodologywith two systematic reviews described in this protocol. • The authors will systematically review studies on occupational exposure to long working hours (Systematic Review 1). • They will also systematically review and meta-analyse estimates of the effect of long working hours on stroke (Systematic Review 2). • The authors will develop both systematic reviews in tandem and in a harmonized way, using the Navigation Guide systematic review methodology as an organizing framework. [ABSTRACT FROM AUTHOR]

Energy storage technologies are required to make full use of renewable energy sources, and electrochemical cells offer a great deal flexibility in the design of energy systems. For large scale electrochemical storage to be viable, the materials employed and device production methods need to be low cost, devices should be long lasting and safety during operation is of utmost importance. Energy and power densities are of lesser concern. For these reasons, battery chemistries that make use of aqueous electrolytes are favorable candidates where large quantities of energy need to be stored. Herein we describe several different aqueous based battery chemistries and identify some of the research challenges currently hindering their wider adoption. Lead acid batteries represent a mature technology that currently dominates the battery market, however there remain challenges that may prevent their future use at the large scale. Nickel–iron batteries have received a resurgence of interest of late and are known for their long cycle lives and robust nature however improvements in efficiency are needed in order to make them competitive. Other technologies that use aqueous electrolytes and have the potential to be useful in future large-scale applications are briefly introduced. Recent investigations in to the design of nickel–iron cells are reported with it being shown that electrolyte decomposition can be virtually eliminated by employing relatively large concentrations of iron sulfide in the electrode mixture, however this is at the expense of capacity and cycle life. [ABSTRACT FROM AUTHOR]

• 185,000 Nationwide occupational injuries in construction sector were analyzed; • A significant association of occupational injuries with high temperatures was found; • Occupation injuries among construction workers increased during heat waves; • Workers operating with hand-held tools, machine and handling of objects were at risk; • Construction, quarry and industrial sites were the work environments most at risk. Extreme temperatures have impact on the health and occupational injuries. The construction sector is particularly exposed. This study aims to investigate the association between extreme temperatures and occupation injuries in this sector, getting an insight in the main accidents-related parameters. Occupational injuries in the construction sector, with characteristic of accidents, were retrieved from Italian compensation data during years 2014–2019. Air temperatures were derived from ERA5-land Copernicus dataset. A region based time-series analysis, in which an over-dispersed Poisson generalized linear regression model, accounting for potential non-linearity of the exposure- response curve and delayed effect, was applied, and followed by a meta -analysis of region-specific estimates to obtain a national estimate. The relative risk (RR) and attributable cases of work-related injuries for an increase in mean temperature above the 75th percentile (hot) and for a decrease below the 25th percentile (cold) were estimated, with effect modifications by different accidents-related parameters. The study identified 184,936 construction occupational injuries. There was an overall significant effect for high temperatures (relative risk (RR) 1.216 (95% CI: (1.095–1.350))) and a protective one for low temperatures (RR 0.901 (95% CI: 0.843–0.963)). For high temperatures we estimated 3,142 (95% CI: 1,772–4,482) attributable cases during the studied period. RRs from 1.11 to 1.30 were found during heat waves days. Unqualified workers, as well as masons and plumbers, were found to be at risk at high temperatures. Construction, quarry and industrial sites were the risky working environments, as well as specific physical activities like working with hand-held tools, operating with machine and handling of objects. Contact with sharp, pointed, rough, coarse 'Material Agent' were the more risky mode of injury in hot conditions. Prevention policies are needed to reduce the exposure to high temperatures of construction workers. Such policies will become a critical issue considering climate change. [ABSTRACT FROM AUTHOR]