Explore the vast range of titles available.

We estimated the number of people unaware of their human immunodeficiency virus (HIV) infection in our province, Pavia (population 540 000) in Lombardy, Italy, by means of anonymous unlinked testing of 10 044 serum/plasma samples residual from clinical analyses at the outpatient clinic of Policlinico San Matteo in 2014 and 2015. Ethical and legal approval was obtained prior to study start. Samples were irreversibly anonymised, only retaining gender and 5-year age class. Five sample pools were tested for HIV using LIAISON® XL MUREX HIV Ab/Ag (DiaSorin, Saluggia, Italy). If the pool tested positive, individual samples underwent confirmatory tests, Innotest HIV Antigen mAb (Fujirebio Europe, Gent, Belgium) and HIV BLOT 2·2 (MP Diagnostics, Singapore). Among the 10 044 samples processed, eight were confirmed positive (0·08%, 95% confidence interval 0·03–0·16%), all were males and age was >50 in 3 (37·5%). If projected to the entire population of the Pavia province, this would result in approximately 1000 people unaware of their HIV infection, with age older than expected. In Italy, HIV testing is voluntary, universally free-of-charge and (upon request) anonymous. Nevertheless, this study demonstrates that it is suboptimally employed, and that new strategies and population-level actions will be needed to achieve better implementation of HIV testing and HIV control in our province.

Purpose Current conservative treatments for knee OA provide limited benefits, with symptoms relief for a short amount of time. Regenerative medicine approaches such as the use of microfragmented adipose tissue (mFAT) showed promising results in terms of durable effects and the possibility to enhance tissue healing and counteract the progression of the pathology. Nevertheless, up to today, the large part of clinical data about mFAT use refers to uncontrolled studies, especially in the surgical setting. The purpose of this study was to evaluate the effectiveness of mFAT applied in association with arthroscopic debridement (AD) for the treatment of knee OA, in terms of symptoms relief and tissue healing. Methods This study is a prospective, randomized controlled clinical trial. 78 patients affected by knee OA grade 3–4 according to KL classification were randomly assigned to AD or AD + mFAT treatment groups. Clinical, radiological and serological assessments were performed at 6 months after treatment. Additional clinical evaluation was performed at the end of the study with an average follow-up of 26.1 ± 9.5 months. VAS, KOOS, WOMAC and SF-12 were also collected at both timepoints, KSS only at 6 months. Results Treatment with AD + mFAT improved functional scores at both 6 months (KOOS-PS: + 11.7 ± 20.2 vs + 24.4 ± 22.5, in AD and AD + mFAT, respectively, p  = 0.024; KSS: + 14.9 ± 15.9 vs + 24.8 ± 23.5, in AD and AD + mFAT, respectively, p  = 0.046) and 24-month follow-ups (KOOS-PS Functional subscale: − 2.0 ± 3.5 vs − 4.7 ± 4.2, in AD and AD + mFAT, respectively, p  = 0.012). Lower T2-mapping scores were obtained in AD + mFAT-treated group in medial and lateral condyle compartments ( p  < 0.001). Slight increase was observed in the levels of a serum biomarker of cartilage deposition (PIIINP) in both groups at 6-month follow-up ( p  = 0.037). Conclusion mFAT improves functional outcome and MRI appearance when used in association with AD, therefore supporting its use in the treatment of knee OA in an arthroscopic setting.

Background and aimsDespite progress made for the diagnosis of congenital Toxoplasma infection in utero and at birth, serological follow-up in first year of life remains required to exclude or confirm congenital infection. To reduce the constraints of this follow-up, we developed a test to detect anti-Toxoplasma IgG in oral fluid.MethodsIn 362 patients referred for Toxoplasma serology oral fluid was collected on two micro-sponges in parallel to blood sampling. A pilot study on 212 patients aged >15 months (274 samples) was performed to validate sampling procedures and develop an in-house indirect ELISA for the detection of anti-T. gondii IgG in oral fluid. It was then applied to 150 children aged 0-15 months (341 samples) born from 133 women who seroconverted during pregnancy and 17 who remained seronegative. IgG on oral fluid were compared to serum IgG detected with MEIA AxSYM registered Toxo IgG (Abbott Laboratories).ResultsThe pilot study validated the acceptability and the safety of the test and the adequate duration of sampling. IgG detected in serum and in oral fluid had a parallel kinetics among newborns (correlation coefficient: 0.59, p < 0.0001), with a concordant decline in the non-infected ones (n = 110), and matching raising or stable IgG in those who were congenitally-infected (n = 23).ConclusionsCollection of oral fluid is painless and inexpensive. Our new test provides a simple and rapid method to detect anti-Toxoplasma gondii IgG and to manage newborn at risk for congenital infection. It could have many other applications in pregnant women and other groups of patients.

Background and aimsDespite progress made for the diagnosis of congenital Toxoplasma infection in utero and at birth, serological follow-up in first year of life remains required to exclude or confirm congenital infection. To reduce the constraints of this follow-up, we developed a test to detect anti-Toxoplasma IgG in oral fluid.MethodsIn 362 patients referred for Toxoplasma serology oral fluid was collected on two micro-sponges in parallel to blood sampling. A pilot study on 212 patients aged >15 months (274 samples) was performed to validate sampling procedures and develop an in-house indirect ELISA for the detection of anti-T.gondii IgG in oral fluid. It was then applied to 150 children aged 0–15 months (341 samples) born from 133 women who seroconverted during pregnancy and 17 who remained seronegative. IgG on oral fluid were compared to serum IgG detected with MEIA AxSYM® Toxo IgG (Abbott Laboratories).ResultsThe pilot study validated the acceptability and the safety of the test and the adequate duration of sampling. IgG detected in serum and in oral fluid had a parallel kinetics among newborns (correlation coefficient: 0.59, p < 0.0001), with a concordant decline in the non-infected ones (n = 110), and matching raising or stable IgG in those who were congenitally-infected (n = 23).ConclusionsCollection of oral fluid is painless and inexpensive. Our new test provides a simple and rapid method to detect anti-Toxoplasmagondii IgG and to manage newborn at risk for congenital infection. It could have many other applications in pregnant women and other groups of patients.

Background IUGR infants are thought to have impaired gut function after birth, which may result in intestinal disturbances, ranging from temporary intolerance to the enteral feeding to full-blown NEC. In literature there is no consensus regarding the impact of enteral feeding on intestinal blood flow and hence regarding the best regimen and the best rate of delivering the enteral nutrition. Methods/design This is a randomized, non-pharmacological, single-center, cross-over study including 20 VLBW infants. Inclusion criteria * Weight at birth ranging: 700–1501 grams * Gestational age up to 25 weeks and 6 days * Written informed consent from parents or guardians Exclusion criteria * Major congenital abnormality * Patients enrolled in other trials * Significant multi-organ failure prior to trial entry * Pre-existing cutaneous disease not allowing the placement of the NIRS’ probe In the first 24 hours of life, between the 48 th and 72 nd hours of life, and during Minimal Enteral Feeding, all infants’ intestinal perfusion will be evaluated with NIRS and a Doppler of the superior mesenteric artery will be executed. At the achievement of an enteral intake of 100 mL/Kg/day the patients (IUGR and NON IUGR separately) will be randomized in 2 groups: Group A (n=10) will receive a feed by bolus (in 10 minutes); then, after at least 3 hours, they will receive the same amount of formula administered in 3 hours. Group B (n=10) will receive a feed administered in 3 hours followed by a bolus administration of the same amount of formula (in 10 minutes) after at least 3 hours. On the randomization day intestinal and cerebral regional oximetry will be measured via NIRS. Intestinal and celebral oximetry will be measured before the feed and 30 minutes after the feed by bolus during the 3 hours nutrition the measurements will be performed before the feed, 30 minutes from the start of the nutrition and 30 minutes after the end of the gavage. An evaluation of blood flow velocity of the superior mesenteric artery will be performed meanwhile. The infants of the Group A will be fed with continuous nutrition until the achievement of full enteral feeding. The infants of the Group B will be fed by bolus until the achievement of full enteral feeding. Discussion Evaluations of intestinal oximetry and superior mesenteric artery blood flow after the feed may help in differentiating how the feeding regimen alters the splanchnic blood flow and oxygenation and if the changes induced by feeding are different in IUGR versus NON IUGR infants. Trial registration number NCT01341236

Objectives To assess the prevalence of the main causes of morbi-mortality in the antiphospholipid syndrome (APS) during a 10-year-follow-up period and to compare the frequency of early manifestations with those that appeared later. Methods In 1999, we started an observational study of 1000 APS patients from 13 European countries. All had medical histories documented when entered into the study and were followed prospectively during the ensuing 10 years. Results 53.1% of the patients had primary APS, 36.2% had APS associated with systemic lupus erythematosus and 10.7% APS associated with other diseases. Thrombotic events appeared in 166 (16.6%) patients during the first 5-year period and in 115 (14.4%) during the second 5-year period. The most common events were strokes, transient ischaemic attacks, deep vein thromboses and pulmonary embolism. 127 (15.5%) women became pregnant (188 pregnancies) and 72.9% of pregnancies succeeded in having one or more live births. The most common obstetric complication was early pregnancy loss (16.5% of the pregnancies). Intrauterine growth restriction (26.3% of the total live births) and prematurity (48.2%) were the most frequent fetal morbidities. 93 (9.3%) patients died and the most frequent causes of death were severe thrombosis (36.5%) and infections (26.9%). Nine (0.9%) cases of catastrophic APS occurred and 5 (55.6%) of them died. The survival probability at 10 years was 90.7%. Conclusions Patients with APS still develop significant morbidity and mortality despite current treatment. It is imperative to increase the efforts in determining optimal prognostic markers and therapeutic measures to prevent these complications.

Background and aims Antiphospholipid syndrome (APS) is a systemic autoimmune disease characterised by thrombosis, obstetric complications and the presence of anti-phospholipid antibodies such as anti-β2GPI-Abs. These antibodies may set off the coagulation cascade via several mechanisms, including the induction of tissue factor (TF) expression. Vitamin D has recently emerged as an immunomodulator that might exert an anti-thrombotic effect. Therefore, we studied serum vitamin D levels in a cohort of APS patients, as well as the effect of vitamin D in an in vitro model of APS-mediated thrombosis. Methods Serum vitamin D levels were measured in 179 European APS patients and 141 healthy controls using the LIAISON chemiluminescent immunoassay, and the levels were evaluated in conjunction with a wide spectrum of clinical manifestations. In an vitro model, anti-β2GPI antibodies were purified from four patients with APS to evaluate the expression of TF in activated starved human umbilical vein endothelial cells. The effect of vitamin D (1,25-dihydroxyvitamin D, 10 nm) on anti-β2GPI-Abs mediated TF expression was analysed by immunoblot. Results Vitamin D deficiency (serum level ≤15 ng/ml) was documented in 49.5% of our APS patients versus 30% of controls (p<0.001) and was significantly correlated with thrombosis (58% vs 42%; p<0.05), neurological and ophthalmic manifestations, pulmonary hypertension, livedo reticularis and skin ulcerations. In vitro vitamin D inhibited the expression of TF induced by anti-β2GPI-antibodies. Conclusions Vitamin D deficiency is common among APS patients and is associated with clinically defined thrombotic events. Vitamin D inhibits anti-β2GPI-mediated TF expression in vitro. Thus, vitamin D deficiency might be associated with decreased inhibition of TF expression and increased coagulation in APS. Evaluation of vitamin D status and vitamin D supplementation in APS patients should be considered.

In the core of the Sun, energy is released through sequences of nuclear reactions that convert hydrogen into helium. The primary reaction is thought to be the fusion of two protons with the emission of a low-energy neutrino. These so-called pp neutrinos constitute nearly the entirety of the solar neutrino flux, vastly outnumbering those emitted in the reactions that follow. Although solar neutrinos from secondary processes have been observed, proving the nuclear origin of the Sun’s energy and contributing to the discovery of neutrino oscillations, those from proton–proton fusion have hitherto eluded direct detection. Here we report spectral observations of pp neutrinos, demonstrating that about 99 per cent of the power of the Sun, 3.84 × 10 33 ergs per second, is generated by the proton–proton fusion process. Spectral observations of the low-energy neutrinos produced by proton–proton fusion in the Sun demonstrate that about 99 per cent of the Sun’s power is generated by this process. Sun's elusive pp neutrinos tracked down The Sun's energy output derives from a sequence of nuclear reactions that converts hydrogen into helium, most of it from the fusion of two protons (the proton–proton or pp reaction) accompanied by the release of a low-energy neutrino. These neutrinos have proved elusive: only solar neutrinos from secondary reactions had been directly observed. But here the Borexino collaboration reports observations of the pp neutrinos themselves, so providing a direct view of the principal fusion process that powers the Sun.

The B/Ca ratio in calcareous marine species is informative of past seawater CO32- concentrations, but scarce data exist on B/Ca in coralline algae. Recent studies suggest influences of temperature and growth rates on B/Ca, the effect of which could be critical for the reconstructions of surface ocean pH and atmospheric pCO2. In this paper, we present the first laser ablation inductively coupled plasma mass spectrometry (LA-ICP-MS) analyses of Mg, Sr, Li, and B in the coralline alga Lithothamnion corallioides collected from different geographic settings and depths across the Mediterranean Sea and in the Atlantic Ocean. We produced the first data on putative temperature proxies (Mg/Ca, Li/Ca, Sr/Ca, Mg/Li) and B/Ca in a coralline algal species grown in different basins from across the photic zone (12, 40, 45, and 66 m depth). We tested the B/Ca correlation with temperature proxies and growth rates in order to evaluate their possible effect on B incorporation. Our results suggested a growth rate influence on B/Ca, which was evident in the sample with the lowest growth rate of 0.10 mm yr−1 (Pontian Isl., Italy; 66 m depth) and in Elba (Italy; 45 m depth), where the algal growth rate was the highest (0.14 mm yr−1). At these two sites, the measured B/Ca was the lowest at 462.8 ± 49.2 µmol mol−1 and the highest at 757.7 ± 75.5 µmol mol−1, respectively. A positive correlation between B/Ca and temperature proxies was found only in the shallowest sample from Morlaix (Atlantic coast of France; 12 m depth), where the amplitude of temperature variation (ΔT) was the highest (8.9 ∘C). Still, fluctuations in B/Ca did not mirror yearly seasonal temperature oscillations as for Mg/Ca, Li/Ca, and Sr/Ca. We concluded that growth rates, triggered by the different ΔT and light availability across depth, affect the B incorporation in L. corallioides.