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1. How Covid-19 changed psychiatric department admissions: observational study comparison of psychiatric department admissions over three years

Author

T. Barlattani, C. D’Amelio, A. Russo, R. Santini, F. Pacitti, and A. Rossi

Subjects
Psychiatry, RC435-571
Abstract

Introduction Although the role of SARS-CoV2 pandemic on psychiatric Emergency Department (ED) encounters, has been analysed, few studies have focused on the pandemic influence on patients’ characteristics and admission rates in a psychiatric ward. Objectives The aim of this cross-sectional study is to analyse characteristics of patients admitted in the psychiatric ward of “San Salvatore” Hospital in L’Aquila (Italy) in a three-year timeframe, from 2019 to 2021, and evaluate the impact of COVID-19 pandemic on admission trends over the course of these three years. Methods We collected data regarding 1115 patients from the hospital discharge summaries (Scheda di Dimissione Ospedaliera, SDO) of “San Salvatore” Hospital. Patients were sorted according to diagnosis, year of admission and age range. Comparison of mean values from each group was attained using the Student’s t-test, while percentages and ratios were compared by means of the Chi-Square test. Results Between January 2019 and December 2021, 1115 patients were admitted in our psychiatric ward. In 2020, during pandemic outbreak, we observed a reduction of the number of admissions, with 351 patients. Although no statistically significant differences were found regarding patients’ gender or age, we observed a higher number of male patients admitted during all three years (male/female ratio: 231/171 in 2019, 217/134 in 2020 and 192/170 in 2021). Admission rates of patients aged between 18 to 30 years were higher during 2020 and 2021, conversely in the previous year the most represented group were patients aged between 41 to 50 years. Regarding diagnostic categories, percentages remained relatively steady during the three years. Nevertheless, it was possible to observe a slight reduction of Schizo-Psychotic disorders (175/402; 45,53% in 2019, 135/351; 38.46% in 2020 and 119/362; 32,87% in 2021) and a slighter reduction of Personality disorders percentages (49/402; 12,19% in 2019, 37/351; 10,54% in 2020 and 36/362; 9,94% in 2021). Conversely, results showed an increase in admission of patients with substance use disorder: 24 out of 402 patients (5,97%) in 2019, 32 out of 351 patients (9,12%) in 2020, and 46 out of 362 patients (12,71%) in 2021. Image 2: Image 3: Conclusions Despite biases due to the one-site evaluation, the strength of the present study relies in the retrospectively cross-sectional observation design conducted to evaluate a three-year timeframe, spanning throughout the pandemic. The sharp reduction of admissions rates in 2020, is in line with other data regarding ED accesses’ trends during pandemic. Increasing rates of admission of patients between 18 and 30 years could be a result of a stronger impact of the pandemic on young people’s mental health. Moreover, increasing trends of admission of patients with substance abuse disorders may be potentially addressed to distress symptoms brought by the pandemic. Disclosure of Interest None Declared

Published
2023
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2. How Covid-19 changed emergency department access: observational study comparison of patient stage of the day access in the psychiatric emergency department over three years

Author

R. Santini, T. Barlattani, T. Jannini, A. Mariano, F. Bianchi, C. Niolu, and A. Siracusano

Subjects
accesses, emergency room, stage of the day, Covid-19, Psychiatry, RC435-571
Abstract

Introduction A few studies have analyzed the impact of COVID-19 pandemic on psychiatric Emergency Department (ED) accesses. The pandemic may indeed have influenced the phase of day accesses for patients with psychiatric disorders. Objectives Aim of this cross-sectional study is to analyze how COVID-19 weighed on psychiatric patients daily accesses over the course of three years. Methods Data on 219 patients were retrospectively collected from the ED in the Policlinico Tor Vergata, Rome. According to the stage of the day, accesses were divided into 4 groups: between 00:00 and 6:00; between 6:00 a.m. and 12:00 a.m.; between 12:00 a.m. and 18:00 p.m.; between 18:00 p.m. and 00:00 p.m. Results Performing a regression analysis, a relation was found between psychiatric symptoms, stage of the day admission and year. In 2019 the admissions seem to be homogeneously distributed, however during 2021 and 2020 the admissions rates have a delayed evening trend. Conclusions Despite the low number of accesses considered, the Covid-19 pandemic appears to exert an effect that still lasts in terms of both accesses and worsening or new onset of psychiatric symptoms. Measures taken to prevent the spread of infections may have affected access in the ED of patients in various ways. However, the trend of increasing evening accesses could be related to a saturation of territorial psychiatric services that work mainly until the afternoon. Thus, an enhancement of territorial psychiatric services seems highly necessary to cope with what could be an increase in psychopathology in patients without previous diagnosis. Disclosure No significant relationships.

Published
2022
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3. Covid-19 and impulsivity: an evaluation of self-harm admissions in emergency care

Author

A. Mariano, R. Santini, T. Jannini, F. Di Michele, F. Bianchi, A. Siracusano, and C. Niolu

Subjects
emergency care, self-harm, Impulsivity, Covid-19, Psychiatry, RC435-571
Abstract

Introduction Several studies highlighted how COVID-19-related isolation and quarantine deeply weighed on the mental health of both the general and psychiatric population. There has been limited investigation about self-harm and impulsivity during the COVID-19 pandemic. Objectives The aim of this study is to evaluate how COVID-19-related lockdown affected self-harm rates in an Italian hospital. Methods Data on 59 patients were retrospectively collected from the Emercency deparment of the Policlinico Tor Vergata, Rome, from March 11 to May 4, 2020 (Italian mass quarantine) and the same periods of 2019 and 2021. Demographics, psychiatric history, substance use/abuse, types of self-harm and admission in psychiatric acute unit (PAU) rates were recorded. Results No statistical difference was reported in self-harm rates [9.8%(26/266) in 2019 vs 13.2%(10/76) in 2020 vs 10.7%(23/215) in 2021;p>0.05]. In 2020 subjects were younger (31.9±12.1 vs 39.2±14.4,p=0.22;vs 38.1±14.4;p=0.15) and had higher incidence of psychiatric history [90%(9/10) vs 73.1%(19/26), p=0.42;vs 65.2% (15/23),p=0.29],than 2019 and 2021 respectively. Substance use/abuse rates were significantly lower in 2020 compared to 2019 and 2021 [10%(1/10) vs 53.8%(14/26),p=0.04;vs 60.9% (14/23), p=0.02]. In 2020, subjects committing self-harms were more frequently admitted to PAU compared to 2019 and 2021 [60%(6/10)vs19.2%(5/26),p=0.04; vs 17.4% (4/23), p=0.04). Conclusions Consistent with the literature, lockdown-related measures negatively impacted on younger people, with higher rates of self-harm between March and May 2020. This, together with a higher rate of admissions to PAU, should warn the mental health system to target with specific programs to support adolescents and youngers. Disclosure No significant relationships.

Published
2022
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4. Comparison of psychiatric emergency service admission rates in an italian COVID-19 hospital during lockdown and last year

Author

F. Fiori Nastro, A. Mariano, R. Santini, F. Di Michele, F. Bianchi, and C. Niolu

Subjects
COVID-19, psychological impact, Hospital Admission rates, Psychiatric Emergency Service, Psychiatry, RC435-571
Abstract

Introduction Italy has been one of the most affected countries by Covid-19 pandemic. Our University General Hospital, Policlinico of “Tor Vergata” (PTV) in Rome, has become a Covid Hub in order to manage the spread of the epidemic. Thus, our Psychiatric Emergency Service (PES)’s access has been partially limited. Direct indicators of PES activity, as admission rates, can be useful for evaluating the psychological impact of Covid epidemic. Objectives To assess psychiatric admittance rates to PES of PTV before and during Covid-19 global pandemic. Methods Data from our PES register have been obtained and analyzed. We compared all the psychiatric access during the trimester March – May 2019 and 2020. All patients have been characterized according to clinical features. Results A marked reduction of the number of patients presenting to PES has been observed (76 patients) in the 57-day period (March 11–May 04, 2020) of lockdown compared to the same period in 2019 (266 patients). The cutback was visible for all diagnostic groups, except for “Borderline Personality Disorder” diagnosis which have slightly increased. On the other hand, hospitalization rates in our psychiatric inpatients unit remained steady. Conclusions Although larger study are needed to understand the mental consequences of the lockdown experience, people’s fear of potential infection might explain our results. Interestingly, personality disorder patients represent an exception to it, suggesting the importance of the clinical characteristics of fearless, engagement in dangerous behavior and detachment from reality. These findings might be helpful to improve psychosocial crisis interventions during the pandemic.

Published
2021
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6. Al-alkyls as acceptor dopant precursors for atomic-scale devices

Author

Jeffrey A. Ivie, Ezra Bussmann, Quinn Campbell, R Santini, Andrew Baczewski, Scott W. Schmucker, Shashank Misra, John N. Randall, and James H. G. Owen

Subjects
Materials science, Hydrogen, Dopant, Silicon, Hydride, Inorganic chemistry, chemistry.chemical_element, Condensed Matter Physics, law.invention, chemistry, Aluminium, law, Molecule, General Materials Science, Density functional theory, Scanning tunneling microscope
Abstract

Atomically precise ultradoping of silicon is possible with atomic resists, area-selective surface chemistry, and a limited set of hydride and halide precursor molecules, in a process known as atomic precision advanced manufacturing (APAM). It is desirable to expand this set of precursors to include dopants with organic functional groups and here we consider aluminium alkyls, to expand the applicability of APAM. We explore the impurity content and selectivity that results from using trimethyl aluminium and triethyl aluminium precursors on Si(001) to ultradope with aluminium through a hydrogen mask. Comparison of the methylated and ethylated precursors helps us understand the impact of hydrocarbon ligand selection on incorporation surface chemistry. Combining scanning tunneling microscopy and density functional theory calculations, we assess the limitations of both classes of precursor and extract general principles relevant to each.

Published
2021

7. Comparison of psychiatric emergency service admission rates in an italian COVID-19 hospital during lockdown and last year

Author

Cinzia Niolu, F. Fiori Nastro, A. Mariano, R. Santini, F. di Michele, and Francesco Bianchi

Subjects
Service (business), medicine.medical_specialty, Coronavirus disease 2019 (COVID-19), business.industry, media_common.quotation_subject, Psychological intervention, medicine.disease, Psychiatry and Mental health, Pandemic, Medicine, Personality, General hospital, business, Psychiatry, Psychosocial, Borderline personality disorder, media_common
Abstract

IntroductionItaly has been one of the most affected countries by Covid-19 pandemic. Our University General Hospital, Policlinico of “Tor Vergata” (PTV) in Rome, has become a Covid Hub in order to manage the spread of the epidemic. Thus, our Psychiatric Emergency Service (PES)’s access has been partially limited. Direct indicators of PES activity, as admission rates, can be useful for evaluating the psychological impact of Covid epidemic.ObjectivesTo assess psychiatric admittance rates to PES of PTV before and during Covid-19 global pandemic.MethodsData from our PES register have been obtained and analyzed. We compared all the psychiatric access during the trimester March – May 2019 and 2020. All patients have been characterized according to clinical features.ResultsA marked reduction of the number of patients presenting to PES has been observed (76 patients) in the 57-day period (March 11–May 04, 2020) of lockdown compared to the same period in 2019 (266 patients). The cutback was visible for all diagnostic groups, except for “Borderline Personality Disorder” diagnosis which have slightly increased. On the other hand, hospitalization rates in our psychiatric inpatients unit remained steady.ConclusionsAlthough larger study are needed to understand the mental consequences of the lockdown experience, people’s fear of potential infection might explain our results. Interestingly, personality disorder patients represent an exception to it, suggesting the importance of the clinical characteristics of fearless, engagement in dangerous behavior and detachment from reality. These findings might be helpful to improve psychosocial crisis interventions during the pandemic.

Published
2021

8. Drug Prescription and Delirium in Older Inpatients: Results From the Nationwide Multicenter Italian Delirium Day 2015-2016

Author

Aloisi, Gaetano, Marengoni, Alessandra, Morandi, Alessandro, Zucchelli, Alberto, Cherubini, Antonio, Mossello, Enrico, Mario, Bo, Di Santo Simona, Mazzone, Andrea, Trabucchi, Marco, Cappa, Stefano, Fimognari, Filippo, Antonelli Incalzi Raffaele, Gareri, Pietro, Perticone, Francesco, Campanini, Mauro, Montorsi, Marco, Latronico, Nicola, Zambon, Antonella, Bellelli, Giuseppe, Rispoli, Vincenzo, Malara, Alba, Spadea, Fausto, Di Cello Serena, Ceravolo, Francesco, Fabiano, Francesco, Chiaradia, Giuseppe, Gabriele, Amedeo, Lenino, Peluso, Andrea, Taristano, Settembrini, Vincenzo, Capomolla, Domenico, Citrino, Antonella, Scriva, Antonietta, Bruno, Irene, Secchi, Roberto, De Martino Eugenio, Muccinelli, Roberto, Lupi, Gerardo, Paonessa, Patrizio, Fabbri, Andrea, Passuti Maria Teresa, Castellari, Sofia, Andrea, Po, Gaggioli, Guido, Varesi, Massimo, Moneti, Paolo, Capurso, Sebastiano, Latini, Vincenzo, Ghidotti, Stefano, Riccardelli, Francesco, Macchi, Maurizio, Rigo, Rosaria, Claudio, Pascale, Bosio, Angelo, Cerrato, Flavio, Bardelli, Benedetta, Boffelli, Stefano, Cassinadri, Angela, Franzoni, Simone, Spazzini, Elena, Andretto, Daniela, Tonini, Gabriele, Andreani, Laura, Coralli, Mirco, Balotta, Antonio, Cancelliere, Roberto, Ballardini, Giorgio, Simoncelli, Margherita, Mancini, Annarita, Strazzacapa, Mara, Fabio, Stefano, De Filippi Francesco, Giudice, Chiara, Dentizzi, Cosimo, Azzini, Margherita, Cazzadori, Marco, Mastroeni, Valeria, Bertassello, Paolo, Santana, Helena, Benati, Claudia, Nesta, Elisa, Tobaldini, Chiara, Guerini, Fabio, Tambara, Elena, Mombelloni, Paolo, Fontanini, Fulvio, Lassa, Gabriella, Lassa, Pizzorni, Crosio, Oliverio, Martina, Del, Grosso, Luciano, Luca, Giavedoni, Cristina, Bidoli, Giuliano, Mazzei, Bruno, Corsonello, Andrea, Fusco, Sergio, Vena, Silvio, De Vuono Tommaso, Maiuri, Giorgio, Fimognari Filippo Luca, Arone, Andrea, Sgro, Giovanni, Nicolazzo, Rossella, Castegnaro, Eugenio, De Rosa Salvatore, Sechi Bazzano Rossella, Benvenuti, Enrico, Del Lungo Ilaria, Giardini, Sante, Giulietti, Chiara, Di Bari Mauro, Barghini, Eleonora, Paoli, Martina, Fiordelli, Irene, Barucci, Riccardo, Sgrilli, Federica, Bertoletti, Erik, D'Amico, Ferdinando, Caronzolo, Francesco, Grippa, Alessandro, Lombardo, Giuseppina, Pipicella, Tiziana, Saitta, Antonino, Corica, Francesco, Cucinotta, Valeria, Giaritta, Prestipino, Larosa, Daniela, Cucinotta, Domenico, Basile, Giorgio, March, Albert, Nitti Maria Teresa, Felici, Alessandro, Pavan, Silvia, Piazzani, Fabrizio, Lunelli, Alessandra, Dimori, Sergio, Margotta, Alessandro, Soglia, Tiziano, Postacchini, Demetrio, Brunelli, Roberto, Santini, Silvia, Francavilla, Monia, Macchiati, Ilenia, Sorvillo, Francesca, Giuli, Cinzia, Mecocci, Patrizia, Longo, Annalisa, Addesi, Desiree, Rosa Paola Cerra, Bencardino, Giuseppe, Falbo, Tania, Grillo, Nadia, Filice, Marco, Mirella, Filippo, Fanto, Fausto, Isaia, Gianluca, Pezzilli, Stella, Bergamo, Daniele, Furno, Elisabetta, Rrodhe, Sokol, Lucarini, Simonetta, Dijk, Babette, Dall'Acqua, Francesca, Cappelletto, Francesco, Calvani, Donatella, Becheri, Dimitri, Mottino, Giuseppe, Mitidieri, Costanza, Antonio, Vito, Bartalucci, Francesca, Magherini, Lorenza, Malin, Novella, Boni, Franca, Gambardella Paoli Martina Lucia, Valente, Carlo, Bracali, Ilaria, Bracali, Foschini, Alice, Porrino, Paola, Ceci, Giacomo, Bottignole, Giuliana, Tibaldi, Michela, Coppo, Eleonora, Ettore, Evaristo, Camellini, Cinzia, Servello, Adriana, Grassi, Alessandro, Rozzini, Renzo, Tironi, Sara, Grassi Maria Grazia, Troisi, Elio, Caltagirone, Carlo, Franchini, Flaminia, Ratto, Federica, Pavoni, Beatrice, Toniolo, Sofia, Gabutto, Anna, Quazzo, Loredana, Rosatello, Annalisa, Suraci, Domenico, Tagliabue, Benedetta, Perrone, Chiara, Ferrara, Lucia, Castagna, Alberto, Tremolada Maria Luisa, Castoldi, Giuseppe, Barbero, Stefano, Oltramonti, Davide, Piano, Simonetta, Serviddio, Gaetano, Lo Buglio Aurelio, Gurrera, Tiziana, Merlo, Valeria, Rovai, Carla, Cotroneo Antonino Maria, Carlucci, Rosaria, Abbaldo, Anna, Monzani, Fabio, Qasem Ahmad Amedeo, Bini, Giacomo, Tafuto, Silvia, Galli, Giovanni, Bruni Amalia Cecilia, Mancuso, Giovanna, Mancuso, Gerardo, De Luca Giuseppe Massimiliano, Calipari Daniela., Bernardini, Bruno, Corsini, Carla, Ciccarelli, Michele, Dal Farra Sara, Dal, Farra, Cagnin, Annachiara, Fragiacomo, Federica, Pompanin, Sara, Amodio, Piero, Cagnin, Marco, Zurlo, Amedeo, Guerra, Gianluca, Pala, Marco, Menozzi, Luca, Delli Gatti Chiara, Magon, Stefania, Manfredini, Roberto, De Giorgi Alfredo, Fabbian, Fabio, Tiseo, Ruana, Misurati, Elisa, Boari, Benedetta, Molino, Christian, Gallerani, Massimo, Di Francesco Vincenzo, Faccioli, Silvia, Pellizzari, Luca, Fontana, Giorgia, Barbagallo, Giuseppe, Lunardelli Maria Lia, Martini, Emilio, Ferrari, Eleonora, Macchiarulo, Maria, Corneli, Maria, Bacci, Monica, Battaglia, Giuseppe, Anastasio, Luigi, Lo Storto Mario Sostene, Seresin, Chiara, Simonato, Matteo, Loreggian, Michele, Cestonaro, Fausta, Durando, Mario, Latella, Raffaele, Mazzoleni, Marta, Russo, Giuseppe, Ponte, Martino, Valchera, Alessandro, Salustri, Giuseppe, Petritola, Donatella, Costa, Alfredo, Sinforiani, Elena, Cotta Matteo Ramusino, Pizio Renato Nicola, Cester, Alberto, Formilan, Marino, Bonometto, Pietro, Carbone, Pasqualina, Cazzaniga, Ilaria, Appollonio, Ildebrando, Cereda, Diletta, Stabile, Andrea, Xhani, Rubjona, Acampora, Roberto, Tremolizzo, Lucio, Pieruzzi, Federico, Ciaccio, Antonio, Pontecorvi, Valerio, Burti, Cesare, Mokini, Zhirajr, Vitale, Giovanni, Amigoni, Maria, Sparacino, Mariaelena, Bottacchi, Edo, Bucciantini, Elisabetta, Di Giovanni Marco, Franchi, Fabrizio, Lucchetti, Lucio, Mariani, Claudio, Grande, Giulia, Rapazzini, Piero, Mauri, Marco, Romanelli, Giuseppe, Nicosia, Franco, Margola, Alessio, Bonardelli, Stefano, Porcella, Laura, Portolani, Nazario, Concoreggi, Carlo, Grassini, Chiara, Salvi, Andrea, Bianchetti, Luca, Spagnoli, Francesca, Apuzzo, Roberto, Fontanella, Ceraso, Anna, Castelli, Francesco, Fugazza, Luciano, Guerrini, Chiara, De Paduanis Giovanna, Iallonardo, Lucia, Palumbo, Pasquale, Zuliani, Giovanni, Ortolani, Beatrice, Capatti, Eleonora, Soavi, Cecilia, Bianchi, Lara, Francesconi, Daniela, Miselli, Agata, Brombo, Gloria, Romagnoli, Tommaso, Pazzaglini, Chiara, Miselli Maria Agata, Dall'Agata, Marco, Suardi, Teresa, Zaccarini, Cinzia, Riva, Manuela, Mirra, Gianluca, Muti, Ettore, Bottura, Renato, Moretti, Gianpaolo, Secreto, Piero, Bisio, Erika, Cecchettani, Marco, Naldi, Tamara, Pallavicino, Alessandra, Pugliese, Michela, Iozzo Rosaria Cosima, Grassi, Guido, Bombelli, Michele, Delloro, Raffaella, Quarti Trevano Fosca, Giussani Carlo Giorgio, Paterno, Giovanni, Contro, Ernesto, Mannironi, Antonio, Giorli, Elisa, Oberti, Sara, Fierro, Brigida, Piccoli, Tommaso, Giacalone, Fabio, Mandas, Antonella, Serchisu, Luca, Costaggiu, Diego, Pinna, Elisa, Orru, Francesca, Mannai, Martina, Cordioli, Zeno, Pelizzari, Luca, Turcato, Emanuela, Arduini, Pietro, Cacace, Carlo, Chiloiro, Roberta, Cimino, Rosella, Ruberto, Carmen, Ruotolo, Giovanni, Greco, Laura, Dal Santo Pierluigi, Andriolli, Antonino, Burattin, Giuseppe, Rossi, Laura, Andreolli, Antonino, Cervati, Giovanna, Catalano, Giuseppe, Tezza, Fabiana, Pizzardini, Maddalena, Stievano, Laura, Crippa, Patrizia, Aloisio, Paola, Di Monda Tiziana, Malighetti, Alessandro, Galbassini, Gloria, Ivaldi, Claudio, Russo Anna Maria, Bennati, Ettore, Pino, Elisabetta, Zavarise, Gianmaria, Pesci, Alberto, Suigo, Giulia, Faverio, Paola, Gori, Andrea, Perego Sabrina Perego, Zanasi, Massimo, Moniello, Giovanni, Rostagno, Carlo, Cartei, Alessandro, Polidori, Gianluca, Ungar, Andrea, Melis Maria Ramona, Martellini, Eleonora, Torrini, Monica, Giordano, Antonella, Leone, Giovanna, Migliorini, Marta, Caramelli, Francesca, Battiston, Bruno, Berardino, Maurizio, Cavallo, Simona, Masse, Alessandro, Santoro, Anna, Lombardi, Bruna, D'Ippolito, Pierpaolo, Furini, Angela, Villani, Daniele, Raimondi, Clara, Guarneri, Massimo, Paolucci, Stefano, Bassi, Andrea, Coiro, Paola, De Angelis Domenico, Morone, Giovanni, Venturiero, Vincenzo, Palleschi, Lorenzo, Raganato, Paolo, Di Niro Giuseppina, Casini Anna Rosa, Bove, Loredana, Imoscopi, Alessandra, Isaia, Giancarlo, Tibaldi, Vittoria, Calvi, Elisa, Clementi, Carlotta, Zanocchi, Mauro, Agosta, Luca, Criasia, Antonio, Spertino, Elena, Nortarelli, Antonella, Provenzano, Giuseppe, Principato, Pietro, Rizzo, Anita, Cellura, Eleonora, Mari, Daniela, Romano Federica Ylenia, Rosini, Francesca, Mansi, Marta, Rossi, Silvia, Riccardelli, Alex, Inzaghi, Lorenzo, Bonini, Giulia, Rossi, Paolo, Potena, Alfredo, Lichii, Mihaela, Candiani, Tiziana, Grimaldi, William, Bertani, Emiliano, Porta, Alessandra, Calogero, Pietro, Pinto, Daniela, Bernardi, Roberto, Nicolino, Francesco, Galetti, Caterina, Gianstefani, Alice, Corvalli, Giulia, Mulazzani, Lorenzo, Odetti, Patrizio, Monacelli, Fiammetta, Prefumo, Matteo, Canepa, Marta, Minaglia, Cecilia, Paolisso, Giuseppe, Rizzo Maria Rosaria, Prestano, Raffaele, Dalise Anna Maria, Barra, Davide, Dal Bosco Livio, Asprinio, Vincenzo, Dallape, Luciana, Maina, Paola, Perina, Elisa, Bartoli Rossi Isaura, Pluderi, Alice, Maina, Antonella, Pecoraro, Elisabetta, Sciarra, Michela, Prudente, Angela, Mete, Francesca, Ventura, Manuel, Cesari, Luisella, Pernigotti Luigi Maria, Santangelo, Tina, Benini, Lucia, Levato, Francesco, Mhiuta, Victor, Alius, Florin, Davidoaia, Diana, Giardini, Vittorio, Garancini, Mattia, Bellamoli, Claudio, Terranova, Luciano, Bozzini, Claudia, Tosoni, Paolo, Provoli, Emma, Cascone, Luisa, Dioli, Andrea, Ferrarin, Gianfranco, Bucci, Adelmo, Bua, Guido, Fenu, Sara, Bianchi, Giovanna, Casella, Silvia, Romano, Valentina, Poli, Maurizio, Mascherona, Ilenia, Belotti, Gloria, Cavaliere, Sabina, Cuni, Estella, Merciuc, Nina, Oberti, Rosella, Veneziani, Silvia, Capoferri, Emanuela, De Bernardi Elisabetta, Colombo, Katia, Bravi, Marco, Negrinotti, Nicoletta, D'Arcangelo, Paolo, Montenegro, Nicola, Montanari, Roberto, Lamanna, Pierpaolo, Gasperini, Beatrice, Montesi, Isabella, Diotallevi, Stefania, Altobelli, Gaia, Cacinaro, Filippo, Palama, Chiara, Di Emidio Chiara, Scarpini, Elio, Arighi, Andrea, Scrimieri, Antonia, Fumagalli, Giorgio, Basilico, Paola, Migone De Amicis Margherita, Mancarella, Marta, Maira, Diletta, Granata, Antonino, Ranalli, Claudia, Cammilli, Alessandra, Cavallini Maria Chiara, Tricca, Manola, Natella, Daniela, Gabbani, Luciano, Tesi, Francesca, Martella, Letizia, Imbrici, Rosalba, Pacchioni, Maurizio, Gianbattista, Guerrini, Scotuzzi Anna Maria, Sozzi, Ferdinando, Valenti, Luigi, Chiarello, Antonino, Monella, Monia, Pilotto, Alberto, Prete, Camilla, Senesi, Barbara, Meta Anna Cristina, Pendenza, Enrico, Pasqualetti, Giuseppe, Polini, Antonio, Tognini, Sara, Ballino, Elena, Dell'Aquila, Giuseppina, Gasparrini Pina Maria, Marotti, Elisabetta, Migale, Monica, Falsetti, Lorenzo, Salvi, Aldo, Toigo, Gabriele, Ceschia, Giuliano, Rosso, Alessia, Tongiorgi, Chiara, Scarpa, Cristina, De Dominicis Luigino, Pucci, Eugenio, Renzi, Sara, Cartechini, Elisabetta, Tomassini Pia Francesca, Del Gobbo Maurizio, Ugenti, Francesca, Romeo, Pasquale, Nardelli, Anna, Lauretani, Fulvio, Visioli, Sandra, Montanari, Ilaria, Ermini, Francesca, Giordano, Antonio, Pigato, Giorgio, Simeone, Emilio, Colameco, Franco, Cecamore, Antonella, Scurti, Rosa, Lupinetti Maria Cristina, Barbujani, Mario, Perazzi, Beatrice, Giampieri, Marina, Amoruso, Raffaele, Piccinini, Maristella, Ferrari, Camilla, Gambetti, Claudio, Sfrappini, Mario, Semeraro, Letizia, Striuli, Rinaldo, Mariani, Claudia, Pelliccioni, Giuseppe, Marinelli, Donatella, Fabi, Katia, Rossi, Tommaso, Pesallaccia, Martina, Sabbatini, Debora, Gobbi, Beatrice, Cerqua, Raffaella, Tagliani, Giancarla, Schlauser, Elena, Caser, Luciano, Caramello, Elisa, Sandigliano, Franca, Rosso, Giorgio, Bendini, Chiara, Davoli, Maria, Casella, Monica, Prampolini, Raffaella, Scevola, Moreno, Vitale, Enrico, Brugiolo, Roberto, Brugiolo, Fagherazzi, Carlo, Scarpa, Alberto, Zara, Daniela, Bertozzo, Giulia, Granziera, Serena, Barazzuol, Michele, Maugeri, Domenico, Sorace, Rosaria, Anzaldi, Massimiliano, De Gesu Roberto, Morrone, Giuseppe, Davolio, Federica, Fabbo, Andrea, Palmieri, Marina, Forti, Paola, Pirazzoli, Luca, Fabbri, Elisa, Terenzi, Laura, Bergolari, Federica, Wenter, Christian, Ruffini, Ingrid, Insam, Miriam, Abraham, Elisabeth, Kirchlechner, Christine, Lasco, Antonino, Arena Maria Grazia, Parise, Pasquale, Boccali, Andrea, Amici, Serena, Gambacorta, Maurizia, Ferrari, Alberto, Lasagni, Anna, Lovati, Roberto, Giovinazzo, Francesca, Kimak, Elzbieta, Zappa, Paolo, Medici, Francesco, Lo Castro Marika, Mauro, Flavia, De Luca Alessandro, Sancesario, Giuseppe, Martorana, Alessandro, Scaricamazza, Beatrice, Di Lorenzo Francesco, Liguori, Claudio, Vita, Natale, Giomi, Mirna, Forte, Floriana, Padovani, Alessandro, Rozzini, Luca, Caratozzolo, Salvatore, Cottino, Maria, Vitali, Silvia, Marelli, Eleonora, Tripi, Gabriele, Miceli, Salvatore, Urso, Giovanni, Grioni, Giuseppe, Vezzadini, Giuliana, Misaggi, Giulia, Forlani, Chiara, Avanzi, Stefano, Saulle, Serena, Casarini, Claudia, Viggiano, Marilena, Alberto, Luisa, Ghianda, Diego, Giordano, Alessandro, Iemolo, Francesco, Giordano, Antonello, Sanzaro, Enzo, D'Asta, Gabriele, Proietto, Maria, Carnemolla, Anna, Razza, Grazia, Spadaro, Daniela, Bertolotti, Marco, Mussi, Chiara, Neviani, Francesca, Chiesa, Roberto, Guerzoni, Valentina, Morselli, Linda, Venturelli, Francesca, Tarozzi, Adriano, Balestri, Francesca, Mannarino, Giulio, Bigolari, Michela, Natale, Alessia, Grassi, Simona, Bottaro, Cinzia, Stefanelli, Sara, Bovone, Ugo, Tortorolo, Umberto, Quadri, Roberto, Leone, Giuseppe, Ponzetto, Maria, Frasson, Paola, Annoni, Giorgio, Bruni, Adriana, Confalonieri, Roberto, Corsi, Maurizio, Moretti, Daniela, Teruzzi, Fabiola, Umidi, Simona, Mazzola, Paolo, Perego, Sabrina, Persico, Ilaria, Olivieri, Giulia, Bonfanti, Alessandra, Hajnalka, Szabo, Galeazzi, Marianna, Massariello, Francesca, Anzuini, Alessandra, Caffarra, Paolo, Barocco, Federica, Spallazzi, Marco, Ceda Gian Paolo, Morganti, Simonetta, Artoni, Andrea, Chioatto, Paolo, Bortolamei, Sandra, Soattin, Lucia, Beneamino, Borelli, Barilaro, Giuseppe, Bertazzoli, Marco, Rota, Elisabetta, Adobati, Annamaria, Zuccher, Paola, Dal Fabbro Angela, Lo Nigro Ambra, Franchetti, Lorena, Toniolo, Marika, Marcuzzo, Cinzia, Rollone, Marco, Guerriero, Fabio, Sgarlata, Carmelo, Anna, Santoro, Zatti, Giovanni, Piatti, Massimiliano, Graci, Jole, Benati, Giuseppe, Boschi, Federica, Biondi, Mario, Fiumi, Nicoletta, Erika, Tamburini, Locatelli Sergio Mario, Mauri, Sabrina, Beretta, Mauro, Margheritis, Laura, Desideri, Giovanbattista, Liberatore, Ester, Carucci Anna Cecilia, Bonino, Paolo, Caput, Margherita, Antonietti Maria Paola, Polistena, Giuseppe, De la Pierre Franz, Mari, Marcello, Massignani, Paola, Tombesi, Fabio, Selvaggio, Fabio, Verbo, Brunella, Bodoni, Paolo, Marchionni, Niccolo, Sabatini, Tony, Mussio, Eleonora, Magni, Eugenio, Bianchetti, Angelo, Crucitti, Andrea, Titoldini, Giulia, Cossu, Beatrice, Fascendini, Sara, Licini, Cristina, Tomasoni, Angela, Calderazzo, Massimo, Tropiano, Daniela, Lagana, Valentina, Melotti Rita Maria, Lilli, Albina, Buda, Simona, Adversi, Marco, Noro, Gabriele, Turco, Renato, Chiara, Ubezio M., Mantovani Anna Roberta, Viola Maria Cristina, Serrati, Carlo, Pretta, Stefano, Infante, Maria, Gentile, Simona, D'Ambrosio, Viviana, Mazzanti, Paolo, Brambilla, Cristina, Sportelli, Silvia, Platto, Caterina, Faraci, Bianca, Quattrocchi, Daniela, Pisu, Cristina, Sicuro, Francesca, Del Grosso Luciano Luca, Zagnoni, Piergiuseppe, Ghiglia, Stefania, Mosca, Massimiliano, Corazzin, Ileana, Deola, Mariangela, Biagini Carlo Adriano, Bencini, Francesca, Cantini, Claudia, Tonon, Elisabetta, Pierinelli, Silvia, Onofrj, Marco, Thomas, Astrid, Borbone, Filomena, Bonanni, Laura, Cacchio, Gabriella, Comi, Giancarlo, Magnani, Giuseppe, Santangelo, Roberto, Mazzeo, Salvatore, Caso, Francesca, Cecchetti, Giordano, Sant’Angelo, Roberto, Barbieri, Cristina, Giroldi, Liviana, Bandini, Fabio, Masina, Marco, Malservisi, Simona, Cicognani, Annalena, Ricca, Laura, Piccininni, Maristella, Tassinari, Tiziana, Brogi, Davide, Sugo, Annalisa, Filippi, Alessandra, Manfredi, Sonia, Vanni, Valerio, Usai carlo Andrea, Colombo, Enrico, Renna Vera Francesca, Sauchella, Assunta, Prete, Mauro, Bisagni, Pietro, Masini, Roberto, Carrabetta, Salvatore, Barone, Antonella, Razzano, Monica, Imperoli, Giuseppe, Bini, Angela, Serra, Francesco, D’Agostino, Valeria, Gianolla, Federico, Pietrangeli, Lucia, Velardi, Antonella, Di Cello Elisabetta, Rosati, Cristina, Casali, Nadia, Casali, Sessa, Maria, Abruzzi, Luciano, Costanzi, Chiara, Bini, Paolo, Pignata, Michele, Buonaugurio, Enrico, Vollery, Maria, Carrieri, Giovanni, Cioni, Giorgio, Toschi, Andrea, Metra, Marco, Ranieri, Piera, Ceccon, Anna, Magrin, Laura, Marin, Sara, Barbara, Sofia, Ghedini, Laura, Moroni, Matteo, Paragona, Marco, Pallotti Maria Caterina, Rota, Carla, Gottardi, Federica, Tomasoni, Clara, Cappuccio, Melania, Bonini, Giampaolo, Guerini, Stefano, Guerini, Valeria, Merlaj, Lucia, Tovaglieri, Maurizio, Antonio, Grillo, Francesca, Arenare, Mineo, Tonino, Kanah, David, Vianello, Giorgio, Vianello, Piero, Balducci, Ubaldo, Sidoti, Vincenzo, Montanari, Stefano, Murelli Flavio Teodolindo Busonera, Albanese, Paolo, Maselli, Monica, Bolzetta, Francesco, Fabris, Roberto, Durante-Mangoni, Emanuele, Testoni, Michela, Di Stefano Fabio, Seccia, Loredana, Sonzini, Valeria, Fabiano, Maria, Di Giorgio Annabella, De Cosmo Salvatore, Greco, Antonio, D’Onofrio, Grazia, Sancarlo, Daniele, Resta, Gianluca, Girardello, Renzo, Girardello, Minervini, Sergio, Boni, Morena, Vitali, Mariagrazia, Pizzoni, Marina, De Colle Paolo, Frattola, Alessandra, Orlandini, Francesco, La Regina Micaela, Padulo, Filomena, Margheriti, Cristina, Rolano, Dario, Moscatelli, Giancarla, Radaelli, Guido, Montini, Elena, Prete, Cosimo, Novello, Marileda, Bramuzzo, Igor, Bertin, Nicole, Rinaldo, Elena, Paolillo, Ciro, Riccardi, Angela, Benedetti, Claudia, Rizzi, Barbara, Montagna, Francesca, Cutaia, Chiara, Baca, Oliver, Colombo, Mauro, Procino, Giuseppe, Tarara, Rosaria, Dell’Acqua, Davide, Cislaghi, Stefania, Cairati, Marco, Porta, Massimo, Scaglione, Luca, De Feo Martina, Vertolli, Paola, Salvati, Lia, Cinotti, Sandro, De Santis Valentina, Biferi, Erminia, Cheli, Paola, Rebizzo, Romina, Salvatore, Minisola, Luciano, Colangelo, Abete, Pasquale, Liguori, Ilaria, Curcio, Francesca, Spassini, Guglielmo, Engheben, Marco, Rotunno, Sara, Rotunno, Arosio, Paola, Angelini, Claudio, Reggiani, Francesco, Cappelli, Alessandro, Marcheselli, Simona, Fratticci, Lara, Ranzani, Paola, Cesarini, Simonetta, Cerini, Antonella, Gallucci, Fernando, Serra, Emanuela, Sola, Mariolina, Delitala, Alessandro, Pes, Chiara, Lobianco, Giulia, Giani, Alessandro, Famularo, Simone, Sandini, Marta, Pinotti, Enrico, Gianotti, Luca, Battuello, Antonella, Pintore, Giulia, Rossi, Andrea, Rubele, Sofia, Sant, Selena, Vignati, Marco, Clerici, Danila, Rosa, Fabio, Bandirali Maria Pia, Cattaneo, Nicoletta, Boffi, Laura, Avalli, Leonello, Scanziani, Margherita, De Notaris Stefania, Del Santo Pierluigi, Del, Santo, Catalano, Felice, Fogli, Danilo, Di Bella Giovanna, Landi, Francesco, Salini, Sara, Brunetti Maria Angela, Cappa, Giorgetta, Galvagno, Giovanni, Cena, Paola, Bruno, Gerardo, Raspo, Silvio, Semeraro, Pedrotti, Sabrina, Palmieri Vincenzo Ostilio, Palasciano, Giuseppe, Belfiore, Anna, Portincasa, Piero, Sabbà, Carlo, Solfrizzi, Vincenzo, D’Introno, Alessia, Valiani, Vincenzo, Bologna, Carolina, Ciarambino, Tiziana, Magnani, Turelli, Paola, Pazzaglia, Ugo, Rodella, Federica, Piana, Giacomo, Castellano, Maurizio, Garelli, Anna, Garelli, Casella, Elisa, Campana, Federica, Coschigliano Maria Antonietta, Marinangeli, Luigi, Lorico, Fabio, Bazzano, Salvatore, Menculini, Giuseppe, Gelosa, Giorgio, Viviana Ambrogio Teresa, Piras, Valentina, Ciricugno, Andrea, Bollari, Alessandra, Coen, Daniele, Magliola, Renata, Milanesio, Deborah, Muzzulini Carlo Lorenzo, Fogliacco, Paolo, Marinella, Turla, Cotelli Maria Sofia, Bianchi, Marta, Siano, Pietro, Capo, Giuseppe, Napoletano, Rosa, Politi, Cecilia, Mancini, Concetta, Del Buono Corrado, De Bartolomeo Giuseppe, Martinelli, Addolorata, Cefalogli, Carmen, Cozzi, Roberto, Virtuani Angelo Giovanni, Moschettini, Gianfilippo, Mastroianni, Franco, Roglia, Daniela, D'Amico, Gabriella, Palella, Mirella, Endrizzi, Cristina, Trotta, Lucia, Zanetti, Orazio, Terazzi, Emanuela, Sacchetti, Marta, Fleetwood, Thomas, Tondo, Giacomo, Di Fazio Ignazio, Bruni, Andrea, Orsitto, Giuseppe, Fabbro, Emanuela, D’Imporzano, Elena, Casanova, Anna, Bertolio, Serena, Nervo, Silvestri, Roberto, Semproni, Elena, Pintus, Manuela, Aloe, Francesca, Tagliaccica, Angelo., Aloisi G., Marengoni A., Morandi A., Zucchelli A., Cherubini A., Mossello E., Bo M., Di Santo S.G., Mazzone A., Trabucchi M., Cappa S., Fimognari F.L., Incalzi R.A., Gareri P., Perticone F., Campanini M., Montorsi M., Latronico N., Zambon A., Bellelli G., Rispoli V., Malara A., Spadea F., Di Cello S., Ceravolo F., Fabiano F., Chiaradia G., Gabriele A., Lenino P., Andrea T., Settembrini V., Capomolla D., Citrino A., Scriva A., Bruno I., Secchi R., De Martino E., Muccinelli R., Villa Del Sole R.S.A., Lupi G., Paonessa P., Fabbri A., Passuti M.T., Castellari S., Po A., Gaggioli G., Varesi M., Moneti P., Capurso S., Latini V., Ghidotti S., Riccardelli F., Macchi M., Rigo R., Claudio P., Angelo B., Flavio C., Benedetta B., Boffelli S., Cassinadri A., Franzoni S., Spazzini E., Andretto D., Tonini G., Andreani L., Coralli M., Balotta A., Cancelliere R., Ballardini G., Simoncelli M., Mancini A., Strazzacapa M., Fabio S., De Filippi F., Giudice C., Dentizzi C., Azzini M., Cazzadori M., Mastroeni V., Bertassello P., Benati H.S.C., Nesta E., Tobaldini C., Guerini F., Elena T., Mombelloni P., Fontanini F., Gabriella L., Pizzorni C., Oliverio M., Del Grosso L.L., Giavedoni C., Bidoli G., Mazzei B., Corsonello A., Fusco S., Vena S., De Vuono T., Maiuri G., Luca F.F., Andrea A., Giovanni S., Rossella N., Castegnaro E., De Rosa S., Benvenuti E., Del Lungo I., Giardini S., Giulietti C., Mauro D.B., Eleonora B., Martina P., Irene F., Riccardo B., Federica S., Bertoletti E., D'Amico F., Caronzolo F., Grippa A., Lombardo G., Pipicella T., Antonino S., Francesco C., Valeria P.G., Daniela L., Domenico C., Giorgio B., March A., Nitti M.T., Felici A., Pavan S., Piazzani F., Lunelli A., Dimori S., Margotta A., Soglia T., Postacchini D., Brunelli R., Santini S., Francavilla M., Macchiati I., Sorvillo F., Giuli C., Mecocci P., Longo A., Addesi D., Rosa P.C., Bencardino G., Falbo T., Grillo N., Marco F., Mirella F., Fanto F., Isaia G., Pezzilli S., Bergamo D., Furno E., Rrodhe S., Lucarini S., Dijk B., Dall'Acqua F., Calvani D., Becheri D., Giuseppe M., Costanza M., Vito A., Francesca B., Magherini L., Novella M., Franca B., Gambardella P.M.L., Valente C., Ospedale N., Ilaria B., Alice F., Porrino P., Ceci G., Giuliana B., Michela T., Eleonora C., Ettore E., Camellini C., Servello A., Grassi A., Rozzini R., Tironi S., Grassi M.G., Troisi E., Carlo C., Gabriella D.S.S., Flaminia F., Federica R., Beatrice P., Sofia T., Gabutto A., Quazzo L., Rosatello A., Suraci D., Tagliabue B., Perrone C., Ferrara L., Castagna A., Tremolada M.L., Giuseppe C., Stefano B., Davide O., Piano S., Serviddio G., Lo Buglio A., Gurrera T., Merlo V., Rovai C., Cotroneo A.M., Carlucci R., Abbaldo A., Monzani F., Qasem A.A., Bini G., Tafuto S., Galli G., Bruni A.C., Mancuso G., Calipari D., Bernardini B., Corsini C., Michele C., Sara D.F., Cagnin A., Fragiacomo F., Pompanin S., Piero A., Marco C., Zurlo A., Guerra G., Pala M., Menozzi L., Delli Gatti C., Magon S., Roberto M., Alfredo D.G., Fabio F., Ruana T., Elisa M., Christian M., Marco P., Massimo G., Di Francesco V., Faccioli S., Pellizzari L., Giorgia F., Barbagallo G., Lunardelli M.L., Martini E., Ferrari E., Macchiarulo M., Corneli M., Bacci M., Battaglia G., Anastasio L., Lo Storto M.S., Seresin C., Simonato M., Loreggian M., Cestonaro F., Durando M., Latella R., Mazzoleni M., Russo G., Ponte M., Valchera A., Salustri G., Petritola D., Costa A., Sinforiani E., Cotta M.R., Pizio R.N., Cester A., Formilan M., Pietro B., Carbone P., Cazzaniga I., Appollonio I., Cereda D., Stabile A., Xhani R., Acampora R., Tremolizzo L., Federico P., Antonio C., Valerio P., Cesare B., Zhirajr M., Giovanni V., Maria A., Mariaelena S., Bottacchi E., Bucciantini E., Di Giovanni M., Franchi F., Lucchetti L., Mariani C., Grande G., Rapazzini P., Marco M., Romanelli G., Franco N., Alessio M., Nicola L., Laura P., Nazario P., Chiara G., Soccorso P., Andrea S., Luca B., Francesca S., Roberto A., Anna C., Infettive M., Fugazza L., Guerrini C., De Paduanis G., Iallonardo L., Palumbo P., Zuliani G., Ortolani B., Capatti E., Soavi C., Bianchi L., Francesconi D., Miselli A., Gloria B., Tommaso R., Chiara P., Agata M.M., Dall'Agata M., Luca M., Gianluca G., Suardi T., Zaccarini C., Manuela R., Mirra G., Muti E., Bottura R., Gianpaolo M., Secreto P., Bisio E., Cecchettani M., Naldi T., Pallavicino A., Pugliese M., Iozzo R.C., Grassi G., Michele B., Dell'Oro R., Fosca Q.T., Giorgio G.C., Giovanni P., Ernesto C., Mannironi A., Giorli E., Oberti S., Fierro B., Piccoli T., Giacalone F., Mandas A., Serchisu L., Costaggiu D., Pinna E., Orru F., Mannai M., Cordioli Z., Pelizzari L., Turcato E., Arduini P., Cacace C., Chiloiro R., Cimino R., Ruberto C., Giovanni R., Pietro G., Laura G., Alberto C., Carmen R., Dal Santo P., Andriolli A., Burattin G., Rossi L., Antonino C.G.A., Tezza F., Maddalena P., Laura S., Crippa P., Aloisio P., Di Monda T., Malighetti A., Galbassini G., Ivaldi C., Russo A.M., Bennati E., Pino E., Zavarise G., Pesci A., Suigo G., Faverio P., Andrea G., Sabrina P., Zanasi M., Moniello G., Rostagno C., Cartei A., Polidori G., Ungar A., Melis M.R., Martellini E., Enrico M., Monica T., Antonella G., Giovanna L., Migliorini M., Caramelli F., Battiston B., Berardino M., Cavallo S., Alessandro M., Anna S., Lombardi B., D'Ippolito P., Furini A., Villani D., Clara R., Guarneri M., Paolucci S., Bassi A., Coiro P., De Angelis D., Morone G., Venturiero V., Palleschi L., Raganato P., Di Niro G., Rosa C.A., Loredana B., Imoscopi A., Tibaldi V., Bottignole G.G., Calvi E., Clementi C., Zanocchi M., Agosta L., Criasia A., Spertino E., Nortarelli A., Provenzano G., Principato P., Rizzo A., Cellura E., Mari D., Romano F.Y., Rosini F., Mansi M., Rossi S., Riccardelli A., Inzaghi L., Bonini G., Rossi P., Potena A., Lichii M., Candiani T., Grimaldi W., Bertani E., Alessandra P., Calogero P., Pinto D., Bernardi R., Nicolino F., Galetti C., Gianstefani A., Giulia C., Lorenzo M., Odetti P., Monacelli F., Prefumo M., Fiammetta M., Canepa M., Minaglia C., Paolisso G., Rizzo M.R., Prestano R., Dalise A.M., Barra D., Dal Bosco L., Asprinio V., Dallape L., Perina E., Bartoli I.R., Pluderi A., Maina A., Pecoraro E., Sciarra M., Prudente A., Paola M., Francesca M., Manuel V., Luisella C., Maria P.L., Tina S., Benini L., Levato F., Mhiuta V., Alius F., Davidoaia D., Giardini V., Garancini M., Bellamoli C., Terranova L., Bozzini C., Tosoni P., Provoli E., Cascone L., Dioli A., Ferrarin G., Bucci A., Bua G., Fenu S., Bianchi G., Casella S., Romano V., Maurizio P., Mascherona I., Belotti G., Cavaliere S., Cuni E., Merciuc N., Oberti R., Veneziani S., Capoferri E., De Bernardi E., Colombo K., Bravi M., Nicoletta N., D'Arcangelo P., Montenegro N., Montanari R., Lamanna P., Gasperini B., Isabella M., Stefania D., Gaia A., Filippo C., Palama C., Di Emidio C., Scarpini E., Arighi A., Fumagalli G., Basilico P., De Amicis Margherita M., Marta M., Diletta M., Granata A., Ranalli C., Cammilli A., Cavallini M.C., Tricca M., Natella D., Gabbani L., Tesi F., Martella L., Imbrici R., Guerrini G., Scotuzzi A.M., Sozzi F., Valenti L., Chiarello A., Monia M., Pilotto A., Prete C., Senesi B., Meta A.C., Pendenza E., Pasqualetti G., Polini A., Tognini S., Ballino E., Dell'Aquila G., Gasparrini P.M., Marotti E., Migale M., Scrimieri A., Falsetti L., Salvi A., Toigo G., Ceschia G., Rosso A., Tongiorgi C., Scarpa C., De Dominicis L., Pucci E., Renzi S., Cartechini E., Tomassini P.F., Del Gobbo M., Ugenti F., Romeo P., Nardelli A., Lauretani F., Visioli S., Montanari I., Ermini F., Giordano A., Pigato G., Simeone E., Colameco F., Cecamore A., Scurti R., Lupinetti M.C., Barbujani M., Perazzi B., Giampieri M., Amoruso R., Piccinini M., Ferrari C., Gambetti C., Sfrappini M., Semeraro L., Striuli R., Pelliccioni G., Marinelli D., Fabi K., Rossi T., Pesallaccia M., Sabbatini D., Gobbi B., Cerqua R., Tagliani G., Schlauser E., Caser L., Caramello E., Sandigliano F., Rosso G., Ferrari A., Bendini C., Luisa D.M., Casella M., Prampolini R., Scevola M., Vitale E., Roberto B., Carlo F., Sergio F., Alberto S., Daniela Z., Giulia B., Serena G., Maugeri D., Sorace R., Anzaldi M., De Gesu R., Morrone G., Davolio F., Fabbo A., Palmieri M., Zoli M., Forti P., Pirazzoli L., Fabbri E., Terenzi L., Bergolari F., Wenter C., Ruffini I., Insam M., Abraham E., Kirchlechner C., Cucinotta D., Antonino L., Basile G., Grazia A.M., Parise P., Boccali A., Amici S., Gambacorta M., Lasagni A., Lovati R., Giovinazzo F., Kimak E., Zappa P., Medici F., Lo Castro M., Mauro F., De Luca A., Sancesario G., Martorana A., Scaricamazza B., Toniolo S., Di Lorenzo F., Liguori C., Lasco A., Vita N., Giomi M., Forte F., Padovani A., Rozzini L., Ceraso A., Salvatore C., Cottino M., Vitali S., Marelli E., Tripi G., Miceli S., Urso G., Grioni G., Vezzadini G., Misaggi G., Forlani C., Avanzi S., Serena S., Claudia C., Marilena V., Alberto L., Diego G., Alessandro G., Iemolo F., Sanzaro E., D'Asta G., Proietto M., Carnemolla A., Razza G., Spadaro D., Bertolotti M., Mussi C., Neviani F., Roberto C., Valentina G., Linda M., Francesca V., Tarozzi A., Balestri F., Mannarino G., Bigolari M., Natale A., Grassi S., Bottaro C., Stefanelli S., Bovone U., Tortorolo U., Quadri R., Leone G., Ponzetto M., Frasson P., Annoni G., Bruni A., Confalonieri R., Corsi M., Moretti D., Teruzzi F., Umidi S., Mazzola P., Perego S., Persico I., Olivieri G., Bonfanti A., Hajnalka S., Galeazzi M., Massariello F., Anzuini A., Caffarra P., Barocco F., Spallazzi M., Paolo C.G., Simonetta M., Chioatto P., Bortolamei S., Soattin L., Ruotolo G., Beneamino B., Giuseppe B., Bertazzoli M., Rota E., Adobati A., Scarpa A., Granziera S., Zuccher P., Dal Fabbro A., Zara D., Lo Nigro A., Franchetti L., Toniolo M., Marcuzzo C., Rollone M., Guerriero F., Sgarlata C., Masse A., Zatti G., Piatti M., Graci J., Benati G., Boschi F., Biondi M., Fiumi N., Erika T., Locatelli S.M., Mauri S., Beretta M., Margheritis L., Desideri G., Liberatore E., Carucci A.C., Bonino P., Caput M., Antonietti M.P., Polistena G., De La Pierre F., Mari M., Massignani P., Tombesi F., Selvaggio F., Verbo B., Bodoni P., Marchionni N., Sabatini T., Mussio E., Magni E., Bianchetti A., Crucitti A., Titoldini G., Cossu B., Fascendini S., Licini C., Tomasoni A., Calderazzo M., Daniela T., Valentina L., Melotti R.M., Lilli A., Buda S., Adversi M., Noro G., Turco R., Ubezio M.C., Mantovani A.R., Viola M.C., Serrati C., Pretta S., Infante M., Gentile S., D'Ambrosio V., Mazzanti P., Brambilla C., Sportelli S., Platto C., Faraci B., Quattrocchi D., Pernigotti L.M., Pisu C., Sicuro F., Zagnoni P., Ghiglia S., Mosca M., Corazzin I., Deola M., Di Agordo O., Biagini C.A., Bencini F., Cantini C., Tonon E., Pierinelli S., Onofrj M., Thomas A., Filomena B., Bonanni L., Gabriella C., Comi G., Magnani G., Santangelo R., Mazzeo S., Francesca C., Giordano C., Roberto S., Barbieri C., Giroldi L., Bandini F., Masina M., Malservisi S., Cicognani A., Ricca L., Piccininni M., Tassinari T., Brogi D., Sugo A., Alessandra F., Sonia M., Valerio V., Andrea U.C., Enrico C., Vera R.F., Assunta S., Gianmaria Z., Mauro P., Barone A., Razzano M., Giuseppe I., Angela B., Francesco S., D'Agostino V., Federico G., Lucia P., Antonella V., Di Cello E., Cristina C., Nadia C., Maria S., Luciano A., Chiara C., Bini P., Pignata M., Enrico B., Maria V., Giovanni C., Giorgio C., Piera R., Alberto Z., Ceccon A., Magrin L., Marin S., Barbara S., Matteo M., Caterina P.M., Carla R., Federica G., Clara T., Melania C., Giampaolo B., Stefano G., Valeria G., Lucia M., Giovambattista D., Ester L., Cecilia C.A., Maurizio T., Nadia B., Grillo A., Arenare F., Tonino M., David K., Giorgio V.P., Ubaldo B., Vincenzo S., Stefano M., Marino F., Flavio M.T.B., Paolo A., Monica M., Francesco B., Roberto F., Paolo B., Durante-Mangoni E., Testoni M., Di Stefano F., Loredana S., Daniela M., Valeria S., Fabiano M., Di Giorgio A., De Cosmo S., Greco A., D'Onofrio G., Daniele S., Gianluca R., Renzo G., Sergio M., Morena B., Vitali M., Marina P., De Colle P., Cristina S., Orlandini F., La Regina M., Desiree A., Mario B., Paola P., Padulo F., Cristina M., Dario R., Giancarla M., Guido R., Elena M., Marileda N., Igor B., Nicole B., Elena R., Paolillo C., Riccardi A., Claudia B., Barbara R., Silvia V., Oliver B., Mauro C., Eleonora M., Giuseppe P., Rosaria T., Maria C., Dell'Acqua D., Stefania C., Massimo P., Luca S., De Feo M., Paola V., Lia S., Sandro C., De Santis V., Erminia B., Paola C., Romina R., Minisola S., Luciano C., Pasquale A., Ilaria L., Guglielmo S., Marco E., Sara R., Paola A., Claudio A., Francesco R., Alessandro C., Simona M., Lara F., Paola R., Simonetta C., Antonella C., Generoso U., Fernando G., Giuliano C., Emanuela S., Mariolina S., Alessandro D., Giulia L., Famularo S., Sandini M., Pinotti E., Gianotti L., Antonella B., Giulia P., Sante G., Rossi A., Rubele S., Sant S., Marco V., Danila C., Fabio R., Bandirali M.P., Nicoletta C., Laura B., Paolo T., Luciano T., Leonello A., Margherita S., De Notaris S., Del Santo P., Laura R., Fabiana T., Giovanna C., Antonino A., Felice C., Danilo F., Di Bella G., Francesco L., Salini S., Angela B.M., Giorgetta C., Giovanni G., Gerardo B., Silvio R., Letizia S., Davide B., Rosaria R.M., Maria D.A., Raffaele P., Palmieri V.O., Palasciano G., Belfiore A., Portincasa P., Carlo S., D'Introno A., Valiani V., Carolina B., Tiziana C., Paola T., Ugo P., Giacomo P., Castellano M., Anna G., Elisa C., Federica C., Antonietta C.M., Luigi M., Fabio L., Salvatore B., Gelosa G., Viviana A.T., Piras V., Andrea C., Alessandra B., Coen D., Magliola R., Milanesio D., Muzzulini C.L., Paolo F., Marinella T., Sofia C.M., Marta B., Siano P., Capo G., Napoletano R., Cecilia P., Mancini C., Del Buono C., De Bartolomeo G., Addolorata M., Carmen C., Giovanni V.A., Moschettini G., Franco M., Mulli O.F., Daniela R., D'Amico G., Mirella P., Endrizzi C., Trotta L., Ciarambino T., Orazio Z., Emanuela T., Marta S., Thomas F., Giacomo T., Di Fazio I., Andrea B., Giuseppe O., Emanuela F., Serena A., D'Imporzano E., Serena B., Erika N., Elena S., Manuela P., Francesca A., Angelo T., Aloisi, G., Marengoni, A., Morandi, A., Zucchelli, A., Cherubini, A., Mossello, E., Bo, M., Di Santo, S.G., Mazzone, A., Trabucchi, M., Cappa, S., Fimognari, F.L., Incalzi, R.A., Gareri, P., Perticone, F., Campanini, M., Montorsi, M., Latronico, N., Zambon, A., Bellelli, G., Rispoli, V., Malara, A., Spadea, F., Di Cello, S., Ceravolo, F., Fabiano, F., Chiaradia, G., Gabriele, A., Lenino, P., Andrea, T., Settembrini, V., Capomolla, D., Citrino, A., Scriva, A., Bruno, I., Secchi, R., De Martino, E., Muccinelli, R., Villa Del Sole, R.S.A., Lupi, G., Paonessa, P., Fabbri, A., Passuti, M.T., Castellari, S., Po, A., Gaggioli, G., Varesi, M., Moneti, P., Capurso, S., Latini, V., Ghidotti, S., Riccardelli, F., Macchi, M., Rigo, R., Claudio, P., Angelo, B., Flavio, C., Benedetta, B., Boffelli, S., Cassinadri, A., Franzoni, S., Spazzini, E., Andretto, D., Tonini, G., Andreani, L., Coralli, M., Balotta, A., Cancelliere, R., Ballardini, G., Simoncelli, M., Mancini, A., Strazzacapa, M., Fabio, S., De Filippi, F., Giudice, C., Dentizzi, C., Azzini, M., Cazzadori, M., Mastroeni, V., Bertassello, P., Benati, H.S.C., Nesta, E., Tobaldini, C., Guerini, F., Elena, T., Mombelloni, P., Fontanini, F., Gabriella, L., Pizzorni, C., Oliverio, M., Del Grosso, L.L., Giavedoni, C., Bidoli, G., Mazzei, B., Corsonello, A., Fusco, S., Vena, S., De Vuono, T., Maiuri, G., Luca, F.F., Andrea, A., Giovanni, S., Rossella, N., Castegnaro, E., De Rosa, S., Benvenuti, E., Del Lungo, I., Giardini, S., Giulietti, C., Mauro, D.B., Eleonora, B., Martina, P., Irene, F., Riccardo, B., Federica, S., Bertoletti, E., D'Amico, F., Caronzolo, F., Grippa, A., Lombardo, G., Pipicella, T., Antonino, S., Francesco, C., Valeria, P.G., Daniela, L., Domenico, C., Giorgio, B., March, A., Nitti, M.T., Felici, A., Pavan, S., Piazzani, F., Lunelli, A., Dimori, S., Margotta, A., Soglia, T., Postacchini, D., Brunelli, R., Santini, S., Francavilla, M., Macchiati, I., Sorvillo, F., Giuli, C., Mecocci, P., Longo, A., Addesi, D., Rosa, P.C., Bencardino, G., Falbo, T., Grillo, N., Marco, F., Mirella, F., Fantò, F., Isaia, G., Pezzilli, S., Bergamo, D., Furno, E., Rrodhe, S., Lucarini, S., Dijk, B., Dall'Acqua, F., Calvani, D., Becheri, D., Giuseppe, M., Costanza, M., Vito, A., Francesca, B., Magherini, L., Novella, M., Franca, B., Gambardella, P.M.L., Valente, C., Ospedale, N., Ilaria, B., Alice, F., Porrino, P., Ceci, G., Giuliana, B., Michela, T., Eleonora, C., Ettore, E., Camellini, C., Servello, A., Grassi, A., Rozzini, R., Tironi, S., Grassi, M.G., Troisi, E., Carlo, C., Gabriella, D.S.S., Flaminia, F., Federica, R., Beatrice, P., Sofia, T., Gabutto, A., Quazzo, L., Rosatello, A., Suraci, D., Tagliabue, B., Perrone, C., Ferrara, L., Castagna, A., Tremolada, M.L., Giuseppe, C., Stefano, B., Davide, O., Piano, S., Serviddio, G., Lo Buglio, A., Gurrera, T., Merlo, V., Rovai, C., Cotroneo, A.M., Carlucci, R., Abbaldo, A., Monzani, F., Qasem, A.A., Bini, G., Tafuto, S., Galli, G., Bruni, A.C., Mancuso, G., Mancuso, G., Calipari, D., Bernardini, B., Corsini, C., Michele, C., Sara, D.F., Cagnin, A., Fragiacomo, F., Pompanin, S., Piero, A., Marco, C., Zurlo, A., Guerra, G., Pala, M., Menozzi, L., Delli Gatti, C., Magon, S., Roberto, M., Alfredo, D.G., Fabio, F., Ruana, T., Elisa, M., Benedetta, B., Christian, M., Marco, P., Massimo, G., Di Francesco, V., Faccioli, S., Pellizzari, L., Giorgia, F., Barbagallo, G., Lunardelli, M.L., Martini, E., Ferrari, E., Macchiarulo, M., Corneli, M., Bacci, M., Battaglia, G., Anastasio, L., Lo Storto, M.S., Seresin, C., Simonato, M., Loreggian, M., Cestonaro, F., Durando, M., Latella, R., Mazzoleni, M., Russo, G., Ponte, M., Valchera, A., Salustri, G., Petritola, D., Costa, A., Sinforiani, E., Cotta, M.R., Piano, S., Pizio, R.N., Cester, A., Formilan, M., Pietro, B., Carbone, P., Cazzaniga, I., Appollonio, I., Cereda, D., Stabile, A., Xhani, R., Acampora, R., Tremolizzo, L., Federico, P., Antonio, C., Valerio, P., Cesare, B., Zhirajr, M., Giovanni, V., Maria, A., Mariaelena, S., Bottacchi, E., Bucciantini, E., Di Giovanni, M., Franchi, F., Lucchetti, L., Mariani, C., Grande, G., Rapazzini, P., Marco, M., Romanelli, G., Franco, N., Alessio, M., Stefano, B., Nicola, L., Laura, P., Nazario, P., Carlo, C., Chiara, G., Soccorso, P., Andrea, S., Luca, B., Francesca, S., Roberto, A., Marco, F., Anna, C., Francesco, C., Infettive, M., Fugazza, L., Guerrini, C., De Paduanis, G., Iallonardo, L., Palumbo, P., Zuliani, G., Ortolani, B., Capatti, E., Soavi, C., Bianchi, L., Francesconi, D., Miselli, A., Gloria, B., Tommaso, R., Chiara, P., Agata, M.M., Dall'Agata, M., Luca, M., Gianluca, G., Suardi, T., Zaccarini, C., Manuela, R., Mirra, G., Muti, E., Bottura, R., Gianpaolo, M., Secreto, P., Bisio, E., Cecchettani, M., Naldi, T., Pallavicino, A., Pugliese, M., Iozzo, R.C., Grassi, G., Michele, B., Dell'Oro, R., Fosca, Q.T., Giorgio, G.C., Giovanni, P., Ernesto, C., Mannironi, A., Giorli, E., Oberti, S., Fierro, B., Piccoli, T., Giacalone, F., Mandas, A., Serchisu, L., Costaggiu, D., Pinna, E., Orrù, F., Mannai, M., Cordioli, Z., Pelizzari, L., Turcato, E., Arduini, P., Cacace, C., Chiloiro, R., Cimino, R., Ruberto, C., Giovanni, R., Pietro, G., Laura, G., Alberto, C., Carmen, R., Dal Santo, P., Andriolli, A., Burattin, G., Rossi, L., Antonino, C.G.A., Giuseppe, C., Tezza, F., Maddalena, P., Laura, S., Crippa, P., Aloisio, P., Di Monda, T., Malighetti, A., Galbassini, G., Ivaldi, C., Russo, A.M., Bennati, E., Pino, E., Zavarise, G., Pesci, A., Suigo, G., Faverio, P., Andrea, G., Sabrina, P., Zanasi, M., Moniello, G., Rostagno, C., Cartei, A., Polidori, G., Ungar, A., Melis, M.R., Martellini, E., Enrico, M., Monica, T., Antonella, G., Giovanna, L., Migliorini, M., Caramelli, F., Battiston, B., Berardino, M., Cavallo, S., Alessandro, M., Anna, S., Lombardi, B., D'Ippolito, P., Furini, A., Villani, D., Clara, R., Guarneri, M., Paolucci, S., Bassi, A., Coiro, P., De Angelis, D., Morone, G., Venturiero, V., Palleschi, L., Raganato, P., Di Niro, G., Rosa, C.A., Loredana, B., Imoscopi, A., Isaia, G., Tibaldi, V., Bottignole, G.G., Calvi, E., Clementi, C., Zanocchi, M., Agosta, L., Criasia, A., Spertino, E., Nortarelli, A., Provenzano, G., Principato, P., Rizzo, A., Cellura, E., Mari, D., Romano, F.Y., Rosini, F., Mansi, M., Rossi, S., Riccardelli, A., Inzaghi, L., Bonini, G., Rossi, P., Potena, A., Lichii, M., Candiani, T., Grimaldi, W., Bertani, E., Alessandra, P., Calogero, P., Pinto, D., Bernardi, R., Nicolino, F., Galetti, C., Gianstefani, A., Giulia, C., Lorenzo, M., Odetti, P., Monacelli, F., Prefumo, M., Fiammetta, M., Canepa, M., Minaglia, C., Paolisso, G., Rizzo, M.R., Prestano, R., Dalise, A.M., Barra, D., Dal Bosco, L., Asprinio, V., Dallape, L., Perina, E., Bartoli, I.R., Pluderi, A., Maina, A., Pecoraro, E., Sciarra, M., Prudente, A., Paola, M., Francesca, M., Manuel, V., Luisella, C., Maria, P.L., Tina, S., Benini, L., Levato, F., Mhiuta, V., Alius, F., Davidoaia, D., Giardini, V., Garancini, M., Bellamoli, C., Terranova, L., Bozzini, C., Tosoni, P., Provoli, E., Cascone, L., Dioli, A., Ferrarin, G., Bucci, A., Bua, G., Fenu, S., Bianchi, G., Casella, S., Romano, V., Maurizio, P., Mascherona, I., Belotti, G., Cavaliere, S., Cuni, E., Merciuc, N., Oberti, R., Veneziani, S., Capoferri, E., De Bernardi, E., Colombo, K., Bravi, M., Nicoletta, N., D'Arcangelo, P., Montenegro, N., Galli, G., Montanari, R., Lamanna, P., Gasperini, B., Isabella, M., Stefania, D., Gaia, A., Filippo, C., Palamà, C., Di Emidio, C., Scarpini, E., Arighi, A., Fumagalli, G., Basilico, P., De Amicis Margherita, M., Marta, M., Diletta, M., Granata, A., Ranalli, C., Cammilli, A., Cavallini, M.C., Tricca, M., Natella, D., Gabbani, L., Tesi, F., Martella, L., Imbrici, R., Guerrini, G., Scotuzzi, A.M., Sozzi, F., Valenti, L., Chiarello, A., Monia, M., Pilotto, A., Prete, C., Senesi, B., Meta, A.C., Pendenza, E., Pasqualetti, G., Polini, A., Tognini, S., Ballino, E., Dell'Aquila, G., Gasparrini, P.M., Marotti, E., Migale, M., Scrimieri A., Falsetti, L., Salvi A., Toigo, G., Ceschia, G., Rosso, A., Tongiorgi, C., Scarpa, C., Maurizio, P., De Dominicis, L., Pucci, E., Renzi, S., Cartechini, E., Tomassini, P.F., Del Gobbo, M., Ugenti, F., Romeo, P., Nardelli, A., Lauretani, F., Visioli, S., Montanari, I., Ermini, F., Giordano, A., Pigato, G., Simeone, E., Colameco, F., Cecamore, A., Scurti, R., Lupinetti, M.C., Barbujani, M., Perazzi, B., Giampieri, M., Amoruso, R., Piccinini, M., Ferrari, C., Gambetti, C., Sfrappini, M., Semeraro, L., Striuli, R., Mariani, C., Pelliccioni, G., Marinelli, D., Fabi, K., Rossi, T., Pesallaccia, M., Sabbatini, D., Gobbi, B., Cerqua, R., Tagliani, G., Schlauser, E., Caser, L., Caramello, E., Sandigliano, F., Rosso, G., Ferrari, A., Bendini, C., Luisa, D.M., Casella, M., Prampolini, R., Scevola, M., Vitale, E., Roberto, B., Carlo, F., Sergio, F., Alberto, S., Daniela, Z., Giulia, B., Serena, G., Michele, B., Maugeri, D., Sorace, R., Anzaldi, M., De Gesu, R., Morrone, G., Davolio, F., Fabbo, A., Palmieri, M., Barbagallo, G., Zoli, M., Forti, P., Pirazzoli, L., Fabbri, E., Terenzi, L., Bergolari, F., Wenter, C., Ruffini, I., Insam, M., Abraham, E., Kirchlechner, C., Cucinotta, D., Antonino, L., Basile, G., Grazia, A.M., Parise, P., Boccali, A., Amici, S., Gambacorta, M., Lasagni, A., Lovati, R., Giovinazzo, F., Kimak, E., Zappa, P., Medici, F., Lo Castro, M., Mauro, F., De Luca, A., Sancesario, G., Martorana, A., Scaricamazza, B., Toniolo, S., Di Lorenzo, F., Liguori, C., Lasco, A., Vita, N., Giomi, M., Forte, F., Padovani, A., Rozzini, L., Ceraso, A., Salvatore, C., Cottino, M., Vitali, S., Marelli, E., Tripi, G., Miceli, S., Urso, G., Grioni, G., Vezzadini, G., Misaggi, G., Forlani, C., Avanzi, S., Serena, S., Claudia, C., Marilena, V., Alberto, L., Diego, G., Alessandro, G., Iemolo, F., Giordano, A., Sanzaro, E., D'Asta, G., Proietto, M., Carnemolla, A., Razza, G., Spadaro, D., Bertolotti, M., Mussi, C., Neviani, F., Roberto, C., Valentina, G., Linda, M., Francesca, V., Tarozzi, A., Balestri, F., Mannarino, G., Bigolari, M., Natale, A., Grassi, S., Bottaro, C., Stefanelli, S., Bovone, U., Tortorolo, U., Quadri, R., Leone, G., Ponzetto, M., Frasson, P., Annoni, G., Bruni, A., Confalonieri, R., Corsi, M., Moretti, D., Teruzzi, F., Umidi, S., Mazzola, P., Perego, S., Persico, I., Olivieri, G., Bonfanti, A., Hajnalka, S., Galeazzi, M., Massariello, F., Anzuini, A., Caffarra, P., Barocco, F., Spallazzi, M., Paolo, C.G., Simonetta, M., Andrea, A., Chioatto, P., Bortolamei, S., Soattin, L., Ruotolo, G., Beneamino, B., Giuseppe, B., Bertazzoli, M., Rota, E., Adobati, A., Scarpa, A., Granziera, S., Zuccher, P., Dal Fabbro, A., Zara, D., Lo Nigro, A., Franchetti, L., Toniolo, M., Marcuzzo, C., Piano, S., Rollone, M., Guerriero, F., Sgarlata, C., Massè, A., Zatti, G., Piatti, M., Graci, J., Benati, G., Boschi, F., Biondi, M., Fiumi, N., Erika, T., Locatelli, S.M., Mauri, S., Beretta, M., Margheritis, L., Desideri, G., Liberatore, E., Carucci, A.C., Bonino, P., Caput, M., Antonietti, M.P., Polistena, G., De La Pierre, F., Mari, M., Massignani, P., Tombesi, F., Selvaggio, F., Verbo, B., Bodoni, P., Marchionni, N., Sabatini, T., Mussio, E., Magni, E., Bianchetti, A., Crucitti, A., Titoldini, G., Cossu, B., Fascendini, S., Licini, C., Tomasoni, A., Calderazzo, M., Daniela, T., Valentina, L., Prampolini, R., Melotti, R.M., Lilli, A., Buda, S., Adversi, M., Noro, G., Turco, R., Ubezio, M.C., Mantovani, A.R., Viola, M.C., Serrati, C., Pretta, S., Infante, M., Gentile, S., D'Ambrosio, V., Mazzanti, P., Brambilla, C., Sportelli, S., Platto, C., Faraci, B., Quattrocchi, D., Pernigotti, L.M., Pisu, C., Sicuro, F., Del Grosso, L.L., Zagnoni, P., Ghiglia, S., Mosca, M., Corazzin, I., Deola, M., Di Agordo, O., Biagini, C.A., Bencini, F., Cantini, C., Tonon, E., Pierinelli, S., Onofrj, M., Thomas, A., Filomena, B., Bonanni, L., Gabriella, C., Comi, G., Magnani, G., Santangelo, R., Mazzeo, S., Giuseppe, M., Francesca, C., Giordano, C., Roberto, S., Barbieri, C., Giroldi, L., Bandini, F., Masina, M., Malservisi, S., Cicognani, A., Ricca, L., Ricca, L., Piccininni, M., Tassinari, T., Brogi, D., Sugo, A., Alessandra, F., Sonia, M., Valerio, V., Andrea, U.C., Enrico, C., Vera, R.F., Assunta, S., Gianmaria, Z., Mauro, P., Pietro, B., Roberto, M., Salvatore, C., Barone, A., Razzano, M., Giuseppe, I., Angela, B., Francesco, S., D'Agostino, V., Federico, G., Lucia, P., Antonella, V., Di Cello, E., Cristina, C., Nadia, C., Maria, S., Luciano, A., Chiara, C., Bini, P., Pignata, M., Enrico, B., Maria, V., Giovanni, C., Giorgio, C., Andrea, T., Marco, M., Piera, R., Alberto, Z., Ceccon, A., Magrin, L., Marin, S., Barbara, S., Marco, M., Laura, G., Matteo, M., Marco, P., Caterina, P.M., Carla, R., Federica, G., Clara, T., Melania, C., Giampaolo, B., Stefano, G., Valeria, G., Lucia, M., Giovambattista, D., Ester, L., Cecilia, C.A., Maurizio, T., Vera, R.F., Nadia, B., Grillo, A., Arenare, F., Tonino, M., David, K., Giorgio, V.P., Ubaldo, B., Vincenzo, S., Stefano, M., Marino, F., Flavio, M.T.B., Paolo, A., Monica, M., Francesco, B., Roberto, F., Paolo, B., Durante-Mangoni, E., Testoni, M., Di Stefano, F., Loredana, S., Daniela, M., Valeria, S., Fabiano, M., Di Giorgio, A., De Cosmo, S., Greco, A., D'Onofrio, G., Daniele, S., Gianluca, R., Renzo, G., Sergio, M., Morena, B., Vitali, M., Marina, P., De Colle, P., Cristina, S., Alessandra, F., Orlandini, F., La Regina, M., Desirée, A., Mirella, F., Mario, B., Paola, P., Padulo, F., Cristina, M., Dario, R., Giancarla, M., Guido, R., Elena, M., Prete, C., Marileda, N., Igor, B., Nicole, B., Elena, R., Paolillo, C., Riccardi, A., Claudia, B., Barbara, R., Francesca, M., Silvia, V., Chiara, C., Oliver, B., Mauro, C., Eleonora, M., Giuseppe, P., Rosaria, T., Maria, C., Dell'Acqua, D., Stefania, C., Marco, C., Massimo, P., Luca, S., De Feo, M., Paola, V., Lia, S., Sandro, C., De Santis, V., Erminia, B., Paola, C., Romina, R., Minisola, S., Luciano, C., Pasquale, A., Ilaria, L., Francesca, C., Guglielmo, S., Marco, E., Sara, R., Paola, A., Claudio, A., Francesco, R., Alessandro, C., Simona, M., Lara, F., Paola, R., Simonetta, C., Antonella, C., Generoso, U., Fernando, G., Giuliano, C., Emanuela, S., Mariolina, S., Alessandro, D., Chiara, P., Giulia, L., Alessandro, G., Famularo, S., Sandini, M., Pinotti, E., Gianotti, L., Antonella, B., Giulia, P., Sante, G., Rossi, A., Rubele, S., Sant, S., Marco, V., Danila, C., Fabio, R., Bandirali, M.P., Nicoletta, C., Laura, B., Paolo, T., Luciano, T., Leonello, A., Margherita, S., De Notaris, S., Del Santo, P., Laura, R., Fabiana, T., Giovanna, C., Antonino, A., Felice, C., Giuseppe, B., Danilo, F., Di Bella, G., Francesco, L., Salini, S., Angela, B.M., Giorgetta, C., Giovanni, G., Paola, C., Gerardo, B., Silvio, R., Letizia, S., Sabrina, P., Davide, B., Rosaria, R.M., Maria, D.A., Raffaele, P., Palmieri, V.O., Palasciano, G., Belfiore, A., Portincasa, P., Carlo, S., Vincenzo, S., D'Introno, A., Valiani, V., Carolina, B., Tiziana, C., Giordano, C., Paola, T., Ugo, P., Federica, R., Giacomo, P., Castellano, M., Anna, G., Elisa, C., Federica, C., Antonietta, C.M., Luigi, M., Fabio, L., Salvatore, B., Giuseppe, M., Gelosa, G., Viviana, A.T., Piras, V., Andrea, C., Alessandra, B., Coen, D., Magliola, R., Milanesio, D., Muzzulini, C.L., Paolo, F., Marinella, T., Sofia, C.M., Marta, B., Siano, P., Capo, G., Napoletano, R., Cecilia, P., Mancini, C., Del Buono, C., De Bartolomeo, G., Addolorata, M., Carmen, C., Roberto, C., Giovanni, V.A., Moschettini, G., Franco M., Mulli, O.F., Daniela, R., D'Amico, G., Mirella, P., Endrizzi, C., Trotta, L., Ciarambino, T., Orazio, Z., Emanuela, T., Marta, S., Thomas, F., Giacomo, T., Di Fazio, I., Andrea, B., Giuseppe, O., Emanuela, F., Serena, A., D'Imporzano, E., Anna, C., Serena, B., Erika, N., Roberto, S., Elena, S., Manuela, P., Francesca, A., Angelo, T., Aloisi, G, Marengoni, A, Morandi, A, Zucchelli, A, Cherubini, A, Mossello, E, Bo, M, Di Santo, S, Mazzone, A, Trabucchi, M, Cappa, S, Fimognari, F, Incalzi, R, Gareri, P, Perticone, F, Campanini, M, Montorsi, M, Latronico, N, Zambon, A, Bellelli, G, and Faverio, P

Subjects
Male, diagnosis, medications, 0302 clinical medicine, prevention, Aged, 80 and over, Delirium, Drug Prescriptions, Female, Hospital Departments, Humans, Prevalence, Polypharmacy, Prescription Drugs, 80 and over, Medicine, LS4_4, 030212 general & internal medicine, Acute hospital, media_common, Confounding, elderly patients, hip fracture, hospitalized patients, prediction rule, risk factor, dementia, events, medications, prevention, diagnosis, risk-factor, risk factor, hip fracture, Psychiatry and Mental Health, medicine.symptom, events, Drug, medicine.medical_specialty, hospitalized-patients, media_common.quotation_subject, MEDLINE, Socio-culturale, elderly-patients, elderly patients, behavioral disciplines and activities, 03 medical and health sciences, Internal medicine, mental disorders, Dementia, Medical prescription, prediction rule, Aged, business.industry, hospitalized patients, medicine.disease, nervous system diseases, dementia, business, 030217 neurology & neurosurgery
Abstract

Objective This study aimed to evaluate the association between polypharmacy and delirium, the association of specific drug categories with delirium, and the differences in drug-delirium association between medical and surgical units and according to dementia diagnosis. Methods Data were collected during 2 waves of Delirium Day, a multicenter delirium prevalence study including patients (aged 65 years or older) admitted to acute and long-term care wards in Italy (2015-2016); in this study, only patients enrolled in acute hospital wards were selected (n = 4,133). Delirium was assessed according to score on the 4 "A's" Test. Prescriptions were classified by main drug categories; polypharmacy was defined as a prescription of drugs from 5 or more classes. Results Of 4,133 participants, 969 (23.4%) had delirium. The general prevalence of polypharmacy was higher in patients with delirium (67.6% vs 63.0%, P = .009) but varied according to clinical settings. After adjustment for confounders, polypharmacy was associated with delirium only in patients admitted to surgical units (OR = 2.9; 95% CI, 1.4-6.1). Insulin, antibiotics, antiepileptics, antipsychotics, and atypical antidepressants were associated with delirium, whereas statins and angiotensin receptor blockers exhibited an inverse association. A stronger association was seen between typical and atypical antipsychotics and delirium in subjects free from dementia compared to individuals with dementia (typical: OR = 4.31; 95% CI, 2.94-6.31 without dementia vs OR = 1.64; 95% CI, 1.19-2.26 with dementia; atypical: OR = 5.32; 95% CI, 3.44-8.22 without dementia vs OR = 1.74; 95% CI, 1.26-2.40 with dementia). The absence of antipsychotics among the prescribed drugs was inversely associated with delirium in the whole sample and in both of the hospital settings, but only in patients without dementia. Conclusions Polypharmacy is significantly associated with delirium only in surgical units, raising the issue of the relevance of medication review in different clinical settings. Specific drug classes are associated with delirium depending on the clinical setting and dementia diagnosis, suggesting the need to further explore this relationship.

Published
2019

9. Renal Cell Carcinoma With Tumor Thrombus: A Case Series in Puerto Rico.

Author

Bernaschina-Rivera SA, Alayón-Rosario G, Dieppa-Barnés G, Encarnación J, Ortiz-Sánchez C, Santini-Domínguez R, Martínez-Trabal JL, and Ruiz-Deyá G

Abstract

Introduction:  Renal cell carcinoma (RCC) is one of the most common types of kidney cancer. While RCC tends to present as a localized tumor, a notable proportion may present with distant metastasis. In some instances, RCC may also present with intravascular tumor extension, often called tumor thrombus (TT). Its presence confers a worse prognosis and has important implications for the tumor's staging and treatment. Despite extensive documentation of RCC TT in the US, limited data exists regarding its presentation, management, and outcomes in Puerto Rico (PR). This study aims to broaden the available information on RCC TT, emphasizing surgical management and outcomes. We also provide descriptive data on patient demographics and clinical presentation to improve decision-making among clinicians caring for Puerto Rican men and women., Methods:  In this single-center, retrospective study, we evaluated patients who underwent partial or total nephrectomy at Saint Luke's Episcopal Medical Center between 2018 and 2022. Data was abstracted from electronic health records (EHR). Patients without documented evidence of TT during the peri-operative period were excluded from the study. A total of 220 patient records were evaluated, of which 12 met the inclusion criteria for the study. Cases were categorized using the latest RCC TT guidelines. Central tendency measurements were used to describe the sample distribution. The mean was considered to make assumptions regarding the prevalent observations, and the median was considered to rule out possible outliers. Categorical data were evaluated using proportion analyses, including TT extension level and BMI variables. Fisher's exact test evaluated the association between the World Health Organization/International Society of Urological Pathology (WHO/ISUP) grade and TT extension level., Results:  Most patients lacked TT-related symptoms. The most severe presenting symptom was a pulmonary embolism (8.3%). Hypertension (83.3%), BMI greater than 25 at the time of diagnosis (75%), and type 2 diabetes mellitus (66.7%) were the most common comorbid conditions within our cohort. Nearly 75% of patients underwent laparoscopic radical nephrectomy with TT resection. One left-sided level III case was managed by laparoscopic-assisted open radical nephrectomy with a right subcostal incision. There were zero intraoperative complications and two postoperative complications. The histopathological reports of all cases were consistent with clear cell carcinoma, and half of the cases (n=6) were WHO/ISUP G4. All patients are alive and free of disease., Conclusion:  RCC is a common renal neoplasm in PR that can present with intravascular tumor extension. Our findings do not establish a definitive association between BMI, tumor size, WHO/ISUP grading, and TT extension level. Our study shows that laparoscopic removal of RCC TT is a safe and effective approach. However, the generalizability of our findings is limited by the study's design and sample size. Future research should focus on identifying predictive markers, establishing effective screening protocols, and determining if our hybrid approach has comparable outcomes to the standard open approach., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Bernaschina-Rivera et al.)

Published
2024
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10. Image-guided moderately hypofractionated radiotherapy for localized prostate cancer: a multicentric retrospective study (IPOPROMISE).

Author

Ingrosso G, Ponti E, Francolini G, Caini S, Fondelli S, Santini R, Valeriani M, Rago L, Duroni G, Bruni A, Augurio A, Tramacere F, Trippa F, Russo D, Bottero M, Tamburo M, Parisi S, Borghesi S, Lancia A, Gomellini S, Scoccianti S, Stefanacci M, Vullo G, Statuto T, Miranda G, Santo B, Di Marzo A, Bellavita R, Vinciguerra A, Livi L, Aristei C, Bertini N, Orsatti C, and Detti B

Subjects
Male, Humans, Retrospective Studies, Androgen Antagonists, Prospective Studies, Neoplasm Recurrence, Local, Prostatic Neoplasms radiotherapy, Radiotherapy, Image-Guided methods, Radiotherapy, Intensity-Modulated methods
Abstract

Background: Moderate hypofractionated radiotherapy is a treatment option for the cure of localized prostate cancer (PCa) patients based on the results of randomized prospective trials, but there is a clinical concern about the relatively short length of follow-up, and real-world results on outcome and toxicity based on cutting-edge techniques are lacking. The objective of this study is to present the long-term results of a large multicentric series., Materials and Methods: We retrospectively evaluated 1325 PCa patients treated with daily volumetric image-guided hypofractionated radiotherapy between 2007 and 2020 in 16 Centers. For survival endpoints, we used Kaplan-Meier survival curves and fitted univariate and multivariable Cox's proportional hazards regression models to study the association between the clinical variables and each survival type., Results: At the end of the follow-up, 11 patients died from PCa. The 15-year values of cancer-specific survival (CSS) and biochemical relapse-free survival (b-RFS) were 98.5% (95%CI 97.3-99.6%) and 85.5% (95%CI 81.9-89.4%), respectively. The multivariate analysis showed that baseline PSA, Gleason score, and the use of androgen deprivation therapy were significant variables for all the outcomes. Acute gastrointestinal (GI) and genitourinary (GU) toxicities of grade ≥ 2 were 7.0% and 16.98%, respectively. The 15-year late grade ≥ 2 GI and GU toxicities were 5% (95%CI 4-6%) and 6% (95%CI 4-8%), respectively., Conclusion: Real-world long-term results of this multicentric study on cutting-edge techniques for the cure of localized PCa demonstrated an excellent biochemical-free survival rate of 85.5% at 15 years, and very low rates of ≥ G3 late GU and GI toxicity (1.6% and 0.9% respectively), strengthening the results of the available published trials., (© 2024. The Author(s).)

Published
2024
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11. Switching from paliperidone palmitate 3-monthly long-acting injection to oral aripiprazole in a pregnant woman with schizophrenia: a case report and short review.

Author

Pinci C, Bianciardi E, Sferra I, Castellani G, Santini R, Siracusano A, and Niolu C

Subjects
Humans, Female, Pregnancy, Adult, Administration, Oral, Drug Substitution, Injections, Intramuscular, Aripiprazole administration & dosage, Aripiprazole therapeutic use, Paliperidone Palmitate administration & dosage, Paliperidone Palmitate therapeutic use, Antipsychotic Agents administration & dosage, Antipsychotic Agents therapeutic use, Schizophrenia drug therapy, Delayed-Action Preparations, Pregnancy Complications drug therapy
Abstract

Treatment with long-acting injection (LAI) antipsychotics, such as paliperidone palmitate, has improved the quality of life in terms of symptoms and prevention of relapses in patients with schizophrenia. Although there are plenty of evidences about the efficacy and safety of paliperidone palmitate 3-monthly injection (PP3M) in adults with schizophrenia, literature appears lacking about the use of LAIs during pregnancy. We hereby describe the clinical case of a pregnant woman affected by schizophrenia (DSM-5-TR), taking pharmacological treatment of PP3M. Considering the inadequate evidence regarding the use of PP3M in pregnancy in agreement with the patient, we switched PP3M to an oral therapy with aripiprazole. The switch to oral aripiprazole allowed the patient to improve her sense of autonomy and strengthen the therapeutic relationship. To our knowledge, this is the first case report monitoring an entire pregnancy of a women affected by schizophrenia in treatment with PP3M injection and oral aripiprazole. No obstetrical or fetal complications were reported. As the research in this field is very demanding, it would be precipitous to derive final conclusions from the current case report, but we hope to build a growing number of data that would allow us to make more appropriate and safe therapeutic choices in such a vulnerable phase as the peripartum.

Published
2024
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12. Human gelatin thrombin matrix with rifampin for the treatment of prosthetic vascular graft infections.

Author

Ortiz-Fullana JL, Sánchez C, Pagán P, Mulero-Soto P, Dieppa-Barnes G, Santini-Domínguez R, and Martinez-Trabal JL

Abstract

We aim to describe and report on a novel graft preservation technique using a human gelatin thrombin matrix with rifampin for the treatment of vascular graft infections. Eight patients with vascular graft infections were included, one with bilateral infections, for a total of nine cases from January 2016 through June 2021. All the patients underwent wound exploration and placement of human gelatin thrombin matrix with rifampin. No deaths or allergic reactions had been reported at the 30-day follow-up, with only one major amputation. The graft and limb salvage rates were 77.8% at the 1-year follow-up. The mean time to a major amputation was 122 days, and the mean time to graft excision was 30 days., Competing Interests: None., (© 2023 The Author(s).)

Published
2023
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13. Early results of PRO-EPI: PROspective multicenter observational study on elective pelvic nodes irradiation in patients with intermediate/high/very high-risk non-metastatic prostate cancer submitted to radical, adjuvant, or salvage radiotherapy with or without concomitant androgen deprivation therapy.

Author

Guerini AE, Noale M, Mortellaro G, Lisi R, Bruni A, Santini R, Muto P, Ferrera G, Cossali G, Morelli V, Magrini SM, Spiazzi L, and Buglione M

Abstract

Simple Summary: Although radiotherapy plays a fundamental role in the management of intermediate/high/very high-risk non-metastatic prostatic cancer (IHR-nmPca), there is still no consensus on the optimal treatment strategy in this setting. Remarkably, the role of elective nodal irradiation (ENI) is still highly controversial. The PROspective multicenter observational study on Elective Pelvic nodes Irradiation (PRO-EPI) was designed to provide "real life" data regarding the patterns of care for IHR-nmPca. Forty-three Italian Radiation Oncology centers participated in the PROspective multicenter observational study on Elective Pelvic nodes Irradiation (PRO-EPI) project, with 1029 patients enrolled. In this preliminary analysis, we longitudinally evaluated the impact of Elective Nodal Irradiation (ENI) and radiotherapy features on toxicity and quality of life (QoL). Six months follow-up data were available for 913 patients and 12 months data for 762 patients. Elective Nodal Irradiation was given to 506 patients (48.9%). Volumetric Intensity-Modulated Radiation Therapy (IMRT) was adopted in more than 77% of patients and Image-Guided Radiation Therapy (IGRT) in 84.4%. Androgen deprivation therapy (ADT) was administered to the majority of patients (68.3%), and it was associated to ENI in 408 cases (81.1%). Toxicity was mostly mild and reversible and IGRT resulted in a significant reduction of rectal toxicity, although a non-significant trend toward increased urinary toxicity was observed. No statistically significant differences in QoL and toxicity were seen in patients treated with or without ENI. The adoption of IGRT is widespread and increasing and could reduce treatment toxicity. ENI is not yet the standard treatment, but it is performed in a growing fraction of cases and not resulting into an increase in toxicity or in a deterioration of QoL. Further analyses are needed to clarify the long-term toxicity profile and the impact of ENI on survival., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Guerini, Noale, Mortellaro, Lisi, Bruni, Santini, Muto, Ferrera, Cossali, Morelli, PRO-EPI study group, Magrini, Spiazzi and Buglione.)

Published
2022
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14. Buprenorphine/naloxone (Suboxone®) withdrawal may facilitate antipsychotic-induced priapism. A case report.

Author

Jannini TB, Di Lorenzo G, Mariano A, Santini R, Ciocca G, Jannini EA, Siracusano A, and Niolu C

Subjects
Adult, Analgesics, Opioid adverse effects, Antisocial Personality Disorder, Buprenorphine, Naloxone Drug Combination adverse effects, Chlorpromazine adverse effects, Clopenthixol adverse effects, Haloperidol, Humans, Male, Methadone adverse effects, Receptors, Adrenergic, Antipsychotic Agents adverse effects, Buprenorphine adverse effects, Clozapine adverse effects, Priapism chemically induced, Priapism drug therapy
Abstract

Introduction: Priapism is defined as a prolonged penile erection in absence of sexual arousal, leading also to serious sexual and urological problems such as erectile dysfunction and penile fibrosis. Amongst many different etiologies, priapism may be caused by a wide range of antipsychotic medications, mainly due to the α1-adrenergic receptor antagonism. On the other hand, only a couple of cases of opioid compounds have been linked to the onset of priapism, with evidence coming only from methadone and buprenorphine. Here we describe the case of a patient treated with antipsychotics who developed priapism four times following rapid discontinuation of buprenorphine/naloxone (Suboxone®)., Case Presentation: S.C. is a 30-year-old Caucasian man suffering from chronic buprenorphine/naloxone (Suboxone®) abuse, borderline personality disorder, antisocial traits, and multiple suicide attempts. During the acute and the first part of post-acute Suboxone® withdrawal, four episodes of priapism developed while he was treated with clotiapine, clozapine, and chlorpromazine. However, after the last episode of priapism, despite he was either on haloperidol or zuclopenthixol and chlorpromazine, no other urological event occurred during the following 6 months of observation., Conclusions: As opioids may have dampened the patient's sexual function due to chronic consumption, a rapid drug suspension coupled with an antipsychotic therapy might have created the conditions to facilitate the occurrence of close clustered priapism events.

Published
2022
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15. Medical Comorbidities in 181 Patients With Bipolar Disorder vs . Schizophrenia and Related Psychotic Disorders: Findings From a Single-Center, Retrospective Study From an Acute Inpatients Psychiatric Unit.

Author

Mariano A, Di Lorenzo G, Jannini TB, Santini R, Bertinelli E, Siracusano A, and Niolu C

Abstract

Introduction: Medical comorbidities (MCs) represent a significant burden in terms of more frequent hospitalizations and overall lower life expectancy among people with severe mental disorders, such as schizophrenia and related psychotic disorders (SZ) and bipolar disorder (BD). The present article aims to compare the prevalence of MCs and to examine the associated characteristics as marital status, job occupation, level of education, and living arrangements, between BD and SZ patients. Methods: One-hundred-eight-one patients with MCs (85/47% had BD and 96/53% had SZ) were recruited retrospectively from the Acute Inpatients Psychiatry Unit of Policlinico Tor Vergata, Rome, between January-2017 and December-2020. MCs were: cardiovascular diseases (CVD), bacterial infections, mycoses, viral diseases, neoplasms, musculoskeletal, respiratory tract, urological and male genital, gynecological, neurological, gastrointestinal, metabolic syndrome, nutritional, and metabolic diseases. Results: BD had more MC than SZ (36.2 vs. 28.2%, respectively, p = 0.04). CVD and metabolic MC were more common among BD (51.8 vs.34.4%; 51.8 vs.35.3%; p = 0.018; p = 0.039; respectively), while viral diseases were more frequent in SZ (13.5 vs.3.5%, p = 0.035). Hypertension was common in both psychiatric illnesses (81.8% BD vs. 65.6% SZ, p = 0.18). Obesity was the most frequent metabolic disease in both BD and SZ (75% BD vs. 73.5% SZ, p = 0.91), followed by diabetes mellitus (52.3% BD vs . 55.9% SZ, p = 0.93), metabolic syndrome (54.5% BD vs. 47.1% SZ, p = 0.67) and dysthyroidism (47.7% BD vs. 25.7% SZ, p = 0.093). After performing a binary logistic regression analysis, only two MCs showed a statistically significant association: patients with SZ had an OR of 2.01 [CI 95% (1.00-4.01)] for CVD compared to BD; on the other hand, patients with BD had an OR of 16.57 [CI 95% (3.58-76.77)] for gynecological diseases compared to SZ patients. Conclusions: MCs are common among people with severe mental illness, especially CVD and metabolic diseases, highlighting the need for a more collaborative relationship between general medical providers and psychiatrists., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Mariano, Di Lorenzo, Jannini, Santini, Bertinelli, Siracusano and Niolu.)

Published
2021
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16. Al-alkyls as acceptor dopant precursors for atomic-scale devices.

Author

Owen JHG, Campbell Q, Santini R, Ivie JA, Baczewski AD, Schmucker SW, Bussmann E, Misra S, and Randall JN

Abstract

Atomically precise ultradoping of silicon is possible with atomic resists, area-selective surface chemistry, and a limited set of hydride and halide precursor molecules, in a process known as atomic precision advanced manufacturing (APAM). It is desirable to expand this set of precursors to include dopants with organic functional groups and here we consider aluminium alkyls, to expand the applicability of APAM. We explore the impurity content and selectivity that results from using trimethyl aluminium and triethyl aluminium precursors on Si(001) to ultradope with aluminium through a hydrogen mask. Comparison of the methylated and ethylated precursors helps us understand the impact of hydrocarbon ligand selection on incorporation surface chemistry. Combining scanning tunneling microscopy and density functional theory calculations, we assess the limitations of both classes of precursor and extract general principles relevant to each., (© 2021 IOP Publishing Ltd.)

Published
2021
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17. Simultaneous rupture of two renal artery aneurysms in a patient with tuberous sclerosis complex.

Author

Pérez S, Mulero-Soto P, Schoene A, Pereira G, Santini-Domínguez R, and Martínez-Trabal J

Abstract

Tuberous sclerosis complex (TSC) is an autosomal dominant multisystem neurocutaneous genetic condition. It is characterized by TSC-associated neuropsychiatric disorders, epilepsy, tumors, and angiomyolipoma in multiple organs, such as the skin, lungs, and kidneys. TSC is also associated with the development of aneurysms of the medium and large arteries, including the renal arteries. This condition will usually be diagnosed early in life, and active surveillance is required of tumor and aneurysm growth to prevent life-threatening events. We have presented the case of a 41-year-old patient with TSC that had not been previously diagnosed. The patient had presented with retroperitoneal hematoma secondary to the rupture of two left renal artery branch aneurysms that had likely developed within the angiomyolipoma.

Published
2021
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18. Transcarotid Endovascular Repair of Extracranial Internal Carotid Artery Aneurysms Using Flow Reversal for Distal Embolic Protection.

Author

Ahmed SM, Hosseini M, Santini R, Sahajwani S, Vallabhaneni R, Toursavadkohi S, Karwowski J, and Nagarsheth K

Subjects
Aged, Aged, 80 and over, Aneurysm diagnostic imaging, Aneurysm physiopathology, Blood Vessel Prosthesis Implantation adverse effects, Carotid Artery Diseases diagnostic imaging, Carotid Artery Diseases physiopathology, Carotid Artery, Internal diagnostic imaging, Carotid Artery, Internal physiopathology, Endovascular Procedures adverse effects, Humans, Intracranial Embolism etiology, Male, Middle Aged, Prosthesis Design, Regional Blood Flow, Treatment Outcome, Aneurysm surgery, Blood Vessel Prosthesis, Blood Vessel Prosthesis Implantation instrumentation, Carotid Artery Diseases surgery, Carotid Artery, Internal surgery, Embolic Protection Devices, Endovascular Procedures instrumentation, Intracranial Embolism prevention & control, Stents
Abstract

Extracranial carotid artery aneurysms (ECAAs) have a low incidence between 0.4% and 4% of all peripheral artery aneurysms and involving 0.1-2% of all carotid artery procedures. Some form of repair is generally warranted as nonoperative management has shown mortality as high as 71%. However, to date a standard method for ECAA repair has not been suggested. Generally, open surgical repair is the preferred technique; however, it has its own limitations and risks. Recently, endovascular approach is increasingly being used not only for the elective repair of unruptured ECAA but also for the management of ruptured ECAA. Herein we present 3 cases of distal extracranial internal carotid artery aneurysms treated with placement of stent grafts., (Published by Elsevier Inc.)

Published
2020
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19. Presentation and management of rare saccular superior mesenteric artery trunk and branch aneurysms.

Author

Sahajwani S, Tolaymat B, Khalifeh A, Hosseini M, Santini-Dominguez R, Blitzer D, Sarkar R, and Toursavadkohi S

Abstract

Superior mesenteric artery (SMA) aneurysm is caused by degeneration of the visceral arteries. Although a rarely encountered entity, it requires timely management owing to the high mortality rate associated with rupture, particularly when the aneurysm is saccular in nature. As such, urgent treatment is generally indicated. We present five cases of SMA aneurysm arising from the main trunk or branches of the SMA., (© 2020 The Authors.)

Published
2020
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20. Successful Treatment of Acute Limb Ischemia Secondary to Iatrogenic Distal Embolization Using Catheter Directed Aspiration Thrombectomy.

Author

Farhat-Sabet AA, Tolaymat B, Voit A, Drucker CB, Santini-Dominguez R, Ucuzian AA, Toursavadkohi SA, and Nagarsheth KH

Abstract

Objective: Acute limb ischemia (ALI) due to thromboembolism is a limb- and life-threatening condition regularly encountered by vascular surgeons. Iatrogenic distal embolization is occasionally seen as a complication of various endovascular procedures. We present a series of four patients who developed ALI due to arterial embolization during cardiovascular procedures that were successfully treated via catheter directed aspiration embolectomy. Methods: Retrospective review of demographics, risk factors, and procedural outcomes was completed for 4 patients who presented with ALI due to distal embolization following cardiovascular procedures. All patients were successfully treated with catheter directed aspiration embolectomy using the Penumbra Indigo System (Penumbra Inc., Alameda, California). All patients had high-quality angiography demonstrating successful embolectomy and end-procedure patency. Results: Three patients presented with Rutherford 2A and one with Rutherford 2B ALI secondary to intraoperative distal embolization. Three patients presented with ALI secondary to distal embolization during peripheral vascular interventions, and one following emergent intra-aortic balloon pump (IABP) placement for myocardial infarction. All emboli were located in the infra-inguinal vasculature. Median post-operative ABIs were 0.94 ( n = 4). Median length of stay was 2 days. There were no mortalities and no need for adjunctive fasciotomy, amputation, or bypass for limb salvage. All patients improved clinically after intervention, and returned to their reported pre-hospitalization functional status. Conclusion: All procedures achieved technical success with catheter-directed aspiration thrombectomy with or without adjunctive lysis. Catheter-directed aspiration embolectomy with the Penumbra Indigo System for ALI following an iatrogenic embolic event is a safe, less-invasive treatment option. The use of this technology may reduce the need for traditional open thrombectomy or thrombolytic therapy to address ALI., (Copyright © 2020 Farhat-Sabet, Tolaymat, Voit, Drucker, Santini-Dominguez, Ucuzian, Toursavadkohi and Nagarsheth.)

Published
2020
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21. Pharmacophore-Based Virtual Screening for Identification of Negative Modulators of GLI1 as Potential Anticancer Agents.

Author

Manetti F, Stecca B, Santini R, Maresca L, Giannini G, Taddei M, and Petricci E

Abstract

Starting from known GLI1 inhibitors, a pharmacophore-based virtual screening approach was applied to databases of commercially available compounds with the aim of identifying new GLI1 modulators. As a result, three different chemical scaffolds emerged that were characterized by a significant ability to reduce the transcriptional activity of the endogenous Hedgehog-GLI pathway and GLI1 protein level in murine NIH3T3 cells. They also showed a micromolar antiproliferative activity in human melanoma (A375) and medulloblastoma (DAOY) cell lines, without cytotoxicity in non-neoplastic mammary epithelial cells., Competing Interests: The authors declare the following competing financial interest(s): G. Giannini participated in the project as Project Leader, thanks to the agreement signed between Leadiant Bioscience and Sigma-Tau IFR SpA (now Alfasigma SpA). Part of the results described herein have been the subject of a patent application: "GLI inhibitors and uses thereof" Application No EP 17166194.5 April 12, 2017. EP3388419A1. Giannini, G.; Taddei, M.; Manetti, F.; Petricci, E.; Stecca, B., (Copyright © 2020 American Chemical Society.)

Published
2020
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22. Endovascular Vertebral Artery Transposition Using Flow Reversal Technique for Left Subclavian Artery Stump Syndrome.

Author

Santini-Dominguez R, Zhang JM, Hosseini M, Cronin LA, and Toursavadkohi SA

Subjects
Aged, Aortic Aneurysm, Thoracic diagnostic imaging, Blood Vessel Prosthesis, Brain Infarction diagnostic imaging, Brain Infarction etiology, Brain Infarction physiopathology, Cerebrovascular Circulation, Humans, Male, Stents, Subclavian Steal Syndrome diagnostic imaging, Subclavian Steal Syndrome etiology, Subclavian Steal Syndrome physiopathology, Thrombosis diagnostic imaging, Thrombosis etiology, Thrombosis physiopathology, Treatment Outcome, Vertebral Artery diagnostic imaging, Vertebral Artery physiopathology, Aortic Aneurysm, Thoracic surgery, Blood Vessel Prosthesis Implantation adverse effects, Blood Vessel Prosthesis Implantation instrumentation, Brain Infarction surgery, Endovascular Procedures adverse effects, Endovascular Procedures instrumentation, Neck Dissection adverse effects, Subclavian Steal Syndrome surgery, Thrombosis surgery, Vertebral Artery surgery
Abstract

Background: Cerebellar strokes are a rare complication related to thoracic endovascular aortic repair (TEVAR). This can manifest in an indolent manner or as a neurological catastrophe. Often it is unclear when a surgical intervention would be needed. Patients at risk for this relatively rare complication are not easily identified., Case: We describe an endovascular option with flow reversal for left vertebral artery transposition using stent grafts for relocating arterial inflow and excluding a floating thrombus at the proximal subclavian artery (SCA) related to a previous TEVAR., Conclusions: Ligation of the subclavian artery proximal to the vertebral artery should be considered when performing a carotid subclavian bypass for elective TEVAR. This case details a unique, less invasive approach for vertebral artery transposition and thrombus exclusion in a high-risk patient with previous neck dissection., (Published by Elsevier Inc.)

Published
2020
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23. Endovascular Reconstruction of the Hepatic Arterial System for the Management of Mycotic Pseudoaneurysm in a Liver Transplant Patient.

Author

Zhang J, Khalifeh A, Santini-Dominguez R, Barth RN, Bruno D, Desikan S, Gupta A, and Toursavadkohi S

Subjects
Aneurysm, False diagnostic imaging, Aneurysm, False microbiology, Aneurysm, Infected diagnostic imaging, Aneurysm, Infected microbiology, Anti-Bacterial Agents therapeutic use, Blood Vessel Prosthesis, Hepatic Artery diagnostic imaging, Hepatic Artery microbiology, Humans, Male, Middle Aged, Reoperation, Stents, Treatment Outcome, Aneurysm, False surgery, Aneurysm, Infected surgery, Blood Vessel Prosthesis Implantation instrumentation, Endovascular Procedures instrumentation, Hepatic Artery surgery, Liver Transplantation adverse effects
Abstract

Background: Hepatic artery pseudoaneurysm is a rare but very morbid complication after liver transplant. Treatment options include ligation or endovascular embolization, followed by revascularization. We describe a new endovascular approach by stent exclusion in a high-risk patient., Results: A 62-year-old male who received a second liver transplant after failed allograft presented with hemobilia and was diagnosed with a hepatic artery pseudoaneurysm in the setting of infection. Given his hostile abdomen, an endovascular approach was sought. We excluded the mycotic pseudoaneurysm with multiple covered stent grafts extending from the common hepatic artery to the right and left hepatic arteries. He was discharged with long-term antibiotics. On his 6-month follow-up visit, his stent was patent and hepatic function was stable., Conclusions: Endovascular stent-graft placement for management of hepatic artery pseudoaneurysm after liver transplant should be considered as a lower morbidity alternative to surgical repair, even in the setting of infection., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Published
2019
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25. Mesenteric lymph nodes as alternative site for pancreatic islet transplantation in a diabetic rat model.

Author

Veroux M, Bottino R, Santini R, Bertera S, Corona D, Zerbo D, Li Volti G, Ekser B, Puzzo L, Raffaele M, Lo Bianco S, Giaquinta A, Veroux P, and Vanella L

Subjects
Animals, Insulin metabolism, Lymph Nodes, Male, Pancreas pathology, Pancreas Transplantation methods, Rats, Rats, Inbred Lew, Blood Glucose metabolism, Diabetes Mellitus, Experimental therapy, Islets of Langerhans Transplantation methods
Abstract

Background: Islet transplantation has progressively become a safe alternative to pancreas transplantation for the treatment of type 1 diabetes. However, the long-term results of islet transplantation could be significantly increased by improving the quality of the islet isolation technique even exploring alternative islet transplantation sites to reduce the number of islets required to mitigate hyperglycemia. The goal of the study was to test the lymph node as a suitable anatomical location for islet engraftment in a rodent model., Methods: Forty Lewis rats, 6-8 weeks old, body weight 250-300 g, have been used as islet donors and recipients in syngeneic islet transplantation experiments. Ten rats were rendered diabetic by one injection of 65 mg/Kg of streptozotocin. After pancreas retrieval from non diabetic donors, islet were isolated and transplanted in the mesenteric lymph nodes of 7 diabetic rats. Rats were followed for 30 days after islet transplantation., Results: A total of 7 islet transplantations in mesenteric lymph nodes have been performed. Two rats died 24 and 36 h after transplantation due to complications. No transplanted rat acquired normal glucose blood levels and insulin independence after the transplantation. However, the mean blood levels of glycemia were significantly lower in transplanted rats compared with diabetic rats (470.4 mg/dl vs 605 mg/dl, p 0.04). Interestingly, transplanted rats have a significant weight increase after transplantation compared to diabetic rats (mean value 295 g in transplanted rats vs 245 g in diabetic rats, p < 0.05), with an overall improvement of social activities and health. Immunohistochemical analysis of the 5 mesenteric lymph nodes of transplanted rats demonstrated the presence of living islets in one lymph node., Conclusions: Although islet engraftment in lymph nodes is possible, islet transplantation in lymph nodes in rats resulted in few improvements of glucose parameters.

Published
2019
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26. Abdominal CT Scan Findings of Decompression Sickness: A Case Report.

Author

Schwartz T, Gough-Fibkins S, Santini R, and Kopylov D

Subjects
Decompression Sickness therapy, Humans, Male, Middle Aged, Decompression Sickness diagnostic imaging, Radiography, Abdominal methods, Tomography, X-Ray Computed methods
Abstract

This case report depicts the radiologic findings of a 51-year-old male presenting with Decompression Sickness. Decompression Sickness is diagnosed clinically, therefore radiologic imaging of this disease entity is limited. Our patient's history includes a scuba dive to depth of 110 feet with a descending time of 24 minutes and an ascending time of 8 minutes. The patient subsequently presented to the Emergency Room with symptoms of shortness of breath and abdominal pain. The abdominal pain prompted physicians to explore further, and hence computed tomography (CT) imaging of the abdomen and pelvis was performed. This case report demonstrates a striking and unique gas pattern in both the systemic and portal venous system of our patient and provides an excellent example of the imaging findings of Decompression Sickness in the literature.

Published
2018
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27. Targeted inhibition of Hedgehog-GLI signaling by novel acylguanidine derivatives inhibits melanoma cell growth by inducing replication stress and mitotic catastrophe.

Author

Pietrobono S, Santini R, Gagliardi S, Dapporto F, Colecchia D, Chiariello M, Leone C, Valoti M, Manetti F, Petricci E, Taddei M, and Stecca B

Subjects
Animals, Apoptosis drug effects, Cell Cycle Checkpoints drug effects, Cell Line, Tumor, Cell Proliferation drug effects, Cell Self Renewal, Cell Survival drug effects, DNA Damage, Female, Humans, Inhibitory Concentration 50, Mice, Nude, Neoplastic Stem Cells drug effects, Neoplastic Stem Cells metabolism, Neoplastic Stem Cells pathology, Smoothened Receptor metabolism, Xenograft Model Antitumor Assays, DNA Replication drug effects, Guanidines pharmacology, Hedgehog Proteins metabolism, Melanoma pathology, Mitosis drug effects, Signal Transduction, Stress, Physiological, Zinc Finger Protein GLI1 metabolism
Abstract

Aberrant activation of the Hedgehog (HH) signaling is a critical driver in tumorigenesis. The Smoothened (SMO) receptor is one of the major upstream transducers of the HH pathway and a target for the development of anticancer agents. The SMO inhibitor Vismodegib (GDC-0449/Erivedge) has been approved for treatment of basal cell carcinoma. However, the emergence of resistance during Vismodegib treatment and the occurrence of numerous side effects limit its use. Our group has recently discovered and developed novel and potent SMO inhibitors based on acylguanidine or acylthiourea scaffolds. Here, we show that the two acylguanidine analogs, compound (1) and its novel fluoride derivative (2), strongly reduce growth and self-renewal of melanoma cells, inhibiting the level of the HH signaling target GLI1 in a dose-dependent manner. Both compounds induce apoptosis and DNA damage through the ATR/CHK1 axis. Mechanistically, they prevent G2 to M cell cycle transition, and induce signs of mitotic aberrations ultimately leading to mitotic catastrophe. In a melanoma xenograft mouse model, systemic treatment with 1 produced a remarkable inhibition of tumor growth without body weight loss in mice. Our data highlight a novel route for cell death induction by SMO inhibitors and support their use in therapeutic approaches for melanoma and, possibly, other types of cancer with active HH signaling.

Published
2018
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28. Combining Abiraterone and Radiotherapy in Prostate Cancer Patients Who Progressed During Abiraterone Therapy.

Author

Detti B, D'Angelillo RM, Ingrosso G, Olmetto E, Francolini G, Triggiani L, Bruni A, Borghesi S, Fondelli S, Carfagno T, Santini R, Santoni R, Trodella LE, and Livi L

Subjects
Aged, Aged, 80 and over, Combined Modality Therapy, Humans, Male, Middle Aged, Survival Analysis, Androstenes therapeutic use, Cytochrome P-450 Enzyme Inhibitors therapeutic use, Prostatic Neoplasms, Castration-Resistant drug therapy, Prostatic Neoplasms, Castration-Resistant radiotherapy
Abstract

Background/aim: This multicenter, retrospective, 'field-practice' study investigated treatment outcomes of ongoing abiraterone therapy with the addition of radiotherapy (RT) - initiated for oligoprogression or with a palliative intent., Patients and Methods: Consecutive patients affected by metastatic castration-resistant prostate cancer (mCRPC) treated with abiraterone acetate were considered if they had received RT after the initiation of abiraterone treatment., Results: A total of 32 patients were enrolled in the study. Median duration of abiraterone treatment was 13.0 months (range=3.8-40.9 months). Median duration of abiraterone treatment before RT was 5.9 months (range=0.4-40.0 months), and 7.2 months after RT (range=0.1-29.7 months). Median progression-free survival (PFS) was 12.6 months (95%CI=10.5-14.7) from the initiation of abiraterone treatment. From RT administration, PFS was 9.6 months (95%CI=6.4-12.9). Median overall survival (OS) since abiraterone initiation was 18.9 months (95%CI=4.7-33.0)., Conclusion: RT prolongs abiraterone treatment in mCRPC patients leading to better clinical outcomes with this molecule., (Copyright© 2017, International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.)

Published
2017
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29. Psychological perspective of medication adherence in transplantation.

Author

De Pasquale C, Veroux M, Fornaro M, Sinagra N, Basile G, Gozzo C, Santini R, Costa A, and Pistorio ML

Abstract

Aim: To identify the risk factors and the post-transplant psychological symptoms that affect adherence to therapy in a population of kidney transplant recipients., Methods: The study examined the psychological variables likely responsible for the non-adherent behavior using a psychological-psychiatric assessment, evaluation of the perception of patients' health status, and an interview regarding the anti-rejection drug therapy assumption. The study included 74 kidney transplant recipients., Results: Individuals with a higher level of education and more years since transplantation showed better mental balance. Regarding gender, women appeared to be less adherent to therapy. Further, the years since transplantation adversely affected the proper pharmacological assumption. Adherence to therapy did not significantly change with the mental health index., Conclusion: The biopsychosocial illness model provides a conceptual frame of reference in which biological, psychological, and social aspects take on the same importance in the adherence to treatment protocols. For effective management, it is necessary to understand the patients' personal experiences, their assumptions about the disease, health status perception, and mood, and to identify any "barriers" that could cause them to become noncompliant., Competing Interests: Conflict-of-interest statement: None of the authors declare any conflict of interest.

Published
2016
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30. Low dose rate brachytherapy (LDR-BT) as monotherapy for early stage prostate cancer in Italy: practice and outcome analysis in a series of 2237 patients from 11 institutions.

Author

Fellin G, Mirri MA, Santoro L, Jereczek-Fossa BA, Divan C, Mussari S, Ziglio F, La Face B, Barbera F, Buglione M, Bandera L, Ghedi B, Di Muzio NG, Losa A, Mangili P, Nava L, Chiarlone R, Ciscognetti N, Gastaldi E, Cattani F, Spoto R, Vavassori A, Giglioli FR, Guarneri A, Cerboneschi V, Mignogna M, Paoluzzi M, Ravaglia V, Chiumento C, Clemente S, Fusco V, Santini R, Stefanacci M, Mangiacotti FP, Martini M, Palloni T, Schinaia G, Lazzari G, Silvano G, Magrini S, Ricardi U, Santoni R, and Orecchia R

Subjects
Adult, Aged, Aged, 80 and over, Brachytherapy mortality, Dose-Response Relationship, Radiation, Humans, Italy epidemiology, Kaplan-Meier Estimate, Male, Middle Aged, Neoplasm Recurrence, Local mortality, Practice Patterns, Physicians', Prostate-Specific Antigen, Prostatic Neoplasms mortality, Radiotherapy Dosage, Treatment Outcome, Ultrasonography, Interventional methods, Brachytherapy methods, Prostatic Neoplasms radiotherapy
Abstract

Objective: Low-dose-rate brachytherapy (LDR-BT) in localized prostate cancer is available since 15 years in Italy. We realized the first national multicentre and multidisciplinary data collection to evaluate LDR-BT practice, given as monotherapy, and outcome in terms of biochemical failure., Methods: Between May 1998 and December 2011, 2237 patients with early-stage prostate cancer from 11 Italian community and academic hospitals were treated with iodine-125 ((125)I) or palladium-103 LDR-BT as monotherapy and followed up for at least 2 years. (125)I seeds were implanted in 97.7% of the patients: the mean dose received by 90% of target volume was 145 Gy; the mean target volume receiving 100% of prescribed dose (V100) was 91.1%. Biochemical failure-free survival (BFFS), disease-specific survival (DSS) and overall survival (OS) were estimated using Kaplan-Meier method. Log-rank test and multivariable Cox regression were used to evaluate the relationship of covariates with outcomes., Results: Median follow-up time was 65 months. 5- and 7-year DSS, OS and BFFS were 99 and 98%, 94 and 89%, and 92 and 88%, respectively. At multivariate analysis, the National Comprehensive Cancer Network score (p < 0.0001) and V100 (p = 0.09) were correlated with BFFS, with V100 effect significantly different between patients at low risk and those at intermediate/high risk (p = 0.04). Short follow-up and lack of toxicity data represent the main limitations for a global evaluation of LDR-BT., Conclusion: This first multicentre Italian report confirms LDR-BT as an excellent curative modality for low-/intermediate-risk prostate cancer., Advances in Knowledge: Multidisciplinary teams may help to select adequately patients to be treated with brachytherapy, with a direct impact on the implant quality and, possibly, on outcome.

Published
2016
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31. SOX2 regulates self-renewal and tumorigenicity of human melanoma-initiating cells.

Author

Santini R, Pietrobono S, Pandolfi S, Montagnani V, D'Amico M, Penachioni JY, Vinci MC, Borgognoni L, and Stecca B

Subjects
Aldehyde Dehydrogenase metabolism, Animals, Apoptosis, Carcinogenesis metabolism, Carcinogenesis pathology, Cell Line, Tumor, Cell Proliferation, Female, Humans, Melanoma pathology, Mice, Mice, Nude, Neoplasm Transplantation, Signal Transduction, Skin Neoplasms pathology, Transcription Factors metabolism, Zinc Finger Protein GLI1, Melanoma metabolism, Neoplastic Stem Cells physiology, SOXB1 Transcription Factors physiology, Skin Neoplasms metabolism
Abstract

Melanoma is one of the most aggressive types of human cancer, characterized by enhanced heterogeneity and resistance to conventional therapy at advanced stages. We and others have previously shown that HEDGEHOG-GLI (HH-GLI) signaling is required for melanoma growth and for survival and expansion of melanoma-initiating cells (MICs). Recent reports indicate that HH-GLI signaling regulates a set of genes typically expressed in embryonic stem cells, including SOX2 (sex-determining region Y (SRY)-Box2). Here we address the function of SOX2 in human melanomas and MICs and its interaction with HH-GLI signaling. We find that SOX2 is highly expressed in melanoma stem cells. Knockdown of SOX2 sharply decreases self-renewal in melanoma spheres and in putative melanoma stem cells with high aldehyde dehydrogenase activity (ALDH(high)). Conversely, ectopic expression of SOX2 in melanoma cells enhances their self-renewal in vitro. SOX2 silencing also inhibits cell growth and induces apoptosis in melanoma cells. In addition, depletion of SOX2 progressively abrogates tumor growth and leads to a significant decrease in tumor-initiating capability of ALDH(high) MICs upon xenotransplantation, suggesting that SOX2 is required for tumor initiation and for continuous tumor growth. We show that SOX2 is regulated by HH signaling and that the transcription factors GLI1 and GLI2, the downstream effectors of HH-GLI signaling, bind to the proximal promoter region of SOX2 in primary melanoma cells. In functional studies, we find that SOX2 function is required for HH-induced melanoma cell growth and MIC self-renewal in vitro. Thus SOX2 is a critical factor for self-renewal and tumorigenicity of MICs and an important mediator of HH-GLI signaling in melanoma. These findings could provide the basis for novel therapeutic strategies based on the inhibition of SOX2 for the treatment of a subset of human melanomas.

Published
2014
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