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"Obesity affects the population worldwide. A hypercaloric diet associated with a sedentary life, stress, and genetic background, triggers various metabolic disorders, such as metabolic syndrome, diabetes mellitus, cancer, cardiovascular diseases, non-alcoholic fatty liver disease, and cognitive impairment. A healthy diet correlated with physical activity, not smoking, and moderate alcohol consumption reduces the risk of developing metabolic diseases. The Mediterranean diet contains antioxidants, fiber, polyunsaturated fats, and compounds with anti-inflammatory, anti-oxidant, anti-cancer, and anti-obesity properties. In a wide variety of species including humans, the reduction of calories between 20-40% significantly improves health, increaseslongevity, and delaysthe development of various pathologies. The main aim of this review is to present the comparative effects of the Mediterranean diet versus the hypercaloric diet on insulin sensitivity. "

During the optimization of 36Cl determination in solid wastes from nuclear decommissioning, a residual 36Cl signal was observed in procedural blanks measured after processing active samples. To uncover the possible causes, we investigated the interaction of chlorine with the components of a Pyrolyser-6 Trio™, as well as the chemicals used during the procedure. Diferent treatments for identifying the source of chlorine carryover were thoroughly investigated, demonstrating that the 36Cl memory efect arises from the interaction with pyrolyser components and that it occurs almost every time when the analysis procedure is performed. Therefore, results obtained using this analysis procedure need to be corrected for this memory efect by measuring procedural blank samples before and after measuring 36Cl-containing samples

Background Worldwide, the COVID-19 pandemic has been associated with a drop in overall stroke hospitalizations. Additionally, there is a well-known association between stroke and socioeconomic status. This study aims to assess the COVID-19 effect on stroke admissions in France during the first national lockdown and investigate the factors associated with its spatial heterogeneity. Methods In this retrospective nationwide study, we used data from the French hospital discharge database (PMSI) to estimate rates of admission for stroke to all public and private hospitals in 2019 and 2020. We used negative binomial regression to test for a nationwide change in stroke admissions during the first lockdown, compared to the same period in 2019 (from week 12 to week 19). We conducted a multivariate analysis to explore the factors associated with the stroke admission incidence rate ratio variation (2020 incidence rate/2019 incidence rate) at the county level. Results We found a significant nationwide reduction in stroke admissions during the first wave of COVID-19 (incidence rate ratio 0,91 [0,86 - 0.97]), with notable geographic variations. After adjustment on hospital bed capacity, cumulative in-hospital COVID-19 incidence, standardized death rate at age 65 and unemployment rate, a higher share of labourers at the county level was associated with a higher incidence rate ratio (p < 0.01). Conclusions During the first national lockdown, there has been an overall decrease in stroke admission rates. Socio-economic determinants such as low-skilled jobs were independently associated with an increase in the stroke admission incidence rate ratio, while we did not find any independent effect from the local COVID 19 burden and hospital capacities. Key messages The first national lockdown led to an overall decrease in stroke admissions in France. This decrease varied between counties according to socio-economic determinants.

The present essay includes the main results of the research project on community-based cooperatives, promoted in 2018 by Fondosviluppo and FEDAM, and implemented by researchers of University of Molise. The volume highlights the potential and the modes of operating of community-based cooperatives, which carry out a mix of productive and socially useful activities for local community well-being. The research, through a new methodological and operational path, reaches the following results: a) devise a strategy to detect the degree of social, economic and environmental vulnerability levels of Italian inner areas; b) outline the needs of local communities; c) define the role of community-based cooperatives in bridging regional gaps, also identifying their possible policy support.Il presente volume riprende i principali risultati del progetto di ricerca sulle cooperative di comunita promosso nel 2018 da Fondosviluppo e FEDAM, e realizzato da ricercatori dell’Universita del Molise. Il volume mette in luce le potenzialita e le modalita di funzionamento delle cooperative di comunita, che creano nuove forme di condivisione e co-producono beni e/o servizi. La ricerca, sperimentando un nuovo percorso metodologico-operativo, permette di raggiungere i seguenti risultati: a) delineare una strategia per individuare il grado di vulnerabilita sociale, economica e ambientale del territorio; b) definire i fabbisogni delle comunita locali; c) indicare il ruolo di ipotetiche cooperative di comunita a supporto dei fabbisogni individuati e individuarne i canali di finanziamento.

Basing on multivariate statistical methods, text and sentiment analysis, and profitability analysis, a study is performed, with the aim to define the role of Community-based cooperatives in the development process of the inner areas of the Italian region of Molise. Census data, direct interviews data, and balance sheets data are employed to identify a new model of local development based on cooperative principles.

BACKGROUND : In a previous quality control assessment of the management of STEMI in our centre–a tertiary centre in a rural area–we observed a decrease in intrahospital delays over time (2004→2013) from 98→39 minutes (median) but unchanged extrahospital delays (203–220 minutes). AIM :To elucidate the determinants of these long extrahospital delays, 181 patients, undergoing PCI for STEMI (2013–2017) in our centre, were carefully interviewed. The first medical contact (FMC) allowed to assess 2 periods: onset of symptoms–FMC (period 1) and FMC–diagnosis (period 2). Results are given as mean values (median). RESULTS :In 36%, the FMC took place via the general practitioner (GP). Period 1 was associated with the type of FMC (GP: 210 ± 294, median = 79 min/EM call: 78 ± 114, median = 43 min/direct hospital admission: 222 ± 44, median = 115 min), the moment of symptoms onset (0–4 am: 198 ± 192, median 142 min/8–12 am: 96 ± 126, median 60 min), age (70–80 y: 262 ± 324, median 120 min/50–60 y: 198 ± 438, median 63 min) and the distance to our PCI centre expressed in minutes by car (< 30′: 108 ± 156, median = 60 min/ > 60′: 216 ± 288, median = 116 min). Period 2 was depending on the type of FMC (GP: 234 ± 600, median 56 min/EM call: 31 ± 29, median 22 min/direct hospital admission: 25 ± 55, median 10 min). CONCLUSION :In our local experience, FMC via the GP in case of STEMI is a major determinant for a longer extrahospital delay and should therefore be discouraged.

The ATLAS experiment at the Large Hadron Collider (LHC) operated very successfully in the years 2008 to 2013, a period identified as Run 1. ATLAS achieved an overall data-taking efficiency of 94%, largely constrained by the irreducible dead-time introduced to accommodate the limitations of the detector read-out electronics. Out of the 6% dead-time only about 15% could be attributed to the central trigger and DAQ system, and out of these, a negligible fraction was due to the Control and Configuration sub-system. Despite these achievements, and in order to improve the efficiency of the whole DAQ system in Run 2 (2015-2018), the first long LHC shutdown (2013-2014) was used to carry out a complete revision of the control and configuration software. The goals were three-fold: properly accommodate additional requirements that could not be seamlessly included during steady operation of the system; re-factor software that had been repeatedly modified to include new features, thus becoming less maintainable; and seize the opportunity of modernizing software written even before Run 1, thus profiting from the rapid evolution in IT technologies. This upgrade was carried out retaining the important constraint of minimally impacting the mode of operation of the system and public APIs, in order to maximize the acceptance of the changes by the large user community. This paper presents, using a few selected examples, how the work was approached and which new technologies were introduced into the ATLAS DAQ system, and how they were performing in course of Run 2. Despite these being specific to this system, many solutions can be considered and adapted to different distributed DAQ systems.

In this paper we present a novel approach to the optimisation of complex systems affected by epistemic uncertainty when system and uncertainty evolve dynamically with time; we propose a new modelling approach that uses Evidence Theory to capture epistemic uncertainty A system is considered which is affected by the time during the operational life (failure rate, performance degradation, function degradation, etc.). The goal is to obtain a resilient design: robust with respect to performance variability and reliable against possible partial failures of one or more components. We propose to enhance the Evidence Network Model (ENM) with time-dependent reliability functions and decompose the problem into subproblems of smaller complexity. Through this decomposition uncertainty quantification of complex systems becomes affordable for a range of real-world applications. The method is here applied to a simple resource allocation problem where the goal is to optimally position subsystems within a spacecraft [1]

Among the meson decays, K → π ν ν ‾ are the cleanest environment, from the theoretical point of view, where to search for new physics effects. The NA62 Experiment at CERN SPS aims to measure the BR ( K + → π + ν ν ‾ ) with a 10% precision by the end of 2018. It has been commissioned with technical runs in 2014 and 2015, and some preliminary results of the detector performances and quality of data are here reported.

The $K^+\rightarrow \pi^+ \nu \bar \nu$ decay is one of the theoretically cleanest meson decay where to look for indirect effects of new physics complementary to LHC searches. The NA62 experiment at CERN is designed to measure the branching ratio (BR) of this decay with 10\% precision. NA62 has been successfully launched in October 2014, took data in pilot runs in 2014 and 2015 reaching the final designed beam intensity. The NA62 experimental setup is illustrated and quality of data acquired in view of the final measurement is reported. The $K^+\rightarrow \pi^+ \nu \bar \nu$ decay is theoretically one of the cleanest meson decays and so a good place to look for indirect effects of new physics complementary to LHC searches. The NA62 experiment at CERN is designed to measure the branching ratio of this decay with 10\% precision. NA62 was commissioned in October 2014, took data in pilot runs in 2014 and 2015. The NA62 experimental setup is illustrated and data quality is reported. The K+→π+νν‾ decay is theoretically one of the cleanest meson decays and so a good place to look for indirect effects of new physics complementary to LHC searches. The NA62 experiment at CERN is designed to measure the branching ratio of this decay with 10% precision. NA62 was commissioned in October 2014, took data in pilot runs in 2014 and 2015. The NA62 experimental setup is illustrated and data quality is reported.

Objective. We previously showed that DU significantly increased global and hand disability with a significant impact on activities of daily living (ADLs) and work disability. This study aims to evaluate the impact of digital ulcer (DU) healing on disability and daily activity limitations in SSc. Methods. From January 2008 and June 2009, we prospectively evaluated 189 SSc patients for DU history, disability, employment and occupational status during meetings of the French SSc Patient Association (n = 86, 45.5%) or during hospitalization (n = 103, 54.5%)1. Among the 60 patients with at least one active DU at baseline (M0), 40 patients were followed longitudinally over 6 (3) months. These patients were evaluated for DU history, global and hand disability, health-related quality of life (HRQoL), daily activity limitation and employment status. Results. The median (IQR) age was 57.5 (43.5-68) years and the median (IQR) disease duration was 8.3 (3-16.5) years. Twenty-two (55%) patients had diffuse SSc and 34 (85%) were females. At baseline, a mean of 2.9 (2.8) DU per patient was reported. Thirty-three (82.5%) patients had ischaemic DU, 7 (17.5%) patients had >1 DU associated with calcinosis and 13 (32.5%) patients had mechanical DU. Thirteen (32.5%) patients had >4 DU at baseline. Among the 40 patients, 16 (40%) patients showed complete ulcer healing. In these patients with DU, the presence of calcinosis was associated with a lower probability of healing (P = 0.03). Comparison between healed and no-healed DU patients showed an improvement of hand disability provided by an improvement of the Cochin Hand Function score (P = 0.05)) and a trend towards HAQ domain dressing and grooming (P = 0.06) between M0 and M6 (3) visit in healed patients but not in no-healed patients. Concerning HRQoL, there were no difference for Mental and Physical component Scores of SF-36 but significant improvement of Bodily Pain score (P = 0.04) and Physical Role score (P = 0.05) between M0 and M6 (3) visit in patients with healed DU. The absence of healing was associated with significantly decreased work productivity (P = 0.05), whereas the performance in ADL was not significantly decreased (P = 0.15). Patients who were on sick-leave and who received some help for household tasks at the time of active DU were more likely to heal. Conclusion. For the first time, we provide prospective data with evidence that DU healing is associated with an improvement in hand function. Sick leave was associated with better healing of DU

Aims Perform an agreement and reproducibility study of the estimation of iron overload in highly transfused pediatric patients comparing R2* relaxometry (R2* = 1000/T2*) to the reference technique liver/muscle signal intensity ratio (SIR). Patients and methods Ninety-two MRI were performed in 68 children who were mainly transfused for sickle cell disease, mean age 9.9 years old. The examination included six sequences for the SIR protocol and a single multiecho T2* sequence. R2* relaxometry was measured by two radiologists independently, either by a region of interest (ROI) in the right liver, or an outline of the whole liver. Hepatic iron load was determined by the Wood formula (Fe mg/g = R2* × 0.0254 + 0.202). The validity of R2* relaxometry compared to SIR was evaluated by the coefficient of variation and the quadratic weighted Kappa value. Results The correlation between R2* relaxometry and SIR was very good with a Pearson coefficient of 0.89 and a coefficient of variation of 17.3%. The inter- and intraobserver reproducibility of the measurement of R2* relaxometry by ROI and whole liver mapping was excellent. However, we observed a common positive variation of one class between SIR and R2* relaxometry, with higher hepatic iron content values with SIR than with R2* relaxometry. Conclusion Hepatic iron content can be rapidly and precisely estimated on MRI by multiecho gradient-echo sequences.

In 2009, the CCRI approved a supplementary comparison to be organised by the IRMM as pilot laboratory for the activity concentrations of 137Cs, 90Sr and 40K in a matrix material of dried bilberries. The organisation of this comparison and the material and measurement methods used are described. The supplementary comparison reference value (SCRV) for each of the three radionuclides are given together with the degrees of equivalence of each participating laboratory with the SCRV for the specific radionuclide. The results of this supplementary comparison allow the participating NMIs/designated institutes to declare calibration and measurement capabilities (CMCs) for the given radionuclides in a similar type of food matrix, an important aspect seen the relatively few supplementary comparisons for activity in matrix materials organised so far., JRC.D.4-Standards for Nuclear Safety, Security and Safeguards

To present the technique of total body irradiation (TBI), applied for the first time in Romania, at the Institute of Oncology Bucharest, as part of stem cell transplantation for hematological malignancies.The total dose administered was 12 Gy at the reference point, 2 Gy/fraction, one fraction per day, 6 consecutive days, with a total dose of 8 - 11.4 Gy delivered to the lung, using Mevatron Primus linear accelerator (6 MV15 MV, 200-300 cGy/min in isocenter), in vivo dosimetry detectors and equipment for the reference dosimetry, personalized blocks for lung shielding sustained by polymethylmethaacrylate (PPMA) plate, Simulix HP simulator, and computer tomographic (CT) scans. Techniques used were: a) two parallel opposed anteroposterior / posteroanterior (AP/PA) fields with the patient in prone and supine position; b) two parallel opposed lateral fields with the patient placed on a lateral table, at 320 cm from the source. The percentage depth dose, tissue maximum ratio (TMR), off axis ratio (OAR) and the reference dose rate were measured for every patient's geometrical characteristics, with an uncertainty of +/- 2.2% and were used to calculate monitor units and to evaluate the dose in organs at risk (lungs, gonads, eyes etc).5 patients (3 with the AP/PA technique and 2 with the lateral technique) were irradiated. All patients completed their irradiation in good clinical condition. The acute side effects were minimal (WHO grade 1: nausea/ vomiting--all patients; diarrhea--1 patient; headache--2 patients; photophobia and diplopia--1 patient; head and neck skin erythema--all patients). Because of the short follow-up period no safe evaluation of late side effects can be done. However, during this period one patient developed a non-aggressive form of chronic liver graft vs. host disease (GVHD) and one patient died due to acute GVHD.TBI as part of stem cell transplantation for hematological malignancies was successfully realized at our Institute, with favorable clinical results. This technique is easy to carry out and reproducible.

Currently, we are searching for a range of solutions for repairing the crankshafts that had snapped during operation. The paper deals with the extension of the two methods for reconditioning by welding in the energy industry in the field of repairing the crankshafts in the automotive industry. The results obtained through the application of methods for reconditioning Weld Toe Tempering Technique and filling layers of sidings, which was used as a welding procedure SMAW. Qualitative and quantitative comparisons between the results of the two methods based on the criterion of rigidity are carried out.

One of the goals of modern society is represented by reducing the cost for the maintenance of cars. One of the pieces that break down most often on the engine block is the crankshaft, in various areas of it. Due to the fact that the price of a crankshaft is very high, specialists seek solutions for repairing and not replacing them. In this study, it is presented a comparison in terms of hardness obtained at recovering the counterweight by welding by using two methods of welding, WIG and SMAW through various techniques: normal, WTO, lateral depositing.

Background:One of the main goals of psychotherapy should be increasing the patient's quality of life. This purpose is of extreme importance in patients diagnosed with cancer that have to fight with anxiety, depression, social and occupational adjustment difficulties.Methods:We included in a 3 months weekly sessions program of cognitive psychotherapy a number of 12 patients, 8 female and 4 male, mean age 52.4, diagnosed with malignant tumors (lung cancer 2 cases, ovarian cancer 2 cases and stomach cancer one case). The assessment included Cancer Coping Questionnaire (CCQ)- 21 items version, Hamilton Rating Scale for Anxiety (HAM-A), Beck Depression Inventory-21 items (BDI), Global Assessment of Functioning (GAF) and the dysfunctional beliefs monitoring throughout all the 3 months of this trial. Therapy focused on working with “realistic” negative automatic thoughts, attention switch on resources instead of loses, stimulating emotional expression of frustration, anger or blaming, involving in planning activities and isolation prevention. Inclusion criteria: CCQ baseline value under 42, either anxiety or depressive symptoms, or both, that interfere with daily functioning (HAM-A score over 20, BDI over 15, GAF under 75).Results:All patients that reach the endpoint (two drop-outs recorded) improved their cognitive approach to cancer because their coping methods improved and dysfunctional beliefs decreased in frequency and strength. CCQ score improved with 34.5%, HAM-A decreased with 15+/-2.5%, BDI decreased with 18+/-1.5% and GAF increased with 10+/-1.1% at endpoint.Conclusion:Cognitive therapy is an usefull approach in oncologic patients, helping them to focus on resources, activity and relational support.

We present a case of ectopic pregnancy with a peculiar localisation: beneath the peritoneal serosa covering the anterior wall of the uterus, at the level of the uterovesical pouch. The case raised some diagnostic and management problems for the medical team. Considerations are made concerning the etiopathology of this unusual form of ectopic pregnancy.

Background:Although the mechanisms explaining metabolic impairments observed during antipsychotic treatment are not well known, there are important differences between drugs regarding the possibility of inducing lipidic and glucose impairments.Objective:To assess the effects of atypical and typical antipsychotics -olanzapine, aripiprazole, risperidone and haloperidol over the weight, glucose and HDL-cholesterol levels, during 24 weeks of treatment.Method:A 43 patients group, 30 male and 13 female, mean age 42.1, admitted during an acute phase of chronic schizophrenia (DSM-IV-TR), were distributed on flexible dose of olanzapine (N=12) 10-20 mg/day, aripiprazole (N=11) 15-30 mg/day, risperidone (N=10) 4-8 mg/day or haloperidol (N=10) 10-20 mg/day. Weight, fasting glucose and HDL-cholesterol were weekly monitored during the first month and monthly after that. Inclusion criteria: baseline glucose and HDL-cholesterol levels within normal range. Exclusion criteria: familial history of diabetus mellitus or obesity.Results:Regarding the weight gain, the safest antipsychotic is aripiprazole (+0.4+/-0.2 kg at endpoint), followed by haloperidol (+1.9+/-0.2 kg), while olanzapine (+5.6+/-1.1 kg) and risperidone (+3.4+/-0.5 kg) are less tolerated. The glucose level >125 mg/dl was observed at endpoint in 3 patients with risperidone, 6 with olanzapine, 2 with haloperidol. The HDL-cholesterol over 40 mg/dl (men) and over 50 mg/dl (female) appeared in 4 cases of olanzapine and 3 cases of risperidone treated patients.Conclusions:There are quantitative differences in the level of weight gain, HDL-cholesterol and glucose level induced by antipsychotics. The safest antipsychotic agent is aripiprazole because it doesn't induce significant weight gain or other metabolic complications.

Systemic sclerosis (SSc) is a chronic connective tissue disease characterised by excessive fibrosis resulting in its most noticeable symptom, the hardened skin. SSc also affects organs including the gastrointestinal (GI) tract, the vascular system, the lungs and the joints. We could previously show that profibrotic cytokines and infiltration of CD4 T lymphocytes are increased in the gastric wall (GW) of SSc patients. In rheumatoid arthritis (RA) we found that certain adipokines have immunomodulatory functions. We therefore analysed localisation of …

ObjectiveTo evaluate the efficacy of three different strategies in the management of self-aggressive behavior (defined as repeated overdoses, explicit suicidal attempts or self-mutilation) observed in heroin dependent patients.MethodsA group of 16 patients, mean age 26.2, diagnosed with heroin dependence, were treated as outpatients, with (1) oxcarbazepine (mean daily dose 900 mg), (2) cognitive behavioral therapy focused on coping strategies and cognitive restructuring (2 sessions per week) or (3) the combination of the previous two methods. All the included patients were monitored for 6 months using Inventory of Drug Taking Situations (IDTS), Clinical Global Impression-Improvement (CGI-I), Suicide Attempt-Self Injury Interview-Short Version (SAS II-B) and Global Assessment of Function (GAF). The randomization of the patients in the three groups was single blinded.ResultsOxcarbazepine was well tolerated and no drop out related to adverse events was registered. Patients that received combined therapy registered an improvement (p< 0.01) in all self-aggressive behaviors (33% to baseline), global functioning (25%) and clinical impression (24%). There was a significant difference between this group and the psychotherapy only treated group (p< 0.01 on SAS II-B, GAF, CGI), but not significant when it was compared to oxcarbazepine group (p=0.06). Regarding the impact of treatment strategies over the severity of addiction, only the combined therapy had some success, by decreasing with 11% the IDTS score.ConclusionThe combined therapy, using CBT and oxcarbazepine, reduced the risk for self-aggressive behaviors on medium term in heroin dependent patients and mildly decreased the severity of the dependence.

ObjectiveTo evaluate the impact of conflicting patient and psychiatrist conceptualizations of the depression over the treatment response and general prognosis.MethodsA group of 25 patients, mean age 36.8, diagnosed with major depressive disorder, first depressive episode, according to DSM IV TR criteria, have completed a closed-ended questionnaire that included their perspective over the depression (on a 7 points Likert scale, from the pure medical/pharmacological, to the pure psychological/reactive paradigm). Psychiatrists who managed their treatment responded to a similar questionnaire regarding their preferred method of treatment. Patients were evaluated initially and after 3 and 6 months using Hamilton Depression Rating Scale-17 items (HAMD), Beck Depression Inventory (BDI), Global Assessment of Functioning. Patients satisfaction over the treatment (on a 10 points visual analogic scale) was evaluated at endpoint.ResultsPatients who received a treatment corresponding to their preferred paradigm (n=17) responded better (−5.6 on HAMD, −4.5 on BDI, +7.6 on GAF, p< 0.01) to the treatment, compared to the group where the paradigms weren’t the same. The satisfaction over the treatment was also significant higher in the first group (+2.5, p< 0.01). Patients who have discussed their beliefs about the disorder and were informed by their psychiatrists about the advantages of the treatment had a greater rate of response to treatment (p< 0.05).ConclusionPsychiatrists should routinely explore the patient conceptualization of the depression and to discuss together the best treatment approach. Prognosis, patient satisfaction and treatment response are significantly influenced by exploring the patient beliefs about its disorder.

ObjectiveTo evaluate the impact of depression treatment over the quality of life in oncologic patients.MethodsA group of 27 patients, 14 male and 13 female, mean age 56,3, diagnosed with lung (n=7), gastric (n=7), prostate (n=5), colon (n=4) and breast (n=4) cancer, were also diagnosed with moderate or severe depression (Hamilton Depression Rating Scale-17 items score at the inclusion was over 14). These patients received a combined, psychopharmacological (escitalopram mean daily dose 15 mg, n=15 or mirtazapine, mean daily dose 30 mg, n=12) and psychotherapeutic (cognitive behavior therapy) approach for 3 months and were monitored using monthly HAMD, Global Assessment of Functioning and Lehman Quality of Life Interview (QOLI). Patients didn’t present any significant axis I, II or III comorbid condition.ResultsPatients responded well to the combined therapy, as the final HAMD (-11.2, p< 0.01) and GAF (+12.3, p< 0.01) scores reflected, with no significant inter-group difference (p=0.23). The quality of life scales regarding health, family relations and social relations from the QOLI registered significant improvement compared to baseline (+10%, +12.2% and +12.5% respectively, p< 0.01). Patients who had the higher response rate to the treatment also had the higher rate of life quality improvement (r=0.65).ConclusionThe treatment of depression in oncologic patients is a necessity, due to the impact of depressive symptoms over the patient quality of life and is associated with a significant rate of success. The improvements are observed especially in the patient perception of health, family and social relationship and functioning.

ObjectiveTo evaluate the comparative efficacy of 3 antidepressants, each representative of a distinct psychopharmacologic class, in the treatment of depressive disorders associated to Parkinson disease with dementia (PDD).MethodsA group of 23 patients, mean age 72.1, diagnosed with PDD for at least 2 years, who were admitted in our department for a major depressive episode (DSM IV TR), received antidepressant treatment with escitalopram (mean dose 15 mg daily, n=7), duloxetine (mean dose 45 mg daily, n=8) or trazodone (mean dose 150 mg daily, n=8). All patients received treatment for PDD with rivastigmine or donepezil continuously, for at least 12 months. The distribution of patients on the antidepressant treatment was randomized, in a single-blind manner. Patients were evaluated monthly, for 6 months, using Montgomery Asberg Depression Rating Scale, Hamilton Rating Scale for Depression- 17 items, Clinical Global Impression-Improvement and Mini Mental Status Examination.ResultsPatients treated with duloxetine had the most significant improvement in the depressive symptoms, as the endpoint MADRS (-18.6+/-2.3, p< 0.01), HAMD (-13.2+/-1.1, p< 0.01) and CGI-I (- 3.2+/-0.5, p< 0.01) scores reflected. The differences between escitalopram and trazodone didn’t reach a significant level but, overall, both improved the depressive symptoms compared to baseline (p< 0.05). The difference between duloxetine and the other two antidepressants became significant after 8 weeks (p< 0.01). The severity of dementia symptoms didn’t vary significantly between the three groups at endpoint.ConclusionDuloxetine had proven itself more efficient than escitalopram and trazodone in the improvement of the depressive symptoms in PDD.

ObjectiveTo establish the frequency of self-image distorsions in alcohol dependent patients and if addressing them through a targeted psychotherapeutic approach would be beneficial.MethodsA group of 45 patients, 32 male and 13 female, mean age 39.6, diagnosed with alcohol dependence (DSM IV TR), were evaluated for establishing the severity of self-image distorsions, using-baseline and endpoint- Rotter Incomplete Sentence Test (RIST) and Thematic Apperception Test (TAT); for the monitoring of the dependence severity and its associated impairments we used Inventory of Drug Taking Situations (IDTS)-alcohol focused version and Global Assessment of Function (GAF) every 4 weeks for 6 months. From the initial group, 38 (84.4%) patients have been found with moderate and severe self-image distorsions (feeling of insecurity and inferiority, external locus of control, frequent use of denial, regression and projection). They received cognitive-behavior therapy (CBT) focused on restructuring cognitive dysfunctional beliefs about self and experimenting new ways to relate to self and significant others.ResultsThe psychotherapeutic approach decreased the overall severity of alcohol dependence (-35.7 on IDTS, p< 0.01) and consequently improved the global functioning (+18.2 on GAF, p< 0.01) after 6 months. These results correlated with the improvement of self-image, reflected on the severity of P-Ego scale from RIST (-23.2%, p< 0.01) and on the improvement of defense system (more frequent use of anticipation, suppression and rationalization and less of denial and projection).ConclusionPatients with alcohol dependence have very often self-image distorsions and could, therefore, benefit from a psychotherapy that addresses specifically this phenomenon.

Background:Perceptual and thought distorsions that are observed in the acute episodes of schizophrenia make the adaptation to reality very difficult, but there are residual symptoms that interfere with coping in the interepisodic phases, also. There are specific coping strategies found by such patients in order to face the difficult challenges of hallucinations, delusions, attentional and memory deficits, but also the social stigma and negative symptoms, like isolation.Methods:We assessed 51 patients, 40 male and 11 female, mean age 39.8, diagnosed with chronic schizophrenia- paranoid (n=22), residual (n=14), catatonic (n=10) and disorganised (n=5) type, according to DSM -IV- TR criteria, in order to establish a correlation between main categories of coping mechanisms and the specific type of schizophrenia. Inclusion criteria: patients included in a cognitive- behavioural therapy and antipsychotic maintenance treatment for at least 4 weeks. Exclusion criteria: axis II comorbidity or severe somatic pathology that could modify patients coping strategies.Results:Patients with paranoid schizophrenia associated maladaptive coping strategies like alcoholism (36.3%) and aggression (27.2%), those with residual type presented more social withdrawal (71.4%) and self- harming (35.7%), while catatonic and disorganised schizophrenia cases had a high incidence of thought blocking (60% and 40%, respectively) and social isolation (60% in both groups).Conclusion:There are more frequent types of coping mechanisms in each form of schizophrenia. This is an important fact for focusing the psychotherapy approach on conversion to adaptative coping strategies, using techniques like verbal challenge and reality testing, reatributtion- enhancing methods, activities daily programming.

Background:Patients with dual diagnosis, major depressive disorders and cluster B personality disorders, must be carefully monitored because of the refractory cases high incidence to either psychotherapeutic or pharmacologic therapy, when applied alone. In histrionic patients the the emphasis during psychotherapy must be on the collaborative therapeutic relationship and on the goals operationalizing process.Methods:We prospectively evaluated 12 patients, female, mean age 35.5 years, diagnosed with major depressive disorder and histrionic personality disorder (according to DSM IV TR criteria) treated with antidepressants (fluoxetine 30 mg/day, n=5, paroxetine 30 mg/day, n=4, mirtazapine 45 mg/day, n=3) and weekly sessions of cognitive-behavioural therapy, for 6 months. We used Beck Depression Inventory (BDI)- 21 items form initially and every two weeks until the endpoint. The Global Assessment of Functioning (GAF) was used also, with the same frequency. The specific schemas of histrionic personality disorder had been addressed simultaneously with depressive specific dysfunctional beliefs.Results:There were 4 cases of discontinuation after a mean duration of 10.6 weeks. These patients presented at 6 months a higher score on BDI (+6.5) and a lower degree of social and professional level of functioning (-15 on GAF); a follow-up evaluation (after one year from baseline) observed more residual symptoms or recurrence of depression than patients that participated in all study sessions (mean BDI score 15.6vs.9.5, GAF 78vs.89, 2vs.0.5 depression episodes incidence).Conclusion:Adressing dysfunctional schemas of histrionic personality disorder improves the long term prognosis in depressed patients with dual diagnosis.

Background:Venlafaxine extended release (XR) stands as an optimal therapeutic choice for the major depressive disorder (MDD) and generalized anxiety disorder (GAD) dual diagnosis.Objective:We focused upon the evaluation of venlafaxine XR efficacy in treating MDD and GAD dual diagnosis patients, using an selective serotoninergic reuptake inhibitor comparator, fluoxetine.Methods:A 23 patients group, 13 male and 10 female, mean age 36.7, admitted in our clinic, that met the DSM IV TR criteria for both MDD and GAD, were distributed in two groups, receiving venlafaxine XR in 75-150 mg flexible dose (n=12) or fluoxetine 20-40 mg flexible dose (n=11). We assessed patients evolution under treatment every two weeks for 6 months using Hamilton Depression Rating Scale 17 items (HAMD-17), Hamilton Anxiety Scale for Anxiety (HAMA), Global Assessment of Functioning Scale (GAF) and Clinical Global Impressions (CGI).Results:In the intent-to-treat (ITT) and last-observation-carried-forward (LOCF) analysis, differences between groups became statistically significant at week 4, venlafaxine XR treated patients improved better as HAMD-17 (-7.8 points, p

The evaluation of the on-ground casualty risk assessments due to a controlled or uncontrolled re-entry is highly sensitive to the accurate prediction of fragmentation events during an atmospheric re-entry. The main objective of this study is an investigation into the use of peridynamics (PD) to improve the analysis of fragmentation during atmospheric re-entry with respect to currently adopted semi-empirical approaches. The high temperatures characterising such scenarios may substantially impact fragmentation, which requires appropriate modelling of the damage process within the PD method. The damage models in PD require experimentally determined fracture mechanical properties that are unavailable as a function of temperature. This work proposes a numerical methodology to estimate the PD damage parameters changes with temperature to enable the study of fragmentation during atmospheric re-entry. Initially, tensile-testing simulation experiments are performed in peridynamics to calibrate material parameters for steel and aluminium alloys as a function of temperature. Then, a parametric study is carried out to evaluate the temperature-dependent damage model parameters for the same materials. The applicability of the proposed methodology is showcased using a re-entry test case scenario.

Purpose of this work is the development of an automatic classification system which could be useful for radiologists in the investigation of breast cancer. The software has been designed in the framework of the MAGIC-5 collaboration. In the traditional way of learning from examples of objects the classifiers are built in a feature space. However, an alternative ways can be found by constructing decision rules on dissimilarity (distance) representations. In such a recognition process a new object is described by its distances to (a subset of) the training samples. The use of the dissimilarities is especially of interest when features are difficult to obtain or when they have a little discriminative power. In the automatic classification system the suspicious regions with high probability to include a lesion are extracted from the image as regions of interest (ROIs). Each ROI is characterized by some features extracted from co-occurrence matrix containing spatial statistics information on ROI pixel grey tones. A dissimilarity representation of these features is made before the classification. A feed-forward neural network is employed to distinguish pathological records, from nonpathological ones by the new features. The results obtained in terms of sensitivity and specificity will be presented.