Despite the implementation of control efforts and funds to fight against the disease, African swine fever (ASF) has been present in Sardinia since 1978. It has caused serious problems for both the ...industrial pig sector and the regional authorities in Sardinia, as well as the economy of Italy and the European Union, which annually supports the costly eradication programme. During this time, ASF has persisted, especially in the central‐east part of Sardinia where almost 75% of the total outbreaks are concentrated. The Sardinian pig sector is clearly divided into two categories based on the specialization and industrialization of production: industrial farms, which represents only 1.8% of the farms in the island and non‐professional holdings, which are comprised of small producers (90% of pig holdings have <15 pigs) and apply little to no biosecurity measures. Additionally, illegally raised pigs are still bred in free‐ranging systems in certain isolated parts of the island, despite strict regulations. The illegal raising of pigs, along with other high‐risk management practices (e.g. use of communal areas) are likely the primary reasons for endemic persistence of the virus in this area. The compensation provided to the farmers, and other aspects of the eradication programme have also negatively influenced eradication efforts, indicating that socio‐cultural and economic factors play an important role in the epidemiology of ASF on the island. The aim of this study was to comprehensively review the evolution of the 35‐year presence of ASF in Sardinia, including control measures, and the environmental and socio‐economic factors that may have contributed to disease endemicity on the island. The present review highlights the need for a coordinated programme that considers these socio‐economic and environmental factors and includes an assessment of new cost‐effective control strategies and diagnostic tools for effectively controlling ASF in Sardinia.
Covid-19 is severely impacting hospitality establishments, with consequences on consumers' decision-making. Yet, little is known about current factors influencing travelers' accommodation choice. ...This paper adopts a sequential mixed-methods design to examine the importance attributed to additional measures implemented in tourism accommodation during a pandemic, by interviewing sixteen potential travelers, and then profiling a convenience sample of 4,386 consumers accordingly. Findings suggest that accommodation key factors are sanitization and PPE use, physical distancing in restaurant service, room service delivery, reception automation, and social and environmental engagement. Consumers attribute different importance to accommodation services in three configurations: Sanitization and Physically Distancing Seekers, All-round Concerned, and Sustainability Supporters. Profiling of the segments revealed numerous distinctive characteristics.
Pulmonary arterial hypertension (PAH) and interstitial lung disease (ILD) are the leading causes of death in systemic sclerosis (SSc). Until now, no prospective biomarker to predict new onset of ...SSc-ILD or SSc-PAH in patients with SSc has reached clinical application. In homeostasis, the receptor for advanced glycation end products (RAGE) is expressed in lung tissue and involved in cell-matrix adhesion, proliferation and migration of alveolar epithelial cells, and remodeling of the pulmonary vasculature. Several studies have shown that sRAGE levels in serum and pulmonary tissue vary according to the type of lung-related complication. Therefore, we investigated levels of soluble RAGE (sRAGE) and its ligand high mobility group box 1 (HMGB1) in SSc and their abilities to predict SSc-related pulmonary complications.
One hundred eighty-eight SSc patients were followed retrospectively for the development of ILD, PAH, and mortality for 8 years. Levels of sRAGE and HMGB1 were measured in serum by ELISA. Kaplan-Meier survival curves were performed to predict lung events and mortality and event rates were compared with a log-rank test. Multiple linear regression analysis was performed to examine the association between sRAGE and important clinical determinants.
At baseline, levels of sRAGE were significantly higher in SSc-PAH-patients (median 4099.0 pg/ml 936.3-6365.3, p = 0.011) and lower in SSc-ILD-patients (735.0 pg/ml IQR 525.5-1988.5, p = 0.001) compared to SSc patients without pulmonary involvement (1444.5 pg/ml 966.8-2276.0). Levels of HMGB1 were not different between groups. After adjusting for age, gender, ILD, chronic obstructive pulmonary disease, anti-centromere antibodies, the presence of puffy fingers or sclerodactyly, use of immunosuppression, antifibrotic therapy, or glucocorticoids, and use of vasodilators, higher sRAGE levels remained independently associated with PAH. After a median follow-up of 50 months (25-81) of patients without pulmonary involvement, baseline sRAGE levels in the highest quartile were predictive of development of PAH (log-rank p = 0.01) and of PAH-related mortality (p = 0.001).
High systemic sRAGE at baseline might be used as a prospective biomarker for patients with SSc at high risk to develop new onset of PAH. Moreover, high sRAGE levels could predict lower survival rates due to PAH in patients with SSc.
Raynaud's Phenomenon (RP) leading to repetitive ischemia and reperfusion (IR) stress, is the first recognizable sign of systemic sclerosis (SSc) leading to increased oxidative stress. High-mobility ...group box-1 (HMGB1) is a nuclear factor released by apoptotic and necrotic cells after oxidative stress. Since HMGB1 can signal through the receptor for advanced glycation end products (RAGE), we investigated whether an RP attack promotes the release of HMGB1, leading to fibroblast activation and the upregulation of interferon (IFN)-inducible genes. A cold challenge was performed to simulate an RP attack in patients with SSc, primary RP (PRP), and healthy controls. We measured levels of HMGB1 and IFN gamma-induced Protein 10 (IP-10) at different time points in the serum. Digital perfusion was assessed by photoplethysmography. In vitro, HMGB1 or transforming growth factor (TGF-β1) (as control) was used to stimulate healthy human dermal fibroblasts. Inflammatory, profibrotic, and IFN-inducible genes, were measured by RT-qPCR. In an independent cohort, sera were obtained from 20 patients with SSc and 20 age- and sex-matched healthy controls to determine HMGB1 and IP-10 levels. We found that HMGB1 levels increased significantly 30 min after the cold challenge in SSc compared to healthy controls. In vitro stimulation with HMGB1 resulted in increased mRNA expression of IP-10, and interleukin-6 (IL-6) while TGF-β1 stimulation promoted IL-6 and Connective Tissue Growth Factor (CTGF). In serum, both HMGB1 and IP-10 levels were significantly higher in patients with SSc compared to healthy controls. We show that cold challenge leads to the release of HMGB1 in SSc patients. HMGB1 induces IP-10 expression in dermal fibroblasts partly through the soluble RAGE (sRAGE) axis suggesting a link between RP attacks, the release of HMGB1 and IFN-induced proteins as a putative early pathogenetic mechanism in SSc.
Calcinosis cutis affects 20-40% of patients with systemic sclerosis (SSc). When calcinosis cutis becomes clinically apparent, it is irreversible in most cases. Detection of active calcification ...formation might allow early disease-modifying interventions. We assessed the feasibility of visualizing active calcifications using 18FSodium Fluoride (18FNaF) PET/low-dose CT (LDCT) in SSc patients with calcinosis cutis.
In this cross-sectional, observational pilot study patients underwent a whole body 18FNaF PET/LDCT. All patients met the 2013 ACR/EULAR SSc criteria and had clinically detectable calcinosis cutis. (Sub)cutaneous calcifications were described by three investigators.
Nine female patients were included (median age 59.0 years IQR 51.5-70.5). 18FNaF uptake was mostly visible in the fingers (n=7) and knees (n=5). 18FNaF PET showed calcifications in the fingers of 3 patients where calcifications were undetected on LDCT and in the clinic. Ninety-seven percent of 18FNaF positive lesions was visible on LDCT. Of all lesions visible on LDCT, 70% was also visible on 18FNaF PET.
Imaging of active calcifications in SSc is feasible using 18FNaF PET/LDCT. Seventy percent of calcifications on LDCT were 18FNaF PET positive. Although these findings require replication, 18FNaF PET/LDCT may detect active calcification formation, being potentially suitable for early disease-modifying interventions.
The objective of this research is to verify whether European projects on Active Aging (AA) and Elderly Quality of Life (Qol) funded by the Seventh Framework Programme (FP7) produce an impact on ...literature similar to projects funded by the National Health Institute (NHI) of the United States on international literature using well-known bibliometric indicators. This effort may be useful in developing standardized and replicable procedures.
Fifteen randomly selected projects on AA and Elderly Qol concluded in August 2017 and funded by FP7 were compared to similar projects funded by the US NHI with reference to papers published (Scopus and Scholar), papers published in Q1 journals, and the number of citations of the papers linked to the projects.
In all the indicators considered, the European projects showed no difference with the US NHI projects.
The EU-funded AA and Qol Elderly projects have an impact on scientific literature comparable to projects funded in the United States by the NHI Agency.Our results are consistent with the data on general medical research, which indicates that, European research remains at a high level of competitiveness.In this experimental study, our methodology appeared to be convincing and reliable and it could be applied to the extent of the impact of more extensive research areas.Our research did not evaluate the relationship between funding required by research and scientific productivity.
•SAF is a validated marker of AGE accumulation in the skin.•SAF may be influenced by several factors which should be addressed when used as a systemic biomarker of AGEs.•Studies focusing on ...eliminating confounding factors of the AGE Reader measurement should be encouraged.
Advanced glycation endproducts (AGEs) are sugar-modified adducts which arise during non-enzymatic glycoxidative stress. These compounds may become systemically elevated in disease states, and accumulate in tissue, especially on long-lived proteins. AGEs have been implicated in various acute, and chronic diseases, stressing the need for reliable and comprehensive measuring techniques. Measurement of AGEs in tissue such as skin requires invasive skin biopsies. The AGE Reader has been developed to assess skin autofluorescence (SAF) non-invasively using the fluorescent properties of several AGEs.
Various studies have shown that SAF is a useful marker of disease processes associated with oxidative stress. It is prospectively associated with the development of cardiovascular events in patients with diabetes, renal or cardiovascular disease, and it predicts diabetes, cardiovascular disease, and mortality in the general population. However, when measuring SAF in individual subjects, several factors may limit the reliability of the measurement. These include endogenous factors present in the skin that absorb emission light such as melanin in dark-skinned subjects, but also factors that lead to temporal changes in SAF such as acute diseases and strenuous physical exercise associated with glycoxidative stress. Also, exogenous factors could potentially influence SAF levels inadvertently such as nutrition, and for example the application of skin care products. This review will address the AGE Reader functionality and the endogenous, and exogenous factors which potentially influence the SAF assessment in individual subjects.
Non-invasively assessed skin autofluorescence (SAF) measures advanced glycation endproducts (AGEs) in the dermis. SAF correlates with dermal AGEs in Caucasians and Asians, but studies in dark-skinned ...subjects are lacking. In this pilot we aimed to assess whether SAF signal is representative of intrinsic fluorescence (IF) and AGE accumulation in dark skin.
Skin biopsies were obtained in 12 dark-skinned subjects (6 healthy subjects, median age 22 years; 6 diabetes mellitus (DM) subjects, 65 years). SAF was measured with the AGE Reader, IF using confocal microscopy, and AGE distribution with specific antibodies. CML and MG-H1 were quantified with UPLC-MS/MS and pentosidine with HPLC and fluorescent detection.
SAF correlated with IF from the dermis (405nm, r = 0.58, p < 0.05), but not with CML (r = 0.54, p = 0.07). CML correlated with IF from the dermis (405nm, r = 0.90, p < 0.01). UV reflectance and the coefficient of variation of SAF were negatively correlated (r = -0.80, p < 0.01). CML and MG-H1 were predominantly present around blood vessels, in collagen and fibroblasts in the dermis.
This proof of concept study is the first to compare non-invasive SAF with AGE levels measured in skin biopsies in dark-skinned subjects. SAF did not correlate with individual AGEs from biopsies, but was associated with IF. However, the intra-individual variance was high, limiting its application in dark-skinned subjects on an individual basis.
Diabetes; Pathology; Internal Medicine; Clinical Research; Diagnostics; Advanced glycation endproducts; Diabetes mellitus; Skin autofluorescence.
To study the long-term effects of simvastatin on urinary albumin excretion rate (AER) in normotensive microalbuminuric type 2 diabetic patients with hypercholesterolemia.
A total of 19 normotensive ...microalbuminuric hypercholesterolemic type 2 diabetic patients entered a double-blind crossover study for 2 years, receiving either simvastatin (20 mg/day) or placebo (each treatment for 1 year).
Simvastatin significantly decreased plasma cholesterol (total and LDL) after 52 weeks of treatment. A concomitant significant decrease of AER (25% from basal) with no significant changes in creatinine clearance was observed during the same period.
Our data are in keeping with the hypothesis that simvastatin might be used as an additional means to preserve renal function in microalbuminuric hypercholesterolemic type 2 diabetic patients.
Research literature suggests that burnout, depression, and a low mental quality of life (QOL) are common among health care workers. Economic crisis might have increased the burden of burnout, ...depression and low QOL in health care workers.
To identify depression risk, burnout levels, and quality of life in a sample of workers of an Italian university hospital.
Cross sectional study with comparison with two community surveys database results (n = 2000 and 1500, respectively). Overall, 522 workers accepted to take part in the study, representing a 78% response rate (out of 669 individuals).
The frequency of positivity at the screener for Major Depressive Disorder among health care workers was more than double than that in the standardized community sample (33.3% vs 14.1%, p<0.0001). All professionals, except the administrative staff and technicians (
those who do not have contact with patients), showed a statistically higher frequency of positivity for depressive episodes compared to the controls. Among the medical staff, the highest risk was found in the surgeon units, while the lowest one was in the laboratories. Surgeons also were those most exposed to high risk of burnout, as measured by the Maslach Burnout Inventory.
Since burnout is linked to patient safety and quality of patient care, and contribute to medical errors, dedicated interventions aimed at reducing poor mental health and low quality of life in medical staff are indicated.
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