The distinctive effect of different insect powders as meat extenders in beef burgers subjected to cooking and in vitro gastrointestinal digestion

Mealworm (MWP), migratory locust (LP), and house cricket (CP) are novel foods recently authorized by the European Commission. This work tested their powders as meat extenders at 5% inclusion in beef burgers. Insect powders were abundant in phenolics, recording the highest values in LP (1184.9 μg/g). The sensory analysis highlighted a higher visual and olfactory acceptability for MWP-burgers, followed by CP- and LP-burgers, whereas the texture of cooked burgers remained unaffected. Following pan-cooking, MWP-burgers and control exhibited comparable chemical profiles, while a significant down-accumulation of the heterocyclic amine 2-Amino-3,8-dimethylimidazo[4,5-f]quinoxaline was observed in CP-burgers. In vitro gastrointestinal digestion highlighted metabolomic trends like control for MWP- and LP-burgers. In contrast, a reduced accumulation of lipids and increased content of dipeptides like glutaminylarginine (possibly acting as enzyme modulators) was observed for the CP-burgers.

Replacement of nitrates and nitrites in meat-derived foods through the utilization of coagulase-negative staphylococci: A review

Nitrates and nitrites, which are synthetic additives, are traditionally used as curing agents in meat-based products. These synthetic additives are employed in the preparation of fermented meat foods to improve quality characteristics and microbiological safety, develop distinct flavours and red-colour stability, and counteract lipid oxidation. Nitrites also display significant bacteriostatic and bactericidal action against spoilage microorganisms and foodborne pathogens (such as Clostridium botulinum and Listeria monocytogenes). However, meat curing is currently under scrutiny because of its links to cardiovascular diseases and colorectal cancer. Based on the current literature, this review provides recent scientific evidence on the potential utilisation of coagulase-negative staphylococci (CNS) as nitrate and nitrite substitutes in meat-based foods. Indeed, CNS are reported to reproduce the characteristic red pigmentation and maintain the typical high-quality traits of cured-meats, thanks to their arginine degradation pathway, thus providing the nitrite-related desirable attributes in cured meat. The alternative strategy, still based on the NOS pathway, consisting of supplementing meat with arginine to release nitric oxide (NO) and obtain a meat characterised by the desired pinkish-red colour, is also reviewed. Exploiting NOS-positive CNS strains seems particularly challenging because of CNS technological adaptation and the oxygen dependency of the NOS reaction; however, this exploitation could represent a turning point in replacing nitrates and nitrites in meat foods.

Reuterin, Phenyllactic Acid, and Exopolysaccharides as Main Antifungal Molecules Produced by Lactic Acid Bacteria: A Scoping Review

The primary goal of this scoping review is to collect, analyze, and critically describe information regarding the role of the main compounds (reuterin, phenyllactic acid, and exopolysaccharides) produced by LAB that possess antifungal properties and provide some suggestions for further research. The use of lactic acid bacteria (LAB) to mitigate spoilage and extend the shelf life of foodstuffs has a long history. Recently, there has been a growing interest in the unique properties of these additions to the foodstuffs in which they are applied. In recent studies regarding biopreservation, significant attention has been given to the role of these microorganisms and their metabolites. This fascinating recent discipline aims not only to replace traditional preservation systems, but also to improve the overall quality of the final product. The biologically active by-products produced by lactic acid bacteria are synthesized under certain conditions (time, temperature, aerobiosis, acidity, water activity, etc.), which can be enacted through one of the oldest approaches to food processing: fermentation (commonly used in the dairy and bakery sectors). This study also delves into the biosynthetic pathways through which they are synthesized, with a particular emphasis on what is known about the mechanisms of action against molds in relation to the type of food.

The effect of common duckweed (Lemna minor L.) extract on the shelf-life of beef burgers stored in modified atmosphere packs: A metabolomics approach

The impact of duckweed extracts (DEs) on the shelf-life of packaged beef burgers was evaluated through classical assays and untargeted metabolomics. Beef burgers were formulated with an antioxidants-free control (CON), 1 g/kg sodium ascorbate (ASC), and increasing levels of a DEs, namely 1 (DE1), 5 (DE5), and 10 (DE10) g/kg, packaged under modified atmosphere and stored at 4 °C for 19 days. The DEs, abundant in phytochemicals, determined no issues with the hygienic status of the product. DEs modulated the redox status, being ineffective in preserving linolenic acid from peroxidation. However, the oxidation marker 2-nonenoic acid was down-accumulated in the DE10 sample following 19 days of storage, recording a lower glutathione:glutathione disulfide ratio. The accumulation of adipate semialdehyde revealed the inefficiency of DEs in coping with protein oxidation, while DEs prevented the accumulation of biogenic amines. Therefore, this work suggests a potential pro-oxidant role of the formulated DEs.

(Re)thinking the city of proximity for Salutogenic purposes

As centres of population and human activities, nowadays urban environments are simultaneously the main cause of and solution to a growing number of health-related challenges. In this setting, COVID-19 pandemic has helped reiterate this and serves as a wake-up call and an opportunity to rethink the way we approach cities. Aim of this paper is to research what today seems the most promising urban model for long-term individual and global resilience: the “city of proximity”, namely about inclusive walkable and cycling environments where people can access all basic destinations within reasonable times and distances from home. Therefore, urban proximity dimension, methodological approach and urban features and functions become the main subject of a quanti-qualitative matrix of comparison of five international case studies centred on the topic, by which it is possible to set out general criteria for such model, along with a methodology to measure all cities in its respect. As a result, residential density, functional mix, pedestrian surface, cycle routes, public transport stops, green areas, schools, cultural facilities, sport facilities, retail services and urban gardens make up the fix components of a comprehensive set of 11+n urban features, whose occurrence is investigated through GIS-based analysis within designated distance ranges, creating a comprehensive assessment framework that is adjustable to all urban contexts worldwide. In the end, the application of such framework to the city of Milan finally helps to validate its effectiveness in providing a picture of city-wide accessibility to proximity services, and in highlighting the value of integrated analysis in view of shaping public policies and informed planning choices which put health and sustainability at the centre.

Bridging Epidemiological Data with Features of the Urban Context: An experience of Urban Public Health within the City of Milan, Italy

Referring to the Research Project “Enhancing Healthcare and Well-Being Through the Potential of Big Data: An Integration of Survey, Administrative, and Open Data to Assess Health Risk in the City of Milan with Data Science” the Authors present preliminary results regarding a survey distributed to a sample of citizens across all neighborhoods of Milano city. This survey sought to collect data regarding health risk factors of this population, including both individual (e.g. socio-demographic characteristics, behaviors, etc.) and community (e.g. environmental/morphological features, available social services, etc.) data. A digital survey was designed to collect information on the health conditions, risk factors, and lifestyle characteristics of a representative sample of the Milanese population at the neighborhood level, with reference to the census tracts and Local Identity Units (NIL). Collected survey data are entered into a system containing corresponding individual health information acquired from the Local Health Authority databases, creating a synthesized information profile with each respondent's state of health, including existing conditions, health services used, and drug therapies. The disseminated survey was developed from comparisons with similar experiences at the national/international level and divided into 60 multiple choice questions (6 for Sociodemographic profile; 8 for Context of residence; 12 for Functional limitations; 25 for Behaviors and lifestyles; 9 for Access to health services). The data from urban analysis conducted on the NIL of the City of Milan are assessed with particular reference to the theme of bicycle-pedestrian accessibility (Walkability) in the urban context and repercussions on the adoption of Healthy Lifestyles. The models developed through this research are expected to provide critical insight for designing health promotion, health protection, and disease prevention interventions aimed both at individual and community level.

O-192 Concomitant autoimmunity in endometriosis-affected women and In Vitro Fertilization (IVF) outcomes: a cohort study

Study question

To evaluate whether the presence of concomitant autoimmunity in endometriosis patients may affect In Vitro Fertilization (IVF)/Intracytoplasmic Injection (ICSI) outcomes.

Summary answer

In ‘normo-responders’ patients autoimmunity did not affected ovarian response to gonadotrophin stimulation yet was the only significant negative predictor of cumulative pregnancy rate (CPR).

What is known already

In the last years, endometriosis has been redefined as a multifactorial disease with a complex pathogenesis. In this setting, a role of both innate and adaptive immune systems have been proposed in endometriosis development. The coexistence of endometriosis and autoimmunity is well-documented. Also, an increased risk of more severe stages of endometriosis in patients with autoimmunity has been recently reported. Even if autoimmunity has been associated with lower pregnancy rates and higher miscarriage rates, whether the presence of autoimmunity in endometriosis patients could act as an additive factor worsening IVF/ICSI response is still not known.

Study design, size, duration

Single-center, retrospective, cohort study. First IVF/ICSI cycles of endometriosis patients with or without autoimmunity carried out from 2007 to 2021 at the Fertility Unit of IRCSS San Raffaele Hospital(Milan) were included. Patients with endometriosis and concomitant autoimmunity were age-matched to endometriosis only controls. Only patients with a complete disease control following endometriosis treatment were admitted to IVF/ICSI. A total of 471 patients were enrolled. The study was conducted according to STROBE guidelines for observational studies.

Participants/materials, setting, methods

Endometriosis diagnosis was surgical/histopathological, yet also ovarian endometriosis at ultrasound assessment by expert operators was included. Autoimmunity was assessed by blood tests for auto-antibodies and/or rheumatological records. Stratified analysis by “expected” ovarian response at baseline according to AFC and/or AMH were performed. Expected ‘poor-responders’ were defined according to Bologna Criteria. The primary outcome was CPR. Secondary outcomes included oocytes retrieved, metaphase II(MII)oocytes and ovarian sensitivity index(OSI), the latter defined as:(number of retrieved oocytes/total gonadotrophin dose)×1000.

Main results and the role of chance

113/471 cases with endometriosis and concomitant autoimmunity and 358/471 age-matched endometriosis only controls were enrolled. The mean age was 35.70±3.75 and 35.95±3.72 (p = 0.543) in cases and controls respectively. No baseline differences in endometriosis disease stage (p = 0.414), surgical treatment for endometriosis prior to IVF (p = 0.617), BMI (p = 0.866) or type of infertility (p = 0.255) were observed when comparing the two groups. In “expected normo-responders”, cases with autoimmunity had significantly higher numbers of oocytes retrieved (p = 0.007), MII oocytes (p = 0.007) and OSI index (p = 0.013) when compared to controls with endometriosis only; the CPR was 12.5% in cases vs. 17.5% in controls, thus comparable between the two groups (p = 0.143). In “expected poor-responders” no significant differences were observed neither in the number of oocytes retrieved and MII oocytes, nor in OSI index; the CPR was 12% in cases with concomitant autoimmunity compared to 7.75% in controls with endometriosis only (p = 0.256). In the generalized linear models (GLMs) of independent predictors associated with CPR, in expected ‘normo-responders’ autoimmunity was the only significant negative predictor of CPR (p = 0.004) whereas in ‘poor-responders’ only age negatively affected CPR (p = 0.001).

Limitations, reasons for caution

This study has a retrospective design. The interpretation of results is based on the validated yet still debated definition of poor-responders according to Bologna Criteria. Results should be interpreted with caution until replicated by future research providing multi-centric and prospective design, larger sample size and more standardized data collection.

Wider implications of the findings

Autoimmunity does not seem to impact neither ovarian reserve nor ovarian response to gonadotropin, as it may act a ‘competitive’ rather than ‘additive’ risk factor for infertility in endometriosis. However, in ‘normo-responders’ autoimmunity seems to reduce the chances of pregnancy following IVF/ICSI perhaps impairing endometrial receptivity and embryo implantation.

Trial registration number

Due to the retrospective design of the study, full IRB approval at the institution was not needed.

Strategies for Nitrite Replacement in Fermented Sausages and Effect of High Pressure Processing against Salmonella spp. and Listeria innocua

The development of nitrite-free meat products is a current industrial concern. Many efforts have been attempted to replace the nitrite effect in cured meats colour formation and pathogens control. Our previous work evidenced that lactic acid and a cold ripening were the best hurdle technologies for nitrite-free fermented sausages from metabolomics. In the first part of this work, we investigated the effect of lactic acid compared with both two alternative additives (glucono-D-lactone and a mix of sodium di-acetate/sodium lactate) and with low-nitrite sausages, all of them following either cold or traditional ripening. For this purpose, microbiological analysis, pH, water activity (aw), and a sensory study were performed. All nitrite-free sausages (cold or traditional ripened) showed quality and safety traits similar to low-nitrite traditionally ripened ones used as control. In addition, sensory study revealed that sausages with lactic acid were the most preferred cold ripened samples, supporting that this is an optimal strategy for the production of nitrite-free sausages. We selected this product for further studies. Indeed, in the second part, we evaluated the impact of ripening, and other hurdle technologies as High Pressure Processing (HPP) and under-vacuum storage against Listeria innocua and Salmonella spp. by a challenge test. Maximal declines were obtained for ripening along with HPP (i.e., 4.74 and 3.83 log CFU/g for L. innocua and Salmonella spp., respectively), suggesting that HPP might guarantee nitrite-free sausages safety. Although the quality of raw materials remains essential, these hurdle strategies largely contributed to nitrite-free sausages safety, offering a promising tool for the meat industry.

Urban Green Spaces and Public Health Outcomes: a systematic review of literature

Background

As stressed by COVID-19 pandemic, urbanicity might represent a risk factor for chronic non-communicable diseases or generally impacting on healthy lifestyle, among them physical activity.

Methods

In light of this, we performed a systematic review aimed to explore the association between urban greenspaces and two important health indicators for both mental and physical health. In particular, our aims were to analyze the association between publicly accessible urban greenspaces exposure, and mental health outcomes (MH) and objectively-measured physical activity (PA). The review was conducted from 2000/01/01 to 2020/09/30 searching in two electronic databases: PubMed/Medline and Excerpta Medica dataBASE (EMBASE). Only articles in English were included.

Results

Out of 356, a total of 34 studies were included in our review, of which 19 assessed MH outcomes, the remaining dealt with PA. Only a few included studies found a non-effect or a negative effect on MH outcomes, whereas, all the others demonstrated a positive effect of urban greenspace and both MH and PA. However, our results stressed not only the importance of green space presence, but also the importance of maintenance, renovation, closeness to residential areas, the presence of interactive activities, and perceived security aspects.

Conclusions

To conclude, even some methodological limitations of the included studies, results are concordant in demonstrating that urban greenspaces show potentially beneficial effects on mental health and physical activity. Our results are significant for public health experts and policymakers involved in urban planning, community health promotion, and improvement of health and social equity.

Key messages

Urban green spaces are important factors, impacting on both physical and mental health. Policymakers involved in urban planning should pay more attention in urban green spaces.

The city of proximity as an Urban Health strategy for the post pandemic neighborhood’s needs

The lockdown due to the pandemic has prevented travels, forcing many people to work at home and reducing the possibility of accessing services in the territory. This condition has further highlighted the importance of urban living areas capable of satisfying basic needs within a reasonably easy range of accessibility. The concept of the “15 minutes city” is a useful vision to represent the city of proximity, where it is possible to meet the needs for sustainable, fair, quality, and healthy living. However, even if the objectives represented are fundamental, the model it proposes - accessibility within 15 minutes - is not always applicable in all urban contexts, mostly peripheral, peri-urban, or low-density ones. This dimension of proximity - to be defined from time to time according to urban contexts - can be central to formulating strategies to improve the quality of urban life. Still, it can also play a role in constructing forms of intervention to improve public health and in ordinary conditions, both in extraordinary and emergency conditions. From this point of view, a proximity area can be an area to be defined with a variety of tools typical of urban analysis but fed by overlapping layers that also refer to the health dimension. A place of proximity, therefore not only defined based on the physical characteristics and people's uses, but also based on the data collected from a public health perspective in which it is also possible to try to test different types of information and build the conditions to suggest suitable policies and projects. Aim of the authors is to illustrate a survey about several case studies considered virtuous at the international level, analyzed in detail to highlight the main urban and architectural features of those healthy experiences and the related health outcomes, such as sedentary lifestyle reduction, increase of the attractiveness of places, reduction of air and noise pollution.

Healthy Design and Urban Planning Strategies framing the SDG 11 Sustainable Cities and Communities

According to the “Urban Health Rome Declaration” at European meeting “G7 Health” that defines the strategic aspects and actions to improve Public Health into the cities, and referring to the Agenda 2030 in which the 11th SDG argue about “Sustainable Cities and Communities. Make cities and human settlements inclusive, safe, resilient and sustainable”, one of the most expressive syntheses of the challenging relationship between urban planning and Public Health is stated by WHO (2016): “Health is the precondition of urban sustainable development and the first priority for urban planners”. Referring to the Healthy Cities & Urban Health definitions, we can consider Public Health not merely an aspect of health protection and promotion, but an individual and collective condition, strongly influenced by the environmental context and by the strategies implemented by local Governments. The “Health in All Policies” strategy, clearly underlines how health doesn't depend only on the supply of the healthcare services, but also, on the quality of outdoor and indoor living environments. Aim of the Presentation 3 is the share the findings of a literature review about the link between the urban contexts' morphological and functional features; the results are divided into: 14 Health Outcomes, representing the main Non-Communicable Diseases (NCDs) whose come from the urban environment's quality and by the adoption of healthy lifestyles; 8 types of Environmental Risk Factors (Urban Heat Island Effect; soil/air/acoustic/light pollution; vehicular traffic; Safety & Security; weak attractiveness of places); and 14 Healthy Urban Planning Strategies (green/blue/grey infrastructures; biodiversity protection; adverse meteoric events management; public transport systems; vehicular traffic reduction; pedestrian and cycling paths; social and functional mix; urban solid waste's management; renewable energy and efficiency; outdoor spaces lighting; Design for All).

P–349 Does concomitant autoimmunity affect IVF/ICSI outcomes in women with endometriosis? A retrospective observational study

Study question

To investigate differences in In Vitro Fertilization (IVF)/Intracytoplasmic Sperm Injection (ICSI) outcomes between endometriosis women who do or don’t have a concomitant autoimmune disease.

Summary answer

Despite a higher oocyte yield, a trend for reduction in clinical pregnancy rates was observed in the autoimmunity group compared to women without concomitant autoimmunity.

What is known already

Endometriosis is an inflammatory chronic gynaecological disorder with a known detrimental impact on fertility. Endometriosis pathogenesis is still unclear. It has been postulated a role of both innate and adaptive immune system. The coexistence of endometriosis and autoimmunity is a well-documented occurrence Some recent findings have revealed an increased risk to have concomitant autoimmune disease in women with endometriosis, but no study has so far investigated whether this association could affect IVF/ICSI outcomes. Indeed, autoimmune phenomena, including proinflammatory cytokines and auto-antibody production, may result in diminished quality of oocytes/embryos with lower pregnancy rates among these patients.

Study design, size, duration

This was a retrospective observational study carried out at the Fertility Unit of IRCSS San Raffaele Hospital (Milan). We reviewed medical patients’ notes of women with a confirmed diagnosis of endometriosis who referred to our Fertility Unit from October 2018 to January 2021.

Participants/materials, setting, methods

Out of 1441 patients undergoing IVF/ICSI, 98 women had surgical/histopathological diagnosis of endometriosis. 25 of them had a clinical and/or serological diagnosis of autoimmunity. Autoimmunity was assessed by clinical data (blood tests for auto-antibodies or rheumatological records) obtained from the electronic patient files stored in the database of our Fertility Centre. Clinical pregnancy was defined as the presence of at least one intrauterine gestational sac with a viable embryo at week 6 after transfer.

Main results and the role of chance

25/98 (25.5%) endometriosis women with a concomitant autoimmune disease (cases) were compared with 73/98 (74.5%) endometriosis patients without autoimmunity (controls). The mean age was 37.36±3.63 and 36.93±3.79 (p=.623) in cases and controls respectively. The mean number of oocytes retrieved was higher in cases (5.78±4.07) than in controls (3.82±2.69;p=.041); similarly, cases showed an higher number of embryos (2.13±1.93 vs. 1.19±1.37;p=.041) and blastocysts (1.89±2.02 vs. 0.85±1.61;p=.041) obtained. A total of 47 fresh embryo transfer (ET) were performed. Considering all the endometriosis patients, the clinical pregnancy rate (CPR) per cycle was 34.0% (16/47); when stratifying for the presence of autoimmunity the CPR was 23.1% (3/13) in cases, and 38.2% (13/34) in controls (p=.494).

Limitations, reasons for caution

This is a retrospective study based on data extraction from electronic records of our Fertility Centre. The sample size is limited and some information about past medical history could be missed. Results should be interpreted with caution until validated by future research providing more standardized data collection.

Wider implications of the findings: Despite significantly higher numbers of oocytes retrieved and embryos/blastocysts formed, the presence of concomitant autoimmune disease in patients with endometriosis may impair pregnancy rates. Whether this finding is confirmed and whether it could be due to a defect in embryo/blastocysts quality or in endometrial receptivity deserves further studies.

Trial registration number

Not applicable

Do we trust scientific evidence? A multicentre retrospective analysis of first IVF/ICSI cycles before and after the OPTIMIST trial

STUDY QUESTION

Has the practice of individualizing the recombinant-FSH starting dose been superseded after the largest randomized controlled trial (RCT) in assisted reproduction technology (ART), the OPTIMIST trial?

SUMMARY ANSWER

The OPTIMIST trial has influenced our ART daily practice to a limited degree, but adherence is still generally poor.

WHAT IS KNOWN ALREADY

Although the 'one size fits all' approach has been discouraged for decades by most authors, the OPTIMIST study group demonstrated in a large prospective RCT that, in general, dosage individualization does not improve the prospects for live birth, although it may decrease ovarian hyperstimulation syndrome (OHSS) risk in expected high responders.

STUDY DESIGN, SIZE, DURATION

Retrospective analysis of all first in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) cycles from 1st January 2017 to 31st December 2018, before and after the OPTIMIST publication on November 2017.

PARTICIPANTS/MATERIALS, SETTING, METHODS

Two thousand six hundred and seventy-seven patients, between 18 and 42 years old, undergoing their first IVF-ICSI cycle in seven Italian fertility centres, were included. Patients were allocated to three groups according to their ovarian reserve markers: predicted poor ovarian responders (POR), predicted normo-responders (NR) and expected hyper-responders (HRs).

MAIN RESULTS AND THE ROLE OF CHANCE

Between 2017 and 2018, there was an overall increase in prescription of the standard 150 IU dose proposed by the OPTIMIST trial and a reduction in the use of a starting dose >300 IU. After subgroup analysis, the decrease in doses >300 IU remained significant in the POR and NR sub-groups.

LIMITATIONS, REASONS FOR CAUTION

The retrospective nature of the study. Physicians need time to adapt to new scientific evidence and a comparison between 2017 and 2019 may have found a greater impact of the Optimist trial, although other changes over the longer time span might have increased confounding. We cannot be sure that the observed changes can be attributed to knowledge of the OPTIMIST trial.

WIDER IMPLICATIONS OF THE FINDINGS

Clinicians may be slow to adopt recommendations based on RCTs; more attention should be given to how these are disseminated and promoted.

STUDY FUNDING/COMPETING INTEREST(S)

No external funding was used for this study. E.P. reports grants and personal fees from MSD, grants from Ferring, from IBSA, grants and personal fees from Merck, grants from TEVA, grants from Gedeon Richter, outside the submitted work. E.S. reports grants from Ferring, grants and personal fees from Merck-Serono, grants and personal fees from Theramex, outside the submitted work. All other authors do not have conflicts of interest to declare.

TRIAL REGISTRATION NUMBER

Not applicable.

From building regulations and local health rules to the new local building codes: a national survey in Italy on the prescriptive and performance requirements for a new performance approach

BACKGROUND

World Health Organization has highlighted the need to strengthen the relationship between health and built environment factors, such as inappropriate housing conditions. Building Regulations and Local Health Rules provide safety and building hygiene in construction practices. Currently the Italian Government is giving rise to a Building Regulation Type and the paper aims to verify the present contents of recent innovative Local Health Rules and Building Regulations of several Italian municipalities for supporting the performance approach of the future Building Regulations including hygienic issues.

METHODS

The analysis examines both Building Regulations and Local Health Rules of a sample of about 550 cities, analysing some specific fields of interest: urban field, outdoor issues, housing features, housing restrictions, and qualitative aspects.

RESULTS

The analysis focuses on some specific aspects defining the general data reported in Building Regulations and Local Health Rules, in particular around surfaces, heights, lighting and aeration ratio, basements and semi-basements, gas radon, building greenery, etc.

CONCLUSION

The investigation permitted to have a wide vision on the present State of the Art in order to highlight some innovative aspects and design approaches of Building Regulations and Local Health Rules. New perspectives in the new regulations should have a performance approach, starting also from the recent SARS-CoV-2 pandemic.

A proposal of hygienic and sanitary standards for the new Building Code in Italy

The traditional emphasis of Public Health on the type and quality of housing today merges with other wider determinants of health such as: the neighbourhood, the community and the "place" where a home is located, but also the policies that make access to a healthy home within everyone's reach. At the neighbourhood scale, context-related aspects heavily influence the internal quality and real usability of the buildings themselves, with particular reference to factors such as the quality of the site, the relationship between the building and the context, the presence and quality of the greenery and open spaces surrounding the building, as well as all measures that make it possible to reduce the building's impact on the environment, to protect it against environmental pollution, and to manage the building in an integrated manner for maintenance purposes. Creating healthy living environments means referring to the different dimensions mentioned above, and this not only requires the attention of Public Health operators, but also implies an integration of vision and objectives among various professional skills and competences that puts health at the center of all policies. This proposal, which starts from the analysis of existing local hygiene regulations and scientific literature, aims to take stock of a number of areas considered fundamental for the assessment of building hygiene aspects, with particular reference to the eco-sustainability of buildings and adaptation to climate change. The aspects identified can be considered as a starting point for the preparation of integrated building and hygiene regulations based on documented effective practices for the protection of Public Health.

Genome-Assisted Characterization of Lactobacillus fermentum, Weissella cibaria, and Weissella confusa Strains Isolated from Sorghum as Starters for Sourdough Fermentation

Sourdough fermentation of bakery products is a well-established and widespread technique to confer an added value to the resulting food. In recent decades, gluten-free raw materials have gained more attention due to the diffusion of food disorders such as coeliac disease, but, at the same time, they present difficult manipulation and scarce technological properties because of the absence of gluten. For this reason, the present work was aimed at selecting starter cultures for sourdough application that are isolated from fermentation of sorghum flour. Three isolates of Lactobacillus fermentum, Weissella cibaria, and Weissella confusa were selected for the following properties: exopolysaccharide synthesis, acidification, CO2 production, and amylase activity. The investigated phenotypic characteristics were confirmed by genomic analyses, which also highlighted other potentially beneficial features for use in bakery products employment. These strains, together with bakery yeast, were used for bread preparation using sorghum and wheat flour and after 24 h of fermentation the resulting dough was analyzed to assess the improvement of its characteristics. The presence of lactic acid bacteria (LAB) had a great impact on the final dough, and the best preparation, from a rheological point of view, resulted in one made of sorghum and wheat flour with added LAB and bakery yeast, whose resulting characteristics were similar to all wheat flour doughs. The results of this study suggest a potential application of the selected starters in sorghum composite bread and should be validated with data from large-scale pilot tests conducted in industrial bakeries.

New competences to manage Urban Health: Health City Manager core curriculum

Health as a common good is a prior essential objective to be pursued by an alliance including citizens and local administrations. Role of cities in health promotion is emphasized by urbanization, entailing 70% of the global population living in urban areas. Cities are therefore perfect laboratories within which to act: studying and monitoring dimensions that determine the level of quality of life in cities, improving their sustainability and capacity for growth, is fundamental for a new governance model able of managing this complexity. Under the premises, the Health City Manager (HCM) has been launched, a professional gaining skills in PH management, sociology of communities, urban design and control in reducing health inequalities. A course lasting 80 hours gives then the opportunity to put into practice, at municipal level, knowledge, competences and abilities achieved. In the background, both the former EU Commissioner for Health and the Committee of the Regions warmly supported the establishment of HCMs, who would coordinate a process ensuring alignment of policies on a macro and micro scale. During G7 in 2017, Ministry for Health and Presidency of Italian Municipalities signed the Urban Health Rome Declaration, underlining the need for a stronger synergy facilitated by HCMs. In 2019, Ministry of Youth and Sport approved and financed the project. On the basis of a core curriculum, validated by a group of experts, the course is starting in 2020 for the first 120 HCMs. Innovation lies in the holistic approach, a multidisciplinary project managing method overcoming silos logic. Customization of public policies and participatory process make the figure ideal to be applied in all countries. Sustainability is ensured by a relatively high return on investment. Main impact relates to improvement of the quality of life through a full involvement and accountability of local administrations; contrast of climate change identifying strategies of urban resilience.

Key messages

Improvement of the quality of life through a full involvement and accountability of local administrations. Contrast of climate change identifying strategies of urban resilience.

Urban health and Physical Activity: how urban design can improve cycling

Introduction

It is well-known that physical inactivity is among the main risk factors that increases chronic degenerative diseases. The emergency is relevant in urban contexts, where, most transfers have a distance of less than 5 km, easily done by foot or bicycle. They would ensure an adequate daily physical activity. An increase of cycling would also lead to several other positive effects on the urban environment (air quality, less traffic, noise, etc.). Therefore, it is necessary to investigate which characteristics of the cycling and walking infrastructures encourage or not adequate lifestyles.

Methods

Starting from an analysis of the State of the Art related to the correlation among active transport, physical activity and health, a questionnaire was handed out to collect data on the current level of urban cycling and to quantify the expected increase in case of the improvement of the bicycle path network. The questionnaire was circulated through on-line and paper forms (1675 users), for a period of 3 months in the city of Milan. The aim was to quantify the increase in physical activity related to a provisional improvement of the infrastructures.

Results

The data collected subdivided into 9 districts show that the choice to use the bicycle, as an active means of transport, would significantly increase both in frequency and in duration: for example in the expected scenario 76.5% of the sample (over 21% more than the current one) would reach 150 minutes of physical activity per week, as WHO suggests. The main reasons for daily use or non-use of the bicycle were also identified.

Conclusions

The survey conducted highlighted the direct correlation between urban planning and active mobility. Actions related to mobility redesign, especially small-scale ones, could play a key-role in reducing physical inactivity with positive effects on health. The methodology could be replicated in other realities in order to highlight the specific strategies to be adopted.

Key messages

Questionnaires for improving cycling in urban contexts. Data analysis on citizens’ lifestyles for encouraging active mobility.

Measuring health outcomes of OECD countries’ urban greenspace, with a special focus on Milan (Italy)

Background

Urban world population has raised to 4.2 billion in 2018, with 2.5 billion more forecasted by 2050. Cities are places of opportunities but, at the same time, sites of environmental and social risk factors. Scientific evidence about urban green's environmental benefits is abundant, but Public Health outcomes are seldom carefully defined. The project aims at assessing the Public, Urban and Mental Health outcomes of urban green areas in Organisation for Economic Co-operation and Development (OECD) countries, and at exploring citizen urban greenspace perception in Milan, Italy.

Methods

A systematic review of literature was conducted according to the 2015 PRISMA statement. Two online databases (Medline and Embase), were consulted, and inclusion criteria were set, ruling in all OECD countries-based, English-written studies from 2000 to December 2019. Only objectively measurable health outcomes were deemed suitable for analysis. Based on the main review findings, a community-based survey was created, targeting residents of Milan and its suburban area to understand better how they benefit from the urban green areas in their city. The study is being carried out by an interdisciplinary team of medical doctors and architects.

Results

We grouped health outcomes into five separate domains, namely cardiovascular, obesity, respiratory, neoplasia and mental health. We found negative associations between disease prevalence and urban greenspace overall quantity. Size, perceived quality and accessibility were powerfully explanatory variables. Milan community-based survey drafting is underway. Results are still preliminary and will be presented by tables, graphs and plots.

Conclusions

Cities are increasingly becoming critical points for many emerging Public Health challenges. The results of our study may help urban planners, key stakeholders, policymakers and communities to preserve and increase existing green spaces, and to improve Urban Public Health.

Key messages

Urban greenspace is paramount to OECD cities’ current and future sustainability because of its significant impact on Public, Urban and Mental Health. Milan citizens show remarkable care for urban greenspaces integrity and development.

Exploring Coagulase-Negative Staphylococci Diversity from Artisanal Llama Sausages: Assessment of Technological and Safety Traits

Llama sausage is still produced following artisanal procedures, with the autochthonous microbiota being mainly responsible for the fermentation process. In this work, the taxonomical identification and technological-safety criteria of coagulase-negative staphylococci (CNS) isolated from two different productions of llama sausages (P: pilot and A: artisanal) were investigated. Staphylococcus (S) equorum and S. saprophyticus were the species most frequently found in P production, followed by S. succinis and S. warneri; a wider species variability was observed in A factory being S. equorum, S. capitis, S. xylosus, S. pasteuri, S. epidermidis and S. saprophyticus as the main identified species. The technological characterization of 28 CNS strains showed their ability to hydrolyze gelatin and tributyrin together with a relevant nitrate reductase activity. Phenotypic and genotypic approaches were conducted to investigate the main safety traits. Llama's CNS strains exhibited weak decarboxylase and hemolytic activity and low biofilm production; additionally, no enterotoxin genes were detected. Correlation analysis between phenotypic and genotypic data showed low values for the biofilm parameters, while high correlation was observed for oxacillin, ampicillin, tetracycline and aminoglycosides resistance and their genetic determinants. Data obtained may contribute to broaden knowledge about the autochthonous strains of this poorly studied fermented product, thus helping to select an appropriate combination of potential starter cultures to improve llama sausage safety and quality.

Evidence Based Hospital Design. A literature review of the recent publications about the EBD impact of built environment on hospital occupants' and organizational outcomes

INTRODUCTION

Healthcare facilities are complex infrastructures where different features from technological, social, clinical and architectural field interact. In modern healthcare systems there is a growing attention to the need of quality in terms of process and outcome, while the structural (physical) aspects are not often considered. Since the Nineties the theory of the Evidence Based Design (EBD) states that there is significant relationship between built environment and health related outcome.

OBJECTIVE

Aim of this paper is to investigate, in the recent scientific literature, which are the most important occupants' and organizational outcomes influenced by EBD hospital built environment qualities.

METHODOLOGY

A Literature Review based on Scopus and PubMed databases has been run in order to understand the existing situation in terms of hospital quality evaluation from the physical and architectural point of view and to highlight the current trends. The results of the different reviews, empirical studies and post Occupancy Evaluations have been analyzed according to Ulrich's EBD conceptual framework.

RESULTS

35 peer reviewed papers from the last 2 years were included. The methodologies adopted are very different and data are mainly collected through structured interviews or observations and elaborated with qualitative (33%), quantitative (26%) or mixed (41%) methodologies. The topic is mostly investigated in USA, Australia, Canada, UK and in the Scandinavian region; few contributions come also from Italy. Built environment variables that affect user's or organizational outcomes are mainly the Visual Environment (29%), the Audio Environment (20%) and the Patient Room Design (20%).

DISCUSSION AND CONCLUSION

The most recurrent outcomes found to be affected by the built environmental qualities are staff job satisfaction (n=11), patients' stress reduction (n=9), patients' satisfaction (n=6) and patients' fall reduction (n=6). Organizational outcomes are mentioned only two times. Although EBD is an old theory, the topic is both contemporary and relevant. Due to the diversity of the contributions and the limitations of the research, a deep comparison is challenging. Further investigation is necessary to deepen each of the variables identified.

Impact of cooking and fermentation by lactic acid bacteria on phenolic profile of quinoa and buckwheat seeds

In this work, quinoa and buckwheat cooked seeds were fermented by two autochthonous strains of lactic acid bacteria isolated from the corresponding seeds, namely Lactobacillus paracasei A1 2.6 and Pediococcus pentosaceus GS·B, with lactic acid chemically acidified seeds as control. The impact of cooking and fermentation on the comprehensive phenolic profile of quinoa and buckwheat seeds was evaluated through untargeted ultra-high-pressure liquid chromatography coupled to quadrupole-time-of-flight mass spectrometry (UHPLC-QTOF-MS). Samples were analyzed also for in vitro antioxidant capacity (as FRAP and ORAC assays) and total phenolic content (TPC). The in vitro spectrophotometric assays highlighted that the microbial fermentation was more efficient in increasing (p < .05) the TPC and in vitro antioxidant potential in quinoa cooked seeds. However, an increase (p < .05) in TPC and ORAC radical scavenging was observed in both pseudocereals after the different cooking processes (i.e., boiling or toasting). The untargeted phenolic profiling depicted the comprehensive phenolic composition in these matrices. Raw seeds of both pseudocereals possessed a similar phenolic content (4.4 g kg^-1 equivalents; considering free and bound fractions). Besides, the metabolomics-based approach showed that all treatments (i.e., cooking and fermentation) induced the release of specific classes, namely phenolic acids and tyrosols. The PLS-DA multivariate approach identified in flavonoids the best markers allowing to discriminate the different treatments considered (i.e., cooking, chemical acidification and microbial fermentation). These findings support the use of cooking and microbial fermentation to ensure the health-promoting properties of non-wheat grains, such as buckwheat and quinoa.

Measuring the expected increase in cycling in the city of Milan and evaluating the positive effects on the population's health status: a Community-Based Urban Planning experience

BACKGROUND

It's scientifically known that inactivity is one of the major risk factors for Non-Communicable Diseases. One of the elements affecting the choice of transport mode, regarding circulation in the city, is the cities' urban morphology, i.e. the infrastructural facilities for the slow mobility service. Cyclability, in fact, can help to increase daily physical activity level, therefore becoming a protective factor for individual health.

METHODS

After a literature review about the state of the art regarding the correlation between built environment, active transport and quantification of the physical activity level, we have developed a specific questionnaire to collect information about current and forecast use of bicycle, in case of improvement and implementation of the cycling network. The questionnaire also investigated social and health aspects concerning the anamnesis of the interviewees (age, gender, health status, sport activity performed, etc) and users' opinions about existing infrastructure and planned interventions, designed to promote cycling mobility. Aim of the research was to quantify the increase of physical activity people would have realized in front of an improvement of the specific infrastructures, and the expected positive effects in terms of health.

RESULTS

The collected data (343 interviewed in a district of Milan, named "Zona 7") demonstrate that through the implementation of the cycle network, there would be more cyclists to practice the 150 minutes weekly of physical activity recommended by WHO: time spent in cycling, indeed, would increases by 34.4% compared to the current level of cyclability, as detected by our survey.

CONCLUSIONS

The investigation confirmed that urban interventions, especially those in small-scale, could play a key role in the promotion of healthy lifestyles, inducing therefore important positive effects on the population health. It was also carried out an application of the WHO "Health Economic Assessment Tool" to evaluate the benefits in terms of Non-Communicable Diseases' reduction, specifically a provisional quantification of deaths saved.

Strategies for Disease Prevention and Health Promotion in Urban Areas: The Erice 50 Charter

The Erice 50 Charter titled "Strategies for Diseases Prevention and Health Promotion in Urban Areas" was unanimously approved at the conclusion of the 50th Residential Course "Urban Health. Instruments for promoting health and for assessing hygienic and sanitary conditions in urban areas", held from 29th March to 2nd April 2017 in Erice, at the "Ettore Majorana" Foundation and Centre for Scientific Culture and promoted by the International School of Epidemiology and Preventive Medicine "G. D'Alessandro" and the Study Group "Building Hygiene" of the Italian Society of Hygiene, Preventive Medicine and Public Health (SItI). At the conclusion of the intense learning experience during the Course, with more than 20 lectures, workshops and long-lasting discussions between Professors and Students, the participants identified the major points connecting urban features and Public Health, claiming the pivotal role of urban planning strategies for the management of Diseases Prevention and Health Promotion activities. The Erice 50 Charter is configured as a Decalogue for Healthy Cities and as a Think Tank for designing effective strategic actions and best practices to develop urban regeneration interventions and improve the urban quality of contemporary cities. The Decalogue is structured into the following key strategic objectives: 1. Promoting urban planning interventions that address citizens towards healthy behaviours; 2. Improving living conditions in the urban context; 3. Building an accessible and inclusive city, with a special focus on the frail population; 4. Encouraging the foundation of resilient urban areas; 5. Supporting the development of new economies and employment through urban renewal interventions; 6. Tackling social inequalities; 7. Improving stakeholders' awareness of the factors affecting Public Health in the cities; 8. Ensuring a participated urban governance; 9. Introducing qualitative and quantitative performance tools, capable of measuring the city's attitude to promote healthy lifestyles and to monitor the population's health status; 10. Encouraging sharing of knowledge and accessibility to informations. Finally, all the participants underlined that a multidisciplinary team, composed of Physicians specialized in Hygiene, Preventive Medicine, Public Health and Technicians as Architects, Urban planners and Engineers, is needed to deepen the research topic of Urban Health.

Impact of cystic fibrosis disease on archaea and bacteria composition of gut microbiota

Cystic fibrosis is often associated with intestinal inflammation due to several factors, including altered gut microbiota composition. In this study, we analyzed the fecal microbiota among patients with cystic fibrosis of 10–22 years of age, and compared the findings with age-matched healthy subjects. The participating patients included 14 homozygotes and 14 heterozygotes with the delF508 mutation, and 2 heterozygotes presenting non-delF508 mutations. We used PCR-DGGE and qPCR to analyze the presence of bacteria, archaea and sulfate-reducing bacteria. Overall, our findings confirmed disruption of the cystic fibrosis gut microbiota. Principal component analysis of the qPCR data revealed no differences between homozygotes and heterozygotes, while both groups were distinct from healthy subjects who showed higher biodiversity. Archaea were under the detection limit in all homozygotes subjects, whereas methanogens were detected in 62% of both cystic fibrosis heterozygotes and healthy subjects. Our qPCR results revealed a low frequency of sulfate-reducing bacteria in the homozygote (13%) and heterozygote (13%) patients with cystic fibrosis compared with healthy subjects (87.5%). This is a pioneer study showing that patients with cystic fibrosis exhibit significant reduction of H₂-consuming microorganisms, which could increase hydrogen accumulation in the colon and the expulsion of this gas through non-microbial routes.

Archaeal microbiota population in piglet feces shifts in response to weaning: Methanobrevibacter smithii is replaced with Methanobrevibacter boviskoreani

Methanogens commonly inhabit swine intestine. We analyzed the gut archaeal population by extracting DNA from the feces of nine piglets. We performed PCR to target the V6-V8 region of the 16S rRNA gene. Subsequent denaturing gradient gel electrophoresis (DGGE) revealed the presence of Methanobrevibacter boviskoreani, which has not previously been identified in pigs. We confirmed these data with a PCR-DGGE analysis of the mcrA gene, and subsequent sequencing. At 63 days old, the only band in fecal samples corresponded to M. boviskoreani. The DGGE analysis also showed that Methanobrevibacter smithii, which was abundant at 28 days, was dramatically reduced at 42 days, and it completely disappeared at 63 days. To confirm these data, we quantified M. smithii and the total archaeal population by quantitative PCR (qPCR); moreover, we designed a new set of species-specific primers based on the 16S rRNA gene of M. boviskoreani. The qPCR results confirmed the reduction in M. smithii over time and a simultaneous increase in M. boviskoreani. At 63 days, the total numbers of archaea and M. boviskoreani genomes were comparable, which suggested that M. boviskoreani represented the dominant archaea. This work showed that the archaeal population shifted during weaning, and M. boviskoreani replaced M. smithii.

Soft qualities in healthcare. Method and tools for soft qualities design in hospitals' built environments

BACKGROUND

The design of hospital environments is determined by functional requirements and technical regulations, as well as numerous protocols, which define the structure and system characteristics that such environments need to achieve. In order to improve people's well-being and the quality of their experience within public hospitals, design elements (soft qualities) are added to those 'necessary' features. The aim of this research has been to experiment a new design process and also to create health care spaces with high environmental quality and capable to meet users' emotional and perceptual needs.

METHODS

Such needs were investigated with the help of qualitative research tools and the design criteria for one of these soft qualities - colour - were subsequently defined on the basis of the findings. The colour scheme design for the new San Paolo Hospital Emergency Department in Milan was used as case study. Focus groups were fundamental in defining the project's goals and criteria.

RESULTS

The issues raised have led to believe that the proper procedure is not the mere consultation of the users in order to define the goals: users should rather be involved in the whole design process and become co-agents of the choices that determine the environment characteristics, so as to meet the quality requirements identified by the users themselves.

CONCLUSIONS

The case study has shown the possibility of developing a designing methodology made by three steps (or operational tools) in which users' groups are involved in the choices, loading to plan the environments where compliance with expectations is already implied and verified by means of the process itself. Thus, the method leads to the creation of soft qualities in Healthcare.

Erythromycin- and tetracycline-resistant lactobacilli in Italian fermented dry sausages

AIMS

To assess the frequency of erythromycin- and tetracycline-resistant lactobacilli in Italian fermented dry sausages.

METHODS AND RESULTS

We isolated lactobacilli colonies from 20 salami from the north of Italy (Piacenza province) using selective medium supplemented with erythromycin or tetracycline; we determined the minimum inhibitory concentration and searched for selected erythromycin and tetracycline resistance genes. A total of 312 lactobacilli colonies were genetically ascribed to 60 different strains belonging to seven Lactobacillus species. Lactobacillus sakei, Lactobacillus curvatus and Lactobacillus plantarum were the most frequently found species. Thirty strains (50%) were phenotypically resistant to erythromycin, 45 (75%) to tetracycline and 27 (45%) were resistant to both. The most frequently detected resistance genes were tet(M) and erm(B).

CONCLUSIONS

This study provides evidence of the presence of tetracycline- and, to a lesser extent, erythromycin-resistant lactobacilli in fermented dry sausages produced in northern Italy.

SIGNIFICANCE AND IMPACT OF THE STUDY

Although these antibiotic-resistant lactobacilli could serve as reservoir organisms, in our study, 16 of 20 salami could be considered safe in regard to possible antibiotic resistance gene transfer to pathogens, whereas 4 of 20 could represent a borderline situation.

Changes of gut microbiota and immune markers during the complementary feeding period in healthy breast-fed infants

INTRODUCTION

Little is known about changes in intestinal microbiota during the important period of complementary feeding (weaning). This descriptive study investigated changes of selected gut microbiota and markers of gut permeability and the immune system in breast fed infants during the complementary feeding period.

METHODS

22 healthy, exclusively breast fed infants (from birth to 4 months) with no antibiotic intake during the month prior to the study, were followed from 4 to 9 months of age. Faecal and saliva samples were collected at the start of the study (V0) and at monthly intervals (V1-V5) for measurement of selective gut microbiota (bifidobacteria, lactobacilli, vancomycin-insensitive lactobacilli, enterobacteria, enterococci, Clostridium perfringens) using semi-selective media. Immune markers (alpha-1-antitrypsin, eosinophil cationic protein (ECP), secretory IgA and TNF-alpha were measured in saliva and secretory IgA and TNF-alpha in faecal samples.

RESULTS

High stool bifidobacteria counts at the start of the study (7.99 1 1.95 log10 CFU/g faeces) remained stable throughout the 5 months of complementary feeding while counts of enterobacteria and enterococci increased with age (P < 0.05 and P = 0.02 respectively). Vancomycin-insensitive lactobacilli increased significantly during weaning for V0 to V3 (P < 0.01), and then decreased slightly (V4). Faecal Clostridium perfringens remained below the detection limit during the study and parameters measured in saliva did not change. Faecal ECP decreased significantly from 1.011.4 (V0) to 0.510.9 mg/mg protein (V5) P = 0.03.

CONCLUSION

Age and/or diet modifications during complementary feeding had no impact on faecal bifidobacteria counts but increased those of enterobacteria and enterococci. Transient increases in faecal lactobacilli and vancomycin-insensitive lactobacilli counts were observed. The reduction in faecal ECP may indicate a decrease in gut permeability (reinforcement of gut mucosa integrity) during the weaning period with age [corrected]

Physiological and molecular techniques for the study of bacterial community development in sausage fermentation

The development of the microbial community involved in the production process of Italian dry sausage was investigated using physiological analysis and molecular techniques for strain typing and taxonomical identification. A cycle of sausage production was followed collecting samples during the 2 months of ripening process. Microbiological analysis allowed the identification of the main bacterial groups responsible for the fermentation process as lactobacilli and coagulase-negative staphylococci. The use of a polymerase chain reaction-based technique of strain typing, RAPD fingerprinting, demonstrated that the environmental parameters interact to select a limited number of strains that dominate the fermentation process. The staphylococcal populations were characterized for their physiological properties and the two dominant strains were identified as Staphylococcus xylosus and Staph. sciuri. The use of 16S rDNA sequencing allowed the definition of the taxonomical position of the two dominant strains of lactic acid bacteria, as belonging to Lactobacillus sake and Lact. plantarum.

Multiple ocular impairment in a patient affected by Waldenström's macroglobulinaemia

BACKGROUND

We studied a bilateral tumefaction of the lacrimal gland in a female patient.

METHOD

Ocular and general clinical examinations were carried out.

RESULT

Computerized tomography (CT) of the cranial orbit showed a tumefaction of solid density in the lacrimal gland. Histological examination of material removed by needle aspiration revealed the presence of elements of a lymphoplasmacytoid nature. Fluorescein angiography showed dilatation of the veins, intraretinal flame haemorrhages and small ischaemic areas. Chest CT showed an increase in the size of the middle and upper mediastinal lymph nodes, and examination of a specimen of bone marrow from the chest revealed the presence of small lymphocytes with a plasmacytoid tendency.

CONCLUSION

On the basis of the findings, we diagnosed Waldenström's disease with rare multiple ocular impairment (lacrimal gland and retina) in an early stage.

Serum cholesterol levels in axenic mice colonized with Enterococcus faecium and Lactobacillus acidophilus

Hypocholesterolemic effect was shown in axenic, mono, bicolonized and conventional mice: the effect was different depending on probiotic properties of intestinal microorganisms. Contamination by Enterococcus faecium CX determined the highest effect: haematic cholesterol level decrease was 16.9% in females and 7.8% in males. In mice contaminated by Lactobacillus acidophilus N5 the decrease of haematic cholesterol levels was less and not relevant in mice contaminated by conventional microflora. Enterococcus faecium CX and Lactobacillus acidophilus N5 strains were able to grow in presence of bile salts, to colonize intestinal tract, to survive at gastric conditions and to assimilate cholesterol (E. faecium more than L. acidophilus). The authors consider the possibility to associate probiotic strains with these characteristics for the health of consumers.