The Italian coronavirus disease 2019 outbreak: recommendations from clinical practice.

Novel coronavirus 2019 is a single-stranded, ribonucleic acid virus that has led to an international pandemic of coronavirus disease 2019. Clinical data from the Chinese outbreak have been reported, but experiences and recommendations from clinical practice during the Italian outbreak have not. We report the impact of the coronavirus disease 2019 outbreak on regional and national healthcare infrastructure. We also report on recommendations based on clinical experiences of managing patients throughout Italy. In particular, we describe key elements of clinical management, including: safe oxygen therapy; airway management; personal protective equipment; and non-technical aspects of caring for patients diagnosed with coronavirus disease 2019. Only through planning, training and team working will clinicians and healthcare systems be best placed to deal with the many complex implications of this new pandemic.

Transanal Endoscopic Operation under spinal anaesthesia.

BACKGROUND: Transanal Endoscopic Operation (TEO(®) ) for rectal benign lesions and early rectal cancer may provide better oncological outcomes than flexible endoscopy. The major advantage of flexible endoscopy is that it does not require general anaesthesia. This prospective observational study assessed the feasibility and safety of TEO(®) performed under spinal anaesthesia. METHODS: The study population comprised eligible consecutive patients who underwent TEO(®) under spinal anaesthesia with curative or palliative intent for rectal neoplasms larger than 20 mm in diameter or for recurrent lesions of any size. The primary endpoints were feasibility and safety; secondary endpoints were postoperative pain, as measured on a visual analogue scale, heart rate, systolic and diastolic BP, opioid requested, postoperative nausea or vomiting, and urinary retention. RESULTS: The study included 50 patients (median age 70 years; 29 men and 21 women). No intraoperative complications occurred. The median duration of operation was 60 (range 20-165) min. No opioids were requested during the perioperative or postoperative period. The median postoperative pain score was 0 at 4, 8, 24 and 48 h after surgery. There were no significant fluctuations in heart rate, systolic and diastolic BP up to 48 h after the procedure (P = 0·379, P = 0·386 and P = 0·617 respectively). Postoperative nausea and vomiting occurred in one patient, and urinary retention in four. CONCLUSION: TEO(®) under spinal anaesthesia was safe and feasible with no conversions to general anaesthesia.

Antarctic contribution to meltwater pulse 1A from reduced Southern Ocean overturning.

During the last glacial termination, the upwelling strength of the southern polar limb of the Atlantic Meridional Overturning Circulation varied, changing the ventilation and stratification of the high-latitude Southern Ocean. During the same period, at least two phases of abrupt global sea-level rise--meltwater pulses--took place. Although the timing and magnitude of these events have become better constrained, a causal link between ocean stratification, the meltwater pulses and accelerated ice loss from Antarctica has not been proven. Here we simulate Antarctic ice sheet evolution over the last 25 kyr using a data-constrained ice-sheet model forced by changes in Southern Ocean temperature from an Earth system model. Results reveal several episodes of accelerated ice-sheet recession, the largest being coincident with meltwater pulse 1A. This resulted from reduced Southern Ocean overturning following Heinrich Event 1, when warmer subsurface water thermally eroded grounded marine-based ice and instigated a positive feedback that further accelerated ice-sheet retreat.

Phase transitions in strongly coupled three-dimensional Z(N) lattice gauge theories at finite temperature.

We perform an analytical and numerical study of the phase transitions in three-dimensional Z(N) lattice gauge theories at finite temperature for N>4, exploiting equivalence of these models with a generalized version of the two-dimensional vector Potts models in the limit of vanishing spatial coupling. In this limit the Polyakov loops play the role of Z(N) spins. The effective couplings of these two-dimensional spin models are calculated explicitly. It is argued that the effective spin models have two phase transitions of BKT type. This is confirmed by large-scale Monte Carlo simulations. Using a cluster algorithm we locate the position of the critical points and study the critical behavior across both phase transitions in details. In particular, we determine various critical indices and compute the helicity modulus, the average action, and the specific heat. A scaling formula for the critical points with N is proposed.

Phase transitions in two-dimensional Z(N) vector models for N>4.

We investigate both analytically and numerically the renormalization group equations in two-dimensional (2D) Z(N) vector models. The position of the critical points of the two phase transitions for N>4 is established and the critical index ν is computed. For N=7 and 17 the critical points are located by Monte Carlo simulations, and some of the corresponding critical indices are determined. The behavior of the helicity modulus is studied for N=5, 7, and 17. Using these and other available Monte Carlo data we discuss the scaling of the critical points with N and some other open theoretical problems.

Inhibition of Notch3 signalling induces rhabdomyosarcoma cell differentiation promoting p38 phosphorylation and p21(Cip1) expression and hampers tumour cell growth in vitro and in vivo.

Rhabdomyosarcoma (RMS) is a paediatric soft-tissue sarcoma arising from skeletal muscle precursors coexpressing markers of proliferation and differentiation. Inducers of myogenic differentiation suppress RMS tumourigenic phenotype. The Notch target gene HES1 is upregulated in RMS and prevents tumour cell differentiation in a Notch-dependent manner. However, Notch receptors regulating this phenomenon are unknown. In agreement with data in RMS primary tumours, we show here that the Notch3 receptor is overexpressed in RMS cell lines versus normal myoblasts. Notch3-targeted downregulation in RMS cells induces hyper-phosphorylation of p38 and Akt essential for myogenesis, resulting in the differentiation of tumour cells into multinucleated myotubes expressing Myosin Heavy Chain. These phenomena are associated to a marked decrease in HES1 expression, an increase in p21(Cip1) level and the accumulation of RMS cells in the G1 phase. HES1-forced overexpression in RMS cells reverses, at least in part, the pro-differentiative effects of Notch3 downregulation. Notch3 depletion also reduces the tumourigenic potential of RMS cells both in vitro and in vivo. These results indicate that downregulation of Notch3 is sufficient to force RMS cells into completing a correct full myogenic program providing evidence that it contributes, partially through HES1 sustained expression, to their malignant phenotype. Moreover, they suggest Notch3 as a novel potential target in human RMS.

Numerical study of the phase transitions in the two-dimensional Z(5) vector model.

We investigate the critical properties of the two-dimensional Z(5) vector model. For this purpose, we propose a cluster algorithm, valid for Z(N) models with odd values of N. The two-dimensional Z(5) vector model is conjectured to exhibit two phase transitions with a massless intermediate phase. We locate the position of the critical points and study the critical behavior across both phase transitions in details. In particular, we determine various critical indices and compare the results with analytical predictions.

Impacts of marine aquaculture at large spatial scales: evidences from N and P catchment loading and phytoplankton biomass.

While several studies point at off-shore aquaculture as a possible source of impacts on the local marine environment, very few have analysed its effects at large scales such as at the bay, gulf or basin levels. Similar analyses are hampered by the multiple sources of disturbance that may concomitantly affect a given area. The present paper addresses these issues taking the Gulf of Castellammare (Southern Tyrrhenian Sea) as an example. Nitrogen (N) and phosphorous (P) loads were calculated for the period 1970-2007, and compared to chlorophyll-a concentration as measured inside and outside the Gulf over the same period. Results indicate that N and P catchment loading has constantly decreased because of improved environmental management. Nevertheless, nutrient concentration in the Gulf has steadily increased since the establishment of aquaculture facilities in 1999. Chlorophyll-a concentration followed this trend, showing a marked increase from 2001 onwards. In the same period, chlorophyll-a concentrations measured inside and outside the Gulf have significantly diverged. As all the other possible causes can be ruled out, aquaculture remains the sole explanation for the observed situation. This paper demonstrates for the first time ever that off-shore aquaculture may affect the marine ecosystem well beyond the local scale and provides an additional element of concern to be kept into consideration when allocating oceans' space for new fish-farming activities.

Fibrous tumour of the pleura (SFTP): a proteiform disease. Clinical, histological and atypical radiological patterns selected among our cases.

First described by Klemperer and Rabin in 1931, solitary fibrous tumour of the pleura (SFTP) is a mesenchymal tumour that tends to involve the pleura, although it has also been described in other thoracic areas (mediastinum, pericardium and pulmonary parenchyma) and in extrathoracic sites (meninges, epiglottis, salivary glands, thyroid, kidneys and breast). SFTP usually presents as a peripheral mass abutting the pleural surface, to which it is attached by a broad base or, more frequently, by a pedicle that allows it to be mobile within the pleural cavity. A precise preoperative diagnosis can be arrived at with a cutting-needle biopsy, although most cases are diagnosed with postoperative histology and immunohistochemical analysis of the dissected sample. SFTP, owing to its large size or unusual locations (paraspinal, para-mediastinal, intra-fissural and intraparenchymal), can pose interpretation problems or, indeed, point towards a diagnosis of diseases of a totally different nature. We present some unusual radiographic and computed tomography (CT) images of large SFTP or SFTP located in atypical thoracic locations in patients who underwent surgical resection.

Radiological aspects of diffuse alveolar haemorrhage.

PURPOSE: This paper describes chest X-ray (CXR) and computed tomography (CT) findings of diffuse alveolar haemorrhage (DAH). MATERIALS AND METHODS: We retrospectively reviewed 23 episodes of DAH in 20 patients, 17 of known aetiology and three of unknown aetiology. All cases were studied by CXR and 15 also by CT. Parenchymal consolidations and ground-glass opacities were evaluated after dividing each lung into three regions (upper, middle, lower) for a total of six zones. RESULTS: Consolidations or ground-glass opacities were identified on CXR in 16/20 patients, mainly in the middle fields (73%). In 4/20 patients, all with Wegener's granulomatosis, CXR was negative or demonstrated only nodular opacities; in two of these cases, CT revealed ground-glass opacities. A complete follow-up was available for ten patients: initially, they showed consolidation opacities in 36/60 zones, which persisted in 16/60 after 7 days and in 11/60 after 15 days. Conversely, ground-glass opacities increased after 7 days owing to the partial regression of consolidation opacities, and they markedly diminished after 15 days. CONCLUSIONS: DAH is radiologically characterised by a nonspecific alveolar-filling pattern. Diagnosis or suspicion of DAH needs to be supported by the evidence of haemoptysis and/or rapid-onset anaemia. CT is superior in detecting ground-glass opacities and is required in cases of suspected DAH with normal CXR findings.

Role of chest radiography in the diagnosis of allergic bronchopulmonary aspergillosis in adult patients with cystic fibrosis.

PURPOSE: This study aimed to verify the usefulness of chest radiography in the diagnosis of allergic bronchopulmonary aspergillosis (ABPA) in adult patients with cystic fibrosis. MATERIALS AND METHODS: Eleven patients (with a total of 14 episodes) affected by ABPA were selected from among subjects attending a Regional Cystic Fibrosis Centre. For each episode, we retrospectively reviewed the baseline chest radiographs obtained before the diagnosis of ABPA, those obtained during the course of ABPA and those obtained during follow-up. Radiographs were assessed for the presence of bronchial wall thickening, bronchiectasis, infiltrates, atelectasis, mucoid impaction, lymphadenopathy, pleural effusion and fluid levels. Radiographic findings that had appeared at the time of ABPA diagnosis and disappeared after treatment were considered related to ABPA and thus useful for a correct diagnosis of the disease. Chest radiograph abnormalities were compared with changes on the respiratory function tests [forced expiratory volume in 1 s (FEV1)] during the different stages of the disease. RESULTS: Radiographic findings at the time of ABPA diagnosis appeared to have deteriorated in 8/14 cases when compared with the baseline films; after treatment, the radiographic findings deteriorated in 6/14 cases and improved in 6/14. The most significant among the radiographic signs considered (infiltrates and mucoid impaction) appeared at the time of ABPA diagnosis in 7/14 and 4/14 cases, respectively, and in some patients, they were also present at baseline and persisted during follow-up. FEV1 values were significantly decreased (>10%) in 9/14 cases at the time of ABPA diagnosis. CONCLUSIONS: Our results demonstrate the limited usefulness of chest radiography in the diagnosis of ABPA in patients with cystic fibrosis. The most significant abnormalities are nonspecific and commonly seen on baseline films in cystic fibrosis without ABPA and persist after treatment in most cases.

Three-year findings of an early lung cancer detection feasibility study with low-dose spiral computed tomography in heavy smokers.

BACKGROUND: Low-dose spiral computed tomography (sCT) showed a four-fold increase in the detection rate in high-risk subjects and a higher percentage of stage I lung cancer in comparison with chest X-ray. However, there is a considerable discrepancy among studies in the percentage of lung nodules, overall lung cancer and stage I detection rate. SUBJECTS AND METHODS: From April to December 2001, 520 asymptomatic volunteers aged >or=55 years with a history of cigarette smoking >or=20 pack-years and no previous cancer were enrolled to receive an annual sCT of the chest for five consecutive years. RESULTS: Seventy three per cent were male, median age was 59 years and 91% were current smokers. At baseline, nodules >or=5 mm were detected in 114 (22%) undergoing sCT; the size of lung nodules ranged from 5 to 9.9 mm in 81.5% of the cases. Five (1%) cases of lung cancer were detected. In two additional cases a pathological diagnosis of atypical adenomatous hyperplasia was made. Three new cases of lung cancer were detected in the second and third year of the study. One interval case was detected during the third year. CONCLUSIONS: Despite some promising data, convincing evidence from ongoing randomized trials is needed to support the routine use of sCT as a recommended tool for screening of lung cancer.

Treatment of blepharospasm with botulinum neurotoxin type A: long-term results.

PURPOSE: To describe the long-term efficacy and side effects of treatment of blepharospasm with botulinum neurotoxin type A (Botox). METHODS: A total of 178 patients with blepharospasm were treated by injections of botulinum toxin in the Eye Clinic of the University of Naples from 1980 to 2001. The severity of spasm for each patient was graded on a four-point scale. Duration of improvement was assessed and reported in months. RESULTS: Of 178 cases, 10 were lost to follow-up; of the remaining patients, 93% reported improvement after treatments. The mean duration of improvement was 3.6 months. Twelve patients (76%) who underwent more than 14 treatments maintained stable relief. Three patients (1.7%) had a total remission of spasms. Side-effects were local; none of the 168 patients experienced any systemic or toxic reaction. CONCLUSIONS: Botulinum toxin therapy for blepharospasm can provide long-lasting relief and reduction of spasms in the majority of patients. This therapy has the advantages of being safe, simple, and repeatable.

Conjugated linoleic acid depresses the delta9 desaturase index and stearoyl coenzyme A desaturase enzyme activity in porcine subcutaneous adipose tissue.

Conjugated linoleic acid (CLA) has been shown to have an effect on subcutaneous fatty acid composition and has been reported to decrease stearoyl coenzyme A desaturase (SCD) activity by decreasing mRNA expression and(or) catalytic activity in rodents and rodent cell lines. This investigation was designed to study the effects of CLA, corn oil, or beef tallow supplementation on s.c. adipose tissue fatty acid composition, adiposity, SCD enzyme activity, and the delta9 desaturase index in piglets. Eighteen crossbred barrows 16 to 18 d of age were adapted to diet for 1 wk and then assigned randomly to one of three treatments: 1.5% added CLA, 1.5% added corn oil, or 1.5% added beef tallow. Barrows were penned individually and fed the supplemental oils for 35 d (to 25.6 +/- 0.6 kg BW). Subcutaneous adipose tissue samples were obtained after slaughter. Fatty acid composition of the s.c. adipose tissue differed for each fatty acid measured due to diet with the exception of 18:3. The concentrations of CLA trans-10, cis-12 and cis-9, trans-11 were elevated from nondetectable to 1.62 and 2.52 g/100 g lipid, respectively (P < 0.001 for both isomers). Conjugated linoleic acid decreased the delta9 desaturase index (P < 0.01) and SCD enzyme activity, expressed as nanomoles of palmitate converted to palmitoleate/(7 min x g of tissue) (P = 0.075) and nanomoles of palmitate converted to palmitoleate/(7 min 105 cells) (P= 0.056). Tallow-fed pigs had a greater proportion of large adipocytes (> 700 pL) and the greatest SCD activity. These data provide the first direct evidence that dietary CLA depresses SCD enzyme activity in porcine adipose tissue, which may in part be responsible for the depression of adiposity by CLA observed by others in market weight pigs.

Influencia de sexo y talla en la erupción de piezas permanentes / Influence of sex and height on the eruption of permanent teeth

El estudio de este trabajo es presentar los resultados de un estudio de corte transversal sobre piezas permanentes erupcionadas de niños del Gran Buenos Aires con relación al sexo y a los percentilos nacionales de talla. Una odontóloga calibrada evaluó 801 niños pertenecientes a escuelas públicas e identificó las piezas permanentes erupcionadas obteniendo las tallas, sexo y edades de las historias médicas realizadas en la misma oportunidad. Se constituyeron dos grupos para el análisis de diferentes piezas dentarias, que fueron subdivididos según el percentilo y analizados estadísticamente por test de McNemar. En relación con el sexo las comparaciones fueron realizadas por Chi. Conclusiones: de los resultados obtenidos puede inferirse que en este grupo de niños existe vinculación entre los percentilos de talla y la erupoción de piezas permanentes en los grupos extremos (percentilos < a 25 y > a 75) observándose erupción más lenta en los de corta estatura con respecto a los más altos, y en los varones respecto a las mujeres sólo en el grupo de mayor edad

Influencia de sexo y talla en la erupción de piezas permanentes / Influence of sex and height on the eruption of permanent teeth

El estudio de este trabajo es presentar los resultados de un estudio de corte transversal sobre piezas permanentes erupcionadas de niños del Gran Buenos Aires con relación al sexo y a los percentilos nacionales de talla. Una odontóloga calibrada evaluó 801 niños pertenecientes a escuelas públicas e identificó las piezas permanentes erupcionadas obteniendo las tallas, sexo y edades de las historias médicas realizadas en la misma oportunidad. Se constituyeron dos grupos para el análisis de diferentes piezas dentarias, que fueron subdivididos según el percentilo y analizados estadísticamente por test de McNemar. En relación con el sexo las comparaciones fueron realizadas por Chi. Conclusiones: de los resultados obtenidos puede inferirse que en este grupo de niños existe vinculación entre los percentilos de talla y la erupoción de piezas permanentes en los grupos extremos (percentilos < a 25 y > a 75) observándose erupción más lenta en los de corta estatura con respecto a los más altos, y en los varones respecto a las mujeres sólo en el grupo de mayor edad (AU)

[Usefulness of chest X-ray during cystic fibrosis exacerbation in adult patients]. / Utilità del radiogramma del torace negli episodi di riacutizzazione della fibrosi cistica nel paziente adulto.

PURPOSE: Verify the real usefulness of chest X-ray during clinical exacerbation of cystic fibrosis (FC). MATERIAL AND METHODS: The study was based on a group of 46 adult patients affected by FC. For every subject we selected one or more pair of chest films, of which the first was used as reference image (To), whereas the second (T1) was selected among the following controls, either in course of clinical obvious exacerbation, or during another routine control. The 64 pairs of chest films (32 representing phases of clinical stability, 32 documenting evolution towards clinical deterioration) were subjected to evaluation by two radiologists, who were first asked to judge if stability, improvement or worsening of the overall radiographic picture could be observed; then to estimate the improvement, worsening, stability or absence of the 12 radiographic signs, selected among those more frequently correlating with the acute phase of disease. RESULTS: The comprehensive radiological evaluation, which shows a statistically significant difference (p=0.012) between the two groups considered, weakly correlates with the patient clinical status. Among the patients with exacerbation, the radiographic picture appeared worsened in only 18/32 cases (sensibility 56%, specificity 78%), while on the contrary 7/32 clinically stable patients exhibited a radiographic deterioration. Among the considered radiographic-sings, some were exclusively observed during exacerbation (specificity 100%), but with low sensitivity (pneumothorax: 6%, increment of bronchiectasis: 9%, air space disease 22%); the most common alterations (mucoid impactions and bronchial wall thickening) were observed in both groups of patients. DISCUSSION AND CONCLUSIONS: Our results demonstrate that there is not a precise correlation between the radiographic picture and the clinical manifestations of exacerbation and confirm the poor usefulness of chest X-ray in such a phase of disease. Chest X-ray is needed to exclude pnemothorax or extensive air space disease, rather then to accurately diagnose exacerbation.