Search Results (22)

Adult congenital heart disease (ACHD) represents a significant portion of congenital anomalies, and with improved treatments leading to an increased life expectancy, its prevalence has been increasing over the past few decades. Nonetheless, a considerable number of patients with ACHD require cardiac rhythm management devices during their lifetime. Traditionally, transvenous pacemaker placement has been the standard mode of treatment for these patients. However, some patients with ACHD have anatomical barriers that obscure this mode of treatment. Leadless pacing systems (LPSs) have changed the field of pacing. Currently, two different LPSs are available. In a real-world setting, implanting an LPS in patients after tricuspid valve (TV) surgery seems to be a straightforward procedure with a low risk of complications, with patients showing no valvular dysfunction after the intervention. LPS implantation is an option to avoid device-related complications in patients with previous TV surgery. Moreover, it has been demonstrated that even the jugular approach seems as safe as the femoral approach and could be considered an alternative implantation method for LPSs. The Aveir VR leadless pacemaker is a helix LPS with unique features, such as its capacity as a dual-chamber leadless pacemaker, the ability to map electrical parameters before releasing the device, and its possibility of being retrievable. Hereby, we present the case of Ebstein’s anomaly, atrial septal defect closure, and previous TV surgery with symptomatic intermittent advanced atrioventricular block. This case illustrates that a transjugular approach for LPSs is also feasible in patients with ACHD. Full article

Colorectal cancer (CRC) is the fourth most commonly diagnosed cancer and one of the leading causes of cancer death worldwide. Despite diagnostic and therapeutic advances, CRC mortality remains high, especially in industrialized countries. Numerous studies have highlighted the pathogenetic role of altered microRNA (miRNA) expression among the various factors contributing to the development and progression of colorectal cancer (CRC). However, the data regarding specific miRNAs involved in CRC pathogenesis remain inconsistent, and no miRNAs have been recognized so far as reliable or effective biomarkers for the diagnosis of this tumor type. To identify novel miRNA biomarkers in CRC, this study validated the expression levels of a four-miRNA signature predicted to be involved in CRC by analyzing both tissue and liquid biopsy samples. Our experimental and bioinformatics results highlighted the diagnostic potential of hsa-miR-21-5p, hsa-miR-503-5p, and hsa-miR-375, as well as the potential prognostic value of hsa-miR-497-5p overexpression and hsa-miR-375-3p downregulation. Overall, the results obtained suggest the diagnostic and prognostic significance of this four-miRNA signature in CRC. Full article

Multidrug-resistant Klebsiella pneumoniae is a significant healthcare challenge that particularly affects vulnerable patients through opportunistic nosocomial infections. Surveillance is crucial for monitoring the prevalence of these infections. Eighty-four KPC K. pneumoniae strains (2019–2022) were collected from patients admitted in Fondazione Policlinico Universitario Campus Bio-Medico. Strains were identified by MALDI-TOF and tested for antimicrobial susceptibility, and gene amplification was performed to identify the different blaKPC variants. Phylogenetic reconstructions were carried out using Bayesian methods. Additionally, to create a Bayesian skyline plot (BSP), additional analyses were conducted, running a simulation of 100 million generations under a Bayesian skyline model along with the uncorrelated log-normal relaxed clock model. To identify potential subgroups within genetic clusters and evaluate genetic variability among sequences, principal coordinate analysis (PCoA) was performed. In total, 84 Klebsiella pneumoniae isolates were classified as multidrug-resistant (MDR), characterized by resistance to three or more antibiotic classes, including carbapenems, and testing positive for KPC gene presence, and were included in the study. The Bayesian evolutionary tree for K. pneumoniae showed strongly supported branches but no genetic structure related to sampling dates or hospital departments. Phylogenetic analysis revealing a 73-year evolutionary span of K. pneumoniae strains. PCoA analysis identified three genetic outliers from 2022 and one from 2021, indicating higher genetic distances. The Bayesian skyline plot revealed increased genetic variability peaking at the end of 2019, followed by stabilization from early 2020 onward, with no significant changes in genetic variability thereafter. Overall, the study found no genetic structure correlating with sampling date or hospital department, suggesting significant variability in pathogen introduction during the pandemic. The increase in multidrug-resistant K. pneumoniae was linked to the influx of severe COVID-19 cases, prolonged hospitalizations, and heightened broad-spectrum antibiotic use, which likely facilitated resistance development and transmission amidst altered infection control practices. Full article

Background and Objectives: Acute kidney injury (AKI) remains a significant complication following major cardiac surgery. Marinobufagenin (MBG), a cardiotonic steroid involved in sodium balance and blood pressure regulation, has been linked to organ damage after ischemia–reperfusion events. This pilot, prospective study investigates the utility of circulating MBG to improve AKI risk assessment in cardiac surgery patients as a stand-alone biomarker and after inclusion in a validated risk model (STS-AKI score). Materials and Methods: We included 45 patients undergoing elective cardiac surgery. The MBG levels were measured preoperatively and at 4, 8, and 12 h post-surgery. The AKI was defined according to the KDIGO guidelines. Statistical analyses assessed the diagnostic and prognostic utility of MBG and its integration with the STS-AKI score. Results: An AKI occurred in 26.7% of the patients. The STS-AKI score performed well in this cohort (AUC: 0.736). The MBG levels displayed a decreasing trend in the whole population after surgery (p = 0.02). However, in the AKI patients, MBG increased at 4 and 8 h before decreasing at 12 h post-surgery. The MBG changes from the baseline to 8 h and from 8 to 12 h post-surgery showed a remarkable diagnostic accuracy for an AKI (AUCs: 0.917 and 0.843, respectively). Integrating these MBG changes with the STS-AKI score significantly improved the model performance, including discrimination, calibration, and risk reclassification. Conclusions: The MBG measurement, particularly any dynamic changes post-surgery, enhances AKI risk stratification in cardiac surgery patients. Integrating MBG with the STS-AKI score offers more accurate risk predictions, potentially leading to better patient management and outcomes. Full article

Background: Biomarkers development for prognostication or prediction of perioperative myocardial disease is critical for the evolution of treatment options in patients undergoing cardiac surgery. The aim of our prospective monocentric study was to investigate the role of selenoprotein 1 (SEEP 1) as a potential biomarker for assessing the risk of myocardial injury after cardiac surgery. Methods: Circulating SEPP1 was measured in the blood of 45 patients before surgery and at 4 h, 8 h and 12 h after CPB by enzyme-linked immunosorbent assay (ELISA); (3) Results: circulating SEPP-1 levels measured 4 h after surgery were strongly correlated with CK-MB levels measured at 48 h (R = 0.598, p < 0.0001) and at 72 h (R = 0.308, p = 0.05). Close correlations were also found between 4 h SEPP-1 and Hs-c troponin values measured at 24 h (R = 0.532, p < 0.0001), 48 h (R = 0.348, p = 0.01) and 72 h (R = 0.377, p = 0.02), as well as with cardiopulmonary bypass (CPB) (R = 0.389, p = 0.008) and cross-clamp time (R = 0.374, p = 0.001); (4) Conclusions: Early SEPP1 measurement after CPB may hold great potential for identifying cardiac surgery patients at risk of developing perioperative myocardial injury. Full article

Pivotal environmental geology research was carried out in the protected area of Cape Peloro (Messina, NE Sicily, Italy). The main aims were the ascertainment of the presence of Asbestos Cement Materials (ACMs), their mapping, and, consequently, an estimation of the potential risk for human health and marine coastal environments. The beaches surveyed covered 4500 m of coastline. Through high-resolution photographic surveys, over 520 fiber cement fragments were documented on the beaches as well as in beach deposits. The materials, after microscope, SEM-EDS, and FTIR analyses, were found to be composed of Portland cement with chrysotile and crocidolite fibers. Fragments of ACMs showed typical corrugated forms with centimeter-to-decimeter sizes and prevailing well-rounded, platy, and sub-elongate shapes. In a few localities, some fragments were found to be angular or friable. Furthermore, some fragments found on the beach were covered by conspicuous encrustations of marine organisms, testifying to their long staying in shallow-water marine environments. Illicit landfills and abandoned materials were identified in natural sections on the coastal plain. Most of the rounded ACMs were characterized by their surface texture, with mm-size asbestos fibers exposed on the surface due to significant weathering and abrasion. Notably, new fragments appeared after storms. Significant criticisms have been made related to the ACMs, analogously to what was reported for other Italian marine beaches. Possible intervention and reclamation activities cannot limit themselves to removing the fragments on the beach, as fragments are immersed in the coastal sediments at different depths and are also found in the marine deposits. Here, it is underlined that any asbestos removal and reclamation activities, if not designed and based on a multidisciplinary approach and knowledge of local coastal dynamics and the meteo-marine climate, will be very expensive and ineffective. Full article

Background: Breast cancer (BC) is a heterogeneous disease made up of clones with different metastatic potential. Intratumoral heterogeneity may cause metastases to show divergent biomarker expression, potentially affecting chemotherapy response. Methods: We investigated the immunohistochemical (IHC) and FISH profile of estrogen receptors (ER), progesterone (PR) receptors, Ki67, and HER2 in a series of BC-matched primary tumors (PTs) and axillary lymph node (ALN) metastases in pre-operative core needle biopsies (CNBs). Phenotypical findings were correlated to morphological features and their clinical implications. Results: Divergent expression between PTs and ALNs was found in 10% of the tumors, often involving multiple biomarkers (12/31, 39%). Most (52%) displayed significant differences in ER and PR staining. HER2 divergences were observed in almost three-quarters of the cases (23/31, 74%), with five (16%) switching from negativity to overexpression/amplification in ALNs. Roughly 90% of disparities reflected significant morphological differences between PTs and ALN metastases. Less than half of the discrepancies (12/31, 39%) modified pre/post-operative treatment options. Conclusions: We observed relevant discrepancies in biomarker expression between PTs and metastatic ALNs in a noteworthy proportion (10%) of preoperative BC CNBs, which were often able to influence therapies. Hence, our data suggest routine preoperative assessment of biomarkers in both PTs and ALNs in cases showing significant morphological differences. Full article

Breast cancer (BC), a complex disease with several influencing factors, is significantly impacted by dietary habits. The ketogenic diet (KD), characterized by high fat and low carbohydrate intake, has gained attention as a potential therapeutic approach, but its effects on BC remain unclear. This review seeks to summarize the current knowledge on the principles of the KD, its metabolic influence on BC cells, and the findings of recent clinical trials, in order to elucidate the potential therapeutic role of the KD in BC management. For these purposes, a comprehensive literature review was conducted selecting preclinical and clinical studies that investigate the relationship between the KD and BC. The selection criteria prioritized studies exploring the KD’s metabolic effects on BC cells and current clinical trials involving the KD in BC management. The reviewed studies provide a diverse range of findings, with some suggesting potential benefits of the KD in inhibiting tumor growth and improving treatment response. However, robust clinical trials providing clear evidence of the KD’s efficacy as a standalone therapeutic approach in BC are still lacking. There are also significant concerns regarding the safety and long-term effects of sustained ketosis in cancer patients. The therapeutic potential of the KD in BC remains an area of active research and debate. While preliminary findings are promising, definitive conclusions are hindered by inconsistent results and limited human trial data. Future research, specifically well-structured, large-scale clinical trials, is necessary to provide a comprehensive understanding of the role of the KD in BC treatment. Until then, caution should be exercised in its application, and patients should continue prioritizing evidence-based, standard-of-care treatments. Full article

Although the gut microbiota is known to affect body weight, its relationship with overweight/obesity is unclear. Our aim was to characterize microbiota composition in a cohort from the southernmost area of Italy. We investigated whether an altered gut microbiota could play an etiological role in the pathogenesis of overweight/obesity. A total of 163 healthy adults were enrolled. Microbiome analysis was performed via 16S rRNA gene sequencing. We found significant phylum variations between overweight (N = 88) and normal-weight (N = 75) subjects. Bacteroidetes and Proteobacteria were higher in overweight participants (p = 0.004; p = 0.03), and Firmicutes and Verrucomicrobia were lower (p = 0.02; p = 0.008) compared to normal-weight participants. Additionally, Akkermansia and Bifidobacterium (genus level) were significantly lower in the overweight group, as well as Akkermansia muciniphila at the species level. The Firmicutes/Bacteroidetes ratio (F/B ratio), an index of dysbiosis, was found to be inversely associated with BMI in linear and logistic regression models (p = 0.001; p = 0.005). The association remained statistically significant after adjustment for potential confounders. This cross-sectional study contributes to defining the gut microbiota composition in an adult population living in southern Italy. It confirms the relationship between overweight susceptibility and the dysbiosis status, highlighting the possible etiological role of the F/B ratio in disease susceptibility. Full article

In this article, an investigation of the natural radioactivity content of pyroclastic products from Mt. Etna, eastern Sicily, Southern Italy, was carried out. In particular, the assessment of the average activity concentration of the investigated radionuclides, related to the mineralogical phase composition of the analyzed samples, and the radiological health risk for the population, was performed. High Purity Germanium (HPGe) gamma-ray spectrometry was employed in order to quantify the average specific activity of ²²⁶Ra, ²³²Th, and ⁴⁰K natural radioisotopes. The absorbed gamma dose rate (D), the radium equivalent activity (Ra_eq), the hazard indices (H_in and H_ex), the annual effective dose equivalent outdoor (AEDE_out), and the excess lifetime cancer risk (ELCR) were also estimated in order to assess any possible radiological hazard for the population. In our case, they were found to be lower than the maximum recommended values for the population members, thus reasonably excluding radiological hazard effects. Moreover, the identification of the source of the aforementioned naturally occurring radionuclides was attempted by X-ray Diffraction (XRD) and Micro-Raman Scattering (MRS), thereby recognizing the main radioisotope-bearing minerals present in the investigated pyroclastic products. Finally, Pearson correlation, Principal Component Analysis (PCA), and Hierarchical Cluster Analysis (HCA) were performed by processing observed radioactivity and radiological parameters in order to determine their correlation with the sampling locations. Full article

In this article, the authors report experimental results obtained for the assessment of the ²²⁶Ra content in 80 drinking water samples from the Calabria region, Southern Italy. The activity concentration, measured with the Perkin Elmer Tricarb 4910 TR Liquid Scintillation Counter (LSC) setup, was compared with the reference values reported in the Italian Legislative Decree 28/2016 in order to evaluate any possible radiological health hazards for the population in terms of ²²⁶Ra content due to the ingestion of the investigated drinking water. The obtained results put in evidence that the average ²²⁶Ra specific activity is lower than the LSC minimum detectable activity (MDA) in all cases, thus, excluding any radiological risk. They also represent the main reference for the investigated area and can be used as a baseline to extend this investigation to the whole region. Full article

The natural (⁴⁰K) and anthropogenic (¹³⁷Cs) radioactivity concentration in four different typologies of early childhood (up to two years old) foods, i.e., homogenized fruit, homogenized meat, childhood biscuits and baby pasta, produced in Italy and sold in Italian large retailers, was investigated through High Purity Germanium (HPGe) gamma spectrometry. The present study is carried out with the aim to: (i) evaluate the background levels of the investigated radionuclides in the analyzed early childhood foods, (ii) identify whether the twenty analyzed samples were appropriate for infant consumption and (iii) contribute to construct a database on the radioactivity of early childhood foods sold in Italy. Full article

The radiological quality of drinking water is directly associated with the health of the population. Indeed, it is well known that the presence of radionuclides in drinking water constitutes a health risk for humans because the consumption of such water increases the likelihood of incurring cancer. For this reason, all the studies aimed at developing new methodologies for the qualitative and quantitative analysis of the radioisotopic composition of drinking water are absolutely desired by the international scientific community, as well as by the institutes that deal with the protection of public health. In this paper, a new methodological approach was developed for the evaluation of the ²³⁸U content in drinking water. A sample coming from Paola, Calabria region, southern Italy, was taken as a case study. The assessment was performed by using High Purity Germanium (HPGe) gamma-ray spectrometry, with the aim of quantifying the specific activity of the ^234mPa radioisotope after a preconcentration procedure, and thus to assess the activity concentration of ²³⁸U, in the hypothesis of the secular radioactive equilibrium between it and its daughter. The obtained results were validated through the comparison with the ²³⁸U (µg/L) concentration as measured with Inductively Coupled Plasma-Mass Spectrometry (ICP-MS). Full article

Legionella pneumophila (L. pneumophila) is one of the most threatening nosocomial pathogens. The implementation of novel and more effective surveillance and diagnostic strategies is mandatory to prevent the occurrence of legionellosis outbreaks in hospital environments. On these bases, the present review is aimed to describe the main clinical and molecular features of L. pneumophila focusing attention on the latest findings on drug resistance mechanisms. In addition, a detailed description of the current guidelines for the disinfection and surveillance of the water systems is also provided. Finally, the diagnostic strategies available for the detection of Legionella spp. were critically reviewed, paying the attention to the description of the culture, serological and molecular methods as well as on the novel high-sensitive nucleic acid amplification systems, such as droplet digital PCR. Full article

Plasters and mortars of the Church of the Annunciation (Tortorici, Sicily) were characterized, for the first time, both at the elemental and molecular levels, by means of portable X-ray fluorescence (XRF) and Raman spectroscopy, to achieve information on the “state of health” of the whole structure. The understanding of their degradation mechanisms and the identification of consequent degradation patterns can define the environmental factors responsible for interpreting the potential pathological forms that can impact the general building vulnerability. In this sense, the results obtained in this article provide relevant information to identify and address both the characterization of building materials and the fundamental causes of their deterioration. At the same time, if coupled with the attempt to supply a chronological order of the major restoration interventions carried out on the investigated site, they provide new insights to calibrate the models for building vulnerability studies. Full article