Clinical Presentation of COVID19 in Dementia Patients.

OBJECTIVE: No studies analyzing the role of dementia as a risk factor for mortality in patients affected by COVID-19. We assessed the prevalence, clinical presentation and outcomes of dementia among subjects hospitalized for COVID19 infection. DESIGN: Retrospective study. SETTING: COVID wards in Acute Hospital in Brescia province, Northern Italy. PARTICIPANTS: We used data from 627 subjects admitted to Acute Medical wards with COVID 19 pneumonia. MEASUREMENTS: Clinical records of each patients admitted to the hospital with a diagnosis of COVID19 infection were retrospectively analyzed. Diagnosis of dementia, modalities of onset of the COVID-19 infection, symptoms of presentation at the hospital and outcomes were recorded. RESULTS: Dementia was diagnosed in 82 patients (13.1%). The mortality rate was 62.2% (51/82) among patients affected by dementia compared to 26.2% (143/545) in subjects without dementia (p<0.001, Chi-Squared test). In a logistic regression model age, and the diagnosis of dementia resulted independently associated with a higher mortality, and patients diagnosed with dementia presented an OR of 1.84 (95% CI: 1.09-3.13, p<0.05). Among patients diagnosed with dementia the most frequent symptoms of onset were delirium, especially in the hypoactive form, and worsening of the functional status. CONCLUSION: The diagnosis of dementia, especially in the most advanced stages, represents an important risk factor for mortality in COVID-19 patients. The clinical presentation of COVID-19 in subjects with dementia is atypical, reducing early recognition of symptoms and hospitalization.

Genome-wide association study identifies quantitative trait loci regions involved in muscle acidic profile in Large White heavy pigs.

The widespread use of genome-wide association studies resulted in the discovery of genomic regions associated with fatty acid (FA) composition in different porcine tissues, but little information exists about the genes involved in FA composition of meat obtained from heavy pigs selected for the production of Italian dry-cured hams. To this objective, we genotyped with a single nucleotide polymorphism (SNP) panel 795 Italian Large White heavy pigs to identify the markers and genomic regions associated with Semimembranosus muscle FA profile. Heritability estimates for intramuscular fat FA profile were of low-to-moderate magnitude, suggesting that these traits may be improved with genomic selection. On the whole, 45 SNPs were significantly associated with 14 FAs, and 4 of them (ALGA008109, ALGA0081097, CASI0010164 and SIRI0000267) were associated with more than 1 FA. The palmitoleic : palmitic and oleic : stearic ratios displayed the highest number of significant markers and the most significant associations (Bonferroni adjusted P < 5.00E-07). Of particular interest, the palmitoleic : palmitic ratio was strongly associated with markers located at 111 to 114 Mb on chromosome 14, in the same chromosomal region where Stearoyl-CoA desaturase Δ9 (SCD) gene is located. Several significant chromosomal regions were found; some of them harbour key genes playing pivotal roles in FA desaturation and elongation, such as SCD and some members of the Elongation of Very Long-Chain FA (ELOVL) gene family. The results suggest that the identification of causal mutations in these regions may provide a set of markers useful for selection schemes aimed at improving FA composition in pork products.

Peritoneal mesothelioma mortality in Italy: Spatial analysis and search for asbestos exposure sources.

BACKGROUND: This study is part of a national plan of epidemiological surveillance of malignant mesothelioma (MM) mortality in Italy. The paper shows the results of malignant peritoneal mesothelioma (MPeM) mortality study in Italian Regions and municipalities. METHODS: National Bureau of Statistics data for MPeM municipal mortality (ICD-10, Code C45.1) were analyzed in the time-window 2003-2014: mortality standardized rates (reference Italian population, census 2011), temporal trends of the annual national rates, Standardized Mortality Ratios and a municipal clustering analysis were performed. RESULTS: 747 deaths for MPeM were recorded (0.10/100,000): 464 in men (0.14/100,000) and in 283 women (0.07/100,000). No significant MPeM mortality temporal trend was found. Seventeen municipalities showed excesses of mortality for MPeM in at least one gender and/or overall population. Four clusters in male population, and one in women were identified. CONCLUSIONS: The study identifies some areas where remediation activities and/or health care actions may be warranted.

Evaluation of the Italian cytological subclassification of thyroid indeterminate nodules into TIR-3A and TIR-3B: a retrospective study of 290 cases with histological correlation from a single institution.

PURPOSE: The Italian consensus to classify thyroid cytology has provided a standardized reporting scheme, including the subdivision of indeterminate for malignancy TIR-3 category into TIR-3A (low-risk) and TIR-3B (high-risk). We aimed to present our experience on this subclassification by evaluating risks of malignancy and the validity in sorting nodules with dissimilar risks. Another aim was to compare our performance against the Bethesda system. METHODS: Fine-needle aspirates of 290 TIR-3 that underwent thyroid surgery at our hospital (2008-2013) were reviewed and divided into TIR-3A or TIR-3B, and AUS/FLUS or FN/SFN. Cytological diagnoses were then correlated to histology. Results were evaluated using univariate analysis. RESULTS: The subclassification into TIR-3A and TIR-3B differentiated hyperplastic nodules (p = 0.000) but not adenomas (p = 0.090). Rates of malignancy were significantly different between TIR-3A (10.2%) and TIR-3B (43.8%); TIR-3B malignancies were often papillary carcinomas (83%). TIR-3A/TIR-3B accounted for high sensitivity (84.5%; CI 79.7-88.4%), accuracy (64.1%; CI 58.6-69.6%) and NPV (89.8%; CI 85.6-93.0%) as opposed to modest specificity (55.8%; CI 49.9-61.6%) and PPV (43.8%; CI 38.1-49.8%). The rate of malignancy in AUS-FLUS was higher than in TIR-3A (p = 0.007), whereas it was not different between FN/SFN and TIR-3B (p = 0.337). Sensitivity of the Bethesda system was significantly lower respect to the Italian system. CONCLUSIONS: The study supports the Italian consensus showing a different risk of malignancy for TIR-3A as compared to TIR-3B. TIR-3A/TIR-3B subclassification is valid to sort out benign nodules (high NPV) and malignancies (high sensitivity) but not adenomas (modest specificity, low PPV). In our experience, sensitivity is the main difference between Italian and Bethesda systems.

Numerical Investigation of Active Flow Control Around a Generic Truck A-Pillar.

Large Eddy Simulations (LES) are conducted to study the actuated flow field around a bluff body. The model is a simplified section of a truck. The aim of the work is to model the separation of the flow acting at the front rounded corners, the so called A-pillars, and to minimize the separation of the flow by means of Zero Net Mass Flux synthetic jets. LES data show the interaction of the flow main structures, the separation mechanism and the effects of the actuation on the flow field. The flow is post processed using modal and frequency decompositions. Relevant results in terms of drag reduction were observed for the actuated flow. The principle flow mechanisms are discussed and an optimal actuation frequency, in terms of induced fluctuations and drag reduction, is identified.

[Methods for mortality analysis in SENTIERI Project]. / Materiali e metodi dell'analisi della mortalità nel Progetto SENTIERI.

The methods of mortality analysis in Italian polluted sites (IPS) are described. The study concerned 44 IPSs; each one included one or more municipalities. Mortality at municipality level was studied in the period 1995-2002, using the following indicators: crude rate, standardized rate, standardized mortality ratio (SMR), and SMR adjusted for an ad hoc deprivation index. Regional populations were used as reference for indirect standardization. The deprivation index was constructed using the 2001 national census variables representing the following socioeconomic domains: education, unemployment, dwelling ownership, overcrowding. Mortality indicators were computed for 63 single or grouped causes. The results for all the 63 analysed causes of death are available for each IPS, and in this Chapter the results for each IPS for causes selected on the basis of a priori evidence of risk from local sources of environmental pollution are presented. The procedures and results of the evidence evaluation have been published in the 2010 Supplement of Epidemiology & Prevention devoted to SENTIERI.

[The use of municipality-level data on mortality in Italy: SENTIERI Project]. / L'utilizzo dei dati di mortalità a livello comunale in Italia: Progetto SENTIERI.

In Italy, complete municipality-level data on specific-cause mortality have been available at central level since 1980; Italy's National Institute of Statistics (Istat) collects data from all municipalities using two sources: i) the Office of Vital Statistics; and ii) the Civil Status Office. The Office of Vital Statistics records data on events such as births, deaths and migration for the population with official residence in the municipality, with the aim of describing the resident population's structure and composition. The Civil Status Office records data on the demographic dynamics (not only marital status but also causes of death); the data refer to the population living in the municipality, independently of official residence. Changes in the status of a municipality (e.g., the creation of a new municipality or the unification of diverse municipalities) are often not recorded simultaneously by these two offices, so that the data do not correspond.

The potential for a concerted system for the rapid monitoring of excess mortality throughout Europe.

We present the results of a survey conducted in the context of the project European Monitoring of Excess Mortality for Public Health Action (EuroMOMO), which is being conducted to develop a routine public health mortality monitoring system for the timely detection of excess deaths related to public health threats in Europe. The survey was conducted in 32 European countries using two questionnaires on: i) the existing and planned mortality monitoring systems, and ii) the routine collection of mortality data. Nine existing mortality monitoring systems were identified in seven countries (Belgium, Germany, France (two systems), Italy (two systems), Portugal, Spain, and Switzerland), as well as several systems that were in a pilot or planning state. Each system is described in detail. The results will be used for the subsequent phases of EuroMOMO, in particular for identifying the minimum requirements for the planned European system and for selecting countries to be included in the project's pilot phase.

Cause-specific mortality in classic Kaposi's sarcoma: a population-based study in Italy (1995-2002).

BACKGROUND: Little information is available on the causes of death among persons with classic Kaposi's sarcoma (CKS). METHODS: We conducted a population-based study in Italy to identify deceased persons with CKS and the underlying causes of death among them, by reviewing multiple-causes-of-death records. Standardised mortality ratios (SMRs) and 95% confidence intervals were calculated to compare the distribution of causes to that among the same-age general population of deceased persons. The geographical distribution was also evaluated. RESULTS: Of the 946 deaths among persons with CKS, 65.9% were attributable to non-neoplastic conditions and 21.9% to malignancies. For 12.2%, no lethal pathology was identified and CKS was considered as the underlying cause. In 90% of these cases, there was visceral/nodal involvement, therapy-related complications, or neoplastic cachexia. Among persons with CKS who died of other causes, an excess for lymphoid malignancies emerged (SMR=4.40) (chronic lymphocytic leukaemia (11.03), non-Hodgkin's lymphoma (4.22), Hodgkin's lymphoma (11.80), and multiple myeloma (2.3)), balanced by a deficit for all solid cancers (0.56), with a marked deficit for lung cancer (0.41). We found an excess for respiratory diseases (chronic obstructive pulmonary disease (1.86)) and genitourinary diseases (chronic renal failure (6.47)). There was marked geographical heterogeneity in the distribution of deaths. CONCLUSIONS: Though referring specifically to Italy, the results are informative for other countries and populations and all cases of CKS in general.

Gender differentials in life expectancy in Italy.

OBJECTIVE: To analyze the gender differential in life expectancy in Italy from 1970 to 1997, to determine which ages and causes of death mostly influenced its trend. METHODS: Pollard method was used to explain which ages and which pathologies give the highest contribution to the gender differential. RESULTS: A slight reduction of the gender differential has been observed since 1980. The olds and very olds became the most relevant contributors to the differential. Cardiovascular diseases were the principal contributing causes of death until 1980 and Cancer replaced them afterwards. CONCLUSION: Relatively recent adoption of unhealthy life styles by women together with an opposite process run by young men towards healthier behaviour, seem to be at the basis of the slight reduction of the gender differential in life expectancy observed since 1980.

Sevoflurane analgesia in obstetrics: a pilot study.

Continuous and intermittent administration of inhalational anesthetics has been successfully employed for treating pain during labor. We conjectured that intermittent sevoflurane administration would be effective for pain relief during labor without side effects to the mother or fetus. Fifty parturients breathed a mixture of 2-3% sevoflurane, oxygen and air before each uterine contraction began. The patients assessed the quality of analgesia by using a visual analogue scale (0-10) before the administration of sevoflurane and after each uterine contraction. All parturients but one were satisfied, demonstrating a mean visual analogue score before and after sevoflurane administration of 8.7 +/- 1.1 and 3.3 +/- 1.5, respectively. Apgar scores at 1 and 5 min were 9 (range 5-9) and 10 (range 8-10), respectively. Our findings suggest that sevoflurane could be effective for the treatment of labor pain.

Oxidative stability and sensory and functional properties of eggs from laying hens fed supranutritional doses of vitamins E and C.

This study evaluated the effects of two dietary doses of vitamins E and C supplemented separately and together, on the content of vitamin E in the yolk, on the lipid stability of fresh and stored eggs, and on their sensory and functional properties. Hy-Line Brown hens (n = 216) received a basal diet for 8 wk supplemented with 100 or 200 mg DL-alpha-tocopheryl acetate (E100 or E200, respectively)/kg, 500 or 1,000 mg ascorbic acid (C500 and C1000, respectively)/kg, or 100 mg DL-alpha-tocopheryl acetate plus 500 mg ascorbic acid (E100+C500)/kg, whereas the control group received no supplementation. Fresh eggs and eggs stored 30,60, and 90 d at 4 C or stored 28 d at room temperature were analyzed for vitamin E content and TBA-reactive substances (TBARS). We also evaluated functional properties of fresh and cooked eggs and sensory properties of boiled and scrambled eggs. The yolk content of vitamin E depended on the level of dietary addition and decreased after 90 d of storage at 4 C or after 28 d at 25 C. Vitamin supplementation had no effect on fresh or refrigerated eggs, whereas 4 wk of storage at room temperature increased TBARS in the control and the group supplemented with the highest doses of vitamins. Ascorbic acid improved Haugh units and elasticity of albumen gels, whereas cohesiveness and hardness of yolk, albumen and whole-egg gels were not affected by dietary treatment. Panelists were not able to distinguish treated eggs from control eggs.

3H-spiperone binding capacity in mononuclear cells: a family study.

1. A family study was carried out using a putative biological vulnerability trait in families of schizophrenics and schizoaffective indexprobands to investigate, if the clinical phenotype and a biological marker for schizophrenia are cosegregating within families. 2. The binding capacity of the dopamine antagonist spiperone to mononuclear cells was investigated in 21 indexprobands and a total of 147 first and second degree relatives. 3. Increased binding capacity could be found in 17 indexprobands and in their affected relatives, independently from clinical diagnosis and in 22% of their normal relatives. 4. No increased binding capacity was found in 4 indexprobands and in their affected relatives and not n any of the unaffected relatives. These results indicate, that increased spiperone binding may cosegregate with the risk for functional psychoses and that families, loaded with psychiatric disturbances may be distinguished on a biological basis.

Choroidal and iris angioarchitecture of the newt: a scanning electron-microscopic study of vascular corrosion casts.

The corrosion cast technique provided for the first time an excellent three-dimensional visualization of the vascular pattern of the choroid and iris in the newt eye. The results show the presence of a single arterial afference to the choroidal and iris capillaries: the ophthalmic artery is the origin of both ciliary arteries and the long posterior ciliary artery. Slightly behind the equatorial circumference of the eyeball the venous drainage consists of a single vessel on the dorsal side and two distinct vessels on the ventral one. It receives blood from both iris and choroid. The surface of the plastic endocasts shows some details of fine luminal structures of the endothelial cells. Shallow depressions may be regarded as imprints of endothelial cell nuclei, and they are distinctly different for arteries and capillaries. The angioarchitecture of the newt eye differs from that of brain in that hairpin-shaped capillary loops are not observed at all.

6-H3 thymidine uptake in the central nervous system of newt following lesion and cold shock.

The uptake of 6-H3 thymidine in the optic tectum and the forebrain of the newt following injury to one of the two nervous areas, shows a marked proliferative response in the telencephalon in the presence of a lesion on the right optic tectum, and a poor response of the optic tectum after a lesion on the right telencephalic lobe. A similar proliferative response is also obtained when the specimens received only the cold shock. In both experimental conditions maximum uptake is obtained after 7 days. It is assumed that the matrix cells of the forebrain and the undifferentiated cells of the optic tectum respond differently to the regeneration factor released by the nervous tissue following a lesion or a cold shock.

Nerve cell rearrangement in neocortical layers of MAM treated foetal mice.

In this study we examined the changes in cortical layers when Methylazoxymethanol-acetate (MAM) was injected on 13th, 15th and 17th day of gestation (MAM13, MAM15, MAM17). Prenatal MAM administration prevents neuron precursor proliferation; the subsequent cell number decrease is followed by an increase in size of surviving cells. When MAM was injected on 13th or 15th day of gestation the significant decrease in cell density, in II and III zone (MAM13) and in the upper layers (MAM15), was compensated by a proportional increase in cell size and synaptic density. When MAM was injected on 17th embryonal day it did not cause a significant change in the neuron density and soma size was not altered while the distribution of cell size among layers showed significant differences with respect to the controls. Our findings of some area and synaptic density show that the cell surface increase is proportional to the decrease in cell number and that in the surviving cells there is a rearrangement in synaptic connections that compensate for the cellular density decrease.

Proliferative response of the mesencephalic matrix areas in the reparation of the optic tectum of Triturus cristatus carnifex.

The localization and proliferative response of optic tectum matrix cells has been studied in adult newt following an experimental lesion on an optic lobe. The results show that 15 days after the lesion the cells in division, autoradiographically labelled, are located in the periventricular layer. Thirty days after the lesion the labelled cells are also found in the innermost grey layers; at 90 days the injured optic tectum regains the cytoarchitecture characteristic of this centre, with labelled cells, whether in the external or in the internal pyriform layers. In all the stages the labelled cells are also found in the periventricular layers of the controlateral optic tectum, in the dorsal pallium and in the striatum. The quantitative data exhibit the existence of a direct relationship between the number of proliferating cells in the injured optic lobe and the extent of the lesion. These data show the possibility of active cellular proliferation for the reconstruction of the lesioned nervous area and for restoration of the characteristic histological structure.

Mitotic activity of the telencephalic matrix areas following optic tectum or pallial cortex lesion in newt.

The telencephalic proliferative response has been studied in adult newts after lesion on the central nervous system. Both in the animals injured on the optic tectum and in those on the telencephalon a telencephalic proliferative response was observed, localized in the dorsal pallial areas and in the striatum. Quantitative analysis of the proliferative activity of the matrix cells present in the telencephalon showed a different response pattern. In the animals lesioned on the telencephalon the labelled cells are much more numerous in the injured hemisphere than in the healthy one and these cells persists at a high level even in the specimens fixed 90 days after the lesion. In this case no labelled cells are observed in the midbrain. The number of labelled cells in the animals lesioned on the optic tectum was identical in both telencephalic hemispheres; this number decreases from 15 to 30 days after the injury and at 90 days labelled cells are not observed. These data confirm the presence of a neuronotrophic factor released in the ependymal fluid and active on the telencephalic periventricular matrix cells but not on the undifferentiated cells of the grey layers of the optic tectum. It is also assumed that the proliferation of matrix cells of an injured area causes the formation of glial cells and neurons, such proliferation in an intact zone is oriented to differentiation of glial cells alone.

Target neurons of endogenous androgens immunocytochemically localized in male rat hypothalamus.

A polyclonal antiserum against androgens, i.e., testosterone, 5alpha-dihydrotestosterone and androstenedione, was tested to reveal target neurons of endogenous androgens in the hypothalamus of both intact and castrated male rats. Paraffin sections of hypothalamus and testis were immunostained by using Avidin-Biotin Complex method and 3-3' diaminobenzidine to visualize the immunoperoxidase complex. Conventional control experiments for method and antiserum specificity were performed. The antiserum proved to be specific for androgens, i.e., testosterone, 5alpha-dihydrotestosterone and androstenedione. The nuclear labeling observed in tissues stained by this procedure is consistent with the hypothesis that the labeled neurons contained DHT, which is the main testosterone metabolite active in the cell nucleus. The antiserum was effective in staining not only the hypothalamic neurons of intact males with normal serum levels of testosterone but also the hypothalamic neuron of castrated males with very low serum levels of testosterone. Evidence is presented indicating that the immunostaining technique represents a more specific and sensitive method to identify target neurons of endogenous androgens than autoradiography.