Modulation of miR-146b Expression during Aging and the Impact of Physical Activity on Its Expression and Chondrogenic Progenitors.

The finding of molecules associated with aging is important for the prevention of chronic degenerative diseases and for longevity strategies. MicroRNAs (miRNAs) are post-transcriptional regulators involved in many biological processes and miR-146b-5p has been shown to be involved in different degenerative diseases. However, miR-146b-5p modulation has not been evaluated in mesenchymal stem cells (MSCs) commitment or during aging. Therefore, the modulation of miR-146b-5p in the commitment and differentiation of mesenchymal cells as well as during maturation and aging in zebrafish model were analyzed. In addition, circulating miR-146b-5p was evaluated in human subjects at different age ranges. Thus, the role of physical activity in the modulation of miR-146b-5p was also investigated. To achieve these aims, RT (real-time)-PCR, Western blot, cell transfections, and three-dimensional (3D) culture techniques were applied. Our findings show that miR-146b-5p expression drives MSCs to adipogenic differentiation and increases during zebrafish maturation and aging. In addition, miR-146b-5p expression is higher in females compared to males and it is associated with the aging in humans. Interestingly, we also observed that the physical activity of walking downregulates circulating miR-146b-5p levels in human females and increases the number of chondroprogenitors. In conclusion, miR-146b-5p can be considered an age-related marker and can represent a useful marker for identifying strategies, such as physical activity, aimed at counteracting the degenerative processes of aging.

Long-Term Spasticity Management in Post-Stroke Patients: Issues and Possible Actions-A Systematic Review with an Italian Expert Opinion.

Spasticity is a well-known motor dysfunction occurring after a stroke. A group of Italian physicians' experts in treating post-stroke spasticity (PSS) reviewed the current scientific evidence concerning the state-of-the-art clinical management of PSS management and the appropriate use of botulinum toxin, aiming to identify issues, possible actions, and effective management of the patient affected by spasticity. The participants were clinicians specifically selected to cover the range of multidisciplinary clinical and research expertise needed to diagnose and manage PSS. When evidence was not available, the panel discussed and agreed on the best way to manage and treat PSS. To address the barriers identified, the panel provides a series of consensus recommendations. This systematic review provides a focused guide in the evaluation and management of patients with PSS and its complications. The recommendations reached by this panel of experts should be used by less-experienced doctors in real life and should be used as a guide on how to best use botulinum toxin injection in treating spasticity after a stroke.

Clinical and Economic Impact of COVID-19 in Vascular Surgery at a Tertiary University "Hub" Hospital of Italy.

BACKGROUND: Since the first cases of a novel respiratory disease were reported in December 2019, coronavirus disease (COVID-19) Emergency State (Cov-ES) caused a worldwide outbreak requiring a complete reorganization of the healthcare system and new management of its personnel; aim of this study was to analyze the clinical and financial impact of Cov-ES in the Department of Vascular Surgery at a Tertiary University "Hub" Hospital in northeast Italy. METHODS: Differences in clinical practice according to Diagnostic Related Group (DRG) and International Statistical Classification of Diseases (ICD) and Related Health Problems and the financial impact of Cov-ES were considered. Vascular procedures performed between March 2019 and December 2019 (Prepandemic) were compared to those performed in the period March-December 2020 (Pandemic). Prepandemic and pandemic reimbursements of all vascular activities and the top 3 vascular diagnoses were evaluated. RESULTS: Prepandemic versus pandemic era documented a decrease of vascular consultations performed (2,882 vs. 2,270, -21.2%). The number of total vascular procedures decreased from 997 to 797 (-20.1%) with a higher reduction observed in outpatient surgical activities (247 to 136, -45.0%, P = 0.0005) rather than inpatient surgical activities (750 vs. 661, 11.9%, P = 0.02). Length of hospital stay (LOS) increased from 3.3 ± 2.7 days in prepandemic to 5.3 ± 3.9 in the pandemic era (P = 0.004). Among patients with limb-threatening ischemia, the rate of major limb amputation was higher in the pandemic (3.3% vs. 5.4%, respectively, P = 0.02), and a higher rate of elective hospitalization procedures was performed as urgent/emerging setting after clinical deterioration (2.8 % vs. 6.4%, P = 0.0002). According to DRG classification, an increase of "complicated" limb-threatening ischemia (DRG 554) and aortic aneurysm (DRG 110) was observed prepandemic to pandemic (+84.2% and +25.0%, respectively). Total reimbursement for vascular activities between pandemic versus prepandemic was 4,646,108€ vs. 5,054,398€, respectively (-8.0%). Management of "complicated" limb-threatening ischemia (DRG 554) and aortic aneurysm (DRG 110) required a higher clinical and financial support that was translated into higher economic reimbursement during the pandemic (273,035€ vs. 150,005€, +82.0% and 749,250€ vs. 603,680€, +24.1%, respectively). CONCLUSIONS: During the pandemic, the main resources were employed for the treatment of limb-threatening ischemia, aortic aneurysm, and carotid stenosis. Inpatient activities documented an increase in major limb amputation and LOS. An increased reimbursement for each vascular procedure and for all "complicated" diagnoses revealed that the more serious and resource-demanding pathology occurred in this period.

Two years of on-site influenza vaccination strategy in an Italian university hospital: main results and lessons learned.

Although the vaccination of healthcare workers (HCWs) is considered essential for preventing influenza circulation in the hospital setting, vaccination coverage (VC) in this group remains low. Among the reasons cited by HCWs is a lack of time to attend the vaccination clinic. For the 2018/2019 influenza season, active (on-site) influenza vaccination was offered directly in 44 operative units (OUs) of the Bari Policlinico hospital (50 OUs, 3,397 HCWs). At the same time, the hospital granted the HCW access to the vaccination clinic during October and December 2018. VC achieved among HCWs of Bari Policlinico during the 2018/2019 influenza season was then analyzed, and the results compared with those of the 2017/18 season. During the 2018/19 season, VC was 20.4% (n = 798) and thus higher than the 14.2% of the 2017/18 season (+6.2%). The highest VC was among physicians (33.4%), followed by other HCWs (23.8%), auxiliary staff (8.6%), and nurses (7.2%). Overall, 284 (36.5%) HCWs were vaccinated at on-site sessions. Multivariate analysis showed that vaccination uptake was associated with male gender and with work in OU where vaccination was actively offered. On the other hand, being a nurse or auxiliary staff member and working in the surgical area were deterrents. Although VC remained unsatisfactory, active on-site vaccination proved to be an important strategy to improve vaccination compliance, increasing 44% compared to the previous season. Nonetheless, mandatory vaccination directed by public health institutions may be the only way to reach a minimum level of coverage.

Management of Microbiological Contamination of the Water Network of a Newly Built Hospital Pavilion.

The good installation, as well as commissioning plan, of a water network is a crucial step in reducing the risk of waterborne diseases. The aim of this study was to monitor the microbiological quality of water from a newly built pavilion before it commenced operation. Overall, 91 water samples were tested for coliforms, Escherichia coli, enterococci, Pseudomonas aeruginosa and Legionella at three different times: T0 (without any water treatment), T1 (after treatment with hydrogen peroxide and silver ions at initial concentration of 20 mg/L and after flushing of water for 20 min/day for seven successive days) and T2 (15 days later). Coliforms were detected in 47.3% of samples at T0, 36.3% at T1 and 4.4% at T2. E. coli was isolated in 4.4% of the samples only at T1, while enterococci appeared in 12.1% of the samples at T1 and in 2.2% at T2. P. aeruginosa was isolated in 50.5% of the samples at T0, 29.7% at T1 and 1.1% at T2. Legionella pneumophila serogroup 8 was isolated in 80.2% of the samples at T0, 36.3% at T1 and 2.2% at T2. Our results confirmed the need for a water safety plan in new hospital pavilions to prevent the risk of waterborne diseases.

Impact of lockdown on the microbiological status of the hospital water network during COVID-19 pandemic.

The COVID-19 pandemic started in China in early December 2019, and quickly spread around the world. The epidemic gradually started in Italy at the end of February 2020, and by May 31, 2020, 232,664 cases and 33,340 deaths were confirmed. As a result of this pandemic, the Italian Ministerial Decree issued on March 11, 2020, enforced lockdown; therefore, many social, recreational, and cultural centers remained closed for months. In Apulia (southern Italy), all non-urgent hospital activities were suspended, and some wards were closed, with a consequent reduction in the use of the water network and the formation of stagnant water. This situation could enhance the risk of exposure of people to waterborne diseases, including legionellosis. The purpose of this study was to monitor the microbiological quality of the water network (coliforms, E. coli, Enterococci, P. aeruginosa, and Legionella) in three wards (A, B and C) of a large COVID-19 regional hospital, closed for three months due to the COVID-19 emergency. Our study revealed that all three wards' water network showed higher contamination by Legionella pneumophila sg 1 and sg 6 at T1 (after lockdown) compared to the period before the lockdown (T0). In particular, ward A at T1 showed a median value = 5600 CFU/L (range 0-91,000 CFU/L) vs T0, median value = 75 CFU/L (range 0-5000 CFU/L) (p-value = 0.014); ward B at T1 showed a median value = 200 CFU/L (range 0-4200 CFU/L) vs T0, median value = 0 CFU/L (range 0-300 CFU/L) (p-value = 0.016) and ward C at T1 showed a median value = 175 CFU/L (range 0-22,000 CFU/L) vs T0, median value = 0 CFU/L (range 0-340 CFU/L) (p-value < 0.001). In addition, a statistically significant difference was detected in ward B between the number of positive water samples at T0 vs T1 for L. pneumophila sg 1 and sg 6 (24% vs 80% p-value < 0.001) and for coliforms (0% vs 64% p-value < 0.001). Moreover, a median value of coliform load resulted 3 CFU/100 ml (range 0-14 CFU/100 ml) at T1, showing a statistically significant increase versus T0 (0 CFU/100 ml) (p-value < 0.001). Our results highlight the need to implement a water safety plan that includes staff training and a more rigorous environmental microbiological surveillance in all hospitals before occupying a closed ward for a longer than one week, according to national and international guidelines.

AOU Policlinico di Bari - West China Hospital of Sichuan University. Global experience of medical profession, battle, health, friendship against COVID -19.

BACKGROUND: The global context we are experiencing, characterized by the pandemic spread of SARS-CoV2, imposes strict containment, isolation and physical distance measures, necessary to control and contain the risk of contagion. Despite social distances and isolation in this context of threat to Global Health, the sharing of experiences, professionalism, scientific research and Public Health strategies is fundamental. Never before has telemedicine played a decisive role in supporting the healthcare organization, The University Hospital Consortium Policlinico of Bari has launched an experimental partnership project with West China Hospital of Sichuan University through periodic and scheduled video conferences. MATERIALS AND METHODS: The Company Strategic Management, the Dean of the Faculty of Medicine and Surgery of the University of Bari, Medical Executives of the Health Department, of the U.O of Infectious Diseases, Anesthesia and Resuscitation, Pulmonology, Emergency, Hygiene, Occupational Medicine, Psychiatry and Doctors Resident operating in the COVID Area. are involved in the Experimental Project., all adequately trained and instructed on the operating protocol. RESULTS: From the preliminary data of this study, it appears that the Bari Polyclinic has adopted the same therapeutic strategies started in China in the previous months, believing early diagnosis and treatment to be a strength in the battle against COVID-19. The project makes it possible to make the management of COVID-19 patients optimal, safe and better, using the experience acquired in the field by Chinese doctors who, first caught by this health emergency, have obtained positive results.

Stand by me 2.0. Visits by family members at Covid-19 time.

BACKGROUND: In the complex health emergency situation of our country, the application of Information Technology tools has a decisive role in supporting health insurance, creating a highly performing and technologically advanced system that reduce distances, suffering of disease and the weight of necessary isolation. The theme of the humanization of care, understood as attention to the person as a whole, is a highly topical issue today. The humanization in the healthcare is intended as the ability to make the places of care and the same medical care practices more open, safer and painless, reconciling hospitality, information and comfort with care paths as much as possible in sharing with the patient and his family. MATERIALS AND METHODS: Pursuing the purposes inherent in the concept of humanization of care and assistance, with the aim of offering Apulian citizens a complementary, but also fundamental, service in clinical-therapeutic assistance to the patient affected by COVID-19, in the hope of improving the quality of care, also in relation to the perception of the user, the Strategic Management of the AOU Policlinico of Bari has launched an experimental project that fits into the context of care quality, a crucial and not negligible issue, despite the extreme difficulties dictated by the ongoing medical emergency. RESULTS: The experimental project proposes an innovative clinical-organizational model which, through Information and Communications Technology (ICT), intends to make the management of COVID-19 patients optimal, safe and better, in all the spheres that jointly define the concept of Health.

Mood states in long-term cancer survivors: an Italian descriptive survey.

PURPOSE: Since long-term survivorship is now a reality for an increasing number of people with cancer, understanding their mood states (i.e., transient subjective emotional states) can inform health-care policy as well as help support individual patients. This study described the mood states of Italian long-term cancer survivors, compared them with normative data, and tested their association with the main clinical and socio-demographic sample's characteristics. METHODS: One hundred and fifty-eight Italian adults free from cancer and its treatments for at least 5 years were administered the Profile of Mood States (POMS) and two ad hoc 0-10-point visual-analogue scales on personal health-related worry and risk perception for a personal relapse, respectively. RESULTS: In comparison with the Italian normative sample, the current sample displayed a higher score in Vigor-Activity (p = 0.003) and a lower score in Confusion-Bewilderment (p = 0.008). In Tension-Anxiety, Confusion-Bewilderment, Depression-Dejection, Anger-Hostility, Fatigue-Inertia, and Vigor-Activity, 14.6, 15.9, 17.1, 17.8, 19.7, and 13.3 % of the sample, respectively, displayed meaningful scores (i.e., scores above or below 1 standard deviation from the normative mean score). The mood state profile POMS-provided was associated with gender (p = 0.002), occupational status (p = 0.003), reported health issues (p < 0.001), and quality of sleep (p < 0.001). In personal health-related worry and risk perception for a personal relapse, the average scores were 4.8 (SD = 3.0) and 4.1 (SD = 2.9), respectively. CONCLUSIONS: These data encourage a multidimensional assessment of emotional functioning of this specific population.