Point-Contact Spectroscopy in Bulk Samples of Electron-Doped Cuprate Superconductors

Point-contact spectroscopy was performed on bulk samples of electron-doped high temperature superconductor Nd2-xCexCuO4-δ. The samples were characterized using X-ray diffraction and scanning electron microscopy equipped with a wavelength-dispersive spectrometer and an electron backscatter diffraction detector. Samples with Ce content x = 0.15 showed the absence of spurious phases and randomly oriented grains, most of which had dimensions of approximately 220 µm2. The low-bias spectra in the tunneling regime, i.e., high-transparency interface, exhibited a gap feature at about ±5 meV and no zero-bias conductance, despite the random oriented grains investigated within our bulk samples, consistent with most of the literature data on oriented samples. High-bias conductance was also measured in order to obtain information on the properties of the barrier. A V-shape was observed in some cases, instead of the parabolic behavior expected for tunnel junctions.

Rough and Porous Micropebbles of CeCu2Si2 for Energy Storage Applications

Supercapacitors have attracted considerable attention due to their advantages, including being lightweight and having rapid charge-discharge, a good rate capability, and high cyclic stability. Electrodes are one of the most important factors influencing the performance of supercapacitors. Herein, a three-dimensional network of rough and porous micropebbles of CeCu2Si2 has been prepared using a one-step procedure and tested for the first time as a supercapacitor electrode. The synthesized material was extensively characterized in a three-electrode configuration using different electrochemical techniques, such as cyclic voltammetry (CV), galvanostatic charge and discharge (GCD) tests, and electrochemical impedance spectroscopy (EIS). CeCu2Si2 shows rather high mass-capacitance values: 278 F/g at 1 A/g and 295 F/g at 10 mV/s. Moreover, the material exhibits remarkable long-term stability: 98% of the initial capacitance was retained after 20,000 cycles at 10 A/g and the Coulombic efficiency remains equal to 100% at the end of the cycles.

Upper critical magnetic field in NbRe and NbReN micrometric strips

Non-centrosymmetric superconductors have recently received significant interest due to their intriguing physical properties such as multigap and nodal superconductivity, helical vortex states, as well as non-trivial topological effects. Moreover, large values of the upper critical magnetic field have been reported in these materials. Here, we focus on the study of the temperature dependence of the perpendicular magnetic field of NbRe and NbReN films patterned in micrometric strips. The experimental data are studied within the Werthamer-Helfand-Hohenberg theory, which considers both orbital and Zeeman pair breaking. The analysis of the results shows different behavior for the two materials with a Pauli contribution relevant only in the case of NbReN.

Emergency hernia repair in the elderly: multivariate analysis of morbidity and mortality from an Italian registry

PURPOSE

The incidence of inguinal hernia is higher in elderly because of aging-related diseases like prostatism, bronchitis, collagen laxity. A conservative management is common in elderly to reduce surgery-related risks, however watchful waiting can expose to obstruction and strangulation. The aim of the present study was to assess the impact of emergency surgery in a large series of elderly with complicated groin hernia and to identify the independent risk factors for postoperative morbidity and mortality. The predictive performance of prognostic risk scores has been also assessed.

METHODS

This is a prospective observational study carried out between January 2017 and June 2018 in elderly patients who underwent emergency surgery for complicated hernia in 38 Italian hospitals. Pre-operative, surgical and postoperative data were recorded for each patient. ASA score, Charlson's comorbidity index, P-POSSUM and CR-POSSUM were assessed.

RESULTS

259 patients were recruited, mean age was 80 years. A direct repair without mesh was performed in 62 (23.9%) patients. Explorative laparotomy was performed in 56 (21.6%) patients and bowel resection was necessary in 44 (17%). Mortality occurred in seven (2.8%) patients. Fifty-five (21.2%) patients developed complications, 12 of whom had a major one. At univariate and multivariate analyses, Charlson's comorbidity index ≥ 6, altered mental status, and need for laparotomy were associated with major complications and mortality CONCLUSION: Emergency surgery for complicated hernia is burdened by high morbidity and mortality in elderly patients. Preoperative comorbidity played a pivotal role in predicting complications and mortality and therefore Charlson's comorbidity index could be adopted to select patients for elective operation.

Dimensionality of the Superconductivity in the Transition Metal Pnictide WP

We report theoretical and experimental results on the transition metal pnictide WP. The theoretical outcomes based on tight-binding calculations and density functional theory indicate that WP is a three-dimensional superconductor with an anisotropic electronic structure and nonsymmorphic symmetries. On the other hand, magnetoresistance experimental data and the analysis of superconducting fluctuations of the conductivity in external magnetic field indicate a weakly anisotropic three-dimensional superconducting phase.

Majorana/Andreev crossover and the fate of the topological phase transition in inhomogeneous nanowires

Majorana bound states (MBS) and Andreev bound states (ABS) in realistic Majorana nanowires setups have similar experimental signatures which make them hard to distinguishing one from the other. Here, we characterize the continuous Majorana/Andreev crossover interpolating between fully-separated, partially-separated, and fully-overlapping Majorana modes, in terms of global and local topological invariants, fermion parity, quasiparticle densities, Majorana pseudospin and spin polarizations, density overlaps and transition probabilities between opposite Majorana components. We found that in inhomogeneous wires, the transition between fully-overlapping trivial ABS and nontrivial MBS does not necessarily mandate the closing of the bulk gap of quasiparticle excitations, but a simple parity crossing of partially-separated Majorana modes (ps-MM) from trivial to nontrivial regimes. We demonstrate that fully-separated and fully-overlapping Majorana modes correspond to the two limiting cases at the opposite sides of a continuous crossover: the only distinction between the two can be obtained by estimating the degree of separations of the Majorana components. This result does not contradict the bulk-edge correspondence: indeed, the field inhomogeneities driving the Majorana/Andreev crossover have a length scale comparable with the nanowire length, and therefore correspond to a nonlocal perturbation which breaks the topological protection of the MBS.

Critical Current and Pinning Features of a CaKFe4As4 Polycrystalline Sample

We analyze the magnetic behavior of a CaKFe4As4 polycrystalline sample fabricated by a mechanochemically assisted synthesis route. By means of DC magnetization (M) measurements as a function of the temperature (T) and DC magnetic field (H) we study its critical parameters and pinning features. The critical temperature Tc has been evaluated by M(T) curves performed in Zero Field Cooling-Field Cooling conditions. These curves show the presence of a little magnetic background for temperatures above Tc, as also confirmed by the hysteresis loops M(H). Starting from the M(H) curves, the critical current density Jc of the sample has been calculated as a function of the field at different temperatures in the framework of the Bean critical state model. The Jc(H) values are in line with the ones reported in the literature for this typology of samples. By analyzing the temperature dependence of the critical current density Jc(T) at different magnetic fields, it has been found that the sample is characterized by a strong type pinning regime. This sample peculiarity can open perspectives for future improvement in the fabrication of this material.

Effective Magnetic Field Dependence of the Flux Pinning Energy in FeSe0.5Te0.5 Superconductor

The role of a layered structure in superconducting pinning properties is still at a debate. The effects of the vortex shape, which can assume for example a staircase form, could influence the interplay with extrinsic pinning coming from the specific defects of the material, thus inducing an effective magnetic field dependence. To enlighten this role, we analysed the angular dependence of flux pinning energy U(H,θ) as a function of magnetic field in FeSe0.5Te0.5 thin film by considering the field components along the ab-plane of the crystal structure and the c-axis direction. U(H,θ) has been evaluated from magneto-resistivity measurements acquired at different orientations between the applied field up to 16 T and FeSe0.5Te0.5 thin films grown on a CaF2 substrate. We observed that the U(H,θ) shows an anisotropic trend as a function of both the intensity and the direction of the applied field. Such a behaviour can be correlated to the presence of extended defects elongated in the ab-planes, thus mimicking a layered superconductor, as we observed in the microstructure of the compound. The comparison of FeSe0.5Te0.5 with other superconducting materials provides a more general understanding on the flux pinning energy in layered superconductors.

Transport and Point Contact Measurements on Pr1-xCexPt4Ge12 Superconducting Polycrystals

We performed a detailed investigation of the superconducting properties of polycrystalline Pr1-xCexPt4Ge12 pellets. We report the effect of Ce substitution, for x = 0.07, on magnetic field phase diagram H-T. We demonstrate that the upper critical field is well described by the Ginzburg-Landau model and that the irreversibility field line has a scaling behaviour similar to cuprates. We also show that for magnetic fields lower than 0.4 T, the activation energy follows a power law of the type ?-1/2, suggesting a collective pinning regime with a quasi-2D character for the Ce-doped compound with x = 0.07. Furthermore, by means of a point contact Andreev reflection spectroscopy setup, we formed metal/superconductor nano-junctions as small as tens of nanometers on the PrPt4Ge12 parent compound (x = 0). Experimental results showed a wide variety of conductance features appearing in the dI/dV vs. V spectra, all explained in terms of a modified Blonder-Tinkham-Klapwijk model considering a superconducting order parameter with nodal directions as well as sign change in the momentum space for the sample with x = 0. The numerical simulations of the conductance spectra also demonstrate that s-wave pairing and anisotropic s-waves are unsuitable for reproducing experimental data obtained at low temperature on the un-doped compound. Interestingly, we show that the polycrystalline nature of the superconducting PrPt4Ge12 sample can favour the formation of an inter-grain Josephson junction in series with the point contact junction in this kind of experiments.

Potential toxic elements in groundwater and their health risk assessment in drinking water of Limpopo National Park, Gaza Province, Southern Mozambique

Concentrations of trace elements in drinking water affect its safety and acceptability for use. Potentially toxic element (PTE) contaminations are considered extremely hazardous because of toxicity, persistence, and bioaccumulative behaviour. Many areas in the Southern African Development Community are data poor and have poor accessibility. The results of our previous research identified the presence of fossil waters in southern Limpopo National Park. Groundwater and river water are the only sources of drinking water for the villages in the study area. The current study focuses on the understanding of trace element distribution and health perspectives of PTEs (Hg, U, Sr, B, and Mn) in the groundwater and surface water samples (rivers and lakes) collected within the buffer zone of the Limpopo National Park, Southern Mozambique. Two sampling campaigns (October 2016-March 2017) were carried out during the end of the wet season and the end of the dry season to analyse the differences. The results improved our knowledge of the occurrence of trace elements in drinking water in an area where water resources play a fundamental role-because of their scarcity-and where the climate is harsh. ICP-MS results provided information on concentration ranges, highlighting the exceedance of the permissible maximum limit of mercury imposed by the World Health Organization on several groundwater samples. In the buffer zone of Limpopo Park, the highest levels of risk seem to be associated with the presence of Hg and U in drinking water. The use of risk assessment markers such as non-cancer risk value (hazard quotient [HQ]) revealed the exceedance of HQ values for Hg and U. The HQ values are higher in the wet season than the dry season, and most of the exceedance has been found in groundwater. HQ values are higher in exposed children than exposed adults. The water of Lake Massingir seems to be safer than any other source, but people do not currently use it because of the distance between the lake and their villages. Proactive control and research on alternative solutions for the water needs of the population and on creation of water distribution are recommended. In the current study, drinking water was the only route of exposure that was evaluated. Therefore, it would be appropriate to investigate the concentrations of PTEs in crops, livestock, and any other potential pathways.

Vortex lattice instability at the nanoscale in a parallel magnetic field

In superconducting materials a dynamical rearrangement of the vortex lattice occurs by forcing vortices at high velocities, until the system can become unstable. This phenomenon is known as vortex lattice instability, in which a sudden transition drives the superconducting system abruptly to the normal state. We present an experimental study on submicron bridges of NbN and NbTiN ultra-thin films with a thickness of few nanometers. The nanoscale effect on vortex lattice instability is investigated not only by the ultra-thin thickness in wide bridges, but also by changing the direction of the external magnetic field applied parallel and perpendicular to the c-axis epitaxial films. Indeed, measurements are performed for both orientations and show the vortex lattice instability, regardless of the superconducting material. Critical currents I _c as well as instability currents I* have been compared. However, only in the parallel configuration an unusual 'flying birds' feature appears in the magnetic field dependence of current switching, as a consequence of the ratio I*/I _c that is approaching 1. This amazing tendency becomes relevant for practical applications involving nanostructures, since by scaling down sample thickness and rotating the external field towards the in-plane orientation, the ultra-thin film geometry can mimic the bridge narrowing down to the nanoscale.

Assessment of groundwater quality in the buffer zone of Limpopo National Park, Gaza Province, Southern Mozambique

Many areas in the Southern African Development Community are data-poor and poorly accessible. Water quality assessment in these areas therefore has to rely on the limited available data, coupled with restricted field sampling. This paper documents the first evaluation of the main geochemical processes and impact of anthropogenic and natural sources of contamination on the groundwater quality of the aquifer system used for domestic and agricultural purposes in Limpopo National Park, Gaza Province, Southern Mozambique. Twenty-five groundwater and surface water samples were collected during two field campaigns, one in October 2016 (the end of the arid period) and the other in March 2017 (the end of the wet period). In the field, the researchers analysed chemical-physical parameters such as temperature, pH and EC. In the laboratory, the major ions (boron, Na⁺, Ca²⁺, K⁺, Mg²⁺) and anions (Cl^-, SO₄^2-, NO₃^-, HCO₃^-, CO₃^2-) were determined, and almost all groundwater samples fall into the brackish water category. The B/Cl ratio and δ¹¹B concentrations were then measured to better understand the origin of these brackish waters. The direct relationship between boron and chlorine and δ¹¹B concentrations above 40‰ suggests the presence of fossil water in the aquifer. The groundwater in this area was found to be above the limits stated as desirable by the Department of Water and Sanitation (DWS) and the World Health Organisation for domestic and irrigation purposes. The suitability of the groundwater for drinking purposes was also evaluated, with the results indicating that it is not suitable. The values of the sodium absorption ratio, sodium percentage and electrical conductivity show that most of the groundwater samples are also not suitable for agricultural purposes. However, the surface waters have higher quality for both domestic and irrigation purposes. The water of Massingir Lake turns out to be the most suitable resource for a possible rural development plan for the area.

Angular dependence of vortex instability in a layered superconductor: the case study of Fe(Se,Te) material

Anisotropy effects on flux pinning and flux flow are strongly effective in cuprate as well as iron-based superconductors due to their intrinsically layered crystallographic structure. However Fe(Se,Te) thin films grown on CaF2 substrate result less anisotropic with respect to all the other iron based superconductors. We present the first study on the angular dependence of the flux flow instability, which occurs in the flux flow regime as a current driven transition to the normal state at the instability point (I*, V*) in the current-voltage characteristics. The voltage jumps are systematically investigated as a function of the temperature, the external magnetic field, and the angle between the field and the Fe(Se,Te) film. The scaling procedure based on the anisotropic Ginzburg-Landau approach is successfully applied to the observed angular dependence of the critical voltage V*. Anyway, we find out that Fe(Se,Te) represents the case study of a layered material characterized by a weak anisotropy of its static superconducting properties, but with an increased anisotropy in its vortex dynamics due to the predominant perpendicular component of the external applied magnetic field. Indeed, I* shows less sensitivity to angle variations, thus being promising for high field applications.

Retrospective observational study to investigate Sinerga, a multifactorial nutritional product, and bacterial extracts in the prevention of recurrent respiratory infections in children

In this retrospective observational clinical study, 167 children, aged 3 to 7 years, of both sexes, with a clinical history of recurrent respiratory infections, administered with bacterial extracts of first and second generation or Sinerga a nutritional product containing palmitoylethanolamide, bovine colostrum, phenylethylamine and the new generation of probiotic kluyveromyces FM B0399, were observed. The goal of the study was to compare the supplementation with Sinerga with the supplementation with bacterial extracts, for the effect on the frequency of episodes of respiratory infection that had resulted in a prescription for antibiotics. The study focused retrospectively on the months from March 2013 to November 2012. The results showed a greater reduction in the frequency of respiratory infections with antibiotic therapy in the group of children supplemented with Sinerga than in the group treated with bacterial extracts. In particular, it was observed that 49.3% of the children supplemented with Sinerga, against 5% of those supplemented with extracts, had no infectious episodes requiring the administration of an antibiotic. 100% of subjects supplemented with Sinerga have had no more than two episodes of respiratory infection, while this condition, in the cohort treated with bacterial extracts, was observed in only 51% of cases.

MiR-30e and miR-181d control radial glia cell proliferation via HtrA1 modulation

The precise mechanisms by which microRNAs (miRNAs) contribute to the dynamic regulation of gene expression during the forebrain development are still partly elusive. Here we show that the depletion of miRNAs in the cerebral cortex and hippocampus, via genetic inactivation of Dicer after the onset of forebrain neurogenesis, profoundly impairs the morphological and proliferative characteristics of neural stem and progenitor cells. The cytoarchitecture and self-renewal potential of radial glial (RG) cells located within the cerebral cortex and the hippocampus were profoundly altered, thus causing a significant derangement of both the post natal dorsal sub-ventricular zone and the dentate gyrus. This effect was attributed to the High-temperature requirement A serine peptidase 1 (HtrA1) gene product whose overexpression in the developing forebrain recapitulated some of the aspects of the Dicer^−/− phenotype. MiR-30e and miR-181d were identified as posttranscriptional negative regulators of HtrA1 by binding to its 3′ untranslated region. In vivo overexpression of miR-30e and miR-181d in Dicer^−/− forebrain rescued RG proliferation defects.

Intragastric balloon in association with lifestyle and/or pharmacotherapy in the long-term management of obesity

BACKGROUND

Intragastric balloon (BioEnterics Intragastric Balloon, BIB®) or pharmacotherapy are possible options for the treatment of obese patients when traditional approaches have failed. The aim of our study was to compare in obese patients the effect on weight loss and metabolic changes of lifestyle modifications associated with either BIB or pharmacotherapy or the two treatments in sequence as a maintenance strategy for weight loss.

METHODS

Fifty obese patients were recruited and randomly assigned to lifestyle modifications combined with either BIB for 6 months (n = 30) or sibutramine (pharmacotherapy group) for 1 year (n = 20). After BIB removal, patients were randomly assigned to either correct lifestyle (BIB/lifestyle) or lifestyle plus pharmacotherapy (BIB/pharmacotherapy).

RESULTS

At 6 months, patients treated with BIB lost significantly (P < 0.05) more weight (percent of initial weight lost, %IWL = 14.5 ± 1.2; percent of excess BMI lost, %EBL = 37.7 ± 3.2) than patients who received pharmacological treatment (%IWL = 9.1 ± 1.5, %EBL = 25.3 ± 4.1). At 1 year, the weight lost was significantly (P < 0.05) greater in patients treated with either BIB/pharmacotherapy (%IWL = 15.8 ± 2.3%, %EBL = 41.3 ± 6.7%) or BIB/lifestyle (%IWL = 14.3 ± 2.7, %EBL = 34.9 ± 6.5%) in respect to pharmacotherapy group (%IWL = 8.0 ± 1.4%, %EBL = 22.1 ± 3.9%). Moreover, patients treated sequentially with BIB/lifestyle or BIB/pharmacotherapy showed a significant (P < 0.05) improvement in insulin sensitivity and triglycerides levels.

CONCLUSIONS

BIB represents an efficacious long-term obesity treatment when supplemental strategies, as lifestyle modifications or pharmacotherapy, are established for weight maintenance after its removal.

The SH2B1 obesity locus is associated with myocardial infarction in diabetic patients and with NO synthase activity in endothelial cells

OBJECTIVE

Obesity and cardiovascular disease recognize a common metabolic soil and may therefore share part of their genetic background. Genome-wide association studies have identified variability at the SH2B1 locus as a predictor of obesity. We investigated whether SNP rs4788102, which captures the entire SH2B1 variability, is associated with coronary artery disease (CAD) and/or myocardial infarction (MI) in patients with type 2 diabetes mellitus (T2DM).

DESIGN AND SETTING

SNP rs4788102 was typed in 2015 White subjects with T2DM from three CAD case-control studies [n=740 from the Gargano Hearth Study (GHS, Italy); n=818 from the Joslin Hearth Study (JHS, Boston); n=457 from the University of Catanzaro (CZ, Italy)].

RESULTS

SNP rs4788102 (G/A) was not associated with CAD (overall allelic OR=1.06, 95% CI=0.93-1.21; p=0.37). On the contrary, it was associated with MI in GHS (1.42, 1.12-1.81; p=0.004) and in the three samples analyzed together (1.21, 1.04-1.41; p=0.016). Insulin stimulated nitric oxide synthase (NOS) activity in human vein endothelial cells from G/G (n=4, p=0.03) but not the G/A (n=5, p=0.83) genotype. Of the SNPs in perfect LD with rs4788102, one (rs7498665) affects amino acid polarity (Ala484Thr) and falls into a highly conserved protein segment of SH2B1 containing a class II SH3 domain binding site.

CONCLUSIONS

Variability at the SH2B1 obesity locus is associated with MI in diabetic patients and with reduced insulin-stimulated NOS activity in human endothelial cells. Further studies are needed to replicate this association and dissect the biology underlying this finding.

TRIB3 R84 variant affects glucose homeostasis by altering the interplay between insulin sensitivity and secretion

AIMS/HYPOTHESIS

The results of studies on the genetics of complex traits need to be replicated and to reach robust statistical significance before they can be considered as established. We here tried to replicate the previously reported association between the TRIB3 Q84R polymorphism (rs2295490) and glucose homeostasis.

METHODS

Three samples of Europeans with fasting glucose <7.0 mmol/l were studied. In sample 1 (n=791), the association between TRIB3 Q84R and impaired glucose regulation (IGR; defined as impaired fasting glucose and/or impaired glucose tolerance and/or type 2 diabetes by OGTT) and insulin sensitivity (ISI), and its interplay with early-phase insulin secretion (i.e. disposition index [DI]) were analysed. Sample 2 (n=374) and sample 3 (n=394) were used to replicate the association with IGR and insulin sensitivity (by glucose clamp), respectively. Genotyping was performed by TaqMan allele discrimination.

RESULTS

R84 carriers were at higher risk of IGR: OR for the additive model 1.54, p=0.004, and 1.63, p=0.027, in samples 1 and 2, respectively. In sample 1, both ISI (p=0.005) and DI (p=0.043) were progressively lower from QQ to QR and RR individuals. A 'triangulation approach' indicated that the association with IGR was mostly mediated by DI rather than by ISI changes (i.e. being the expected ORs 1.51 and 1.25, respectively). In sample 3, glucose disposal was 38.8+/-17.7, 33.8+/-14.4, and 31.6+/-13.3 micromol min(-1)kg(-1), p=0.022, in QQ, QR and RR individuals, respectively.

CONCLUSIONS/INTERPRETATION

Our data confirm that the TRIB3 R84 variant affects glucose homeostasis and suggest this effect is due to an alteration of the interplay between insulin sensitivity and secretion.

Magnetic field and temperature dependence of the critical vortex velocity in type-II superconducting films

We study the vortex dynamics in the instability regime induced by high dissipative states well above the critical current in Nb superconducting strips. The magnetic field and temperature behavior of the critical vortex velocity corresponding to the observed dynamic instability is ascribed to intrinsic non-equilibrium phenomena. The Larkin-Ovchinnikov (LO) theory of electronic instability in high velocity vortex motion has been applied to interpret the temperature dependence of the critical vortex velocity. The magnetic field dependence of the vortex critical velocity shows new features in the low-field regime not predicted by LO.

Role of the ENPP1 K121Q polymorphism in glucose homeostasis

OBJECTIVE

To study the role of the ENPP1 Q121 variant on glucose homeostasis in whites from Italy.

RESEARCH DESIGN AND METHODS

We conducted case-control studies in 764 adults (from two independent samples of 289 nonobese and 485 obese individuals) and 240 overweight/obese children undergoing oral glucose tolerance testing (OGTT). Early-phase insulin secretion and insulin sensitivity (the insulinogenic index and the insulin sensitivity index) and their interplay (the disposition index) were calculated.

RESULTS

In adult subjects, glucose profiles during OGTT were significantly (P = 2 x 10(-2)) different across K121Q genotype groups and higher in QQ than KK individuals (P = 5 x 10(-2)). The insulinogenic index was significantly reduced in QQ (18.5 +/- 3.4) compared with both KK (31.6 +/- 1.0; P = 2.2 x 10(-7)) and KQ (30.5 +/- 1.5; P = 3.2 x 10(-6)) individuals. KQ individuals also showed a reduced insulin sensitivity index compared with KK subjects (P = 3.6 x 10(-2)). The disposition index was lower in QQ carriers than in KQ and KK individuals (P = 8 x 10(-3) and 4 x 10(-4), respectively) and lower in KQ than in KK individuals (P = 3 x 10(-2)). Data obtained in overweight/obese children were very similar to those observed in adults, with QQ individuals showing (compared with KQ and KK subjects) a reduced insulinogenic index (P = 7 x 10(-3) and 2 x 10(-2), respectively) and disposition index (P = 2 x 10(-2) and 7 x 10(-3), respectively).

CONCLUSIONS

Homozygous carriers of the ENPP1 Q121 variant are characterized by an altered glucose homeostasis. Reduced early-phase insulin secretion and inefficient interplay between insulin secretion and sensitivity, which occur at early ages, are major determinants of this defect.

Italian evidence-based recommendations for the management of ankylosing spondylitis: the 3E Initiative in Rheumatology

OBJECTIVE

The 3E (Evidence, Expertise, Exchange) Initiative is a multinational effort of rheumatologists aimed at developing evidence-based recommendations addressing specific questions relevant to clinical practice. The objective of the Italian part of the 3E Initiative was to develop new recommendations designed to help Italian rheumatologists in everyday clinical practice management of patients suffering from ankylosing spondylitis (AS).

METHODS

An international scientific committee selected a set of questions concerning the diagnosis, monitoring, and treatment of AS using a Delphi procedure. Evidence-based answers to each question were sought by a systematic literature search in MedLine for papers published up to August 2006. A panel of 55 Italian rheumatologists with expertise in the field of AS used the evidence thus gathered to develop recommendations, filling gaps in evidence with their expert opinion.

RESULTS

After discussion and votes, the panel developed 12 statements/recommendations: 3 concerning diagnosis (low back pain approach, early diagnosis, and GPs referral recommendations); 3 concerning monitoring (disease activity, severity, and prognosis), and 6 concerning treatment (bisphosphonates role; treatment of enthesitis; inter-agent safety/efficacy, long-term safety/efficacy, efficacy on different disease manifestations, and the role on inflammatory bowel disease flare precipitation of NSAIDs/COX-II inhibitors).

CONCLUSION

Italian recommendations for the management of AS in everyday practice were developed. Their dissemination and implementation in daily clinical practice should help to improve practice uniformity and eventually optimize the management of AS patients.

Inclusive K(S);(0)K(S);(0) resonance production in ep collisions at HERA

Inclusive K_{S};{0}K_{S};{0} production in ep collisions at the DESY ep collider HERA was studied with the ZEUS detector using an integrated luminosity of 0.5 fb;{-1}. Enhancements in the mass spectrum were observed and are attributed to the production of f_{2}(1270)/a_{2};{0}(1320), f_{2};{'}(1525) and f_{0}(1710). Masses and widths were obtained using a fit which takes into account theoretical predictions based on SU(3) symmetry arguments, and are consistent with the Particle Data Group values. The f_{0}(1710) state, which has a mass consistent with a glueball candidate, was observed with a statistical significance of 5 standard deviations. However, if this state is the same as that seen in gammagamma-->K_{S};{0}K_{S};{0}, it is unlikely to be a pure glueball state.

Loss-of-function mutation of the GPR40 gene associates with abnormal stimulated insulin secretion by acting on intracellular calcium mobilization

BACKGROUND

Free fatty acids (FFAs) acutely stimulate but chronically impair glucose-stimulated insulin secretion from beta-cells. The G protein-coupled transmembrane receptor 40 (GPR40) mediates both acute and chronic effects of FFAs on insulin secretion and plays a role in glucose homeostasis. Limited information is available on the effect of GPR40 genetic abnormalities on insulin secretion and metabolic regulation in human subjects.

STUDY DESIGN AND RESULTS

For in vivo studies, we screened 734 subjects for the coding region of GPR40 and identified a new single-nucleotide mutation (Gly180Ser). The mean allele frequency was 0.75%, which progressively increased (P < 0.05) from nonobese subjects (0.42%) to moderately obese (body mass index = 30-39.9 kg/m2, 1.07%) and severely obese patients (body mass index > or = 40 kg/m2, 2.60%). The relationship between the GPR40 mutation, insulin secretion, and metabolic alterations was studied in 11 Gly/Ser mutation carriers. In these subjects, insulin secretion (insulinogenic index derived from oral glucose tolerance test) was significantly lower than in 692 Gly/Gly carriers (86.0 +/- 48.2 vs. 183.7 +/- 134.4, P < 0.005). Moreover, a case-control study indicated that plasma insulin and C-peptide responses to a lipid load were significantly (P < 0.05) lower in six Gly/Ser than in 12 Gly/Gly carriers. In vitro experiments in HeLa cells cotransfected with aequorin and the mutated Gly/Ser GPR40 indicated that intracellular Ca2+ concentration increase after oleic acid was significantly lower than in Gly/Gly GPR40-transfected cells. This fact was confirmed using fura-2 acetoxymethyl ester.

CONCLUSIONS

This newly identified GPR40 variant results in a loss of function that prevents the beta-cell ability to adequately sense lipids as an insulin secretory stimulus because of impaired intracellular Ca2+ concentration increase.

[Cellular dynamics of pathogenesis induced by bovine leukemia virus]

Bovine leukemia virus (BLV) is the etiological agent of a lymphoproliferative disease in cattle. This retrovirus can also be experimentally transmitted to sheep, in which the pathology is more rapid and more frequent. This review summarizes the current knowledge on the BLV virus and more particularly on its role in lymphocyte homeostasis and induction of pathogenesis. This system has been informative for understanding pathogenesis induced by human T-lymphotropic virus type I (HTLV-1).

Screening for children from families with Rendu-Osler-Weber disease: from geneticist to clinician

BACKGROUND

Rendu-Osler-Weber syndrome, or hereditary hemorrhagic telangiectasia (HHT), is an autosomal dominant vascular disorder. The syndrome is characterized by telangiectases and arteriovenous malformations (AVMs) affecting skin, mucosae and internal organs. AVMs often remain clinically silent until provoking sudden serious complications, responsible for important morbidity and mortality which can occur both in adulthood and in children. The incidence of AVMs in HHT pediatric populations is unknown.

OBJECTIVE

To describe the screening protocol performed in the first genotypically confirmed HHT pediatric population and to estimate the incidence of occult brain, lung and liver AVMs and the different disease phenotypes.

MATERIALS AND METHODS

Molecular analysis was performed on 35 children, both symptomatic and asymptomatic, who were family members of probands with a previously identified mutation. Clinical-instrumental examination was performed on the mutation positive cases. Nasal telangiectases were investigated by anterior rhinoscopy. Contrast echocardiography and high resolution thoracic multislice computed tomography (CT) were performed to detect pulmonary arteriovenous malformations (PAVMs), and echo-color Doppler, and abdominal CT to detect hepatic arteriovenous malformations (HAVMs). Brain magnetic resonance imaging was utilized to detect cerebral angiopathic involvement.

RESULTS

Molecular analysis demonstrated the mutation-carrier status in 22/35 children. Nineteen children, 12 of whom had epistaxis, positive to molecular testing underwent clinical evaluation. Nasal teleangiectases were found in 68%, mucocutaneous telangiectases (fingers, lips and oral cavity) in 79%, PAVMs in 53%, HAVMs in 47% and cerebral anteriovenous malformations and/or cerebral ischemic changes secondary to PAVMs in 12%.

CONCLUSIONS

We evidenced a high incidence of HHT children with occult visceral lesions suggesting that a diagnostic screening may be indicated to appropriately treat brain and lung malformations.

HHT in Childhood: Screening for Special Patients

Hereditary hemorrhagic telangiectasia (HHT) or the Rendu-Osler-Weber disease is a systemic fibrovascular autosomal dominant dysplasia, recognised when three of the following four clinical manifestations are present, according to the proposal of Shovlin.: recurrent nosebleeds, lelangiectasias of the skin, visceral lesions, and positive family history. HHT is often difficult to diagnose on the basis of history and physical examination alone, especially in infants and children. The signs and symptoms of HHT are nonspecific and are extremely variable within families. Given the frequent occurrence of clinically silent lesions in lung and brain arteriovenous malformations which can result in morbidity or death, much consideration should be given to screening patients with HHT for asymptomatic fistulae and to their treating once they are discovered. Presymptomatic interventions in such cases may substantially affect the outcome. It may be possible to state that lesions of HHT arise early in life, but do not reach sufficient size to cause symptoms until the second decade. Furthermore, as clinical manifestations often occur later in life, the development and the implementation of a molecular diagnosis will allow the identification of subjects with no evident signs of the disease but carrying the familial mutation. This is fundamental in order to establish reliable screening protocols for the prevention and cure of the disease and, to determine the presence of family members with no disease-associated mutation, who do not require further clinical screening.

Management of Liver Disease in Thalassemia: Main Drug Targets for a Correct Therapy

Liver disease is the second cause of mortality in thalassemia major. We present a review on the hepatic damage in thalassemic patients aimed at a knowledge of current preventive, diagnostic and therapeutic approaches, useful to guide in clinical judgment and treatment decisions. Transfusion related iron overload and hepatitis are the causes of liver damage in thalassemic patients. We examined means of primary prevention, anti-hepatitis vaccinations, blood donors screening; diagnostic tests for secondary prevention (computed tomography, magnetic resonance imaging, super conducting quantum interference device and biopsy) were also discussed about. A survey of treatment methods and strategies ( chelation therapy, antiviral treatments and liver and bone marrow transplantation) follows.

[Sarcoidosis presenting with Raynaud's syndrome: a case report]

We report a case of association between sarcoidosis and Raynaud's syndrome. A 39 year old female presented fatigue, Raynaud's syndrome, IgG and erithrosedimentation rate (ESR) increase, polyarthralgy in which disseminated micronodular infiltration in the chest X-ray and histological demonstration of non-caseating epitheloid microgranulomas led to a diagnosis of concomitant sarcoidosis. Clues to the diagnosis of sarcoidosis coexisting with autoimmune disease are discussed.

[Prevention and treatment of congenital toxoplasmosis: organization protocol]

AIM

Prevention and treatment of congenital toxoplasmosis are still a matter of debate among obstetricians, pediatricians and epidemiologists. There is no consensus about antenatal screening and diagnostic tests, nor there is about treatment for presumed infection in pregnancy. As an example of this type of organisation for health care delivery, a regional model has been promoted as a multidisciplinary approach for prenatal diagnosis of congenital toxoplasmosis. The model had been designed on the national guidelines of the National Health Institute (Istituto Superiore di Sanità, ISS).

METHODS

Suspected maternal infections are referred and seen as outpatients at our centre on a specific day of the week; maternal investigation (specific IgG, IgM, IgA and IgG avidity titres) are performed at the Institute of Virology of the University of Bari, and patients are started on spiramycin. All cases of true or presumed seroconversion are counselled for amniotic fluid sampling and the sample is sent to ISS. In cases of late seroconversion and positive amniotic fluid results, patients are prescribed pyrimethamine+sulphonamide+folinic acid and alternate spiramycin until the end of pregnancy. A fetal-neonatal follow-up is performed in all cases.

RESULTS

During the period 1999-2001, 180 cases of presumed toxoplasmosis infection have been referred (average 60 cases per year). We have been able to reclute, since the adoption of the national network protocol, 1/3 of presumed regional cases with a positive increasing trend.

CONCLUSION

The service for prenatal diagnosis of toxoplasma gondii infection has definitely benefitted from the adoption of this protocol, which combines adherence to a national network and pays respect to regional requirements.

Bullous pemphigoid in Liguria: a 2-year survey

BACKGROUND

The epidemiology of bullous pemphigoid (BP) is not clear because of the heterogeneity of the disease, and its possible association with internal malignancies has been under debate for many years. We report the findings of a 2-year study on incident BP cases in the Liguria region of Italy.

SUBJECTS AND METHODS

Thirty-two patients with BP were collected over the 2-year period. Diagnosis was made based on clinical findings and confirmed by histology, direct immunofluorescence (DIF) and indirect immunofluorescence (IIF) with salt-split skin and monkey oesophagus, and immunoblotting (IB). All patients were thoroughly investigated for possible malignancies and all were followed up for 6 months to monitor the response to treatment.

RESULTS

DIF showed linear deposits at the dermoepidermal junction in all but one patient. IIF gave positive findings for 15 sera tested with monkey oesophagus and 20 tested with salt-split skin. IB gave positive findings in 19 cases. There was a malignancy in six cases, but no clinical or immunological features that could be considered to predict this occurrence.

CONCLUSIONS

The findings of this study are in accordance with most of the data found in the literature, including the fact that IgG serum levels did not predict the course of the disease. Contrary to previous indications, IgE levels were not indicative of disease course either. Mucosal lesions, erythema multiform-like lesions, negative IIF findings and antibodies to AgPB2 were not a prediction for the development of malignancy.

Papular-purpuric gloves and socks syndrome in HIV-positive patients

Three HIV-positive women showed clinical signs of papular-purpuric gloves and socks syndrome and serologic evidence of acute Parvovirus B19 infection. The course of the disease was complicated by anemia and persistent skin lesions, probably related to inadequate immune response. Because anemia in AIDS patients may be due to many causes, the history of recent Parvovirus B19 infection is helpful in suggesting the etiologic diagnosis.

Persistent solar urticaria. A case report

Solar urticaria is an uncommon dermatological disease characterized by wheals developing within a few minutes after sun exposure and lasting a few hours. We describe a man in whom wheals developed on his trunk and arms more than 30 min after sun exposure and lasted more than 24 h. High doses of UVA reproduced lesions with histological features typical of urticaria. After 7 years, urticaria began to develop even in winter and without sun exposure. Our patient is unusual in that his wheals were delayed in onset and longlasting. The later association of idiopathic urticaria is an additional unusual feature.