Tear-Based Vibrational Spectroscopy Applied to Amyotrophic Lateral Sclerosis.

Biofluid analysis by optical spectroscopy techniques is attracting considerable interest due to its potential to revolutionize diagnostics and precision medicine, particularly for neurodegenerative diseases. However, the lack of effective biomarkers combined with the unaccomplished identification of convenient biofluids has drastically hampered optical advancements in clinical diagnosis and monitoring of neurodegenerative disorders. Here, we show that vibrational spectroscopy applied to human tears opens a new route, offering a non-invasive, label-free identification of a devastating disease such as amyotrophic lateral sclerosis (ALS). Our proposed approach has been validated using two widespread techniques, namely, Fourier transform infrared (FTIR) and Raman microspectroscopies. In conjunction with multivariate analysis, this vibrational approach made it possible to discriminate between tears from ALS patients and healthy controls (HCs) with high specificity (∼97% and ∼100% for FTIR and Raman spectroscopy, respectively) and sensitivity (∼88% and ∼100% for FTIR and Raman spectroscopy, respectively). Additionally, the investigation of tears allowed us to disclose ALS spectroscopic markers related to protein and lipid alterations, as well as to a reduction of the phenylalanine level, in comparison with HCs. Our findings show that vibrational spectroscopy is a new potential ALS diagnostic approach and indicate that tears are a reliable and non-invasive source of ALS biomarkers.

Single-Tear Proteomics: A Feasible Approach to Precision Medicine.

Lacrimal fluid is an attractive source of noninvasive biomarkers, the main limitation being the small sample amounts typically collected. Advanced analytical methods to allow for proteomics profiling from a few microliters are needed to develop innovative biomarkers, with attractive perspectives of applications to precision medicine. This work describes an effective, analytical pipeline for single-tear analysis by ultrahigh-resolution, shotgun proteomics from 23 healthy human volunteers, leading to high-confidence identification of a total of 890 proteins. Highly reproducible quantification was achieved by either peak intensity, peak area, or spectral counting. Hierarchical clustering revealed a stratification of females vs. males that did not emerge from previous studies on pooled samples. Two subjects were monitored weekly over 3 weeks. The samples clustered by withdrawal time of day (morning vs. afternoon) but not by follow-up week, with elevated levels of components of the immune system in the morning samples. This study demonstrates feasibility of single-tear quantitative proteomics, envisaging contributions of this unconventional body fluid to individualized approaches in biomedicine.

Broadband control of the optical properties of semiconductors through site-controlled self-assembly of microcrystals.

We investigate light-matter interactions in periodic silicon microcrystals fabricated combining top-down and bottom-up strategies. The morphology of the microcrystals, their periodic arrangement, and their high refractive index allow the exploration of photonic effects in microstructured architectures. We observe a notable decrease in reflectivity above the silicon bandgap from the ultraviolet to the near-infrared. Finite-difference time-domain simulations show that this phenomenon is accompanied by a ∼2-fold absorption enhancement with respect to a flat sample. Finally, we demonstrate that ordered silicon microstructures enable a fine tuning of the light absorption by changing experimentally accessible knobs as pattern and growth parameters. This work will facilitate the implementation of optoelectronic devices based on high-density microcrystals arrays with optimized light-matter interactions.

Towards a uniform and large-scale deposition of MoS2 nanosheets via sulfurization of ultra-thin Mo-based solid films.

Large-scale integration of MoS2 in electronic devices requires the development of reliable and cost-effective deposition processes, leading to uniform MoS2 layers on a wafer scale. Here we report on the detailed study of the heterogeneous vapor-solid reaction between a pre-deposited molybdenum solid film and sulfur vapor, thus resulting in a controlled growth of MoS2 films onto SiO2/Si substrates with a tunable thickness and cm(2)-scale uniformity. Based on Raman spectroscopy and photoluminescence, we show that the degree of crystallinity in the MoS2 layers is dictated by the deposition temperature and thickness. In particular, the MoS2 structural disorder observed at low temperature (<750 °C) and low thickness (two layers) evolves to a more ordered crystalline structure at high temperature (1000 °C) and high thickness (four layers). From an atomic force microscopy investigation prior to and after sulfurization, this parametrical dependence is associated with the inherent granularity of the MoS2 nanosheet that is inherited by the pristine morphology of the pre-deposited Mo film. This work paves the way to a closer control of the synthesis of wafer-scale and atomically thin MoS2, potentially extendable to other transition metal dichalcogenides and hence targeting massive and high-volume production for electronic device manufacturing.

The health and economic burden of bloodstream infections caused by antimicrobial-susceptible and non-susceptible Enterobacteriaceae and Staphylococcus aureus in European hospitals, 2010 and 2011: a multicentre retrospective cohort study.

We performed a multicentre retrospective cohort study including 606,649 acute inpatient episodes at 10 European hospitals in 2010 and 2011 to estimate the impact of antimicrobial resistance on hospital mortality, excess length of stay (LOS) and cost. Bloodstream infections (BSI) caused by third-generation cephalosporin-resistant Enterobacteriaceae (3GCRE), meticillin-susceptible (MSSA) and -resistant Staphylococcus aureus (MRSA) increased the daily risk of hospital death (adjusted hazard ratio (HR) = 1.80; 95% confidence interval (CI): 1.34-2.42, HR = 1.81; 95% CI: 1.49-2.20 and HR = 2.42; 95% CI: 1.66-3.51, respectively) and prolonged LOS (9.3 days; 95% CI: 9.2-9.4, 11.5 days; 95% CI: 11.5-11.6 and 13.3 days; 95% CI: 13.2-13.4, respectively). BSI with third-generation cephalosporin-susceptible Enterobacteriaceae (3GCSE) significantly increased LOS (5.9 days; 95% CI: 5.8-5.9) but not hazard of death (1.16; 95% CI: 0.98-1.36). 3GCRE significantly increased the hazard of death (1.63; 95% CI: 1.13-2.35), excess LOS (4.9 days; 95% CI: 1.1-8.7) and cost compared with susceptible strains, whereas meticillin resistance did not. The annual cost of 3GCRE BSI was higher than of MRSA BSI. While BSI with S. aureus had greater impact on mortality, excess LOS and cost than Enterobacteriaceae per infection, the impact of antimicrobial resistance was greater for Enterobacteriaceae.

Water Safety Plan, Monochloramine Disinfection and Extensive Environmental Sampling Effectively Control Legionella and Other Waterborne Pathogens in Nosocomial Settings: The Ten-Year Experience of an Italian Hospital.

Legionella contamination control is crucial in healthcare settings where patients suffer an increased risk of disease and fatal outcome. To ensure an effective management of this health hazard, the accurate application of a hospital-specific Water Safety Plan (WSP), the choice of a suitable water disinfection system and an extensive monitoring program are required. Here, the ten-year experience of an Italian hospital is reported: since its commissioning, Legionellosis risk management has been entrusted to a multi-disciplinary Working Group, applying the principles of the World Health Organization's WSP. The disinfection strategy to prevent Legionella and other waterborne pathogens relies on the treatment of domestic hot water with a system ensuring the in situ production and dosage of monochloramine. An average of 250 samples/year were collected and analyzed to allow an accurate assessment of the microbiological status of water network. With the aim of increasing the monitoring sensitivity, in addition to the standard culture method, an optimized MALDI-ToF MS-based strategy was applied, allowing the identification of Legionella species and other relevant opportunistic pathogens. Data collected so far confirmed the effectiveness of this multidisciplinary approach: the fraction of positive samples never overcame 1% on a yearly basis and Legionnaires' Disease cases never occurred.

Strain Relaxation of InAs Quantum Dots on Misoriented InAlAs(111) Metamorphic Substrates.

We investigate in detail the role of strain relaxation and capping overgrowth in the self-assembly of InAs quantum dots by droplet epitaxy. InAs quantum dots were realized on an In0.6Al0.4As metamorphic buffer layer grown on a GaAs(111)A misoriented substrate. The comparison between the quantum electronic calculations of the optical transitions and the emission properties of the quantum dots highlights the presence of a strong quenching of the emission from larger quantum dots. Detailed analysis of the surface morphology during the capping procedure show the presence of a critical size over which the quantum dots are plastically relaxed.

At the peak of COVID-19 age and disease severity but not comorbidities are predictors of mortality: COVID-19 burden in Bergamo, Italy.

BACKGROUND: Findings from February 2020, indicate that the clinical spectrum of COVID-19 can be heterogeneous, probably due to the infectious dose and viral load of SARS-CoV-2 within the first weeks of the outbreak. The aim of this study was to investigate predictors of overall 28-day mortality at the peak of the Italian outbreak. METHODS: Retrospective observational study of all COVID-19 patients admitted to the main hospital of Bergamo, from February 23 to March 14, 2020. RESULTS: Five hundred and eight patients were hospitalized, predominantly male (72.4%), mean age of 66±15 years; 49.2% were older than 70 years. Most of patients presented with severe respiratory failure (median value [IQR] of PaO2/FiO2: 233 [149-281]). Mortality rate at 28 days resulted of 33.7% (N.=171). Thirty-nine percent of patients were treated with continuous positive airway pressure (CPAP), 9.5% with noninvasive ventilation (NIV) and 13.6% with endotracheal intubation. 9.5% were admitted to Semi-Intensive Respiratory Care Unit, and 18.9% to Intensive Care Unit. Risk factors independently associated with 28-day mortality were advanced age (≥78 years: odds ratio [OR], 95% confidence interval [CI]: 38.91 [10.67-141.93], P<0.001; 70-77 years: 17.30 [5.40-55.38], P<0.001; 60-69 years: 3.20 [1.00-10.20], P=0.049), PaO2/FiO2<200 at presentation (3.50 [1.70-7.20], P=0.001), need for CPAP/NIV in the first 24 hours (8.38 [3.63-19.35], P<0.001), and blood urea value at admission (1.01 [1.00-1.02], P=0.015). CONCLUSIONS: At the peak of the outbreak, with a probable high infectious dose and viral load, older age, the severity of respiratory failure and renal impairment at presentation, but not comorbidities, are predictors of 28-day mortality in COVID-19.

A Snapshot from the Department of Urology in Bergamo Evaluating the Timeline of the SARS-CoV-2 Outbreak: Which Patients Are We Missing?

The province of Bergamo in Italy and in particular Papa Giovanni XXIII Hospital was one of the first areas to be hit by the SARS-CoV-2 outbreak and experience firsthand all the different phases of the crisis. We describe the timeline of the changes in overall urological workload during the outbreak period from lockdown to the slow reopening of activities. We sought to compare the 2020 hospital scenario with normality in the same period in 2019, highlighting the rationale behind decision-making when guidelines were not yet available. While we focus on the changes in surgical volumes for both elective (oncological and noncancer) and urgent cases, we have still to confront the risk of untreated and underdiagnosed patients. PATIENT SUMMARY: We present a snapshot of changes in urology during the peak of the COVID-19 outbreak in our hospital in Bergamo, Italy. The effect of medical lockdown on outcomes for untreated or underdiagnosed patients is still unknown.

Optically reconfigurable polarized emission in Germanium.

Light polarization can conveniently encode information. Yet, the ability to tailor polarized optical fields is notably demanding but crucial to develop practical methods for data encryption and to gather fundamental insights into light-matter interactions. Here we demonstrate the dynamic manipulation of the chirality of light at telecom wavelengths. This unique possibility is enrooted in the multivalley nature of the conduction band of a conventional semiconductor, namely Ge. In particular, we demonstrate that optical pumping suffices to govern the kinetics of spin-polarized carriers and eventually the chirality of the radiative recombination. We found that the polarized component of the emission can be remarkably swept through orthogonal eigenstates without magnetic field control or phase shifter coupling. Our results provide insights into spin-dependent phenomena and offer guiding information for the future selection and design of spin-enhanced photonic functionalities of group IV semiconductors.

Critical strain for Sn incorporation into spontaneously graded Ge/GeSn core/shell nanowires.

We address the role of non-uniform composition, as measured by energy-dispersive x-ray spectroscopy, in the elastic properties of core/shell nanowires for the Ge/GeSn system. In particular, by finite element method simulations and transmission electron diffraction measurements, we estimate the residual misfit strain when a radial gradient in Sn and a Ge segregation at the nanowire facet edges are present. An elastic stiffening of the structure with respect to the uniform one is concluded, particularly for the axial strain component. More importantly, refined predictions linking the strain and the Sn percentage at the nanowire facets enable us to quantitatively determine the maximum compressive strain value allowing for additional Sn incorporation into a GeSn alloy. The progressive incorporation with increasing shell thickness, under constant growth conditions, is specifically induced by the nanowire configuration, where a larger elastic relaxation of the misfit strain takes place.

Strong confinement-induced engineering of the g factor and lifetime of conduction electron spins in Ge quantum wells.

Control of electron spin coherence via external fields is fundamental in spintronics. Its implementation demands a host material that accommodates the desirable but contrasting requirements of spin robustness against relaxation mechanisms and sizeable coupling between spin and orbital motion of the carriers. Here, we focus on Ge, which is a prominent candidate for shuttling spin quantum bits into the mainstream Si electronics. So far, however, the intrinsic spin-dependent phenomena of free electrons in conventional Ge/Si heterojunctions have proved to be elusive because of epitaxy constraints and an unfavourable band alignment. We overcome these fundamental limitations by investigating a two-dimensional electron gas in quantum wells of pure Ge grown on Si. These epitaxial systems demonstrate exceptionally long spin lifetimes. In particular, by fine-tuning quantum confinement we demonstrate that the electron Landé g factor can be engineered in our CMOS-compatible architecture over a range previously inaccessible for Si spintronics.

Highly Mismatched, Dislocation-Free SiGe/Si Heterostructures.

Defect-free mismatched heterostructures on Si substrates are produced by an innovative strategy. The strain relaxation is engineered to occur elastically rather than plastically by combining suitable substrate patterning and vertical crystal growth with compositional grading. Its validity is proven both experimentally and theoretically for the pivotal case of SiGe/Si(001).

Structural investigations of the α12 Si-Ge superstructure.

This article reports the X-ray diffraction-based structural characterization of the α12 multilayer structure SiGe2Si2Ge2SiGe12 [d'Avezac, Luo, Chanier & Zunger (2012 ▶). Phys. Rev. Lett.108, 027401], which is predicted to form a direct bandgap material. In particular, structural parameters of the superlattice such as thickness and composition as well as interface properties, are obtained. Moreover, it is found that Ge subsequently segregates into layers. These findings are used as input parameters for band structure calculations. It is shown that the direct bandgap properties depend very sensitively on deviations from the nominal structure, and only almost perfect structures can actually yield a direct bandgap. Photoluminescence emission possibly stemming from the superlattice structure is observed.

Composition profiling of inhomogeneous SiGe nanostructures by Raman spectroscopy.

In this work, we present an experimental procedure to measure the composition distribution within inhomogeneous SiGe nanostructures. The method is based on the Raman spectra of the nanostructures, quantitatively analyzed through the knowledge of the scattering efficiency of SiGe as a function of composition and excitation wavelength. The accuracy of the method and its limitations are evidenced through the analysis of a multilayer and of self-assembled islands.

[Cardiovascular medicine unit: preliminary results of an in-hospital multidisciplinary intervention in heart failure]. / Unità di medicina cardiovascolare: prime esperienze di un approccio intraospedaliero multidisciplinare allo scompenso cardiaco.

BACKGROUND: In Italy the majority of patients with heart failure are admitted to Internal Medicine Divisions, where diagnostic and therapeutic procedures, suggested by guidelines, are less utilized than in Cardiology Divisions. In order to provide a better assistance to patients with heart failure, a Cardiovascular Medicine Unit was founded with interdepartmental valence (Cardiovascular and Internal Medicine) in the "Ospedali Riuniti" Hospital of Bergamo. The purpose of this study was to evaluate the preliminary results, concerning management of heart failure, in the first 6 months of activities carried out at the Cardiovascular Medicine Unit and to compare them with those of other structures that usually manage this disease. METHODS: Analysis of data concerning 150 admissions to the Cardiovascular Medicine Unit for heart failure in 147 patients during the first 6 months of 2003. Comparisons of admittance data for heart failure in the first semester 2001 deriving from the Internal Medicine Division of the "Ospedali Riuniti" Hospital of Bergamo, the TEMISTOCLE study and the Niguarda Ca' Granda Hospital of Milan. RESULTS: A higher prescription of beta-blockers and spironolactone was observed in the Cardiovascular Medicine Unit than in other structures (p < 0.001). Echocardiography and coronary angiography were performed more frequently (p < 0.001) and the number of rehospitalizations was lower for all cases (p < 0.05) as well as for heart failure (p < 0.001). The extensive use of diagnostic procedures and multidisciplinary evaluation of co-morbidities allowed to identify patients who could be managed successfully with surgical therapy; preliminary data suggest a net benefit in terms of NYHA functional class and reduction in rehospitalization in this subgroup of patients. CONCLUSIONS: These data demonstrate that the Cardiovascular Medicine model, based on integration of knowledge between cardiologists and internists, is effective with respect to organization and assistance and allows to optimize heart failure patient management.