Previous infection and the risk of ischaemic stroke in Italy: the IN2 study.

BACKGROUND AND PURPOSE: There is an increasing interest in new risk factors for ischaemic stroke. Acute and chronic infections could contribute to different aetiological mechanisms of atherosclerosis that lead to cerebrovascular disease. The aim of this study was to investigate the hypothesis that previous infections and Chlamydia pneumoniae in particular increase the risk of ischaemic stroke in the population. METHODS: This was a prospective case-control study involving 11 Italian stroke units. Controls were age- and sex-matched with cases, represented by patients admitted to hospital for acute ischaemic stroke. For each participant classical vascular risk factors and previous inflammatory and infectious events up to 1 month before were registered. Blood samples were collected to analyse inflammatory markers and titres of antibodies against C. pneumoniae. RESULTS: A total of 1002 participants were included (mean age 69 years) with 749 ischaemic stroke patients. Infections occurred within 1 month previously in 12% of the entire sample with a higher prevalence in the case group (14.4% vs. 3.9%). At multivariate analysis of the seropositivity of IgA antibodies against C. pneumoniae increased the risk of stroke significantly (relative risk 2.121; 95% confidence interval 1.255-3.584) and an early previous infection (up to 7 days before the event) contributed to a rise in probability of acute cerebral ischaemia (relative risk 3.692; 95% confidence interval 1.134-6.875). CONCLUSIONS: Early previous infections and persistent chronic infection of C. pneumoniae could contribute to increase the risk of ischaemic stroke significantly, in the elderly especially.

The Italian registry of cystic echinococcosis (RIEC): the first prospective registry with a European future.

Cystic echinococcosis (CE), a worldwide zoonosis, is highly endemic in southern and eastern Europe. Its actual prevalence is unknown due to the lack of efficient reporting systems designed to take into account the particular features of the disease. Neglect of CE makes diagnosis and clinical management difficult outside referral centres, with inconsistencies in clinical practice and often unnecessary procedures carried out that have associated risks and costs. The Italian registry of CE (RIEC) is a prospective multicentre registry of CE patients seen from January 2012 in Italian health centres; data are voluntarily submitted to the registry. Its aims are to show the prevalence of CE in Italy, bring the importance of this infection to the attention of health authorities, encourage public health policies towards its control, and stimulate biological, epidemiological and clinical research on CE. From January 2012 to February 2014, a total 346 patients were enrolled in 11 centres, outnumbering national reports of many CE-endemic European countries. We discuss preliminary data and challenges of the RIEC, template for the European registry of CE, which has been implemented within the Seventh Framework Programme project HERACLES (Human cystic Echinococcosis ReseArch in CentraL and Eastern Societies) since September 2014.

Segmentation of Parmigiano Reggiano dairies according to cheese-making technology and relationships with the aspect of the cheese curd surface at the moment of its extraction from the cheese vat.

Parmigiano Reggiano cheese dairies develop specific cheese-making strategies to adapt the variable characteristics of raw, not standardized milk to the final goal of obtaining cheese consistent with the standard. Analyzing 1,175 cheese-making reports from 30 out of 383 dairies associated with the Parmigiano Reggiano Consortium in 2010 and 2011, 4 groups of Parmigiano Reggiano dairies using specific cheese-making technologies were discriminated by means of multiple linear discriminant analysis. Cheese makers manage cheese-making practices to obtain curd with different roughness properties, classified according to jargon words such as "rigata" and "giusta" or synonyms, because they believe that the roughness of the cheese curd surface immediately after the extraction from the vat is associated with different whey-draining properties and to the final outcome of the cheese. The aspect of the surfaces of the curds produced by the 4 groups of dairies was different according to the technology applied by each group. Cutting of the coagulum when it is still soft for a longer time and faster cooking of the cheese curd grains were associated with a less rough appearance of the surface of the curd, whereas under the opposite conditions, cutting the coagulum when it is firm for a shorter time, led to a curd with a rougher surface. These findings partially support the traditional feeling of Parmigiano Reggiano cheese makers, who consider the curd surface aspect one of the main drivers for their technological choices; to date, however, no data are provided about correlation between the aspect of the curd and the quality of the ripened cheese. If a sufficiently strong correlation could be demonstrated by the future development of the research, the operational effectiveness of Parmigiano Reggiano dairies will be able to largely benefit from the availability of sound and early process markers.

Levetiracetam versus carbamazepine in patients with late poststroke seizures: a multicenter prospective randomized open-label study (EpIC Project).

BACKGROUND: Strokes are the leading cause of epileptic seizures in adults and account for 50% of seizures in those over the age of 65 years. The use of antiepileptic drugs to prevent recurrent poststroke seizures is recommended. METHODS: One hundred and twenty-eight patients with poststroke seizures were randomly allocated to treatment with either levetiracetam (LEV) or sustained-release carbamazepine (CBZ) in a multicenter randomized open-label study. After a titration study phase (2 weeks), the optimal individual dose of trial medication was determined and treatment was continued for another 52 weeks. The primary endpoint was defined as the proportion of seizure-free patients; the secondary endpoints were: evaluation of time recurrence to the first seizure, EEG tracings, cognitive functions and side effects. RESULTS: Of 128 patients, 22 discontinued the trial prematurely; thus a total of 106 patients (52 treated with LEV and 54 treated with CBZ) were included in the analysis. The results of the study were as follows: no significant difference in number of seizure-free patients between LEV and CBZ (p = 0.08); time to the first recurrence tended to be longer among patients on LEV; there was no correlation between the therapeutic effect and the EEG findings in either treatment group; LEV caused significantly fewer (p = 0.02) side effects than CBZ; attention deficit, frontal executive functions and functional scales (Activities of Daily Living and Instrumental Activities of Daily Living indices) were significantly worse in the CBZ group. CONCLUSIONS: This trial suggests that LEV may be a valid alternative to CBZ in poststroke seizures, particularly in terms of efficacy and safety. In addition, our results show that LEV has significant advantages over CBZ on cognitive functions. This trial also indicates that LEV in monotherapy is a safe and effective therapeutic option in elderly patients who have suffered epileptic seizures following a stroke.

The International Trichinella Reference Centre database. Report on thirty-three years of activity and future perspectives.

The International Trichinella Reference Centre (ITRC) is the official laboratory of the International Commission on Trichinellosis, of the World Organization for Animal Health and of the European Union Reference Laboratory for Parasites. The ITRC was established in 1988 as a repository of Trichinella strains and a source of reference materials and information for international scientific research. To date, more than 8000 Trichinella isolates collected throughout the world have been identified at the species or genotype level by the ITRC staff and the information has been stored in a freely accessible database providing the largest collection of data available for scientists involved in the systematics and epidemiology of this parasite. This paper presents a summary of the data collected over 33 years of activity and describes the database functionalities. It finally advocates the potential of the database to improve knowledge of the epidemiology and taxonomy of Trichinella, which in turn may help the international surveillance of Trichinella species.

Short term dentoskeletal effects of mandibular advancement clear aligners in Class II growing patients. A prospective controlled study according to STROBE Guidelines.

AIM: To evaluate the dentoskeletal effects of the Invisalign® Mandibular Advancement (MA) (Align Technology, San José, CA, USA) feature in skeletal Class II growing patients with mandibular retrusion, at pre-pubertal and pubertal stages. MATERIALS AND METHODS: Study design: Forty skeletal Class II patients were prospectively recruited and treated with Invisalign® MA. They were divided into two subgroups according to the CVM stage of growth (CVM2 and CVM3) at the beginning of treatment (T0). For each patient, lateral radiographs were collected at the beginning (T0) and at the end of the mandibular advancement treatment (T1) and their measurements were compared with those obtained by an untreated control group of 32 subjects, matched for growth stage and malocclusion. RESULTS: Patients in CVM2 showed significant reduction of ANB angle, A:Po, Wits index, 11^Spp angle and significant increase of 11^41 and B Downs point. In CVM3 significant reduction of the Wits index and of 41^GoGn angle, and significant increase of the linear Co-Gn measurement, were revealed. STATISTICS: The STROBE guidelines were followed. Linear regression analysis was performed to estimate the differences of ? (T1 - T0) means between group (control was used as reference) stratifying by CVM levels. CONCLUSION: The use of Invisalign® MA is effective in treating Class II growing patient with retrognathic mandible in the short term period. While treatment at prepubertal stage of growth results in dentoalveolar rather than skeletal effects, treatment during the pubertal spurt produces skeletal effects with an annual rate of change of 5.8 mm.

Rare but evolutionarily consequential outcrossing in a highly inbred zoonotic parasite.

Recurrent self-mating can result in nearly clonal propagation of biological lineages, but even occasional outcrossing can serve to redistribute variation in future generations, providing cohesion among regional populations. The zoonotic parasite Trichinella spiralis has been suspected to undergo frequent inbreeding, resulting in genetically uniform larval cohorts which differ markedly from one another. Here, we explored the extent of inbreeding for this parasite by determining how genetic variation (at variable microsatellite markers) is distributed among 1379 larvae derived from 41 wild boars in Extremadura, Spain. In particular, we sought to determine how much of the genetic variation in this region's parasites occurs among the larvae of any given wild boar, and whether each derives from one, or more, parental lineages. We found strong evidence for inbreeding, resulting in genetically distinct parasite subpopulations among the parasites derived from many pairs of wild boar. Fully two-thirds of these parasite cohorts appear to derive from inbred parents; in 10% of the wild boars, parasites were so inbred as to become absolutely fixed in all of the assayed genetic loci. In spite of this, more than one pair of parents appear to have given rise to the infections in one-third of the sampled wild boars, resulting in mixed infections. These mixed infections should slow losses of heterozygosity and multi-locus polymorphism in any given parasite lineage. Such outcrossing should limit distinctions that would otherwise accumulate among transmission chains, thereby enforcing cohesion through the region's population in spite of its marked departure from panmixia. Conditions of transmission may differ in other regions, where such epidemiological features may engender different evolutionary outcomes.

Reduction of cell proliferation induced by PD166866: an inhibitor of the basic fibroblast growth factor.

UNLABELLED: Cell proliferation control plays a key role in tumor development. The basic Fibroblast Growth Factor (bFGF), as well as other growth factors, is involved in several pathologies characterized by dysregulation of cell proliferation. In the present work the effects of PD166866, a very potent and selective tyrosine kinase inhibitor were evaluated. Cultured murine fibroblasts (the cell line 3T6) were used to assess the FGFR-1 inhibition mediated by PD166866. Evaluation of cell viability and molecular biology techniques were adopted. PD166866 controls negatively the bFGF/FGFR-1 system thus promoting a significant reduction of cell proliferation and loss of viability in 3T6 cells. The drug possibly controls proliferation via induction of apoptosis as evidenced by a relevant chromatin degradation. CONCLUSION: This study demonstrated that PD166866 might be used in the control of fibrotic proliferative diseases, as well as in other tumor pathologies.

Mesenteric fibromatosis. Case report.

Deep fibromatosis is a rare locally aggressive but not metastasizing proliferation. Intra-abdominal fibromatosis (IAF) occurs either in association with Gardner's syndrome or as a sporadic event and presents in most cases differential diagnostic problems with myofibroblastic or fibroblastic tumors, characterized by a more aggressive biological behaviour such as gastrointestinal stromal tumors (GISTs). In absence of loco-regional and/or distant metastasis differential diagnosis may be difficult and represents a topical issue, since it influences treatment choice. We describe the case of a patient with sporadic IAF in which the tumor locally involved the mesentery and presented no loco-regional and distant spread. On histology, some morphological features of the neoplasm were in common with a GIST. Definitive diagnosis was made, postoperatively, on the basis of immunohistochemical findings.

Proficiency testing to detect Trichinella larvae in meat in the European Union.

According to the Commission Implementing Regulation (EU) 2015/1375 (replacing the Commission Regulation (EC) No 2075/2005), all animals, which are potential carriers of Trichinella spp. larvae, should be tested at the slaughterhouse or game-handling establishments according to one of the approved tests. One of the core duties of the European Union Reference Laboratory for Parasites is to organize proficiency testing (PT), as stated in the Commission Regulation (EC) No. 882/2004 of the European Parliament and of the Council. The aim of this work was to evaluate the results of PTs of the digestion method carried out by the National Reference Laboratories for Parasites (NRLPs) over a nine year period (2007-2015). Participating laboratories received a panel of samples consisting in 35g or 100g of minced pork or horse meat spiked with Trichinella spiralis live larvae. The number of spiked samples varied from 2 to 9 over the years. A negative control was also included in the panel, except during the 2015 PT, when only positive samples were used. The percentage of NRLPs, which passed the PT, increased from 83.3% in 2007 to 100% in 2014. Considering the number of recovered larvae, the heterogeneity in participant's results reduced overtime. The values of the overall mean difference between spiked and recovered larvae decreased during the study period, witnessing a general improvement of NRLPs performance and confirming the effectiveness of PT for a good performance of this test.

[Acute respiratory obstruction caused by laryngo-tracheal candidiasis in a HIV-positive patient]. / Ostruzione respiratoria acuta da candidosi laringotracheale in soggetto HIV positivo.

The authors report a case presenting highly complex symptomatology. In fact, when the patient came under observation he had had a cough, dyspnea, dysphagia and dysphonia for approximately three months. The biopsy, taken by direct laryngoscopy, indicated the presence of candidiasis in the subglottic and tracheal areas. Laboratory tests indicated complete anergy and patient tested serum positive to HIV. During hospitalization acute dyspnea arose requiring emergency tracheostomy.

Hosts and habitats of Trichinella spiralis and Trichinella britovi in Europe.

Trichinella spiralis and Trichinella britovi are the two most common species of Trichinella circulating in Europe. Based on data provided to the International Trichinella Reference Centre over the past 20 years (data referring to 540 isolates of T. spiralis and 776 isolates of T. britovi), we describe the host species and habitat characteristics for these two pathogens in Europe. A Geographical Information System was constructed using administrative boundaries, a Corine Land Cover (CLC) map, and an elevation map. In most countries, T. britovi is more widespread (62.5-100% of the isolates) than T. spiralis (0.0-37.5%), although in Finland, Germany, Poland and Spain, T. spiralis is more prevalent (56.3-84.2% of the isolates). Trichinella britovi is more widespread than T. spiralis in sylvatic carnivores (89% versus 11%), whereas T. spiralis is prevalent in both wild boars (62% versus 38%) and domestic swine (82% versus 18%), as well as in rodents (75% versus 25%). Trichinella spiralis and T. britovi circulate in the same environments: 41.1% and 46.0%, respectively, in agricultural areas, and 45.5% and 46.6% in forested and semi-natural areas. Although both pathogens can be transmitted by domestic and sylvatic cycles, their epidemiology is strongly influenced by the higher adaptability of T. spiralis to swine and of T. britovi to carnivores. These results are important because they include information on the countries at risk for these pathogens, the role played by specific species as reservoirs, the role of the pathogens in domestic and sylvatic cycles, and the role of the habitat in their circulation. The results can also be used to identify the most suitable animal species for the monitoring of these pathogens in Europe.