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Fatal Adverse Events (FADEs) are a major public health problem, and some FADEs could be preventable. The aim of the present study is to describe the frequency, the drugs involved and the preventability in the FADEs collected through the MEREAFaPS Study between 2012 and 2018. All cases including the outcome “death” have been examined. We excluded cases with vaccine-related ADEs, overdose or suicide, and ADEs occurred during the hospitalisation. Two trained assessors evaluated all cases fulfilling the inclusion criteria. ADEs’ preventability was evaluated applying the Schumock and Thornton algorithm. During the study period, we observed 429 cases of death, 92 of which were excluded. The remaining 337 cases involved 187 women and 150 men, with a mean age of 79 and of 77years, respectively. For each report, the suspected drugs and concomitant ones were 1.26 and 4.20, respectively. Anticoagulants and antiplatelet agents account for more than 40% of FADE cases and the most frequent reactions are haemorrhages (37.5%). The 25% of the FADEs were preventable. This study confirms that FADEs are still a relevant clinical occurrence, and are often caused by widely used old drugs associated with adverse events. The death of one in four patients was preventable. Further efforts should be done to improve the appropriateness of the therapy, especially in older patients who are treated with anticoagulants.

Purpose To assess the presence and pattern of incidental interstitial lung alterations suspicious of COVID-19 on fluorine-18-fluorodeoxyglucose positron emission tomography (PET)/computed tomography (CT) ([18F]FDG PET/CT) in asymptomatic oncological patients during the period of active COVID-19 in a country with high prevalence of the virus. Methods This is a multi-center retrospective observational study involving 59 Italian centers. We retrospectively reviewed the prevalence of interstitial pneumonia detected during the COVID period (between March 16 and 27, 2020) and compared to a pre-COVID period (January–February 2020) and a control time (in 2019). The diagnosis of interstitial pneumonia was done considering lung alterations of CT of PET. Results Overall, [18F]FDG PET/CT was performed on 4008 patients in the COVID period, 19,267 in the pre-COVID period, and 5513 in the control period. The rate of interstitial pneumonia suspicious for COVID-19 was significantly higher during the COVID period (7.1%) compared with that found in the pre-COVID (5.35%) and control periods (5.15%) (p Conclusions A significant increase of interstitial pneumonia incidentally detected with [18F]FDG PET/CT has been demonstrated during the COVID-19 pandemic. A majority of interstitial pneumonia were FDG-avid. Our results underlined the importance of paying attention to incidental CT findings of pneumonia detected at PET/CT, and these reports might help to recognize early COVID-19 cases guiding the subsequent management.

Interventional Female Cardiologists (WIC) operating in high case mix laboratories are exposed to a significant chest X-Ray scattered dose from the patient. In this setting stochastic effect may be highly detrimental because of breast radiation sensitivity. Aim of this study is to measure and optimize WICs’ chest radiation exposure in a high case mix electrophysiology laboratory, in order to validate and implement the use of personal protective equipment and lead equivalent glass viewing window, and to evaluate chest X-Ray exposure behind the protective equipment.

Treatment of carbapenemase‐producing Enterobacterales bloodstream infections in solid organ transplant recipients is challenging. The objective of this study was to develop a specific score to predict mortality in solid organ transplant recipients with carbapenemase‐producing Enterobacterales bloodstream infections. A multinational, retrospective (2004‐2016) cohort study (INCREMENT‐SOT, ClinicalTrials.gov NCT02852902) was performed. The main outcome variable was 30‐day all‐cause mortality. The INCREMENT‐SOT‐CPE score was developed using logistic regression. The global cohort included 216 patients. The final logistic regression model included the following variables: INCREMENT‐CPE mortality score ≥8 (8 points), no source control (3 points), inappropriate empirical therapy (2 points), cytomegalovirus disease (7 points), lymphopenia (4 points), and the interaction between INCREMENT‐CPE score ≥8 and CMV disease (minus 7 points). This score showed an area under the receiver operating characteristic curve of 0.82 (95% confidence interval [CI] 0.76‐0.88) and classified patients into 3 strata: 0‐7 (low mortality), 8‐11 (high mortality), and 12‐17 (very‐high mortality). We performed a stratified analysis of the effect of monotherapy vs combination therapy among 165 patients who received appropriate therapy. Monotherapy was associated with higher mortality only in the very‐high (adjusted hazard ratio [HR] 2.82, 95% CI 1.13‐7.06, P = .03) and high (HR 9.93, 95% CI 2.08‐47.40, P = .004) mortality risk strata. A score‐based algorithm is provided for therapy guidance., This work was supported by Plan Nacional de I+D+i 2013‐2016 and Instituto de Salud Carlos III, Subdirección General de Redes y Centros de Investigación Cooperativa, Ministerio de Ciencia, Innovación y Universidades, Spanish Network for Research in Infectious Diseases [REIPI RD16/0016/0008; RD16/0016/0001, RD16/0016/0002, RD16/0016/00010] ‐ co‐financed by European Development Regional Fund “A way to achieve Europe”, Operative program Intelligent Growth 2014‐2020; ESCMID Study Group for Infections in Compromised Hosts [ESGICH grant to JMA]; Sociedad Andaluza de Trasplante de Órgano Sólido [SATOT grant to LMM]; ESCMID Study Group for Bloodstream Infections and Sepsis (ESGBIS); and ESCMID Study Group for Antimicrobial Resistance Surveillance (ESGARS).

Infill walls are commonly used in RC frame structures but are neglected in the structural analysis. It is well known that infill walls could have a significant effect on the structural performance of RC frames under seismic actions, as recently occurred in Italy during the L’Aquila event; furthermore, in many cases, the damage to infill walls is due to out-of-plane actions that can pose a risk to human life (falling of heavy parts). The current paper addresses the behavior of out-of-plane infill walls by conducting parametric linear dynamic time-history analyses. The scope of the parametric study is to evaluate the seismic demand of out-of-plane infill walls by considering the variation of the walls’ properties and the position in the building. Finally, the code provisions for evaluating the seismic action on the infill walls by equivalent static forces are examined and compared with the analytical results from the detailed dynamic analysis.

Autonomous Weapon Systems (AWS) can be defined as weapons systems equipped with Artificial Intelligence (AI). They are an emerging technology and are increasingly deployed on the battlefield. In the societal debate on Autonomous Weapon Systems, the concept of Meaningful Human Control (MHC) is often mentioned as requirement, but MHC will not suffice as requirement to minimize unintended consequences of Autonomous Weapon Systems, because the definition of ‘control’ implies that one has the power to influence or direct the course of events or the ability to manage a machine. The characteristics autonomy, interactivity and adaptability of AI in Autonomous Weapon Systems inherently imply that control in strict sense is not possible. Therefore, a different approach is needed to minimize unintended consequences of AWS. Several scholars are describing the concept of Human Oversight in Autonomous Weapon Systems and AI in general. Just recently Taddeo and Floridi (2018) describe that human oversight procedures are necessary to minimize unintended consequences and to compensate unfair impacts of AI. In my PhD project, I will analyse the concepts that are needed to define, model, evaluate and ensure human oversight in Autonomous Weapons and design a technical architecture to implement this.

Objective: To gain information on safety of drugs used in pediatrics through a 4-year post-marketing active pharmacovigilance program. The program sampled the Italian population and was termed 'Monitoring of the Adverse Effects in Pediatric population' (MEAP).Research design and methods: Adverse drug reactions (ADRs) were collected for individuals aged 0-17 years treated in hospitals and territorial health services in Lombardy, Tuscany, Apulia and Campania; located to gain an appropriate sampling of the population. ADRs were evaluated using the Adverse Drug Reaction Probability Scale (Naranjo) and analyzed with respect to time, age, sex, category of ADR, seriousness, suspected medicines, type of reporter and off-label use.Results: We collected and analyzed reports from 3539 ADRs. Vaccines, antineoplastic and psychotropic drugs were the most frequently pharmacotherapeutic subgroups involved. Seventeen percent of reported ADRs were serious; of them fever, vomiting and angioedema were the most frequently reported. Eight percent of ADRs were associated with off-label use, and 10% were unknown ADRs. Analysis of these revealed possible strategies of therapy optimization.Conclusions: The MEAP project demonstrated that active post-marketing pharmacovigilance programs are a valid strategy to increase awareness on pediatric pharmacology, reduce underreporting and provide information on drug actions in pediatrics. This information enhances drug therapy optimization in the pediatric patients. © Informa UK, Ltd.

Background To investigate the effects of chronic administration of ranolazine (RAN) on experimental model of heart failure with preserved ejection fraction. Methods Seven-weeks old Dahl salt-sensitive rats were fed a high salt diet for 5weeks to induce hypertension. Afterwards, rats continued with a high salt diet and were administered either with vehicle or RAN (20mg/kg/die, ip) for the following 8weeks. Control rats were maintained on a low salt diet. Results While systolic parameters were not altered, diastolic parameters were changed in high salt animals. Hemodynamic analysis showed a decreased dP/dt min, increased LVEDP, longer time constant and steeper slope of the end-diastolic pressure–volume relationship. Treatment with RAN attenuated these alterations and determined a reduction in mortality. Additionally, the magnitude of myocardial hypertrophy and activation of PI3K/Akt pathway were reduced. Alteration in diastolic compliance as a consequence of elevated myocardial stiffness was confirmed by an increase of collagen deposition and activation of pro-fibrotic TGF-β/SMAD3/CTGF signaling. These effects were counteracted by RAN. High salt rats had a decrease in SERCA2 and an increase in Na + /Ca 2+ exchanger (NCX). Treatment with RAN reduced NCX expression and determined an increment of SERCA2. Moreover, the levels of nitrotyrosine and oxidized dyhydroethidium were higher in high salt rats. RAN induced a decrement of oxidative stress, supporting the concept that reduction in ROS may mediate beneficial effects. Conclusions Our findings support the possibility that diastolic dysfunction can be attenuated by RAN, indicating its ability to affect active relaxation and passive diastolic compliance.

FERMI is a seeded free-electron laser (FEL) facility located at the Elettra laboratory in Trieste, Italy, and is now in user operation with its first FEL line, FEL-1, covering the wavelength range between 100 and 20 nm. The second FEL line, FEL-2, a high-gain harmonic generation double-stage cascade covering the wavelength range 20–4 nm, has also completed commissioning and the first user call has been recently opened. An overview of the typical operating modes of the facility is presented.

BACKGROUND: The cardiovascular effects of adding once-weekly treatment with exenatide to usual care in patients with type 2 diabetes are unknown. METHODS: We randomly assigned patients with type 2 diabetes, with or without previous cardiovascular disease, to receive subcutaneous injections of extended-release exenatide at a dose of 2 mg or matching placebo once weekly. The primary composite outcome was the first occurrence of death from cardiovascular causes, nonfatal myocardial infarction, or nonfatal stroke. The coprimary hypotheses were that exenatide, administered once weekly, would be noninferior to placebo with respect to safety and superior to placebo with respect to efficacy. RESULTS: In all, 14,752 patients (of whom 10,782 [73.1%] had previous cardiovascular disease) were followed for a median of 3.2 years (interquartile range, 2.2 to 4.4). A primary composite outcome event occurred in 839 of 7356 patients (11.4%; 3.7 events per 100 person-years) in the exenatide group and in 905 of 7396 patients (12.2%; 4.0 events per 100 person-years) in the placebo group (hazard ratio, 0.91; 95% confidence interval [CI], 0.83 to 1.00), with the intention-to-treat analysis indicating that exenatide, administered once weekly, was noninferior to placebo with respect to safety (P

This document is issued by the Italian Society of Clinical Biochemistry and Clinical Molecular Biology (SIBioC) and a number of other National Scientific Societies and Associations in order to promote a coordinated plan for implementing the standardization of glycated hemoglobin (HbA1c) measurement in Italy according to the recommendations by the International Federation of Clinical Chemistry and Laboratory Medicine (IFCC). Changes in reporting HbA1c results, new units, how to relate old and new units, a timeline for changes and definition of the analytical goals are the main issues discussed. Clin Chem Lab Med 2010;48:623–6.

The accounting systems of all levels of government in Europe have undergone substantial changes during the last 20 years, which have not always been communicated outside country boundaries in a timely manner. This book addresses that shortcoming. With contributions by 25 leading researchers, it discusses in detail the governmental accounting status quo in 14 European countries. The book presents in a concise, thorough and comprehensive way the public sector accounting, budgeting and auditing systems at all levels of government, followed by a comparative analysis of the governmental accounting systems discussed. It also sheds light on the challenges that are likely to be faced by European countries as they move towards adopting the European Public Sector Accounting Standards (EPSAS), and offers a valuable reference resource for academics, researchers, students, auditors, public administrators and policy makers.

The ARGO-YBJ experiment is designed for the detection of Extensive Air Showers (EAS) in the primary energy range 100 GeV–10 TeV. Its full-coverage feature allows to lower the energy threshold about one order of magnitude with respect to sampling EAS detectors. Here the performance of the RPC array is described and the current status of the experiment is presented.

Minimally invasive surgery has recently been improved by the use of robot-assisted procedures in several medical fields. Among the ocular surgeries there are a few examples of sophisticated vitreoretinal procedures, while robotic-assisted surgery of the anterior eye segment is still under study. In this paper we propose a new approach to the robotic assisted ocular surgery: a CO2 laser system is equipped with a micromanipulator and scanner, and it is proposed to induce photothermal effects for the removal of neoformations. A sensorized tool is connected to the patient eye and to the robotic arm. This tool is equipped with force and position sensors: by the use of the spatial information from the robotic console and from the patient it is possible to control the position of the target itself and to block it in the correct position for performing surgery. The system is provided by a feedback alarm that remove the block of the patient head in any moment. The optimized robotic consolle can be used in performing scleral cuts and in the treatment of pterigium or neoformations.

We assessed the prognostic value of minimal residual disease (MRD) within the ML17638 phase 3 trial from the Fondazione Italiana Linfomi, investigating the role of rituximab maintenance in elderly follicular lymphoma (FL) patients after a brief first-line chemoimmunotherapy. MRD for the bcl-2/IgH translocation was determined on bone marrow cells in a centralized laboratory belonging to the Euro-MRD consortium, using qualitative and quantitative polymerase chain reactions (PCRs). Of 234 enrolled patients, 227 (97%) were screened at diagnosis. A molecular marker (MM) was found in 51%. Patients with an MM were monitored at 8 subsequent times. Of the 675 expected follow-up samples, 83% were analyzed. Conversion to PCR negativity predicted better progression-free survival (PFS) at all post-treatment times (eg, end of therapy: 3-year PFS, 72% vs 39%; P < .007). MRD was predictive in both maintenance (83% vs 60%; P < .007) and observation (71% vs 50%; P < .001) groups. PCR positivity at the end of induction was an independent adverse predictor (hazard ratio, 3.1; 95% confidence interval, 1.36-7.07). MRD is a powerful independent outcome predictor in FL patients who receive rituximab-intensive programs, suggesting a need to investigate its value for decision-making. This trial was registered at www.clinicaltrial.gov as #NCT01144364.

This study aimed to evaluate the diagnostic possibilities of MR arthrography in the correct identification of complex tears of the biceps pulley and their possible correlation with anterosuperior impingement (ASI) development. MR arthrography examinations of 23 athletes with clinical suspicion of ASI were reviewed. All examinations were obtained with a 1.5-T unit (Signa Horizon, GE Healthcare). The shoulders were studied with a dedicated surface coil with the patient’s arm in the neutral position and in internal and external rotation. In five patients, images in abduction-external rotation (ABER) were obtained. Within 2 month after MR arthrography, the athletes underwent arthroscopic surgery. MR arthrography images showed a spectrum of tears that, according to the Habermeyer classification, were subdivided into four groups: type 1 in three patients; type 2 in five; type 3 in seven; type 4 in eight. At arthroscopic evaluation, one patient presented type 1 lesion, five type 2, five type 3 and ten type 4. During arthroscopic dynamic manoeuvres, ASI signs were observed in three patients with type 3 lesion and in ten with type 4 lesion. MR arthrography is the imaging modality of choice for evaluating lesions of the rotator interval structures, and only complex lesions of the biceps pulley are related to the development of ASI.

This multicentre, double-blind study compared (100 mg) sumatriptan administered orally with placebo in treating an acute attack of migraine; 238 patients were studied over a 48-h period. Four hours after treatment, 92 of the 142 evaluable sumatriptan patients (65%) showed significant reductions ( P < 0.001) in headache severity, clinical disability and accompanying symptoms compared with 32 of the 80 evaluable placebo-treated patients (40%). The duration of attack prior to taking medication and the history of persistent migraine do not influence the observed difference between the two treatment regimens (sumatriptan and placebo), which remained statistically significant ( P < 0.001) in both cases. The incidence of headache recurrence in patients who experienced relief 4 h after initial treatment was low, occurring in 16 (17%) and 4 (13%) of the sumatriptan- and placebo-treated patients, respectively. Only patients with a history of migraine attacks lasting longer than 24 h suffered headache recurrences, and these recurrences were not consistent with the International Headache Society definition of migraine. Treatment with sumatriptan was well tolerated.

Objective. To describe the activities carried out by the staff of Italian ICUs and to quantify the amount of working time devoted to ICU patients. Design and setting. Prospective, observational, multicenter study in 110 ICUs to report the non-ICU-related activities performed by ICU staff, together with the time such activities require. Of the 110 ICUs 80 participated in the project. Measurements and results. We found substantial variation in the number of activities carried out and in the working time allocated to such activities. Considering the differences in the number of employees, their salaries, and the amount of time spent performing various activities, it was found that the personnel cost for ICU activity was 83.4% (range 55–100%) of the total personnel costs. Conclusions. Given the wide variation in the number of activities performed and in the proportion of working time spent performing non-ICU related activities, data comparing costs between different ICUs should be interpreted with caution.

Introducción: La Gastrectomía Vertical ha reemplazado a la banda gástrica en el manejo de un importante número de pacientes portadores de obesidad. El objetivo de este trabajo es mostrar los resultados de una serie de pacientes, en los que se realizó una Gastrectomía Vertical posterior a la extracción de una banda gástrica en un mismo tiempo operatorio. Método: La serie incluye a 10 pacientes operados entre Mayo de 2008 y Noviembre de 2009. La principal indicación de la Gastrectomía Vertical fue el fracaso de la banda como tratamiento de la obesidad. Resultados: En los 10 pacientes estudiados, la gastrectomía se pudo efectuar sin mayores dificultades ni diferencias con respecto al procedimiento habitual. No existieron complicaciones post operatorias, siendo la totalidad de los pacientes dados de alta dentro de las 72 horas. Conclusión: La Gastrectomía Vertical representa una alternativa de manejo en pacientes portadores de una banda gástrica con indicación de extracción de esta, ya sea por fracaso o por síntomas asociados a su presencia. El procedimiento puede efectuarse de manera segura en el mismo acto operatorio y sus resultados son comparables a los observados cuando la técnica se efectúa en pacientes que no han sido intervenidos previamente.

Background: We describe the development and clinical validation of a patient self-administered tool assessing the quality of multiple sclerosis diagnosis disclosure. Method: A multiple sclerosis expert panel generated questionnaire items from the Doctor’s Interpersonal Skills Questionnaire, literature review, and interviews with neurology inpatients. The resulting 19-item Comunicazione medico-paziente nella Sclerosi Multipla (COSM) was pilot tested/debriefed on seven patients with multiple sclerosis and administered to 80 patients newly diagnosed with multiple sclerosis. The resulting revised 20-item version (COSM-R) was debriefed on five patients with multiple sclerosis, field tested/debriefed on multiple sclerosis patients, and field tested on 105 patients newly diagnosed with multiple sclerosis participating in a clinical trial on an information aid. The hypothesized monofactorial structure of COSM-R section 2 was tested on the latter two groups. Results: The questionnaire was well accepted. Scaling assumptions were satisfactory in terms of score distributions, item—total correlations and internal consistency. Factor analysis confirmed section 2’s monofactorial structure, which was also test—retest reliable (intraclass correlation coefficient [ICC] 0.73; 95% CI 0.54—0.85). Section 1 had only fair test—retest reliability (ICC 0.45; 95% CI 0.12—0.69), and three items had 8—21% missed responses. Conclusions: COSM-R is a brief, easy-to-interpret MS-specific questionnaire for use as a health care indicator.

Background: Autoimmune pancreatitis is a special form of chronic pancreatitis, more common in men and usually presenting as obstructive jaundice or abdominal pain. It may be associated with other immunological disorders and sometimes it is possible to find positive serological markers. Typical images show pancreatic enlargement with focal or diffuse stenosis of the pancreatic duct but sometimes it presents as a focal pancreatic mass that is difficult to differentiate from pancreatic carcinoma. Aim: To report ten cases of autoimmune pancreatitis. Material and Methods: Retrospective review of clinical records of 10 patients aged 26 to 56 years (six males) with autoimmune pancreatitis. Results: The clinical presentation was obstructive jaundice in six cases, acute pancreatitis in two, persistent increase in serum amylase and Upase in one, and permanent abdominal pain and weight loss in one. On imaging studies, a circumscribed mass was founded in six patients. An endoscopic retrograde colangiopancreatography was performed in four patients showing an abnormal pancreatic duct in all. Six patients were operated and tissue for pathological study was obtained in five, showing inflammatory infiltration. Vive patients were treated with steroids with a good clinical response. Conclusions: Autoimmune pancreatitis must be borne in mind in the differential diagnosis of pancreatic lesions.

The importance of donor-recipient human leukocyte antigen (HLA)-DPB1 matching for the clinical outcome of unrelated hematopoietic stem cell transplantation (HSCT) is controversial. We have previously described an algorithm for nonpermissive HLA-DPB1 disparities involving HLA-DPB1*0901,*1001,*1701,*0301,*1401,*4501, based on T-cell alloreactivity patterns. By revisiting the immunogenicity of HLA-DPB1*02, a modified algorithm was developed and retrospectively tested in 621 unrelated HSCTs facilitated through the Italian Registry for onco-hematologic adult patients. The modified algorithm proved to be markedly more predictive of outcome than the original one, with significantly higher KaplanMeier probabilities of 2-year survival in permissive compared with nonpermissive transplantations (55% vs 39%, P = .005). This was the result of increased adjusted hazards of nonrelapse mortality (hazard ratio [HR] = 1.74; confidence interval [CI], 1.19-2.53; P = .004) but not of relapse (HR = 1.02; CI, 0.73-1.42; P = .92). The increase in the hazards of overall mortality by nonpermissive HLA-DPB1 disparity was similar in 10 of 10 (HR = 2.12; CI, 1.23-3.64; P = .006) and 9 of 10 allele-matched transplantations (HR = 2.21; CI, 1.28-3.80; P = .004), both in early-stage and in advanced-stage disease. These data call for revisiting current HLA matching strategies for unrelated HSCT, suggesting that searches should be directed up-front toward identification of HLA-DPB1 permissive, 10 of 10 or 9 of 10 matched donors. (Blood. 2009; 114:1437-1444) RI Porfirio, Berardino/I-1988-2012

Sinus venous atrial septal defects are commonly associated with abnormal pulmonary venous connection. Numerous surgical techniques have been proposed with excellent short- and long-term outcomes. Pulmonary and superior vena cava obstructions, as well as rhythm disturbances, are the most common problems seen during follow up. However, acute postoperative superior vena cava obstruction with successful percutaneous covered-stent implantation has not been reported in the literature. The objective of this study is to report a unique case of acute obstruction of the superior vena cava on the first postoperative day after sinus venous atrial septal defect repair in an infant who was successfully relieved by a percutaneous angioplasty with covered-stent implantation, and the midterm follow up after this intervention.

We study a model in which a group of agents make a sequence of collective decisions on whether to remain in the current state of the system or switch to an alternative state, as proposed by one of them. Examples for instantiations of this model include the step-wise refinement of a bill of law by means of amendments to be voted on, as well as resource allocation problems, where agents successively alter the current allocation by means of a sequence of deals. We specifically focus on cases where the majority rule is used to make each of the collective decisions, as well as variations of the majority rule where different quotas need to be met to get a proposal accepted. In addition, we allow for cases in which the same proposal may be made more than once. As this can lead to infinite sequences, we investigate the effects of introducing a deadline bounding the number of proposals that can be made. We use both analytical and experimental means to characterise situations in which we can expect to see a convergence effect, in the sense that the expected payoff of each agent will become independent from the initial state of the system, as long as the deadline is chosen large enough.

Histiocytic necrotizing lymphadenitis (HNL), also known as Kikuchi 5 disease is a rare condition of unknown etiology. Patients present with cervical lymph node enlargement, fever and malaise. The diagnosis is made by excision biopsy. However, this entity must be distinguished from both reactive processes and malignant tumors such as lymphoma. The clinical course is self limited with spontaneous resolution within a few months. We report three patients with the disease. A 37 year-old woman with a 4 months history of a painless submaxillary mass of 2.5 cm diameter, attached to the deep tissues of the neck. The mass was excised and the biopsy report was HNL. After 26 months of follow up, the patient is asymptomatic. A 30 year-old woman with a history of 2 months of a painless lateral cervical mass and aspiration biopsy was reported as suspicious for lymphoma. An excision biopsy was performed, that was reported as HNL. In both patients, lymphoma was ruled out by immunohistochemistry. A 33 year-old woman with a 3 weeks history of an asymptomatic lateral cervical mass. Biopsy was reported as HNL. This condition must be included in the differential diagnosis of cervical asymptomatic masses. The clinician must be aware of it to avoid long-term, costly treatments

Publisher Summary This chapter describes constraint-based scheduling as the discipline that studies how to solve scheduling problems by using constraint programming (CP). Constraint-based planning in turn is the discipline that studies how to solve planning problems by CP. The chapter discusses that constraint-based scheduling is one of the most successful application areas of CP. One of the key factors of this success lies in the fact that a combination was found of the best of two fields of research that pay attention to scheduling—namely, operations research (OR) and artificial intelligence (AI). The chapter reviews that OR approach aims at achieving a high level of efficiency in its algorithms whereas AI research tends to investigate more general scheduling models and tries to solve the problems by using general problem-solving paradigms. The use of CP in planning is because of the problem complexity, which is less mature than its use in scheduling. Constraint-based planning thus follows the same pattern as constraint-based scheduling where CP is used as a framework for integrating efficient special purpose algorithms into a flexible and expressive paradigm. It also presents CP models for scheduling together with descriptions of propagation techniques for constraints used in these models.

Background: Postoperative hypocalcemia is one of the most common complications of thyroid surgery. It is related to the type of disease (malignant or benign), the number of identified parathyroid glands during the surgical procedure, and the surgeon's experience. Total thyroidectomy is the procedure of choice in our hospital for benign and malignant thyroid disease, but it can increase the incidence of complications. Aim: To evaluate the incidence of postoperative hypocalcemia in patients subjected to a total thyroidectomy. Material and methods: Two studies were performed. A retrospective review of medical records of 448 patients subjected to total thyroidectomy, looking for serum calcium levels of less than 8 mg/dl and clinical signs of hypocalcemia. In a second study, 45 patients were followed with measurements of preoperative and postoperative serum calcium levels. Results: In the retrospective study, only 136 records had reliable information. Clinical signs of hypocalcemia were registered in 14% of patients and a low serum calcium level was detected in 50%. In the prospective study, 42% of patients had a postoperative low serum calcium level and seven patients (15%) had symptoms. Patients were handled with oral calcium and calcitriol in some cases. Ninety nine percent of patients had normal serum calcium levels two moths after surgery. Conclusions: In this series, the rate of postoperative hypocalcemia after total thyroidectomy is similar to internaitonal reports

This paper describes the design activity for the digital baseband processing of a prototype receiver for the Galileo system. According to the applied hardware-software partitioning, the high rate elaborations have been implemented on a dedicated hardware, a Xilinx Virtex2 FPGA, while the remaining low rate processing has been programmed on an analog device DSP. A customarily designed prototype board has been used to validate the receiver under real working conditions: a dynamic GPS and Galileo scenario. Particularly, the paper focuses on the receiver digital channel, which is the critical core of the FPGA, from VHDL modeling to hardware implementation and testing

The authors reviewed pelvic radiographs of 891 dogs in a retrospective study, to determine the incidence of Unilateral Canine Hip Dysplasia (UCHD). Results show that 149 (16.7%) dogs had UCHD. Comparing dogs affected uni- and bilaterally, results show a maximum of 37.6% with UCHD in dogs less than 12 month old, 22.8% in dogs between 12-24 months of age, 25.5% in dogs between 25-72 months and 14.1% in dogs older than 73 months.

The prevalence of asthma and allergic rhinitis has increased worldwide during the 1970s and 1980s.This study was aimed at evaluating whether the increasing trend in prevalence persisted during the 1990s in the young adult Italian population.In 1998 to 2000 a screening questionnaire was sent by mail to a general population sample aged 20 to 44 years; nonresponders were contacted again first by mail and then by phone, achieving a final response rate of 78.1% (6876 of 8800). Prevalence estimates, adjusted to correct for nonresponse bias, were compared with those recorded in Italy in 1991 to 1993 during the European Community Respiratory Health Survey, when response rate had been slightly higher (87.6%). Temporal variations in symptom prevalence were analyzed by a logistic regression model, controlling for sex, age, site of residence (urban vs suburban areas), season of response, response rate, and type of contact (mail vs phone).The prevalence of asthma attacks did not vary significantly from 1991 to 1993 (3.6%) to 1998 to 2000 (3.2%) (P =.188). The prevalence of asthma-like symptoms (wheezing, chest tightness, shortness of breath) tended to decrease in the age classes of 32.5 to 45 years, while increasing in the youngest age class (20 to 26 years). A clear-cut increase from 15.4% to 18.3% was observed for the prevalence of allergic rhinitis (P.001), whereas the proportion of people under antiasthmatic treatment increased in suburban areas but not in urban areas (interaction time-site of residence, P.001).Asthma prevalence has not increased during the last decade in Italy. The persistence of an increasing trend in allergic rhinitis prevalence deserves attention.

We report two males and one female, aged 71, 81 and 73 years old respectively, previously operated of a renal cell carcinoma. During the follow up of the 71 years old male, the CAT scan showed three lesions in the pancreas. Also, the CAT scan in the female showed one lesion in the tail of the pancreas. The 81 years old male was admitted to the emergency room due to a upper gastrointestinal bleeding. Endoscopy showed a proliferating lesion in the second portion of the duodenum whose biopsy showed a clear cell carcinoma. The CAT scan showed also a tumoral mass in the head of the pancreas. All three patients were subjected to surgical resection of the tumors without postoperative complications or mortality (Rev Med Chile 2001; 129: 86-90).

We report a 52 year old man with a pancreatic pseudocyst, that was admitted with severe abdominal pain, severe vomiting, fever and malaise. The clinical picture was considered secondary to a pseudocyst infection and the patient was operated, draining the infected cyst performing a necrosectomy and pancreatocystojejunostomy. Forty eight hours after the operation, an ostomy bleeding was detected. A upper mesenteric artery angiography showed two pseudoaneurysms in the gastroduodenal artery, that were embolized. Bleeding stopped initially, but seven days later, it reappeard. The patient was subjected to an emergency pancreatoduodenectomy. Postoperative evolution was uneventful and the patient was discharged two weeks later. Spontaneous bleeding of pseudoaneurysms secondary to chronic pancreatitis is a complication with a 15 to 40% mortality that must be bore in mind (Rev Méd Chile 2001; 129: 81-85).

Background: Malignant hepatic tumors (Mht) are rare in children. Among them hepatoblastoma (HB) is the most common. Aim: To report the results of the multidisciplinary management in 6 consecutive children: five HB and one metastatic Wilms tumor (MWT). Patients and methods: The mean age of patients was 42 months. All HB patients had elevated serum alfafetoprotein (median 150,000 ng/ml). All patients received preoperative chemotherapy: HB patients received carboplatin/doxorrubicin alternating with cisplatin, and the MWT patient, vincristine alone. Surgery included two formal right and two formal left hepatectomies, one extensive central resection with partial left segmentectomy, and one lateral segmentectomy. Extracorporeal circulation was used in the child with atrial involvement. All patients received postoperative chemotherapy. Results: All tumors had variable regresion on preoperative chemotherapy. Complete resection with negative margins was achieved in all patients. The degree of tumor necrosis on histology ranged from 60% to 90%. Alfafetoprotein levels fell to under 10 ng/ml in all HB cases, one to three months after surgery. All patients survive free of disease at a median follow up of 19 months. Conclusion: A multidisciplinary approach including the well timed used of chemotherapy and surgery is highly effective in the management of pediatric malignant tumors.

For about two and a half years, since Gupta’s 1975 paper on the use of lithium in the Felty syndrome, we have made lithium therapy a part of our oncolytic regimes (Gupta et al., 1975). Incidentally, our first case was in fact a patient with the Felty syndrome and failed to respond, possibly because of poor patient compliance.

Penile and scrotal skin avulsion, an uncommon but not rare event, occurs mainly in machine accidents. According to the authors' experience, reconstruction should be undertaken immediately; penile skin covering is made by free graft and the scrotum is reconstructed by flaps rotated from the thighs. A case is presented, with a ten-year follow-up, in which such reconstruction was performed.

Monocyte-to-macrophage transformation is a phenomenon which correlates with the absolute number of mononuclear cells, principally lymphocytes, contained in the culture. The addition of cimetidine to cultures of mononuclear cells from the peripheral blood of healthy volunteers enhances monocyte transformation (probably by way of blocking the H2 receptors of suppressors T lymphocytes) regardless of the absolute number of monocytes in the culture or of basal transformation rates. Removal of the lymphocytes from the cultures lowers the basal transformation rate and prevents the effect of cimetidine. The addition of histamine to the cultures causes significant depression of the monocyte transformation rate; this effect is partly offset by the concurrent addition of cimetidine. In the case of cancer patients, mononuclear cell cultures from peripheral blood fail to respond to cimetidine even though basal transformation rates are not significantly different from those of healthy controls; this suggests some intrinsic impairment of monocyte function, possibly mediated by blocking factors produced by the tumor.

The paper reviews the network architecture and the structure of the network components in the PeterPan project, and presents the main results of the project field trials. The PeterPan (Provision of an enhanced transport by exploiting reservation in IP and ATM networks) project was included in the ACTS research program of the European Union, and had the main objectives of defining, developing and experimenting a functional architecture suitable for an efficient support of quality of service (QoS) for real time multimedia applications.

Forty-three patients were entered in an uncontrolled study designed to evaluate extracorporeal membrane lung support in severe acute respiratory failure of parenchymal origin. Most of the metabolic carbon dioxide production was cleared through a low-flow venovenous bypass. To avoid lung injury from conventional mechanical ventilation, the lungs were kept "at rest" (three to five breaths per minute) at a low peak airway pressure of 35 to 45 cm H2O (3.4 to 4.4 kPa). The entry criteria were based on gas exchange under standard ventilatory conditions (expected mortality rate, >90%). Lung function improved in thirty-one patients (72.8%), and 21 patients (48.8%) eventually survived. The mean time on bypass for the survivors was 5.4 ± 3.5 days. Improvement in lung function, when present, always occurred within 48 hours. Blood loss averaged 1800±850 mL/d. No major technical accidents occurred in more than 8000 hours of perfusion. Extracorporeal carbon dioxide removal with low-frequency ventilation proved a safe technique, and we suggest it as a valuable tool and an alternative to treating severe acute respiratory failure by conventional means. (JAMA1986;256:881-886)

Participatory budgeting (PB) is a relatively novel approach to the allocation of funds which allows ordinary citizens to become directly involved in how local government money is spent. This study identifies and examines the features and drivers of PB that incentivize citizen participation and the co-production of public services. Our analysis takes a fresh approach by setting PB initiatives in an innovative frame combining a paradigm of ‘ideal’ types of PB and their diachronic constituent phases. The results provide insights for both scholars and policy makers on the key features and drivers of citizen participation through PB. © 2021 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.

Introduction Immune checkpoint inhibitors (ICIs) are widely used in the treatment of many cancers as they improve clinical outcomes. However, ICIs have also been associated with the development of immune-related adverse drug reactions (ADRs). Among immune-related ADRs, cardiac immune-related ADRs are rare, but also associated with high mortality rates. Objective The objective of this study was to evaluate the occurrence of cardiac ADRs reported with ICIs in the European spontaneous reporting system. Methods We retrieved individual case safety reports on ICI-induced cardiac ADRs from the website of suspected ADR (www.adrreports.eu) of the European pharmacovigilance database (Eudravigilance). Data were retrieved from the date of marketing authorization of each ICI (ipilimumab, nivolumab, pembrolizumab, atezolizumab, durvalumab, avelumab, and cemiplimab) to 14 March, 2020. The reporting odds ratio and its 95% confidence interval were computed to assess the reporting frequency of cardiac ADRs for each ICI compared to all other ICIs. Results A total of 2478 individual case safety reports with at least one ICI as the suspected drug were retrieved from Eudravigilance, of which 249 (10%) reported more than one ICI. The three most reported ICIs were nivolumab (43.2%), pembrolizumab (32.5%), and the association of nivolumab/ipilimumab (9.4%). A total of 3388 cardiac ADRs were identified. Cardiac ADRs were serious (99.4%) and had a fatal outcome (30.1%). The most reported cardiac events were myocarditis, cardiac failure, atrial fibrillation, pericardial effusion, and myocardial infarction. Nivolumab was reported with a small increased reporting frequency of individual case safety reports with cardiac ADRs compared to all other ICIs (reporting odds ratio 1.09, 95% confidence interval 1.01–1.18). Conclusions Immune checkpoint inhibitor-induced cardiac ADRs were serious and had unfavorable outcomes. In our study, nivolumab was the only ICI with a small increased reporting frequency of individual case safety reports with cardiac ADRs compared to all other ICIs. In this regard, further head-to-head studies are needed. Supplementary Information The online version contains supplementary material available at 10.1007/s40264-021-01086-8.