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Despite being widely recognized, the importance of deep layers thermohaline and mixing processes in the ocean circulation and variability is still poorly investigated, especially in the Mediterranean Sea. This limits understanding and parametrizing deep dynamics, which result in evident biases in the global circulation representation by observations and numerical ocean simulations. Having access to hydrological datasets, collected on a whole water column, we investigated the abyssal stratification and its variability of the Ionian Sea (Central Mediterranean). Applying multiple analyses, we found a tidal‐period oscillation and the resulting activation of mixing, pointing out that the combined effect of stratification, morphology, and tides has a key role in enhancing local diapycnal diffusivity in the deepest layers, being a mechanism that connects the whole water column with a compelling impact on the vertical transport of heat and tracers. Plain Language Summary The presence of a quasi‐homogeneous density layer in the deep sea made it possible to observe a periodic effect: the layer acts like a “cushion” that is pulled up and then readjusted in circa 12 hr, which is the period typical of tides. The fact that tides can propagate down to the sea interior impacting the deep processes, down to 3,000 m of depth, is not so straightforward to observe. The deep ocean has a very slow dynamic, and the physical‐chemical phenomena involved are still mostly unknown. Key Points Near‐full‐depth Conductivity‐Temperature‐Depth (CTD) casts data collected in the Ionian Sea with an unorthodox methodology allowed resolving tidal scale The temperature and salinity diagram depicted typical water masses for the Ionian area including a dense abyssal water mass The analyses showed a periodic pulsation and an activation of mixing in the abyssal layer due to the baroclinic internal tide

Subaqueous, asymmetric sand waves are typically observed in marine channel/canyon systems, tidal environments, and continental slopes exposed to strong currents, where they are formed by current shear resulting from a dominant unidirectional flow. However, sand-wave fields may be readily observed in marine environments where no such current exists; the physical processes driving their formation are enigmatic or not well understood. We propose that internal solitary waves (ISWs) induced by tides can produce an effective, unidirectional boundary “current” that forms asymmetric sand waves. We test this idea by examining a sand-wave field off the Messina Strait, where we hypothesize that ISWs formed at the interface between intermediate and surface waters are refracted by topography. Hence, we argue that the deflected pattern (i.e., the depth-dependent orientation) of the sand-wave field is due to refraction of such ISWs. Combining field observations and numerical modelling, we show that ISWs can account for three key features: ISWs produce fluid velocities capable of mobilizing bottom sediments; the predicted refraction pattern resulting from the interaction of ISWs with bottom topography matches the observed deflection of the sand waves; and predicted migration rates of sand waves match empirical estimates. This work shows how ISWs may contribute to sculpting the structure of continental margins and it represents a promising link between the geological and oceanographic communities.

Several coastal regions on Earth have been increasingly affected by intense, often catastrophic, flash floods that deliver significant amounts of sediment along shorelines. One of the critical questions related to the impact of these impulsive runoffs is “are flash floods more efficient in delivering non-cohesive sandy sediment along the coasts?” Here we relate flow stages (i.e., from erratic to persistent) to the grain size distribution of the suspended load, by performing a synergic analysis of in-situ river discharge and satellite-retrieved grain size distribution, from 2002 to 2014, covering the 2012 Tiber River (Italy) exceptional flood event. Our analysis shows novel and promising results regarding the capability of remote sensing in characterizing suspended sediment in terms of grain size distribution and reveals that erratic stages favour delivering of non-cohesive sandy sediment more than the persistent stages. This conclusion is supported by numerical simulations and is consistent with previous studies on suspended sediment rating curves.

ObjectiveThe impact of a screening programme on colorectal cancer (CRC) incidence in its target population depends on several variables, including coverage with invitations, participation rate, positivity rate of the screening test, compliance with an invitation to second-level assessment and endoscopists’ sensitivity. We propose a synthetic indicator that may account for all the variables influencing the potential impact of a screening programme on CRC incidence.DesignWe defined the ‘rate of advanced adenoma on the target population’ (AA-TAP) as the rate of patients who received a diagnosis of advanced adenoma within a screening programme, divided by the programme target population. We computed the AA-TAP for the CRC Italian screening programmes (biennial faecal immunochemical test, target population 50–69 year olds) using the data of the Italian National Survey from 2003 to 2016, overall and by region, and assessed the association between AA-TAP and CRC incidence fitting a linear regression between the trend of regional CRC incidence rates in 50–74 year old subjects and the cumulative AA-TAP.ResultsIn 2016, the AA-TAP at a national level was 105×100 000, whereas significant differences were observed between the northern and central regions (respectively 126 and 149×100 000) and the South and Islands (36×100 000). The cumulative AA-TAP from 2004 to 2012 was significantly correlated with the difference between CRC incidence rates in 2013–2014 and those in 2003–2004 (p=0.009).ConclusionThe AA-TAP summarises into a single indicator the potential impact of a screening programme in reducing CRC incidence rates.

We discuss here the evolution of vorticity and potential vorticity (PV) for a bottom current crossing a marine channel in shallow-water approximation, focusing on the effect of friction and mixing. The purpose of this research is indeed to investigate the role of friction and vertical entrainment on vorticity and PV spatial evolution in channels or straits when along-channel morphology variations are significant. To pursue this investigation, we pose the vorticity and PV equations for a homogeneous bottom water vein and we calculate these two quantities as an integral form. Our theoretical findings are considered in the context of in situ hydrographic data related to the Eastern Mediterranean Deep Water (EMDW), i.e., a dense, bottom water vein that flows northwestward, along the Sicily Channel (Mediterranean Sea). Indeed, the narrow sill of this channel implies that friction and entrainment need to be considered. Small tidal effects in the Sicily Channel allow for a steady theoretical approach. We argue that bottom current vorticity is prone to significant sign changes and oscillations due to topographic effects when, in particular, the current flows over the sill of a channel. These vorticity variations are, however, modulated by frictional effects due to seafloor roughness and morphology. Such behavior is also reflected in the PV spatial evolution, which shows an abrupt peak around the sill region. Our diagnoses on vorticity and PV allow us to obtain general insights about the effect of mixing and friction on the pathway and internal structure of bottom-trapped currents flowing through channels and straits, and to discuss spatial variability of the frictional coefficient. Our approach significantly differs from other PV-constant approaches previously used in studying the dynamics of bottom currents flowing through rotating channels.

A record-linkage study was carried out between the Italian AIDS Registry and 24 Italian cancer registries to compare cancer excess among persons with HIV/AIDS (PWHA) before and after the introduction of highly active antiretroviral therapy (HAART) in 1996. Standardised incidence ratios (SIR) were computed in 21951 AIDS cases aged 16–69 years reported between 1986 and 2005. Of 101 669 person-years available, 45 026 were after 1996. SIR for Kaposi sarcoma (KS) and non-Hodgkin lymphoma greatly decreased in 1997–2004 compared with 1986–1996, but high SIRs for KS persisted in the increasingly large fraction of PWHA who had an interval of <1 year between first HIV-positive test and AIDS diagnosis. A significant excess of liver cancer (SIR=6.4) emerged in 1997–2004, whereas the SIRs for cancer of the cervix (41.5), anus (44.0), lung (4.1), brain (3.2), skin (non-melanoma, 1.8), Hodgkin lymphoma (20.7), myeloma (3.9), and non-AIDS-defining cancers (2.2) were similarly elevated in the two periods. The excess of some potentially preventable cancers in PWHA suggests that HAART use must be accompanied by cancer-prevention strategies, notably antismoking and cervical cancer screening programmes. Improvements in the timely identification of HIV-positive individuals are also a priority in Italy to avoid the adverse consequences of delayed HAART use.

Background SS and LC contributed equally to this manuscript.Hypovitaminosis D is common in the general population. Although many studies on 25-hydroxyvitamin D (25(OH)D) are available on systemic lupus erythematosus (SLE), few data are reported in juvenile-onset SLE (JSLE) patients. Design This study aimed to assess serum 25(OH)D levels in JSLE patients and to identify risk factors for vitamin D deficiency in this population. Methods Forty-five Caucasian JSLE patients (36 females, nine males; mean age 18.9 ± 6.3 years) and 109 age- and sex-matched healthy controls entered the study. Dual-energy X-ray absorptiometry (DXA) scans of the lumbar spine, serum calcium and phosphate, bone-specific alkaline phosphatase (BSAP), parathyroid hormone (PTH), and 25(OH)D were assessed. The data were compared with an age- and sex-matched control group including 109 Caucasian healthy subjects. Results JSLE patients exhibited lower 25(OH)D levels than controls (p < 0.005), with the lower values observed in patients with active vs. inactive disease (p < 0.05). JSLE patients exhibited reduced total calcium levels (p < 0.001) and higher phosphate levels (p < 0.001), BSAP (p < 0.001) and PTH (p < 0.001) than controls. In addition, JSLE patients exhibited lower spine bone mineral apparent density (BMAD) SDS values than controls (p < 0.001), with higher values in patients with 25(OH)D sufficiency and insufficiency than in those with 25(OH)D deficiency (p < 0.001). Conclusions Patients with JSLE have significantly lower 25(OH)D levels than controls. Therefore, vitamin D supplementation may be useful to normalize bone mass and quality in subjects with JSLE.

BackgroundPANDAS (Pediatric Autoimmune Neuropsychiatric Disorders associated with Streptococcal Infections) identifies a subgroup of pts with unusually abrupt and dramatic TIC/OCD onset GAS infection related. PANS “Pediatric acute-onset neuropsychiatric syndrome” is a term proposed to describe a clinically distinct presentation of OCD/TIC with post infectious origin. Differently from PANDAS, in PANS other agents may trigger the disease, including Mycoplasma pneumonia, Influenza viruses, Epstein Barr virus, Borrelia Burgdorferi, Herpes simplex and Varicella viruses. Clinical presentation is characterized by an abrupt dramatic onset of OCD and additional neuropsychiatric symptoms nor explained by known neurologic or medical disorders1.ObjectivesTo describe clinical features of 23 Italian children with OCD/TIC diagnosed as PANS in comparison to our PANDAS group.MethodsBetween May 2009 through January 2016 we recruited 23 pts (13 M, 10 F) with OCD/TIC starting before puberty. The mean age at onset 77 mnths±35.6SD.Results19 (86.4%) were full-term born, 3 (13.6%) from Caesarean section (no information in 1 adopted child). 8/21 (38.1%) had familiars with OCD/tics or other neurologic diseases (2 pts without data). At onset, clinical signs were OCD in 3 (13%), OCD and motor tics in 7 (30.4%), motor tics in 5 (21.7%), vocal tics in 1 (4.3%), motor/vocal tics in 5 (21.7%), motor/vocal tics and OCD in 2 (8.7%), Mean age at diagnosis 106.8 months±36.9 SD. Antistreptolysin O and antiDNaseB titers were negative in all pts. In all EBV, Mycoplasma pneumoniae, CMV, Borrelia Burgdorferi were tested: 2 pts had history of tick bite and Borrelia Burgorferi Ab+, 6 pts Mycoplasma pneumoniae Ab+, 1 EBV Ab+; in 2 pts a VZV infectionAb+ was found. In 1 child Rotavirus infection was suspected and 12 had a viral pharyngitis before OCD/Tics onset. All underwent neuropsychiatric evaluation, none had deficit of psychological development; in all autoimmunity (ANA; antiDNA and ENA Ab) was negative as well as cerebral MR and EEG. All received antibiotic therapy according to the specific infection: pts with Mycoplasma macrolide, pts with VZV antiviral, pts with Borrelia amoxicillina. All showed benefit during and after the treatment. Pts, with no specific agent, received amoxicillina and benzathine benzylpenicillin with benefit after a more prolonged period than PANDAS pts.ConclusionsOur data show that PANS as PANDAS prediliges males with higher familiar predisposition in PANS. The age at onset is comparable to PANDAS, while OCD are more common and severe than in PANDAS. All pts had an infectious event, as PANDAS pts, but the trigger agent was different from GAS, and all responded to the specific therapy. PANDAS and PANS mainly differs from the trigger agent. The knowledge of PANS and PANDAS is mandatory to early recognize children at the disease onset avoiding to delay the diagnosis and the beginning of therapy.Acknowledgement1Chang K et al. Clinical evaluation of Youth with pediatric acute onset neuropsychiatric syndrome (PANS): recommendations from the 2013 PANS Consensus Conference. J Child Adolescent Psychopharmacology 2015:25:3–13Disclosure of InterestNone declared

BackgroundVitamin D (vitD) is known for its essential role in calcium homeostasis and bone health. It is now considered as a potent neurosteroid hormone, with a pivotal role on the brain development and normal brain function. VitD ligand-receptor, a receptor that mediates the majority of vitamin D biological actions, has been found throughout the body including the central nervous system (CNS). Vitamin D deficiency is commonly observed in patients with severe mental illness such as schizophrenia. PANDAS is an autoimmune disorder characterized by obsessive-compulsive symptoms and/or tics triggered by group-A beta-hemolytic Streptococcus infections with relapsing/remitting course due to recurrence of infections itself. Despite the action of 25-hydroxyvitamin D [25(OH)D] on immune and CNS system, to our knowledge, no studies have been performed in patients with PANDAS.ObjectivesTo evaluate 25(OH)D levels in a large cohort of children and adolescents with PANDAS 2. To compare the results with a healthy control group.MethodsWe measured plasma 25(OH)D levels in one hundred seventy-nine patients with PANDAS (49 females, 132 males, mean age at diagnosis 101.4 ±30.1 months) and an age, sex, and body mass index-matched control group of 179 subjects.ResultsPatients with PANDAS showed a higher percentage of reduced 25(OH)-vitamin D levels (<30 ng/mL) in comparison with controls (94.6% vs. 82.5%; p<0.005). In addition, PANDAS patients have lower levels of 25(OH) D than controls (20.4±6.9 vs. 24.8±7.3 ng/mL, p<0.0001). This difference has been confirmed also considering the winter (13.7±3.25 vs. 21.4±5.9) and summer (21.8±6.5 vs. 32.5±8.7) period. Yet, serum 25(OH)-vitamin D levels correlated with the number of streptococcal infections before the diagnosis (p<0.005) and with their recurrences (p<0.005).ConclusionsPANDAS patients have reduced 25(OH)D values that seem to be associated with streptococcal infections, and the probability of its recurrences. So, reduced 25(OH)D levels may be a cause significantly important in PANDAS etiopathogenesis. A regular supplementation of VitD in PANDAS patients is recommended as it should improve the course of the disease and prevent or reduce the recurrences of infections and the relapses of neurological symptoms. This hypothesis should be further explored in future studies.Disclosure of InterestNone declared