A 2-year point-prevalence surveillance of healthcare-associated infections and antimicrobial use in Ferrara University Hospital, Italy.

BACKGROUND: Healthcare-Associated Infections (HAIs) represent one of the leading issues to patient safety as well as a significant economic burden. Similarly, Antimicrobial Use (AMU) and Resistance (AMR) represent a growing threat to global public health and the sustainability of healthcare services. METHODS: A Point Prevalence Survey (PPS) following the 2016 ECDC protocol for HAI prevalence and AMU was conducted at Ferrara University Hospital (FUH). Data were collected by a team of trained independent surveyors in 2016 and 2018. Risk factors independently associated with HAI were assessed by a multivariate logistic regression model. RESULTS: Of the 1102 patients surveyed, 115 (10.4%) had an active HAI and 487 (44.2%) were on at least 1 systemic antimicrobial agent. Factors independently associated with increased HAI risk were a "Rapidly Fatal" McCabe score (expected fatal outcome within 1 year), presence of medical devices (PVC, CVC, indwelling urinary catheter or mechanically assisted ventilation) and a length of hospital stay of at least 1 week. The most frequent types of HAI were pneumonia, bloodstream infections, and urinary tract infections. Antimicrobial resistance to third-generation cephalosporins was observed in about 60% of Enterobacteriaceae. CONCLUSIONS: The survey reports a high prevalence of HAI and AMU in FUH. Repeated PPSs are useful to control HAIs and AMU in large acute-care hospitals, highlighting the main problematic factors and allowing planning for improvement actions.

6IMPOSE: bridging the reality gap in 6D pose estimation for robotic grasping.

6D pose recognition has been a crucial factor in the success of robotic grasping, and recent deep learning based approaches have achieved remarkable results on benchmarks. However, their generalization capabilities in real-world applications remain unclear. To overcome this gap, we introduce 6IMPOSE, a novel framework for sim-to-real data generation and 6D pose estimation. 6IMPOSE consists of four modules: First, a data generation pipeline that employs the 3D software suite Blender to create synthetic RGBD image datasets with 6D pose annotations. Second, an annotated RGBD dataset of five household objects was generated using the proposed pipeline. Third, a real-time two-stage 6D pose estimation approach that integrates the object detector YOLO-V4 and a streamlined, real-time version of the 6D pose estimation algorithm PVN3D optimized for time-sensitive robotics applications. Fourth, a codebase designed to facilitate the integration of the vision system into a robotic grasping experiment. Our approach demonstrates the efficient generation of large amounts of photo-realistic RGBD images and the successful transfer of the trained inference model to robotic grasping experiments, achieving an overall success rate of 87% in grasping five different household objects from cluttered backgrounds under varying lighting conditions. This is made possible by fine-tuning data generation and domain randomization techniques and optimizing the inference pipeline, overcoming the generalization and performance shortcomings of the original PVN3D algorithm. Finally, we make the code, synthetic dataset, and all the pre-trained models available on GitHub.

dTap vaccination uptake during pregnancy: Pregnant women-focused and health professionals-focused predictors in the Veneto Region (Italy).

BACKGROUND: Despite recommendations, the uptake of dTap maternal vaccination is still low in many countries. The reasons for this must be investigated both on the patient's and the healthcare professionals' sides. METHODS: A record linkage study was performed linking Birth Assitance Certificates and dTap mothers' vaccination records (5183 deliveries) to describe the influence of socioeconomical and obstetrical-gynecological factors after the recommendations concerning dTap vaccination in pregnancy issued by the Italian Ministry of Health (August 2018). An interview was also administered to a subgroup of 656 new mothers on the occasion of the first vaccination of their newborns, in order to assess the dTap vaccination advice received from maternal care providers during pregnancy. A generalized linear model (binomial family, log link) was implemented to give a correct estimate of the mother's relative risk of being vaccinated. RESULTS: Several pregnant women-focused factors are evident, but the most important ones are related to maternal care providers' practices: after mutual adjustment, the explicit advice towards dTap maternal vaccination given by the Obstetrician-Gynecologist or the Midwife is associated with a 12-fold increase in the dTap coverage. CONCLUSIONS: Multiprofessional training is essential to make Obstetricians-Gynecologists and Midwives more confident in recommending dTaP maternal immunization.

Biological in vitro and in vivo studies of a series of new asymmetrical cationic [99mTc(N)(DTC-Ln)(PNP)]+ complex (DTC-Ln = alicyclic dithiocarbamate and PNP = diphosphinoamine).

(99m)Tc(N)-DBODC5 is a cationic mixed compound under clinical investigation as potential myocardial imaging agent. In spite of this, analogously to the other cationic (99m)Tc-agents, presents a relatively low first-pass extraction. Thus, modification of (99m)Tc(N)-DBODC(5) direct to increase its first-pass extraction keeping unaltered the favorable imaging properties would be desirable. This work describes the synthesis and biological evaluation of a series of novel cationic (99m)Tc-nitrido complexes, of general formula [(99m)TcN(DTC-Ln)(PNP)](+) (DTC-Ln= alicyclic dithiocarbamates; PNP = diphosphinoamine), as potential radiotracers for myocardial perfusion imaging. The synthesis of cationic (99m)Tc-(N)-complexes were accomplished in two steps. Biodistribution studies were performed in rats and compared with the distribution profiles of (99m)Tc(N)-DBODC5 and (99m)Tc-Sestamibi. The metabolisms of the most promising compounds were evaluated by HPLC methods. Biological studies revealed that most of the complexes have a high initial and persistent heart uptake with rapid clearance from nontarget tissues. Among tested compounds, 2 and 12 showed improved heart uptake with respect to the gold standard (99m)Tc-complexes with favorable heart-to-liver and slightly lower heart-to-lung ratios. Chromatographic profiles of (99m)Tc(N)-radioactivity extracted from tissues and fluids were coincident with the native compound evidencing remarkable in vivo stability of these agents. This study shows that the incorporation of alicyclic dithiocarbamate in the [(99m)Tc(N)(PNP)](+) building block yields to a significant increase of the heart uptake at early injection point suggesting that the first-pass extraction fraction of these novel complexes may be increased with respect to the other cationic (99m)Tc-agents keeping almost unaltered the favorable target/nontarget ratios.

Digital venography in horses and its clinical application in Europe.

Clinical diagnostic venography allows in vivo visualization of the digital venous system and the effects of venocompression related to foot load and laminitis pathology. Venography has predictive potential and helps the clinician anticipate and treat laminitis tissue damage before it is detectable by plain radiography. The authors describe the podiatry radiographic technique to correctly perform digital venography and the modifications they have developed. The authors provide guidelines for the interpretation of laminitis venograms in the context of laminitis chronology. Frequent venographic monitoring of laminitis helps clinicians understand the sometimes puzzling chronology of the disease process and improves therapeutic outcome.

Use of serum amyloid A and milk amyloid A in the diagnosis of subclinical mastitis in dairy cows.

Mastitis is the most frequent and costly disease in dairy herds, as it negatively affects yield and milk quality. The presence of clinical mastitis is quite easy to asses, whereas the diagnosis of the subclinical form can be more difficult and requires laboratory assays. Somatic cell count (SCC) is widely used as a rapid and low-cost indicator of mastitis, even if is not useful in discriminating between the clinical and subclinical form. As amyloid A has been investigated as a marker of mastitis, the aim of this study was to assess the potential value of measuring amyloid A in serum and milk and the correlation with SCC in the diagnosis of subclinical mastitis. The reliability of two different ELISA kits for the measurement of amyloid A in milk was also tested. During a 1-month trial period, 21 cows were assigned to three experimental groups according to their health status: 6 cows with clinical mastitis (CM), 10 cows with subclinical mastitis (SM) and 5 healthy cows (HE). Amyloid A was measured both in serum (SAA) and in quarter milk samples (mAA) with a serum ELISA kit, and in quarter milk samples (MAA) with a milk ELISA kit. SCC, total microbial count (TMC) and bacterial examination of the milk were also carried out. After a log transformation, the data were submitted to ANOVA and linear regression. TMC was significantly higher in cows with clinical mastitis, while no differences were observed between the other two experimental groups. SCC and MAA levels were significantly different among the three groups. mAA concentrations were similar between cows with subclinical and clinical mastitis, and SAA was not affected by mastitis. A significant correlation between SCC and MAA or mAA was detected, while no correlation was recorded between SAA and mAA. A close relationship between MAA and mAA was noticeable even at low concentrations, suggesting MAA as a potential physiological marker of subclinical mastitis.

Aortic stenting in the growing sheep causes aortic endothelial dysfunction but not hypertension: Clinical implications for coarctation repair.

BACKGROUND: Stent implantation is the treatment of choice for adolescents and adults with aortic coarctation (CoAo). Despite excellent short-term results, 20%-40% of the patients develop arterial hypertension later in life, which was attributed to inappropriate response of the aortic baroreceptors to increased stiffness of the ascending aorta (ASAO), either congenital or induced by CoAo repair. In particular, it has been hypothesized that stent itself may cause or sustain hypertension. Therefore, we aimed to study the hemodynamic and structural impact following stent implantation in the normal aorta of a growing animal. METHODS: Eight female sheep completed the study and a stent was implanted in four. Every 3 mo we measured blood pressure of the anterior and posterior limbs and left ventricular function by echocardiography. Twelve months later invasive pressure was measured under baseline and simulated stress conditions. Expression of genes indicating oxidative stress (OS), endothelial dysfunction (ED) and stiffness, as well as pathological examination were performed in ascending (ASAO) and descending aorta (DSAO). RESULTS: SOD1 and MMP9 gene expression were higher in ASAO of the stented animals, compared to DSAO and controls, while NOS3 was decreased. No differences were found in blood pressure and echocardiographic parameters. No histological differences were found in the aorta of the two groups of animals. CONCLUSIONS: Stent does not affect central and peripheral hemodynamics, cardiac structure and function even in the long term. However, the finding of markers of OS and increased stiffness of ASAO, proximal to the stent, points to molecular mechanisms for increased cardiovascular risk of patients with stented CoAo.

Stearoylethanolamide exerts anorexic effects in mice via down-regulation of liver stearoyl-coenzyme A desaturase-1 mRNA expression.

Given the recent demonstration that oleoylethanolamide (OEA), a cannabinoid receptor-inactive N-acylethanolamine, decreases food intake by activating the nuclear receptor PPARalpha (peroxisome proliferator-activated receptor alpha) in the periphery, we here evaluated the effects of both saturated and unsaturated C18 N-acylethanolamides (C18:0; C18:1; C18:2) in mice feeding behavior after overnight starvation. Our results show stearoylethanolamide (SEA, C18:0) exerts, unlike other unsaturated C18 homologs, a marked dose-dependent anorexic effect evident already at 2 h after its intraperitoneal administration. In addition, oral administration of SEA (25 mg/kg) was also effective in reducing food consumption, an effect ascribed to the molecule itself and not to its catabolites. Moreover, although the anorexic response to oral administered SEA was not associated with changes in the levels of various hematochemical parameters (e.g., glucose, cholesterol, triglycerides, leptin) nor in liver mRNA expression of peroxisome proliferator-activated receptors (PPARs) including PPARalpha, the anorexic effect of SEA was interestingly accompanied by a reduction in liver stearoyl-CoA desaturase-1 (SCD-1) mRNA expression. As SCD-1 has been recently proposed as a molecular target for the treatment of obesity, the novel observation provided here that SEA reduces food intake in mice in a structurally selective manner, in turn, correlated with downregulation of liver SCD-1 mRNA expression, has the potential of providing new insights on a class of lipid mediators with suitable properties for the pharmacological treatment of over-eating dysfunctions.

Accuracy and precision of computer-assisted analysis of bone density via conventional and digital radiography in relation to dual-energy x-ray absorptiometry.

OBJECTIVE: To evaluate the precision and accuracy of assessing bone mineral density (BMD) by use of mean gray value (MGV) on digitalized and digital images of conventional and digital radiographs, respectively, of ex vivo bovine and equine bone specimens in relation to the gold-standard technique of dual-energy x-ray absorptiometry (DEXA). SAMPLE: Left and right metatarsal bones from 11 beef cattle and right femurs from 2 horses. PROCEDURES: Bovine specimens were imaged by use of conventional radiography, whereas equine specimens were imaged by use of computed radiography (digital radiography). Each specimen was subsequently scanned by use of the same DEXA equipment. The BMD values resulting from each DEXA scan were paired with the MGVs obtained by use of software on the corresponding digitalized or digital radiographic image. RESULTS: The MGV analysis of digitalized and digital x-ray images was a precise (coefficient of variation, 0.1 and 0.09, respectively) and highly accurate method for assessing BMD, compared with DEXA (correlation coefficient, 0.910 and 0.937 for conventional and digital radiography, respectively). CONCLUSIONS AND CLINICAL RELEVANCE: The high correlation between MGV and BMD indicated that MGV analysis may be a reliable alternative to DEXA in assessing radiographic bone density. This may provide a new, inexpensive, and readily available estimate of BMD.

Octopamine, unlike other trace amines, inhibits responses of astroglia-enriched cultures to lipopolysaccharide via a ß-adrenoreceptor-mediated mechanism.

Trace amines (TAs), i.e. ß-phenylethylamine, tyramine and octopamine, are generally regarded as sympathomimetic compounds with structural and functional analogy with catecholamines. Previous reports have shown particularly high levels of circulating TAs in migraine and cluster headache patients. However, no clues are yet available as to the pathophysiological significance of these alterations. The effect of different TAs on the release of nitric oxide was investigated in rat astroglial cells stimulated with lipopolysaccharide (LPS). Octopamine substantially inhibited the release of NO evoked by LPS. Tyramine and ß-PEA were ineffective. The inhibitory effect of octopamine was fully reverted by two selective antagonists of ß-adrenergic receptors, while α-adrenergic blockade was ineffective. These data, consistent with a role of octopamine as a modulator of NO release, uncover an interaction between octopamine and ß-adrenergic receptors in astroglial cells. These results may have an impact in understanding the mechanisms underlying migraine pathophysiology.

Age classes and sex differences in the skull of the Mediterranean monk seal, Monachus monachus (Hermann, 1779). A study based on bone shape and density.

This study analyzes morphometrically 17 skulls of the Mediterranean monk seal Monachus monachus housed in different Italian Museums and collections. We considered several morphometric variables (31 linear, 1 volumetric and 1 surface area measurements). In addition, we identified, measured and compared two nonmorphometric variables, namely, the bone densities of selected areas obtained using a dual-energy X-ray absorptiometry (DXA) device. The high correlation coefficient of all variables indicated continuous growth with the onset of age. The ranking of the hierarchical cluster analysis identified the presence of three main groups containing individuals of similar sizes: lactating pups and yearlings; subadult individuals and adult females; and adult males. Smaller groups were identified within these clusters, and their respective allocations into two subgroups were argued on the basis of skull development and other factors. The discriminant analysis of the three main groups indicated a discriminant diagnostic key, based on condilobasilar length (CBlr-L); maximum mandibular branch height (MB-H); and surface area of the bulla tympanica. The proposed diagnostic key is useful to classify monk seal skulls of unidentified age and sex. The data reported here suggest that in this species certain adult skull growth features (enhanced tympanic bullae surface area extension, occipital bone density) are sexually dimorphic and possibly related to specific anatomical functions. These functions may include an enhanced auditory capacity; an increased development of the cranial musculature capable of supporting a large skull and guaranteeing the mandibular strength necessary for mastication; and male to male social interactions.

Effects of electromagnetic fields of low frequency and low intensity on rat metabolism.

A series of experiments on rats have been performed, to study the effects of long time (50 days) exposure to electromagnetic fields of extremely low frequency (ELF, i.e. less than 100 Hz) and amplitude (non thermal), testing whether the metabolic processes would be affected. The background lies on recent observations on the behaviour of isolated enzymes in vitro exposed to EFL fields. In these experiments, the cyclotron (or Larmor) frequency of the metallic ion has been used to "stimulate" the metalloproteins redox-active site, thus obtaining a clear variation of the enzyme functionality. In this paper we have extended for the first time the check to more complex animal metabolism. The novelty of this approach implies that a large amount of data had to be analyzed since it was not possible, in principle, to select only a few parameters among all the potential effects. Several biochemical parameters have been evaluated by comparing their values during the periods of exposure (field ON) and non exposure (field OFF). The evidence that long term exposure to electromagnetic fields with a well defined frequency may have relevant effects on parameters such as body weight, blood glucose and fatty acid metabolism has been obtained.

Echo-Doppler findings of a carotid-jugular fistula in a foal.

A seven-month-old male Standardbred was referred with a 4-month history of left jugular groove distension. On physical examination severely dilated left maxillary, linguofacial and jugular veins were appreciable. Blood gas analysis results indicated higher degree of oxygenation in the left jugular vein. Bi-directional flow signals, with normal systolic and early diastolic flow, and late diastolic retrograde flow, were noted on pulsed-wave Doppler interrogation and color flow mapping of the left jugular blood flow. A systolic-diastolic signal with spectral broadening was detected when positioning the sample gate near the internal jugular wall, in the distal left cervical region. Color Doppler imaging of the same region showed blood flow passage between the left common carotid artery and the left jugular vein through a small carotid-jugular fistula. Markedly increased blood flow velocities and volumetric flow, and decreased resistive index were recorded in the left compared to the right common carotid artery.

Accuracy and precision of dual-energy x-ray absorptiometry for ex vivo determination of mineral content in turkey poult bones.

The right humerus was removed from 30 20-week-old male turkey poults for humerus strength analysis using dual-energy x-ray absorptiometry and humerus-breaking strength. Specimens were cleaned and dried before scanning. To determine the most precise and accurate protocol of bone densitometry analysis for avian long bones, we scanned each specimen using five different techniques, all aimed to simulate soft-tissue thickness. Correlation coefficients and linear regression equations between 1) bone mineral content and humerus ash, and 2) bone mineral density and humerus-breaking strength were estimated with each technique and compared. The coefficient of variation values for precision ranged from 0.40% to 1.69% for bone mineral content and from 0% to 4.19% for bone mineral density. The accuracy was determined by comparing the bone mineral content of each humerus with the corresponding ash weight; the correlation coefficients between the two parameters were highly significant (range 0.949-0.963; P < or = 0.01). Significant correlations were also observed between humerus-breaking strength and bone density measurements (range 0.762-0.785; P < or = 0.01). Linear regression coefficients relating both parameters considered were also highly significant. We concluded that dual-energy x-ray absorptiometry is an accurate and precise method with which to determine ex vivo bone mineral content and strength in turkey bones. Further investigations are requested for field applications of this method to study factors affecting bone physiology and strength.

Relationship between metabolic bone disease and bone mineral density measured by dual-energy X-ray absorptiometry in the green iguana (Iguana iguana).

The aim of our work was to study the feasibility of using dual-energy X-ray absorptiometry to obtain reference bone density values in relation to body weight, gender, and metabolic bone disease in the green iguana. The study was performed on 28 animals. The weight, age, and gender of each iguana were recorded. Each lizard was carefully examined and radiographed to detect signs of metabolic bone disease. Blood samples were collected from each animal to evaluate Ca/P and total protein. All animals, both affected (group B; n = 11) and unaffected (group A; n = 17) by metabolic bone disease, were individually scanned using an X-ray densitometer. The regions of interest were the head, lumbar spine, right, and left femur. Statistical analysis was performed separately for each region of interest. Body weight had the strongest relationship with bone density (P < 0.01). Within regions of interest, for iguanas of average weight (710 g), statistically significant differences between healthy and sick animals were found: head (0.140 vs. 0.090 g/cm2; P < 0.01); lumbar spine (0.164 vs. 0.107 g/cm2; P < 0.01); right femur (0.103 vs. 0.076 g/cm2; P < 0.01); left femur (0.103 vs. 0.078 g/cm2; P < 0.01). Regression equations to obtain reference values of bone density as a function of body weight for animals affected and not affected by metabolic bone disease are provided. Our data indicate that X-ray bone densitometry is an additional tool for studying bone pathophysiology in reptiles.

Bone density of the arm and forearm as an age indicator in specimens of stranded striped dolphins (Stenella coeruleoalba).

The age of odontocetes living in the wild is determined mainly by analysis of dentine layers in sections of the teeth. We examined a series of specimens from striped dolphins (Stenella coeruleoalba, Meyen, 1833) that had stranded along the Italian coast of the Mediterranean sea. The present study analyzes and describes bone density in the arm and forearm of the stranded specimens, and correlates the data with total body length of the animal and age as determined by the number of dentine layers in sections of the teeth. According to our model, age can be predicted on the basis of bone density and total body length of the stranded animal. This is the first study to use bone density as a biological parameter to understand the wear and tear of life in the sea. The results suggest that bone density is a new tool for recording age in wild odontocetes.

Ureteral stenosis in HDAF pig-to-primate renal xenotransplantation: a phenomenon related to immunological events?

The aim of this study was to analyze the incidence of ureteral stenosis in a life-supporting human decay-accelerating factor (hDAF) transgenic pig-to-cynomolgus monkey kidney transplantation model and determine the role of possible immunological events in its pathogenesis. Thirty consecutive bi-nephrectomized cynomolgus monkeys received a kidney from hDAF transgenic pigs with or without a ureteral stent. Four monkeys were euthanized prematurely after transplantation. In the remaining 26 cases, the mean survival was 24 +/- 19 days. Except in one case, there was a close relationship between ureter and kidney in terms of type and severity of rejection. There were six ureteral stenoses; five were repaired by stent positioning and resurgery extended survival for an additional 16 +/- 10 days. The stenotic ureters showed diffuse acute humoral xenograft rejection (AHXR), while all cases with no or only focal signs of ureteral rejection never revealed ureteral obstruction. Use of a ureteral stent extends the survival of a xenografted primate, thereby helping to clarify the immunological events surrounding the onset of AHXR in kidneys in long-term xenograft recipients.