Supporting the improvement of air quality management practices: The "FAIRMODE pilot" activity.

This paper presents the first outcomes of the "FAIRMODE pilot" activity, aiming at improving the way in which air quality models are used in the frame of the European "Air Quality Directive". Member States may use modelling, combined with measurements, to "assess" current levels of air quality and estimate future air quality under different scenarios. In case of current and potential exceedances of the Directive limit values, it is also requested that they "plan" and implement emission reductions measures to avoid future exceedances. In both "assessment" and "planning", air quality models can and should be used; but to do so, the used modelling chain has to be fit-for-purpose and properly checked and verified. FAIRMODE has developed in the recent years a suite of methodologies and tools to check if emission inventories, model performance, source apportionment techniques and planning activities are fit-for-purpose. Within the "FAIRMODE pilot", these tools are used and tested by regional/local authorities, with the two-fold objective of improving management practices at regional/local scale, and providing valuable feedback to the FAIRMODE community. Results and lessons learnt from this activity are presented in this paper, as a showcase that can potentially benefit other authorities in charge of air quality assessment and planning.

High Temperature Ferromagnetism in a GdAg2 Monolayer.

Materials that exhibit ferromagnetism, interfacial stability, and tunability are highly desired for the realization of emerging magnetoelectronic phenomena in heterostructures. Here we present the GdAg2 monolayer alloy, which possesses all such qualities. By combining X-ray absorption, Kerr effect, and angle-resolved photoemission with ab initio calculations, we have investigated the ferromagnetic nature of this class of Gd-based alloys. The Curie temperature can increase from 19 K in GdAu2 to a remarkably high 85 K in GdAg2. We find that the exchange coupling between Gd atoms is barely affected by their full coordination with noble metal atoms, and instead, magnetic coupling is effectively mediated by noble metal-Gd hybrid s,p-d bands. The direct comparison between isostructural GdAu2 and GdAg2 monolayers explains how the higher degree of surface confinement and electron occupation of such hybrid s,p-d bands promote the high Curie temperature in the latter. Finally, the chemical composition and structural robustness of the GdAg2 alloy has been demonstrated by interfacing them with organic semiconductors or magnetic nanodots. These results encourage systematic investigations of rare-earth/noble metal surface alloys and interfaces, in order to exploit them in magnetoelectronic applications.

Remote measurement of sunflower seed moisture content by the use of microwaves.

BACKGROUND: Modern agriculture demands new methods and equipment that allow operators to conduct the instant control of moisture content over a wide area of agricultural fields with the purpose of providing farmers with the optimal moment of harvesting mature seeds and crops. Here the authors propose a new method and experimentally investigate the possibility to accomplish remote sensing of the moisture content of sunflower seeds using microwave radiation in the millimeter range. RESULTS: An experimental device for measuring the coefficient of reflection of electromagnetic waves from sunflower inflorescences in the frequency range 25.9-37.5 GHz was created. The obtained results showed that the moisture content of mature sunflower seeds affected the reflected signal. A difference in the reflected signal from the front and back sides of unripe sunflower inflorescences was also found. CONCLUSION: The results show that microwave radiation can be used to determine the degree of readiness of seeds for harvesting. The proposed new method opens up the possibility of remote instant diagnosis of sunflower seed ripeness in the field. © 2017 Society of Chemical Industry.

Decline in macrolide resistance rates among Streptococcus pyogenes causing pharyngitis in children isolated in Italy.

Macrolides are often used to treat group A streptococcus (GAS) infections, but their resistance rates reached high proportions worldwide. The aim of the present study was to give an update on the characteristics and contemporary prevalence of macrolide-resistant pharyngeal GAS in Central Italy. A total of 592 isolates causing pharyngitis in children were collected in the period 2012-2013. Clonality was assessed by emm typing and pulsed-field gel electrophoresis (PFGE) for all macrolide-resistant strains and for selected susceptible isolates. Genetic determinants of resistance were screened by polymerase chain reaction (PCR). Forty-four GAS were erythromycin-resistant (7.4 %). Among them, 52.3 % and 50 % were clindamycin- and tetracycline-resistant, respectively. erm(B)-positive isolates (52.3 %) expressed the constitutive cMLSB phenotype. mef(A) and its associated M phenotype were recorded in 40.9 % of the cases. The remaining erm(A)-positive isolates expressed the iMLSB phenotype. Seventeen tetracycline-resistant isolates carried tet(M) and five isolates carried tet(O). Twenty-five emm types were found among all strains, with the predominance of emm types 12, 89, 1, and 4. Eleven emm types and 12 PFGE clusters characterized macrolide-resistant strains, with almost two-thirds belonging to emm12, emm4, and emm11. Macrolide-susceptible and -resistant emm types 12, 89, 11, and 4 shared related PFGE profiles. There was a dramatic decline in macrolide resistance in Central Italy among pharyngeal GAS isolates in 2012-2013 when compared to previous studies from the same region (p < 0.05), although macrolide consumption remained stable over the past 15 years. We observed a decrease in the proportion of macrolide-resistant strains within emm types commonly associated with macrolide resistance in the past, namely emm12, 1, and 89.

Insights on the design of free-spanning pipelines.

The design of free-spanning pipelines is performed with the aim of ensuring their integrity against permanent loads generated by seabed roughness, functional loads induced by internal pressure and temperature, and dynamic loads induced by marine currents and direct wave action. In particular, a load and resistance factored design is applied that focuses on extreme environmental loads, and a fatigue limit state approach is applied as a consequence of free-span dynamics due to vortex shedding-induced vibration and direct wave action. The pipeline free-span scenario can be permanent, when generated by seabed roughness, or characterized by short- to long-term evolution, when generated by seabed mobility and scouring in shallow waters. Free-span analysis is generally a task involving a number of disciplines and should be carried out using a multidisciplinary approach. The paper illustrates various themes related to free-span analysis: (i) free-span scenarios, (ii) characterization of the environment from deep to shallow water related to proper seabed properties, (iii) hydrodynamic load regimes, (iv) pipeline free-span design assessment aiming to reduce overstress and fatigue damage, (v) erodible seabed mobility and local scour, and (vi) some experiences of inspection surveys chosen as representative of a free-spanning pipeline in sandy soils.

Characterization of levofloxacin non-susceptible clinical Streptococcus pyogenes isolated in the central part of Italy.

We investigated the prevalence, genetics, and clonality of fluoroquinolone non-susceptible isolates of Streptococcus pyogenes in the central part of Italy. S. pyogenes strains (n = 197) were isolated during 2012 from patients with tonsillopharyngitis, skin, wound or invasive infections and screened for fluoroquinolone non-susceptibility (resistance to norfloxacin and levofloxacin minimum inhibitory concentration (MIC) = 2 mg/L) following EUCAST guidelines. First-step topoisomerase parC and gyrA substitutions were investigated using sequencing analysis. Clonality was determined by pulsed field gel electrophoresis (PFGE; SmaI digestion) and by emm typing. The fluoroquinolone non-susceptible phenotype was identified in 18 isolates (9.1 %) and correlated with mutations in parC, but not in gyrA, the most frequent leading to substitution of the serine at position 79 with an alanine. Most of the fluoroquinolone non-susceptible isolates belonged to the emm-type 6, even if other emm-types were also represented (emm75, emm89, and emm2). A significant level of association was measured between PFGE and both emm type and substitutions in parC. The prevalence of fluoroquinolone non-susceptible Streptococcus pyogenes isolates in Italy is of concern and, although the well-known emm type 6 is dominant, other types are appearing and spreading.

Periodontal bacteria in the genital tract: are they related to adverse pregnancy outcome?

One of the most important factors implicated in preterm birth (PTB) is acute genitourinary tract infection. The bacteria causing chronic periodontal inflammation include Gram-negative rods and anaerobes similar to those found in women with bacterial vaginosis. The aim of this prospective study is to investigate the relationship between oral and vaginal microflora and preterm low birth weight. Real-time polymerase chain reaction was used to detect both the presence and level of six periodontitis-related species: Aggregatibacter actinomycetemcomitans (Aa), Porphyromonas gingivalis (Pg), Tannerella forsythia (Tf), Treponema denticola (Td), Fusobacterium nucleatum ssp(Fn), and Prevotella intermedia (Pi) for both oral samples of subgingival plaque and cervical samples, obtained from 80 patients, during gynaecological examinations. The more representative oral pathogen (less than 60 percent) species in oral samples of preterm and term group were Tf, Td, and Fn. 24.4 percent of pregnant women presented periodontal pathogens in vaginal swab; the most representative species with a percentage over 0.1 percent of total bacteria in genital tract of preterm group were Tf, Td, and Piwith a positive correlation (less than 0.5). The presence of the bacterium T. denticolain the vagina, regardless of the amount, adversely affects preterm delivery.

Occurrence of Candida species colonization in a population of denture-wearing immigrants.

Infection of the oral cavity and dentures by Candida species are frequent in denture wearers. C. albicans is the most common pathogen; however, other emerging Candida species are also responsible for this condition. Few data are available about the occurrence of Candida species in the oral cavities of denture-wearing immigrants to Italy. In this study, we compare the Candida species found in the oral mucosa and on dentures from a population of denture wearing immigrants to Italy to a matched Italian group. Oral swabs were collected from dentures and the underlying mucosa of patients enrolled in the study and were then cultured to test for the presence of Candida species in each sample. Out of 168 patients enrolled (73 Italians and 95 immigrants), 51 Italians (69.8 percent) and 75 immigrants (78.9 percent) tested positive for the presence of Candida. Candida albicans was the most frequently observed species overall; however, we found a higher occurrence of C. glabrata among immigrants than among Italians. In addition, immigrants displayed a higher incidence of Candida – associated stomatitis and a lower mean age than Candida-positive individuals from the Italian group. Immigrants are more prone to longer colonization of the oral mucosa and dentures by Candida. In these patients, dentures must be checked periodically to prevent the presence of Candida.

Characterization of antimicrobial resistance and class 1 integrons in Enterobacteriaceae isolated from Mediterranean herring gulls (Larus cachinnans).

Mediterranean herring gulls (Larus cachinnans) were investigated as a possible reservoir of antibiotic resistant bacteria and of cassette-borne resistance genes located in class 1 integrons. Two hundred and fourteen isolates of the family Enterobacteriaceae were collected from cloacal swabs of 92 chicks captured in a natural reserve in the North East of Italy. They showed high percentages of resistance to ampicillin and streptomycin. High percentages of resistance to trimethoprim/sulfamethoxazole were found in Proteus and Citrobacter and to chloramphenicol in Proteus. Twenty-two (10%) isolates carried the intI1 gene. Molecular characterization of the integron variable regions showed a great diversity, with the presence of 11 different cassette arrays and of one integron without integrated cassettes. The dfrA1-aadA1a and aadB-aadA2 cassette arrays were the most frequently detected. Also the estX cassette, alone or in combination with other cassettes, was detected in many isolates. From this study it is concluded that the enteric flora of Mediterranean herring gulls may act as a reservoir of resistant bacteria and of resistance genes. Due to their feeding habits and their ability to fly over long distances, these free-living birds may facilitate the circulation of resistant strains between waste-handling facilities, crops, waters, and urban areas.

Antibacterial activity and anti-biofilm effect of chitosan against strains of Streptococcus mutans isolated in dental plaque.

Streptococcus mutans is the major cause of dental plaque and is often associated with biofilm formation. The aim of this study is to evaluate the activity of a hydrosoluble derivative of chitosan against S. mutans biofilms in vitro and in vivo. Strains of S. mutans were isolated from the dental plaque of 84 patients enrolled in the study. The antibacterial activity of chitosan was determined by broth microdilutions. The effect of chitosan at different concentrations and exposure times on S. mutans biofilms at different phases of development was assessed by a clinical study using the classical "4-day plaque regrowth" experiment in adult volunteers. The MIC values of chitosan were between 0.5 and 2 g/L. Compared to distilled water, the chitosan solution significantly decreased the vitality of plaque microflora (p

Characterization of a Staphylococcus aureus strain showing high levels of biofilm formation isolated from a vascular graft: case report.

A methicillin-susceptible Staphylococcus aureus strain, SA-DZ1, was isolated from an infected bypass crossover graft. Its general microbiological features were reminiscent of those previously described for the wound Wiley strain. Removal of the prosthetic device was necessary to resolve the infection. SA-DZ1 grown under different conditions showed a very strong and distinctive biofilm-producing phenotype, which was also visualized by confocal laser scanning microscopy. The biofilm extracellular matrix was essentially polysaccharidic, as determined by differential growth and physicochemical tests. By Multi Locus Sequence Typing (MLST), SA-DZ1 was classified as st94, a single locus variant of st8. Several other genetic traits assayed by PCR, such as agr-type and the presence of gene encoding proteins involved in adhesion and virulence (e.g. ica operon), confirmed the identifying features of this clinical isolate.

Strain-induced effects in the electronic and spin properties of a monolayer of ferromagnetic GdAg2.

We report on the structural, electronic and magnetic properties of a monolayer of GdAg2, forming a moiré pattern on Ag(111). Combining scanning tunneling microscopy and ab initio spin-polarized calculations, we show that the electronic band structure can be shifted linearly via thermal controlled strain of the intra-layer atomic distance in the range of 1-7%, leading to lateral hetero-structuring. Furthermore, the coupling of the incommensurable GdAg2 alloy layer to the Ag(111) substrate leads to spatially varying atomic relaxation causing subsurface layer buckling, texturing of the electronic and spin properties, and inhomogeneity of the magnetic anisotropy energy across the layer. These results provide perspectives for control of electronic properties and magnetic ordering in atomically-thin layers.

Rejection of islets differing by a single antigen is dependent on donor MHC.

To study the effect of expression of a single foreign antigen on the outcome of otherwise compatible mouse islet grafts, we have used transgenic mice expressing the human complement receptor 2 (CR2, CD21, C3d/EBV receptor) on their pancreatic beta-cells (RIP-CR2 mice). Donors were RIP-CR2 mice, typed at the major histocompatibility complex (MHC) as H-2(k), H-2(b), or H-2(bxk), and recipients were streptozotocin-treated nontransgenic B6 x CBA F1 mice (H-2(bxk)). H-2(b) or H-2(bxk) CR2-expressing islets were not rejected (mean survival time [MST] >100 days) but induced a peri-insulitis and an antibody response to CR2. In contrast, H-2(k) CR2-expressing islets were rejected in 80% of the cases with a MST of 65 +/- 23 days and were massively infiltrated by a destructive insulitis. In both cases, the infiltrate was mainly made of CD4+ cells, with few CD8+ cells. The isotype of IgG antibody response to CR2 was studied: recipients of H-2(k) grafts had a predominantly IgG1 response, while recipients of H-2(b) grafts had a balanced IgG2a and IgG1 response. To further evaluate the mechanism of differential rejection of the two types of grafts, recipients were immunized with CR2-expressing rat insulinoma cells before transplantation. Preimmunization with CR2 did not affect the outcome of H-2(b) grafts but greatly accelerated the rejection of H-2(k) grafts. These experiments indicate that expression of a single foreign antigen on beta-cells triggers an immune response leading to rejection or to peri-insulitis, depending on the MHC of donor islets.

Distribution of mef(A)-containing genetic elements in erythromycin-resistant isolates of Streptococcus pyogenes from Italy.

In total, 124 Streptococcus pyogenes isolates were obtained from throat cultures of different symptomatic patients. All isolates showed M-phenotype macrolide resistance and contained the macrolide efflux gene mef(A). The isolates were screened for the presence and insertion site of mef(A)-containing genetic elements. In 25.8% of the isolates, mef(A) was found to be carried by elements belonging to the Tn1207.3/Phi10394.4 family inserted in the comEC gene, while 74.2% contained chimeric elements with a different genetic structure and chromosomal location, probably associated with the recently described 60-kb tet(O)-mef(A) element.

Risk of type 1 diabetes development in children with incidental hyperglycemia: A multicenter Italian study.

OBJECTIVE: The aim of our study was to determine whether children with incidental hyperglycemia are at an increased risk of developing type 1 diabetes. RESEARCH DESIGN AND METHODS: A total of 748 subjects, 1-18 years of age (9.04 +/- 3.62, mean +/- SD), without family history of type 1 diabetes, without obesity, and not receiving drugs were studied and found to have incidental elevated glycemia defined as fasting plasma glucose >5.6 mmol/l confirmed on two occasions. Subjects were tested for immunological, metabolic, and immunogenetic markers. RESULTS: Islet cell antibodies >5 Juvenile Diabetes Foundation units were found in 10% of subjects, elevated insulin autoantibody levels in 4.6%, GAD antibody in 4.9%, and anti-tyrosine phosphatase-like protein autoantibodies in 3.9%. First-phase insulin response (FPIR) was <1st centile in 25.6% of subjects. The HLA-DR3/DR3 and HLA-DR4/other alleles were more frequent in hyperglycemic children than in normal control subjects (P = 0.012 and P = 0.005, respectively), and the HLA-DR other/other allele was less frequent than in normal control subjects (P = 0.000027). After a median follow-up of 42 months (range 1 month to 7 years), 16 (2.1%) subjects (11 males and 5 females), 4.1-13.9 years of age, became insulin dependent. All had one or more islet autoantibodies, and the majority had impaired insulin response and genetic susceptibility to type 1 diabetes. Diabetes symptoms were recorded in 11 patients and ketonuria only in 4 patients. The cumulative risk of type 1 diabetes was similar in males and females, and it was also similar in subjects under or over 10 years, whereas the cumulative risk of type 1 diabetes was increased in subjects with one or more autoantibodies and in those with FPIR <1st centile. CONCLUSIONS: Children with incidental hyperglycemia have a higher-than-normal frequency of immunological, metabolic, or genetic markers for type 1 diabetes and have an increased risk of developing type 1 diabetes.

SmaI macrorestriction analysis of Italian isolates of erythromycin-resistant Streptococcus pyogenes and correlations with macrolide-resistance phenotypes.

High rates of erythromycin resistance among Streptococcus pyogenes strains have been reported in Italy in the last few years. In this study, 370 erythromycin-resistant (MIC, > or = 1 microg/mL) Italian isolates of this species obtained in 1997-1998 from throat swabs from symptomatic patients were typed by analyzing SmaI macrorestriction fragment patterns by pulsed-field gel electrophoresis (PFGE). Among the typable isolates (n = 341; the genomic DNA of the remaining 29 isolates was not restricted by SmaI), 48 distinct PFGE types were recognized, of which 31 were recorded in only one isolate (one-strain types). Fifty-two percent of typable isolates fell into three type clusters and 75% into six, suggesting that erythromycin-resistant group A streptococci circulating in Italy are polyclonal, but the majority of them probably derives from the spread of a limited number of clones. In parallel experiments, the 370 test strains were characterized for the macrolide resistance phenotype: 80 were assigned to phenotype cMLS, 89 to phenotype iMLS-A, 33 to phenotype iMLS-B, 11 to phenotype iMLS-C, and 157 to phenotype M. There was a close correlation between these phenotypic data and the genotypic results of PFGE analysis, the vast majority of the isolates assigned to individual PFGE classes belonging usually to a single phenotype of macrolide resistance. All of the 29 untypable isolates belonged to the M phenotype. Further correlations were observed with tetracycline resistance.

Final height attainment in girls and boys with insulin-dependent diabetes mellitus.

We compared final height to height at diagnosis (expressed as a standard deviation score, SDS), predicted adult height (according to the Bayley and Pinneau method) and target genetic height (expressed as mean parental height in cm, +6.5 for males and -6.5 for females) in 37 patients (15 males, 22 females) with insulin-dependent diabetes mellitus (IDDM), aged 20.6 +/- 3.3 years (16.6-27), with 11.8 +/- 3.7 years (5.2-19.2) mean duration of disease. In the 22 females, final height (162.4 +/- 5.7 cm; range, 150-174 cm) was higher than predicted (161.5 +/- 7.8 cm; range, 146-176.2 cm) and target genetic height (159.7 +/- 3.8 cm; range, 152.8-167.3 cm), although not significantly. Female patients showed a positive correlation between final height and both predicted (P < 0.05) and target genetic height (P < 0.005). No difference was observed in final height between patients diagnosed in the prepubertal or pubertal phase (162.2 +/- 4.6 cm vs. 163.4 +/- 6.2 cm; P-value n.s.). In the 15 males, final height (173.4 +/- 4.4 cm; range, 166.5-181 cm), lower than predicted (175.4 +/- 4.9 cm; range, 166-183 cm), was higher than target genetic height (169.9 +/- 4.8 cm; range, 162.4-177 cm) (P < 0.05). Male patients showed a positive correlation between final height and target genetic height (P < 0.05). No difference was found in final height between patients diagnosed in the prepubertal or pubertal phase (173.6 +/- 3.5 cm vs. 172.7 +/- 5.5 cm; P-value n.s.).(ABSTRACT TRUNCATED AT 250 WORDS)

Central motor conduction time in children and adolescents with insulin-dependent diabetes mellitus (IDDM).

Measurement of central motor conduction time (CMCT) after percutaneous magnetic stimulation of the brain is an electrophysiological method that may discover subclinical impairment of central nervous system (CNS). In order to detect an impairment of CNS, we measured CMCT right (R) and left (L) after percutaneous stimulation of the brain in 34 patients affected by insulin-dependent diabetes mellitus (IDDM) (16 males and 18 females), aged 16.4 +/- 4.1 years (7.3-23.2 years), with duration of disease 7.6 +/- 4.9 years (7/12-16 years), and HbA1c annual mean 7.41 +/- 1.1% (n.v. 5.14 +/- 0.84%). Twenty-three sex- and age-matched healthy subjects served as controls. In our IDDM patients we observed a delay of CMCT R (P < 0.0005) and L (P < 0.0005) as compared to controls. No correlation was found between CMCT (R and L) and chronologic age, duration of disease, peroneal motor nerve conduction velocity. No association was observed between CMCT (R and L) and HLA antigens. On the basis of IDDM duration, patients were divided into 2 groups (G): G I (9 pts) with IDDM < 2 years and G II (25 pts) with IDDM > 5 years, 12 of them with precocious signs of one or more microangiopathic complications. No difference in CMCT (R and L) was observed between the 2 groups and between G I and controls; G II patients had a longer delay of CMCT R (P < 0.0001) and L (P < 0.0001) than controls. In G II patients, a positive correlation between CMCT R and HbA1c of the 5 years before the test (P < 0.025) was also observed.(ABSTRACT TRUNCATED AT 250 WORDS)

Cytotoxic activity in children with insulin-dependent diabetes mellitus.

We determined the percentage of circulating natural killer (NK) cells, using the monoclonal antibodies anti-CD57 and anti-CD16, NK cytotoxic activity (lytic units/10(6)) and lymphokine-activated killer (LAK) activity in 25 IDDM patients aged 3-23 years, 12 with disease for < 1 year (Group I) and 13 with disease for > 3 years (Group II). Nine age-matched healthy subjects served as controls. The percentage of CD57+ cells was similar in IDDM patients and controls, while the percentage of CD16+ cells was lower in IDDM patients (P < 0.05) than in controls. NK cell cytotoxic activity was lower in IDDM patients than in controls (P < 0.01), in Group I and II compared with controls (P < 0.005). LAK activity was similar in IDDM patients and in controls. No correlation was found between NK cytotoxic activity and metabolic control, HLA typing, while a negative correlation was found between NK cytotoxic activity and insulin requirement (P < 0.05). The decreased NK cytotoxic activity observed in our patients, in particular in long-standing diabetics, with normal NK cell number, could be due to a qualitative defect of the NK cells, or to a deficient IL-2 and/or TNF-alpha production, or to a immunomodulatory or immunosuppressing effect of insulin.

Celiac disease and type I (insulin-dependent) diabetes mellitus in childhood: follow-up study.

To ascertain the specificity of IgA and IgG antigliadin (IgA-AGA, IgG-AGA), IgA-antireticulin (R1-ARA), and antiendomysial (AEA) antibodies for the diagnosis of celiac disease, we evaluated 133 type I diabetic children aged 1.4-28.4 years (mean 14.1 +/- 6.6), with diabetes from onset to 20.5 years. Fifty-three patients were considered at onset and 49 of these also during follow-up. IgA-AGA and IgG-AGA were determined by enzyme-linked immunosorbent assay (ELISA), R1-ARA and AEA by indirect immunofluorescence. IgA-AGA were positive in 20 of 133 (15%), IgG-AGA were positive in seven of 133 (5.26%), while R1-ARA and AEA were positive in three patients. At the onset of disease we found elevated IgA-AGA in 17 of 53 (32%) patients, IgG-AGA in four (7.55%) patients, three of them with IgA-AGA as well; R1-ARA and AEA were present in three (5.66%) patients, all with high IgA-AGA levels. During 1-10 year follow-up IgA-AGA decreased to within the normal range in 13 patients, with elevated IgA-AGA at onset but without R1-ARA and AEA; in four patients with high IgA-AGA at onset, IgA-AGA remained constantly elevated as did R1-ARA and AEA in three of them; and two patients, without IgA-AGA, R1-ARA, and AEA at onset, became positive for all three antibodies. Intestinal biopsy confirmed a diagnosis of celiac disease in five of these with IgA-AGA, R1-ARA, and AEA, but not in one patient with persistent IgA-AGA but no AEA and R1-ARA, suggesting that R1-ARA and AEA are more reliable markers for the screening of celiac disease in type I diabetic patients.