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In this paper 5 different case studies of solar hybrid heating and cooling networks serving 5 different school buildings assumed as representative of the 5 provinces of the Campania region (southern Italy) have been modelled, dynamically simulated and analyzed by means of the software TRNSYS over a 5-year period. The plants are based on the operation of solar thermal collectors coupled with a seasonal borehole thermal energy storage; the solar field is also integrated with photovoltaic panels coupled with an electric energy storage; a solar-powered adsorption system is used for covering the cooling requirements. Specific weather data files have been developed for each city based on 1-year in-situ hourly measurements to accurately take into account the influence of climatic conditions on systems’ performance; the effects of thermo-physical properties of underground associated to the different locations have also been taken into consideration according to measured data available in the literature. The proposed systems have been compared with conventional Italian heating and cooling plants from energy, environmental and economic points of view in order to assess the potential benefits, highlight the effects of both weather data and characteristics of underground as well as promote the diffusion of solar systems for Italian applications.

Anthracyclines are widely used in anticancer protocols, but can induce cardiotoxicity by mechanisms that mainly involve oxidative damage and mitochondrial dysfunction. Radiotherapy can also impair cardiac function by promoting myocardial fibrosis, microvascular damage and decreased density of myocardial capillaries. Hence, we aim at investigating prospectively whether radiotherapy impacts heart function in lymphoma patients who had been already treated with anthracyclines. Twenty-nine consecutive patients with Hodgkin or non-Hodgkin lymphomas underwent echocardiography at baseline (before antineoplastic treatments), and then every two months, until 6 months after treatments completion. Echo evaluation included standard 2D and Speckle Tracking. Twenty-two patients treated with anthracycline-based regimens were eligible. Out of the 22 patients, 8 received chemotherapy only (subgroup 1), while 14 underwent radiotherapy after chemotherapy (subgroup 2). At the end of chemotherapy, ejection fraction was significantly reduced in the whole population. At 6 months after completion of therapies, E/E' increased and Global Longitudinal Strain was compromised in subgroup 2, suggesting additional damage induced by radiotherapy after chemotherapy. On the basis of the data from our small prospective study we can hypothesize that in lymphoma patients anthracyclines can worsen cardiac function, and radiotherapy may have an additional unfavorable myocardial impact.

Covance Drug Development produces more than 55 million test results via its central laboratory services, requiring the delivery of more than 10 million reports annually to investigators at 35,000 sites in 89 countries. Historically, most of these data were delivered via fax or electronic data transfers in delimited text or SAS transport file format. Here, we present a new web portal that allows secure online delivery of laboratory results, reports, manuals, and training materials, and enables collaboration with investigational sites through alerts, announcements, and communications. By leveraging a three-tier architecture composed of preexisting data warehouses augmented with an application-specific relational database to store configuration data and materialized views for performance optimizations, a RESTful web application programming interface (API), and a browser-based single-page application for user access, the system offers greatly improved capabilities and user experience without requiring any changes to the underlying acquisition systems and data stores. Following a 3-month controlled rollout with 6,500 users at early-adopter sites, the Xcellerate Investigator Portal was deployed to all 240,000 of Covance’s Central Laboratory Services’ existing users, gaining widespread acceptance and pointing to significant benefits in productivity, convenience, and user experience.

An elderly patient with head injury was registered to the emergency room. Because the patient arrived to the hospital unconscious, her cranial, cerebrovascular, and cardiac function was studied. The cardiac function measurements were (i) heart rate, (ii) blood pressure, (iii) oxygen saturation level, (iv) electrocardiogram (ECG), (v) coronary angiogram, (vi) chest computerized tomography (CT), and (vii) echocardiogram. The head damage was studied by cerebral CT and magnetic resonance imaging (MRI). The serum ischemia and inflammatory biomarkers were analysed. For the immediate treatment, the patient received cardiovascular system supporting medication. The cardiac diagnostic results were (i) the ECG suggested an elevation in the left ventricular systolic function, (ii) the blood test showed neutrophilia, increased creatine and increased troponin I kinase values, and (iii) the coronary angiogram and ECG analysis demonstrated a lack of a myocardial infarction but identified apical akinesia. The patient did not have previous symptoms of cardiovascular disease. The brain imaging demonstrated (iv) an acute ischemia in the left occipital area and (v) increased intracranial pressure. Brain MRI indicated (vi) aqueductal stenosis and (vii) multiple gliomatotic foci demonstrating hydrocephalus caused by gliomatosis cerebri. A chest CT indicated (viii) chronic obstructive pulmonary disease (COPD). One week later, the patient died because of cardiac arrest. The diagnosis was Takotsubo syndrome enforced by gliomatosis cerebri and COPD. To our knowledge, this is the first reported case in which the cardiac dysfunction of the patient is associated with gliomatosis cerebri‐derived hydrocephalus and increased intracranial pressure that together with COPD may have enhanced the negative clinical outcome.

Background Idiopathic Pulmonary Fibrosis (IPF) is an aggressive interstitial lung disease with an unpredictable course. Occupational dust exposure may contribute to IPF onset, but its impact on antifibrotic treatment and disease prognosis is still unknown. We evaluated clinical characteristics, respiratory function and prognostic predictors at diagnosis and at 12 month treatment of pirfenidone or nintedanib in IPF patients according to occupational dust exposure. Methods A total of 115 IPF patients were recruited. At diagnosis, we collected demographic, clinical characteristics, occupational history. Pulmonary function tests were performed and two prognostic indices [Gender, Age, Physiology (GAP) and Composite Physiologic Index (CPI)] calculated, both at diagnosis and after the 12 month treatment. The date of long-term oxygen therapy (LTOT) initiation was recorded during the entire follow-up (mean = 37.85, range 12–60 months). Results At baseline, patients exposed to occupational dust [≥ 10 years (n = 62)] showed a lower percentage of graduates (19.3% vs 54.7%; p = 0.04) and a higher percentage of asbestos exposure (46.8% vs 18.9%; p 0.002) than patients not exposed [

A solar hybrid district heating network integrated with a seasonal borehole thermal energy storage is dynamically simulated and analyzed over a 5-year period. The system is devoted to satisfying the space heating and domestic hot water requirements of a small-scale district consisting of 6 typical Italian single-family houses, located in Naples, with home charging of 6 plug-in electric vehicles. Eight different plant schemes differing in terms of solar field configuration and/or back-up system used for compensating the intermittency of solar source are investigated. Two different configurations of solar field are analyzed: the first one with solar thermal collectors only and the second one integrating solar thermal collectors and photovoltaic panels coupled with a battery storage; three different alternative auxiliary units are considered: natural gas-fired boiler, natural gas-fueled internal combustion engine-based micro-cogeneration unit and wood pellet boiler. An additional operating scheme is also proposed to better exploit the solar energy for domestic hot water production. The primary energy consumption, the carbon dioxide emissions and the operating costs of the proposed plant configurations are evaluated based on simulation results and then compared with those associated to a conventional decentralized heating system in order to assess the main energy, environmental and economic benefits/drawbacks.

Objective We present a new system to track, manage, and report on all risks and issues encountered during a clinical trial. Materials and Methods Our solution utilizes JIRA, a popular issue and project tracking tool for software development, augmented by third-party and custom-built plugins to provide the additional functionality missing from the core product. Results The new system integrates all issue types under a single tracking tool and offers a range of capabilities, including configurable issue management workflows, seamless integration with other clinical systems, extensive history, reporting, and trending, and an intuitive web interface. Discussion and Conclusion By preserving the linkage between risks, issues, actions, decisions, and outcomes, the system allows study teams to assess the impact and effectiveness of their risk management strategies and present a coherent account of how the trial was conducted. Since the tool was put in production, we have observed an increase in the number of reported issues and a decrease in the median issue resolution time which, along with the positive user feedback, point to marked improvements in quality, transparency, productivity, and teamwork.

Background Injection drug use is the leading risk factor for hepatitis C virus (HCV) transmission in the US. Despite the knowledge of the risk factors for HCV among people who inject drugs (PWID), there is a need to better understand how these multiple factors interact and impact young PWID.MethodsData originated from a study of 539 New York City (NYC) residents ages 18-29 recruited via Respondent-Driven Sampling, who reported past-month nonmedical use of prescription opioids and/or heroin. Analyses are based on a subsample of 337 (62%) who reported injecting any drug 12 months prior to the interview. All variables were assessed via self-report, except HCV status, which was established via rapid antibody testing. Building on the statistical associations found we developed a qualitative system dynamics (SD) model to integrate into a single framework key risk and preventive factors for HCV.ResultsHCV antibody prevalence is 31% with an overall incidence of 10 per 100 person-years. HCV status was independently correlated with sharing cookers with two or more people (AOR=2.17); injecting drugs 4-6 years (AOR=2.49) and 7 or more (AOR=4.95); lifetime homelessness (AOR=2.52); and being incarcerated two or more times (AOR=1.99). The SD model facilitates identifying non-linearities and feedback loop structures not included in the statistical model and high leverage points such as harm reduction and HCV treatment that could ameliorate the spread of HCV.ConclusionsThe results may indicate an overall positive impact of harm reduction efforts in reducing HCV prevalence among young PWID in NYC while injection risks and structural factors remain areas of key concern. An SD approach contributes to a better understanding of how these risk factors interact and what policies could be effective in reducing HCV infections.

On March 11, 2020, Italy imposed a national lockdown to curtail the spread of severe acute respiratory syndrome coronavirus 2. We estimate that, 14 days after lockdown, the net reproduction number had dropped below 1 and remained stable at »0.76 (95% CI 0.67-0.85) in all regions for >3 of the following weeks.

Background Most COVID-19-related deaths have occurred in older persons with comorbidities. Specific patterns of comorbidities related to COVID-19 deaths have not been investigated. Methods A random sample of 6085 individuals in Italy who died in-hospital with confirmed COVID-19 between February and December 2020 were included. Observed to expected (O/E) ratios of disease pairs were computed and logistic regression models were used to determine the association between disease pairs with O/E values ≥ 1.5. Results Six pairs of diseases exhibited O/E values ≥ 1.5 and statistically significant higher odds of co-occurrence in the crude and adjusted analyses: (1) ischemic heart disease and atrial fibrillation, (2) atrial fibrillation and heart failure, (3) atrial fibrillation and stroke, (4) heart failure and COPD, (5) stroke and dementia, and (6) type 2 diabetes and obesity. Conclusion In those deceased in-hospital due to COVID-19 in Italy, disease combinations defined by multiple cardio-respiratory, metabolic, and neuropsychiatric diseases occur more frequently than expected. This finding indicates a need to investigate the possible role of these clinical profiles in the chain of events that lead to death in individuals who have contracted SARS-CoV-2.

The available biomonitoring studies on workers producing/handling nanomaterials (NMs) focused on potential effects on respiratory, immune and cardio-vascular system. Aim of this study was to identify a panel of sensitive biomarkers and suitable biological matrices to evaluate particularly genotoxic and oxidative effects induced on workers unintentionally exposed to graphene or silica nanoparticles during the production process. These nanomaterials have been chosen for 'NanoKey' project, integrating the workplace exposure assessment (reported in part I) with the biomonitoring of exposed workers reported in the present work. Simultaneously to workplace exposure characterization, we monitored the workers using: Buccal Micronucleus Cytome (BMCyt) assay, fpg-comet test (lymphocytes), oxidized DNA bases 8-oxoGua, 8-oxoGuo and 8-oxodGuo measurements (urine), analysis of oxidative stress biomarkers in exhaled breath condensate (EBC), FENO measurement and cytokines release detection (serum). Since buccal cells are among the main targets of NM occupational exposure, particular attention was posed to the BMCyt assay that represents a noninvasive assay. This pilot study, performed on 12 workers vs.11 controls, demonstrates that BMCyt and fpg-comet assays are the most sensitive biomarkers of early, still reparable, genotoxic and oxidative effects. The findings suggest that these biomarkers could represent useful tools for the biomonitoring of workers exposed to nanoparticles, but they need to be confirmed on a high number of subjects. However, such biomarkers don't discriminate the effects of NM from those due to other chemicals used in the NM production process. Therefore, they could be suitable for the biomonitoring of workers exposed to complex scenario, including nanoparticles exposure.

Background On 20 February 2020, a locally acquired coronavirus disease (COVID-19) case was detected in Lombardy, Italy. This was the first signal of ongoing transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in the country. The number of cases in Italy increased rapidly and the country became the first in Europe to experience a SARS-CoV-2 outbreak. Aim Our aim was to describe the epidemiology and transmission dynamics of the first COVID-19 cases in Italy amid ongoing control measures. Methods We analysed all RT-PCR-confirmed COVID-19 cases reported to the national integrated surveillance system until 31 March 2020. We provide a descriptive epidemiological summary and estimate the basic and net reproductive numbers by region. Results Of the 98,716 cases of COVID-19 analysed, 9,512 were healthcare workers. Of the 10,943 reported COVID-19-associated deaths (crude case fatality ratio: 11.1%) 49.5% occurred in cases older than 80 years. Male sex and age were independent risk factors for COVID-19 death. Estimates of R0 varied between 2.50 (95% confidence interval (CI): 2.18–2.83) in Tuscany and 3.00 (95% CI: 2.68–3.33) in Lazio. The net reproduction number Rt in northern regions started decreasing immediately after the first detection. Conclusion The COVID-19 outbreak in Italy showed a clustering onset similar to the one in Wuhan, China. R0 at 2.96 in Lombardy combined with delayed detection explains the high case load and rapid geographical spread. Overall, Rt in Italian regions showed early signs of decrease, with large diversity in incidence, supporting the importance of combined non-pharmacological control measures.

Ulaanbaatar (Mongolia) is the coldest capital city in the world with approximately 98% of its heating demand satisfied by means of coal-burning stoves. This leads to enormous air pollutant emissions, with Ulaanbaatar being one of the top five most polluted cities in the world. In this study, an innovative solar hybrid heating system for the Mongolian scenario was used, which was based on the operation of a solar field composed of four series-connected evacuated tube heat pipe collectors, coupled with a thermal energy storage. The solar hybrid heating system was simulated and analyzed using the software TRNSYS. The simulations were designed to satisfy the heating demand of a typical single-family detached house located in Ulaanbaatar and were carried out with and without considering the soiling effects on the solar system operation. The overall performance of the proposed plant was compared with those associated with different fossil fuel-based Mongolian conventional heating systems, in order to assess the potential energy, environmental and economic benefits. The results highlighted that the proposed plant allowed for the obtainment of significant reductions in terms of primary energy consumption (up to 34.6%), global CO2 equivalent emissions (up to 52.3%), and operating costs (up to 49.6%), even if the expected return on the investment could be unacceptable.

In this paper a centralized hybrid renewable district heating system based on the exploitation of solar energy and integrated with a seasonal borehole thermal energy storage is investigated with reference to a 5-year period by means of the dynamic simulation software TRNSYS. The plant is devoted to satisfy the energy demand for heating purposes and domestic hot water (DHW) production of a small-scale district composed of six residential buildings and three schools under the climatic conditions of Naples (south of Italy). Four configurations of the solar field consisting of different combinations of solar thermal collectors (SCs) and photovoltaic/thermal panels (PVTs) are analyzed upon varying both (i) the technology of SCs (flat plate or evacuated tube heat pipe) as well as (ii) the control logic of solar circuit (operation with constant or variable flow rate of heat carrier fluid). The simulation results have been compared with those associated to a conventional decentralized heating system in terms of primary energy consumption, carbon dioxide equivalent emissions and operating costs in order to assess (i) the potential energy, environmental and economic benefits as well as (ii) the impact of solar field design on the overall system performance.

A centralized solar hybrid heating system serving a small-scale district composed of 6 typical Italian residential buildings and 3 schools located in Naples (southern Italy) has been modelled, simulated and analysed by means of the dynamic software TRNSYS over a 5-year period. The plant is based on the operation of solar thermal collectors connected to a seasonal double U-pipe vertical Borehole Thermal Energy Storage (BTES) in order to address the seasonal misalignment between solar energy supply and thermal energy demand for heating purposes. In this paper a parametric analysis has been performed in order to investigate the performance of the district heating network upon varying the characteristics of the BTES in terms of: (i) thermal conductivity of soil, (ii) thermal conductivity of grout, (iii) U-pipe spacing, (iv) heat carrier fluid, (v) number of Borehole Heat Exchangers (BHEs), as well as (vi) type of BHEs connection (series, parallel or mixed). The primary energy consumption, the equivalent carbon dioxide emissions and the operating costs of the proposed district heating plant have been evaluated based on the simulation results upon varying the plant configurations and then compared with those associated to a conventional Italian decentralized heating system assumed as reference with the main aims of (i) assessing the potential reduction of primary energy consumption, global CO2 equivalent emissions and operating costs, (ii) exploring the influence of BTES characteristics on the overall system performance as well as (iii) establishing some simple rules for the initial design of BTES.

Background Pandemic coronavirus disease 2019 (COVID-19) disease represents a challenge for healthcare structures. The molecular confirmation of samples from infected individuals is crucial and therefore guides public health decision making. Clusters and possibly increased diffuse transmission could occur in the context of the next influenza season. For this reason, a diagnostic test able to discriminate severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) from influenza viruses is urgently needed. Methods A multiplex real-time reverse-transcription polymerase chain reaction (PCR) assay was assessed using 1 laboratory protocol with different real-time PCR instruments. Overall, 1000 clinical samples (600 from samples SARS-CoV-2–infected patients, 200 samples from influenza-infected patients, and 200 negative samples) were analyzed. Results The assay developed was able to detect and discriminate each virus target and to intercept coinfections. The limit of quantification of each assay ranged between 5 and 10 genomic copy numbers, with a cutoff value of 37.7 and 37.8 for influenza and SARS-CoV-2 viruses, respectively. Only 2 influenza coinfections were detected in COVID-19 samples. Conclusions This study suggests that multiplex assay is a rapid, valid, and accurate method for the detection of SARS-CoV-2 and influenza viruses in clinical samples. The test may be an important diagnostic tool for both diagnostic and surveillance purposes during the seasonal influenza activity period.

Distributed Acoustic Sensing (DAS) was originally intended to measure oscillatory strain at frequencies of 1 Hertz or more on a fiber optic cable. Recently, measurements at much lower frequencies h...

OBJECTIVE: This study aimed to assess the impact of obesity on nonrespiratory complications in patients dying with coronavirus disease (COVID-19). METHODS: Medical charts of 3,694 of patients dying with COVID-19 in Italy were reviewed to extract information on demographics, preexisting comorbidities, and in-hospital complications leading to death. Multivariate logistic regressions were performed to assess the association of obesity with nonrespiratory complications. These analyses were adjusted for age, gender, and number of preexisting comorbidities. RESULTS: Obesity was present in 411/3,694 (11.1%) patients dying with COVID-19. Obesity was significantly associated with increased probability of experiencing acute renal failure (adjusted odds ratio [OR], 1.33; 95% CI: 1.04-1.71) and shock (adjusted OR, 1.54; 95% CI: 1.19-1.99). The associations of obesity with acute renal failure and shock were stronger in patients aged < 60 years (adjusted OR, 2.00; 95% CI: 1.09-3.67 and OR, 2.37; 95% CI 1.29-4.36) than in those aged 60 years or older (adjusted OR, 1.20; 95% CI: 0.90-1.60 and OR, 1.22; 95% CI: 0.91-1.65). CONCLUSIONS: In patients dying with COVID-19 in Italy, obesity is associated with an increased probability of nonrespiratory complications, particularly shock and acute renal failure. These associations seem stronger in younger than in older adults. Strategies should be put in place in patients with COVID-19 with obesity to prevent these complications.

SUMMARYBackgroundIn February 2020, a locally-acquired COVID-19 case was detected in Lombardia, Italy. This was the first signal of ongoing transmission of SARS-CoV-2 in the country. The outbreak rapidly escalated to a national level epidemic, amid the WHO declaration of a pandemic.MethodsWe analysed data from the national case-based integrated surveillance system of all RT-PCR confirmed COVID-19 infections as of March 24th 2020, collected from all Italian regions and autonomous provinces. Here we provide a descriptive epidemiological summary on the first 62,843 COVID-19 cases in Italy as well as estimates of the basic and net reproductive numbers by region.FindingsOf the 62,843 cases of COVID-19 analysed, 71.6% were reported from three Regions (Lombardia, Veneto and Emilia-Romagna). All cases reported after February 20th were locally acquired. Estimates of R0 varied between 2.5 (95%CI: 2.18-2.83) in Toscana and 3 (95%CI: 2.68-3.33) in Lazio, with epidemic doubling time of 3.2 days (95%CI: 2.3-5.2) and 2.9 days (95%CI: 2.2-4.3), respectively. The net reproduction number showed a decreasing trend starting around February 20-25, 2020 in Northern regions. Notably, 5,760 cases were reported among health care workers. Of the 5,541 reported COVID-19 associated deaths, 49% occurred in people aged 80 years or above with an overall crude CFR of 8.8%. Male sex and age were independent risk factors for COVID-19 death.InterpretationThe COVID-19 infection in Italy emerged with a clustering onset similar to the one described in Wuhan, China and likewise showed worse outcomes in older males with comorbidities. Initial R0 at 2.96 in Lombardia, explains the high case-load and rapid geographical spread observed. Overall Rt in Italian regions is currently decreasing albeit with large diversities across the country, supporting the importance of combined non-pharmacological control measures.Fundingroutine institutional funding was used to perform this work.

Background Aim of the present study is to describe characteristics of COVID-19-related deaths and to compare the clinical phenotype and course of COVID-19-related deaths occurring in adults ( Method Medical charts of 3,032 patients dying with COVID-19 in Italy (368 aged < 65 years and 2,664 aged ≥65 years) were revised to extract information on demographics, preexisting comorbidities, and in-hospital complications leading to death. Results Older adults (≥65 years) presented with a higher number of comorbidities compared to those aged Conclusions Individuals dying with COVID-19 present with high levels of comorbidities, irrespective of age group, but a small proportion of deaths occur in healthy adults with no preexisting conditions. Non-respiratory complications are common, suggesting that the treatment of respiratory conditions needs to be combined with strategies to prevent and mitigate the effects of non-respiratory complications.

Background Among the unknowns posed by the coronavirus disease 2019 (COVID-19) outbreak, the role of biological sex to explain disease susceptibility and progression is still a matter of debate, with limited sex-disaggregated data available. Methods A retrospective analysis was performed to assess if sex differences exist in the clinical manifestations and transitions of care among hospitalized individuals dying with laboratory-confirmed SARS-CoV-2 infection in Italy (February 27–June 11, 2020). Clinical characteristics and the times from symptoms’ onset to admission, nasopharyngeal swab, and death were compared between sexes. Adjusted multivariate analysis was performed to identify the clinical features associated with male sex. Results Of the 32,938 COVID-19-related deaths that occurred in Italy, 3517 hospitalized and deceased individuals with COVID-19 (mean 78 ± 12 years, 33% women) were analyzed. At admission, men had a higher prevalence of ischemic heart disease (adj-OR = 1.76, 95% CI 1.39–2.23), chronic obstructive pulmonary disease (adj-OR = 1.7, 95% CI 1.29–2.27), and chronic kidney disease (adj-OR = 1.48, 95% CI 1.13–1.96), while women were older and more likely to have dementia (adj-OR = 0.73, 95% CI 0.55–0.95) and autoimmune diseases (adj-OR = 0.40, 95% CI 0.25–0.63), yet both sexes had a high level of multimorbidity. The times from symptoms’ onset to admission and nasopharyngeal swab were slightly longer in men despite a typical acute respiratory illness with more frequent fever at the onset. Men received more often experimental therapy (adj-OR = 2.89, 95% CI 1.45–5.74) and experienced more likely acute kidney injury (adj-OR = 1.47, 95% CI 1.13–1.90). Conclusions Men and women dying with COVID-19 had different clinical manifestations and transitions of care. Identifying sex-specific features in individuals with COVID-19 and fatal outcome might inform preventive strategies.

Borrelia crocidurae is endemic in West Africa, where it represents the leading cause of tick-borne relapsing fever (TBRF). TBRF typically presents with high fever and systemic symptoms, followed by recurrent episodes. Neurological complications may occur during febrile relapses. B. crocidurae is considered the most neurotropic agent of TBRF and is associated to severe neurological manifestations i.e. meningitis and encephalitis.To date, European cases of B. crocidurae infection have been reported in travelers returning from endemic areas. We report the first autochthonous case in Europe of B. crocidurae infection, presenting as meningitis with cranial polyneuritis and cavernous sinus thrombosis that were not preceded by classic febrile recurrences. Keywords: Borrelia crocidurae, Europe, Autochthonous, Meningitis, Cranial polyneuritis, Cavernous sinus thrombosis

Bio-energy (like other renewable energy sources) is proposed as a solution for climate change and other energy-related and economic issues. The predominant production model, however, which is based on first-generation biofuels developed on a global scale, creates ecological impacts throughout the production chain, resulting in a sustainability paradox, as well as social unrest and territorial conflict. Therefore, attention here is focussed on agro-energy and second-generation biofuels, investigating the structural differences, the advantages, the potential problems and the possible solutions of some local biofuel initiatives in North Western Europe. Finally, we propose a regional agrarian model to avoid the impacts and contradictions of the global industrial model, to produce a better ecological balance at both the local and the global levels, and to improve the democratic character of energy governance. In addition, we suggest a paradigmatic reading to better understand the cultural, political and socio-economic implications of the two models.

Amyotrophic lateral sclerosis (ALS) is a rapidly progressive neurodegenerative condition where loss of motor neurons within the brain and spinal cord leads to muscle atrophy, weakness, paralysis and ultimately death within 3–5 years from onset of symptoms. The specific molecular mechanisms underlying the disease pathology are not fully understood and neuroprotective treatment options are minimally effective. In recent years, stem cell transplantation as a new therapy for ALS patients has been extensively investigated, becoming an intense and debated field of study. In several preclinical studies using the SOD1G93A mouse model of ALS, stem cells were demonstrated to be neuroprotective, effectively delayed disease onset and extended survival. Despite substantial improvements in stem cell technology and promising results in preclinical studies, several questions still remain unanswered, such as the identification of the most suitable and beneficial cell source, cell dose, route of delivery and therapeutic mechanisms. This review will cover publications in this field and comprehensively discuss advances, challenges and future direction regarding the therapeutic potential of stem cells in ALS, with a focus on mesenchymal stem cells. In summary, given their high proliferation activity, immunomodulation, multi-differentiation potential, and the capacity to secrete neuroprotective factors, adult mesenchymal stem cells represent a promising candidate for clinical translation. However, technical hurdles such as optimal dose, differentiation state, route of administration, and the underlying potential therapeutic mechanisms still need to be assessed.

Health-care personnel handling antineoplastic drugs could be at risk for adverse health effects. We aimed to evaluate genotoxic and cytotoxic effects of antineoplastic drug exposure of personnel preparing and administering such drugs in three Oncology Hospitals in Italy enrolling 42 exposed subjects and 53 controls. Furthermore, we aimed to study the possible influence of XRCC1 and hOGG1 DNA repair genes polymorphisms on genotoxicity induced on buccal cells. We performed workplace and personal monitoring of some drugs and used exposure diary informations to characterize the exposure. Urinary 5-FU metabolite (α-fluoro-β-alanine) was measured. Buccal Micronucleus Cytome (BMCyt) assay was used to evaluate DNA damage and other cellular anomalies. GEM and 5-FU contamination was found in 68% and 42% of wipe/swab samples respectively. GEM deposition was found on workers' pads while no α-fluoro-β-alanine was found. BMCyt-assay showed higher genotoxicity and cytotoxicity on nurses administering antineoplastics than on preparators and controls. Among micronucleus (MN) positive (with MN frequency higher than 1.5‰) exposed subjects, the percentage of those carrying XRCC1 mut/het genotype was higher than in MN positive-controls. Using the sensitive BMCyt assay, we demonstrated that handling antineoplastics still represents a potential occupational health risk for workers that should be better trained/informed regarding such risks.

Background Data on Streptococcus pneumoniae carriage in adults with co-morbidities are limited. In this study we estimated the pneumococcal carriage among adults with co-morbidities and evaluated socio-demographic and clinical risk factors. The potential coverage of the current pneumococcal vaccines recommended for adults (PCV13 and PPV23) was also investigated. Methods A cross-sectional study on S. pneumoniae carriage among unvaccinated adults ≥50 years with co-morbidities, presenting with or without acute respiratory symptoms at general practitioners in Rome, Italy, between October 2015 and July 2016 was conducted. Pneumococcal carriage was investigated by both cultural and molecular methods. Socio-demographic variables and co-morbidities were evaluated by logistic models as possible risk factors for pneumococcal carriage. Results Out of 248 patients (median age: 73 yrs; IQR: 65–79), 12 (4.8%) and 83 (33.5%) individuals were found colonized using cultural or molecular methods, respectively. Potential risk factors for pneumococcal colonization as ascertained by molecular methods were: low level of education (adjusted OR = 3.71, 95% CI: 1.62–9.40), winter months (December-March vs other months, adjusted OR = 2.56, 95% CI: 1.29–5.14), and presence of chronic lung diseases (adjusted OR = 2.18, 95% CI: 1.15–4.16). The combination of serotype-specific multiplex RT-PCR and conventional PCR allowed to identify 22 serotypes/group of serotypes, of which the most common were: 24F/24A/24B, 12F/12A/12B/44/46, 6A/6B, 14, 15B/15C, and 22F/22A. Prevalence of pneumococcal carriage due to PCV13 serotypes and non-PCV13 serotypes was 23.6% and 67.3%, respectively. Prevalence of colonization due to PPV23 serotypes was estimated to be 54.6%. Conclusions A high prevalence of S. pneumoniae carriage was observed among adults with co-morbidities, especially among individuals affected by chronic lung diseases. These results support vaccine strategies based on the sequential administration of PCV13 and PPV23 to control potentially invasive pneumococcal strains in adults, especially in subjects with co-morbidities.

Assembly of complete and error-free clinical trial data sets for statistical analysis and regulatory submission requires extensive effort and communication among investigational sites, central laboratories, pharmaceutical sponsors, contract research organizations and other entities. Traditionally, this data is captured, cleaned and reconciled through multiple disjointed systems and processes, which is resource intensive and error prone. Here, we introduce a new system for clinical data review that helps data managers identify missing, erroneous and inconsistent data and manage queries in a unified, system-agnostic and efficient way. Our solution enables timely and integrated access to all study data regardless of source, facilitates the review of validation and discrepancy checks and the management of the resulting queries, tracks the status of page review, verification and locking activities, monitors subject data cleanliness and readiness for database lock and provides extensive configuration options to meet any study’s needs, automation for regular updates and fit-for-purpose user interfaces for global oversight and problem detection.

Timely, consistent and integrated access to clinical trial data remains one of the pharmaceutical industry’s most pressing needs. As part of a comprehensive clinical data repository, we have developed a data warehouse that can integrate operational data from any source, conform it to a canonical data model and make it accessible to study teams in a timely, secure and contextualized manner to support operational oversight, proactive risk management and other analytic and reporting needs. Our solution consists of a dimensional relational data warehouse, a set of extraction, transformation and loading processes to coordinate data ingestion and mapping, a generalizable metrics engine to enable the computation of operational metrics and key performance, quality and risk indicators and a set of graphical user interfaces to facilitate configuration, management and administration. When combined with the appropriate data visualization tools, the warehouse enables convenient access to raw operational data and derived metrics to help track study conduct and performance, identify and mitigate risks, monitor and improve operational processes, manage resource allocation, strengthen investigator and sponsor relationships and other purposes.

BACKGROUND: Stigmatizing attitudes towards people who use drugs (PWUD) impact their access and retention in health care. Current measures of PWUD stigma in medical settings are limited. Therefore, we developed and validated the Medical Provider Stigma Experienced by PWUD (MPS-PWUD) scale. METHODS: As part of an ongoing clinical trial, we recruited HCV RNA positive people who inject drugs in New York City. Based on 164 participants, principal component analysis (PCA) was conducted on fifteen stigma items answered on a 5-point Likert scale. We evaluated internal consistency using Cronbach’s alpha coefficient and assessed construct validity by comparing stigma levels with willingness to communicate health concerns with medical providers and likelihood to seek HCV treatment. RESULTS: PCA identified a 9-item scale with two components of stigmatization that explained 60.8% of the total variance and overall high internal consistency (alpha=0.90). The enacted stigma (alpha=0.90) consisted of 6 scale items related to the medical providers’ stigmatizing actions or perceptions. The internalized stigma component (alpha=0.84) included 3 scale items related to PWUD’s shame or drug use disclosure. As hypothesized, higher levels of either stigma were associated with less likelihood to openly communicate with medical providers (p

We propose a brief analysis of the “Innovating for Sustainable Growth: A Bioeconomy for Europe” by the European Commission. With this aim, we have used a multiscalar and inductive methodology, a critical, paradigmatic and deconstructionist approach. Special attention is given to the language because it influences the individual’s perceptions and the collective imagination that is the base of ideas, decisions and actions. The main results concern the conceptual and ideological matrix, the population-resource relation and the participation process. We argue that the technocentric and anthropocentric approaches as well as the neoliberal vision are all the same in regards to both the old “fossil” economy and the most recent bioenergy sector’s development. The latter could offer important lessons to avoid errors, contradictions and paradoxes. In addition, the asymmetry regarding the distribution of biomass and advanced level of techno-knowledge could lead to new forms of ecological exploitation, economic domination and power relations on the different levels of spatial scale. This could put in to question the territorial sovereignty. Finally, the EU bioeconomy model cannot be considered an economic revolution because it is focused on the supply side in support of market demand and economic growth, without taking into account the production model and scale. So, it simply appears as one of many steps of the “industrial revolution”: from fossil sources to biobased ones. For this reason, it is very important to make the choice process a democratic one, bringing in the Member State Parliaments on the discussion on the UE biobased policy, as well as opening a broad public debate about the prospects and effects of this choice. In regard to this, the paper could be of interest because it aspires to assume and motivate a more systemic prospective in evaluations and policy decisions.

Background and aim: Systemic lupus erythematosus (SLE) is associated with increased risk of cardiovascular disease (CVD). Among many mechanisms, accelerated atherosclerosis, endothelial dysfunction, and hypercoagulability play a main role. Here, we investigate whether inflammatory, serological and clinical markers of SLE determine and correlate with arterial stiffness in SLE patients. Materials and methods: Routine blood samples, inflammatory mediators, specific antibodies, and 24 h proteinuria were measured in 43 SLE patients and 43 age and sex-matched controls using routine laboratory assays. We also assessed arterial stiffness by measuring radial artery applanation tonometry-derived augmentation index (AI), normalized AI (AIx@75), aortic pulse pressure, central systolic, diastolic and peripheral blood pressure. Results: SLE patients showed a significantly greater arterial stiffness vs. controls, as demonstrated by the significantly higher AIx@75 and aortic pulse pressure. Interestingly, regression analysis showed that age, systolic pulse pressure, inflammatory markers (erythrocyte sedimentation rate and C-reactive protein), daily dose of glucocorticoids, and cumulative organ damage positively correlated with arterial stiffness. Conclusions: SLE patients show increased arterial stiffness which correlates with markers of inflammation, that is involved in early alterations in arterial walls. Applanation tonometry can be used to screen SLE patients for subclinical vascular damage to implement prevention strategies for CVD.

Purpose Clinical trial monitoring is an essential component of drug development aimed at safeguarding subject safety, data quality, and protocol compliance by focusing sponsor oversight on the most important aspects of study conduct. In recent years, regulatory agencies, industry consortia, and nonprofit collaborations between industry and regulators, such as TransCelerate and International Committee for Harmonization, have been advocating a new, risk-based approach to monitoring clinical trials that places increased emphasis on critical data and processes and encourages greater use of centralized monitoring. However, how best to implement risk-based monitoring (RBM) remains unclear and subject to wide variations in tools and methodologies. The nonprescriptive nature of the regulatory guidelines, coupled with limitations in software technology, challenges in operationalization, and lack of robust evidence of superior outcomes, have hindered its widespread adoption. Methods We describe a holistic solution that combines convenient access to data, advanced analytics, and seamless integration with established technology infrastructure to enable comprehensive assessment and mitigation of risk at the study, site, and subject level. Findings Using data from completed RBM studies carried out in the last 4 years, we demonstrate that our implementation of RBM improves the efficiency and effectiveness of the clinical oversight process as measured on various quality, timeline, and cost dimensions. Implications These results provide strong evidence that our RBM methodology can significantly improve the clinical oversight process and do so at a lower cost through more intelligent deployment of monitoring resources to the sites that need the most attention.

Introduction Most of anticancer drugs has in common DNA-damaging properties, therefore health care personnel who handle such drugs is at risk for adverse health effects. We aimed to evaluate exposure and its genotoxic and cytotoxic effects in technicians and nurses who prepare and administer anticancer drugs in oncology units of different hospitals. Methods In the hospitals (A,B,C) we studied 17 pharmacy technicians/nurses who prepare anticancer drugs, 25 nurses who administer them and 53 controls. Workplace monitoring of 5-fluorouracil (5FU) and gemcitabine (GEM) was performed by HPLC-UV on wipes/swabs collected in areas of pharmacy and administering wards. Personal exposure to 5FU and GEM was monitored by pads. We measured urinary metabolite α-fluoro-β-alanine by LC-MS-MS. We calculated total amount of handled drugs. Buccal micronucleus cytome (BMCyt) assay was used to evaluate DNA damage (micronuclei MN and nuclear buds NB), cytokinetic defects (binucleated cells BN) and cell death (as condensed chromatin CC). Results Drug contamination was found only in the 30% of wipe/swab samples, with GEM more frequently present than 5FU. Contamination didn’t show significant difference among the hospitals. Only GEM deposition was found on workers’ pads (93% of samples). No α-fluoro-β-alanine was found. Total amount of prepared drugs was similar in A and B and higher than C. B prepared drugs only manually while in A they were prepared automatically/manually. In A and B we found in workers who prepare drugs, higher genotoxicity than respective controls. Total amounts of administrated drugs were in A>B>C. Nurses who administer drugs showed higher genotoxic (%MN) and cytotoxic (%CC) effects than controls in A and C. Conclusion These findings show that total amount of prepared drugs correlate with higher genotoxicity found in A and B. We also demonstrate the suitability of BMCyt assay as sensitive and no invasive biomarker of early effect for occupational antineoplastic exposure.

This study aimed to identify sensitive and not-invasive biomarkers of early genotoxic/oxidative effect for exposure to styrene in the fibreglass reinforced plastic manufacture. We studied 11 workers of a plastic manufacture using open molding process (A), 16 workers of a manufacture using closed process (B) and 12 controls. We evaluated geno/cytotoxic effects on buccal cells by Buccal Micronucleus Cytome (BMCyt) assay and genotoxic/oxidative effects on lymphocytes by Fpg-comet test. On A workers we also evaluated urinary 8oxoGua, 8oxodGuo and 8oxoGuo to investigate oxidative stress. Personal inhalation exposure to styrene was monitored by passive air sampling and GC/MS. Biological monitoring included urinary metabolites mandelic acid (MA) and phenylglyoxylic acid (PGA). The findings show higher styrene exposure, urinary MA + PGA levels and micronucleus frequency in manufacture A. Higher buccal karyolytic cell frequency vs controls were found in both exposed populations. We found in exposed workers, no induction of direct DNA damage but oxidative DNA damage. Fpg-comet assay and urinary oxidized guanine seem to be sensitive biomarkers of oxidative stress and BMCyt assay a good-not invasive biomarker of cyto-genotoxicity at target organ. The study, although limited by the small number of studied subjects, shows the usefulness of used biomarkers in risk assessment of styrene-exposed workers.

The Mediterranean spotted fever (MSF) rickettsiosis is the predominant rickettsial disease among the spotted fever group (SFG) rickettsiae in the Mediterranean countries and North Africa. Its causative agent is Rickettsia conorii, although, SFG rickettsiosis - cases due to Rickettsia monacensis, Rickettsia massiliae and Rickettsia aeschlimannii were also described. A retrospective study based on hospital discharge records with a diagnosis of SFG rickettsiosis was carried out to describe the spatial pattern, the trend of the disease, and the epidemiological characteristics of persons hospitalized in the period 2001-2015. Standardized hospitalization ratios were calculated at municipal level using the European population. Smoothed maps were produced using a localised smoothing Poisson model. The mean annual standardized hospitalization rate was 1.36/100,000 person years (95%CI: 1.34; 1.39). Rates showed strong summer seasonality and tended to decrease over time. During the study period, 28.89% of municipalities had smoothed standardized hospitalization ratios greater than 1 and 14.01% above 20. Higher standardized hospitalization ratios were found in areas along the Tyrrhenian coast, especially in the south of Calabria and in the islands of Sardinia and Sicily, where the disease is of public health relevance.

Acute respiratory infections (ARI) are the leading cause of pediatric morbidity and mortality worldwide. Information on etiological agents of ARI in developing countries is still limited. This study conducted in Alexandria, Egypt, was designed to determine the prevalence of several microorganisms in 113 children hospitalized with ARI. Overall, 65 agents were identified; 58 (51.3%) individuals were found to be positive for at least one pathogen, and seven of them were also positive for two agents. Chlamydophila pneumoniae was the most commonly detected agent (n = 32; 28.3%), followed by Mycoplasma pneumoniae, respiratory syncytial and influenza. Positivity for C. pneumoniae, which was the most commonly detected agent, was associated with male sex and with mild disease of the upper respiratory tract.

In this study, a TraNsient SYStems (TRNSYS) simulation model for solar thermal systems is developed to assess the potential of solar energy utilization in cold climate zones, such as Ulaanbaatar (Mongolia), which is one of the five cities with the worst air quality in the world. Since air pollution contaminates solar collectors and decreases their efficiency, this model accounts for dust deposition behavior so that the best cleaning time for the collectors can be estimated. The simulation results show that the best cleaning time falls between the middle of January and the beginning of February. In addition, a collector cleaned once during the heating period is estimated to produce 12% more energy compared with a collector that has not been cleaned.

Objective: To describe a rare case of acute Q fever with tache noire. Clinical Presentation and Intervention: A 51-year-old man experienced acute Q fever showing tache noire, generally considered a pathognomonic sign of Mediterranean spotted fever (MSF) and MSF-like illness, but not a clinical feature of Q fever. The patient was treated with doxycycline 100 mg every 12 h. Conclusion: In the Mediterranean area, tache noire should be considered pathognomonic of MSF but it should not rule out Q fever. Clinical diagnosis should be supported by accurate laboratory diagnostic tests to guide proper management.

The agricultural models and innovations are not neutral, in relation both to the goals and to the territorial impacts, with special reference to the ecological and social dimensions. This awareness has become the key to observe the olive quick decline syndrome (OQDS) that has affected the Apulia, a land of secular olive trees characterizing landscape and economy. By an inductive approach and according to data on the provincial level, we have verified the correlation between the ways of land use and the OQDS diffusion. In fact, in the Lecce and Brindisi provinces affected by the phenomenon we have observed an unexpected distribution of herbicides and the location of experimental fields with chemical products. The hypothesis is that the pathogens have damaged the weaker plants, that is to say those in polluted and poor soils, while the zones with a higher presence of organic agricultural land result less affected by the OQDS. Data on the local scale could be very important to know the correlation in greater detail, and make clearer the OQDS focus origin, as well as to better understand the territorial impact. Les modèles agricoles et les innovations ne sont pas neutres quant à leurs objectifs et leurs effets territoriaux (notamment dans leurs dimensions écologique et sociale). Nous utilisons cette clé d’observation pour analyser le complexe du dessèchement rapide des oliviers (CDRO) qui a affecté les Pouilles, terre où les oliviers séculaires marquent le paysage et l’économie. Par une approche inductive et sur la base des données à l’échelle provinciale, nous avons vérifié la corrélation entre les modalités d’utilisation de la terre et la diffusion du CDRO. Dans les provinces de Lecce et Brindisi, affectées par le phénomène, nous avons observé une distribution massive d’herbicides et la présence de champs d’expérimentation de produits chimiques. L’hypothèse est que les pathogènes ont affecté les plantes les plus faibles, c’est-à-dire celles qui sont dans des terrains pauvres et pollués. Par contre, les zones moins affectées comptent une plus grande présence de terrains conduits selon les modalités de l’agriculture biologique. Les données à l’échelle locale pourraient aider à affiner l’étude des corrélations et à rendre plus claire l’origine de l’épicentre du CDRO, ainsi qu’à mieux comprendre l’impact territorial.

We have evaluated and optimized a commercial enzyme-linked immunosorbent assay (ELISA; SeroCP Savyon, Israel), using the commercial microimmunofluorescence test (MIF; Labsystems; Helsinki, Finland) as reference method. This was done for the detection of anti-Chlamydophila pneumoniae IgG and IgA antibodies in patients with coronary heart disease (CHD). After optimization, a good agreement between the ELISA and MIF tests [IgG (P(0.05)=0.0008 and r=0.93) and IgA (P(0.05)=0.00072 and r=0.72)] was found. These ELISA tests proved to be a useful semiquantitative method for seroprevalence studies in CHD patients, with remarkable advantages over MIF test in terms of objective measurement, thus reproducibility, performance and interpretation.

In this paper, we propose a methodology devoted to exploit the outstanding characteristics of COSMO-SkyMed for monitoring water bodies in semiarid countries at a scale never experienced before. The proposed approach, based on appropriate registration, calibration, and processing of synthetic aperture radar (SAR) data, allows outperforming the previously available methods for monitoring small reservoirs, mainly carried out with optical data, and severely limited by the presence of cloud coverage, which is a frequent condition in wet season. A tool has been developed for computing the water volumes retained in small reservoirs based on SAR-derived digital elevation model. These data have been used to derive a relationship between storage volumes and surface areas that can be used when bathymetric information is unavailable. Due to the lack of direct measures of river's discharge, the time evolution of water volumes retained at reservoirs has been used to validate a simple rainfall-runoff hydrological model that can provide useful recommendation for the management of small reservoirs. Operational scenarios concerning the improvement in the efficiency of reservoirs management and the estimation of their impact on downstream area point out the applicative outcomes of the proposed method.

Objective: To determine whether bioterrorism training provided increased awareness and understanding of bioterrorism and to assess physicians’ beliefs about the threat of bioterrorism and how it impacts on preparedness. Design: This is a retrospective review of data obtained from a bioterrorism training grant. Data were obtained from a postevaluation form completed by trainees with an 80 percent return rate. The Institutional Review Board approved this study. Informed consent was not required as data were deidentified and demographic information regarding study subjects was not used. Setting: The Department of Family Medicine within the University of Medicine and and Dentistry of New Jersey, School of Osteopathic Medicine in Stratford, NJ, conducted the training and follow-up study. Participants: The bioterrorism preparedness training was targeted to physicians, residents, and third- and fourth-year medical students in New Jersey. There were 578 trainees; however, responses to each question were varied. Outcome measures: Trainees were asked to complete an evaluation form. Specific questions were selected from the form. Frequency statistics were used to describe responses to the questions. Results: Ninety-four percent of the respondents agreed that the bioterrorism training increased their awareness and/or understanding of bioterrorism; however, only 49 percent believe there is a high probability that a bioterrorism event or other health emergency will occur in the near future in New Jersey, and 42 percent considered themselves prepared to respond as a healthcare professional to a bioterrorism event. Conclusions: Physicians in New Jersey increased their awareness and understanding of bioterrorism through training. However, concerns remain that a physician’s belief in a low threat of bioterrorism translates into a low need for bioterrorism preparedness training.

Nitric oxide (NO), originally discovered as an endothelium-derived relaxing factor, is now known to participate in the physiologic processes of the nervous, renal, gastrointestinal, and cardiovascular systems. NO is an important mediator of vasodilation and is a potent inhibitor of platelet aggregation and endothelial adhesion. Endothelial dysfunction, which is characterized by a deficit in endothelial NO, is associated with cardiovascular risk factors and is a harbinger of impending cardiovascular disease. The association of reduced NO and cardiovascular disease has led to research into drugs that might enhance the activity of endogenous NO or that can donate exogenous NO to vulnerable tissues. Drugs that donate NO include nitroglycerin, which has been used for more than 100 years in the management of angina pectoris. Drugs used to treat erectile dysfunction act primarily by inhibiting the degradation of the second messenger of NO, thus enhancing and prolonging its action. A novel approach to delivering exogenous NO is to link a NO-donating moiety to an existing drug to improve its safety profile. An example of this strategy is naproxcinod, which in clinical trials for osteoarthritis has demonstrated analgesic equivalence with the parent drug, naproxen, while attenuating some of the gastrointestinal and cardiovascular adverse effects. It is anticipated that the practice of medicine will continue to be affected as new drugs are developed that exploit the important pathways modulated by NO.

Although several reports have correlated Chlamydophila pneumoniae (CP) infection with carotid endarterectomy and coronary stent, no data have been reported on the potential relationship between this pathogen and carotid artery stenting (CAS). Hence, we evaluated 47 subjects, 27 symptomatic and 20 asymptomatic, before CAS intervention and during the follow up, for the presence of CP DNA and anti-CP antibodies, including chlamydial HSP60 (Cp-HSP60). Before stent placement, CP DNA was detected exclusively in symptomatic patients, all of whom were also positive for CP IgG and IgA and 85.7% of them also had CP-HSP60 antibodies. At the follow-up, all CP DNA positive and 11 out of the 13 symptomatic patients with Cp-HSP60 antibodies became negatives. In contrast, no change was observed for CP- IgA antibodies. Despite the small number of patients, the present study advocates an important role of CP infection in symptomatic patients with carotid artery disease. Our findings also suggest that stent placement and/or therapy might have a role in favouring resolution of inflammation, though not affecting persistence of CP infection.

To the Editor: A 61-yr-old Caucasian female was referred to our outpatient clinic for persistent cough, right scapular pain and purulent sputum for the past 9 months. Her past medical history was consistent with a diagnosis of pneumonia almost 20 yrs previously. She reported no allergies and was not taking any medications at home. She lived in an urban setting working as a hairdresser, and had no pets at home. She had received all the standard vaccinations based on the Italian law, including diphtheria, smallpox, tetanus, hepatitis A and typhus. She was married and had two daughters in good health. She went on vacation to Cuba 2 yrs previously, India (Rajasthan) 1 yr previously and Portugal 6 months ago. Her history of present illness was consistent with cough and mucopurulent sputum without fever for 9 months prior to visiting our clinic. She reported a scapolar right pain that had occurred 15 days prior to admission to the hospital which was not related to positioning or breathing. A negative chest radiograph had been performed 3 months prior to the visit, and at that point she was treated with oral prednisone (25 mg every 24 h for 15 days) with no evidence of clinical improvement. Finally, she underwent a chest computed tomography (CT) scan with the evidence of lung opacities with enhancement in the medium lobe and in the lingual (fig. 1a …

Objectives Cerebrovascular diseases are leading cause of death worldwide. Plaque rupture and embolization account for one-third of ischemic stroke. The causes are not fully known, but inflammation plays a pathogenic role. Recently, HCV infection has been identify as risk of atherosclerosis. HCV replicates within carotid plaques and brain endothelia cells; moreover, HCV patients showed higher levels of inflammation. Thus, we hypothesized that subjects carrying HCV are at higher risk of stroke. Accordingly, we evaluated prevalence and role of HCV infection in patients with stroke. Methods A priori sample size was calculated. Overall, 820 consecutive patients were enrolled, 123 with stroke and, as control, 697 age- and gender-matched (295 with COPD; 402 with diseases other than HCV-associated). Patients were evaluated for HCV and conventional risk of stroke. Results Prevalence of HCV was higher in patients with stroke than that observed in control (26.8% vs. 6.6%, p = 0.0001). An analysis of stroke patients showed that those HCV positive were younger ( p = 0.017) had lower serum levels of cholesterol ( p = 0.001), triglycerides ( p = 0.045), and higher serum levels of inflammation markers (ESR, p = 0.001; CRP, p = 0.0001; fibrinogen, p = 0.012). A multivariate analysis showed that HCV infection was an independent risk factor of stroke (O.R. 2.04, 95% C.I. 1.69–2.46; p = 0.0001). A secondary analysis showed that HCV patients had higher ( p = 0.031) prevalence of past ischemic heart disease. Conclusions HCV infected patients are at higher and earlier risk of stroke. Inflammation is a key mediator. Clinicians in clinical practice and researchers in future trials should take into account these new findings.