68 research outputs found
Diagnosis and monitoring of cytomegalovirus infection by the quantification of viral load in dried blood spots samples
No full textCytomegalovirus (CMV) represents the major infectious cause of birth defects, as well as an important pathogen for immune-compromised individuals. Several studies described the use of dried blood spots (DBS) for the detection of CMV DNA for late diagnosis of congenital CMV infection in cases of strong clinical suspicion. In the article under evaluation, Limaye et al. perform for the first time the quantification of CMV in pairs of finger-stick DBS and plasma samples collected from transplant patients. The work concluded that finger-stick DBS could be an alternative sample type for quantification of CMV load that correlates well with plasma levels. Prospective trials to evaluate the use of DBS for monitoring CMV load in transplant recipients will be required
A cross-correlation analysis of CMB lensing and radio galaxy maps
No full textAims. The goal of this work is to clarify the origin of the seemingly anomalously large clustering signal detected at large angular separation in the wide TGSS radio survey and, in so doing, to investigate the nature and the clustering properties of the sources that populate the radio sky in the [0.15, 1.4] GHz frequency range.
Methods. To achieve this goal, we cross-correlated the angular position of the radio sources in the TGSS and NVSS samples with the cosmic microwave background (CMB) lensing maps from the Planck satellite. A cross-correlation between two different tracers of the underlying mass density field has the advantage of being quite insensitive to possible systematic errors that may affect the two observables, provided that they are not correlated, which seems unlikely in our case. The cross-correlation analysis was performed in harmonic space and limited to relatively modest multipoles. These choices, together with that of binning the measured spectra, minimize the correlation among the errors in the measured spectra and allowed us to adopt the Gaussian hypothesis to perform the statistical analysis. Finally, we decided to consider the auto-angular power spectrum on top of the cross-spectrum since a joint analysis has the potential to improve the constraints on the radio source properties by lifting the degeneracy between the redshift distribution, N(z), and the bias evolution, b(z).
Results. The angular cross-correlation analysis does not present the power excess at large scales for TGSS and provides a TGSS–CMB lensing cross-spectrum that is in agreement with the one measured using the NVSS catalog. This result strongly suggests that the excess found in TGSS clustering analyses can be due to uncorrected systematic effects in the data. However, we considered several cross-spectra models that rely on physically motivated combinations of N(z) and b(z) prescriptions for the radio sources and find that they all underestimate the amplitude of the measured cross-spectra on the largest angular scales considered in our analysis, ∼10°. This result is robust to the various potential sources of systematic errors, both of observational and theoretical nature, that may affect our analysis, including the uncertainties in the N(z) model. Having assessed the robustness of the results to the choice of N(z), we repeated the analysis using simpler bias models specified by a single free parameter, bg, namely, the value of the effective bias of the radio sources at redshift zero. This improves the goodness of the fit, although not even the best model, which assumes a non-evolving bias, quite matches the amplitude of the cross-spectrum at small multipoles. Moreover, the best fitting bias parameter, bg = 2.53 ± 0.11, appears to be somewhat large considering that it represents the effective bias of a sample that is locally dominated by mildly clustered star-forming galaxies and Fanaroff-Riley class I sources. Interestingly, it is the addition of the angular auto-spectrum that favors the constant bias model over the evolving one.
Conclusions. The nature of the large cross-correlation signal between the radio sources and the CMB lensing maps found in our analysis at large angular scales is not clear. It probably indicates some limitation in the modeling of the radio sources, namely the relative abundance of the various populations, their clustering properties, and how these evolve with redshift. What our analysis does show is the importance of combining the auto-spectrum with the cross-spectrum, preferably obtained with unbiased tracers of the large-scale structure, such as CMB lensing, for answering these questions
Spotlight on measles in Italy: Why outbreaks of a vaccine-preventable infection continue in the 21st century
No full textMeasles is a serious infectious disease that can lead to significant morbidity and mortality. Remarkable progress has been made through measles vaccination in reducing the number of
people dying from measles. In the last years, concerns about the safety of vaccines have led to decline in immunization coverage rates and new outbreaks of measles in many European countries, including Italy. We believe that it is important to reinforce the message that measles vaccine is safe and highly effective through appropriate information campaigns and public awareness
Atypical forms of hand, foot, and mouth disease: A prospective study of 47 Italian children
No full textBackground: Atypical forms of hand, foot, and mouth disease (HFMD) caused by coxsackievirus A6 have been reported in recent years. High fever and severe cutaneous lesions are common, whereas neurologic complications are rare. Eczematous areas of patients with atopic dermatitis show more lesions. The goal of the current study was to describe the clinical characteristics of children with atypical HFMD and to investigate the involvement of the different enterovirus serotypes associated. Methods: All patients referred to our service for atypical HFMD from January 2012 to February 2014 were enrolled and classified as having the diffuse form (lesions extended to the trunk), the acral form (lesions with a mainly acral distribution), or eczema coxsackium (lesions on preexisting eczematous areas). Results: Data from 47 patients were analyzed (median age 22 months [range 4–84 mos]); viral genotyping was performed in 11 cases. Sixty-two percent of the subjects developed the acral form, 23% eczema coxsackium, and 15% the diffuse form. Most patients had a nonclassical vesicular eruption and moderate to severe extent of cutaneous involvement. Approximately 80% of patients had palmoplantar purpuric macules. Most children younger than 2 years old had the acral form, most patients with eczema coxsackium were age 2 years and older, and the diffuse form was similarly distributed between the two age groups. Coxsackievirus A6 was detected in 9 of 11 genotyped cases. Conclusion: Our prospective study allowed the identification of three HFMD phenotypes differing from the classical form. Clinical care of these patients should include symptomatic treatment of extracutaneous features and, if necessary, hospitalization for complications
Antimicrobial Efficacy of Five Probiotic Strains Against Helicobacter Pylori
No full textTreatment ofHelicobacter pylori(H. pylori) infection is a challenge for clinicians. The largeincrease in drug-resistant strains makes the formulation of new therapeutic strategies fundamental.The frequent onset of side effects during antibiotic treatment (mainly due to intestinal dysbiosis)should not be underestimated as it may cause the interruption of treatment, failure ofH. pylorieradication and clonal selection of resistant bacteria. Probiotic integration during antibiotic treatmentcan exert a dual function: a direct antagonistic effect onH. pyloriand a balancing effect on dysbiosis.Therefore, it fulfills the definition of a new therapeutic strategy to successfully treatH. pyloriinfection.Data reported in literature give promising but discrepant results. Aim: To assessin vitrobacteriostaticand bactericidal activity of probiotic strains againstH. pylori. Materials and methods:L. casei, L.paracasei, L. acidophilus, B. lactisandS. thermophilusstrains were used. Agar well diffusion and time-killcurves were carried out to detect bacteriostatic and bactericidal activity, respectively. Results: Allprobiotic strains showed both bacteriostatic and bactericidal activity vs.H. pylori. Conclusions: Suchfindings prompted us to plan a protocol of treatment in which probiotics are given to infected patientsin association with antibiotic therapy
Constitutional Adjudication in Europe between Unity and Pluralism
No full textThe special issue firstly explores the relationships between national constitutional judges and supranational courts, both the ECJ and the European Court of Human Rights, as grounds of cooperation, competition and sometimes of conflict. In the first section of the special issue, Paris deals with this issue from the perspective of EU Member States’ constitutional courts’ case law on the limits to the primacy of EU law. Through a comparative analysis the author shows that important similarities can be detected in this jurisprudence. Moreover, if constitutional review of EU law is performed by constitutional courts in a cooperative manner vis-à-vis the ECJ and within certain boundaries as for the disapplication of EU law, it can even foster the creation of a European legal space where the protection of fundamental rights and of the rule of law across the Member States and in the EU is enhanced while national peculiarities are preserved. Alessia Cozzi’s essay deals with a hypothesis of silent coordination of the fora of constitutional adjudication. Cozzi investigates decisions of national supreme and constitutional courts that implicitly follow a previous European Court on Human Rights (ECtHR) judgment without explicitly referring to it. Her article aims at understanding in which cases this implicit coordination is performed and why national courts are reluctant to make this approach explicit, hiding a successful coordination and turning a battleground into a meeting ground without emphasizing this transformation. Finally, the third essay of the first section deals with the interesting case study of the Belgian Constitutional Court, placed in a comparative perspective. It raises a problem of general and systematic interest for the identification of a system of constitutional adjudication in the EU and the exploration of its procedures and challenges. This case study is extremely promising, as little research has examined whether constitutional courts employ the same strategies applied domestically, when violations of European and international law occur through legislative omissions. Omissions may be an insidious battleground for national and supranational courts, and Verstraelen’s article demonstrates a versatile approach of Member States’ constitutional courts in order to accommodate the potential fragmentation of national judges’ responses with the need to ensure unity and uniformity of EU law. The second section of the special issue is devoted to test the model of the composite European constitutional adjudication under pressure. The Euro-crisis offered an ideal stress test. Whereas legal analysis on the constitutional dimensions of Euro-crisis abounded, some specific aspects of this picture were overlooked also in those jurisdictions where the Euro-crisis had a remarkable impact. A first underestimated aspect concerns the role played by lower courts, often contradicting supreme and European courts. Pavlidou’s article addresses this vastly overlooked aspect, by examining how domestic lowest courts in Greece safeguarded social rights by resorting to alternative constitutional sources and by indirectly enforcing constitutional provisions in order to constitutionalize social rights. Her essay juxtaposes this practice to the opposite interpretation of austerity measures by the European and Supreme Greek courts. In light of this, she analyzes the implications of this contradictory judicial review both in terms of the scope of social rights and conceptions of unity and diversity within the multiple levels of adjudication. Another vastly overlooked aspect in the Euro-crisis scholarship is the absence of preliminary references to the ECJ for the ‘harmonization’ of social rights adjudication stemming from the same supranational instruments. Constitutional courts were eager to solve cases by invoking solely their own constitutional interpretation and standards. Pierdominici’s article tries to fill this gap in the scholarship, questioning constitutional courts’ reluctant approaches toward preliminary references aimed at guaranteeing (European) standards of protection of social rights. Fasone’s essay is devoted to look at the impact of constitutional adjudication on Euro-crisis measures on the role of legislatures, in this critical conjunction, to ascertain whether common challenges to representative democracy have led to unitary or plural (and divergent) judicial responses to the issues of Parliaments’ displacement in Euro-crisis procedures. In particular, the article investigates in this framework how constitutional courts have resorted to the argument of the national constitutional identity showing that, due to several circumstances, the protection of parliamentary powers and, ultimately, of the principle of representative democracy has been of little concern for most constitutional courts in such a critical juncture. After having tested current trends of constitutional adjudication on the battleground of Euro-crisis measures, the third section of the special issue explores possible procedures and remedies to settle emerging conflicts. In this section, Andrea Edenharter claims that in the long run, a legal reconciliation within the EU can only be achieved if national courts enjoy at least some discretion in cases in which EU law allows for the application of national fundamental rights, because otherwise, national constitutional courts might challenge the ECJ’s role as Supreme Court of the EU and thus damage the project of reconciliation as such. Edenharter’s essay deals with the core problem of the possible existence of a system of constitutional adjudication in the area of fundamental rights review. In this respect, her article analyses two possible legal tools that may facilitate the function of such a system of constitutional adjudication. On the one hand, the margin of appreciation doctrine developed by the ECHR should be adopted by the ECJ. On the other hand, the principle of discretion can also be applied in favor of the ECJ, with national constitutional courts reducing the intensity of scrutiny towards the ECJ in accordance with the German Federal Constitutional Court’s position in Honeywell. Zaccaroni’s paper deals with the need of reconciliation of Member States’ constitutional identities and EU law from a different perspective. His article holds this reconciliation as a necessary assumption to make a system of constitutional adjudication workable in the EU. The essay emphasizes the contribution of some recent decisions of the EU for the identification of the concept of EU constitutional identity. Zaccaroni’s aim is to assess how to reconcile the theoretical position of the ECJ with the one of the national constitutional courts, and in particular, the possibility to reconcile the pluralism of national constitutional identities with the (desired) unity of the EU constitutional identity. His essay investigates two possible solutions: a) a clear theorization of an evolutionary interpretation of the principle of conferred powers; b) a real judicial cooperation between EU and national constitutional judges. In the latter perspective, Zaccaroni claims that constitutional courts should openly recognize the existence of an EU constitutional identity. Additionally, his essay claims that a system of constitutional adjudication would benefit from a mechanism of “reverse” preliminary ruling (from the ECJ to national constitutional courts), when identity-related conflicts are at stake. Finally, the last article of the section investigates the legal and practical obstacles to the full affirmation of the ECJ as a constitutional adjudication forum. Starting with the fact that the ECJ is increasingly emerging and self-identifying as a constitutional Court, Carlo Tovo argues that the revision of the ECJ’s rules of procedure, along with the reform of the General Court, may play a major role in strengthening the constitutional adjudication of the Court’s activity. Tovo explores the new centrality of the preliminary ruling proceedings in the revised rules of procedure of the Court of Justice, in connection with the actual and future delimitation of jurisdiction between the ECJ and the General Court. Then, his article focuses on the procedural arrangements introduced by the revised ECJ Rules of procedures and other sources, aimed at balancing the need to ensure the coherence and uniformity of EU law and to strengthen the ‘constitutional authority’ of the Court. Before the special section on “The View from the Bench”, Gábor Halmai presents some conclusive remarks, providing a critical account of the use of the notion of constitutional identity by Member States’ Supreme and Constitutional courts. This is a key element to grasp the tension between unity and pluralism in the composite system of constitutional adjudication. Halmai argues that while a genuine reference to national identity claims is legitimate insofar as a fundamental national constitutional commitment is at stake, the abuse or misuse of constitutional identity by Constitutional courts “is nothing but constitutional parochialism” that can undermine the whole European constitutional construction and subvert the basic principle of sincere cooperation
From the Colon to the Liver: How Gut Microbiota May Influence Colorectal Cancer Metastatic Potential
No full textThe gut microbiota's influence on human tumorigenesis is a burning topic in medical research. With the new ontological perspective, which considers the human body and its pathophysiological processes as the result of the interaction between its own eukaryotic cells and prokaryotic microorganisms living in different body niches, great interest has arisen in the role of the gut microbiota on carcinogenesis. Indeed, dysbiosis is currently recognized as a cancer-promoting condition, and multiple molecular mechanisms have been described by which the gut microbiota may drive tumor development, especially colorectal cancer (CRC). Metastatic power is undoubtedly one of the most fearsome features of neoplastic tissues. Therefore, understanding the underlying mechanisms is of utmost importance to improve patients' prognosis. The liver is the most frequent target of CRC metastasis, and new evidence reveals that the gut microbiota may yield an effect on CRC diffusion to the liver, thus defining an intriguing new facet of the so-called "gut-liver axis". In this review, we aim to summarize the most recent data about the microbiota's role in promoting or preventing hepatic metastasis from CRC, highlighting some potential future therapeutic targets
Contrast-Enhanced Imaging in the Management of Intrahepatic Cholangiocarcinoma: State of Art and Future Perspectives
No full textSimple Summary Contrast imaging techniques play a pivotal role in the diagnosis and management of Intrahepatic cholangiocarcinoma (iCCA). There is an increasing interest in the specific imaging features which can predict tumor behavior or histologic subtypes. Intrahepatic cholangiocarcinoma (iCCA) represents the second most common liver cancer after hepatocellular carcinoma, accounting for 15% of primary liver neoplasms. Its incidence and mortality rate have been rising during the last years, and total new cases are expected to increase up to 10-fold during the next two or three decades. Considering iCCA's poor prognosis and rapid spread, early diagnosis is still a crucial issue and can be very challenging due to the heterogeneity of tumor presentation at imaging exams and the need to assess a correct differential diagnosis with other liver lesions. Abdominal contrast-enhanced computed tomography (CT) and magnetic resonance imaging (MRI) plays an irreplaceable role in the evaluation of liver masses. iCCA's most typical imaging patterns are well-described, but atypical features are not uncommon at both CT and MRI; on the other hand, contrast-enhanced ultrasound (CEUS) has shown a great diagnostic value, with the interesting advantage of lower costs and no renal toxicity, but there is still no agreement regarding the most accurate contrastographic patterns for iCCA detection. Besides diagnostic accuracy, all these imaging techniques play a pivotal role in the choice of the therapeutic approach and eligibility for surgery, and there is an increasing interest in the specific imaging features which can predict tumor behavior or histologic subtypes. Further prognostic information may also be provided by the extraction of quantitative data through radiomic analysis, creating prognostic multi-parametric models, including clinical and serological parameters. In this review, we aim to summarize the role of contrast-enhanced imaging in the diagnosis and management of iCCA, from the actual issues in the differential diagnosis of liver masses to the newest prognostic implications
Multidrug-Resistant Cytomegalovirus Infection in a Patient With Granulomatosis With Polyangiitis During Immunosuppressive Treatment
No full textCytomegalovirus (CMV) infection is a major complica- tion in immunocompromised patients, including those with autoimmune diseases. Here, we describe the first case of granulomatosis with polyangiitis treated with steroids and cyclophosphamide, complicated by a multi- drug-resistant (MDR) CMV infection in presence of weak antiviral cellular immunity. Since reports regarding CMVinfection in rheumatological patients are rarely described and no guidelines on its management exist, the described case contributes to identify potential strategies to pre- dict the risk of CMV disease and developing of MDR-CMV in these patients, through virological and immunological surveillance
Diagnosis and prognosis of congenital CMV infection: A case report and review of the literature
No full textCongenital cytomegalovirus (CMV) infection is the leading non-genetic cause of sensori-neural hearing loss and neurodevelopmental sequelae. Despite these alarming facts, the general public healthcare system is often not aware of CMV and not enough is done to prevent congenital CMV infection.We describe the clinical and laboratory monitoring of a case with primary CMV infection occurring before the fi rst trimester of gestation. Specifi c literature review is included in order to point out major goals achieved in the diagnosis and prognosis of congenital CMV infection and the many questions still unanswered. Serological diagnosis of primary CMV infection was performed based on serum-CMV specifi c-IgM anti bodies,
combined with low avidity anti-CMV IgG antibodies. The maternal infection was asymptomatic, as it is for most infections in immunocompetent patients. Therefore, disclosing primary infection depended on specifi c serological tests during the initial period of pregnancy (before weeks 12 – 16 of gestation). The invasive (amniocentesis) and non-invasive (ultrasonographic examination) prenatal tests, carried out at 21 weeks gestation, revealed a severe CMV infection in a fetus small for gestational age with ventriculomegaly. The presence of overt ultrasound abnormalities combined with high viral load in the amniotic fl uid sampled at the appropriate times was highly suggestive of an unfavourable prognosis. The autopsy performed on the fetus confi rmed severe disseminated CMV infection with histological brain damage
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