Molecular and Serological Detection of Bovine Coronaviruses in Marmots (Marmota marmota) in the Alpine Region

In this study, virological surveillance focused on coronaviruses in marmots in the Alpine region in 2022, captured as part of a population control reduction program in the Livigno area. Seventy-six faecal samples were randomly collected from marmots at the time of capture and release and tested for genome detection of pan-coronavirus, pan-pestivirus, canine distemper virus, and influenza A and D virus. Nine faecal samples were positive in the Pan-CoV RT-PCR, while all were negative for the other viruses. Pan-coronavirus positives were further identified using Illumina's complete genome sequencing, which showed the highest homology with Bovine Coronavirus previously detected in roe deer in the Alps. Blood samples (n.35) were collected randomly from animals at release and tested for bovine coronavirus (BCoV) antibodies using competitive ELISA and VNT. Serological analyses revealed that 8/35 sera were positive for BCoV antibodies in both serological tests. This study provides molecular and serological evidence of the presence of BCoV in an alpine marmot population due to a likely spillover event. Marmots share areas and pastures with roe deer and other wild ruminants, and environmental transmission is a concrete possibility.

Eagle and Ernest syndromes: a scoping review

INTRODUCTION

Ossification disorders can affect the stylohyoid ligament as well the stylomandibular ligament. The symptomathology between those syndromes and other pathologies it has been a problem because there is not a guideline.

EVIDENCE ACQUISITION

With the aim to establish prevalence, diagnosis and etiopathogenesis of Eagle and Ernest syndromes, a scoping review was performed base on PRISMA criteria.

EVIDENCE SYNTHESIS

To review stylohyoid ligament and Eagle Syndrome 93 articles were selected. Three articles regarding the stylomandibular ligament and Ernest Syndrome were founded and selected.

CONCLUSIONS

Both syndromes should be clinically diagnosed and corroborate with imaging (2D or 3D), although imaging in Ernest Syndrome is not clear as well in Eagle Syndrome. A decisional algorithm for diagnosis of Eagle Syndrome and Ernest Syndrome is presented.

First evidence of widespread positivity to anticoagulant rodenticides in grey wolves (Canis lupus)

Second-generation Anticoagulant Rodenticides (ARs) can be critical for carnivores, due to their widespread use and impacts. However, although many studies explored the impacts of ARs on small and mesocarnivores, none assessed the extent to which they could contaminate large carnivores in anthropized landscapes. We filled this gap by exploring spatiotemporal trends in grey wolf (Canis lupus) exposure to ARs in central and northern Italy, by subjecting a large sample of dead wolves (n = 186) to the LC-MS/MS method. Most wolves (n = 115/186, 61.8 %) tested positive for ARs (1 compound, n = 36; 2 compounds, n = 47; 3 compounds, n = 16; 4 or more compounds, n = 16). Bromadiolone, brodifacoum and difenacoum, were the most common compounds, with brodifacoum and bromadiolone being the ARs that co-occurred the most (n = 61). Both the probability of testing positive for multiple ARs and the concentration of brodifacoum, and bromadiolone in the liver, systematically increased in wolves that were found at more anthropized sites. Moreover, wolves became more likely to test positive for ARs through time, particularly after 2020. Our results underline that rodent control, based on ARs, increases the risks of unintentional poisoning of non-target wildlife. However, this risk does not only involve small and mesocarnivores, but also large carnivores at the top of the food chain, such as wolves. Therefore, rodent control is adding one further conservation threat to endangered large carnivores in anthropized landscapes of Europe, whose severity could increase over time and be far higher than previously thought. Large-scale monitoring schemes for ARs in European large carnivores should be devised as soon as possible.

The Ultrasound Evolution of Lateral Thoracic Perforator Flaps Design and Harvest for Partial and Total Breast Reconstruction

BACKGROUND

The lateral thoracic area is a known source for perforator flaps for partial breast reconstruction. In this paper, we report our experience in designing and harvesting lateral thoracic perforator flaps for partial and total breast reconstruction with the introduction of the "propuller" concept.

PATIENTS AND METHODS

Between September 2013 and August 2021, 95 flaps were performed for immediate, partial and total breast reconstruction. On a total of 95 flaps, 30 (19 thoracodorsal artery perforator(TDAP) flaps, 10 lateral intercostal artery perforator(LICAP) flaps and 1 lateral thoracic artery perforator(LTAP) flap) were harvested in the traditional fashion (control group) and 65 (57 LICAP, 2 LTAP and 6 TDAP flaps) according to the propeller concept (study group). All cases were preoperatively planned with Color-Coded Duplex Ultrasound.

RESULTS

No flap losses were experienced in both groups. The mean operative time was 156 minutes (range 118-234) for the control group and 75 minutes (range 53-125) for the study group (p < 0.0001). A significantly higher number of LICAP flaps were chosen in the study group compared to control group. None of the patients had donor site complications. Patients' and Surgeons' satisfaction was high to very high.

CONCLUSION

The ultrasound preoperative planning led to the development of an easier and safer method of local perforator flap harvesting, that we named as propuller design. Its novelty lies in that perforator intraoperative selection and fully skeletonization are not needed and a more efficient flap movement (propeller plus advancement) which transfers more tissue into the new breast can be achieved safely, faster and easier.

Citrus limon Essential Oil: Chemical Composition and Selected Biological Properties Focusing on the Antimicrobial (In Vitro, In Situ), Antibiofilm, Insecticidal Activity and Preservative Effect against Salmonella enterica Inoculated in Carrot

New goals for industry and science have led to increased awareness of food safety and healthier living in the modern era. Here, one of the challenges in food quality assurance is the presence of pathogenic microorganisms. As planktonic cells can form biofilms and go into a sessile state, microorganisms are now more resistant to broad-spectrum antibiotics. Due to their proven antibacterial properties, essential oils represent a potential option to prevent food spoilage in the search for effective natural preservatives. In this study, the chemical profile of Citrus limon essential oil (CLEO) was evaluated. GC-MS analysis revealed that limonene (60.7%), β-pinene (12.6%), and γ-terpinene (10.3%) are common constituents of CLEO, which prompted further research on antibacterial and antibiofilm properties. Minimum inhibitory concentration (MIC) values showed that CLEO generally exhibits acceptable antibacterial properties. In addition, in situ antimicrobial research revealed that vapour-phase CLEO can arrest the growth of Candida and Y. enterocolitica species on specific food models, indicating the potential of CLEO as a preservative. The antibiofilm properties of CLEO were evaluated by MIC assays, crystal violet assays, and MALDI-TOF MS analysis against S. enterica biofilm. The results of the MIC and crystal violet assays showed that CLEO has strong antibiofilm activity. In addition, the data obtained by MALDI-TOF MS investigation showed that CLEO altered the protein profiles of the bacteria studied on glass and stainless-steel surfaces. Our study also found a positive antimicrobial effect of CLEO against S. enterica. The anti-Salmonella activity of CLEO in vacuum-packed sous vide carrot samples was slightly stronger than in controls. These results highlight the advantages of the antibacterial and antibiofilm properties of CLEO, suggesting potential applications in food preservation.

Tick-Borne Encephalitis, Lombardy, Italy

Tick-borne encephalitis was limited to northeast portions of Italy. We report in Lombardy, a populous region in the northwest, a chamois displaying clinical signs of tickborne encephalitis virus that had multiple virus-positive ticks attached, as well as a symptomatic man. Further, we show serologic evidence of viral circulation in the area.

Sensitivity of a mini-TEPC to radiation quality variations in clinical proton beams

PURPOSE

This work aims at studying the sensitivity of a miniaturized Tissue-Equivalent Proportional Counter to variations of beam quality in clinical radiation fields, to further investigate its performances as radiation quality monitor.

METHODS

Measurements were taken at the CATANA facility (INFN-LNS, Catania, Italy), in a monoenergetic and an energy-modulated proton beam with the same initial energy of 62 MeV. PMMA layers were placed in front of the detector to measure at different depths along the depth-dose profile. The frequency- and dose-mean lineal energy were compared to the track- and dose-averaged LET calculated by Monte Carlo simulations. A microdosimetric evaluation of the Relative Biological Effectiveness (RBE) was performed and compared with cell survival experiments.

RESULTS

Microdosimetric distributions measured at identical depths in the two beams show spectral differences reflecting their different radiation quality. Discrepancies are most evident at depths corresponding to the Spread-Out Bragg Peak, while spectra at the entrance and in the dose fall-off regions are similar. This can be explained by the different energy components that compose the pristine and spread-out peaks at each depth. The trend of microdosimetric mean values matches that of calculated LET averages along the entire penetration depth, and the microdosimetric estimation of RBE is consistent with radiobiological data not only at 2 Gy but also at lower dose levels, such as those absorbed by healthy tissues.

CONCLUSIONS

The mini-TEPC is sensitive to differences in radiation quality resulting from different modulations of the proton beam, confirming its potential for beam quality monitoring in proton therapy.

Postharvest wine grape dehydration: ethanol dissipation from grape and biochemical changes

BACKGROUND

During postharvest dehydration, grapes are subject to metabolic changes including ethanol anabolism and catabolism. These changes affect the quality of the final product and ethanol production is a key step. Ethanol dissipation has never been measured during postharvest wine grape dehydration. Thus, the present study aimed to: (i) monitor ethanol dissipation and (ii) investigate chemical-biochemical changes in berries during dehydration.

RESULTS

Ethanol dissipation from Raboso grapes, under controlled postharvest dehydration, was found to comprise up to 36% of weight loss (w.l.). Moreover, the activity of enzymes involved in the anaerobic metabolism of grapes was investigated. Ethanol dissipation was highly correlated with grape weight loss (r2  = 0.989). Alcohol dehydrogenase activity, responsible for the reduction of ethanol to acetaldehyde, declined significantly with w.l. Similarly, pyruvate decarboxylase and lactate dehydrogenase reduced their activity. High lipoxygenase activity was measured at 27% w.l., whereas polyphenol oxidation was constant and declined in the last sampling.

CONCLUSION

Ethanol dissipation during postharvest dehydration allows for reducing anaerobic metabolism and promotes oxidative metabolism. The sensor used can be a useful commercial tool for monitoring berry metabolism. © 2023 Society of Chemical Industry.

Active surveillance of paratuberculosis in Alpine-dwelling red deer (Cervus elaphus)

Paratuberculosis (Johne's disease) is a globally widespread infectious disease affecting domestic and wild ruminants, caused by Mycobacterium avium subsp. paratuberculosis (MAP). The bacterium is excreted in the feces and is characterized by high environmental resistance. The new Animal Health Law (Regulation EU 2016/429) on transmissible animal diseases, recently in force throughout the European Union, includes paratuberculosis within the diseases requiring surveillance in the EU, listing some domestic and wild Bovidae, Cervidae, and Camelidae as potential reservoirs. Taking advantage of a culling activity conducted in the Stelvio National Park (Italy), this study investigated MAP infection status of red deer (Cervus elaphus) between 2018 and 2022, and evaluated the probability of being MAP-positive with respect to individual and sampling-level variables. A total of 390 subjects were examined macroscopically and tested for MAP, using different diagnostic tools: IS900 qPCR, culture, histopathology, and serology. Twenty-three of them were found positive for MAP by at least one test, with an overall prevalence of 5.9% (95% CI 4.0-8.7), that, respectively, ranged from 12.4% in the first culling season to 2.0 and 2.1% in the 2019-2020 and 2021-2022 culling seasons. Quantitative PCR assay on ileocecal valve and mesenteric lymph nodes detected the highest number of MAP positive animals. The results of the study showed the increased probability of being MAP-positive with increasing age and that red deer with lower body mass values were more likely to be infected with MAP. Overall, the absence of signs of clinical paratuberculosis and gross lesions together with the low level of shedding witness early phases of the disease among the positive red deer and support an improvement of the paratuberculosis status of this population, as shown by the decreased prevalence of the disease over the years.

Assessment of Fruity Aroma Intensity in Olive Oils from Different Spanish Regions Using a Portable Electronic Nose

BACKGROUND

The organoleptic profile of an olive oil is a fundamental quality parameter obtained by human sensory panels. In this work, a portable electronic nose was employed to predict the fruity aroma intensity of 199 olive oil samples from different Spanish regions and cultivar varieties (Picual, Arbequina and Cornicabra), with special emphasis in testing the robustness of the predictions versus cultivar variety variability. The primary data given by the electronic-nose was used to obtain two different feature vectors that were employed to fit ridge and lasso regressions models to two datasets: one consisting of all the samples and another just the cv. Picual samples.

RESULTS

The results obtained showed Mean Average Error (MAE) values below 0.88 in all the cases, with a MAE of 0.67 for the Picual model. These MAE values and the similarities in the model parameters fitted for the different data folds are in agreement with the results obtained in previous works.

CONCLUSION

The large number of samples analyzed and the results obtained show the robustness of the approach and the applicability of the methods. Also, the results suggest that better performance can be obtained when specific models are fitted for particular cultivar varieties. Overall, the proposed methods are capable of providing useful information for a fast screening of the fruity aroma intensity of olive oils. This article is protected by copyright. All rights reserved.

Air speed and plastic crate vent-holes for wine grape quality during postharvest dehydration: commercial and laboratory studies

BACKGROUND

Airflow is an important issue to favor postharvest dehydration keeping wine grape quality. The aim of this experimental work was to analyze the grape quality during postharvest dehydration: (i) in a commercial facility ('fruttaia') by monitoring the efficiency of the ventilation system and (ii) at laboratory level, studying the influence of crate type and airflow direction.

RESULTS

In the fruttaia, the airflow was provided by an air duct hanging from the ceiling, and by floor fans. A great gap in air speed from 0 up to 3.7 m s-1 was measured in different sectors of the fruttaia, leading to a different weight loss and grape quality in crates, depending on crate stack height and sector. At the laboratory level, two tunnels, with exhaust or supply fans, were used and four crate types with different percentages of vent-holes were adopted. A decrease of about 5% delayed the weight loss rate depending on the type of crate, and the exhaust fan guaranteed a faster dehydration.

CONCLUSION

The results clarified the inefficiency of the commercial ventilation system in ensuring homogeneous grape weight loss in all crates. In addition, the exhaust fan guaranteed a more uniform air distribution around crates, and a slightly higher air speed. © 2023 Society of Chemical Industry.

The effect of drug-induced sleep endoscopy on surgical outcomes for obstructive sleep apnea: a systematic review

PURPOSE

Drug-induced sleep endoscopy (DISE) is the most widespread diagnostic tool for upper-airway endoscopic evaluation of snoring and obstructive sleep apnea (OSA). However, a consensus on the effectiveness of DISE on surgical outcomes is still lacking. This study aimed to quantify the effect of DISE on surgical outcomes and to compare DISE with awake examination using the Müller Maneuver (MM).

METHODS

This systematic review was performed according to the PRISMA guidelines. Published studies from the last 30 years were retrieved from the Cochrane Library, MEDLINE, SCOPUS, and PubMed databases. Studies comparing DISE with awake examination, or MM were included. Surgical success rate was defined according to Sher's criteria, achieving a postoperative apnoea-hypopnea index (AHI) value < 20 events per hour and a 50% improvement from preoperative AHI. Outcomes are presented in terms of surgical success, pre- and postoperative AHI, Epworth sleepiness score (ESS), oxygen desaturation index (ODI) and lowest oxygen saturation (LOS).

RESULTS

This review included 8 studies comprising 880 patients. DISE group showed a higher LOS increase, ODI decrease, ESS decrease than non-DISE group (6.83 ± 3.7 versus 3.68 ± 2.9, p<0.001; 19.6 ± 11.2 versus 12.6 ± 10.4, p<0.001; 6.72 ± 4.1 versus 3.69 ± 3.1, p<0.001). Differences in surgical success rate were significant only between DISE and MM (64.04% versus 52.48%, p = 0.016). AHI decrease resulted higher in non-DISE than in DISE group (39.92 ± 24.7 versus 30.53 ± 21.7, p<0.001).

CONCLUSION

Results of this systematic review suggest that the evidence is mixed regarding a positive effect of DISE on surgical outcomes.

Microdosimetric analysis of the radiation quality of two different proton beams in the distal edge of the depth-dose profile

Proton-therapy exploits the advantageous depth-dose profile of protons to induce the highest damage to tumoral cells in the last millimetres of their range in sharp Bragg Peak. To cover the whole tumoral volume, beams of different energies are combined to create the Spread Out Bragg Peak (SOBP). In passive modulated beams, the energy spread is created with modulators in which the highest energy beam is degraded through different thicknesses of calibrated plastic materials. The highest energy is chosen depending on the deepest point that needs to be treated. This study aims to investigate differences in the radiation quality in the distal edge of SOBP beams with different initial energy and modulation techniques based on microdosimetric measurements with mini Tissue-Equivalent Proportional Counters. The beams investigated are the 62 MeV proton SOBP of the clinical facility of CATANA and the 148 MeV proton SOBP of the research beam line of the proton-therapy centre of Trento.

Microdosimetry of a 62-MeV clinical proton beam with five detectors

In proton therapy, most treatment planning systems (TPS) use a fixed relative biological effectiveness (RBE) of 1.1 all along the depth-dose profile. Innovative TPS are now investigated considering the variability of RBE with radiation quality. New TPS need an experimental verification in the quality assurance (QA) routine in clinics, but RBE data are usually obtained with radiobiological measurements that are time consuming and not suitable for daily QA. Microdosimetry is a useful tool based on physical measurements which can monitor the radiation quality. Several microdosimeters are available in different research institutions, which could potentially be used for the QA in TPS. In this study, the response functions of five detectors in the same 62-MeV proton Spread Out Bragg Peak is compared in terms of spectral distributions and their average values and microdosimetric RBE. Their different response function has been commented and must be considered in the clinical practice.

Novelty of Italian Grape Ale (IGA) beer: Influence of the addition of Gamay macerated grape must or dehydrated Aleatico grape pomace on the aromatic profile

A new category of fruit style beer resulting from the addition of grape matrices is named Italian Grape Ale (IGA). In this paper, we report data on an experimental work to produce IGA beers, adding macerated (CO2 or N2) red Gamay grape must or Aleatico grape pomace resulting from a grape dehydration process. Our hypothesis, that these wine processes can produce volatile organic compounds (VOCs) to characterize these IGA beers which was confirmed by chemical, sensory and aromatic results. IGA beers especially the one with gas-macerated grape musts (IGA-C and IGA-N) showed higher alcohol content than ALE beer (Control) and a higher polyphenol content and antioxidant activity. As regards VOCS, IGA beers increased the concentration of some classes (i.e., alcohols, esters, norisoprenoids) and IGA-N was better characterized by specific compounds such as isobutyric acid, phenylacetate, tyrosol, ethyl hydrogen succinate. Finally, E-nose and sensory evaluation discriminated significantly all the IGA beers.

Frequency-Dependent Squeezed Vacuum Source for the Advanced Virgo Gravitational-Wave Detector

In this Letter, we present the design and performance of the frequency-dependent squeezed vacuum source that will be used for the broadband quantum noise reduction of the Advanced Virgo Plus gravitational-wave detector in the upcoming observation run. The frequency-dependent squeezed field is generated by a phase rotation of a frequency-independent squeezed state through a 285 m long, high-finesse, near-detuned optical resonator. With about 8.5 dB of generated squeezing, up to 5.6 dB of quantum noise suppression has been measured at high frequency while close to the filter cavity resonance frequency, the intracavity losses limit this value to about 2 dB. Frequency-dependent squeezing is produced with a rotation frequency stability of about 6 Hz rms, which is maintained over the long term. The achieved results fulfill the frequency dependent squeezed vacuum source requirements for Advanced Virgo Plus. With the current squeezing source, considering also the estimated squeezing degradation induced by the interferometer, we expect a reduction of the quantum shot noise and radiation pressure noise of up to 4.5 dB and 2 dB, respectively.

Effect of Different Packaging Strategies on the Secondary Shelf Life of Young and Structured Red Wine

When bottled wine is opened, a completely different scenario occurs that can accelerate the oxidation of the product. This is called the secondary shelf life (SSL), which is generally shorter and less predictable than the primary shelf life (PSL). In this context, the research aim was to evaluate the changes that occur in two types of red wine during two tests to evaluate the secondary shelf life as a function of the packaging systems. The variation of Total SO₂ and Free SO₂ and the other chemical parameters (polyphenols, anthocyanins, proanthocyanidins, color, and volatile acidity) were used to assess the oxidation rate of the packaging samples after opening during the SSL. In both tests and for the two types of stored red wine, the polymeric cap showed the best results. The other types of closure (screw cap, natural cork, crow cap, and Tetra Brik) showed a negative trend and a reduced SSL for both red wines. Finally, the sensory results confirmed that with the polymeric cap, the SSL increases considerably compared to other capping systems. These results may be due to the technical characteristics of polymeric materials, which tend to vary slightly in shape after repeated usage.

Effect of Fertilization Regime of Common Wheat (Triticum aestivum) on Flour Quality and Shelf-Life of PDO Tuscan Bread

The shelf-life of bread is influenced by flour components, such as starch, composed of amylose and amylopectin. The aim was to test the effect of different balances of N (45, 90, 135 kg/ha) and P (48, 96 kg/ha) fertilizers on the flour characteristics and consequently the shelf-life of PDO Tuscan bread, stored in different modified atmosphere packaging (Ar, N₂, Air). The amylose and phytochemical compounds were increased by N and decreased by the addition of P, but excessive doses of N (135 kg/ha) had a negative effect on flour quality. In the bread, the study highlighted the tendency of N₂ and Ar, as storage filler gases, to reduce water loss, slow down the staling process, and prolong shelf-life. However, the most significant influence on shelf-life was related to the different fertilizations of wheat. In fact, when N was present in equal dose to P (90/96 or 45/48 kg/ha) or slightly higher (90/48 kg/ha), the bread tended to last longer over time. Instead, when these ratios were unbalanced in favor of N (135/48 or 135/96 kg/ha) and in favor of P (45/96 kg/ha), the shelf-life decreased considerably.

Simplified Tool for Sizing in Minimally Invasive Mitral Annuloplasty: A Homemade Technique

Currently, minimally invasive cardiac surgery (MICS) has been developing and has been largely approved for mitral valve surgery. The more development of MICS, the more the entire surgical setup needs to be appropriate. We developed a homemade tool for mitral annular sizing that is simple and fits the mini surgical access. It is a plastic-based foldable paper that can be easily inserted through the minithoracotomy, using a surgical forceps.

Hybrid mandibular Bologna midline distractor in combination with surgically assisted rapid maxillary expansion for transverse facial expansion: clinical and cephalometric results

Transverse maxillomandibular hypoplasia can be treated with surgically assisted rapid maxillary expansion (SARME) in association with mandibular symphyseal distraction (MSD). This paper introduces a hybrid mandibular Bologna midline distractor (BMD); the effectiveness of the distractor in combination with SARME for the treatment of transverse skeletal deficiency was evaluated. This two-centre study included 10 patients with a transverse arch width deficit>7 mm and dental crowding, in both the maxilla and mandible, treated with SARME and MSD. The study design was partly retrospective (seven patients) and partly prospective (three patients). Frontal and lateral cephalometric analyses, as well as measurements on dental models, were performed at three different times: before treatment, after the distraction, and 6 months after postoperative orthodontic treatment. The cephalometric analyses and measurements on dental impressions confirmed a balanced and stable skeletal and dental mandibular expansion. An average symphyseal expansion of 7.8 mm was obtained, resolving dental crowding without dental extractions. In conclusion, mandibular expansion performed with the BMD in combination with SARME appears to be a viable surgical approach to transverse maxillomandibular hypoplasia. This technique allows the surgeon to obtain a balanced skeletal and dental expansion, with a low level of relapse.

Popillia japonica - Italian outbreak management

Popillia japonica, a priority pest for the EU, was first detected in Northern Italy in 2014. Since its discovery, the outbreak extended over an area of more than 16,000 square kilometers in Northern Italy and Southern Switzerland. In this review, we summarize the state-of-the-art of research conducted in Italy on both the spreading capacity and control measures of P. japonica. Chemical, physical, and biological control measures deployed since its detection are presented, by highlighting their strengths and weaknesses. An in-depth study of the ecosystems invaded by P. japonica disclosed the presence and pathogenicity of natural strains of entomopathogenic fungi and nematodes, some of which have shown to be particularly aggressive towards the larvae of this pest under laboratory conditions. The Plant Health authorities of the Lombardy and Piedmont regions, with the support of several research institutions, played a crucial role in the initial eradication attempt and subsequently in containing the spread of P. japonica. Control measures were performed in the infested area to suppress adult populations of P. japonica by installing several traps (e.g., for mass trapping, for auto-dissemination of the fungus Metarhizium anisopliae, and "attract & kill"). For larval control, the infested fields were treated with commercial strains of the entomopathogenic fungus M. anisopliae and nematode Heterorhabditis bacteriophora. Future studies will aim at integrating phenological and spread models developed with the most effective control measures, within an ecologically sustainable approach.

Stable cranial parameters to evaluate the occlusal plane orientation in the frontal plane: a systematic review

INTRODUCTION

A systematic review of the literature available up to October 2020 has been conducted to determine which cranial plane could represent a stable and reliable parameter to evaluate the orientation of the occlusal plane in a frontal view.

EVIDENCE ACQUISITION

An electronic research was performed across the following electronic databases: PUBMED, EBSCO, SCOPUS, WoS, COCHRANE LIBRARY, SciELO, EMBASE and GOOGLE SCHOLAR. Observational studies based on imaging and anthropometry were identified, and all languages have been included. The articles were selected and analyzed by three authors independently. PICO format was adopted to analyze the studies and AXIS guidelines were used to assess the quality of evidence.

EVIDENCE SYNTHESIS

We found eleven articles eligible for full-text analysis. All studies included only young subjects and analyzed the occlusal plane in relation to the frontal plane traced between the right and left tragus (Camper's and Frankfurt planes), to the interpupillary plane, and to other soft and hard tissues references. The outcomes of selected studies were various, with a low quality of evidence, and they did not allow to infer a stable cranial relation between the occlusal plane and other bone structures.

CONCLUSIONS

The evidence does not support that the interpupillary plane represent a reliable parameter to evaluate the occlusal plane orientation in a frontal view; instead, the Frankfurt plane could be a much more stable reference parameter, from a morphological perspective. It is necessary to perform an observational study upon craniums to define which are the most stable cranial reference planes to determine the orientation of the occlusal plane in dentate subjects.

Valorization of an Old Variety of Triticum aestivum: A Study of Its Suitability for Breadmaking Focusing on Sensory and Nutritional Quality

"Avanzi 3-Grano 23" (G23) is an old variety of Triticum aestivum from the mountain areas of Lunigiana (north Tuscany, Italy), where traditional farming communities have contributed to its success and on-farm conservation. G23 flour, traditionally used for typical food products, is characterized by particular nutritional and sensory traits but has technological properties which limit its suitability for breadmaking. The aim of this work was to evaluate how to promote the use of G23 through the optimization of bread formulation by leveraging both flour blending and the leavening system. During the preliminary test, three different mixes of G23 flour and a strong flour (C) were tested in terms of their leavening power as a function of leavening agent (baker's yeast or sourdough). The selected M2 flour, composed of G23:C (1:1 w/w), was used for further breadmaking trials and 100% C flour was utilized as a control. The sourdough bread obtained with the M2 flour (SB-M2) showed an improved sensory profile compared with the related control (SB-C). Furthermore, SB-M2 exhibited the best aromatic (high content in aldehydes, pyrazines and carboxylic acids) and phytochemical profile (total polyphenols and flavonoids content and antioxidant activity). In contrast, the use of baker's yeast, although optimal from the point of view of breadmaking, did not result in the same levels of aromatic complexity because it tends to standardize the product without valorizing the sensory and nutritional qualities of the flour. In conclusion, in the experimental conditions adopted, this old wheat variety appears to be suitable for the production of sourdough bakery products.

Prognostic evaluation of Acinetobacter baumannii ventilator-associated pneumonia in COVID-19

BACKGROUND

Since the emergence of the pandemic of SARS-CoV-2, a high reported incidence of VAP in COVID-19 sustained by carbapenem resistant Acinetobacter baumannii (CRAB) has been observed, but data are scarce to date.

MATERIALS AND METHODS

We retrospectively collected COVID-19 patients who developed CRAB-VAP - defined according to Center for Diseases Control (CDC) 2020 criteria and European Society of Clinical Microbiology and Infectious Diseases (ESCMID) or Infectious Diseases Society of America (IDSA) guidelines - to describe characteristics and outcome.

RESULTS

Among 21 patients with CRAB-VAP in COVID-19, median age was 66 years (IQR 41-80). Median time of VAP-onset was 7 days (IQR 0-28 days) from ICU - admission and 76.2% had septic shock. Treatment regimens were all colistin-based, in 28% (n=6) including ampicillin/sulbactam and rifampicin. In three cases, cefiderocol was started as rescue. Survival rate at 28-days was 35% (n=7).

CONCLUSION

Non-fermenting Gram-negative bacteria are an emerging aetiology of VAP in COVID-19 patients. This underscores the urgent need for proper microbiological identification to address therapies and infection control protocols.

Analysis of potential risk factors in the survival of patients with primary retroperitoneal liposarcoma

INTRODUCTION

The present work is an observational study of a series of variables regarding overall survival and disease-free survival in patients diagnosed with primary liposarcoma.

METHODS

The study is prospective with retrolective data collection that includes all patients with primary liposarcoma referred to Hospital Son Espases University Hospital, Palma de Mallorca, Spain from January 1990 to December 2019.

RESULTS

The study includes 50 patients and the compartment surgery was performed in 18 patients (36%) of cases. The mean overall survival of the sample was 15.57 years (95% CI: 12.02-19.12) and the mean disease-free survival was 6.70 years (95% CI: 4.50-8.86).

CONCLUSION

Compartment surgery has not shown benefits in terms of overall survival and disease-free survival. The ASA classification (≥3) predicts a poor prognosis in both overall survival and disease-free survival. Resection with free margins, described on the pathological results and defined in this work as R0, show better disease-free survival.

Effect of Argon as Filling Gas of the Storage Atmosphere on the Shelf-Life of Sourdough Bread-Case Study on PDO Tuscan Bread

The short shelf-life of PDO Tuscan bread limits its distribution to markets close to the production area, affecting its commercial success and the economic return by supply chain operators. While the application of MAP to store bread is widely accepted, the suitability of this technique to extend the shelf life of the PDO Tuscan bread is still to be explored. Furthermore, to the best of our knowledge no data are available in the literature about the use of argon as filling gas neither in pure atmosphere nor in combination with CO₂. In this context, the aim of this study was to evaluate the effect of different modified packaging atmospheres on the shelf-life of sourdough bread. Slices of bread were stored individually in plastic bags at 23 °C in five different atmospheres (Ar (100%), N₂ (100%), CO₂ (100%), Mix CO₂/N₂ (70% CO₂, 30% N₂), Mix CO₂/Ar (70% CO₂, 30% Ar)), and Air was selected as a control. To select the best storage conditions, both chemical-physical, rheological, and organoleptic features were evaluated. Results showed that pure gases (CO₂, N₂, Ar) displayed good qualities as storage atmospheres compared to Air. In contrast, both Mix CO₂/N₂ and Mix CO₂/Ar were the best in slowing down the staling process, thus doubling the shelf-life of bread, compared to other atmospheres. In conclusion, argon, as a preservation atmosphere, seems to be the best solution to extend the shelf-life of PDO Tuscan bread.

The current role of precision surgery in oligometastatic prostate cancer

Oligometastatic prostate cancer (omPCa) is a novel intermediate disease state characterized by a limited volume of metastatic cells and specific locations. Accurate staging is paramount to unmask oligometastatic disease, as provided by prostate-specific membrane antigen-positron emission tomography. Driven by the results of prospective trials employing conventional and/or modern staging modalities, the treatment landscape of omPCa has rapidly evolved over the last years. Several treatment-related questions comprising the concept of precision strikes are under development. For example, beyond systemic therapy, cohort studies have found that cytoreductive radical prostatectomy (CRP) can confer a survival benefit in select patients with omPCa. More importantly, CRP has been consistently shown to improve long-term local symptoms when the tumor progresses across disease states due to resistance to systemic therapies. Metastasis-directed treatments have also emerged as a promising treatment option due to the visibility of oligometastatic disease and new technologies as well as treatment strategies to target the novel PCa colonies. Whether metastases are present at primary cancer diagnosis or detected upon biochemical recurrence after treatment with curative intent, targeted yet decisive elimination of disseminated tumor cell hotspots is thought to improve survival outcomes. One such strategy is salvage lymph node dissection in oligorecurrent PCa which can alter the natural history of progressive PCa. In this review, we will highlight how refinements in modern staging modalities change the classification and treatment of (oligo-)metastatic PCa. Further, we will also discuss the current role and future directions of precision surgery in omPCa.

The influence of anastomotic techniques on postoperative anastomotic complications: Results of the Oesophago-Gastric Anastomosis Audit

BACKGROUND

The optimal anastomotic techniques in esophagectomy to minimize rates of anastomotic leakage and conduit necrosis are not known. The aim of this study was to assess whether the anastomotic technique was associated with anastomotic failure after esophagectomy in the international Oesophago-Gastric Anastomosis Audit cohort.

METHODS

This prospective observational multicenter cohort study included patients undergoing esophagectomy for esophageal cancer over 9 months during 2018. The primary exposure was the anastomotic technique, classified as handsewn, linear stapled, or circular stapled. The primary outcome was anastomotic failure, namely a composite of anastomotic leakage and conduit necrosis, as defined by the Esophageal Complications Consensus Group. Multivariable logistic regression modeling was used to identify the association between anastomotic techniques and anastomotic failure, after adjustment for confounders.

RESULTS

Of the 2238 esophagectomies, the anastomosis was handsewn in 27.1%, linear stapled in 21.0%, and circular stapled in 51.9%. Anastomotic techniques differed significantly by the anastomosis sites (P < .001), with the majority of neck anastomoses being handsewn (69.9%), whereas most chest anastomoses were stapled (66.3% circular stapled and 19.3% linear stapled). Rates of anastomotic failure differed significantly among the anastomotic techniques (P < .001), from 19.3% in handsewn anastomoses, to 14.0% in linear stapled anastomoses, and 12.1% in circular stapled anastomoses. This effect remained significant after adjustment for confounding factors on multivariable analysis, with an odds ratio of 0.63 (95% CI, 0.46-0.86; P = .004) for circular stapled versus handsewn anastomosis. However, subgroup analysis by anastomosis site suggested that this effect was predominantly present in neck anastomoses, with anastomotic failure rates of 23.2% versus 14.6% versus 5.9% for handsewn versus linear stapled anastomoses versus circular stapled neck anastomoses, compared with 13.7% versus 13.8% versus 12.2% for chest anastomoses.

CONCLUSIONS

Handsewn anastomoses appear to be independently associated with higher rates of anastomotic failure compared with stapled anastomoses. However, this effect seems to be largely confined to neck anastomoses, with minimal differences between techniques observed for chest anastomoses. Further research into standardization of anastomotic approach and techniques may further improve outcomes.

Are there country-specific differences in the use of pegvisomant for acromegaly in clinical practice? An analysis from ACROSTUDY

OBJECTIVE

A comprehensive picture of pegvisomant use for treating acromegaly in routine clinical practice in different countries is lacking. We aimed, therefore, to document country-specific behaviors in real-life pegvisomant use, and the main safety and effectiveness outcomes in the ACROSTUDY.

DESIGN

ACROSTUDY is an open-label, non-interventional, post-marketing safety surveillance study.

METHODS

A descriptive analysis was performed using data from the six top-recruiter ACROSTUDY countries, i.e., Germany (n = 548 patients), Italy (n = 466), France (n = 312), USA (n = 207), Spain (n = 200) and the Netherlands (n = 175). These nations accounted for > 85% of the ACROSTUDY cases.

RESULTS

The mean pegvisomant dose at treatment start was lowest in the Netherlands (9.4 mg/day), whereas it ranged between 10.9 and 12.6 mg/day in the other countries. At year 5, the mean pegvisomant dose was around 15 mg/day in all countries, except France (18.1 mg/day). At starting pegvisomant, patients treated with monotherapy ranged between 15% in the Netherlands and 72% in Spain. Monotherapy remained lowest over time in the Netherlands. In all countries, the percentage of patients with normal IGF-1 increased steeply from < 20% at baseline to 43-58% at month 6 and 51-67% at year 1. After that, we observed minor changes in the rate of acromegaly control in all countries. The Netherlands peaked in disease control at year 2 (72%). The proportion of patients reporting changes in pituitary tumor size was generally low. Serious treatment-related adverse events were < 5% in all countries.

CONCLUSIONS

Our study provided a detailed summary of real-life use of pegvisomant in the six top-recruiter ACROSTUDY nations.

Giant mesenteric fibromatosis associated with non-Hodgkin lymphoma. A case report and literature review

BACKGROUND

Mesenteric fibromatosis is a benign locally-aggressive mesenchymal neoplasm that lacks the potential for metastasis. It is related to Gardner's Syndrome, previous trauma, abdominal surgery, and prolonged intake of oestrogen. Differentially diagnosing this from similar tumours is crucial in order for establishing the appropriate treatment and only immunohistochemical features can be used for a definitive diagnosis. Although medical therapies play a role in the treatment of mesenteric fibromatosis, surgical resection is the gold-standard procedure.

METHODS

Our case study is a 40-year-old male with a concomitant diagnosis of non-Hodgkin lymphoma and mesenteric fibromatosis, not associated with any of the risk factors mentioned above. We performed CT and PET scans and observed a vascularised and well-defined mesenteric centre-abdominal hypermetabolic solid mass in contact with the gastric body, duodenum, body and tail of the pancreas, transverse colon, and spleen. An ultrasound-guided tru-cut biopsy revealed features suggestive of mesenteric fibromatosis.

RESULTS

An elective laparotomy was carried out and a giant mass, arising from mesentery, was excised, including a partial gastrectomy and segmental resection of the transverse colon. Distal pancreatectomy, small bowel resection and successive splenectomy were performed due to a large hypertensive component. The postoperative period was uneventful. The histopathology of the surgical pieces was compatible with intra-abdominal desmoid fibromatosis.

CONCLUSION

As far as we know from the literature, this is the largest mesenteric fibromatosis tumour ever to be excised. We also noticed that this is the first reported case of the concomitant presence of mesenteric fibromatosis and non-Hodgkin lymphoma that is not related to any of the described risk factors. Further research is needed to establish what type of association this presentation may indicate.

Application of Five Different Chlorella sp. Microalgal Strains for the Treatment of Vegetation Waters Derived from Unconventional Oil Extractions Enriched with Citrus Byproducts

The Mediterranean diet has, among its cornerstones, the use of olive oil for its nutraceutical and organoleptic properties. Despite the numerous merits, olive-oil mill wastewater (OMWW), which is generated by the olive-oil extraction process, is one of the most serious environmental pollutants in the Mediterranean countries. The polluting potential of OMWW is due to its high content of tannins, polyphenols, polyalcohols, pectins and lipids. In order to close the recovery cycle of a fortified citrus olive oils previously developed, we tested the ability of five microalgae of the Chlorella group (SEC_LI_ChL_1, CL_Sc, CL_Ch, FB and Idr) in lowering the percentage of total phenolic compounds in vegetation water. This was obtained with three different extraction processes (conventional, and lemon and orange peels) at three concentrations each (10%, 25% and 50%). The results showed that strains Idr, FB and CL_Sc from the Lake Massaciuccoli can tolerate vegetation water from conventional and lemon peel extractions up to 25%; these strains can also reduce the phenolic compounds within the tests. The application of microalgae for OMWW treatment represents an interesting opportunity as well as an eco-friendly low-cost solution to be developed within companies as a full-scale approach, which could be applied to obtain a fortified microalgal biomass to be employed in nutraceutical fields.

Textbook outcome following oesophagectomy for cancer: international cohort study

Background

Textbook outcome has been proposed as a tool for the assessment of oncological surgical care. However, an international assessment in patients undergoing oesophagectomy for oesophageal cancer has not been reported. This study aimed to assess textbook outcome in an international setting.

Methods

Patients undergoing curative resection for oesophageal cancer were identified from the international Oesophagogastric Anastomosis Audit (OGAA) from April 2018 to December 2018. Textbook outcome was defined as the percentage of patients who underwent a complete tumour resection with at least 15 lymph nodes in the resected specimen and an uneventful postoperative course, without hospital readmission. A multivariable binary logistic regression model was used to identify factors independently associated with textbook outcome, and results are presented as odds ratio (OR) and 95 per cent confidence intervals (95 per cent c.i.).

Results

Of 2159 patients with oesophageal cancer, 39.7 per cent achieved a textbook outcome. The outcome parameter ‘no major postoperative complication’ had the greatest negative impact on a textbook outcome for patients with oesophageal cancer, compared to other textbook outcome parameters. Multivariable analysis identified male gender and increasing Charlson comorbidity index with a significantly lower likelihood of textbook outcome. Presence of 24-hour on-call rota for oesophageal surgeons (OR 2.05, 95 per cent c.i. 1.30 to 3.22; P = 0.002) and radiology (OR 1.54, 95 per cent c.i. 1.05 to 2.24; P = 0.027), total minimally invasive oesophagectomies (OR 1.63, 95 per cent c.i. 1.27 to 2.08; P &lt; 0.001), and chest anastomosis above azygous (OR 2.17, 95 per cent c.i. 1.58 to 2.98; P &lt; 0.001) were independently associated with a significantly increased likelihood of textbook outcome.

Conclusion

Textbook outcome is achieved in less than 40 per cent of patients having oesophagectomy for cancer. Improvements in centralization, hospital resources, access to minimal access surgery, and adoption of newer techniques for improving lymph node yield could improve textbook outcome.

Textbook outcome following oesophagectomy for cancer: international cohort study

BACKGROUND

Textbook outcome has been proposed as a tool for the assessment of oncological surgical care. However, an international assessment in patients undergoing oesophagectomy for oesophageal cancer has not been reported. This study aimed to assess textbook outcome in an international setting.

METHODS

Patients undergoing curative resection for oesophageal cancer were identified from the international Oesophagogastric Anastomosis Audit (OGAA) from April 2018 to December 2018. Textbook outcome was defined as the percentage of patients who underwent a complete tumour resection with at least 15 lymph nodes in the resected specimen and an uneventful postoperative course, without hospital readmission. A multivariable binary logistic regression model was used to identify factors independently associated with textbook outcome, and results are presented as odds ratio (OR) and 95 per cent confidence intervals (95 per cent c.i.).

RESULTS

Of 2159 patients with oesophageal cancer, 39.7 per cent achieved a textbook outcome. The outcome parameter 'no major postoperative complication' had the greatest negative impact on a textbook outcome for patients with oesophageal cancer, compared to other textbook outcome parameters. Multivariable analysis identified male gender and increasing Charlson comorbidity index with a significantly lower likelihood of textbook outcome. Presence of 24-hour on-call rota for oesophageal surgeons (OR 2.05, 95 per cent c.i. 1.30 to 3.22; P = 0.002) and radiology (OR 1.54, 95 per cent c.i. 1.05 to 2.24; P = 0.027), total minimally invasive oesophagectomies (OR 1.63, 95 per cent c.i. 1.27 to 2.08; P < 0.001), and chest anastomosis above azygous (OR 2.17, 95 per cent c.i. 1.58 to 2.98; P < 0.001) were independently associated with a significantly increased likelihood of textbook outcome.

CONCLUSION

Textbook outcome is achieved in less than 40 per cent of patients having oesophagectomy for cancer. Improvements in centralization, hospital resources, access to minimal access surgery, and adoption of newer techniques for improving lymph node yield could improve textbook outcome.

Lipobrachiopexy: Cosmetic Outcomes and Limb Lymphatic Function of a Novel Brachioplasty Technique in Massive Weight Loss Patients

BACKGROUND

Many types of brachioplasty techniques have been described in the literature, and the main focus has been scar aesthetics, reproducibility and safety. Little attention has been given to other two aspects of the procedure: overall aesthetic with a focus on the torso-brachial angle and on the lymphatic distress related to the procedure. In this paper, we described a novel technique of brachioplasty called lipobrachiopexy, a lymph-sparing procedure which includes tendon suspension suture to improve cosmetics .

PATIENTS AND METHODS

Over 18 months, 22 consecutive patients underwent bilateral lipobrachioplasty with circumferential liposuction sparing brachial artery perforators, J-scar dermolipectomy and superficial fascia suspension to the pectoralis major tendon. Aesthetic outcomes, lymphatic function, sensory function and patient's satisfaction were evaluated at 1-year follow-up. The correction of the bat wing deformity and the shape of the transition of the upper arm to the chest was evaluated by quantifying the torso-brachial angle using Photoshop. Lymphatic function was analysed pre-operatively at 1, 6 and 12 months after surgery by indocyanine green lymphography (PDE, Hamamatsu Photonics, Japan).

RESULTS

An average of 447.5 cc (range, 350-550 cc) of fat was aspirated for each side. No major complications were experienced. Patients' and surgeons' satisfaction was high to very high in all cases. The lymphatic function was found preserved, with the same physiological linear patterns and tracer progression pre-operatively and 1 year after surgery. The torso-brachial angles showed significant improvements (86.7 ± 14.7-100.7 ± 10.2 right side and 85.4 ± 16.3-101.5 ± 9.9 left side).

CONCLUSION

Lipobrachiopexy is a safe and effective technique that adds to the recent trends in brachioplasty, a reestablishment of the brachial fascial systems and addressing the anatomical etiological factor of the bat wing deformity.

LEVEL OF EVIDENCE IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Technological Improvements on FML in the Chianti Classico Wine Production: Co-Inoculation or Sequential Inoculation?

Winemaking variables and techniques are known to affect the composition of wines. To obtain a rapid and safe fermentation course, with a reduced risk of proliferation of unwanted microbial species, frequent recourse is made to the use of selected microorganisms, which can greatly simplify the complex management of the fermentation process. In particular, selected strains of lactic acid bacteria are used, which are much more sensitive than yeasts to the operating conditions of the medium. In this regard, the overall aim of this research was to verify whether the early inoculation of homolactic acid bacteria for hexoses (Lactobacillus plantarum) carried out after 24 h, compared with that of saccharomycetes operating alcoholic fermentation, could be advantageous compared with a traditional innoculation with a different heterolactic bacterial strain for hexoses (Oenococcus oeni) operated at the end of alcoholic fermentation. The grape variety chosen was Sangiovese, the protagonist of Tuscan oenology. The evaluation focused on different aspects such as the management of winery operations, and the quality and longevity of the product; was carried out in all phases of winemaking; and analysed both from a chemical and sensory point of view.