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In this study, virological surveillance focused on coronaviruses in marmots in the Alpine region in 2022, captured as part of a population control reduction program in the Livigno area. Seventy-six faecal samples were randomly collected from marmots at the time of capture and release and tested for genome detection of pan-coronavirus, pan-pestivirus, canine distemper virus, and influenza A and D virus. Nine faecal samples were positive in the Pan-CoV RT-PCR, while all were negative for the other viruses. Pan-coronavirus positives were further identified using Illumina’s complete genome sequencing, which showed the highest homology with Bovine Coronavirus previously detected in roe deer in the Alps. Blood samples (n.35) were collected randomly from animals at release and tested for bovine coronavirus (BCoV) antibodies using competitive ELISA and VNT. Serological analyses revealed that 8/35 sera were positive for BCoV antibodies in both serological tests. This study provides molecular and serological evidence of the presence of BCoV in an alpine marmot population due to a likely spillover event. Marmots share areas and pastures with roe deer and other wild ruminants, and environmental transmission is a concrete possibility.

Small colon impaction can result in accumulation of ingesta, gas, and fluid orally to the impaction site in horses. Large colon tympany, which is caused by ingesta fermentation, can be a predisposing factor for intestinal displacement. The aim of this study is to report the history, clinical, and surgical findings of horses and ponies referred for abdominal pain not responsive to drugs where a right dorsal displacement (RDD) or large colon volvulus (LCV), together with a small colon faecalith (SCF), were diagnosed during surgery. This study included a total of five horses and five ponies. Based on clinical features, ultrasonographic examination, and rectal palpation, an initial suspected diagnosis of RDD, LCV or severe large colon and caecum distension was made in all clinical cases. Due to the lack of response to medical treatment or worsening of colic symptoms, surgery was performed in all horses: diagnosis of RDD or LCV was made and a SCF was incidentally detected in all cases. While exploratory laparotomy was carried out in all the patients for the presence of a large colon issue, it was probably subsequent to an obstruction of the small colon caused by the presence of an SCF, which is generally difficult to diagnose. This study reported the presence of SCF as a possible cause of secondary RDD or LCV in horses and ponies that, to the authors’ knowledge, has never been reported.

The COVID-19 epidemic has changed patients’ approach to dental treatments. While dentists worldwide have shown an excellent level of adaptability to face the new challenges presented by the unprecedented situation due to the rapid spread of COVID-19, dental patients have witnessed a sudden suspension of elective treatments and a slow resumption of dental care activities after several national lockdowns. In addition, the general climate of anxiety and fear due to the high COVID-19 risk and the high level of mortality has influenced the perception and attitudes of people towards dental activity, inducing many dental patients to avoid appointments to the dentist if not highly urgent. We present an overview of the current state of knowledge about dental patients’ perception, perspective, attitude, and expectations towards a full resumption of regular dental treatments.

The management (diagnostic and therapeutic) of cancer in the geriatric population involves a number of complex difficulties. The aim of this study was to assess the impact of a medical specialty on the diagnostic and therapeutic management of elderly cancer patients. Four clinical scenarios of cancer in the geriatric population, with a dedicated survey to gather information regarding each clinical case’s diagnostic and therapeutic approaches, as well as the different criteria influencing physicians’ therapeutic decisions, were exposed to geriatricians, oncologists, and radiotherapists in Saint-Etienne. The surveys were filled out by 13 geriatricians, 11 oncologists, and 7 radiotherapists. There was a homogeneity of responses regarding the confirmation of cancer diagnostics in the elderly. There were strong disparities (inter- and intra-specialties) for several clinical situations regarding the therapeutic management of cancer. There were significant disparities in terms of surgical management, the implementation of a chemotherapy protocol, and the adaptation of the chemotherapy dosage. Contrary to oncologists, who primarily consider the G8 and the Karnofsky score, geriatric autonomy scores and frailty with cognitive assessment were the key factors determining diagnostic/therapeutic therapy for geriatricians. These results raise important ethical questions, requiring specific studies in geriatric populations to provide the homogenous management of elderly patients with cancer.

The occurrence of colic could be influenced by the characteristics of a population, geographical area, and feeding management. The aim of this study was to report the short-term postoperative complications and survival rates and to identify factors that might affect the outcome of horses that underwent colic surgery in three Italian surgical referral centres. Data of horses subjected to colic surgery in three referral centres (2018–2021) were analysed. Comparisons of the outcomes were performed using a Mann–Whitney or a Chi square test. Areas under the receiver operating characteristic (ROC) curve and multivariable logistic regression analysis were used for parameters that were significant in the previous univariate analysis. The goodness-of-fit of the model was assessed using the Akike information criterion (AIC). Significance was defined as p < 0.05, and odds ratios and 95% confidence intervals were calculated as percentages. A total of 451 horses were included. The survival rate was 68.5% of all of the horses that underwent colic surgery and 80% of the horses surviving anaesthesia. Age, BCS, PCV and TPP before and after surgery, amount of reflux, type of disease, type of lesion, duration of surgery, surgeon’s experience, and amount of intra- and postoperative fluids administered influenced the probability of short-term survival. The multivariate analysis revealed that PCV at arrival, TPP after surgery, and BCS had the highest predictive power. This is the first multicentre study in Italy. The results of this study may help surgeons to inform owners regarding the prognosis of colic surgery.

Patients with chronic cardiopulmonary pathologies have an increased risk of developing venous thromboembolic events. The worsening of dyspnoea is a frequent occurrence and often leads patients to consult the emergency department. Pulmonary embolism can then be an exacerbation factor, a differential diagnosis or even a secondary diagnosis. The prevalence of pulmonary embolism in these patients is unknown, especially in cases of chronic heart failure. The challenge lies in needing to carry out a systematic or targeted diagnostic strategy for pulmonary embolism. The occurrence of a pulmonary embolism in patients with chronic cardiopulmonary disease clearly worsens their prognosis. In this narrative review, we study pulmonary embolism and chronic obstructive pulmonary disease, after which we turn to pulmonary embolism and chronic heart failure.

This paper investigates the determinants of mathematics performance by gender, exploiting a multilevel random forest approach. OECD PISA 2018 data from 28 European countries are employed to explore the performance of male and female students as a function of students’ family characteristics, their attitudes towards education, and class and school environment. Results show that the gender gap in favour of boys persists in most European countries. However, teacher and school practices like fostering student reading and creating a cooperative environment allow mitigating the influence of family background in countries without gender gap. Policy implications to foster performance equality are provided.

The potential cardiovascular effects of e-cigarettes remain largely unidentified and poorly understood. E-liquids contain numerous chemical compounds and can induce exposure to potentially toxic ingredients (e.g., nicotine, flavorings, etc.). Moreover, the heating process can also lead to the formation of new thermal decomposition compounds that may be also hazardous. Clinical as well as in vitro and in vivo studies on e-cigarette toxicity have reported potential cardiovascular damages; however, results remain conflicting. The aim of this study was to assess, in vitro, the toxicity of e-liquids and e-cigarette aerosols on human aortic smooth muscle cells. To that purpose, cells were exposed either to e-liquids or to aerosol condensates obtained using an e-cigarette device at different power levels (8 W or 25 W) to assess the impact of the presence of: (i) nicotine, (ii) cinnamon flavor, and (iii) thermal degradation products. We observed that while no cytotoxicity and no ROS production was induced, a pro-inflammatory response was reported. In particular, the production of IL-8 was significantly enhanced at a high power level of the e-cigarette device and in the presence of the cinnamon flavor (confirming the suspected toxic effect of this additive). Further investigations are required, but this study contributes to shedding light on the biological effects of vaping on the cardiovascular system.

Anticoagulant drugs antagonize coagulation and are used to prevent or cure (recurrent) venous thromboembolism (VTE). Drugs to prevent clotting have been used for more than a century, and, nowadays, physicians possess a broad panel of multiple anticoagulants to meet the individual needs of a patient. Within this review, we aimed to revise the history of the different anticoagulants that are currently prescribed in the clinic. In addition, we compared their pharmacological properties, medical indications, and the difficulties in implementing new anticoagulants in vulnerable patient populations. Since the introduction of unfractionated heparin in the 1930s, major advances in the mechanistic understanding and the medical use of anticoagulants have allowed for significant improvements to treat VTE patients. However, a new generation of anticoagulants is currently being tested in clinical trials, with the goal of further optimizing medical care.

(1) Background: In endodontics, anatomical complexities and irregularities in the root canal system may interfere with sealer penetration, increasing the risk of treatment failure. This work aimed to investigate the effects of sonicated Thermafil (Dentsply, Tulsa Dental Specialties, Johnson City, TN, USA) on sealer penetration into the dentinal tubules. (2) Methods: Thirty teeth with single round-shaped root canals were used to compare Sonicated Thermafil with sonication (ST—10 teeth), System B (EIE Analytical Technology, Orange, CE, USA) (SB—10 teeth), and Thermafil without sonication (T—10 teeth). A confocal laser scanning microscope (CLSM) was used to determine the depth, area, and percentage of sealer penetration into the dentinal tubules. (3) Results: ST showed the deepest average penetration at 6 mm from the apex compared to SB (p < 0.01) and T (p < 0.01) and at 3 mm compared to SB (p < 0.01). In addition, it had the highest penetration values at both levels compared to SB (p < 0.01) and T (p < 0.05) and a higher penetration area at 6 mm compared to T (p < 0.05) and SB (p < 0.05). (4) Conclusion: Sonic activation can improve the carrier-based obturation technique thanks to deeper sealer penetration and thus better retention of materials.

(1) Background: To improve endodontic treatments, it is necessary to find good irrigant solutions that balance potential toxic effects with optimal antimicrobial capacity. The aim of this laboratory study was to assess the cytotoxic and antimicrobial capacity of phytic acid (IP6) and BioAktTM in a laboratory setting to determine their suitability prior to endodontic evaluation. (2) Methods: The antimicrobial and cytotoxic effects of IP6 and BioAktTM were compared with those of 1.5% NaOCl. Cytotoxicity was evaluated via crystal violet assay and CellTiter-Glo® 2.0 assay, while antimicrobial capacity was tested via disk diffusion and the effect of a 1-h treatment on Enterococcus faecalis. (3) Results: A crystal violet test and CellTiter-Glo® 2.0 assay showed statistically significant differences in cell viability and cell activity after 4 and 24 h for all tested solutions (p < 0.05). The antimicrobial activity of BioAktTM was similar to that of 1.5% NaOCl, while phytic acid showed the lowest antimicrobial activity compared to BioAktTM (p < 0.05) and 1.5% NaOCl (p < 0.05). (4) Conclusion: BioAktTM showed an optimal balance between antimicrobial activity and cytotoxicity.

Hypochlorite accidents are relatively rare events. Therefore, there is a lack of precise and accurate reports in the scientific literature that could help clinicians better understand the phenomenon and associated risk factors. This study reported four hypochlorite accidents attributable to 5% NaOCl extrusion in patients who had undergone treatment of the maxillary elements canal treatments. In all cases, the accidents occurred during the irrigation phase and were characterised by intracanal bleeding, ecchymosis, and swelling on the hemiface corresponding to the treated tooth. Antibiotics, paracetamol, NSAID, corticosteroids, and cold or warm compresses for oedema were prescribed to treat the symptoms of the accidents. Significant improvement of symptoms was observed in all patients after 5–6 days. Anatomic risk factors such as apical fenestration, root perforation, and large foramina were identified as possible risk factors for the accidents. After the accidents, clinicians applied endodontic procedures for which there is no scientific evidence to continue endodontic treatments, such as changing the type of irrigant or the irrigation method. Our results suggest that using a standardised approach to document each hypochlorite accident will allow researchers to collect more accurate and detailed data that can subsequently be used to identify potential risk factors and better manage the symptomatology of hypochlorite accidents.

Pulmonary embolism is a frequent and potentially fatal disease. The major challenge of initial management lies in prognostic stratification. Since 2014, the European recommendations on the diagnosis and management of acute pulmonary embolism are based on assessing the risk stratification regarding hemodynamic status first, then on a combined risk assessment model using a clinical score, an imaging evaluation of right heart size and the concentration of a serum cardiac biomarker. Usual biomarkers cover cardiac ischemia (troponin and derivates) and dilatation (BNP and derivates). The aim of this review is to offer a practical update on the role of the Troponins and BNPs families of biomarkers and the prognosis of pulmonary embolism, and furthermore, to provide a brief overview of their place in current management.

In Winter 2020, Italy, and in particular the Lombardy region, was the first country in the Western hemisphere to be hit by the COVID-19 pandemic. Plasma from individuals recovered from COVID-19 (COVID-19 convalescent plasma, CCP) was the first therapeutic tool adopted to counteract the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). In this retrospective cohort study, we report the experience of the city hospital of Mantua, Lombardy region, on the compassionate use of CCP in patients hospitalized for severe COVID-19. Between April 2020 and April 2021, 405 consecutive COVID-19 patients received 657 CCP units with a median anti-SARS-CoV-2 neutralizing antibody (nAb) titer of 160 (interquartile range (IQR), 80–320). Their median age was 68 years (IQR, 56–78 years), and 62% were males. At enrollment, 55% of patients had an increased body mass index (BMI), and 25.6% had at least three comorbidities. The 28-day crude mortality rate was 12.6% (51/405). Young age (

Hepatitis B virus-related hepatocellular carcinoma recurrence after liver transplantation (LT) is notoriously difficult to manage and fatal. As a therapeutic option, adoptive cell therapy with HBV-specific TCR-redirected T cells could be employed to target and control relapses in these patients. However, indispensable immunosuppressive medications post-transplantation can significantly hinder the optimum efficacy of such therapy in the clinic. Here we report a new class of Armored TCR T cells which are able to attack recurrent cancer cells in liver transplanted recipients, while temporarily evading immunosuppressant drugs. We believe this strategy could open up new opportunities for treating pathologies under immunosuppressant treatment.

Background: After the first lockdown, Italian dentists resumed their practice while handling several challenges. Reducing contagion risk by complying with the stringent measures recommended by the Italian Ministry of Health for dental activity while also balancing patient needs was a difficult task. This work aims to understand the procedures that were adopted in the second phase of the COVID-19 pandemic (5 May–30 September 2020) and the dentists’ expectations and concerns about returning to normalcy. Methods: A national survey with 38 questions was conducted from November 2020 to January 2021 and comparisons were performed among the five main Italian geographic areas. Results: Located mainly in northwest Italy, 1028 dentists were included in the survey. About 83% of the Italian dentists fully restarted their activities after the lockdown. The resumption was significantly marked in North Italy and the Center than in the South (p < 0.01). Over 80% adopted the recommended precautional guidelines, modifying them according to the specific dental treatment executed. Fifty percent of dentists were confident in returning to normalcy after the COVID-19 crisis. Many precautions adopted during the pandemic will be continued, especially in South Italy and the Islands (p < 0.01). Conclusions: Italian dentists reported excellent autonomous organizational skills and the maintaining of high-quality precautions during the reopening phase.

Teratoma is a rare germ cell testicular cancer composed of cells that are not normally present in the site where it originates. These tumors are rarely described in horses, where they may develop due to cryptorchidism. Teratomas consist of cells originating from different germinal layers, arising from germinal multi-potential cells with differentiation defects, and can simultaneously contain several tissues from two or more embryonic layers. Testicular teratomas are described in horses, cats, dogs, wild boars, bulls, and humans. In the rare descriptions found in literature of testicular teratoma in stallions, they occur frequently in cryptorchid testicles, as a consequence of congenital neoplasm. To our knowledge there is no other report of a dentigerous equine teratoma in a stallion. We describe here a successful laparoscopic removal of a testicular teratoma and its clinic-pathological features.

Nephrosplenic space (NSS) ablation has been demonstrated to be an effective technique for prevention of left dorsal displacement of the large colon and multiple laparoscopic techniques, among which ablation with mesh or with a barbed suture, have been proposed. Our objective was to compare two laparoscopic techniques for closure of the NSS in twenty-eight horses diagnosed with nephrosplenic entrapment. Medical records of horses that had laparoscopic NSS ablation in two referral centers between 2017–2019 were retrieved. Duration of surgery, complications, and short- and long-term follow-up information were collected and compared. Costs were also calculated and compared. All horses met the inclusion criteria: 9 had NSS ablation with a mesh implant (group M), 19 with barbed suture material (group B). One horse in group B had recurrent colic after discharge. At control laparoscopy after 5 months, the NSS resulted in still not being ablated because of a failure of the suture. In group M, three horses had recurrent colic. One was successfully treated medically, one died of unknown causes and the third required a second laparoscopic suturing at 3–6 months because of failure of the mesh implant. The mean time of surgery and costs were lower in group B compared to group M. The barbed suture technique was faster, more cost-effective and had a lower complication rate than the mesh implant.

Canine distemper (CD) is a fatal, highly contagious disease of wild and domestic carnivores. In the Alpine territory, several outbreaks have occurred in the past few decades within wild populations. This study investigated the presence of canine distemper virus (CDV) infections in wild carnivores in Lombardy, relating to the different circulating genotypes. From 2018 to 2020, foxes, badgers, and martens collected during passive surveillance were subjected to necropsy and histological examination, showing classical signs and microscopic lesions related to CDV. Pools of viscera from each animal were analysed by molecular methods and immunoelectron microscopy. Total prevalences of 39.7%, 52.6%, and 14.3% were recorded in foxes, badgers, and stone martens, respectively. A phylogenetic analysis showed that the sequences obtained belonged to the European 1 lineage and were divided into two different clades (a and b) according to the geographical conformation of alpine valleys included in the study. Clade a was related to the European outbreaks originating from Germany in 2006–2010, while clade b was closely related to the CDV sequences originating from northeastern Italy during the 2011–2018 epidemic wave. Our results suggest that CDV is currently well adapted to wild carnivores, mostly circulating with subclinical manifestations and without severe impact on the dynamics of these populations.

Staphylococcal food poisoning (SFP) is one of the most important foodborne diseases. This work describes a SFP event linked to the consumption of alm cheese and involved three people belonging to the same family. Leftovers of the consumed cheese, samples from the grocery store and the producing alm were collected and tested for Coagulase positive staphylococci (CPS) enumeration and for the presence of staphylococcal enterotoxins (SEs). Isolates were typed with MLST, spa typing, and tested for SEs and methicillin resistance genes. An in vitro test evaluated SEs production in relation to bacterial growth. The presence of CPS and SEs was detected in all cheese samples and all isolates belonged to the same methicillin sensitive ST8/t13296 strain harbouring sed, ser and sej genes. The in vitro test showed the production of enterotoxins started from 105 CFU/mL. The farmer was prescribed with corrective actions that led to eradication of the contaminating strain.

Human immunodeficiency virus 1 (HIV-1) infection is a global health issue since neither a cure nor a vaccine is available. However, the highly active antiretroviral therapy (HAART) has improved the life expectancy for patients with acquired immunodeficiency syndrome (AIDS). Nucleoside reverse transcriptase inhibitors (NRTIs) are in almost all HAART and target reverse transcriptase (RT), an essential enzyme for the virus. Even though NRTIs are highly effective, they have limitations caused by RT resistance. The main mechanisms of RT resistance to NRTIs are discrimination and excision. Understanding the molecular mechanisms for discrimination and excision are essential to develop more potent and selective NRTIs. Using protein X-ray crystallography, we determined the first crystal structure of RT in its post-catalytic state in complex with emtricitabine, (-)FTC or stavudine (d4T). Our structural studies provide the framework for understanding how RT discriminates between NRTIs and natural nucleotides, and for understanding the requirement of (-)FTC to undergo a conformation change for successful incorporation by RT. The crystal structure of RT in post-catalytic complex with d4T provides a “snapshot” for considering the possible mechanism of how RT develops resistance for d4T via excision. The findings reported herein will contribute to the development of next generation NRTIs.

The successful control of HBV infection requires an efficient expansion of distinct elements of the adaptive immune system (B cells, helper and cytotoxic T cells) that, due to the hepatotropic nature of HBV, need to operate in the liver parenchyma. In this respect, we will discuss broad features of HBV immunity in patients with resolved or chronic HBV infection and analyze how the liver environment can directly modulate HBV-immunity.

Chronic infection with hepatitis B virus (HBV) progresses through multiple phases, including immune tolerant, immune active, immune control, and, in a subset of patients who achieve immune control, reactivation. The first, the immune tolerant phase, is considered to be prolonged in duration but essentially benign in nature, lacking long-term consequences, and thus not recommended for antiviral therapy. This review challenges the notion that the immune tolerant phase is truly benign and considers the possibility that events during this phase may contribute significantly to cirrhosis, hepatocellular carcinoma (HCC), and the premature death of 25% of HBV carriers worldwide. Thus, earlier treatment than recommended by current guidelines should be considered. Low therapeutic coverage exacerbated by restrictive treatment guidelines may facilitate disease progression in many patients but also increase the risk of neonatal and horizontal transmission from untreated mothers to their children. While a prophylactic vaccine exists, there are many areas worldwide where the treatment of adults and the delivery of an effective vaccination course to newborns present difficult challenges.