The psychological impact of the COVID emergency on Italian nursing homes staff and the effectiveness of eye movement desensitization and reprocessing.

Residential nursing homes were particularly badly affected by the first wave of COVID-19, with large numbers of their frail person getting infected with COVID-19 and dying. The staff in these structures were catapulted into a reality very different from what they were used to. They had to adapt the way they used to take care of their patients in a very short space of time and in a scenario that was continually changing. In this manuscript we describe the subjective experience of staff in a number of Italian nursing homes during the first wave of the COVID-19 pandemic; and we report data showing the effectiveness of the Eye Movement Desensitization and Reprocessing (EMDR) treatment provided to support them during this Pandemic.

Supporting healthcare workers in times of COVID-19 with eye movement desensitization and reprocessing online: A pilot study.

We report the results of a pilot study regarding the adaptation of the group eye movement desensitization and reprocessing (EMDR) protocol for the treatment online, for the management of trauma associated with the COVID-19 Pandemic in Italy. The target group were healthcare workers in a nursing home (Residenza sanitaria assistita, RSA) who decided to live and stay on site during the most acute phase of the Pandemic in order to protect the residents of the home. Scores for perceived post traumatic stress disorder (PTSD) symptoms and quality of emotional experience improved significantly following participation in the therapy programme. These preliminary results confirm the innovative potential of the EMDR protocol when used online on early intervention, to prevent the development of later psychological disturbances.

Being Overweight Is Related to Faster Decline in Annual Glomerular Filtration Rate in Kidney Transplant.

Few studies have examined the relationship between non-immunological factors and glomerular filtration rate (GFR) decline in kidney transplant. Correcting these factors in native kidneys slows the progression of chronic kidney disease. The aim of this study was to analyze the association between the control of non-immunological factors and the annual decline of GFR. METHODS: A single-center, retrospective study was performed. We included 128 patients who received kidney transplants between 2000 and 2015, with at least 1-year post-transplant follow-up. Clinical records were reviewed. GFR was estimated by CKD-EPI. Three groups were defined according to the annual change in eGFR (ΔGFR 2016-1015): non-progressors (> -1 mL/min/1.73 m2), slow progressors (> -1 and < -5 mL/min/1.73 m2), and fast progressors (< -5 mL/min/1.73 m2). Percentage of achievement of KDIGO target was also analyzed. RESULTS: The mean GFR was 62.5 mL/min/1.73 m2. Glomerulonephritis was the most common cause of kidney failure (36%). When the fast progressor group was compared with the non-progressor group, they differed significantly in age-patients were younger (40 ± 12.3 vs 45 ± 13.1 years)-post-transplant body mass index (27.4 ± 5.6 vs 25.2 x ± 5.9 kg/m2), and serum uric acid, which was significantly higher (6.4 ± 1.7 vs 5.5 ± 1.58 mg/dL). There were no differences between the groups with regard to blood pressure, dyslipidemia, proteinuria, or venous bicarbonate. Target systolic blood pressure was achieved by 45% of patients. Biopsy-proven acute rejection was higher in the fast progression group, although this was not statistically significant (13 [24.5%] vs 8 [13.1%]). CONCLUSIONS: High body mass index was associated with a faster decline in glomerular filtration rate in this study. Target blood pressure <140/90 mm Hg was achieved in less than 50% of cases.

Interfacial waveforms in chiral lattices with gyroscopic spinners.

We demonstrate a new method of achieving topologically protected states in an elastic hexagonal system of trusses by attaching gyroscopic spinners, which bring chirality to the system. Dispersive features of this medium are investigated in detail, and it is shown that one can manipulate the locations of stop-bands and Dirac points by tuning the parameters of the spinners. We show that, in the proximity of such points, uni-directional interfacial waveforms can be created in an inhomogeneous lattice and the direction of such waveforms can be controlled. The effect of inserting additional soft internal links into the system, which is thus transformed into a heterogeneous triangular lattice, is also investigated, as the hexagonal lattice represents the limit case of the heterogeneous triangular lattice with soft links. This work introduces a new perspective in the design of periodic media possessing non-trivial topological features.

Acute Antibody-Mediated Rejection in Kidney Transplant Based on the 2013 Banff Criteria: Single-Center Experience in Uruguay.

BACKGROUND: Acute antibody-mediated rejection (AMR) diagnosis criteria have changed in recent consensus of Banff, with current evidence of C4d-negative AMR. Our objective was to evaluate incidence of AMR in renal transplantation according to Banff 2013 criteria and to examine the histological features and outcome. METHODS: This retrospective study involved all kidney transplants with histological diagnosis of acute rejection (AR) at our center between 2000 and 2014. All the biopsies with AR were re-assessed by a nephro-pathologist and classified by use of the Banff 2013 criteria. RESULTS: Of 205 kidney transplants, biopsy-proven AR was diagnosed in 25 cases (12%). Re-assessing them according to Banff 2013 criteria, AMR was diagnosed in 17 (8.3%) and represented 68% of the confirmed rejections. AMR diagnosis was performed on day 23 ± 26, with median of 11 days. From the 17 cases, 7 had concomitant T-cell-mediated rejection. All cases presented endothelial edema and acute tubular necrosis. Glomerulitis was found in 12 cases and capillaritis in 14. In 3, associated thrombotic micro-angiopathy (TMA) was found. Intimal and transmural arteritis was evidenced in 5 and 1 patient. In 2, transplant glomerulopathy was present. Seven of the 10 biopsies with C4d staining in the peri-tubular capillaries were positive. Twelve cases received plasmapheresis, 6 received gamma-globulin, and 6 received rituximab. After administration of anti-AMR therapy, 16 cases recovered renal function, reaching a serum creatinine level of 1.5 ± 0.6 mg %. Graft survival at 1 year was lower in the AMR group versus patients without AMR (81.9% vs 98.9%, log-rank test, P < .001). Risk factors for AMR were re-transplant (30% vs 7%, P = .02), HLA-DR mismatch (1.06 ± 0.65 vs 0.7 ± 0.6, P = .03), panel-reactive antibody (28% ± 33 vs 6.2 ± 13, P = .00), and delayed graft function (82% vs 30%, P = .00). CONCLUSIONS: Adapting the new Banff 2013 criteria increased the sensitivity of the diagnosis of ARM. Regarding our data, despite an adequate response to the therapy, it resulted in a worse graft survival by the first year of renal transplant.

Ultrasound-assisted extraction of hemicelluloses from grape pomace using response surface methodology.

An ultrasound-assisted procedure was applied to the extraction of hemicelluloses from grape pomace at a mild temperature (20°C). A Central composite design (CCD) was employed to optimize the ultrasound-assisted extraction (UAE) of hemicelluloses from grape pomace with the aim to maximize their extraction yield, and, also, the obtention of the main polymers forming this fraction: Xyloglucans (XLG), Mannans (MAN) and Xylans (XN). Extraction time (X1), solid:liquid ratio (X2) and KOH concentration (X3) were the variables used to optimize the process. The conditions that maximize (1) the extraction yield of hemicelluloses and the contents of (2) XLG, (3) MAN and (4) XN, were: (1) X1=2.6h; X2=1:48 (w/v); X3=0.4M, (2) X1=2.9h; X2=1:57 (w/v); X3=2.25M, (3) X1=2.7h; X2=1:58(w/v);X3=2.2M, and (4) X1=3h; X2=1:60 (w/v); X3=2.3M, respectively. Under these conditions, the maximum extraction yield of hemicelluloses, XLG, MAN and XN contents were: ∼7.9±0.2%, ∼3.6±0.02%, ∼1.1±0.04% and ∼1.2±0.02%, respectively. Close agreement between experimental and predicted values was found. The results suggest that the ultrasound-assisted extraction could be a good option for the extraction of hemicellulosic polysaccharides from grape pomace at industrial level.

Respiratory infection by Corynebacterium striatum: epidemiological and clinical determinants.

The increasing prevalence of advanced chronic respiratory disease, with frequent exposure to broad-spectrum antibiotics for repeated and prolonged hospitalizations, favours the emergence of nosocomial respiratory infection by Gram-positive bacteria, such as outbreaks of Corynebacterium striatum. There is little evidence about patterns of respiratory infection, transmission and adaptive ability of this pathogen. Seventy-two C. striatum isolates from 51 advanced respiratory patients, mainly chronic obstructive pulmonary disease, were studied during 38 months. Patients were 74.8 ± 8.6 years old and 81.9% were men, who had required an average of 2.2 hospitalizations and 63.5 days in the hospital in the previous year. Of 49 isolates from 42 patients we were able to identify 12 clones by multilocus sequence analysis (MLSA), nine phenotypic variants and 22 antibiotic susceptibility patterns, and we determined their clinical and epidemiological determinants. MLSA allows identification of the existence of nosocomial outbreaks by transmission of the same or different clones, the persistence of the same clone in the environment or in patient airways for months. The study showed the high variability and adaptive capacity of the isolates, the antibiotic multidrug-resistance in all of them, and their contribution to a high morbidity and mortality (41%) during the study period.

Ultrasound-assisted extraction of pectins from grape pomace using citric acid: a response surface methodology approach.

An ultrasound-assisted procedure for the extraction of pectins from grape pomace with citric acid as the extracting agent was established. A Box-Behnken design (BBD) was employed to optimize the extraction temperature (X1: 35-75°C), extraction time (X2: 20-60 min) and pH (X3: 1.0-2.0) to obtain a high yield of pectins with high average molecular weight (MW) and degree of esterification (DE) from grape pomace. Analysis of variance showed that the contribution of a quadratic model was significant for the pectin extraction yield and for pectin MW whereas the DE of pectins was more influenced by a linear model. An optimization study using response surface methodology was performed and 3D response surfaces were plotted from the mathematical model. According to the RSM model, the highest pectin yield (∼32.3%) can be achieved when the UAE process is carried out at 75°C for 60 min using a citric acid solution of pH 2.0. These pectic polysaccharides, composed mainly by galacturonic acid units (<97% of total sugars), have an average MW of 163.9 kDa and a DE of 55.2%. Close agreement between experimental and predicted values was found. These results suggest that ultrasound-assisted extraction could be a good option for the extraction of functional pectins with citric acid from grape pomace at industrial level.

Randomized trial to evaluate cardiometabolic and endothelial function in patients with plasma HIV-1 RNA suppression switching to darunavir/ritonavir with or without nucleoside analogues.

BACKGROUND: We performed a study to evaluate change in cardiometabolic and endothelial function in HIV-infected patients switching to darunavir/ritonavir (DRV/r) monotherapy versus triple therapy. METHODS: The MONARCH trial recruited 30 patients who were taking triple combination therapy and with HIV RNA<40 copies/ mL. Patients were randomized to either DRV/r 800/100 mg once daily (OD) monotherapy or DRV/r 800/100 mg OD plus 2 nucleoside reverse transcriptase inhibitors (NRTIs). The primary objective was to assess endothelial function change from baseline to 24 and 48 weeks in brachial artery flow-mediated dilation (FMD) test; changes in endothelial precursor cells (EPCs) and circulating endothelial cells (CECs) were secondary objectives. RESULTS: At baseline, the median age of participants was 43 years, 77% were men, and median CD4 cell count was 585 cells/µL. The median FMD (%) decreased in both arms in the study period (P ≯ .05), with no statistically significant difference between arms (10.7% at baseline and 6.7% at week 48 in the DRV/r + 2 NRTIs arm; 11.1% at baseline and 8.8% at week 48 in the DRV/r arm). The changes at week 48 were similar in the 2 arms for EPCs and CECs. Total cholesterol and low-density lipoprotein (LDL) cholesterol showed larger rises to week 48 in the DRV/r arm monotherapy group than in the triple-therapy group (+26 vs +9 mg/dL for total cholesterol and +14 vs +5 mg/dL for LDL cholesterol). CONCLUSIONS: In the MONARCH trial, switching from triple combination treatment to DRV/r, with or without nucleoside analogues, did not translate into clinically meaningful reductions in endothelial function as measured by FMD.

The exposition of a calcareous Mediterranean soil to toxic concentrations of Cr, Cd and Pb produces changes in the microbiota mainly related to differential metal bioavailability.

The involvement of the bacterial community of an agricultural Mediterranean calcareous soil in relation to several heavy metals has been studied in microcosms under controlled laboratory conditions. Soil samples were artificially polluted with Cr(VI), Cd(II) and Pb(II) at concentrations ranging from 0.1 to 5000 mg kg(-1) and incubated along 28 d. The lowest concentrations with significant effects in soil respirometry were 10 mg kg(-1) Cr and 1000 mg kg(-1) Cd and Pb. However, only treatments showing more than 40% inhibition of respirometric activity led to significant changes in bacterial composition, as indicated by PCR-DGGE analyses. Presumable Cr- and Cd-resistant bacteria were detected in polluted microcosms, but development of the microbiota was severely impaired at the highest amendments of both metals. Results also showed that bioavailability is an important factor determining the impact of the heavy metals assayed, and even an inverted potential toxicity ranking could be achieved if their soluble fraction is considered instead of the total concentration. Moreover, multiresistant bacteria were isolated from Cr-polluted soil microcosms, some of them showing the capacity to reduce Cr(VI) concentrations between 26% and 84% of the initial value. Potentially useful strains for bioremediation were related to Arthrobacter crystallopoietes, Stenotrophomonas maltophilia and several species of Bacillus.

Impact of chlorophenols on microbiota of an unpolluted acidic soil: microbial resistance and biodegradation.

The impact of 2-monochlorophenol (MCP), 2,4,6-trichlorophenol (TCP) and pentachlorophenol (PCP) on the microbial community of an acidic forest soil was studied under controlled laboratory conditions by spiking microcosms with the pollutants at concentrations ranging from 0.1 to 5000 mg kg(-1). A decrease in the cumulative respirometric values and changes in the bacterial and fungal community composition were detected at 1000 mg MCP kg(-1), 100 mg TCP kg(-1) and 100 and 1000 mg PCP kg(-1). However, drastic effects on the microbial community were revealed only at higher concentrations of MCP and TCP, although the toxicity of PCP was expected to be stronger. The acidic condition of the soil presumably reduces bioavailability of PCP, leading to less pronounced effects than the other pollutants. This finding highlights the consideration of pollutant bioavailability in each environment to adequately assess contamination effects. Twenty-two different chlorophenol-resistant and potentially degrading microorganisms were isolated from highly polluted microcosms. The most resistant isolates were related to Burkholderia arboris, Bacillus circulans, Paenibacillus taichungensis, Luteibacter rhizovicina and Janibacter melonis. These isolates also showed the capacity to reduce the concentration of TCP or PCP between 15% and 35% after 5 days of incubation (initial concentration of 50 mg L(-1)). The isolate related to B. circulans is an atypical case of a member of the Firmicutes group for which chlorophenol-degrading capacities have been described.

Compliance to the prescribed overall treatment time (OTT) of curative radiotherapy in normal clinical practice and impact on treatment duration of counteracting short interruptions by treating patients on Saturdays.

BACKGROUND AND PURPOSE: To evaluate the compliance of the prescribed OTT in a normal clinical practice and to establish the incidence, duration and causes of unplanned interruptions of radiation therapy. To quantify the impact of an institutional policy to maintain the OTT counteracting some short interruptions by treating patients on Saturday morning. MATERIAL AND METHODS: The treatment charts of all new patients treated with curative intent in a period of one year were reviewed retrospectively. All treatments started on Monday or Tuesday and split-course was not used. The difference between the actual realized and the planned OTT was calculated as a measure of compliance. Recalculations of OTT were made to quantify the impact of compensating short gaps by treating patients on Saturday. The cause of interruption was also recorded and classified. RESULTS: The charts of 478 consecutive patients treated with curative intent were reviewed. The overall incidence of unplanned interruptions was 76.6%. Public holidays and machine maintenance caused most of interruptions, and machine breakdown caused 13%. 17.9% of the interruptions were greater than 5 days and 5.6% greater than 10 days. Only 23.4% of patients finished their radiotherapy in the planned OTT (12.6% if no compensation on Saturday). 48.9% of head and neck cancer patients finished their treatment in the planned OTT (19.5% if no compensation on Saturday). The time in excess ranged up to 44 days, and the average time in excess was 3.3 days for the entire group (4.2 days if no compensation on Saturday). For head and neck cancer patients, the time in excess was 1.9 days (3.9 days if no compensation on Saturday). CONCLUSIONS: This study has documented that the incidence and duration of unplanned interruptions of standard treatment schedules is a major problem in normal clinical practice. Most interruptions are short and due mainly to public holidays and machine maintenance and for these reasons they can be planned. In spite of the extra costs, counteracting some short interruptions by treating patients on Saturday is a good way to maintain the OTT without loss of local control.

Compliance to the prescribed overall treatment time (OTT) of curative radiotherapy in normal clinical practice and impact on treatment duration of counteracting short interruptions by treating patients on Saturdays

BACKGROUND AND PURPOSE: To evaluate the compliance of the prescribed OTT in a normal clinical practice and to establish the incidence, duration and causes of unplanned interruptions of radiation therapy. To quantify the impact of an institutional policy to maintain the OTT counteracting some short interruptions by treating patients on Saturday morning. MATERIAL AND METHODS: The treatment charts of all new patients treated with curative intent in a period of one year were reviewed retrospectively. All treatments started on Monday or Tuesday and split-course was not used. The difference between the actual realized and the planned OTT was calculated as a measure of compliance. Recalculations of OTT were made to quantify the impact of compensating short gaps by treating patients on Saturday. The cause of interruption was also recorded and classified. RESULTS: The charts of 478 consecutive patients treated with curative intent were reviewed. The overall incidence of unplanned interruptions was 76.6%. Public holidays and machine maintenance caused most of interruptions, and machine breakdown caused 13%. 17.9% of the interruptions were greater than 5 days and 5.6% greater than 10 days. Only 23.4% of patients finished their radiotherapy in the planned OTT (12.6% if no compensation on Saturday). 48.9% of head and neck cancer patients finished their treatment in the planned OTT (19.5% if no compensation on Saturday). The time in excess ranged up to 44 days, and the average time in excess was 3.3 days for the entire group (4.2 days if no compensation on Saturday). For head and neck cancer patients, the time in excess was 1.9 days (3.9 days if no compensation on Saturday). CONCLUSIONS: This study has documented that the incidence and duration of unplanned interruptions of standard treatment schedules is a major problem in normal clinical practice. Most interruptions are short and due mainly to public holidays and machine maintenance and for these reasons they can be planned. In spite of the extra costs, counteracting some short interruptions by treating patients on Saturday is a good way to maintain the OTT without loss of local control (AU)

Effects of the agronomic use of olive oil mill wastewater: field experiment.

The aim of this study is to assess the effects of olive oil wastewater application on soils. The work consists of field application of the waste at different rates (30, 180, 360 m(3) ha(-1)). Increasing rates of waste enhance the soil fertility due to P, organic matter and N. However, temporary nitrogen immobilisation, increase in salinity values and in phenolic compounds concentrations, both sorbed and soluble forms, have also been observed. Phenolic compounds have been rapidly biodegraded in soil.

[Nonalcoholic steatohepatitis associated with ovarian stromal hyperplasia]. / Esteatohepatitis no alcohólica asociada a hiperplasia estromal ovárica.

Alterations in liver function tests have previously been reported in patients with ovarian disease. We report the case of a woman with prolonged hypertransaminasemia, significant hirsutism and android phenotype who was diagnosed with nonalcoholic steatohepatitis and ovarian stromal hyperplasia.

Esteatohepatitis no alcohólica asociada a hiperplasia estromal ovárica / Nonalcoholic steatohepatitis associated with ovarian stromal hyperplasia

Se han documentado alteraciones en las pruebas de función hepática en pacientes con enfermedad ovárica. El caso que presentamos es el de una paciente con hipertransaminasemia prolongada, hirsutismo importante y fenotipo androide, que es diagnosticada de esteatohepatitis no alcohólica e hiperplasia estromal ovárica

Alterations in liver function tests have previously been reported in patients with ovarian disease. We report the case of a woman with prolonged hypertransaminasemia, significant hirsutism and android phenotype who was diagnosed with nonalcoholic steatohepatitis and ovarian stromal hyperplasia

On the overlap between apathy and depression in dementia.

BACKGROUND: Whereas apathy is increasingly recognised as a frequent abnormal behaviour in dementia, its overlap with depression remains poorly understood. AIMS: To assess the psychometric characteristics of a structured interview for apathy, and to examine the overlap between apathy and depression in dementia. METHODS: A total of 150 patients with Alzheimer's disease (AD) underwent a comprehensive psychiatric and cognitive assessment. RESULTS: Twelve per cent of the sample met criteria for both apathy and depression, 7% met criteria for apathy only, and 31% met criteria for depression only. Apathy (but not depression) was significantly associated with more severe cognitive deficits. Apathy and anxiety scores accounted for 65% of the variance of depression scores in dementia, and the diagnosis of apathy had a minor impact on the rating of severity of depression. CONCLUSIONS: The Structured Interview for Apathy demonstrated adequate psychometric characteristics. Using a novel structured interview for apathy in AD we demonstrated that whereas the construct of depression primarily consists of symptom clusters of apathy and anxiety, apathy is a behavioural dimension independent of depression.