The positive association between overweight, obesity, and cardiovascular and all-cause mortality is well established, even though this relation is typically U shaped with an increased risk also in ...low-weight subjects. However, being overweight or obese has been associated with a better prognosis in subjects suffering from chronic diseases, id est the “obesity paradox”. In both community-dwelling and hospitalized patients with COPD, several studies have reported a significant protective effect of obesity on all-cause mortality, indicating that also in obstructive pulmonary diseases, an obesity paradox may be present. Interestingly, the “paradox” is more evident for subjects with severe bronchial obstruction (i.e., a lower FEV1), while in mild–moderate conditions, the weight-related mortality shows a behavior similar to that observed in the general population. Several factors may confound the relation between COPD, obesity and mortality. The lower FEV1 found in obese people may be linked to a restrictive defect rather than to an obstructive one. Due to the modified chest wall mechanical properties—related to increased fat mass—obese COPD patients may present, respect to their lean counterpart, a lower lung hyperinflation which is associated with higher mortality. The traditional classification of COPD attributes to obese “blue bloaters” a low-grade emphysema in opposition to lean “pink puffers”; the fact that emphysema extent is related to mortality may bias the relationship between weight and survival. It is also to underline that the majority of the studies, consider BMI rather than body composition (a better predictor of mortality) when studying the intriguing relation between weight, COPD, and mortality. Reverse bias has also to be taken into account, hypothesizing that an unintentional weight loss may be the deleterious factor related to mortality, rather than considering obesity a protective one. Further prospective studies are needed to shed light on the complexity of this emerging issue.
Level of evidence
Level V: Narrative Review.
The SARS-CoV-2 pandemic had a sudden, dramatic impact on healthcare. In Italy, since the beginning of the pandemic, colorectal cancer (CRC) screening programs have been forcefully suspended. We aimed ...to evaluate whether screening procedure delays can affect the outcomes of CRC screening.
We built a procedural model considering delays in the time to colonoscopy and estimating the effect on mortality due to up-stage migration of patients. The number of expected CRC cases was computed by using the data of the Italian screened population. Estimates of the effects of delay to colonoscopy on CRC stage, and of stage on mortality were assessed by a meta-analytic approach.
With a delay of 0-3 months, 74% of CRC is expected to be stage I-II, while with a delay of 4-6 months there would be a 2%-increase for stage I-II and a concomitant decrease for stage III-IV (P = .068). Compared to baseline (0-3 months), moderate (7-12 months) and long (> 12 months) delays would lead to a significant increase in advanced CRC (from 26% to 29% and 33%, respectively; P = .008 and P < .001, respectively). We estimated a significant increase in the total number of deaths (+12.0%) when moving from a 0-3-months to a >12-month delay (P = .005), and a significant change in mortality distribution by stage when comparing the baseline with the >12-months (P < .001).
Screening delays beyond 4-6 months would significantly increase advanced CRC cases, and also mortality if lasting beyond 12 months. Our data highlight the need to reorganize efforts against high-impact diseases such as CRC, considering possible future waves of SARS-CoV-2 or other pandemics.
Production of food nanoemulsions by high pressure homogenization (HPH) is investigated, focusing on the effect on droplet nanonization of emulsifier type and concentration, as well as of the geometry ...of the homogenization chamber. Several food-grade emulsifiers were characterized, in comparison with artificial ones, in terms of their interfacial and dynamic properties, by pendant drop measurements. The kinetics of the emulsification process was determined by dynamic light scattering measurements on the emulsions produced at different pressure levels (70–280 MPa) and number of HPH passes, in four different homogenization chamber geometries. The results show that the kinetic parameters of the emulsification process can be primarily correlated with the interfacial and dynamic properties of the emulsifiers, while the fluid-dynamics regime establishing in the homogenization chamber contributes only to a lesser extent. Nevertheless, the correct design of the homogenization chamber may help in obtaining uniform fluid-dynamic conditions, which ensure a narrow droplet size distribution.
Early risk stratification for complications and death related to Coronavirus disease 2019 (COVID-19) infection is needed. Because many patients with COVID-19 who developed acute respiratory distress ...syndrome have diffuse alveolar inflammatory damage associated with microvessel thrombosis, we aimed to investigate a common clinical tool, the CHA(2)DS(2)-VASc, to aid in the prognostication of outcomes for COVID-19 patients. We analyzed consecutive patients from the multicenter observational CORACLE registry, which contains data of patients hospitalized for COVID-19 infection in 4 regions of Italy, according to data-driven tertiles of CHA(2)DS(2)-VASc score. The primary outcomes were inpatient death and a composite of inpatient death or invasive ventilation. Of 1045 patients in the registry, 864 (82.7%) had data available to calculate CHA(2)DS(2)-VASc score and were included in the analysis. Of these, 167 (19.3%) died, 123 (14.2%) received invasive ventilation, and 249 (28.8%) had the composite outcome. Stratification by CHA(2)DS(2)-VASc tertiles (T1: ≤1; T2: 2 to 3; T3: ≥4) revealed increases in both death (8.1%, 24.3%, 33.3%, respectively; p <0.001) and the composite end point (18.6%, 31.9%, 43.5%, respectively; p <0.001). The odds ratios for mortality and the composite end point for T2 patients versus T1 CHA(2)DS(2)-VASc score were 3.62 (95% CI:2.29 to 5.73,p <0.001) and 2.04 (95% CI:1.42 to 2.93, p <0.001), respectively. Similarly, the odds ratios for mortality and the composite end point for T3 patients versus T1 were 5.65 (95% CI:3.54 to 9.01, p <0.001) and 3.36 (95% CI:2.30 to 4.90,p <0.001), respectively. In conclusion, among Italian patients hospitalized for COVID-19 infection, the CHA(2)DS(2)-VASc risk score for thromboembolic events enhanced the ability to achieve risk stratification for complications and death.
Pulsed Electric Fields (PEF) and High Pressure Homogenization (HPH) are promising and scalable cell disruption technologies of microalgae cells. In this work, the permeabilization degree, ...morphological properties, and extractability of intracellular compounds from microalgae Chlorella vulgaris suspensions (1.2%, w/w) were investigated as a function of PEF treatment at different electric field strengths (10–30 kV/cm) and total specific energy input (20–100 kJ/kg), in comparison with the more disruptive HPH treatment (150 MPa) at different number of passes (nP = 1–10). The conductivity and the particle size analyses, as well as the SEM images, clearly showed that PEF induces the permeabilization of the cell membranes in an intensity-dependent manner, without producing any cell debris, whereas HPH treatment causes the total disruption of the algae cells into small fragments. Coherently with the lower permeabilization capability, PEF promoted the selective extraction of carbohydrates (36%, w/w, of total carbohydrates), and low molecular weight proteins (5.2%, w/w, of total proteins). On the other hand, HPH induced the undifferentiated release of all the intracellular content, resulting in a 1.1 and 10.3 fold higher yields than PEF, respectively of carbohydrates and protein.
These results suggest that, in a multi-stage biorefinery, PEF could represent a suitable cell disruption method for the selective recovery of small-sized cytoplasmic compounds, while HPH should be placed at the end the cascade of operations allowing the recovery of high molecular weight intracellular components.
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•PEF and HPH were compared in the disruption of Chlorella vulgaris.•PEF enabled the electroporation of microalgae without forming any cell debris.•HPH treatments caused the total disruption of algae cells into small fragments.•PEF promoted the selective release of small water-soluble compounds.•HPH caused the instantaneous and complete release of all the intracellular material.
The dynamical environment in the close-proximity of small celestial bodies is characterized by a very weak and irregular gravity field. In this low-acceleration deep-space environment, small ...dynamical perturbations might affect significantly the dynamics of a spacecraft hovering near the surface of such objects. This poses a challenge to the efficient design of trajectories of space probes for space missions aimed at the exploration of small Solar System bodies. This applies especially to CubeSats, small spacecraft with limited autonomy and maneuvering capabilities. In this case, a careful and efficient design of the operational trajectory is mandatory to accomplish the objective of the mission. As a representative and timely case study, we investigate the dynamics around binary asteroid (65803) Didymos, the target of NASA’s Double Asteroid Redirection Test (DART) and ESA’s Hera missions. We analyze all the relevant dynamical contributions concurring to the acceleration environment near Didymos and provide a subdivision of it into subregions, each identified by a different dynamical regime. With reference to the Hera Milani CubeSat mission scenario, we describe the methodology and design approach to find trajectories in the dayside of Didymos system. Finally, we provide examples of suitable trajectory options to host the operational phase of the Hera Milani CubeSat.
Resveratrol was encapsulated in oil-in-water food-grade nanoemulsions of subcellular size, produced by high-pressure homogenization. Physicochemical stability was evaluated under accelerated aging ...(high temperature and UV light exposure), as well as during simulated gastrointestinal digestion. Antioxidant activity was assessed at different stages of digestion by chemical assays and by an improved cellular assay, to measure exclusively the residual activity of resveratrol that penetrated inside Caco-2 cells. Results showed that the nanoemulsions based on soy lecithin/sugar esters and Tween 20/glycerol monooleate were the most physically and chemically stable, in terms of mean droplet size (always <180 nm) and resveratrol loading, during both accelerated aging and gastrointestinal digestion. These formulations also exhibited the highest chemical and cellular antioxidant activities, which was comparable to unencapsulated resveratrol dissolved in DMSO, suggesting that nanoencapsulated resveratrol, not being metabolized in the gastrointestinal tract, can be potentially absorbed through the intestinal wall in active form.
The goal of this article is to investigate ultra wideband localization with time difference of arrival processing at the anchors. We consider scenarios where the anchors are placed very close to each ...other and the target to be localized is around the group of anchors. All target-anchor communications are assumed to be in line-of-sight. Since our analysis shows that symmetries in anchors' placement, with respect to the target position, degrade the positioning accuracy of standard algorithms, we propose to use a subset selection strategy, where position estimates obtained with properly selected subsets of asymmetric anchors are fused together to get the final localization output. Our results show improved localization accuracy with respect to the use of all anchors, especially in estimating the angle of arrival. Finally, we analyze the impact of an inaccurate time synchronization among the anchors, deriving guidelines for hardware implementation.
The present study was undertaken to determine the physicochemical, biochemical, and antioxidant activities of Tunisian honey samples. All the extracted honey samples appeared to conform to the ...European Legislation (EC Directive 2001/110) for all parameters. Mint honey, for instance, possesses significant pH value (p < 0.05), invertase activity, water, and protein contents. In addition, this study demonstrates that the color of the Tunisian honeys is highly variable and ranges from pale yellow to dark brown. The total phenolic, flavonoid and carotenoid contents significantly vary (p < 0.05). The highest values were found in mint honey, which has a very dark color. Correlations between the analyzed parameters are statistically significant (p < 0.05). The DPPH radical scavenging activity of rosemary honey was determined as lower (p < 0.05) than the other analyzed honey samples. Yet, the highest activity was detected in mint honey. The results suggest that Tunisian honeys could be beneficially used as a functional or nutraceutical substance as they prevent or moderate oxidative stress-related diseases.
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