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Abstract Resembling the morphology of Japanese polyp vessels, the classic form of Takotsubo cardiomyopathy is characterized by the presence of systolic dysfunction of the mid-apical portion of the left ventricle associated with basal hyperkinesia. It is believed that this may be due to a higher density of β-adrenergic receptors in the context of the apical myocardium, which could explain the greater sensitivity of the apex to fluctuations in catecholamine levels. The syndrome is precipitated by significant emotional stress or acute severe pathologies, and it is increasingly diagnosed during the perioperative period. Indeed, surgery, induction of general anaesthesia and critical illness represent potential harmful trigger of stress cardiomyopathy. No universally accepted guidelines are currently available, and, generally, the treatment of TTS relies on health care personal experience and/or local practice. In our daily practice, anaesthesiologists can be asked to manage patients with the diagnosis of new-onset Takotsubo before elective surgery or an emergent surgery in a patient with a concomitant stress cardiomyopathy. Even more, stress cardiomyopathy can arise as a complication during the operation. In this paper, we aim to provide an overview of Takotsubo syndrome and to discuss how to manage Takotsubo during surgery and in anaesthesiologic special settings.

La gestione mirata della temperatura (TTM) è un intervento neuroprotettivo cruciale impiegato nelle unità di terapia intensiva per migliorare la prognosi dei pazienti dopo un arresto cardiaco. Il brivido, un effetto collaterale comune della TTM, mette in discussione i suoi benefici neuroprotettivi. Questa scoping review mira a valutare la letteratura disponibile sulle terapie non farmacologiche per il brivido nei pazienti con TTM, identificando le lacune e le potenziali aree di ricerca future. Sono stati analizzati 13 studi sul tema, che hanno coinvolto 743 soggetti, con particolare attenzione alla TTM neuroprotettiva. La revisione ha evidenziato la natura incoerente della letteratura esistente sui trattamenti non farmacologici del brivido, sottolineando la necessità di interventi efficaci supportati da studi clinici. Le coperte ad aria forzata sono emerse come un approccio frequentemente esplorato ed efficace. Lo studio fornisce una base per la ricerca futura sulle terapie non farmacologiche, sottolineando l'importanza di una valutazione oggettiva del brivido e di strumenti di misurazione validati.

Pancreatic malignancy is the fourth cause of cancer-related death in Western countries and is predicted to become the second leading cause of cancer-related mortality by 2030. The standard therapies (FOLFIRINOX and gemcitabine with nab-paclitaxel) are not resolutive because this type of cancer is also characterized by a high chemoresistance, due in part to the activity of the ATP Binding Cassette (ABC) pumps accounting for the reduction in the intracellular concentration of the drugs. In this work, we analyze the occurrence of single-nucleotide polymorphisms (SNPs) in the MDR-1 gene, in different pancreatic cancer cell lines, and in tissues from pancreatic cancer patients by DNA sequencing, as well as the expression levels of MDR-1 mRNA and protein, by qRT-PCR and Western Blot analysis. We found that gemcitabine-resistant cells, in conjunction with homozygosis of analyzed SNPs, showed high MDR-1 basal levels with further increases after gemcitabine treatment. Nevertheless, we did not observe in the human PDAC samples a correlation between the level of MDR-1 mRNA and protein expression and SNPs. Preliminary, we conclude that in our small cohort, these SNPs cannot be used as molecular markers for predicting the levels of MDR-1 mRNA/protein levels and drug responses in patients with PDAC.

Brain damage in children with unilateral cerebral palsy (UCP) affects motor function, with varying severity, making it difficult the performance of daily actions. Recently, qualitative and semi-quantitative methods have been developed for lesion classification, but studies on mild to moderate hand impairment are lacking. The present study aimed to characterize lesion topography and preserved brain areas in UCP children with specific patterns of hand manipulation. A homogeneous sample of 16 UCP children, aged 9 to 14 years, was enrolled in the study. Motor assessment included the characterization of the specific pattern of hand manipulation, by means of unimanual and bimanual measures (Kinematic Hand Classification, KHC; Manual Ability Classification System, MACS; House Functional Classification System, HFCS; Melbourne Unilateral Upper Limb Assessment, MUUL; Assisting Hand Assessment, AHA). The MRI morphological study included multiple methods: (a) qualitative lesion classification, (b) semi-quantitative classification (sq-MRI), (c) voxel-based morphometry comparing UCP and typically developed children (VBM-DARTEL), and (d) quantitative brain tissue segmentation (q-BTS). In addition, functional MRI was used to assess spared functional activations and cluster lateralization in the ipsilesional and contralesional hemispheres of UCP children during the execution of simple movements and grasping actions with the more affected hand. Lesions most frequently involved the periventricular white matter, corpus callosum, posterior limb of the internal capsule, thalamus, basal ganglia and brainstem. VMB-DARTEL analysis allowed to detect mainly white matter lesions. Both sq-MRI classification and q-BTS identified lesions of thalamus, brainstem, and basal ganglia. In particular, UCP patients with synergic hand pattern showed larger involvement of subcortical structures, as compared to those with semi-functional hand. Furthermore, sparing of gray matter in basal ganglia and thalamus was positively correlated with MUUL and AHA scores. Concerning white matter, q-BTS revealed a larger damage of fronto-striatal connections in patients with synergic hand, as compared to those with semi-functional hand. The volume of these connections was correlated to unimanual function (MUUL score). The fMRI results showed that all patients, but one, including those with cortical lesions, had activation in ipsilesional areas, regardless of lesion timing. Children with synergic hand showed more lateralized activation in the ipsilesional hemisphere both during grasping and simple movements, while children with semi-functional hand exhibited more bilateral activation during grasping. The study demonstrates that lesion localization, rather than lesion type based on the timing of their occurrence, is more associated with the functional level of hand manipulation. Overall, the preservation of subcortical structures and white matter can predict a better functional outcome. Future studies integrating different techniques (structural and functional imaging, TMS) could provide further evidence on the relation between brain reorganization and specific pattern of manipulation in UCP children.

Retinitis pigmentosa (RP) is the most common inherited retinal disease (IRD) and is characterized by photoreceptor degeneration and progressive vision loss. We report 4 patients presenting with RP from 3 unrelated families with variants in TBC1D32, which to date has never been associated with an IRD. To validate TBC1D32 as a putative RP causative gene, we combined Xenopus in vivo approaches and human induced pluripotent stem cell–derived (iPSC-derived) retinal models. Our data showed that TBC1D32 was expressed during retinal development and that it played an important role in retinal pigment epithelium (RPE) differentiation. Furthermore, we identified a role for TBC1D32 in ciliogenesis of the RPE. We demonstrated elongated ciliary defects that resulted in disrupted apical tight junctions, loss of functionality (delayed retinoid cycling and altered secretion balance), and the onset of an epithelial-mesenchymal transition–like phenotype. Last, our results suggested photoreceptor differentiation defects, including connecting cilium anomalies, that resulted in impaired trafficking to the outer segment in cones and rods in TBC1D32 iPSC-derived retinal organoids. Overall, our data highlight a critical role for TBC1D32 in the retina and demonstrate that TBC1D32 mutations lead to RP. We thus identify TBC1D32 as an IRD-causative gene.

BACKGROUND: Although research reveals that there are many complex factors influencing the low organ donation rate in addition to nurses, literature suggests that nurses and doctors' active engagement and support have a significant impact on donation rates. Donation rates can be influenced by a variety of factors, including health professionals' attitudes, knowledge, confidence, participation, and training. OBJECTIVES: To investigate the attitudes of undergraduate nursing students at the University of Brescia in the Campus of Cremona regarding organ and tissue donation. MATERIALS AND METHODS: A cross-sectional survey was conducted by administering the Organ Donation Attitudes Scale (ODAS). RESULTS: ODAS showed that most students know someone who has donated an organ during their lifetime or after death, and over half know someone who has received an organ transplant. However, 63.3% of students indicated that they had not received specific training, and attitudes ranged from 45 to 71 with a median score of 61. Bivariate correlation analysis revealed that received academic training does not correlate with students' attitudes (p=.37). Knowing someone who has received a transplant correlates with having expressed willingness to donate (p=.047), and academic training correlates with perceived knowledge about the donation process (p=.0001). CONCLUSIONS: The study found mainly positive attitudes toward organ and tissue donation among nursing undergraduate students from the Cremona campus. Further research involving nursing universities is needed to raise awareness of organ donation among the public and healthcare workers.

BACKGROUND: Gli infermieri hanno un ruolo fondamentale nella cura delle persone affette da patologia oncologica. Fornire un’assistenza infermieristica di qualità significa provvedere a rispondere in modo pertinente ai bisogni fisici e psicosociali dell’assistito. Lo strumento Quality of Oncology Nursing Care Scale (QONCS) è il primo strumento ad essere costruito su un modello concettuale consolidato che include i principali temi emersi da studi precedenti aventi per oggetto la qualità dell’assistenza infermieristica in ambito oncologico. Non esiste ad oggi in Italia uno strumento capace di misurare la qualità dell’assistenza infermieristica percepita dalla persona affetta da patologia oncologica. OBIETTIVI: Finalità generale dello studio è adattare nel contesto italiano lo strumento QONCS al fine di indagare la qualità dell’assistenza infermieristica percepita dagli assistiti oncologici e i fattori che influiscono su di essa. METODI: Lo studio è articolato in quattro fasi: (a) l’adattamento culturale dello strumento al contesto italiano; (b) la valutazione della validità di facciata e contenuto dello strumento; (c) la valutazione della validità di costrutto e affidabilità dello strumento e (d) la descrizione della qualità dell’assistenza infermieristica come percepita dagli assistiti includendo fattori/item confermati nel processo di validazione. ESITI ATTESI: Si intende validare lo strumento su più di 400 persone affette da patologia oncologica. Il costrutto che lo strumento intende misurare sarà confermato attraverso analisi fattoriale esplorativa e confermativa e riporterà una elevata consistenza interna e affidabilità test-retest.

Shigellosis, an acute gastroenteritis infection caused by Shigella species, remains a public health burden in developing countries. Recently, many outbreaks due to Shigella sonnei multidrug-resistant strains have been reported in high-income countries, and the lack of an effective vaccine represents a major hurdle to counteract this bacterial pathogen. Vaccine candidates against Shigella sonnei are under clinical development, including a Generalized Modules for Membrane Antigens (GMMA)-based vaccine. The mechanisms by which GMMA-based vaccines interact and activate human immune cells remain elusive. Our previous study provided the first evidence that both adaptive and innate immune cells are targeted and functionally shaped by the GMMA-based vaccine. Here, flow cytometry and confocal microscopy analysis allowed us to identify monocytes as the main target population interacting with the S. sonnei 1790-GMMA vaccine on human peripheral blood. In addition, transcriptomic analysis of this cell population revealed a molecular signature induced by 1790-GMMA mostly correlated with the inflammatory response and cytokine-induced processes. This also impacts the expression of genes associated with macrophages’ differentiation and T cell regulation, suggesting a dual function for this vaccine platform both as an antigen carrier and as a regulator of immune cell activation and differentiation.

IntroductionThe Notch intracellular domain (NICD) and its ligands Jagged-1(Jag1), Delta-like ligand (DLL-3) and DLL4 play an important role in neoangiogenesis. Previous studies suggest a correlation between the tissue levels of NICD and response to therapy with bevacizumab in colorectal cancer (CRC). Another marker that may predict outcome in CRC is radiomics of liver metastases. The aim of this study was to investigate the expression of NICD and its ligands and the role of radiomics in the selection of treatment-naive metastatic CRC patients receiving bevacizumab.MethodsImmunohistochemistry (IHC) for NICD, Jag1 and E-cadherin was performed on the tissue microarrays (TMAs) of 111 patients with metastatic CRC treated with bevacizumab and chemotherapy. Both the intensity and the percentage of stained cells were evaluated. The absolute number of CD4+ and CD8+ lymphocytes was counted in three different high-power fields and the mean values obtained were used to determine the CD4/CD8 ratio. The positivity of tumor cells to DLL3 and DLL4 was studied. The microvascular density (MVD) was assessed in fifteen cases by counting the microvessels at 20x magnification and expressed as MVD score. Abdominal CT scans were retrieved and imported into a dedicated workstation for radiomic analysis. Manually drawn regions of interest (ROI) allowed the extraction of radiomic features (RFs) from the tumor.ResultsA positive association was found between NICD and Jag1 expression (p < 0.001). Median PFS was significantly shorter in patients whose tumors expressed high NICD and Jag1 (6.43 months vs 11.53 months for negative cases; p = 0.001). Those with an MVD score ≥5 (CD31-high, NICD/Jag1 positive) experienced significantly poorer survival. The radiomic model developed to predict short and long-term survival and PFS yielded a ROC-AUC of 0.709; when integrated with clinical and histopathological data, the integrated model improved the predictive score (ROC-AUC of 0.823).DiscussionThese results show that high NICD and Jag1 expression are associated with progressive disease and early disease progression to anti VEGF-based therapy; the preliminary radiomic analyses show that the integration of quantitative information with clinical and histological data display the highest performance in predicting the outcome of CRC patients.

Abstract Background The rehabilitation of paretic stroke patients uses a wide range of intervention programs to improve the function of impaired upper limb. A new rehabilitative approach, called action observation therapy (AOT) is based on the discovery of mirror neurons and has been used to improve the motor functions of adult stroke patients and children with cerebral palsy. Recently, virtual reality (VR) has provided the potential to increase the frequency and effectiveness of rehabilitation treatment by offering challenging and motivating tasks. Methods The purpose of the present project is to design a randomized controlled six-month follow-up trial (RCT) to evaluate whether action observation (AO) added to standard VR (AO + VR) is effective in improving upper limb function in patients with stroke, compared with a control treatment consisting of observation of naturalistic scenes (CO) without any action content, followed by VR training (CO + VR). Discussion AO + VR treatment may provide an addition to the rehabilitative interventions currently available for recovery after stroke and could be utilized within standard sensorimotor training or in individualized tele-rehabilitation. Trial registration The trial has been prospectively registered on ClinicalTrials.gov. NCT05163210 . 17 December 2021.

Pancreatic malignancy is the fourth cause of cancer-related death in Western countries and is predicted to become the second leading cause of cancer-related mortality by 2030. The standard therapies (FOLFIRINOX and gemcitabine with nab-paclitaxel) are not resolutive because this type of cancer is also characterized by a high chemoresistance, due in part to the activity of the ATP Binding Cassette (ABC) pumps accounting for the reduction in the intracellular concentration of the drugs. In this work, we analyze the occurrence of single-nucleotide polymorphisms (SNPs) in the MDR-1 gene, in different pancreatic cancer cell lines, and in tissues from pancreatic cancer patients by DNA sequencing, as well as the expression levels of MDR-1 mRNA and protein, by qRT-PCR and Western Blot analysis. We found that gemcitabine-resistant cells, in conjunction with homozygosis of analyzed SNPs, showed high MDR-1 basal levels with further increases after gemcitabine treatment. Nevertheless, we did not observe in the human PDAC samples a correlation between the level of MDR-1 mRNA and protein expression and SNPs. Preliminary, we conclude that in our small cohort, these SNPs cannot be used as molecular markers for predicting the levels of MDR-1 mRNA/protein levels and drug responses in patients with PDAC. [ABSTRACT FROM AUTHOR]

We collected 1 year of aerosol chemical speciation monitor (ACSM) data in Magadino, a village located in the south of the Swiss Alpine region, one of Switzerland's most polluted areas. We analysed the mass spectra of organic aerosol (OA) by positive matrix factorisation (PMF) using Source Finder Professional (SoFi Pro) to retrieve the origins of OA. Therein, we deployed a rolling algorithm, which is closer to the measurement, to account for the temporal changes in the source profiles. As the first-ever application of rolling PMF with multilinear engine (ME-2) analysis on a yearlong dataset that was collected from a rural site, we resolved two primary OA factors (traffic-related hydrocarbon-like OA (HOA) and biomass burning OA (BBOA)), one mass-to-charge ratio (m/z) 58-related OA (58-OA) factor, a less oxidised oxygenated OA (LO-OOA) factor, and a more oxidised oxygenated OA (MO-OOA) factor. HOA showed stable contributions to the total OA through the whole year ranging from 8.1 % to 10.1 %, while the contribution of BBOA showed an apparent seasonal variation with a range of 8.3 %–27.4 % (highest during winter, lowest during summer) and a yearly average of 17.1 %. OOA (sum of LO-OOA and MO-OOA) contributed 71.6 % of the OA mass, varying from 62.5 % (in winter) to 78 % (in spring and summer). The 58-OA factor mainly contained nitrogen-related variables which appeared to be pronounced only after the filament switched. However, since the contribution of this factor was insignificant (2.1 %), we did not attempt to interpolate its potential source in this work. The uncertainties (σ) for the modelled OA factors (i.e. rotational uncertainty and statistical variability in the sources) varied from ±4 % (58-OA) to a maximum of ±40 % (LO-OOA). Considering that BBOA and LO-OOA (showing influences of biomass burning in winter) had significant contributions to the total OA mass, we suggest reducing and controlling biomass-burning-related residential heating as a mitigation strategy for better air quality and lower PM levels in this region or similar locations. In Appendix A, we conduct a head-to-head comparison between the conventional seasonal PMF analysis and the rolling mechanism. We find similar or slightly improved results in terms of mass concentrations, correlations with external tracers, and factor profiles of the constrained POA factors. The rolling results show smaller scaled residuals and enhanced correlations between OOA factors and corresponding inorganic salts compared to those of the seasonal solutions, which was most likely because the rolling PMF analysis can capture the temporal variations in the oxidation processes for OOA components. Specifically, the time-dependent factor profiles of MO-OOA and LO-OOA can well explain the temporal viabilities of two main ions for OOA factors, m/z 44 (CO2+) and m/z 43 (mostly C2H3O+). Therefore, this rolling PMF analysis provides a more realistic source apportionment (SA) solution with time-dependent OA sources. The rolling results also show good agreement with offline Aerodyne aerosol mass spectrometer (AMS) SA results from filter samples, except for in winter. The latter discrepancy is likely because the online measurement can capture the fast oxidation processes of biomass burning sources, in contrast to the 24 h filter samples. This study demonstrates the strengths of the rolling mechanism, provides a comprehensive criterion list for ACSM users to obtain reproducible SA results, and is a role model for similar analyses of such worldwide available data.

Abstract Background Cancer‐associated weight loss (WL) associates with increased mortality. International consensus suggests that WL is driven by a variable combination of reduced food intake and/or altered metabolism, the latter often represented by the inflammatory biomarker C‐reactive protein (CRP). We aggregated data from Canadian and European research studies to evaluate the associations of reduced food intake and CRP with cancer‐associated WL (primary endpoint) and overall survival (OS, secondary endpoint). Methods The data set included a total of 12,253 patients at risk for cancer‐associated WL. Patient‐reported WL history (% in 6 months) and food intake (normal, moderately, or severely reduced) were measured in all patients; CRP (mg/L) and OS were measured in N = 4960 and N = 9952 patients, respectively. All measures were from a baseline assessment. Clinical variables potentially associated with WL and overall survival (OS) including age, sex, cancer diagnosis, disease stage, and performance status were evaluated using multinomial logistic regression MLR and Cox proportional hazards models, respectively. Results Patients had a mean weight change of −7.3% (±7.1), which was categorized as: ±2.4% (stable weight; 30.4%), 2.5–5.9% (19.7%), 6.0–10.0% (23.2%), 11.0–14.9% (12.0%), ≥15.0% (14.6%). Normal food intake, moderately, and severely reduced food intake occurred in 37.9%, 42.8%, and 19.4%, respectively. In MLR, severe WL (≥15%) (vs. stable weight) was more likely (P 100 mg/L: OR 2.30 (95% CI 1.62–3.26)]. Diagnosis, stage, and performance status, but not age or sex, were significantly associated with WL. Median OS was 9.9 months (95% CI 9.5–10.3), with median follow‐up of 39.7 months (95% CI 38.8–40.6). Moderately and severely reduced food intake and CRP independently predicted OS (P

Malnutrition is an often-overlooked challenge for patients with cancer. It is associated with muscle mass reduction, poor compliance and response to cancer treatments, decreased quality of life, and reduced survival time. The nutritional assessment and intervention should be a vital part of any comprehensive cancer treatment plan. However, data on artificial nutrition supplied based on caloric needs during cancer care are scarce. In this review, we discuss the recommendations of the European and American societies for clinical nutrition on the use of nutritional interventions in malnourished patients with cancer in the context of current clinical practice. In particular, when enteral nutrition (oral or tube feeding) is not feasible or fails to meet the complete nutritional needs, supplemental parenteral nutrition (SPN) can bridge the gap. We report the available evidence on SPN in cancer patients and identify the perceived barriers to the wider application of this intervention. Finally, we suggest a ‘permissive’ role of SPN in cancer care but highlight the need for rigorous clinical studies to further evaluate the use of SPN in different populations of cancer patients.