Serum IgG2 levels are specifically associated with whole-body insulin-mediated glucose disposal in non-diabetic offspring of type 2 diabetic individuals. a cross-sectional study

.Preclinical studies suggested that IgG2c isotype may specifically impair skeletal muscle insulin sensitivity in mice. In this study we investigated the association between serum levels of the four IgG subclasses and insulin sensitivity in non-diabetic individuals. Total IgG, IgG1, IgG2, IgG3 and IgG4 levels were measured in 262 subjects. Whole-body insulin sensitivity was assessed by euglycemic hyperinsulinemic clamp. IgG2 levels were positively correlated with BMI, waist circumference, 2-h postload glucose levels and complement C3. Serum IgG2, but not IgG1, IgG3 and IgG4 levels were negatively correlated with whole-body insulin sensitivity (r = −0.17; P = 0.003) and muscle insulin sensitivity index (r = −0.16; P = 0.03) after adjustment for age and gender. No significant correlation was found between IgG2 levels and hepatic insulin resistance assessed by HOMA-IR and liver IR index. In a multivariable regression analysis including variables known to affect insulin sensitivity such as age, gender, BMI, smoking, lipids, inflammatory markers, fasting and 2-h post-load glucose levels, IgG2 levels were independently associated with insulin-stimulated glucose disposal (β = −0.115, 95% CI: −0.541 to −0.024; P = 0.03). These data demonstrate the independent association between higher levels of IgG2 and decreased whole-body insulin sensitivity, thus confirming in humans the animal-based evidence indicating the pathogenic role of IgG2 in insulin resistance

Indicazioni alla tiroidectomia nei pazienti pediatrici.

Le patologie tiroidee in età pediatrica ad indicazione chirurgica sono rare ed associate ad un maggior rischio di complicanze rispetto agli adulti. Ad oggi, la ricerca sulla tiroidectomia pediatrica non è sufficiente e risulta meno completa rispetto a quella della popolazione adulta. Tramite la nostra serie di pazienti pediatrici abbiamo analizzato a posteriori le indicazioni alla tiroidectomia per questa fascia di età. PAZIENTI E METODI - Da Gennaio 2002 a Dicembre 2010, 253 pazienti pediatrici (fino a 18 anni) con malattie della tiroide sono stati sottoposti a intervento chirurgico presso il Dipartimento di Chirurgia dell’Università di Pisa. I dati sono stati raccolti dalle cartelle cliniche dei pazienti ed introdotti in un database da cui abbiamo estratto ed analizzato i seguenti parametri: sesso, età, tipo di intervento chirurgico, diagnosi istologica, infiltrazione della capsula tumorale, infiltrazione della capsula tiroidea, multifocalità, bilateralità, metastasi linfonodali e stadio TNM. RISULTATI - In caso di carcinoma è stata effettuata tiroidectomia totale senza dissezione linfonodale in 75 casi mentre l’intervento è stato completato con la dissezione linfonodale in 72 casi con evidenza preoperatoria di linfadenopatia. 45 pazienti con nodulo a citologia indeterminata sono stati sottoposti a tiroidectomia totale o quasi totale; i 33 pazienti con morbo di Graves hanno subìto l’intervento di tiroidectomia totale o quasi totale. Sono state effettuate le lobectomie nei 28 pazienti con gozzo nodulare. Le complicanze post-intervento si sono presentate in percentuale sovrapponibile a quelle registrate per la popolazione adulta: 5 casi (2%) di paralisi del nervo laringeo (bilaterale in 1 solo caso) e 52 casi (20.6%) di ipocalcemia trattati con calcio per via orale. L’esame istologico definitivo ha confermato la diagnosi preoperatoria in tutti i pazienti tranne in 1 caso di iperplasia a cellule C (che si è quindi rivelato l’unico caso di tiroidectomia profilattica “vera” per sospetto CMT); sono stati rilevati 6 sottotipi di PTC. Per ognuna delle patologie tiroidee esaminate si è evidenziata una netta predominanza nel sesso femminile, anche suddividendo i pazienti in due gruppi di età (0-12 anni e 13-18 anni). Si è osservato inoltre un progressivo aumento dell’incidenza di tutte le patologie all’aumentare dell’età; ciò è particolarmente evidente per i DTC il che suggerisce un progressivo aumento della necessità dell’intervento chirurgico per patologie della tiroide all’aumentare dell’età dei pazienti. Le dimensioni medie dei carcinomi sono di 2.2 cm per PTC, 3.3 cm per FTC e 0.8 cm per CTM. La capsula tumorale è infiltrata nel 78.6% dei PTC, 100% dei FTC e 66.7% dei CMT, mentre l’infiltrazione della capsula tiroidea si è trovata solo nel 45% dei PTC. Le metastasi linfonodali sono state trovate nel 42.0% dei PTC, 0% dei FTC e 16.7% dei CMT. Tra le varianti del PTC, CV è quella col maggior numero di casi in stadio T3 o T4; DSV ha la più alta proporzione di caratteristiche di aggressività locali mentre FV quella più bassa. PTC ha la più alta percentuale di metastasi linfonodali rispetto a FTC e CMT (42.0%, 0% e 16.7% rispettivamente). Di tutti i casi N+, il 98.2% sono da PTC. Le metastasi hanno prevalentemente interessato i linfonodi laterocervicali (0.75%) piuttosto che il compartimento centrale(25%). Tra le varianti di PTC, CV è quella col maggior numero di casi N+, DSV ed FV presentano rispettivamente la maggiore e la minore tendenza alle metastasi linfonodali. CONCLUSIONI - Le principali indicazioni alla tiroidectomia nel paziente pediatrico (<18 anni) sono rappresentate dalla patologia neoplastica maligna (CTD 58.1%), dal MG (17.8%) e dalla patologia nodulare tiroidea (14.1%), in ordine di frequenza. Nell’ambito della popolazione pediatrica, i soggetti di sesso femminile ed in età puberale sono quelli più colpiti da patologia tiroidea suscettibile di intervento chirurgico. Non è essenziale un chirurgo pediatrico; è invece importante una datata esperienza nell’ambito della chirurgia della tiroide al fine di limitare il rischio di complicanze post-intervento. Da un punto di vista oncologico, questo studio conferma che il PTC nei bambini è più aggressivo, con maggiori caratteristiche di invasione locale e metastasi linfonodali alla diagnosi, sia rispetto a FTC e CMT che confrontato con la popolazione adulta. In particolare la variante DSV è quella con maggiore tendenza alla diffusione mentre FV è quella meno aggressiva

Understanding the coexistence of competing raptors by Markov chain analysis enhances conservation of vulnerable species.

Understanding ecological interactions among protected species is crucial for correct management to avoid conflicting outcomes of conservation planning. The occurrence of a superior competitor may drive the exclusion of a subordinate contestant, as in Sicily where the largest European population of the lanner falcon is declining because of potentially competing with the peregrine falcon. We measured the coexistence of these two ecologically equivalent species through null models and randomization algorithms on body sizes and ecological niche traits. Lanners and peregrines are morphologically very similar (Hutchinson ratios <1.3) and show 99% diet overlap, and both of these results predict competitive exclusion. In contrast, their use of diverse cliff substrates for breeding in different times of the season would predict coexistence. To compare these two mutually excluding hypotheses, we examined the pattern of inter-specific transitions in 88 sites that were studied for 14 years (2000-2013) using a Markov chain (MC) occupancy state model, and checked the sensitivity and elasticity of the community structure to changes in transition probabilities. During the study period, 1144 territorial transitions occurred in peregrine and lanner territories, and the MCs were predicted to converge to a stable equilibrium in 2065. Markovian analysis suggested that temporal and spatial segregation of habitat during reproduction might prevail over anatomical specialization for hunting and diet, allowing species coexistence, despite the prediction that peregrines will outnumber the lanners in future projections. Our approach combining niche-overlap analysis and species occupancy modelling led to practical information about conservation options available for the threatened lanner. Lanners are very sensitive to site abandonment, and measures increasing adult persistence in occupied territories could be more rewarding than those encouraging juvenile dispersal and colonization of new sites

Two-part investigation of the biopsychosocial model in male reproductive health: a cross-sectional investigation of the association between infertility diagnosis and emotional distress in men (part I) and a prospective controlled investigation of the effect of psychosocial stress on corticosterone, testosterone and sperm parameters in male rats (part II)

This thesis explored the interactions between psychological well-being and male fertility using the biopsychosocial model. The biopsychosocial model proposes that biological, psychological, and social processes interact and impact on health. These interrelationships were investigated in a sample of men undergoing fertility treatment and in a set of experiments using an animal model of stress. It is commonly thought that men with male factor infertility suffer more compared to men in couples with other infertility diagnoses, mainly due to the social stigma attached to being a man unable to father. The inter-relationships among diagnosis, psychological stress, and social environment were examined in men during a twelve month period of fertility treatment. It was found that men, regardless of diagnosis, showed signs of suffering over time and perceived some deterioration in their social environment that was at least partly caused by their psychological well-being at the start of treatment. To better understand how stress and reproductive processes interact, an animal stressor paradigm was developed. Male rats were exposed to a psychosocial cage change stressor (PCCS) where housing alternated every day between being alone, or in a new combination of two or three rats per cage for either 12 or 24 days. The four experiments showed that exposure to PCCS induced a mild physical stress response and consistent effects on reproductive parameters. It was concluded that the psychological and social aspects of the PCCS each have an impact on reproduction. This thesis has provided evidence of biopsychosocial links in the reproductive context supporting a biopsychosocial model of male fertility

Fast-track ruling in/out SARS-CoV-2 infection with rapid 0/1.5 h molecular test in patients with acute coronary syndromes

AIMS: Patients with acute coronary syndrome (ACS) often arrive in the catheterization (cath) lab directly from the field or an emergency department without an accurate triage for Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection.Although in the pandemic period the treatment in the cath laboratory of high-risk ACS should not be delayed because the operators wear special protection systems, the subsequent risk of contagion in a non-Covid coronary care unit could be high in the case of patients positive for SARS-CoV-2. METHODS: We tested the possibility of a fast-track protocol in 51 consecutive patients (mean age 65 ± 12 years) transferred from spokes centres or from the field to our HUB centre and admitted to our coronary care unit (CCU). Once the patient had arrived in the cath lab, the nasopharyngeal swab was performed. The real-time PCR to extract RNA for SARS-CoV-2 detection was performed with an automated rapid molecular Xpert Xpress test. Meanwhile, coronary angiography or percutaneous coronary intervention was performed if necessary. RESULTS: In this fast-track protocol, the time to perform nasopharyngeal swab was 11 ± 11 min; time spent to transport nasopharyngeal swab to the laboratory was 29 ± 20 min; time to detect viral nucleic acid was 68 ± 16 min. The overall time from the execution of nasopharyngeal swab to the result was 109 ± 26 min. The results were immediately put into the hospital computer system and made readily available. Depending on the test result, patients were then transferred to the regular CCU or Covid area. CONCLUSION: This study demonstrates that 0-1.5 h fast-track triage for coronavirus disease 2019 (COVID 19) is feasible in patients with ACS. The execution of nasopharyngeal swab in the cath lab and its analysis with a rapid molecular test allows rapid stratification of SARS-CoV-2 infection

Paleoseismic evidence of five magnitude 7 earthquakes on the Norcia fault system in the past 8,000 years (Central Italy)

Many large-magnitude faults (6.5≤ Mw ≤7.2) of the Italian Apennines are characterized by multi-century return times, so historical sources may have missed their last earthquake or other predecessors. Hence, even in Italy, where seismic catalogs are among the most comprehensive and time-extensive worldwide, there is a need for complementary studies that might fill the lack of historical information and enhance the knowledge concerning the recurrence times of destructive earthquakes. As paleoseismology is the discipline that can do this, in this study, we present results collected in five new trenches opened along the 33-km-long Norcia fault system (central Apennines) where, in addition to the historically known 1703 earthquake (Mw 6.9), we uncovered indications of four Holocene predecessor, with a recurrence time of 1,825 ± 420 years. Considering also the paleoseismic results already published on the nearby Mt Vettore fault system (2016 earthquake of Mw 6.6), we guess that now the seismic hazard of this region could be assessed more robustly