Case Report: False aneurysm as a late unusual complication of the aortofemoral bypass graft in a patient with critical leg ischemic symptoms: interesting case.

Aortofemoral bypass surgery is a common procedure for treating aortoiliac occlusive disease, also known as Leriche syndrome, which can cause lower extremity ischemic symptoms. Diagnostic imaging techniques play a crucial role in managing pseudoaneurysms (PSAs), with Duplex ultrasound and Computed Tomography-angiography (CTA) being effective tools for early diagnosis. Pseudoaneurysms (PSAs) present as pulsating masses with various symptoms, and prompt intervention is essential to avoid complications. A case report is presented involving an 82-year-old male who underwent aorto-bifemoral bypass surgery and later developed a pseudoaneurysm (PSA) of the left branch. Surgical treatment involved the removal of the pseudoaneurysm (PSA) and graft replacement. Other cases from the literature are also described, emphasizing the rarity and potential severity of non-anastomotic pseudoaneurysms (PSAs) in reconstructive vascular surgery. Periodic screening of patients who undergo reconstructive vascular surgery is crucial to detect pseudoaneurysms (PSAs) early and prevent complications. Asymptomatic pseudoaneurysms (PSAs) can grow significantly and become life-threatening if not identified in a timely manner. Regular post-operative imaging, such as annual Computed Tomography-angiography (CTA) and/or Duplex ultrasound, is recommended to ensure early diagnosis and appropriate management of complications.

Environmental impact of Holstein Friesian and 3-breed crossbred dairy cows using a life cycle assessment approach applied to individual animals.

This study aimed to set up a life cycle assessment (LCA) approach at the level of individual animals to assess the effects of a 3-breed crossbreeding program on the environmental impact of cows. The study involved 564 cows, 279 purebred Holstein Friesian (HO) and 285 crossbred cows (CR), that originated from a 3-breed crossbreeding program based on the rotational use of Viking Red, Montebèliarde, and HO sires and kept in 2 dairy herds of northern Italy (224 and 340 cows/herd, respectively). The reference unit of the LCA model was the lifetime of cows, from the birth to culling or death. Data were collected at different levels: individual animal-based data referred to the whole life (birth, calving, dry, cull or death dates, and milk production); individual test-date collection of body measures and BCS, used to predict BW and to estimate energy requirements; common farm-based data concerning herd management (diets composition, and materials used). Data were used to compute DMI, milk and milk components production, gross income (GI), and income over feed costs (IOFC) pertaining to the lifespan of cows. An individual LCA-derived approach was set up to compute global warming potential (GWP), acidification and eutrophication potential (AP and EP, respectively), and land occupation (LO), which have been associated with different functional units (cow in her whole life or per day of life; kilograms of milk fat plus protein, and GI and IOFC [in euros] produced in the herd life). Data were analyzed using a generalized linear model including the fixed effects of genetic group (CR vs. HO), farm, and their interaction (genetic group × farm). Compared with HO, CR cows completed more lactations (+12%), had earlier first calving (-2 wk), yielded more fat plus protein in milk both in the lifespan (+8%) and per day of life (+4%). Concerning the environmental impact, when compared with HO herd mates, CR cows had nominal greater emissions per cow in the whole life, similar emissions per day of life and ∼3% lower GWP, AP, and EP per kilogram of fat plus protein yielded in lifespan. Income over feed costs per unit of emission tended to be ∼4% greater in CR compared with HO cows. Also, the use of land tended to be lower in CR compared with HO in most indicators considered. In conclusion, LCA could be adapted to represent individual animals. Moreover, managing dairy cows according to a 3-breed rotational crossbreeding scheme may be regarded as a strategy that can contribute to mitigate the emissions and to improve the environmental impact of dairy operations.

Effect of intramammary infection and inflammation on milk protein profile assessed at the quarter level in Holstein cows.

In this study we wanted to investigate the associations between naturally occurring subclinical intramammary infection (IMI) caused by different etiological agents (i.e., Staphylococcus aureus, Streptococcus agalactiae, Streptococcus uberis, and Prototheca spp.), in combination with somatic cell count (SCC), on the detailed milk protein profile measured at the individual mammary gland quarter. An initial bacteriological screening (time 0; T0) conducted on individual composite milk from 450 Holstein cows reared in 3 herds, was performed to identify cows with subclinical IMI. We identified 78 infected animals which were followed up at the quarter level at 2 different sampling times: T1 and T2, 2 and 6 wk after T0, respectively. A total of 529 quarter samples belonging to the previously selected animals were collected at the 2 sampling points and analyzed with a reversed phase HPLC (RP-HPLC) validated method. Specifically, we identified and quantified 4 caseins (CN), namely αS1-CN, αS2-CN, κ-CN, and ß-CN, and 3 whey protein fractions, namely ß-lactoglobulin, α-lactalbumin, and lactoferrin (LF), which were later expressed both quantitatively (g/L) and qualitatively (as a percentage of the total milk nitrogen content, % N). Data were analyzed with a hierarchical linear mixed model with the following fixed effects: days in milk (DIM), parity, herd, SCC, bacteriological status (BACT), and the SCC × BACT interaction. The random effect of individual cow, nested within herd, DIM and parity was used as the error term for the latter effects. Both IMI (i.e., BACT) and SCC significantly reduced the proportion of ß-CN and αS1-CN, ascribed to the increased activity of both milk endogenous and microbial proteases. Less evident alterations were found for whey proteins, except for LF, which being a glycoprotein with direct and undirect antimicrobial activity, increased both with IMI and SCC, suggesting its involvement in the modulation of both the innate and adaptive immune response. Finally, increasing SCC in the positive samples was associated with a more marked reduction of total caseins at T1, and αS1-CN at T2, suggesting a synergic effect of infection and inflammation, more evident at high SCC. In conclusion, our work helps clarify the behavior of protein fractions at quarter level in animals having subclinical IMI. The inflammation status driven by the increase in SCC, rather the infection, was associated with the most significant changes, suggesting that the activity of endogenous proteolytic enzymes related to the onset of inflammation might have a pivotal role in directing the alteration of the milk protein profile.

Observational study on the associations between milk yield, composition, and coagulation properties with blood biomarkers of health in Holstein cows.

The considerable increase in the production capacity of individual cows owing to both selective breeding and innovations in the dairy sector has posed challenges to management practices in terms of maintaining the nutritional and metabolic health status of dairy cows. In this observational study, we investigated the associations between milk yield, composition, and technological traits and a set of 21 blood biomarkers related to energy metabolism, liver function or hepatic damage, oxidative stress, and inflammation or innate immunity in a population of 1,369 high-yielding Holstein-Friesian dairy cows. The milk traits investigated in this study included 4 production traits (milk yield, fat yield, protein yield, daily milk energy output), 5 traits related to milk composition (fat, protein, casein, and lactose percentages and urea), 11 milk technological traits (5 milk coagulation properties and 6 curd-firming traits). All milk traits (i.e., production, composition, and technological traits) were analyzed according to a linear mixed model that included the days in milk, the parity order, and the blood metabolites (tested one at a time) as fixed effects and the herd and date of sampling as random effects. Our findings revealed that milk yield and daily milk energy output were positively and linearly associated with total cholesterol, nonesterified fatty acids, urea, aspartate aminotransferase, γ-glutamyl transferase, total bilirubin, albumin, and ferric-reducing antioxidant power, whereas they were negatively associated with glucose, creatinine, alkaline phosphatase, total reactive oxygen metabolites, and proinflammatory proteins (ceruloplasmin, haptoglobin, and myeloperoxidase). Regarding composition traits, the protein percentage was negatively associated with nonesterified fatty acids and ß-hydroxybutyrate (BHB), while the fat percentage was positively associated with BHB, and negatively associated with paraoxonase. Moreover, we found that the lactose percentage increased with increasing cholesterol and albumin and decreased with increasing ceruloplasmin, haptoglobin, and myeloperoxidase. Milk urea increased with an increase in cholesterol, blood urea, nonesterified fatty acids, and BHB, and decreased with an increase in proinflammatory proteins. Finally, no association was found between the blood metabolites and milk coagulation properties and curd-firming traits. In conclusion, this study showed that variations in blood metabolites had strong associations with milk productivity traits, the lactose percentage, and milk urea, but no relationships with technological traits of milk. Specifically, increasing levels of proinflammatory and oxidative stress metabolites, such as ceruloplasmin, haptoglobin, myeloperoxidase, and total reactive oxygen metabolites, were shown to be associated with reductions in milk yield, daily milk energy output, lactose percentage, and milk urea. These results highlight the close connection between the metabolic and innate immunity status and production performance. This connection is not limited to specific clinical diseases or to the transition phase but manifests throughout the entire lactation. These outcomes emphasize the importance of identifying cows with subacute inflammatory and oxidative stress as a means of reducing metabolic impairments and avoiding milk fluctuations.

Associations between subclinical intramammary infection and milk fatty acid profile at the quarter level in Holstein cattle.

Mastitis, especially the subclinical form, is the most common economic and health problem in dairy cows. Little is known about changes in milk fatty acid (FA) composition according to infection/inflammation status of the mammary gland. The aim of this study was to investigate the associations between naturally occurring subclinical intramammary infection (IMI) from different pathogens, i.e. Streptococcus agalactiae, Staphylococcus aureus, Streptococcus uberis and Prototheca spp., and the detailed milk FA profile assessed at quarter level in Holstein cows. After an initial bacteriological screening (T0) on 450 Holstein cows reared in three dairy herds, we identified 78 cows positive at the bacteriological examination. These animals were followed up at the quarter level two weeks (T1) and six weeks (T2) after T0. In total, 600 single-quarter samples were obtained at T1 and T2. Individual FAs were determined using the gas chromatography analytical method. Investigated traits were 70 individual FAs, 12 FA groups, and six desaturation indices. The associations between subclinical IMI combined with somatic cell count (SCC) and milk FA profile were investigated using a hierarchical linear mixed model (i.e., observational unit was quarter within cow) with the following fixed effects: days in milk (DIM), parity, herd, SCC, bacteriological status (BACT, positive and negative), and the SCC × BACT interaction. The random effect of individual cow nested within herd, DIM and parity was used as the error term for the latter effects. The most significant associations were detected at T2. Notably, IMI reduced the proportions of individual short-chain FA, especially 4:0 and 6:0 (-14%), but increased the proportion of the most abundant medium-chain FA (MCFA), 16:0 (+4%). A reduction in the desaturation indices was observed mostly for 14:1 index (-9%), in line with the reduction in 14:1 (-10%). Somatic cell count significantly affected 14 individual FAs. In particular, samples with high SCC (≥200 000) had significantly lower proportions of 8:0, 10:0, 11:0, 12:0, and 13:0 compared with samples with low SCC (<200 000). Increasing SCC in animals positive at the bacteriological examination were associated with a reduction in total MCFA at T2 (while in negative animals, they remained constant across SCC classes), possible evidence that elongation of the FA chain from 11 to 16 carbons is affected by a combination of infection and SCC. This study showed that subclinical IMI and SCC are mainly associated with reductions in the synthesis of FA and the desaturation process in the mammary gland.

Agricultural drift depositional simulation of a copper-based fungicide and its effects on non-target terrestrial and freshwater compartments.

Our research investigated the potential impacts of the fungicide Bordeaux mixture drift processes on off-target species representing terrestrial vegetation and fluvial-lacustrine zooplankton. The simulation of drift events was carried out by a predictive scaling analysis of the quantities potentially exported to a predetermined area adjacent to an agricultural field. The theoretical rate of deposition on a terrestrial species, the lichen Pseudevernia furfuracea, was calculated following high (4 kg ha-1) and low (2 kg ha-1) rate treatments using anti-drift nozzles and non-anti-drift nozzles. The experimental set up consisted in 40 boxes holding lichen thalli, all stored in a climatic chamber for 40 days. Spraying of the fungicide was alternated with rainfall simulations to reproduce scenarios related to agricultural practices. Following a single simulation, anti-drift nozzles resulted in a higher overall load deposited per unit of lichen surface area compared to non-anti-drift nozzles, although both loads significantly differed from controls. However, only anti-drift nozzles, associated with the high rate, caused a remarkable impairment of several ecophysiological parameters, differing (p < 0.05) from controls. Rainfalls promoted activation of lichen metabolism, mitigating the cell damage, but exported only 2.5% of the copper deposited on the thalli surfaces. Nevertheless, the exposure of Daphnia magna neonates to leachates showed significant outcomes for the two rates. After only 24 h, leachates resulting from the high application rate led to widespread mortality, which appeared to be extremely relevant after 48 h, whereas the lower rate induced much lower toxicity for both exposure times.

Predicting milk protein fractions using infrared spectroscopy and a gradient boosting machine for breeding purposes in Holstein cattle.

In recent years, increasing attention has been focused on the genetic evaluation of protein fractions in cow milk with the aim of improving milk quality and technological characteristics. In this context, advances in high-throughput phenotyping by Fourier transform infrared (FTIR) spectroscopy offer the opportunity for large-scale, efficient measurement of novel traits that can be exploited in breeding programs as indicator traits. We took milk samples from 2,558 Holstein cows belonging to 38 herds in northern Italy, operating under different production systems. Fourier transform infrared spectra were collected on the same day as milk sampling and stored for subsequent analysis. Two sets of data (i.e., phenotypes and FTIR spectra) collected in 2 different years (2013 and 2019-2020) were compiled. The following traits were assessed using HPLC: true protein, major casein fractions [αS1-casein (CN), αS2-CN, ß-CN, κ-CN, and glycosylated-κ-CN], and major whey proteins (ß-lactoglobulin and α-lactalbumin), all of which were measured both in grams per liter (g/L) and proportion of total nitrogen (% N). The FTIR predictions were calculated using the gradient boosting machine technique and tested by 3 different cross-validation (CRV) methods. We used the following CRV scenarios: (1) random 10-fold, which randomly split the whole into 10-folds of equal size (9-folds for training and 1-fold for validation); (2) herd/date-out CRV, which assigned 80% of herd/date as the training set with independence of 20% of herd/date assigned as the validation set; (3) forward/backward CRV, which split the data set in training and validation set according with the year of milk sampling (FTIR and gold standard data assessed in 2013 or 2019-2020) using the "old" and "new" databases for training and validation, and vice-versa with independence among them; (4) the CRV for genetic parameters (CRV-gen), where animals without pedigree as assigned as a fixed training population and animals with pedigree information was split in 5-folds, in which 1-fold was assigned to the fixed training population, and 4-folds were assigned to the validation set (independent from the training set). The results (i.e., measures and predictions) of CRV-gen were used to infer the genetic parameters for gold standard laboratory measurements (i.e., proteins assessed with HPLC) and FTIR-based predictions considering the CRV-gen scenario from a bi-trait animal model using single-step genomic BLUP. We found that the prediction accuracies of the gradient boosting machine equations differed according to the way in which the proteins were expressed, achieving higher accuracy when expressed in g/L than when expressed as % N in all CRV scenarios. Concerning the reproducibility of the equations over the different years, the results showed no relevant differences in predictive ability between using "old" data as the training set and "new" data as the validation set and vice-versa. Comparing the additive genetic variance estimates for milk protein fractions between the FTIR predicted and HPLC measures, we found reductions of -19.7% for milk protein fractions expressed in g/L, and -21.19% expressed as % N. Although we found reductions in the heritability estimates, they were small, with values ranging from -1.9 to -7.25% for g/L, and -1.6 to -7.9% for % N. The posterior distributions of the additive genetic correlations (ra) between the FTIR predictions and the laboratory measurements were generally high (>0.8), even when the milk protein fractions were expressed as % N. Our results show the potential of using FTIR predictions in breeding programs as indicator traits for the selection of animals to enhance milk protein fraction contents. We expect acceptable responses to selection due to the high genetic correlations between HPLC measurements and FTIR predictions.

Cull cow carcass traits and risk of culling of Holstein cows and 3-breed rotational crossbred cows from Viking Red, Montbéliarde, and Holstein bulls.

Culled dairy cows represent a considerable source of meat production, but their carcasses may vary greatly in quality because of the wide variation in the age, stage of lactation, breed, body condition, and other characteristics of the cows at slaughter. However, the effect of crossbreeding on the value of culled cows has so far received little investigation. The aim of this observational study was to compare a range of carcass attributes of cull cows from 3-breed rotational crossbreeding using Viking Red, Montbéliarde (MO), and Holstein (HO) bulls with those of HO purebred cows. Data on 1,814 dairy cows were collected. Cows were reared together in one herd and slaughtered in 4 slaughterhouses. The carcass weight, fleshiness, and fatness scores, the total value, and the price (€/kg) of each cow carcass were recorded. The culling of a few cows in the sample (n = 86) was classified by the farm manager as "urgent" following a diagnosis of injury or sickness, and this information was recorded. Carcass traits were analyzed with a mixed model which included the fixed effects of parity, days in milk, genetic group (purebred HO, 787 cows, and crossbred cows, classified according to the breed of sire within crossbreds, with 309, 428, and 290 cows sired by Viking Red, MO, and HO bulls, respectively), and interactions, and the random effects of month × year of the date of slaughter, and slaughterhouse. Logistic regression was used to investigate the association of parity, days in milk and purebred or crossbred origin with unplanned, "urgent" culling compared with regular culling. Average carcass weight across genetic groups was 297 ± 65 kg, average price €2.03 ± 0.53/kg, and average value €631 ± 269. Compared with HO, crossbred carcasses were 7 to 12% heavier depending on the breed of sire, were graded + 0.12 to + 0.28 units higher for fleshiness and + 0.26 to + 0.30 units higher for fatness, and fetched an 8 to 11% higher price. As a consequence, compared with purebred HO, carcasses from crossbreds had 15 to 24% higher value (€84 to €133 more per cow), with crossbred cows sired by MO showing the greatest values. Moreover, compared with the HO cows, the crossbred cows had a 37% lower risk of being urgently removed from the herd, which raises welfare concerns and may reduce the salvage value of cull cows. Because cull cows represent a supplemental source of income for dairy farmers, the greater overall value of crossbred cull cows should be taken into account in evaluating the economic effectiveness of crossbreeding schemes.

Total Severity Score (TSS) comparison in vaccinated and unvaccinated patients during the fourth wave (December 2021 - January 2022) of COVID-19 in Italy.

OBJECTIVE: This study aims at comparing the severity score assessed using high-resolution computed tomography (HRCT) in vaccinated and unvaccinated COVID-19 patients. PATIENTS AND METHODS: From the first of December 2021 to first of February 2022, we conducted a single-center retrospective analysis on COVID-19 patients who accessed ED services. The hospital in question is a level II facility with a catchment area of around 200,000 people. According to the Italian recommendations, patients were divided into four groups based on the CT score of Micheal Chung. The sum of acute inflammatory lung lesions involving each lobe was scored as 1 (0-25%), 2 (26-50%), 3 (51-75%) or 4 (76-100%) on a visual quantitative assessment of CT. The total severity score (TSS) was determined by summing the five lobe scores. RESULTS: The study included 134 patients divided into two groups: 67 vaccinated and 67 unvaccinated people. 53 people had incomplete (single dose/double dose) immunization, while 14 people completed the vaccination cycle. It was discovered that the mean CT severity score was lower in fully vaccinated patients compared to partially vaccinated or unvaccinated patients. The mean CT score was significantly lower in fully vaccinated patients aged 60 compared to older patients. The mean CT score was higher in unvaccinated patients compared to fully vaccinated patients. CONCLUSIONS: Individuals who received three doses of COVID-19 vaccination had lower CT severity scores than patients who received only one dose of vaccine or no vaccines at all.

Impact of somatic cell count combined with differential somatic cell count on milk protein fractions in Holstein cattle.

Udder health in dairy herds is a very important issue given its implications for animal welfare and the production of high-quality milk. Somatic cell count (SCC) is the most widely used means of assessing udder health status. However, differential somatic cell count (DSCC) has recently been proposed as a new and more effective means of evaluating intramammary infection dynamics. Differential SCC represents the combined percentage of polymorphonuclear neutrophils and lymphocytes (PMN-LYM) in the total SCC, with macrophages (MAC) accounting for the remaining proportion. The aim of this study was to evaluate the association between SCC and DSCC and the detailed milk protein profile in a population of 1,482 Holstein cows. A validated reversed-phase HPLC method was used to quantify 4 caseins (CN), namely αS1-CN, αS2-CN, κ-CN, and ß-CN, and 3 whey protein fractions, namely ß-lactoglobulin, α-lactalbumin, and lactoferrin, which were expressed both quantitatively (g/L) and qualitatively (as a percentage of the total milk nitrogen content, %N). A linear mixed model was fitted to explore the associations between somatic cell score (SCS) combined with DSCC and the protein fractions expressed quantitatively and qualitatively. We ran an additional model that included DSCC expressed as PMN-LYM and MAC counts, obtained by multiplying the percentages of PMN-LYM and MAC by SCC for each cow in the data set. When the protein fractions were expressed as grams per liter, SCS was significantly negatively associated with almost all the casein fractions and positively associated with the whey protein α-lactalbumin, while DSCC was significantly associated with αS1-CN, ß-CN, and α-lactalbumin, but in the opposite direction to SCS. We observed the same pattern with the qualitative data (i.e., %N), confirming opposite effects of SCS and DSCC on milk protein fractions. The PMN-LYM count was only slightly associated with the traits of concern, although the pattern observed was the same as when both SCS and DSCC were included in the model. The MAC count, however, generally had a greater impact on many casein fractions, in particular decreasing both ß-CN content (g/L) and proportion (%N), and exhibited the opposite pattern to the PMN-LYM count. Our results show that information obtained from both SCS and DSCC may be useful in assessing milk quality and protein fractions. They also demonstrate the potential of MAC count as a novel udder health trait.

Associations between ultrasound hepatic measurements, body measures, and milk production traits in Holstein cows.

Ultrasound (US) imaging has been proposed as a noninvasive tool for monitoring liver dysfunction in dairy cows. This study, carried out on 306 clinically healthy Holstein cows in the first 120 d of lactation kept in 2 herds in northern Italy, aimed at investigating the association between US imaging-derived traits, namely predicted liver triacylglycerol content (pTAG, mg/g), liver depth (LD, mm), portal vein depth (PVD, mm) and area (PVA, mm2), and body size measurements, body condition score (BCS), and milk productivity indicators. Transcutaneous US examination, milk sampling, body size measurements (withers height and heart girth), and BCS were collected once from all cows in 10 sampling batches. The body weights (BW) of a subsample of 73 cows were recorded and used together with an existing data set of BW and measures of Holstein Friesian cows (n = 399) to develop a regression equation to predict BW, which was then used to compute productivity indicators by scaling the milk production traits to predicted BW. Body size measures, BCS, milk traits, and productivity indicators were classified (low, medium, and high) in 0.75 units of standard deviation of the residuals generated from a linear model that included the effects of parity, days in milk, and sampling batch. Liver pTAG, PVA, PVD, and LD were analyzed with a sequence of linear mixed models that included the fixed effects of days in milk and parity and the random effect of sampling batch as common terms, whereas the classes of body and milk traits and the productivity indicators were included one by one. The US-related traits were found to be associated with body size measurements and BCS. Specifically, pTAG was inversely related to BCS, whereas PVD and LD increased with increasing heart girth, BCS, and predicted BW. Generally, no relevant associations were observed between the US parameters and milk production traits, including when expressed in terms of productivity. In conclusion, this study suggests that US measures of liver dimensions of clinically healthy cows are related to their size, whereas pTAG concentrations reflect body condition status, with no particular implications for milk production and productivity. Moreover, healthy cows seemed able to counteract the metabolic stress of the first 120 d of the lactation period without straining liver functionality. Finally, US imaging proved to be a promising technique to assess liver metabolic conditions. However, further studies are needed to confirm its potential as a noninvasive tool for monitoring liver conditions in healthy cows.

Serious Games: A new Approach to Foster Information and Practices About Covid-19?

The current Covid-19 pandemic poses an unprecedented global challenge in the field of education and training. As we have seen, the lack of proper information about the virus and its transmission has forced the general population and healthcare workers to rapidly acquire knowledge and learn new practices. Clearly, a well-informed population is more likely to adopt the correct precautionary measures, thus reducing the transmission of the infection; likewise, properly educated healthcare workers are better equipped to manage the emergency. However, the need to maintain physical distancing has made it impossible to provide in-presence information and training. In this regard, new technologies have proved to be an invaluable resource by facilitating distance learning. Indeed, e-learning offers significant advantages because it does not require the physical presence of learners and teachers. This innovative method applied to serious games has been considered potentially effective in enabling rapid and large-scale dissemination of information and learning through content interactivity. We will review studies that have observed the development and use of serious games to foster information and practices about Covid-19 aimed at promoting behavioral changes in the population and the healthcare personnel involved on the front line.

Proactive vs. reactive psoriasis therapy: a long-term evaluation with dermoscopic and confocal microscopy assessment.

OBJECTIVE: The PSO-LONG trial demonstrated that proactive management of psoriasis based on the regular application of the fixed-dose combination calcipotriol and betamethasone dipropionate (Cal/BD) foam twice a week for 52 weeks prolonged the time to first relapse and reduced the number of relapses, compared with the reactive management. Nevertheless, data about proactive management in clinical practice are still poor. This observational study compares the Cal/BD foam proactive management of psoriasis with the reactive scheme in consecutive patients with localized mild-to-moderate psoriasis. The degree of the skin atrophy was also assessed with dermoscopic and confocal microscopy analyses. PATIENTS AND METHODS: This retrospective observational study was conducted at the Federico II University Dermatological Clinic of Naples in adult patients treated with the fixed-dose combination Cal/BD foam (Enstilar®, Leo Pharma, Ballerup, Denmark) according to either a proactive or a reactive scheme (on-demand treatment). The observation time was 52 weeks. RESULTS: 149 patients were involved. The effectiveness of the proactive therapy was sustained by the significant reduction of the mean number of relapses (p=0.004) and by the significant increase of the median time to relapse (p=0.014) compared to the reactive regimen. Compared to the baseline values, significant improvements in the Psoriasis Area and Severity Index (PASI) score, Investigator Global Assessment (IGA) score, and Skindex-16 index were reported. Dermoscopy and confocal microscopy analyses showed the absence of cutaneous atrophy during the proactive treatment and improved the lesion's appearance. CONCLUSIONS: The proactive regimen represents a valuable therapeutic novelty in treating mild-to-moderate psoriasis.

Quarter-level analyses of the associations among subclinical intramammary infection and milk quality, udder health, and cheesemaking traits in Holstein cows.

In this study, we investigated associations among subclinical intra-mammary infection (IMI) and quarter-level milk composition, udder health indicators, and cheesemaking traits. The dataset included records from 450 Holstein cows belonging to three dairy herds. After an initial screening (T0) to identify animals infected by Streptococcus agalactiae, Streptococcus uberis, Staphylococcus aureus, and Prototheca spp., 613 quarter milk samples for 2 different sampling times (T1 and T2, 1 mo after T1) were used for analysis. Milk traits were analyzed using a hierarchical linear mixed model including the effects of days in milk, parity and herd, and bacteriological and inflammatory category [culture negative with somatic cell count (SCC) <200,000 cells/mL; culture negative with SCC ≥200,000 cells/mL; or culture positive]. All udder health indicators were associated with increased SCC and IMI at both sampling times. The largest effects were detected at T2 for milk lactose (-7% and -5%) and milk conductivity (+9% and +8%). In contrast, the increase in differential SCC (DSCC) in samples with elevated SCC was larger at T1 (+17%). Culture-negative samples with SCC ≥200,000 cells/mL had the highest SCC and greatest numbers of polymorphonuclear-neutrophils-lymphocytes and macrophages at both T1 and T2. Regarding milk cheesemaking ability, samples with elevated SCC showed the worst pattern of curd firmness at T1 and T2. At T2, increased SCC and IMI induced large decreases in recoveries of nutrients into the curd, in particular recovered protein (-14% and -16%) and recovered fat (-12% and -14%). Different behaviors were observed between Strep. agalactiae and Prototheca spp., especially at T2. In particular, samples that were positive for Strep. agalactiae had higher proportions of DSCC (+19%) compared with negative samples with low SCC, whereas samples that were positive for Prototheca spp. had lower DSCC (-11%). Intramammary infection with Prototheca spp. increased milk pH compared with culture-negative samples (+3%) and negative samples that had increased SCC (+2%). The greatest impairment in curd firmness at 30 min from rennet addition was observed for samples that were positive for Prototheca spp. (-99% compared with negative samples, and -98% compared with negative samples with high SCC). These results suggest that IMI caused by Prototheca spp. have detrimental effects on milk technological traits that deserve further investigation of the mechanisms underlying animals' responses to infection.

Direct antimicrobial susceptibility testing (AST) from positive blood cultures using Microscan system for early detection of bacterial resistance phenotypes.

Antimicrobial Susceptibility Testing is mandatory for Bloodstream Infections management in order to establish appropriate antimicrobial therapy. Herein we evaluated new approach based on AST results directly from positive blood cultures, using Microscan WA to carry out rapid phenotypical profile of antibiotic resistance. Our investigations allow to reduce time versus traditional results.

Genetic parameters of differential somatic cell count, milk composition, and cheese-making traits measured and predicted using spectral data in Holstein cows.

Mastitis is one of the most prevalent diseases in dairy cattle and is the cause of considerable economic losses. Alongside somatic cell count (SCC), differential somatic cell count (DSCC) has been recently introduced as a new indicator of intramammary infection. The DSCC is expressed as a count or a proportion (%) of polymorphonuclear neutrophils plus lymphocytes (PMN-LYM) in milk somatic cells. These numbers are complemented to total somatic cell count or to 100 by macrophages (MAC). The aim of this study was to investigate the genetic variation and heritability of DSCC, and its correlation with milk composition, udder health indicators, milk composition, and technological traits in Holstein cattle. Data used in the analysis consisted in single test-day records from 2,488 Holstein cows reared in 36 herds located in northern Italy. Fourier-transform infrared (FTIR) spectroscopy was used to predict missing information for some milk coagulation and cheese-making traits, to increase sample size and improve estimation of the genetic parameters. Bayesian animal models were implemented via Gibbs sampling. Marginal posterior means of the heritability estimates were 0.13 for somatic cell score (SCS); 0.11 for DSCC, MAC proportion, and MAC count; and 0.10 for PMN-LYM count. Posterior means of additive genetic correlations between SCS and milk composition and udder health were low to moderate and unfavorable. All the relevant genetic correlations between the SCC traits considered and the milk traits (composition, coagulation, cheese yield and nutrients recovery) were unfavorable. The SCS showed genetic correlations of -0.30 with the milk protein proportion, -0.56 with the lactose proportion and -0.52 with the casein index. In the case of milk technological traits, SCS showed genetic correlations of 0.38 with curd firming rate (k20), 0.45 with rennet coagulation time estimated using the curd firming over time equation (RCTeq), -0.39 with asymptotic potential curd firmness, -0.26 with maximum curd firmness (CFmax), and of -0.31 with protein recovery in the curd. Differential somatic cell count expressed as proportion was correlated with SCS (0.60) but had only 2 moderate genetic correlations with milk traits: with lactose (-0.32) and CFmax (-0.33). The SCS was highly correlated with the log PMN-LYM count (0.79) and with the log MAC count (0.69). The 2 latter traits were correlated with several milk traits: fat (-0.38 and -0.43 with PMN-LYM and MAC counts, respectively), lactose percentage (-0.40 and -0.46), RCTeq (0.53 and 0.41), tmax (0.38 and 0.48). Log MAC count was correlated with k20 (+0.34), and log PMN-LYM count was correlated with CFmax (-0.26) and weight of water curd as percentage of weight of milk processed (-0.26). The results obtained offer new insights into the relationships between the indicators of udder health and the milk technological traits in Holstein cows.

Light bending and X-ray echoes from behind a supermassive black hole.

The innermost regions of accretion disks around black holes are strongly irradiated by X-rays that are emitted from a highly variable, compact corona, in the immediate vicinity of the black hole1-3. The X-rays that are seen reflected from the disk4, and the time delays, as variations in the X-ray emission echo or 'reverberate' off the disk5,6, provide a view of the environment just outside the event horizon. I Zwicky 1 (I Zw 1) is a nearby narrow-line Seyfert 1 galaxy7,8. Previous studies of the reverberation of X-rays from its accretion disk revealed that the corona is composed of two components: an extended, slowly varying component extending over the surface of the inner accretion disk, and a collimated core, with luminosity fluctuations propagating upwards from its base, which dominates the more rapid variability9,10. Here we report observations of X-ray flares emitted from around the supermassive black hole in I Zw 1. X-ray reflection from the accretion disk is detected through a relativistically broadened iron K line and Compton hump in the X-ray emission spectrum. Analysis of the X-ray flares reveals short flashes of photons consistent with the re-emergence of emission from behind the black hole. The energy shifts of these photons identify their origins from different parts of the disk11,12. These are photons that reverberate off the far side of the disk, and are bent around the black hole and magnified by the strong gravitational field. Observing photons bent around the black hole confirms a key prediction of general relativity.