Development of a strategy to control COVID-19 in hard-to-reach migrant communities

Issue/Problem

The risk of SARS-Cov-2 infection and its adverse health effects proved to be higher among socially disadvantaged groups, including migants and ethnic minorities. Hard-to-reach (HTR) migrants, such as undocumented people, those living in informal settelments (e.g squats) or roma people have experienced severe barries to access COVID-19 information, testing and vaccination services.

Description of the problem

During 2020 and 2021, the Migrants'Health Unit of Roma 2 Local Health Unit (ASL) developed different strategies to control the COVID-19 epidemics in HTR communities, addressing both the containment of clusters in informal settelments and access to COVID-19 vaccination for these population.

Methods

A multicomponent and multidisciplinary strategy was implemented, based on a strong collaboration of different services across the ASL and with Non Governmental Organizations (NGOs). Starting from a mapping of the settlements and the identification of the main critical issues for the control of the epidemic in the target populations, interventions were carried out that included the involvement of NGOS in active surveillance, reporting of suspected cases of COVID-19 to the ASL and information to the communities, and the reorganization of health interventions (eg, swabs, epidemiological investigations, COVID-19 vaccinations) directly in HTR communities’ life places.

Results

In the period from April 2020 to February 2021, 15 outbreaks were controlled, for a total of over 4500 persons reached, and 265 COVID-19 cases identified. From July to November 2021, vaccinations were offered in outreach or with dedicated vaccination sessions, which reached 1664 people. The intervention model, based on a deep context analysis, strong multisectoral collaboration, community involvement, lays the foundations for the design of public health strategies, not only aimed at HTR populations.

Key messages

• Controlling COVID-19 in Hard- to- reach migrant populations was possible thanks to a strong collaboration between public health services and NGOs.

• Public health interventions addressed complex groups should envisage intersectoral collaborations, reorientation of services in order to meet target groups’ need and community involvement.

Association between cardiovascular disease- and inflammation-related serum biomarkers and poor lung function in elderly

Background

Cardiovascular disease (CVD) is a common comorbidity in chronic obstructive pulmonary disease (COPD) and reduced lung function is an important risk factor for CVD and CVD-related death. However, the mechanisms behind the increased risk for CVD in COPD patients are not fully understood.

Methods

We examined the association between CVD- and inflammation-related serum biomarkers, and pulmonary function in a geriatric population. 266 biomarkers related to CVD and inflammation were analyzed in blood samples from 611 subjects aged 66–86 years who participated in the Good Aging in Skåne study. Serum levels were assessed by a proximity extension assay. Pulmonary function was measured using the lower limit of normality (LLN) spirometry criteria, i.e., forced expiratory volume in 1 s (FEV1)/forced vital capacity (FVC)  <  LLN. Logistic regression models were implemented and multiple comparisons were accounted for.

Results

10.3% of the study participants fulfilled pulmonary function decline criteria according to LLN. Out of the 266 biomarkers, only plasminogen activator, urokinase receptor (PLAUR) was statistically significantly associated with decreased pulmonary function. We could not find a statistically significant association between pulmonary function decline and other biomarkers previously linked to COPD, such as interleukin 6, tumor necrosis factor and surfactant protein D.

Conclusion

We found that serum levels of PLAUR are associated with pulmonary function decline in older adults. PLAUR is activated following inflammation and promotes matrix metallopeptidase (MMP) activation and extracellular matrix (ECM) degradation. This implies that PLAUR could play a role in the early phase of COPD pathogenesis.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12014-021-09329-7.

What is the Prevalence of Low Health Literacy in European Union Member States? A Systematic Review and Meta-analysis

BACKGROUND

Many studies have shown that low health literacy (HL) is associated with several adverse outcomes. In this study, we systematically reviewed the prevalence of low HL in Europe.

METHODS

PubMed, Embase, and Scopus were searched. Cross-sectional studies conducted in the European Union (EU), published from 2000, investigating the prevalence of low HL in adults using a reliable tool, were included. Quality was assessed with the Newcastle-Ottawa Scale. Inverse-variance random effects methods were used to produce pooled prevalence estimates. A meta-regression analysis was performed to assess the association between low HL and the characteristics of the studies.

RESULTS

The pooled prevalence of low HL ranged from of 27% (95% CI: 18-38%) to 48% (95% CI: 41-55%), depending on the literacy assessment method applied. Southern, Western, and Eastern EU countries had lower HL compared to northern Europe (β: 0.87, 95% CI: 0.40-1.35; β: 0.59, 95% CI: 0.25-0.93; and β: 0.72, 95% CI: 0.06-1.37, respectively). The assessment method significantly influenced the pooled estimate: compared to word recognition items, using self-reported comprehensions items (β: 0.61, 95% CI: 0.15-1.08), reading or numeracy comprehensions items (β: 0.77, 95% CI: 0.24-1.31), or a mixed method (β: 0.66, 95% CI: 0.01-1.33) found higher rates of low HL. Refugees had the lowest HL (β: 1.59, 95% CI: 0.26-2.92). Finally, lower quality studies reported higher rates of low HL (β: 0.56, 95% CI: 0.06-1.07).

DISCUSSION

We found that low HL is a public health challenge throughout Europe, where one in every three to almost one in every two Europeans may not be able to understand essential health-related material. Additional research is needed to investigate the underlying causes and to develop remedies.

PROSPERO REGISTRATION

CRD42019133377.

Resting state connectivity within the basal ganglia and gait speed in older adults with cerebral small vessel disease and locomotor risk factors

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Basal ganglia connectivity and its role in gait is not well understood.

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Basal ganglia connectivity grouped into high and low connectivity.

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Groups were not spatially distinct within the basal ganglia.

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Lower connectivity was associated with slower gait speed.

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Association was significant after adjusting for other locomotor risk factors.

Background and Aim

The basal ganglia are critical for planned locomotion, but their role in age-related gait slowing is not well known. Spontaneous regional co-activation of brain activity at rest, known as resting state connectivity, is emerging as a biomarker of functional neural specialization of varying human processes, including gait. We hypothesized that greater connectivity amongst regions of the basal ganglia would be associated with faster gait speed in the elderly. We further investigated whether this association was similar in strength to that of other risk factors for gait slowing, specifically white matter hyperintensities (WMH).

Methods

A cohort of 269 adults (79–90 years, 146 females, 164 White) were assessed for gait speed (m/sec) via stopwatch; brain activation during resting state functional magnetic resonance imaging, WMH, and gray matter volume (GMV) normalized by intracranial volume via 3T neuroimaging; and risk factors of poorer locomotion via clinical exams (body mass index (BMI), muscle strength, vision, musculoskeletal pain, cardiometabolic conditions, depressive symptoms, and cognitive function). To understand whether basal ganglia connectivity shows distinct clusters of connectivity, we conducted a k-means clustering analysis of regional co-activation among the substantia nigra, nucleus accumbens, subthalamic nucleus, putamen, pallidum, and caudate. We conducted two multivariable linear regression models: (1) with gait speed as the dependent variable and connectivity, demographics, WMH, GMV, and locomotor risk factors as independent variables and (2) with basal ganglia connectivity as the dependent variable and demographics, WMH, GMV, and locomotor risk factors as independent variables.

Results

We identified two clusters of basal ganglia connectivity: high and low without a distinct spatial distribution allowing us to compute an average connectivity index of the entire basal ganglia regional connectivity (representing a continuous measure). Lower connectivity was associated with slower gait, independent of other locomotor risk factors, including WMH; the coefficient of this association was similar to those of other locomotor risk factors. Lower connectivity was significantly associated with lower BMI and greater WMH.

Conclusions

Lower resting state basal ganglia connectivity is associated with slower gait speed. Its contribution appears comparable to WMH and other locomotor risk factors. Future studies should assess whether promoting higher basal ganglia connectivity in older adults may reduce age-related gait slowing.

Macroalgal forest vs sea urchin barren: Patterns of macro-zoobenthic diversity in a large-scale Mediterranean study

The study aimed at contributing to the knowledge of alternative stable states by evaluating the differences of mobile and sessile macro-zoobenthic assemblages between sea urchin barrens and macroalgal forests in coastal Mediterranean systems considering a large spatial scale. Six sites (100 s km apart) were selected: Croatia, Montenegro, Sicily (Italy), Sardinia (Italy), Tuscany (Italy), and Balearic Islands (Spain). A total of 531 taxa, 404 mobile and 127 sessile macro-invertebrates were recorded. Overall, 496 and 201 taxa were found in macroalgal forests and in barrens, respectively. The results of this large-scale descriptive study have met the expectation of lower macrofauna complexity and diversity in barrens rather than in macroalgal forests, and have allowed estimating the differences in levels of diversity and the consistency of variability across Mediterranean sites. Some peculiar patterns in barrens, related to both abundance of specific taxa and to high values of beta diversity, have been evidenced.

Revision of the genus Setosella (Bryozoa: Cheilostomata) with description of new species from deep-waters and submarine caves of the Mediterranean Sea

The genus Setosella included to date six species. After revision, only four of these species were retained, i.e. S. vulnerata, S. cavernicola, S. folini and S. spiralis. The remaining two species were tentatively placed in Woodipora, W.? antilleana n. comb., and Andreella,  A.? fragilis n. comb. On the other hand, scanning electron microscopy examination of Mediterranean material, revealed the presence of three new species previously included in species complexes: S. cyclopensis n. sp. from the open-shelf, S. rossanae n. sp. from submarine caves, and S. alfioi n. sp. from deep-waters. The diagnosis of the genus was amended to include the occurrence of kenozooids in S. cyclopensis n. sp. and S. cavernicola, and of free-living ring-shaped and scorpioid colonies in S. folini and S. alfioi n. sp. All the seven species now in Setosella have present-day representatives; the geographic distribution of the genus is restricted to the NE Atlantic and adjacent seas; its stratigrafic distribution is rejuvenated to the late Tortonian-early Messinian of southern Italy and insular Greece, with only three species occasionally and discontinuously reported. All species are able to produce numerous, subsequent intramural buds and morphological differences seem to be consistently associated with exploitation of particular habitats and substrata.

A systematic review of factors influencing pregnant women’s future vaccination choices

Background

Over the last years, vaccine hesitancy has been increasing globally, leading to a decrease in vaccination coverage in several Countries, mostly in Europe. Several systematic reviews were conducted to assess the determinants of hesitancy and of vaccination choices, but none of them focused on pregnant women, which would represent an ideal population to promote correct information on vaccines.

Methods

We conducted a systematic review of studies assessing knowledge and attitudes on paediatric vaccinations, vaccination choices and their determinants among pregnant women. We searched Medline, Scopus and Web of Science, adapting search terms to the different databases, following PRISMA Statement criteria. No time limits were set.

Results

A total of 5,309 records were retrieved. After duplicates removal and title/abstract selection, 15 full texts were included in the narrative synthesis. Most studies (14/15) were quantitative surveys, 2 focused only on specific vaccines (rotavirus and HPV), 4 studies were conducted in European countries (Germany and Italy). The main factors associated with vaccine hesitancy or refusal were the fear of side effects, in particular for the most recent vaccines, the perception of a greater importance of natural immunity and a low perception of utility of vaccines, the lack of trust in health professionals, having obtained information on vaccines not from a doctor, primiparity and a low level of education (for these two last factors, with inconsistent results between studies).

Conclusions

Available evidence shows that the perceived risks and importance of vaccinations and the information received during pregnancy can influence vaccination choices of future mothers, and that the determinants of hesitancy may vary in different contexts. Pregnant women represent a key population for the implementation of interventions aimed at increasing knowledge and acceptance of vaccinations, which should be based on an analysis of the specific context.

Key messages

The perceived risks and importance of vaccinations and the information received during pregnancy can influence vaccination choices of future mothers. Interventions aimed at increasing knowledge and acceptance of vaccinations should be based on an analysis of the specific context.

Genetic services for Hereditary Cancer: a systematic review of Patient Reported Outcomes studies

Background

Genetic services for Hereditary Breast and Ovarian Cancer (HBOC) have become part of clinical and public health practice. Nevertheless, the evaluation of such services, including genetic testing and counseling, is challenging as they rarely affect health status measures (e.g. mortality and morbidity). A possible way is using Patient Reported Outcomes (PROs) i.e. subjective reports coming from patients, directly attributable to genetic services. We performed a systematic review to explore the use of PROs in HBOC genetic services.

Methods

We searched Pubmed, Scopus, and ISI Web of Knowledge for observational studies using PROs to assess standard genetic counseling (i.e. in person and individual) for HBOC.

Results

We identified ten surveys from various countries (USA n = 5; Europa n = 6), published between 2000 and 2018 and mainly conducted in Teaching hospitals and Cancer Research and Treatment Institutes (n = 9). The majority assessed pre-test counseling (n = 6) with diagnostic or predictive purpose. The most frequently measured outcomes were patient satisfaction (n = 9), adherence to recommended interventions (n = 3), information sharing with relatives (n = 3); disease risk perception (n = 2), and psychosocial distress (n = 2). Six studies adopted standardized PROs collection tools: the most common were the Genetic Counseling Satisfaction Scale and the Hospital Anxiety and Depression Scale. Questionnaires were mainly administered by post, soon after genetic counseling or up to seven years later. Overall, patients seem satisfied with genetic counseling. Nevertheless, more attention to the psycho-social aspects of genetic testing is needed.

Conclusions

PROs are very promising for the assessment of HBOC genetic services. Their routine use could provide important elements to improve the quality and the patient-centeredness of genetic services. Emerging information and communication technologies will help this process by making it easier collecting patient data.

Key messages

Precision medicine, where medical decisions are tailored to an individual’s characteristics, including the patient’s genetic profile, is becoming a paradigm for chronic diseases, particularly cancer. PROs are expected to be increasingly used as a measure of performance in order to drive the changes in how clinical genetic services, and healthcare in general, are organized, delivered and founded.

Prevalence of non-adequate health literacy in Europe: a systematic review and meta-analysis

Background

Many studies show that a low level of health literacy (HL) is associated with several adverse outcomes. The aim of this systematic review was to estimate the prevalence of non-adequate HL (NAHL) in European countries and outline the main needs for interventions.

Methods

The systematic search was performed in April 2019 and updated in June 2019. PubMed, Embase and Scopus were searched. Articles were considered eligible if they were cross-sectional studies published in English after 2000 and estimating the NAHL prevalence in European countries. Globally, 15490 articles were retrieved. Adapted Newcastle-Ottawa Scale was applied for the quality assessment. Several stratified meta-analyses were carried out. We also performed a meta-regression analysis to test the association between variables and NAHL.

Results

In total, 59 articles of heterogeneous quality were included, providing data for 98 studies to include in the proportion meta-analysis. Overall, quantitative analysis yielded a pooled NAHL prevalence of 40% (95%CI, 36%-43%). Despite the prevalence varied considerably by country, it seemed to follow a geographic gradient, with the northern countries clearly having a lower prevalence than the other European counterparts. The pooled prevalence estimates (PEs) varied significantly according to the different type of HL assessment method applied. Also, high study quality was found to be significantly associated with a reduction of NAHL in the PEs. Grouping the sample in general population, oncology patients, chronic disease patients and refugees, the meta-regression analysis showed a significantly lower prevalence of NAHL in oncology patients.

Conclusions

Although the PEs varied in relation to several factors (e.g. either among population groups, or depending on the HL assessment method), this study shows that more than one in every three surveyed participants had NAHL. Targeted strategies and coordinated policies aiming at improving HL in the Region are needed.

Key messages

Despite several variations, a significant proportion of European population has non-adequate health literacy. Targeted public health strategies of intervention are crucial to address this deficit.

Are midwives ready to fight vaccine hesitancy? First results from an Italian cross-sectional study

Background

Pregnancy is widely recognized as a ’teachable moment’ since attitudes and beliefs about childhood vaccines are not completely structured. Among healthcare workers (HCWs), midwives play a pivotal role in the maternal care pathway and should have a key role also in promoting opportunities of discussion and correct information about vaccinations.

Methods

We conducted a cross-sectional survey to assess knowledge and attitudes of a sample of Italian midwives towards vaccinations. A questionnaire was designed ad hoc and sent electronically to midwives members of the professional register of Rome.

Results

Preliminary results on data collected from 140 midwives (mean age 37.32, DS ± 11.61; mean years on the job: 11.94 DS ± 12.78) who completed the survey showed a heterogeneous level of knowledge: only 50% of the sample indicated the correct threshold of vaccination coverage for herd immunity, while safety of multiple shots and of the additives contained in vaccines was reported by 61% and 31% of respondents, respectively. Only 41% of midwives had identified the pertussis vaccine as one of the vaccinations recommended during pregnancy. Attitudes were generally positive: 84% of respondents recognized recommended vaccines as effective and 86% as one of the safest health interventions. However, vaccinations against MMR and Varicella were perceived as useful by 86% and 71% of the midwives, while 89% and 77%, respectively, would recommend them to parents (compared to 96% in case of hexavalent). Globally, 79% of respondents would agree with the introduction of mandatory vaccinations for HCWs in maternity wards.

Conclusions

Midwives show some gaps in the knowledge on vaccinations. The final results of this study will be used to build specific and tailored training programs directed to midwives involved in pregnancy management. This may help them to transfer the correct vaccination information for the empowerment and the growth of vaccine literacy.

Key messages

Pregnancy is a strategic teachable moment to influence attitudes regarding childhood vaccinations and healthcare professionals must be trained to be the vehicle of the most accurate information. Specific under- and post-graduate training courses on vaccinations directed to midwives are strongly needed to ensure good level of knowledge on this topic.

Healthcare workers and measles outbreaks in Italy: is it time to act? A systematic review

Background

Despite healthcare workers (HCWs) vaccination against measles is strongly recommended in Europe, many studies showed their low vaccination coverage and a significant involvement in hospital and community outbreaks. The aim of this systematic review was to analyze the available evidence on HCW role in measles outbreaks and identify the epidemiological characteristics of the transmission patterns related to HCW infection.

Methods

PubMed, Scopus and ISI Web of Science were searched to detect the measles outbreaks occurred in Italy and involving at least one HCW. English or Italian records were considered eligible. The quality assessment was performed using the ORION checklist. We also analyzed national or regional measles reports and the Measles outbreaks reporting forms that are annually submitted to the World Health Organization (WHO) of the period 2014-2018.

Results

Twenty-one articles were identified in the literature search and were in general of good quality. Of these, six were regional or Italian reports, two referred to one city, 13 were single outbreak reports. The national data showed that the number of infected HCWs increases with the rise of the total number of cases. A total of 72 descriptions of measles outbreaks were retrieved from the WHO reports. The vast majority was confined to the hospital or started at the hospital and spread in the community. The index cases were mainly patients seeking care for measles-related symptoms but, in the last years, a growing number of infected HCWs was identified as infection source. Similarly, the number of outbreaks with more than one infected HCW recorded a small increase over time.

Conclusions

HCWs play a critical role in measles transmission especially in hospital outbreaks, which are significantly costly and disruptive for the healthcare delivery quality and safety. Vaccination policy aiming at increasing their immunization rate is crucial to limit the virus spread and the economic impact on the institutions.

Key messages

In spite of the remarkable progress, measles elimination in Italy is far from being met and the virus transmission in healthcare settings is increasingly notified. Vaccination policies aiming at increasing HCW immunization coverages are essential.

Determinants of the intention to vaccinate with MMR among pregnant women from the City of Rome

Background

Further to the increase in measles cases reported in Italy since 2016, MMR vaccination became mandatory in 2017, leading to an increase in vaccination coverage in the Country. To guarantee sustained coverage, factors influencing the intention to vaccinate in the population should be better understood.

Methods

We conducted a cross-sectional survey to assess knowledge and attitudes on pediatric vaccinations and intention to vaccinate among pregnant women attending Antenatal Classes in Rome, through distribution of a self-administered questionnaire, which included a specific section on MMR vaccination. Multiple logistic regression analysis was performed to analyze the determinants of the intention to vaccinate with MMR.

Results

A total of 458 pregnant women attending CANs in 36 family health centers and two hospitals answered the survey. Intention to vaccinate with MMR was associated with having received information from a healthcare professional (OR 1.92, 95%CI 1.01-3.63), the perceived importance of vaccines to protect against measles (OR 4.68, 95%CI 2.48- 9.54) and rubella (OR 5.97, 95%CI 2.98-11.95), not believing in news about the risks of MMR vaccine (OR 2.75, 95%CI 1.38-5.50), and the sense of guilt in case the child should contract the disease (OR 2.56, 95%CI 1.16-5.62). Factors negatively associated with the intention to vaccinate were the use of alternative medicine (OR 0.34, 95%CI 0.16- 0.76), believing that MMR vaccine can have serious side effects (OR 0.37, 95%CI 0.00-0.29) and guilt in case of serious side effects (OR 0.40, 95%CI 0.21-0.76).

Conclusions

Fear of MMR side effects is a relevant driver of the intention to vaccinate, coupled with the perceived importance to vaccinate to protect against measles and rubella. Also the source of information plays an important role in shaping ideas on vaccines. Information and communication strategies should be promoted to increase trust in vaccines, with a direct involvement of healthcare workers.

Key messages

Fear of MMR side effects and perceived benefits of the vaccine influence the intention to vaccinate. Information and communication strategies to increase vaccination appectance involving healthcare workers are needed.

Cribrilinids (Bryozoa, Cheilostomata) associated with deep-water coral habitats at the Great Bahama Bank slope (NW Atlantic), with description of new taxa

Four cribrilinid bryozoans associated with deep-water corals (578-682 m depth) from the Great Bahama Bank slope, are described, two of them are new. The generic allocation of some species prompted us to raise the subgenera Puellina, Cribrilaria, and Glabrilaria to genus rank. The new combination Cribrilaria saginata (Winston, 2005) n. comb. is proposed. Genus Glabrilaria is reported from the NW Atlantic for the first time based on the description of Glabrilaria hirsuta Rosso n. sp. and Glabrilaria polita Rosso n. sp. The new genus Teresaspis Rosso n. gen. is erected, and Teresaspis lineata (Canu Bassler, 1928) n. comb. is proposed as its type species. The new genus Harmelinius Rosso n. gen. is erected for Cribrilina uniserialis (Harmelin, 1978). Both genera have uniserial colonies formed by slightly caudate zooids with extensive gymnocyst and a frontal shield of flattened costae. Teresaspis lineata n. comb., however, has costae with pelmatidia that are connected by few intercostal bridges and separated by intercostal spaces, four orificial costa-like processes with the proximal pair arching above the orifice, hyperstomial acleithral ovicells with a pseudoporous ooecium formed by the distal zooid or a kenozooid, two types of kenozooids (large with costate frontal shield and small with smooth shield and central opesia), and an ancestrula with costate frontal shield. Avicularia are apparently absent in this species. In contrast, the type species of Harmelinius Rosso n. gen. has costae lacking pelmatidia and which are separated by slit-like intercostal spaces. The hyperstomial cleithral ovicells have smooth ooecia with a median suture and without pseudopores, and are formed by a distal kenozooid associated with a small avicularium. Additional paired oral avicularia are occasionally present, as are large kenozooids with a central opesia. Oral spines or spine-like processes are absent. Taxonomy of the above reported cribrilinid genera is discussed in detail together with the geographic distribution of all mentioned taxa.

The Cost-effectiveness of Genetic Screening for Familial Hypercholesterolemia: a Systematic Review

BACKGROUND

Familial hypercholesterolemia (FH) is a genetic disorder that leads to elevated plasma LDL-cholesterol levels and premature coronary heart disease (CHD). An understanding of the mutations responsible for FH and the effectiveness of statins in lowering the risk of CHD in FH patients has increased interest in genetic screening strategies to improve FH diagnosis. In this study, we aimed to evaluate the cost-effectiveness of such strategies.

METHODS

We performed a systematic review of full economic evaluations that assessed the cost-effectiveness of FH genetic screening strategies. We used relevant search terms to investigate Medline, Scopus, Web of Science, the Database of Abstracts of Reviews of Effects, the Health Technology Assessment Database, and the National Health Service Economic Evaluation Database. Data extraction and assessment of the quality of the studies were performed independently by two reviewers. The key features of the included studies are summarized in a narrative synthesis.

RESULTS

We included seven economic evaluations that assessed the cost-effectiveness of genetic screening for FH, published mainly in Europe between 2002 and 2015. Most studies had a no-screening strategy as a comparator, focused on relatives of index cases with genetic or clinical diagnosis of FH (cascade screening), considered a lifetime horizon and adopted a health care payer viewpoint. Cascade screening, based on genetic testing of relatives of an index case with confirmed clinical or genetic diagnosis of FH, was shown to be cost-effective in most settings.

CONCLUSIONS

Our review confirms the cost-effectiveness of cascade genetic screening for the diagnosis of FH. Further research may be needed to assess the cost-effectiveness of cascade screening following the introduction of newly recommended therapeutic regimes and next-generation sequencing.

Retraction Note to: MIR221/MIR222-driven post-transcriptional regulation of P27KIP1 and P57KIP2 is crucial for high-glucose- and AGE-mediated vascular cell damage

The authors are retracting this article [1]. Following publication, concerns were raised with respect to some of the western blots and the authors were asked to supply the original unmodified blots.

Avalanches dynamics in reaction fronts in disordered flows

We report on numerical studies of avalanches of an autocatalytic reaction front in a porous medium. The front propagation is controlled by an adverse flow resulting in upstream, static, or downstream regimes. In an earlier study focusing on front shape, we identified three different universality classes associated with this system by following the front dynamics experimentally and numerically. Here, using numerical simulations in the vicinity of the second-order transition, we identify an avalanche dynamics characterized by power-law distributions of avalanche sizes, durations, and lateral extensions. The related exponents agree well with the quenched-Kardar-Parisi-Zhang theory, which describes the front dynamics. However, the geometry of the propagating front differs slightly from that of the theoretical one. We show that this discrepancy can be understood in terms of the nonquasistatic correction induced by the finite front velocity.

Nuclear magnetic resonance studies of DNP-ready trehalose obtained by solid state mechanochemical amorphization

(1)H nuclear spin-lattice relaxation and Dynamic Nuclear Polarization (DNP) have been studied in amorphous samples of trehalose sugar doped with TEMPO radicals by means of mechanical milling, in the 1.6-4.2 K temperature range. The radical concentration was varied between 0.34 and 0.81%. The highest polarization of 15% at 1.6 K, observed in the sample with concentration 0.50%, is of the same order of magnitude of that reported in standard frozen solutions with TEMPO. The temperature and concentration dependence of the spin-lattice relaxation rate 1/T1, dominated by the coupling with the electron spins, were found to follow power laws with an exponent close to 3 in all samples. The observed proportionality between 1/T1 and the polarization rate 1/Tpol, with a coefficient related to the electron polarization, is consistent with the presence of Thermal Mixing (TM) and a good contact between the nuclear and the electron spins. At high electron concentration additional relaxation channels causing a decrease in the nuclear polarization must be considered. These results provide further support for a more extensive use of amorphous DNP-ready samples, obtained by means of comilling, in dissolution DNP experiments and possibly for in vivo metabolic imaging.

14C BOMB-PULSE DATING AND STABLE ISOTOPE ANALYSIS FOR GROWTH RATE AND DIETARY INFORMATION IN BREAST CANCER?

The purpose of this study was to perform an initial investigation of the possibility to determine breast cancer growth rate with (14)C bomb-pulse dating. Tissues from 11 breast cancers, diagnosed in 1983, were retrieved from a regional biobank. The estimated average age of the majority of the samples overlapped the year of collection (1983) within 3σ Thus, this first study of tumour tissue has not yet demonstrated that (14)C bomb-pulse dating can obtain information on the growth of breast cancer. However, with further refinement, involving extraction of cell types and components, there is a possibility that fundamental knowledge of tumour biology might still be gained by the bomb-pulse technique. Additionally, δ (13)C and δ (15)N analyses were performed to obtain dietary and metabolic information, and to serve as a base for improvement of the age determination.

The role of the glassy dynamics and thermal mixing in the dynamic nuclear polarization and relaxation mechanisms of pyruvic acid

The temperature dependence of (1)H and (13)C nuclear spin-lattice relaxation rate 1/T1 has been studied in the 1.6-4.2 K temperature range in pure pyruvic acid and in pyruvic acid containing trityl radicals at a concentration of 15 mM. The temperature dependence of 1/T1 is found to follow a quadratic power law for both nuclei in the two samples. Remarkably the same temperature dependence is displayed also by the electron spin-lattice relaxation rate 1/T1e in the sample containing radicals. These results are explained by considering the effect of the structural dynamics on the relaxation rates in pyruvic acid. Dynamic nuclear polarization experiments show that below 4 K the (13)C build up rate scales with 1/T1e, in analogy to (13)C 1/T1 and consistently with a thermal mixing scenario where all the electrons are collectively involved in the dynamic nuclear polarization process and the nuclear spin reservoir is in good thermal contact with the electron spin system.

Clustering of branching Brownian motions in confined geometries

We study the evolution of a collection of individuals subject to Brownian diffusion, reproduction, and disappearance. In particular, we focus on the case where the individuals are initially prepared at equilibrium within a confined geometry. Such systems are widespread in physics and biology and apply for instance to the study of neutron populations in nuclear reactors and the dynamics of bacterial colonies, only to name a few. The fluctuations affecting the number of individuals in space and time may lead to a strong patchiness, with particles clustered together. We show that the analysis of this peculiar behavior can be rather easily carried out by resorting to a backward formalism based on the Green's function, which allows the key physical observables, namely, the particle concentration and the pair correlation function, to be explicitly derived.

Commensal symbiosis between agglutinated polychaetes and sulfate-reducing bacteria

Pendant bioconstructions occur within submerged caves in the Plemmirio Marine Protected Area in SE Sicily, Italy. These rigid structures, here termed biostalactites, were synsedimentarily lithified by clotted-peloidal microbial carbonate that has a high bacterial lipid biomarker content with abundant compounds derived from sulfate-reducing bacteria. The main framework builders are polychaete serpulid worms, mainly Protula with subordinate Semivermilia and Josephella. These polychaetes have lamellar and/or fibrillar wall structure. In contrast, small agglutinated terebellid tubes, which are a minor component of the biostalactites, are discontinuous and irregular with a peloidal micritic microfabric. The peloids, formed by bacterial sulfate reduction, appear to have been utilized by terebellids to construct tubes in an environment where other particulate sediment is scarce. We suggest that the bacteria obtained food from the worms in the form of fecal material and/or from the decaying tissue of surrounding organisms and that the worms obtained peloidal micrite with which to construct their tubes, either as grains and/or as tube encompassing biofilm. Peloidal worm tubes have rarely been reported in the recent but closely resemble examples in the geological record that extend back at least to the early Carboniferous. This suggests a long-lived commensal relationship between some polychaete worms and heterotrophic, especially sulfate-reducing, bacteria.

Predictive genetic testing for complex diseases: a public health perspective

From a public health perspective, systematic, evidence-based technology assessments and economic evaluations are needed to guide the incorporation of genomics into clinical and public health practice. However, scientific evidence on the effectiveness of predictive genetic tests is difficult to obtain. This review first highlights the similarities and differences between traditional screening tests and predictive genetic testing for complex diseases and goes on to describe frameworks for the evaluation of genetic testing that have been developed in recent years providing some evidence that currently genetic tests are not used in an appropriate way. Nevertheless, evidence-based recommendations are already available for some genomic applications that can reduce morbidity and mortality and many more are expected to emerge over the next decade. The time is now ripe for the introduction of a range of genetic tests into healthcare practice, but this will require the development of specific health policies, proper public health evaluations, organizational changes within the healthcare systems, capacity building among the healthcare workforce and the education of the public.

Global health, international health and public health: which relationship?

The international scientific community has recently seen a growing debate on global health, and what similarities exist between this, public health and international health. Going through the definitions of global health found in the literature, we will highlight points of contact and differences, and discuss the definition of global health provided by the Italian Network Global Health Education. Finally, we will stress the need to incorporate the global health approach in the training of future medical doctors,in particular public health specialists, with the aim of providing current and future health professionals with the skills to deal with the challenges posed by globalization at the local level.

Seismic cycles, size of the largest events, and the avalanche size distribution in a model of seismicity

We address several questions on the behavior of a numerical model recently introduced to study seismic phenomena, which includes relaxation in the plates as a key ingredient. First, we make an analysis of the scaling of the largest events with system size and show that, when parameters are appropriately interpreted, the typical size of the largest events scale as the system size, without the necessity to tune any parameter. Second, we show that the temporal activity in the model is inherently nonstationary and obtain from here justification and support for the concept of a "seismic cycle" in the temporal evolution of seismic activity. Finally, we ask for the reasons that make the model display a realistic value of the decaying exponent b in the Gutenberg-Richter law for the avalanche size distribution. We explain why relaxation induces a systematic increase in b from its value b≃0.4 observed in the absence of relaxation. However, we have not been able to justify the actual robustness of the model in displaying a consistent b value around the experimentally observed value b≃1.

Lack of Activity of Docetaxel in Soft Tissue Sarcomas: Results of a Phase II Study of the Italian Group on Rare Tumors

Purpose. The prognosis of advanced soft tissue sarcoma is poor, only a few drugs showing some activity with response rates around 15– 25%. Consequently drug development seems mandatory to improve treatment outcome. Following previous favourable EORTC experience, the Italian Group on Rare Tumors started a phase II study with docetaxel to confirm the activity of this drug in soft tissue sarcoma.

Patients and methods. Thirty-seven patients with soft tissue sarcoma resistant to at least one anthracyclinecontaining regimen were enrolled in a phase II multicenter study evaluating docetaxel 100 mg/m² in a 1-h i.v. infusion q³ weeks.

Results.Thirty-seven patients were enrolled onto this phase II study and 36 were evaluable for response. Only one partial remission was observed [2.8% with 95% confidence interval (CI) 0.1– 16.2%]. Median progression-free and overall survival were 42 and 350 days, respectively. Neutropenia and leukopenia as well as cutaneous manifestations were the most common toxicities.

Discussion. The results of this phase II study do not confirm a previous EORTC repor t on the activity of docetaxel in soft tissue sarcoma, but are consistent with other more recent phase II studies. The accumulated evidence does not justify the use of this drug in the management of patients suffering from this disease, resistant to anthracyclinecontaining regimens.

MIR221/MIR222-driven post-transcriptional regulation of P27KIP1 and P57KIP2 is crucial for high-glucose- and AGE-mediated vascular cell damage

AIMS/HYPOTHESIS

MicroRNAs (miRNAs) are a novel group of small non-coding RNAs that regulate gene expression at the post-transcriptional level and act on their target mRNAs in a tissue- and cell-type-specific manner. Herein, the relevance of MIR221/MIR222 in high-glucose- and AGE-mediated vascular damage was investigated.

METHODS

Functional studies were performed using human mature endothelial cells and endothelial progenitor cells subjected to high glucose or AGE. Quantitative real-time amplification was performed to analyse MIR221/MIR222 expression in these experimental conditions. Luciferase assay was used to identify MIR221/MIR222 targets. Functional studies were performed in vitro and in vivo in mice using gain- and loss-of-function approaches.

RESULTS

Using an in vivo mouse model we demonstrated that exposure to AGE and high glucose impaired vessel formation. Moreover, in vitro functional studies revealed that both high glucose and AGE inhibit cell-cycle progression by modulating the expression of P27KIP1 (also known as CDKN1B) and P57KIP2 (also known as CDKN1C), which encode cyclin-dependent kinase inhibitor 1B (p27, Kip1) (P27KIP1) and cyclin-dependent kinase inhibitor 1C (p57, Kip2) (P57KIP2), respectively. Crucial to AGE- and high-glucose-mediated cell-cycle arrest was the downregulation of MIR221/MIR222 expression. Luciferase assay showed that MIR221 and MIR222 specifically bind to the P27KIP1 and P57KIP2 mRNA 3'-untranslated regions, implicating P27KIP1 and P57KIP2 as MIR221/MIR222 targets. These results were confirmed by gain-of-function experiments in vitro, and by injecting mice with endothelial cells overexpressing MIR221 and MIR222.

CONCLUSIONS/INTERPRETATION

We provide evidence that high-glucose- and AGE-induced inhibition of vascular cell proliferation is controlled by MIR221/MIR222-driven post-transcriptional regulation of P27KIP1 and P57KIP2. These data add further insight to the possible contribution of miRNAs in vascular damage mediated by a high-glucose environment.

MIR221/MIR222-driven post-transcriptional regulation of P27KIP1 and P57KIP2 is crucial for high-glucose- and AGE-mediated vascular cell damage

AIMS/HYPOTHESIS

MicroRNAs (miRNAs) are a novel group of small non-coding RNAs that regulate gene expression at the post-transcriptional level and act on their target mRNAs in a tissue- and cell-type-specific manner. Herein, the relevance of MIR221/MIR222 in high-glucose- and AGE-mediated vascular damage was investigated.

METHODS

Functional studies were performed using human mature endothelial cells and endothelial progenitor cells subjected to high glucose or AGE. Quantitative real-time amplification was performed to analyse MIR221/MIR222 expression in these experimental conditions. Luciferase assay was used to identify MIR221/MIR222 targets. Functional studies were performed in vitro and in vivo in mice using gain- and loss-of-function approaches.

RESULTS

Using an in vivo mouse model we demonstrated that exposure to AGE and high glucose impaired vessel formation. Moreover, in vitro functional studies revealed that both high glucose and AGE inhibit cell-cycle progression by modulating the expression of P27KIP1 (also known as CDKN1B) and P57KIP2 (also known as CDKN1C), which encode cyclin-dependent kinase inhibitor 1B (p27, Kip1) (P27KIP1) and cyclin-dependent kinase inhibitor 1C (p57, Kip2) (P57KIP2), respectively. Crucial to AGE- and high-glucose-mediated cell-cycle arrest was the downregulation of MIR221/MIR222 expression. Luciferase assay showed that MIR221 and MIR222 specifically bind to the P27KIP1 and P57KIP2 mRNA 3'-untranslated regions, implicating P27KIP1 and P57KIP2 as MIR221/MIR222 targets. These results were confirmed by gain-of-function experiments in vitro, and by injecting mice with endothelial cells overexpressing MIR221 and MIR222.

CONCLUSIONS/INTERPRETATION

We provide evidence that high-glucose- and AGE-induced inhibition of vascular cell proliferation is controlled by MIR221/MIR222-driven post-transcriptional regulation of P27KIP1 and P57KIP2. These data add further insight to the possible contribution of miRNAs in vascular damage mediated by a high-glucose environment.