Health City Institute

Naturally Occurring Asbestos (NOA) has drawn the attention worldwide when investigation revealed an increased incidence of malignant mesothelioma in population living near NOA sites. In Basilicata region (South Italy), population living in the villages of Castelluccio Superiore and Inferiore, Lauria, Latronico, Episcopia, San Severino Lucano, and Francavilla in Sinni may be considered at high risk of asbestos exposure because these villages are either surrounded by or built on NOA-rich ophiolitic outcrops. In this work we investigated an asbestos tremolite sample coming from the ophiolitic rocks outcropping in the quarry of Iacolinei, widely used in the past to extract aggregates for various applications. A detailed mineralogical characterization has been attained by using a multi-analytical approach (EMPA, SEM-EDS, TEM-EDS, Mössbauer, µ-Raman, X-ray powder diffraction, and thermal analysis). Morphological investigation highlighted that the sample is composed of long fibers (> 5 µm) with a significant fraction (ca. 55%) having width below 0.25 µm, considered the most biologically active fibers. Moreover, the crystal chemical characterization showed that Fe occurs at the octahedral sites of the tremolite structure. It should be noted that Fe plays a primary role in the toxicity of asbestos. Based on these results, the investigated asbestos tremolite may be considered a potent mesothelial carcinogen, requiring therefore special attention for public health protection purposes. Investigations using sentinel animals to assess the diffusion of the tremolite fibers into the environment from the serpentinite rocks and soils of Iacolinei quarry are in progress.

Motivation: Single cell RNA sequencing (scRNA-seq) data makes studying the development of cells possible at unparalleled resolution. Given that many cellular differentiation processes are hierarchical, their scRNA-seq data is expected to be approximately tree-shaped in gene expression space. Inference and representation of this tree-structure in two dimensions is highly desirable for biological interpretation and exploratory analysis.Results:Our two contributions are an approach for identifying a meaningful tree structure from high-dimensional scRNA-seq data, and a visualization method respecting the tree-structure. We extract the tree structure by means of a density based minimum spanning tree on a vector quantization of the data and show that it captures biological information well. We then introduce DTAE, a tree-biased autoencoder that emphasizes the tree structure of the data in low dimensional space. We compare to other dimension reduction methods and demonstrate the success of our method both qualitatively and quantitatively on real and toy data.Availability: Our implementation relying on PyTorch and Higra is available at https://github.com/hci-unihd/DTAE.

BackgroundSince 2010, more than half of World population lives in Urban Environments. Urban Diabetes has arisen as a novel nosological entity in Medicine. Urbanization leads to the accrual of a number of factors increasing the vulnerability to diabetes mellitus and related diseases. Herein we report clinical-epidemiological data of the Milano Metropolitan Area in the contest of the Cities Changing Diabetes Program. Since the epidemiological picture was taken in January 2020, on the edge of COVID-19 outbreak in the Milano Metropolitan Area, a perspective addressing potential interactions between diabetes and obesity prevalence and COVID-19 outbreak, morbidity and mortality will be presented. To counteract lock-down isolation and, in general, social distancing a pilot study was conducted to assess the feasibility and efficacy of tele-monitoring via Flash Glucose control in a cohort of diabetic patients in ASST North Milano.MethodsData presented derive from 1. ISTAT (National Institute of Statistics of Italy), 2. Milano ATS web site (Health Agency of Metropolitan Milano Area), which entails five ASST (Health Agencies in the Territories). A pilot study was conducted in 65 screened diabetic patients (only 40 were enrolled in the study of those 36 were affected by type 2 diabetes and 4 were affected by type 1 diabetes) of ASST North Milano utilizing Flash Glucose Monitoring for 3 months (mean age 65 years, HbA1c 7,9%. Patients were subdivided in 3 groups using glycemic Variability Coefficient (VC): a. High risk, VC > 36, n. 8 patients; Intermediate risk 20 < VC < 36, n. 26 patients; Low risk VC < 20, n. 4 patients. The control group was constituted by 26 diabetic patients non utilizing Flash Glucose monitoring.ResultsIn a total population of 3.227.264 (23% is over 65 y) there is an overall prevalence of 5.65% with a significant difference between Downtown ASST (5.31%) and peripheral ASST (ASST North Milano, 6.8%). Obesity and overweight account for a prevalence of 7.8% and 27.7%, respectively, in Milano Metropolitan Area. We found a linear relationship (R = 0.36) between prevalence of diabetes and aging index. Similarly, correlations between diabetes prevalence and both older people depending index and structural dependence index (R = 0.75 and R = 0.93, respectively), were found. A positive correlation (R = 0.46) with percent of unoccupied people and diabetes prevalence was also found. A reverse relationship between diabetes prevalence and University level instruction rate was finally identified (R = − 0.82). Our preliminary study demonstrated a reduction of Glycated Hemoglobin (p = 0.047) at 3 months follow-up during the lock-down period, indicating Flash Glucose Monitoring and remote control as a potential methodology for diabetes management during COVID-19 lock-down.Hypothesis and discussionThe increase in diabetes and obesity prevalence in Milano Metropolitan Area, which took place over 30 years, is related to several environmental factors. We hypothesize that some of those factors may have also determined the high incidence and virulence of COVID-19 in the Milano area. Health Agencies of Milano Metropolitan Area are presently taking care of diabetic patients facing the new challenge of maintaining sustainable diabetes care costs in light of an increase in urban population and of the new life-style. The COVID-19 pandemic will modify the management of diabetic and obese patients permanently, via the implementation of approaches that entail telemedicine technology. The pilot study conducted during the lock-down period indicates an improvement of glucose control utilizing a remote glucose control system in the Milano Metropolitan Area, suggesting a wider utilization of similar methodologies during the present “second wave” lock-down.

The risk of transmission of malignancy from donor to recipient is low. However, this occurrence has dramatic consequences. Many reports of donor-derived cancers in liver transplant recipients have been published, but they have not been systematically summarized into a lucid and unified analysis. The present study is an attempt to provide clarity to this unusual but clinically important problem. We systematically reviewed all patient reports, patient series, and registries published on cancer transmission events through the end of December 2019. We identified a total of 67 publications with 92 transmission events. The most frequently transmitted cancers were lymphomas (30; 32.6%), melanomas (8; 8.7%), and neuroendocrine tumors (8; 8.7%). Most of the melanomas were metastasizing, whereas most of the lymphomas were localized to the graft. The median time to cancer diagnosis after transplantation was 7months, with 78.1% of diagnoses established in the first year. Melanoma carried the worst prognosis, with no recipients alive at 1year after cancer diagnosis. Lymphoma recipients had a better outcome, with more than 75% surviving at 2years. A metastatic cancer carries a worse prognosis for recipients, and recipients with localized cancer can benefit from the chance to undergo transplantation again. The findings confirm the need to pay attention to donors with a history of melanoma but also suggest the need for a more careful evaluation of groups of donors, such as those dying from cerebral hemorrhage. Finally, recipients of organs from donors with cancer should be carefully followed to detect potential transmission.

Patient engagement is receiving a growing attention in the healthcare context. However, although worldwide healthcare stakeholders agree that patient engagement is a priority for quality and effective care, no shared recommendations on how to promote patient engagement are currently available. Based on these premises, a Consensus Conference (CC) was promoted to address four main issues: What is the definition of Patient Engagement? How measuring Patient Engagement? What are the most recommended methodologies and the tools to promote Patient Engagement? What is the role of new technologies in promoting of Patient Engagement? The consensus was obtained through an iterative process that began with a systematic synthesis of the available literature in each domain followed by plenary expert discussions. This CC - including the systematic analysis of internationals scientific evidences (2749 sources across the major international scientific databases) together with experiences of a multi-disciplinary consortium of investigators and key stakeholders - attempted to provide the first evidence-based Expert Consensus Statement for the promotion of Patient Engagement in chronic care. These recommendations should be envisaged as inspirational principles to promote a real eco-system of engagement and might orient health services research and interventions.

Durant les années 1960, l’Italie a connu une migration interne de masse des régions méridionales vers celles du Nord-Ouest, où se déroulait le boom économique italien de l’après-guerre. La présence féminine dans ces flux était importante mais, pendant longtemps, les études ont dirigé leur attention vers les hommes, rendus plus visibles en raison, surtout, de leur présence prépondérante dans le secteur mécanique ainsi que dans les luttes syndicales ouvrières des années 1960 et 1970. L’expérience des femmes immigrées a été très peu étudiée et a souvent été évoquée de façon superficielle, en ayant recours aux stéréotypes les plus diffusés sur « la culture méridionale », que l’on suppose être hostile au travail des femmes. De plus, l’invisibilité du rôle actif des femmes immigrées pendant les années du « miracle économique » italien est liée à l’idée que la décennie 1960 avait été caractérisée par un processus de ménagérisation (« casalinghizzazione ») des femmes des couches populaires. Selon cette hypothèse, le nouveau bien-être économique aurait encouragé les femmes d’ouvriers à quitter le marché du travail pour réaliser leur rêve de devenir femmes au foyer. Mais les femmes qui ont quitté le Sud pour s’établir dans le Nord industriel sont-elles vraiment restées en dehors du marché du travail ?Dans cet article nous nous interrogerons sur l’idée de la ménagérisation à partir de l’observation de l’expérience des femmes immigrées à Turin, l’une des principales villes du triangle industriel italien. Les parcours migratoires et les itinéraires dans le marché du travail de ces femmes révèlent une réalité complexe, où l’aspiration au travail des femmes ayant des enfants est contrastée par des facteurs liés à la spécificité de la condition d’immigrée. Nous mettrons en lumière ces facteurs et nous analyserons les stratégies mises en place par les femmes et leurs familles pour faire face à ces contraintes. Dans certains cas, on peut observer une nouvelle répartition des tâches domestiques entre les genres en fonction du travail de la femme ; dans d’autres cas, les femmes doivent se replier sur des activités par intermittence, plus flexibles que le travail industriel mais souvent non déclarées. On observera qu’au-delà d’une dimension économique, le travail, pour les femmes immigrées, peut aussi répondre à d’autres besoins, notamment sortir de l’isolement social causé par le déplacement dans le nouvel environnement.

Background:The world is rapidly urbanizing, causing alarming health problems to their citizens. The Cities Changing Diabetes program aims to address the social factors and cultural determinants that can increase type 2 diabetes (T2D) vulnerability among people living in cities.Methods:Public data of Italian Institute for Statistics (ISTAT) and available scientific reports were reviewed and findings integrated. The prevalence of T2D in the 8 health districts of Rome was mapped and the correlation between prevalence and social and cultural determinants was assessed.Results:The metropolitan area of Rome has 4.3 million inhabitants. People over 65 has increased by 136,000 units in the last decade, reaching 631,000 citizens in 2015. Elderly people living alone are 28.4%. The obesity prevalence is 9.3%, as compared to 8.2% in the year 2000. The prevalence of T2D is 6.6%, varying in the different 8 health districts between 5.9% and 7.3%. A linear correlation exists between the prevalence of diabetes in the districts, unemployment rate and use of private transportation rate (Pearson R 0.52 and 0.60, respectively), while an inverse correlation is present with aging index, school education level, and slow mobility rate (Person R -0.57, -0.52, and -0.52, respectively).Conclusions:Important socio-demographic changes have occurred in Rome during the last decades with a raise in the prevalence of obesity and diabetes. A wide variation exists in the prevalence of T2D among the districts of Rome, associated with social and cultural determinants. This study model can help rethinking diabetes in an urban setting. (www.actabiomedica.it)

Il fallimento dei moti del 1848 costringe a ragionare sulla natura dei processi storici in atto. Le stesse parole del vocabolario politico repubblicano sono rimesse in gioco e sono esaminate nel loro valore. Carlo Pisacane offre una prima interpretazione dei fatti. Illustrando i modi della rivolta, riflette sulle condizioni della Sicilia, la regione più depressa nello scenario italiano. La crisi in cui si trova può sfociare in un rinnovamento rivoluzionario oppure può produrre il trionfo dei peggiori comportamenti. Quarant’anni dopo Pisacane, Verga racconta, nel Mastro-don Gesualdo, la vittoria dell’egoismo e dell’interesse. Tutta la storia della modernità si svolge sotto il segno di queste passioni negative, che generano la guerra feroce tra gli individui. Le parole della cultura repubblicana e risorgimentale sono utilizzate solo come uno schermo ingannevole. Esse nascondono l’attaccamento alla roba e proteggono il potere che i nuovi ricchi hanno acquisito. De Roberto e Pirandello si muovono sulla stessa via indicata da Verga. La separazione tra la falsità delle parole e la verità degli interessi è esplicita e perfino teorizzata. Del sogno del Risorgimento non resta più nulla, se non una memoria debole e sterile.