Generalizability and robustness evaluation of attribute-based zero-shot learning.

In the field of deep learning, large quantities of data are typically required to effectively train models. This challenge has given rise to techniques like zero-shot learning (ZSL), which trains models on a set of "seen" classes and evaluates them on a set of "unseen" classes. Although ZSL has shown considerable potential, particularly with the employment of generative methods, its generalizability to real-world scenarios remains uncertain. The hypothesis of this work is that the performance of ZSL models is systematically influenced by the chosen "splits"; in particular, the statistical properties of the classes and attributes used in training. In this paper, we test this hypothesis by introducing the concepts of generalizability and robustness in attribute-based ZSL and carry out a variety of experiments to stress-test ZSL models against different splits. Our aim is to lay the groundwork for future research on ZSL models' generalizability, robustness, and practical applications. We evaluate the accuracy of state-of-the-art models on benchmark datasets and identify consistent trends in generalizability and robustness. We analyze how these properties vary based on the dataset type, differentiating between coarse- and fine-grained datasets, and our findings indicate significant room for improvement in both generalizability and robustness. Furthermore, our results demonstrate the effectiveness of dimensionality reduction techniques in improving the performance of state-of-the-art models in fine-grained datasets.

A COVID-19 specific multiparametric and ECG-based score for the prediction of in-hospital mortality: ELCOVID score.

We aimed to develop and validate a COVID-19 specific scoring system, also including some ECG features, to predict all-cause in-hospital mortality at admission. Patients were retrieved from the ELCOVID study (ClinicalTrials.gov identifier: NCT04367129), a prospective, multicenter Italian study enrolling COVID-19 patients between May to September 2020. For the model validation, we randomly selected two-thirds of participants to create a derivation dataset and we used the remaining one-third of participants as the validation set. Over the study period, 1014 hospitalized COVID-19 patients (mean age 74 years, 61% males) met the inclusion criteria and were included in this analysis. During a median follow-up of 12 (IQR 7-22) days, 359 (35%) patients died. Age (HR 2.25 [95%CI 1.72-2.94], p < 0.001), delirium (HR 2.03 [2.14-3.61], p = 0.012), platelets (HR 0.91 [0.83-0.98], p = 0.018), D-dimer level (HR 1.18 [1.01-1.31], p = 0.002), signs of right ventricular strain (RVS) (HR 1.47 [1.02-2.13], p = 0.039) and ECG signs of previous myocardial necrosis (HR 2.28 [1.23-4.21], p = 0.009) were independently associated to in-hospital all-cause mortality. The derived risk-scoring system, namely EL COVID score, showed a moderate discriminatory capacity and good calibration. A cut-off score of ≥ 4 had a sensitivity of 78.4% and 65.2% specificity in predicting all-cause in-hospital mortality. ELCOVID score represents a valid, reliable, sensitive, and inexpensive scoring system that can be used for the prognostication of COVID-19 patients at admission and may allow the earlier identification of patients having a higher mortality risk who may be benefit from more aggressive treatments and closer monitoring.

Inflammatory Response Associated with West Nile Neuroinvasive Disease: A Systematic Review.

BACKGROUND: West Nile virus (WNV) infection is a seasonal arbovirosis with the potential to cause severe neurological disease. Outcomes of the infection from WNV depend on viral factors (e.g., lineage) and host-intrinsic factors (e.g., age, sex, immunocompromising conditions). Immunity is essential to control the infection but may also prove detrimental to the host. Indeed, the persistence of high levels of pro-inflammatory cytokines and chemokines is associated with the development of blood-brain barrier (BBB) damage. Due to the importance of the inflammatory processes in the development of West Nile neuroinvasive disease (WNND), we reviewed the available literature on the subject. METHODS: According to the 2020 updated PRISMA guidelines, all peer-reviewed articles regarding the inflammatory response associated with WNND were included. RESULTS: One hundred and thirty-six articles were included in the data analysis and sorted into three groups (in vitro on-cell cultures, in vivo in animals, and in humans). The main cytokines found to be increased during WNND were IL-6 and TNF-α. We highlighted the generally small quantity and heterogeneity of information about the inflammatory patterns associated with WNND. CONCLUSIONS: Further studies are needed to understand the pathogenesis of WNND and to investigate the extent and the way the host inflammatory response either helps in controlling the infection or in worsening the outcomes. This might prove useful both for the development of target therapies and for the development of molecular markers allowing early identification of patients displaying an inflammatory response that puts them at a higher risk of developing neuroinvasive disease and who might thus benefit from early antiviral therapies.

[Public access defibrillation programs: Progetto Vita, current legal aspects and challenges for the future]. / Programmi di pubblico accesso alla defibrillazione: l'esperienza ultraventennale di Progetto Vita a Piacenza, aspetti legislativi attuali e sfide per il futuro.

Out-of-hospital cardiac arrest (OHCA) represents a significant healthcare issue that is often underestimated. OHCA predominantly affects the general population, with staggering numbers: 400 000 cases annually in Europe and 350 000 in the United States, contributing to 50% of cardiovascular-related deaths. The vast majority of OHCA cases begin with a shockable rhythm, making effective treatment possible through early defibrillation, even by non-medical personnel using automated external defibrillators (AEDs). Despite the availability of such devices, survival from OHCA remains below 10%, with no substantial improvements over the last 25 years. Public access defibrillation programs, which reduce response times with AEDs, have demonstrated a significant increase in survival chances for OHCA victims. Particularly, the "Progetto Vita" in Piacenza is an emblematic example of early defibrillation in Europe, tripling survival rates in OHCA patients treated by laypersons compared to patients treated with the traditional system. This experience contributed to the approval of Law 116, dated August 4, 2021, in Italy, aimed at promoting the distribution and use of AEDs in sports facilities, public venues, transportation, and public services. The law also emphasizes that AEDs can be used without the need for specific training, thus promoting wider usage. In this article, we will briefly examine the epidemiology of OHCA and delve into the organizational model of the "Progetto Vita", which aligns with the principles of Law 116/2021. The goal is to provide some insights into organizational aspects that could facilitate the nationwide expansion of early defibrillation programs in the near future.

Modified transmanubrial approach for complicated type 1 cervical rib resection requiring subclavian artery reconstruction.

The transmanubrial musculoskeletal sparing approach (TMA) is commonly used for resecting apical lung tumours with vascular involvement. Non-neoplastic conditions which might require surgical exploration of the thoracic outlet include the 'cervical rib', a clinical condition consisting of an additional rib forming above the first rib and growing from the base of the neck just above the clavicle. Type 1 cervical rib-when a complete cervical rib articulates with the first rib or manubrium of the sternum-is the most challenging scenario where the subclavian artery can be damaged by continuous compression due to the narrow space between clavicle, first rib and supernumerary cervical rib, requiring prosthetic reconstruction of the involved tract. Here, we describe a modified TMA in which the incision in the neck is conducted posteriorly to the sternocleidomastoid muscle, thus allowing safe dissection of the superior and middle trunk of the brachial plexus.

Finger nodules with a papulovesicular hands and feet eruption: a complicated human Orf virus infection.

BACKGROUND: Orf virus (ORFV) is the pathogen responsible for Orf, a zoonotic viral infection that can be spread to humans from sheep and goats. Here, we present a case of human Orf complicated by an immune-related reaction, to raise awareness of this under-recognized disease avoiding unnecessary investigations and overtreatment. CASE REPORT: A 51-year-old woman with no previous medical history presented with a one-week history of three asymptomatic swelling nodules with a grey necrotic center and red outer halo on her index finger. At physical examination there was also a pruritic papulovesicular eruption on her hands and feet. She reported a recent contact with a goat which had a similar nodular lesion in its mouth. A biopsy of the lesions was performed and a diagnosis of Orf complicated by widespread erythema multiforme was made based on the clinical and histopathological features. The lesions spontaneously resolved within the next 2 weeks. CONCLUSIONS: Orf is not very prevalent in our region, so we performed a biopsy of the lesion to guide us toward a diagnosis. However, we should remember that the diagnosis of ecthyma relies on clinical evaluation and epidemiological criteria.

Teachers during COVID-19: Examining burnout levels and their work-life.

BACKGROUND: In March 2020, with the scope to reduce the spread of COVID-19, most national governments around the world canceled in-person education and moved to online learning. Therefore, teachers and students had to adapt a new way of teaching. Most of Italian teachers never had such an experience before and encountered difficulties in effectively carrying out this process on their own. Difficulties that can naturally increase anxiety and stress, leading, in situations perceived as extreme, to burnout syndrome. OBJECTIVES: This paper endeavored to verify levels of job stress and burnout of Italian teachers caused by the COVID-19 pandemic using the validated Maslach Burnout Inventory-General. This study aimed to measure the association among the three main dimensions of burnout and the variables of teachers' personal and working lives that changed due to COVID-19. METHOD: The aim of this paper was to verify burnout state and to measure the association among the three dimensions of burnout and the personal and working lives of Italian teachers using structural equation model analysis. The analysis was conducted in December 2021 and considered the situation in which the Italian teachers (from primary to middle and upper school) are working since March 2020. RESULTS: The results showed that teachers were emotionally exhausted; they did not feel able to fully fulfill their task towards the students. This involved a high absenteeism, a lower quality of work performance and the impossibility of making an objective evaluation of the students with an inevitable flattening of the class level. In contrast, the study shows that teachers who experienced few problems had relatively low levels of burnout. CONCLUSION: The findings brought out some proposals to reduce the risk of burnout and increase the individual well-being of schoolwork organization with positive effects on the lives of students: to strengthen social identity, to avoid a full-time online connection, to promote a psychological support service and to promote resilience training.

Case-report: Massive infection by Cysticercus longicollis in a captive Lemur catta from Italy.

An adult male ring-tailed lemur (Lemur catta) from a biopark of northern Italy was submitted to necropsy. A multi-organ parasitic infection was macroscopically evident. Abundant sero-hemorrhagic fluid with larval parasites was present in all cavities. The microscopic evaluation of parasites and the molecular characterization revealed the presence of Cysticercus longicollis (the larval stage of Taenia crassiceps). Histology of liver, lungs, intestine and urinary bladder revealed several larval parasites surrounded by a severe lymphocytic infiltrate, fibrous tissue and hemorrhages. This is the first report of a ring-tailed lemur with an infection of C. longicollis in Italy. The source of infection is still not known however, the discovery of this parasite in a captive lemur poses more attention on the control of parasitic diseases implementing monitoring tests and biosecurity measures.

Deep learning-based algorithm for postoperative glioblastoma MRI segmentation: a promising new tool for tumor burden assessment.

OBJECTIVE: Clinical and surgical decisions for glioblastoma patients depend on a tumor imaging-based evaluation. Artificial Intelligence (AI) can be applied to magnetic resonance imaging (MRI) assessment to support clinical practice, surgery planning and prognostic predictions. In a real-world context, the current obstacles for AI are low-quality imaging and postoperative reliability. The aim of this study is to train an automatic algorithm for glioblastoma segmentation on a clinical MRI dataset and to obtain reliable results both pre- and post-operatively. METHODS: The dataset used for this study comprises 237 (71 preoperative and 166 postoperative) MRIs from 71 patients affected by a histologically confirmed Grade IV Glioma. The implemented U-Net architecture was trained by transfer learning to perform the segmentation task on postoperative MRIs. The training was carried out first on BraTS2021 dataset for preoperative segmentation. Performance is evaluated using DICE score (DS) and Hausdorff 95% (H95). RESULTS: In preoperative scenario, overall DS is 91.09 (± 0.60) and H95 is 8.35 (± 1.12), considering tumor core, enhancing tumor and whole tumor (ET and edema). In postoperative context, overall DS is 72.31 (± 2.88) and H95 is 23.43 (± 7.24), considering resection cavity (RC), gross tumor volume (GTV) and whole tumor (WT). Remarkably, the RC segmentation obtained a mean DS of 63.52 (± 8.90) in postoperative MRIs. CONCLUSIONS: The performances achieved by the algorithm are consistent with previous literature for both pre-operative and post-operative glioblastoma's MRI evaluation. Through the proposed algorithm, it is possible to reduce the impact of low-quality images and missing sequences.

Air pollution and out-of-hospital cardiac arrest risk: a 7-year study from a highly polluted area.

AIMS: Globally, nearly 20% of cardiovascular disease deaths were attributable to air pollution. Out-of-hospital cardiac arrest (OHCA) represents a major public health problem; therefore, the identification of novel OHCA triggers is of crucial relevance. The aim of the study was to evaluate the association between air pollution (short-, mid-, and long-term exposures) and OHCA risk, during a 7-year period in a highly polluted urban area in northern Italy, with a high density of automated external defibrillators (AEDs). METHODS AND RESULTS: Out-of-hospital cardiac arrests were prospectively collected from the 'Progetto Vita Database' between 1 January 2010 and 31 December 2017; day-by-day air pollution levels were extracted from the Environmental Protection Agency stations. Electrocardiograms of OHCA interventions were collected from the AED data cards. Day-by-day particulate matter (PM) 2.5 and 10, ozone (O3), carbon monoxide (CO), and nitrogen dioxide (NO2) levels were measured. A total of 880 OHCAs occurred in 748 days. A significant increase in OHCA risk with a progressive increase in PM2.5, PM10, CO, and NO2 levels was found. After adjustment for temperature and seasons, a 9% and 12% increase in OHCA risk for each 10 µg/m3 increase in PM10 (P < 0.0001) and PM2.5 (P < 0.0001) levels was found. Air pollutant levels were associated with both asystole and shockable rhythm risk, while no correlation was found with pulseless electrical activity. CONCLUSION: Short- and mid-term exposures to PM2.5 and PM10 are independently associated with the risk of OHCA due to asystole or shockable rhythm.

Reversible supraventricular tachycardia and left bundle branch block in a marathon runner with exertional heat stroke in the Po Valley.

We report the case of a 52-year-old marathon runner admitted to our emergency department for exertional heat stroke (EHS). The electrocardiogram (ECG) showed a supraventricular tachycardia, probably an atrial flutter with 2:1 block, conducted with left bundle branch block. After 10 minutes of aggressive fluid management and rapid external cooling, the ECG returned to normal. As the high-sensitivity cardiac troponin I was elevated, coronary angiography and an electrophysiological study were performed, revealing normal coronary arteries and excluding inducible arrhythmias. As reported in the current literature, our findings confirm that the electrocardiographic changes and elevation of cardiac markers in EHS do not reflect cardiac ischemia, but rather a myocardial injury due to the pathophysiological response to dehydration and hyperthermia, which markedly impaired stroke volume and cardiac output. EHS is a life-threatening condition with a complex pathophysiology caused by thermoregulatory failure. Diagnosis is not always straightforward, but early recognition and timely management (the "golden hour") with rapid cooling and intravenous fluids are crucial to prevent irreversible and fatal organ damage. EHS is defined by a rectal temperature > 40.5 °C with symptoms or signs of neurological dysfunction, such as confusion, drowsiness, or seizures, which can rapidly worsen with delirium, coma, and cardiac arrest. With this case report, we want to remind emergency physicians that early diagnosis and appropriate management of EHS can avoid death and inappropriate treatment. (www.actabiomedica.it).

Dalbavancin in Bone and Joint Infections: A Systematic Review.

BACKGROUND: Approved for acute bacterial skin and skin structure infections, dalbavancin (DBV) has gradually acquired over the years a role as an off-label treatment for several infections caused by Gram-positive bacteria even in other anatomical sites. Osteoarticular (OA) infections are one of the most difficult-to-treat infections and, since the absence of recommendations, clinicians use different and heterogenic DBV dosing schedule regimens for the off-label treatment of osteomyelitis, spondylodiscitis, and septic arthritis. Our aim is to systematically review the current literature to describe DBV administration schedules and their outcome in OA infections. METHODS: According to the 2020 updated PRISMA guidelines, all peer-reviewed articles regarding the use of DBV in OA infections were included. We conducted a literature search on PubMed and Cochrane Controlled Trials. RESULTS: A total of 23 studies and 450 patients were included, prevalently male (144/195, 73.8%) and diabetic (53/163, 32.5%). Overall, 280 (280/388, 72.2%) osteomyelitis, 79 (79/388, 20.4%) spondylodiscitis, and 29 (29/388, 7.5%) septic arthritis were considered. Staphylococcus aureus (164/243, 67.5%) was the most common pathogen isolated. A previous treatment failure (45/96, 46.9%) was the main reason for a switch to a long-acting antibiotic. Most patients were successfully cured with DBV (318/401, 79.3%). A source control was performed in most patients with a favourable outcome (80.4%), while MRSA was prevalently isolated in people with an unfavourable outcome (57%). While a higher percentage of success was found in people who received three doses of DBV 1 week apart (92.3%), a higher rate of treatment failure was recorded in cases of when the DBV cycle was composed of less than two or more than four doses (27.8%). CONCLUSIONS: DBV has shown to be effective as a treatment for OA infections. The most favourable outcome was found in patients receiving three doses of DBV and with an adequate surgical management prior to antibiotic treatment. Although a rigorous administration schedule does not exist, DBV is a viable treatment option in the management of OA infections.

Human Orf with Immune-Mediated Reactions: A Systematic Review.

Background: Orf is a highly contagious zoonosis caused by Orf virus (ORFV), which is endemic in sheep and goats worldwide. Human Orf is usually a self-limiting disease, but potential complications, including immune-mediated reactions, may occur. Methods: We included all articles regarding Orf-associated immunological complications published in peer-reviewed medical journals. We conducted a literature search of the United States National Library of Medicine, PubMed, MEDLINE, PubMed Central, PMC, and the Cochrane Controlled Trials. Results: A total of 16 articles and 44 patients were included, prevalently Caucasian (22, 95.7%) and female (22, 57.9%). The prevailing immunological reaction was erythema multiforme (26, 59.1%), followed by bullous pemphigoid (7, 15.9%). In most cases, the diagnosis was made on the basis of clinical and epidemiological history (29, 65.9%), while a biopsy of secondary lesions was performed in 15 patients (34.1%). A total of 12 (27.3%) patients received a local or systemic treatment for primary lesions. Surgical removal of primary lesion was described in two cases (4.5%). Orf-immune-mediated reactions were treated in 22 cases (50.0%), mostly with topical corticosteroids (12, 70.6%). Clinical improvement was reported for all cases. Conclusions: Orf-related immune reactions can have a varied clinical presentation, and it is important for clinicians to be aware of this in order to make a prompt diagnosis. The main highlight of our work is the presentation of complicated Orf from an infectious diseases specialist's point of view. A better understanding of the disease and its complications is essential to achieve the correct management of cases.

Sarcoptic mange in Felidae: does Sarcoptes scabiei var. felis exist? A first molecular study.

Domestic and wild felids are considered suitable hosts for the parasitic mite Sarcoptes scabiei, and sarcoptic mange is reported in several felid species in the scientific literature. However, the historic classification of Sarcoptes mites into host-specific varieties does not include S. scabiei var. felis. It is unclear whether sarcoptic mange transmission in felids involves canids, other sympatric species, or exclusively felids. This study aimed to characterize the genetic structure of S. scabiei mites from domestic cats (Felis catus) and Eurasian lynx (Lynx lynx carpathicus), comparing them with Sarcoptes mites from sympatric domestic and wild carnivores. Ten Sarcoptes microsatellite markers were used to genotype 81 mites obtained from skin scrapings of 36 carnivores: 4 domestic cats, one dog (Canis lupus familiaris), 4 Eurasian lynx, 23 red foxes (Vulpes vulpes), and 4 grey wolves (Canis lupus lupus) from either Italy, Switzerland or France. Two genetic clusters of S. scabiei with a geographical distribution pattern were detected: mites from cats originating from Central Italy clustered with those from sympatric wolves. In contrast, all the other mites from Switzerland, France and Northern Italy clustered together. These results strengthen the previously advanced hypothesis that genetic variants of S. scabiei have a predominant geographic-related distribution with cryptic transmission patterns. These patterns may rely on the interactions between different hosts living in the same ecological niche rather than a simple infection among hosts belonging to the same taxon, reinforcing the idea that the S. scabiei historic classification into "var" might have little ongoing relevance.

Title: La gale sarcoptique chez les félidés : Sarcoptes scabiei var. felis existe-t-il ? Première étude moléculaire. Abstract: Les félidés domestiques et sauvages sont considérés comme des hôtes appropriés pour l'acarien parasite Sarcoptes scabiei, et la gale sarcoptique est signalée chez plusieurs espèces de félidés dans la littérature scientifique. Cependant, la classification traditionnelle des acariens du genre Sarcoptes en variétés spécifiques à l'hôte n'inclut pas S. scabiei var. felis. On ne sait pas si la transmission de la gale sarcoptique chez les félidés implique des canidés, d'autres espèces sympatriques ou exclusivement des félidés. Cette étude visait à caractériser la structure génétique des acariens S. scabiei des chats domestiques (Felis catus) et du lynx eurasien (Lynx lynx carpathicus), en les comparant aux Sarcoptes des carnivores domestiques et sauvages sympatriques. Dix marqueurs microsatellites de Sarcoptes ont été utilisés pour génotyper 81 acariens issus de grattages cutanés de 36 carnivores : 4 chats domestiques, un chien (Canis lupus familiaris), 4 lynx eurasiens, 23 renards roux (Vulpes vulpes) et 4 loups gris (Canis lupus lupus) d'Italie, de Suisse ou de France. Deux groupes génétiques de S. scabiei, qui suivent un modèle de distribution géographique, ont été détectés. Les acariens des chats originaires du centre de l'Italie se regroupent avec ceux des loups sympatriques. En revanche, tous les autres acariens de Suisse, de France et d'Italie du Nord sont groupés ensemble. Ces résultats renforcent l'hypothèse précédemment avancée selon laquelle les variants génétiques de S. scabiei ont une distribution géographique prédominante avec des schémas de transmission cryptiques. Ces modèles peuvent reposer sur les interactions entre différents hôtes vivant dans la même niche écologique plutôt que sur une simple transmission parmi des hôtes appartenant au même taxon, renforçant l'idée que la classification historique de S. scabiei en "var" a peu de pertinence.

Top-predator carrion is scary: Fight-and-flight responses of wild boars to wolf carcasses.

Predation risk largely constrains prey behavior. However, whether predators may be scary also after death remains unexplored. Here, we describe the "fight-and-flight" responses of a prey, the wild boar (Sus scrofa), to carcasses of (a) its main predator, the gray wolf (Canis lupus) and (b) a carnivore that very rarely kills wild boars, the red fox (Vulpes vulpes), in the western Alps (Italy). We recorded the behavior of wild boars at 10 wolf and 9 fox carcass sites. We found eight "fight-and-flight" responses toward wolf carcasses, and none toward fox carcasses. Our results suggest that carnivore carcasses may indeed be scary; fear responses toward them are dependent on the species to which the carcass belongs; and animals approaching the carcasses are feared mainly when the latter are relatively fresh. This emphasizes the multiple and complex roles that carrion plays in the landscape of fear and opens exciting ecological, epidemiological, and evolutionary research avenues.

Programmatic management of tuberculosis preventive therapy: Past, present, future.

BACKGROUND: Tuberculosis (TB) infection (TBI) is an emerging public health priority, involving about one-fourth of the world population. Because patients with TBI are the reservoir for TB, stopping the progression to active disease by preventive treatment is one of the main interventions needed to achieve TB elimination. As of today, the proportion of people with TBI receiving treatment is minimal at the global level, mostly because current international policies recommend systematic testing and treatment for less than 2% of infected people. PRESENT: FACTS AND GAPS: The programmatic management of TB preventive treatment involves a set of cascading interventions, of which the effectiveness is limited by the poor predictivity of diagnostic tests, the length and the potential toxicity of treatment, and the suboptimal prioritization within global policies. Partly because of this, competing priorities and the lack of adequate funding are significant barriers for scale-up, particularly in low- and middle-income countries. MONITORING AND EVALUATION: To date, there is no universal system of monitoring and evaluation for the programmatic management of TB preventive treatment elements, and just a few countries use the standard recording and reporting tools, contributing to leaving TBI a neglected condition. CONCLUSION: Better financed research and resources reallocation are essential steps to progress toward TB elimination worldwide.

Wolf Is Back: A Novel Sensitive Sentinel Rejoins the Trichinella Cycle in the Western Alps.

Trichinella is a foodborne parasite whose wildlife reservoirs are represented by carnivores and omnivores with predatory and scavenger behavior. The aim of the present study was to investigate the occurrence of Trichinella infection in grey wolves (Canis lupus) that recolonized the Western Alps from the end of the past century, and discuss the epidemiological role played by this apex predator in the early phases of its return. During the period 2017-2022, diaphragm samples were obtained from 130 individuals collected in the frame of a wolf mortality survey. Trichinella larvae were found in 15 wolves (11.53%) with a parasite intensity of 11.74 larvae per gram. Trichinella britovi was the only species identified. This is the first prevalence survey of Trichinella in wolves recolonizing the Alps. Results suggest that, in this particular biotope, the wolf has rejoined the Trichinella cycle and has the potential to play an increasingly important role as maintenance host. Arguments in favor and against this perspective are discussed and knowledge gaps highlighted. The calculated Trichinella larval biomass in the estimated wolf population roaming in Northwest Italy will serve as baseline value to explore possible shifts in the relative importance of wolves as Trichinella reservoir within the regional carnivore community. Finally, wolves re-colonizing the Alps already appear as sensitive sentinels to monitor the risk of Trichinella zoonotic transmission by infected wild boar meat.

Interdisciplinary approach to solve unusual mortalities in the European common frog (Rana temporaria) in two high-mountain ponds affected by climate change.

The global decline in amphibian populations is a major environmental issue. Chytridiomycosis, Ranaviruses and the red-leg syndrome have been identified in unusual mortality events. However, these infections do not account for all causes of declining amphibian populations. Moreover, several cases of amphibian mortality are difficult to solve without resorting to an interdisciplinary approach. Two cases of unusual mortality in Rana temporaria occurred at two high-mountain ponds (northwest Italy) in April and May 2021. Water and frog samples were analysed to understand the possible causes responsible for the unusual mortalities. Results of the main physicochemical (pH, conductivity, dissolved oxygen, chemical and biochemical oxygen demand) and nutrient (ammonia/ammonium, nitrite, nitrate, total phosphorus) parameters revealed a good condition of the water quality, with the absence of the main cyanotoxins (microcystins/nodularins). However, unseasonably high spring water temperatures were recorded in both ponds (12.73 °C and 14.21 °C for Frog Pond and Selleries Pond, respectively). Frogs (n = 50; snout-vent length: 7.0-9.8 cm; body mass: 85-123 g) collected from Frog Pond mainly presented bumps on the ventral cavity and dermal ulceration associated with the isolation of Carnobacterium maltaromaticum. On the other hand, frogs (n = 5; snout-vent length: 8.0-9.1 cm; body mass: 87-92 g) from Selleries Pond presented petechiae and dermal ulcerations on the rear limbs associated with the isolation of Aeromonas salmonicida and A. sobria. In both mortality events, the interdisciplinary approach revealed an association between frog mortalities and the isolation of bacteria. Isolated bacteria are considered opportunistic pathogens, and the high values of the water temperature has certainly led a stress on the frogs, favouring the spread of bacteria and the death of the frogs. Further studies are needed to assess the pathophysiological effects of the opportunistic bacteria here isolated, clarifying the interactions between emerging pathogens and climate change.

Impact of Systematic Use of Intracardiac Ultrasound during Transseptal Catheterization in the Electrophysiology Laboratory.

AIMS: To explore the impact of the use of intracardiac echocardiography (ICE) in the ablation of supraventricular arrhythmias requiring transseptal catheterization (TSC), whilst analyzing the reduction in periprocedural complications and complications specifically related to TSC. METHODS: A retrospective multicenter study collecting data from consecutive atrial fibrillation (AF) and supraventricular ablation procedures that required TSC was performed in five Italian centers. Based on physician discretion, TSC was performed with or without ICE. Periprocedural complications, separating all complications from complications directly related to TSC, were collected. Independent predictors of periprocedural complications and TSC-related complications were investigated. RESULTS: A total of 2181 TSCs were performed on 1862 patients at five Italian centers from 2006 to 2021, in 76% of cases by AF ablation and in 24% by ablation of other arrhythmias with a circuit in the left atrium. Overall, 1134 (52%) procedures were performed with ICE support and 1047 (48%) without ICE. A total of 67 (3.1%) complications were detected, 19 (1.7%) in the ICE group and 48 (4.6%) in the no ICE group, p < 0.001. A total of 42 (1.5%) complications directly related to TSC: 0.9% in the ICE group and 3.1% in the no ICE group (p < 0.001). The independent predictors of all complications were age (OR 1,02 95% C.I 1.00-1.05; p = 0.036), TSC with the use of ICE (OR 0.27 95% C.I 0.15-0.46; p < 0.001) and AF ablation (OR 2,25 95%C.I 1.05-4.83; p = 0.037). The independent predictors for TSC complications were age (OR 1.03 95% C.I 1.01-1.06; p = 0.013) and TSC with the use of ICE (OR 0.24 95% C.I 0.11-0.49; p < 0.001). CONCLUSIONS: ICE reduced periprocedural and TSC-related complications during electrophysiological procedures for ablation of left atrial arrhythmias.