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Research shows that Italians' religiosity is in constant decline. Religious literacy, individual and collective practice, participation in rituals, faith's transmission and symbols' sharing seem to be following a slow but inexorable downward trend. Catholic communities are being depopulated and churches are emptying out. These phenomena, already emerging in those generations born during the economic boom, seem to have a greater impact on younger generations: the decline of Catholicism as a socio‐cultural phenomenon is characterising our era. Despite those general trends, young generations are not merely abandoning their faith. Even if faith has lost its social function, young Catholics in Italy often cultivate it on an individual level, between the autonomous search for their own spiritual path and the reproduction of forms of high religiosity derived from the family. In some cases, the younger generations show a renewed religiosity, stronger and more secure than that of their parents, which may sometimes involve them in a path of Catholicism's rediscovery. The article presents and discusses results on highly religious young Catholics deriving from empirical research on intergenerational religious transmission in Italian families, which has been conducted through focus groups and in‐depth interviews between 2020 and 2022. [ABSTRACT FROM AUTHOR]

Large-scale slow-moving deep-seated landslides are complex and potentially highly damaging phenomena. The detection of their dynamics in terms of displacement rate distribution is therefore a key point to achieve a better understanding of their behavior and support risk management. Due to their large dimensions, ranging from 1.5 to almost 4 km2, in situ monitoring is generally integrated using satellite and airborne remote sensing techniques. In the framework of the EFRE-FESR SoLoMon project, three test-sites located in the Autonomous Province of Bolzano (Italy) were selected for testing the possibility of retrieving significant slope displacement data from the analysis of multi-temporal airborne optic and light detection and ranging (LiDAR) surveys with digital image correlation (DIC) algorithms such as normalized cross-correlation (NCC) and phase correlation (PC). The test-sites were selected for a number of reasons: they are relevant in terms of hazard and risk; they are representative of different type of slope movements (earth-slides, deep seated gravitational slope Deformation and rockslides), and different rates of displacement (from few cm/years to some m/years); and they have been mapped and monitored with ground-based systems for many years (DIC results can be validated both qualitatively and quantitatively). Specifically, NCC and PC algorithms were applied to high-resolution (5 to 25 cm/px) airborne optic and LiDAR-derived datasets (such as hillshade and slope maps computed from digital terrain models) acquired during the 2019–2021 period. Qualitative and quantitative validation was performed based on periodic GNSS surveys as well as on manual homologous point tracking. The displacement maps highlight that both DIC algorithms succeed in identifying and quantifying slope movements of multi-pixel magnitude in non-densely vegetated areas, while they struggle to quantify displacement patterns in areas characterized by movements of sub-pixel magnitude, especially if densely vegetated. Nonetheless, in all three landslides, they proved to be able to differentiate stable and active parts at the slope scale, thus representing a useful integration of punctual ground-based monitoring systems. [ABSTRACT FROM AUTHOR]

Urban space can be seen as the social field in which the religious diversification of European societies emerges and assumes visibility. In this contexts, minority places of worship can be used at the same time as the marker of the presence - past and/or present - of a specific religious group and a reliable marker of religious diversity, helping assess the state of health of religious pluralism in itself. More than the national level of State-religions relationships, the local milieu of the city contributes in shaping and assessing contemporary forms of religious life. At the same time, cities represent the arena where old and new minorities struggle for space, visibility and recognition. At this level, the right to religious freedom interacts with the right to the city: local public institutions increasingly stand at the forefront in the regulation of religion-driven needs. This contribution presents evidences from research conducted in the city of Turin, a representative case in the Italian scenario on the above-mentioned issues. Based on a comparative case study, it focuses on the different dynamics of symbolical positioning and material placing enacted by four different minorities: Islam, Judaism, Orthodoxy, and Scientology. Drawing on empirical evidences collected over a period of three years, we analyse the actor constellation involved in the regulation of religious diversity in the city, discussing both policy implications and policy transferability guidelines. [ABSTRACT FROM AUTHOR]

The article discusses the prolonged use of the slogan 'acqua della salute' ('water of health') by the Italian mineral water brands 'Uliveto' and 'Rocchetta,' owned by CoGeDi International SpA, despite multiple sanctions totaling €110,000 for misleading advertising. It explores the regulatory framework, past actions by the Italian Advertising Standards Authority and Antitrust Authority, and recent decisions, questioning the effectiveness of measures in curbing the continued use of the slogan.

This work presents the case study of the San Lorenzo road tunnel, a linear infrastructure located in Friuli Venezia Giulia, northern Italy, affected by the so-called Passo della Morte landslide. This slope instability phenomenon has caused several problems since the beginning of the tunnel construction works, like water seepage and concrete lining detachments, increasing the safety risk for road users. Due to these circumstances, numerous studies have been conducted and a monitoring system has been developed since 2014 to control the ongoing situation of the most damaged portions of the road tunnel. Building on the monitoring data, studies and knowledge accumulated over the years, this paper describes the work done to trace back the sum of landslide-induced stresses directly responsible for the current damages on the tunnel. The first steps taken in this direction have included an adequate representation of the crack pattern on the tunnel vault. This has been used both as an initial goal and as a means of validation in the development of a finite element model. From the latter, it will be possible to infer the landslide-induced stress combination mentioned earlier. [ABSTRACT FROM AUTHOR]

Background: Parental stress in neonatal intensive care units (NICU) is well known, as is the stress induced by the COVID-19 pandemic. This combination might increase stress to the extent of affecting the availability of maternal expressed milk and the success of establishing breastfeeding. This is particularly relevant in very preterm infants. Methods: We conducted a single-centre retrospective analysis in two cohorts of very low birth weight infants born in a hospital in Italy. Babies born before the pandemic (September 2017 – December 2019) (n = 101) and during the pandemic (March 2020 – December 2021) (n = 67) were included in the analysis. We compared the rate of babies fed with maternal milk (both expressed and / or donated) at the achievement of full enteral feeding and the rate of those exclusively breastfed at discharge in the two groups. Then, we analysed the impact of donated human milk availability on infant formula use. We also compared mother's need for psychological support during NICU stay and the duration of psychological follow-up after discharge. Results: In our NICU the availability of expressed maternal milk significantly decreased during the COVID-19 pandemic (86.1% before the pandemic vs 44.8% during the pandemic, p < 0.001) at the time of full enteral feeding achievement. Thanks to the availability of donated human milk, the rate of formula-fed babies remained almost unchanged (13.9% vs 14.9%). At discharge, the rate of breastfeeding was similar (73.3% vs 72.7%). The maternal need for psychological support was significantly higher during the pandemic (33% vs 64%, p < 0.001), as well as the duration of follow-up > 6 months (1% vs 15%, p < 0.001). No differences in the main clinical outcomes were found. Conclusion: Pandemic-induced stress had a significant impact on the availability of expressed maternal milk in NICU. However, the presence of human donated milk was fundamental in preventing increased use of infant formula during NICU stays. This underlines how strategies to implement the widespread establishment of donor milk banks on a national level are warranted. Further research is desirable to optimise the use of donated human milk banks during emergency situations. [ABSTRACT FROM AUTHOR]

In mountain areas, anthropic pressure is growing while, concurrently, landslide frequency in most of the mountain regions of the world is increasing due to a more extreme precipitation pattern and permafrost deglaciation. Because of budget constraints, the need to investigate innovative and low-cost countermeasures for landslide risk is becoming more and more pressing. In this context, the Passo della Morte area (North-East Italy) is a perfect benchmark case. It comprises an extensive, long-term database of monitoring data that allows for testing hypotheses and validating them. Based on this data, a strong correlation between the velocity of a displacement of a landslide and the discharge of the Rio Verde stream was found. According to this evidence, local authorities have started the construction of a completely innovative mitigation strategy. It is focused on the triggering factor by identifying a significant component of the flow rate of the stream that cuts through the landslide. In addition, aiming to reduce the cost of construction and maintenance, this mitigation strategy is coupled with a micro-hydropower plant that can provide economic revenue by exploiting the discharge itself to produce electricity. Considering the active monitoring system that will be used to verify the effectiveness of the countermeasure, the Passo della Morte case study could become a starting point for implementing this pioneering and low-cost mitigation solution in similar morphologies. [ABSTRACT FROM AUTHOR]

Cancer and anticancer treatments can lead to several negative side effects, including malnutrition. Despite the recognized need for adequate nutritional support in cancer patients, in daily clinical practice, nutrition is still not considered one of the first aspects to be considered. Malnutrition negatively affects the clinical outcomes, treatment response, and overall survival of cancer patients. In this study, three of the most controversial issues related to malnutrition, which emerged during an Italian Consensus Conference, were addressed specifically for patients with head and neck as well as gastrointestinal cancer. The timing of nutritional evaluation and intervention, extension of the Enhanced Recovery after Surgery (ERAS®) protocols, and cost-effectiveness of nutritional interventions have been considered. This study aimed to illustrate the state-of-the art of each issue and hypothesize future perspectives and actions to be taken, trying to suggest a new nutritional management model for cancer patients in Italy that overcomes the critical issues encountered. Of note, the timely diagnosis of nutritional issue appears to be essential to ensure the correct management of malnourished cancer patients as well as those who are at high risk of malnutrition. Standardized protocols, screening tests, and the inclusion of nutritional parameters in patient medical records would help to achieve good clinical outcomes. Finally, appropriate nutritional support is also associated with cost savings, and it seems necessary to promote its clinical and economic value to obtain improvements in both outcomes and management costs. [ABSTRACT FROM AUTHOR]

Introduction: Several countries imposed nationwide or partial lockdowns to limit the spread of COVID-19 and avoid overwhelming hospitals and intensive care units. Lockdown may involve restriction of movement, stay-at-home orders and self-isolation, which may have dramatic consequences on mental health. Recent studies demonstrated that the negative impact of lockdown restrictions depends on a wide range of psychological and socio-demographic factors. Aims: This longitudinal study aimed to understand how internal factors such as personality and mindfulness traits, and external factors, such as daily habits and house features, affect anxiety, depression and general wellbeing indicators, as well as cognitive functions, during the course of a lockdown. Methods: To address these questions, 96 participants in Italy and the United Kingdom filled out a survey, once a week for 4 weeks, during the first-wave lockdowns. The survey included questions related to their habits and features of the house, as well as validated questionnaires to measure personality traits, mindful attitude and post-traumatic symptoms. Indicators of wellbeing were the affective state, anxiety, stress and psychopathological indices. We also measured the emotional impact of the pandemic on cognitive ability by using two online behavioral tasks [emotional Stroop task (EST) and visual search]. Results: We found that internal factors influenced participants' wellbeing during the first week of the study, while external factors affected participants in the last weeks. In the first week, internal variables such as openness, conscientiousness and being non-judgmental toward one's own thoughts and emotions were positively associated with wellbeing; instead, neuroticism and the tendency to observe and describe one's own thoughts and emotions had detrimental effects on wellbeing. Toward the end of the study, external variables such as watching television and movies, browsing the internet, walking the dog, and having a balcony showed a protective value, while social networking and engaging in video calls predicted lower values of wellbeing. We did not find any effects of wellbeing on cognitive functioning. Conclusion: Recognizing specific traits and habits affecting individuals' wellbeing (in both short and long terms) during social isolation is crucial to identify people at risk of developing psychological distress and help refine current guidelines to alleviate the psychological consequences of prolonged lockdowns. [ABSTRACT FROM AUTHOR]

Although research shows a general decrease in religiosity in Western societies, religious transmission still seems to be a poorly studied phenomenon, especially in Italy. We do not know much about the dynamics of socialisation that take place in the family and the main factors that determine the success or failure of religious transmission from one generation to the next. Yet, the family context represents the first agency of socialisation to religion, from an early age, through experiences with parents, grandparents and relatives. On the other hand, in the age of religious diversification, the migration factor is becoming increasingly crucial for national religious landscapes. Nevertheless, religious transmission in foreign families and the impact of migration on family religiosity are still little studied. This contribution presents some research perspectives that have emerged from a wide-ranging survey, still in progress, on intergenerational transmission of religion in Catholic, Muslim and Orthodox families in Italy. [ABSTRACT FROM AUTHOR]

Objectives: The role of radiotherapy (RT) for oligometastases is currently established in different oncological settings but data on salivary gland cancer (SGC) are lacking. We evaluated the role of RT in oligometastatic SGC patients, focusing on stereotactic body radiation therapy (SBRT). Materials and methods: We performed a retrospective, multicentric study of oligometastatic SGC treated with palliative RT or SBRT. Endpoints included response evaluation and local control (LC). Results: Between 2006 and 2016, 64 patients were collected from 9 Italian Cancer Centers, on behalf of the Italian Association of Radiotherapy and Clinical Oncology (AIRO) Head and Neck Working Group. 37 patients (57.8%) were suffering from adenoid cystic carcinoma (ACC) and 27 patients (42.2%) had non‐ACC. Thirty‐four patients underwent palliative RT (53,1%), and 30 received SBRT (46,9%). Most common metastatic sites were bone for palliative RT and lung for SBRT. Among patients treated with SBRT, an objective response or a stability was observed in all treated lesions. After a median follow‐up of 29.2 months (range 2.3–117.1), LC at 12 months was 57.5% for patients treated with SBRT and was higher in ACC subgroup. Conclusion: We confirmed the potential role of SBRT in the management of oligometastatic SGC patients to control limited burden of disease considering the absence of effective systemic therapies. [ABSTRACT FROM AUTHOR]

Purpose: Telephone coaching and health apps are effective means to support subjects with diabetes. Patient support programs (PSP) on type 2 diabetes are scanty, and none has been conducted in Italy. In a pilot phase, conducted during the COVID-19 pandemic, we aimed to examine the feasibility and acceptance of such program. Methods: The "BE THere for diabetes CARE" (BETHCARE) project is a real-world PSP conducted through telephone and digital coaching system to provide educational and emotional support to Italian adults with diabetes receiving long-acting basal insulin degludec. This pilot phase was conducted in 11 centres that enrolled a total of 63 patients (89% with type-2 diabetes). Counselors contacted patients to define a set of emotional, physical and nutritional targets, and monitoring calls were performed on a monthly basis. Data were collected on socio-demographic and anthropometric characteristics, selected clinical information, quality of life, achievement of targets and patient satisfaction. Results: Fifty-eight subjects (92%) chose to participate by telephone and 5 (8%) by mobile app. Most participants (ie, ≥ 80%) evaluated counselors' calls "useful/very useful", duration of calls "adequate/adequately long", were satisfied with the educational pathway and declared to be more confident in diabetes management after the program. About half of participants were confident to maintain their targets after the PSP. Achievement of nutritional targets improved during counseling, from a mean score of 1.56 at week 1 to 1.88 at week 16 (p-value = 0.03). No significant variations in the achievement of emotional and physical targets emerged. Mean patients weight decreased from 84.9 kg (week 1) to 84.3 kg (week 4) and then levelled off (84.2 kg, week 16). Conclusion: This project demonstrated the feasibility and patient appreciation of a PSP in diabetes care, which is particularly important for a chronic disease of the elderly and during a pandemic period when face-to-face counseling is problematic. [ABSTRACT FROM AUTHOR]

Background: Angiotensin converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) prevent microalbuminuria in normoalbuminuric type 2 diabetic patients. We assessed whether combined therapy with the 2 medications may prevent microalbuminuria better than ACE inhibitor or ARB monotherapy.Methods and Findings: VARIETY was a prospective, randomized, open-label, blinded endpoint (PROBE) trial evaluating whether, at similar blood pressure (BP) control, combined therapy with benazepril (10 mg/day) and valsartan (160 mg/day) would prevent microalbuminuria more effectively than benazepril (20 mg/day) or valsartan (320 mg/day) monotherapy in 612 type 2 diabetic patients with high-normal albuminuria included between July 2007 and April 2013 by the Istituto di Ricerche Farmacologiche Mario Negri IRCCS and 8 diabetology or nephrology units in Italy. Time to progression to microalbuminuria was the primary outcome. Analyses were intention to treat. Baseline characteristics were similar among groups. During a median [interquartile range, IQR] follow-up of 66 [42 to 83] months, 53 patients (27.0%) on combination therapy, 57 (28.1%) on benazepril, and 64 (31.8%) on valsartan reached microalbuminuria. Using an accelerated failure time model, the estimated acceleration factors were 1.410 (95% CI: 0.806 to 2.467, P = 0.229) for benazepril compared to combination therapy, 0.799 (95% CI: 0.422 to 1.514, P = 0.492) for benazepril compared to valsartan, and 1.665 (95% CI: 1.007 to 2.746, P = 0.047) for valsartan compared to combination therapy. Between-group differences in estimated acceleration factors were nonsignificant after adjustment for predefined confounders. BP control was similar across groups. All treatments were safe and tolerated well, with a slight excess of hyperkalemia and hypotension in the combination therapy group. The main study limitation was the lower than expected albuminuria at inclusion.Conclusions: Risk/benefit profile of study treatments was similar. Dual renin-angiotensin system (RAS) blockade is not recommended as compared to benazepril or valsartan monotherapy for prevention of microalbuminuria in normoalbuminuric type 2 diabetic patients.Trial Registration: EudraCT 2006-005954-62; ClinicalTrials.gov NCT00503152. [ABSTRACT FROM AUTHOR]

Background: Despite the prevalence of pain among patients with cancer and the availability of pertinent guidelines, the clinical management of oncological pain is decisively insufficient. To address this issue, we evaluated current trends in clinical practice and subsequently generated a list of ten corrective actions—five things to do and five things not to do—for the diagnosis, management, and monitoring of cancer pain. Methods: The survey included 18 questions about clinical practice surrounding background pain and breakthrough cancer pain (BTcP). Survey questions were developed by a scientific board of 10 physician experts and communicated via email to an expanded panel of physicians in Italy. Responses were tabulated descriptively for analysis. Results: Of 51 invited physicians, 32 (63%) provided complete survey responses. The responses revealed several incongruencies with current guideline recommendations: physicians did not always diagnose or monitor pain using diagnostically validated or disease-specific instruments; frequently based clinical decision-making on time availability or convenience; and pharmacological therapy was often inappropriate (eg, prescribing NSAIDs or corticosteroids for BTcP). The list of corrective actions generated by the scientific board favored a guideline-oriented approach that systematically characterizes oncological pain and implements treatment based on pain characteristics (eg, fast-acting transmucosal opioids for BTcP) and evidence-based recommendations. Conclusion: Oncologists require better education and training about the diagnosis, treatment, and monitoring of oncological pain. Physicians should be aware of current guideline recommendations as well as available pharmacological tools for BTcP. [ABSTRACT FROM AUTHOR]

Objectives: A high rate of thrombotic events has been reported in COVID-19 population. The study aims to assess the incidence of deep vein thrombosis (DVT) in COVID-19 patients admitted to a single tertiary hospital. Methods: From April 2nd to April 18th, 2020, hospitalized patients with SARS-CoV-2 infection were screened by lower limb duplex ultrasound (DUS). Patients were on (low molecular weight heparin) LMWH prophylaxis in medical wards, and on therapeutic anticoagulation in intensive care unit (ICU). DVT risk factors, reported by the Padua prediction score and blood tests, were retrieved from institutional electronic charts. The study primary endpoint was the incidence of DVT in the in-hospital COVID-19 population and its association with clinical and laboratory risk factors. The secondary endpoint was the association of DVT with mortality. Results: Two hundred patients (median age 62 years, 72% male, 40 in ICU) received DUS screening. DVT was observed in 29 patients (14.5%), with proximal extension in 16 patients, and in association with symptoms in four patients. The DVT rate was similar in ICU (12.5%) and non-ICU patients (15%). Eighty-seven patients underwent a computed tomography angiography (CTA) that showed pulmonary embolism in 35 patients (40.2%) not associated with DVT in 25/35 cases (71.4%). DVT in the ten patients with pulmonary embolism were symptomatic in four and with a proximal localization in eight cases. A D-dimer level ≥5 mg/l at admission was predictive of DVT (OR 1.02; IC95% 1.03-1.16; p =.003). At the multivariate analysis in-hospital mortality was predicted by age (OR 1.06; 95% CI 0.02-1.15; p =.004) and by being an ICU patient (OR 1.23; 95% CI 0.30-2.25; p =.01). Conclusions: Despite LMWH prophylaxis or full anticoagulant therapy, the incidence of DVT, mainly asymptomatic, in hospitalized COVID-19 patients was 14.5%. Further research should focus on the appropriate antithrombotic therapy for COVID-19 patients. [ABSTRACT FROM AUTHOR]

Within the wider debate about the future of religion and the secularization processes in Western societies, so far the intergenerational religious transmission has received little attention, especially in Italy. Yet, actually the religious transmission appears to be one of the most crucial factors in the decline of religiosity. Nevertheless, little is known about the dynamics within families, as well as on the influence of friendships, school, leisure, work, critical and turning points that mark people's lives. This contribution discusses some lines of investigation emerging from an ongoing research, now in its explorative phase. The first part of the article depicts and try to assess the relevance of the subject, presents a brief review of national and international literature and describes the methodology used so far. The second part is dedicated to debating some dimensions of analysis that seem to deserve more attention, since thus far little considered, in view of a more precise validation of the hypotheses. [ABSTRACT FROM AUTHOR]

Introduction: Dulaglutide, a long-acting glucagon-like peptide-1 receptor agonist (GLP-1RA), became available in Italy in April 2016. The aim of ANDREW (Active Notes on Dulaglutide in the REal World), a multicenter, prospective, observational study, was to evaluate glycemic control and weight (co-primary outcomes) for up to 24 months in the real-life setting in consecutive outpatients with type 2 diabetes (T2D) who initiated dulaglutide. Co-secondary outcomes were durability of treatment effects on both glycated hemoglobin (HbA1c) and body weight. Methods: Overall, 1584 subjects (696 women, 888 men) with T2D (mean age [± standard deviation] 61.7 ± 10.2 years; mean T2D duration 9.9 ± 6.9 years) were treated with dulaglutide (0.75 or 1.5 mg once weekly) between April 2016 and December 2019. Results: A total of 1130 patients completed 12 months of follow-up, while 170 patients interrupted treatment before the 12-month endpoint. At 12 months, average HbA1c and average fasting plasma glucose (FPG) were significantly lower compared to baseline levels (− 10 mmol/mol and − 24.9 mg/dL, respectively), as were body weight (− 3.4 kg) and waist circumference (− 3.3 cm) values (all p < 0.0001). Among subjects that completed 24 months of follow-up (n = 270), the rapid decline in HbA1c and FPG values in the first 12 months was followed by stabilization in the following 12 months (p value for 12–24 months trend: 0.4 and 0.6, respectively). Conclusions: Dulaglutide is an effective drug for the treatment of T2D that is administered once weekly using a simple auto-injector device. Real-life data confirm the observations in randomized controlled trials that persistent treatment with dulaglutide may help patients with T2D achieve an improvement in some metabolic features and in body weight. It is important that the benefits of therapy with dulaglutide, i.e., the effects of the "glycemic" and the so-called "extra-glycemic" actions of GLP-1RAs, are supported by diabetes care teams emphasizing the need for patients to maintain a healthy lifestyle. [ABSTRACT FROM AUTHOR]

Introduction: Recent guidelines for the treatment of type 2 diabetes mellitus (T2DM) provide evidence supporting limited use of sulphonylureas (SUs), especially in specific risk patient categories, yet data from national registries still suggest their widespread use. The aim of this study was to investigate characteristics of patients with diabetes treated with SUs and quantify the proportion of patients that met the recommendations for use of SUs by recent guidelines and of those presenting characteristics representing an inappropriate prescription risk (IPR). Methods: A multicenter, retrospective, cross-sectional, observational study in patients with T2DM receiving treatment with SUs (as monotherapy or in combination with another diabetes therapy) was conducted between 2017 and 2018 in 22 outpatient diabetes clinics across Italy. Exclusion criteria were type 1 diabetes, diabetes mellitus secondary to other conditions, and presence of severe/life-threatening diseases. Results: A total of 510 patients with T2DM (306 men, 204 women; mean age ± standard deviation 69.8 ± 9.3 years) who were receiving treatment with a SU (as monotherapy or in combination therapy) were assessed in the study. Overall, 70.6% [n = 360; 95% confidence interval (CI) 66.4%, 74.5%] were assessed to have an IPR. Of these, approximately half presented one factor for risk of inappropriate prescription, and 27 and 10.6% presented two and three factors, respectively. In terms of factors contributing to the total burden of risk of inappropriate treatment with SUs, 37.5% (95% CI 33.2%, 41.8%) of all patients were obese; 33.3% (95% CI 29.3%, 37.6%)] were aged ≥ 75 years; 18.6% (95% CI 15.3%, 22.3%) had a history of cardiovascular disease; 14.1% (95% CI 11.2%, 17.4%) had chronic renal insufficiency; 1.8% (95% CI 0.8%, 3.3%) had a history of severe hypoglycemia; 1.8% (95% CI 0.8%; 3.3%) had cognitive impairment; and 2.4% (95% CI 1.2%, 4.1%) had a risky occupation. Conclusions: The results of this study provide evidence of a high rate of inappropriate SU prescription risk among patients with T2DM, especially among those with overweight/obesity, older age, history of cardiovascular disease, and hypoglycemia. [ABSTRACT FROM AUTHOR]

Background: In recurrent and/or metastatic head and neck squamous cell cancer, Cetuximab is administered once a week, followed by weekly doses. We present the clinical rationale of a different schedule of maintenance Cetuximab and we estimate the potential economic benefits on the health care budget from a societal perspective in Italy. Methods: A budget impact (BI) excel‐based model was developed comparing a base case scenario of 100% weekly administration with a dose of 250 mg/m2 to an every‐other‐week (EOW) administration at 50% or 100% with a dose of 500 mg/m2. Results: In the EOW, 50% scenario it was calculated a cost reduction of €347 000 of which 70% attributable to indirect costs, increasing to €694 000 after 4 months. Conclusions: In our analysis, we showed that this simplified schedule could also reduce the costs of treatments both for the health system (direct costs) and for the society (indirect costs). [ABSTRACT FROM AUTHOR]

Purpose: To retrospectively test 2 nomograms recently validated as prognostic tools for patients with oropharyngeal cancer treated with curative radiation-based therapy, in 184 consecutive subjects treated from April 2004 to January 2016.Patient and Methods: Complete information regarding disease, survival status, and nomogram covariates was retrieved for 174 patients, with a median follow-up of 51 months. Calibration of the nomograms was obtained by evaluating the ability to accurately predict the absolute risk level; discriminative ability estimated by the Harrell C statistic was tested by assessing the ability of the nomograms to rank the patients from low risk to high risk.Results: The outcome predicted by the nomograms was worse than observed, especially for progression-free survival. This may be due to several factors: geographic and genetic background, smoking, alcohol use, the different national health system organization, which provides universal and free-of-charge coverage to all individuals, and the setting of treatment in clinical practice, outside of clinical trials.Conclusions: Our results show that the usefulness of nomograms to predict outcome of oropharyngeal cancer may not be generalizable to patients of different countries. Further studies are needed to clarify whether sociodemographic, epidemiologic, and cultural scenarios may seriously affect the prognostic ability of newly developed predictive tools. [ABSTRACT FROM AUTHOR]

Background: Acute/subacute haematogenous osteomyelitis (AHOM/SAHOM) are potentially devastating diseases. Updated information about the epidemiology, management and outcome of AHOM/SAHOM is needed to minimize the risk of complications and sequelae.Methods: A multicenter study was performed to evaluate retrospectively the management and outcome of AHOM/SAHOM in Italy. Data from children aged >1 month, and hospitalized between 2010 and 2016, in 19 pediatric centers, were analyzed.Results: 300 children with AHOM and 98 with SAHOM were included. Median age was 6.0 years (IQR: 2.0-11.0). No clinical difference was observed with the exception of fever at onset (63.0% vs. 42.9%; P < 0.0001), and a more common spinal involvement in SAHOM (6.7% vs 20.4%; P < 0.001). Fifty-Eight Staphylococcus aureus strains were isolated; 5 (8.6%) were MRSA. No Kingella kingae infection was documented. No different risk for complication/sequela was observed between AHOM and SAHOM (38.3% vs. 34.7%; OR:0.85; 95%CI: 0.53-1.38; P = 0.518). Duration and type of antibiotic therapy were not associated with risk of complication/sequelae.Conclusion: AHOM and SAHOM displayed some differences, however occurrence and risk factors for complications and sequelae are similar, and the same empiric treatment might be recommended. [ABSTRACT FROM AUTHOR]

Introduction: The aim of the study was to evaluate whether the reduction in glycated hemoglobin (HbA1c) observed in clinical trials with liraglutide in type 2 diabetes (T2D) could be attained in routine clinical practice.Methods: ReaL was a multicenter, non-interventional, observational, retrospective, longitudinal study on the effectiveness of liraglutide, a human glucagon-like peptide-1 analog, in individuals with T2D treated in daily practice in Italy. Between 26 March and 16 November 2015, data were taken from clinical records of patients aged ≥ 18 years with treatment follow-up data of up to 24 months and who received their first prescription of liraglutide in 2011.Results: A total of 1723 patients were included in the analysis. At baseline, mean age was 58.9 years, duration of diabetes was 9.6 years, and HbA1c was 8.3%. At 12 months, 36.1% of patients were prescribed the maximum 1.8 mg dose; 43.5% [95% confidence interval (CI): 40.9; 46.2] of patients attained the primary outcome of a reduction in HbA1c of ≥ 1% point at 12 months. At 24 months, 40.9% (95% CI 38.1; 43.7) of patients had attained the HbA1c target of ≤ 7%. Additionally, body weight significantly decreased by 3.4 kg (95% CI - 3.6; - 3.1, p < 0.0001).Conclusion: In this observational study conducted in routine clinical practice for up to 2 years, treatment with liraglutide improved HbA1c and reduced body weight in a similar fashion to that observed under randomized clinical trial conditions. The data support the use of liraglutide as an effective treatment for T2D in clinical practice.Funding: Novo Nordisk S.p.A.Trial Registration: ClinicalTrials.gov identifier, NCT02255266. [ABSTRACT FROM AUTHOR]

BACKGROUND: Dairy milking is a demanding work task that has been associated with hand and wrist musculoskeletal disorders. Clinical approaches to identify the early effects of musculoskeletal disorders among dairy parlor workers' wrist have not been well defined. OBJECTIVES: The purpose of this pilot study was to develop a study protocol that would assist in the identification and quantification of hand and wrist disorders among dairy workers that perform tasks in the dairy parlor. Additionally, such a study protocol was needed to perform relatively rapid assessments of the wrist/hand on large samples of dairy workers. METHODS:Fourteen dairy parlorworkers were assessed for i) upper limb symptoms andwork history through questionnaire, ii) a physical examination of the upper limb and in particular wrists and iii) wrist ultrasonography. An additional 21 unexposed paired participants (the control group) also participated in the data collection. RESULTS: The study results identified two ultrasound acoustic windows characterized by the highest predictive value for alteration of the wrist's structure. Study results indicated an impairment of the distal median nerve in structure and mobility and impairment of the distal tendon of the muscle extensor carpi ulnaris that included dislocation and frank damage. CONCLUSIONS: This study identified at least two acoustic windows that should be assessed with ultrasound studies on larger groups and in prospective periodical health surveillance of dairy workers. The study confirmed the wrist was at risk for biomechanical stress among workers conducting milking tasks in the dairy parlors. [ABSTRACT FROM AUTHOR]

Background: Head and neck cancer (HNC) patients can experience symptoms due to the tumor itself or to the treatment, with an impact on health-related quality of life (HRQoL). Patient-reported outcome (PRO) measures pertaining to HRQoL are used in medical research and to support clinical decisions. PRO instrument applicability and cultural adaptation must be tested for each population. The aim of this study is to linguistically validate the Italian translation of the M.D. Anderson Symptom Inventory--Head and Neck Module (MDASI-HN).Methods: Following forward and backward translation of the items of the English MDASI-HN into Italian, it was administered along with a cognitive debriefing to HNC patients able to read and understand Italian language. Individual and group responses are presented using descriptive statistics.Results: From May 2013 through September 2013, 56 patients with HNC (18 during curative treatment, 20 in palliative chemotherapy, and 18 in follow-up period) completed the MDASI-HN followed by accompanying cognitive debriefing. Ninety-nine percent of the individual MDASI-HN items were completed. Average time to complete the MDASI-HN was 8.5 min (range 3-15). Results suggested overall ease of completion, relevance, and comprehensibleness of this translated self-report instrument in this Italian patient population.Conclusions: The Italian version of the MDASI-HN is linguistically valid; future research should explore dimensionality, reliability, and convergent, discriminant, and predictive validity of this patient-reported instrument, in order to use this translated version in outcomes research and clinical settings. [ABSTRACT FROM AUTHOR]

The geomorphological change detection through the comparison of repeated topographic surveys is a recent approach that benefits greatly from the latest developments in topographical data acquisition techniques. Among them, airborne LiDAR makes the monitoring of geomorphological changes a more reliable and accurate approach for natural hazard and risk management. In this study, two LiDAR digital terrain models (DTMs) (2 m resolution) were acquired just before and after a complex 340 000 m3 landslide event (4 November 2010) that generated a debris flow in the channel of the Rotolon catchment (eastern Italian Alps). The analysis of these data was used to set up the initial condition for the application of a dynamic model. The comparison between the pre- and post-event DTMs allowed us to identify erosion and depositional areas and the volume of the landslide. The knowledge of the phenomenon dynamics was the base of a sound back analysis of the event with the 3-D numerical model DAN3D. This particular code was selected for its capability to modify the rheology and the parameters of the moving mass during run-out, as actually observed along the path of the 2010 debris flow. Nowadays some portions of Mt. Rotolon flank are still moving and show signs of detachment. The same soil parameters used in the back-analysis model could be used to simulate the run-out for possible future landslides, allowing us to generate reliable risk scenarios useful for awareness of civil defense and strategy of emergency plans. [ABSTRACT FROM AUTHOR]

This study is one of the first aiming at investigating the mental health in the post-lockdown period in an Italian adult population and detecting demographic and psychological predictors for a worse outcome. 1401 participants answered a web-based survey including the Emotional Reaction Questionnaire (ERQ), the Positive Affect and Negative Affect Scale (PANAS), the Impact of Event Scale-Revised (IES-R), the General Health Questionnaire (GHQ), the Depression, Anxiety and Stress Scale (DASS-21), and the Dutch Work Addiction Scale (DUWAS). Simple slope analyses highlighted that women, lower age, and suppression were related to higher scores for the PANAS negative affect scale, the DASS-21, the IES-R, the GHQ, and the DUWAS. In our sample, 1.2% of participants showed depressive symptoms, 0.5% anxiety symptoms, and 2% stress symptoms. Moreover, 5.4% of participants reported post-traumatic symptoms and 15% signs of psychological distress. Compared with data on the lockdown period, our results show lower levels of depressive, anxiety, and stress symptoms, possibly due to the slackening of preventive measures adopted since June. Despite this, post-traumatic symptoms and signs of psychological distress were still present. Our data suggest the necessity to monitor psychological adaption over time in general and at-risk subjects. • We investigated psychological adaption in the post-lockdown period in Italy. • Cross sectional data showed a relief of psychological distress and symptoms. • A minority of participants showed significant signs of psychological distress. • Gender and age were related to higher risk of psychological distress and symptoms. • Prolonged home-working may contribute to workaholism in women and younger adults. [ABSTRACT FROM AUTHOR]

Purpose. The standard treatment of peritoneal pseudomyxoma is based on cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy (HIPEC). The establishment of newer systemic treatments is an unmet clinical need for unresectable or relapsed peritoneal pseudomyxoma. The aim of our study was to assess the activity of chemotherapy with 5-fluorouracil and oxaliplatin (FOLFOX-4 regimen) in terms of response rate in this subset of patients. Materials and Methods. Patients were included in a singlecenter, observational study and treated with FOLFOX-4 administered every 2 weeks for up to 12 cycles or until progressive disease or unacceptable toxicity. Results. Twenty consecutive patients were reviewed from July 2011 to September 2013. Only partial responses were observed, with an objective response rate of 20%. Median progression-free survival and overall survival were 8 months and 26 months, respectively. Two patients were able to undergo laparotomy with complete cytoreduction and HIPEC in one case. Safety data for FOLFOX-4 were consistent with the literature. By means of a mutant enriched polymerase chain reaction, KRAS mutation was found in 16 of 19 cases (84%), and MGMT promoter methylation was found in 8 (42%, all KRAS mutant). Conclusion. FOLFOX-4 chemotherapy is tolerable and active in patients with peritoneal pseudomyxoma when disease is deemed unresectable or relapsed after peritonectomy and HIPEC.The identification of predictive biomarkers, such as KRAS for resistance to anti-epidermal growth factor receptor monoclonal antibodies and MGMT for response to temozolomide, is a priority for the development of evidence-based treatment strategies for peritoneal pseudomyxoma. The Oncologist 2014;19:845-850 [ABSTRACT FROM AUTHOR]

Purpose: There is a limited number of therapies with a high level of recommendations for mucositis, while several strategies are currently employed with a limited evidence for efficacy. A national survey among Italian oncologists who treat head and neck cancer (HNC) was conducted in order to assess the most common preventive and therapeutic protocols (including nutritional support and pain control) for oral mucositis (OM) in patients undergoing chemoradiotherapy. Methods: From September to November 2012, a nationwide electronic survey with 21 focused items was proposed to chemotherapy and radiotherapy centers. Results: We collected 111 answers. Common Terminology Criteria for Adverse Events (CTCAE) scale is employed by 55 % of the physicians in assessing mucosal toxicity. The most relevant predictive factors for OM development are considered smoke, alcohol use, planned radiotherapy, and concurrent use of radiosensitizing chemotherapy. Prophylactic gastrostomy is adopted in <10 % of the patients. Preventive antibiotics or antimycotics are prescribed by 46 % of the responders (mainly local or systemic antimycotic drugs). Alkalinizing mouthwashes or coating agents are frequently adopted (70 % of the cases). Among therapeutic interventions, systemic fluconazole is administered by 80 % of the physicians. Pain is mainly treated by weak followed by strong opioids. Conclusions: A variety of preventive and therapeutic protocols for OM exists among the participating Italian centers, with some uniformity in respect to nutritional support, use of antimycotic and painkillers. There is an urgent need for well-conducted clinical trials aimed at assessing the best choices for OM prevention and treatment in HNC. [ABSTRACT FROM AUTHOR]

Background: Evidence for TP53 mutations as biomarker in colorectal cancer (CRC) is conflicting. Methods: We assessed TP53 mutations in 51 patients with advanced CRC enrolled into a phase II, randomised trial of first-line tegafur-uracil (UFT)/leucovorin (LV) plus irinotecan (n = 23) versus UFT/LV plus oxaliplatin (n = 28). Results: Non-functional TP53 mutations were found in 35% of patients. The response rate was not significantly different according to TP53 status. Progression-free and overall survival were longer in patients with TP53 mutations compared to those with wild-type TP53 (9 vs. 6.5 months, p = 0.0504, and 39.2 vs. 19.6 months, p = 0.0055, respectively). On multivariable analysis, TP53 mutation was independently associated with a decreased risk of death (hazard ratio 0.329, 95% CI 0.159-0.679; p = 0.0026). Treatment arm did not interact with TP53 in influencing outcomes. Conclusion:TP53 was not predictive of benefit from first-line irinotecan- or oxaliplatin-based chemotherapy. TP53 mutations may possibly be associated with a more indolent course of CRC after the diagnosis of metastatic disease. © 2014 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Objective Lyme arthritis (LA) is characterized by infiltration of inflammatory cells, mainly neutrophils (polymorphonuclear cells [PMNs]) and T cells, into the joints. This study was undertaken to evaluate the role of the neutrophil-activating protein A (NapA) of Borrelia burgdorferi in eliciting inflammation and in driving the adaptive immune response. Methods Levels of NapA, interferon-γ (IFNγ), interleukin-17 (IL-17), and T cell-attracting chemokines were assessed by enzyme-linked immunosorbent assay in synovial fluid from patients with LA. The profile of T cells recruited into the synovia of patients with LA was defined by fluorescence-activated cell sorting analysis. NapA was intraarticularly injected into rat knees, and the cells recruited in synovia were characterized. The role of NapA in recruiting immune cells was confirmed by chemotaxis assays using a Transwell system. Results NapA, IFNγ, IL-17, CCL2, CCL20, and CXCL10 accumulated in synovial fluid from patients with LA. Accordingly, T cells obtained from these patients produced IFNγ or IL-17, but notably, some produced both cytokines. NapA promoted neutrophil and T lymphocyte recruitment both in vitro and in vivo. Interestingly, the infiltration of T cells not only resulted from the chemotactic activity of NapA but also relied on the chemokines produced by PMNs exposed to NapA. Conclusion We provide evidence that NapA functions as one of the main bacterial products involved in the pathogenesis of LA. Accordingly, we show that, at very early stages of LA, NapA accumulates and, in turn, orchestrates the recruitment of inflammatory cells into the joint cavity. Thereafter, with the contribution of recruited cells, NapA promotes the infiltration of T cells producing IL-17 and/or IFNγ. [ABSTRACT FROM AUTHOR]

We have conducted a pilot trial of a home telemonitoring system involving 60 adult patients with cystic fibrosis (CF) enrolled at four Italian CF centres. Thirty randomly selected patients received a home device to perform spirometry and to measure oxygen saturation. The data were transferred to a data centre which forwarded them to the patient's CF clinic. The telemonitoring system was evaluated using questionnaires completed by patients and their doctors. The doctors reported that telemonitoring was useful in monitoring their patients' health status and in decreasing the CF centre workload. The data transfer procedure posed no particular problems for the patients. The major difficulties reported by the patients were night-time saturimetry measurements, and in the first week of the study, data transmission to the data centre. The pilot trial was positive and therefore merits a larger study. [ABSTRACT FROM AUTHOR]

Patients with cancer frequently use dietary supplementation and herbal therapies to control symptoms of disease and adverse effects of cancer therapy. Despite the widespread use of dietary supplementation and herbal therapies in oncology, robust scientific evidence in this area is lacking. Not only do these products need to be tested in large and well-designed observational or randomized studies, but their manufacturing process must be improved to achieve higher levels of standardization in product quality. Ginger is frequently used to counteract chemotherapy-induced nausea and vomiting (CINV), and some suggestions that it might be effective against CINV come from randomized and/or crossover clinical trials. However, several limitations in the methods of these studies limit their power and generalizability. The authors are conducting a randomized, double-blind study with a large sample size and homogeneous inclusion criteria in order to evaluate the efficacy of a wellstandardized ginger extract in reducing nausea in patients with cancer. The widespread use of standardized herbal therapies and natural components among patients requires that scientific and rigorous research strategies are applied in this field to guide the physicians and the patients in safer use. [ABSTRACT FROM AUTHOR]

OBJECTIVE--Cross-sectional studies found less microalbuminuria in type 2 diabetic patients with the Ala12 allele of the peroxisome proliferator-activated receptor-γ2 (PPAR-γ2) Pro12Ala polymorphism. We prospectively evaluated the association between Pro12Ala polymorphism (rs1801282) and new-onset microalbuminuria. RESEARCH DESIGN AND METHODS--Pro12Ala polymorphism was genotyped by TaqMan-based assay in genomic DNA of 1,119 consenting patients from BErgamo NEphrologic Diabetic Complications Trial (BENEDICT)--a prospective, randomized trial evaluating ACE inhibition effect on new-onset microalbuminuria (albuminuria 20-200 µg/min in at least two of three consecutive overnight urine collections in two consecutive visits) in hypertensive type 2 diabetes with albuminuria <20 µg/min at inclusion. RESULTS--Baseline characteristics of Ala (Ala/Ala or Ala/ Pro) carriers and Pro/Pro homozygotes were similar, with a nonsignificant trend to lower albuminuria (P = 0.1107) in the 177 Ala carriers. Over a median (interquartile range) of 44.0 (17.1-51.9) months, 7 (4%) Ala carriers and 86 (9.1%) Pro/Pro homozygotes developed microalbuminuria (hazard ratio [HR] 0.45 [95% CI 0.21-0.97]; P = 0.042). Final albuminuria was significantly lower in Ala carriers than Pro/Pro homozygotes (7.3 ± 9.1 vs. 10.5 ± 24.9 µg/min, respectively), even after adjustment for baseline albuminuria (P = 0.048). Baseline and follow-up blood pressure and metabolic control were similar in both groups. Incidence of microalbuminuria was significantly decreased by ACE versus non-ACE inhibitor therapy in Pro/Pro homozygotes (6.3 vs. 11.9%, respectively, HR 0.46 [0.29-0.72]; P < 0.001). CONCLUSIONS--In type 2 diabetes, the Ala allele protects from worsening albuminuria and new-onset microalbuminuria, and ACE inhibition blunts the excess risk of microalbuminuria associated with the Pro/Pro genotype. Evaluating Pro12Ala polymorphism may help identifying patients at risk who may benefit the most from early renoprotective therapy. Diabetes 58:2920-2929, 2009 [ABSTRACT FROM AUTHOR]

Fusarium oxysporum MSA 35 [wild-type (WT) strain] is an antagonistic Fusarium that lives in association with a consortium of bacteria belonging to the genera Serratia, Achromobacter, Bacillus and Stenotrophomonas in an Italian soil suppressive to Fusarium wilt. Typing experiments and virulence tests provided evidence that the F. oxysporum isolate when cured of the bacterial symbionts [the cured (CU) form], is pathogenic, causing wilt symptoms identical to those caused by F. oxysporum f. sp. lactucae. Here, we demonstrate that small volatile organic compounds (VOCs) emitted from the WT strain negatively influence the mycelial growth of different formae speciales of F. oxysporum. Furthermore, these VOCs repress gene expression of two putative virulence genes in F. oxysporum lactucae strain Fuslat10, a fungus against which the WT strain MSA 35 has antagonistic activity. The VOC profile of the WT and CU fungus shows different compositions. Sesquiterpenes, mainly caryophyllene, were present in the headspace only of WT MSA 35. No sesquiterpenes were found in the volatiles of ectosymbiotic Serratia sp. strain DM1 and Achromobacter sp. strain MM1. Bacterial volatiles had no effects on the growth of the different ff. spp. of F. oxysporum examined. Hyphae grown with VOC from WT F. oxysporum f. sp. lactucae strain MSA 35 were hydrophobic whereas those grown without VOCs were not, suggesting a correlation between the presence of volatiles in the atmosphere and the phenotype of the mycelium. This is the first report of VOC production by antagonistic F. oxysporum MSA 35 and their effects on pathogenic F. oxysporum. The results obtained in this work led us to propose a new potential direct long-distance mechanism for antagonism by F. oxysporum MSA 35 mediated by VOCs . Antagonism could be the consequence of both reduction of pathogen mycelial growth and inhibition of pathogen virulence gene expression. [ABSTRACT FROM AUTHOR]

Aim: We developed a machine learning model based on T1 MRI pre-treatment radiomics and clinical data to predict the personal risk of prostate cancer (PC) patient to not respond to Cyberknife treatment within 36 months and support medical decision-making towards long-interval follow-up versus short-interval or treatment changing. Materials and methods: From a retrospective serie of consecutive clinically localized PC patients treated from 2015 to 2018 by Cyberknife at Centro Diagnostico Italiano, Milan Italy, we analyzed 66 patients (23 low risk, 31 medium risk and 12 high risk according to D’Amico risk classification) with at least 36 months of follow-up: 13 with recurrence within 36 months (not-responding to treatment) and 53 under biochemical control at 36 months (responding to treatment). All the patient were treated with Cyberknife stereotactic body radiotherapy and two schedules were administred: a total does of 37.5 Gy in 5 fraction of 7.5 Gy and a total dose of 38 Gy in 4 fraction of 9.5 Gy. We collected PC pre-treatment MR T1-weighted images, risk class, stage and PSA values (% difference before and after 6 months from treatment). Such dataset was used for training and cross-validation of ensembles of machine learning algorithms supervised during learning by 36 months follow-up as a reference standard. Results: Based on a majority vote, an ensemble of support vector machines (SVM) showed a sensitivity of 74% in identifying subjects with high risk of not responding and a specificity of 71% in identifying subjects with low risk of recurrence (training set of 34 patients treated in 2015-2017, 25 responding to treatment, 9 not responding). When externally tested on a temporally independent set of patients treated in 2018 (32 patients), the SVM ensemble correctly classified all 4 patients with recurrence (sensitivity 100%) and 22 of 28 patients currently under biochemical control (specificity 71%). Conclusions: Although trained and tested on a limited cohort of patients, our radiomic model shows high potential to support medical decision-making towards long-interval follow-up versus short-interval or treatment changing of PC treated by CyberKnife. Subsequent studies are ongoing to consolidate these results. [ABSTRACT FROM AUTHOR]

The article focuses on management of breast cancer in an EUSOMA-accredited Breast Unit (BU) in Lombardy, Italy, during the COVID-19 pandemic. Topics include the treatment of cancer patients should not be postponed nor compromised during a pandemic, the interventional procedure must be balanced against increased risk of infection, and the evaluated on a case-by-case basis to address urgency of procedures.

Introduction: Many patients (pts) with schizophrenia exhibit difficulties in maintaining adherence to oral antipsychotics (OA). Long-acting injectable antipsychotics (LAI) may have a slight edge about promoting treatment adherence, reducing costs and rehospitalization rates. Objectives: To value demographic and clinical features, global functioning in schizophrenic using Haldol LAI (H-LAI) or second-generation antipsychotics (S-LAI). Methods: Follow up study (T0 January 2017; T1 18 months later) in naturalistic setting (Mental Health Service-MHS, Novara, Italy). Statistical analysis was performed with SPSS 19 and significance at p=0.05. Results: 90 pts were recruited (45 on H-LAI, 45 on S-LAI). At T1 4.4% pts on H-LAI modified therapy for inefficacy, 4.4 % switched to OA. At T1 Clinical Global Impression (CGI) and Personal and Social Performance (PSP) mean scores remained the same (respectively 85% and 83.8%). At T1 13 pts on SG LAI modified therapy (6 switching to other SG LAI, 4 to H-LAI and 3 to OA. CGI and PSP mean scores improved at T1 (respectively 27.6% and 43.8%). In terms of substance use and somatic comorbidity no statistical differences were found among the 2 groups at TO, neither in oral augmentation, anticholinergic use, hospitalization rate, CGI score between T0 and T1. S-LAI group was younger (p=.0009), reaching higher scores in PSP "care of self" (p=0.047) at T0 and was observed scores improvement of PSP "work" (p=0.049) and PSP total (p<0.001) at T1. Conclusions: the use of LAI among pts attending the MHS Novara, Italy, especially for S-LAI, increased among younger people with better functioning. [ABSTRACT FROM AUTHOR]

This study describes the clinical, immunologic, and virological characteristics of 30 vertically human immunodeficiency virus type 1 (HIV-1)–infected children older than 8 years of age (long-survivors) before the introduction of protease inhibitors therapy. All of them were followed from birth. At the age of 8 years, 7 children presented no HIV-1–associated signs or only mild ones and only 5 had severe clinical manifestations (acquired immune deficiency virus [AIDS]). The remaining 18 children presented moderate signs with some immunodeficiency. The follow-up from 8 years of age (3.5 years on the average) showed that 6 children remained asymptomatic and were therefore defined as long-survivors nonprogressors (average, 13 years) and only 4 children developed AIDS. Progressive encephalopathy was the most striking clinical manifestation at follow-up and occurred in 6 children (always after immunodeficiency) with a polymorphic picture combining eye movement alterations, pyramidal signs and symptoms and mental deterioration. The majority of our long-survivors carried a virus with nonsyncytia-inducing phenotype, thus confirming its association with long survival. A switch to syncytia-inducing phenotype was observed only in 2 cases during the follow-up, but their clinical status did not change at follow-up. [ABSTRACT FROM AUTHOR]

Introduction: After-Action Reviews (AARs) are healthcare management tools applied to evaluate responses to public health emergencies, identifying best practices and challenges. They are included in the International Health Regulations (IHR) and recommended by the World Health Organization (WHO). The aim of this study was to adapt the WHO AAR guidelines to assess the response during the COVID-19 first epidemic wave (February 22nd-May 3rd, 2020) at San Raffaele Scientific Institute, a large university hospital in Milan, Italy. The hospital treated 951 patients and underwent massive re-organization. Methods: We developed a hospital-oriented AAR based on the keyinformant interview format. After establishing an AAR planning and analysis team, an ad-hoc questionnaire was designed to explore four areas: i)Staff management; ii)Logistics and supplies; iii)Diagnosis and clinical management; iv)Communication. The questionnaire was used to support 36 semi-structured interviews of professionals with executive, clinical, technical and administrative roles within the hospital. Results: The hospital response was rated as overall effective and sufficiently prompt. Participants stressed the key roles played by: i)strong governance and coordination; ii)readiness and availability of healthcare personnel; iii)multidisciplinary model of care based on levels of intensity. Major challenges concerned communication strategies and staff training. In addition, participants highlighted the need for greater collaboration among hospitals and primary care services. Conclusions: This study represents one of the first applications of an AAR to the COVID-19 emergency and to the hospital setting. The tool provided San Raffaele's hospital management with a multilayered analysis of the emergency response that informed the critical planning for next phases of the pandemic response. The tool can be adapted to other settings to pursue continuous operational improvement. Key messages: After-action reviews are healthcare managements tools used to to evaluate a country or government's response to infectious disease outbreaks, environmental or natural disasters and societal crises. After Action Reviews can be adapted or scaled for other settings to pursue continuous operational improvement and support preparedness strategies for future public health emergencies. [ABSTRACT FROM AUTHOR]

The design of countermeasure works to mitigate landslide risk needs to deal with the multiple unknowns that are linked with soil properties, distribution and rheology. Most of the time, the degree of definition of all these elements is low. Through landslide monitoring, it is possible to acquire signals from the landslide that carry synthetic information about its dynamic. Thus, if it is possible to define a model that is able to link the landslide displacements with the triggering factors and to predict them consistently, that model may be used to evaluate the effect of a countermeasure work directly, bypassing the geomechanical uncertainty. In this paper, an example application of this approach is described. The displacements of a landslide located in North East Italy are connected with the water discharge of the small stream the crosses the landslide body. A countermeasure work that intercepts the discharge of the torrent is expected to reduce the landslide displacements of approximately 70%, with lower costs of construction and smaller impacts on the environment and landscape with respect of other types of structural mitigation works such as slope reprofiling and large retaining walls. [ABSTRACT FROM AUTHOR]

This second part of practical Guidelines related to Kawasaki disease (KD) has the goal of contributing to prompt diagnosis and most appropriate treatment of KD resistant forms and cardiovascular complications, including non-pharmacologic treatments, follow-up, lifestyle and prevention of cardiovascular risks in the long-term through a set of 17 recommendations. Guidelines, however, should not be considered a norm that limits the treatment options of pediatricians and practitioners, as treatment modalities other than those recommended may be required as a result of peculiar medical circumstances, patient’s condition, and disease severity or individual complications. [ABSTRACT FROM AUTHOR]

The primary purpose of these practical guidelines related to Kawasaki disease (KD) is to contribute to prompt diagnosis and appropriate treatment on the basis of different specialists’ contributions in the field. A set of 40 recommendations is provided, divided in two parts: the first describes the definition of KD, its epidemiology, etiopathogenetic hints, presentation, clinical course and general management, including treatment of the acute phase, through specific 23 recommendations. Their application is aimed at improving the rate of treatment with intravenous immunoglobulin and the overall potential development of coronary artery abnormalities in KD. Guidelines, however, should not be considered a norm that limits treatment options of pediatricians and practitioners, as treatment modalities other than those recommended may be required as a result of peculiar medical circumstances, patient’s condition, and disease severity or complications. [ABSTRACT FROM AUTHOR]

Objectives: A multi-disciplinary team (MDT) is essential in the management of cancer. Head and neck cancer (HNC) is a rare, complex and heterogeneous group of malignancies for which different treatment options are available. However, the potential impact of MDT on the management of HNC has been only poorly evaluated to date. This study evaluates the impact of MDT on the management of HNC in a tertiary centre.Methods: We retrospectively analysed records of HNC patients referred to a MDT evaluation at the Istituto Nazionale Tumori of Milan, Italy, from May 2007 to January 2012. All cases were reviewed by a MDT consisting of a head and neck surgeon, a radiation oncologist, and a medical oncologist.Results: Data from 781 HNC patients were analysed. Approximately 70% of patients were referred to our Institution for a second opinion consultation. Following MDT evaluation, new staging examinations were requested in 49% of patients, and treatment plan was modified in 10%.Conclusions: A MDT approach in a tertiary referral hospital leads to staging refinement of disease or changes in treatment plan in about 60% of patients. [ABSTRACT FROM AUTHOR]

The aims of the study are to evaluate the clinical outcomes of first-line treatment with platinum-based chemotherapy and cetuximab in patients with relapsing/metastatic head and neck cancer (RM HNC) and to identify predictors of treatment response. This is a retrospective, observational, longitudinal, real-world study involving 6 oncology centres in Italy. All consecutive patients with RM HNC treated between January 2007 and December 2016 with a first-line therapy consisting of a platinum-based chemotherapy regimen plus cetuximab were included. The primary objective of the study was to assess overall survival (OS) and progression-free survival (PFS). Secondary objectives included the identification of predictors of treatment response. Overall, 297 patients were identified. Median OS was 10.8 months (95% confidence interval [CI] 9.3–12.2), whereas median PFS was 4.8 months (95% CI 4.3–5.5). On multivariable analysis, independent unfavourable prognostic factors for OS were performance status (PS) Eastern Cooperative Oncology Group (ECOG) >0, presence of residual tumour at primary site, platinum resistance and lack of objective response. Unfavourable predictors for PFS included cancer primary site (paranasal sinuses, hypopharynx), PS ECOG >0, presence of residual tumour at primary site, platinum resistance and lack of objective response. Independent unfavourable predictors of objective response were tumour site (oral cavity, larynx-hypopharynx), residual tumour at primary site and prior chemotherapy. The availability of new treatment modalities and epidemiological changes make the periodic reassessment of prognostic factors of great relevance to guide clinical practice and the design of future randomised clinical trials. • Changes in epidemiology and treatment of relapsing/metastatic head and neck cancer (RM HNC) require a reassessment of prognostic factors. • Platinum resistance emerged as an important predictor of shorter progression-free survival and overall survival. • Poor performance status, residual tumour at primary site and no objective response play a prognostic role. • After the adoption of the EXTREME regimen for RM HNC, prognostic factors profile has changed. [ABSTRACT FROM AUTHOR]

Objectives: There are no commonly accepted standards for monitoring patients treated for head and neck cancer. The aim of this study was to assess patients' preferences for different aspects of follow-up.Methods: A best-worst survey was conducted in a sample of head and neck cancer patients in clinical follow-up at the National Cancer Institute (Milan, Italy). Conditional logit regression with choice as the dependent variable was run to analyse the data. A covariate-adjusted analysis was performed in order to identify socio-demographic and clinical factors related to the selection of best-worst items. The participants were asked to report any difficulties encountered during the survey.Results: A total of 143 patients, predominantly male (74%) and with a mean age of 58 years were enrolled in the survey. The strongest positive preference was expressed for a hospital-based program of physical examinations with frequency decreasing over time. Conversely, the lowest valued item was not performing any positron emission tomography (PET) scan during follow-up. Patients with high educational levels were more likely to value attending a primary care-based program and undergoing intensive radiological investigations. Other patient-specific variables significantly associated with the choice of items were employment and living status, time already spent in follow-up and number of treatments received.Conclusions: Overall, patients were more likely to choose an intensive follow-up scheme broadly consistent with the program currently administered by the hospital. There is little evidence of preference heterogeneity that might justify customized programs based on demographics. The best-worst scaling task appeared feasible for most participants. [ABSTRACT FROM AUTHOR]

Abstract: Lung transplantation (LT) is the only effective form of therapy for cystic fibrosis (CF) associated with end-stage pulmonary failure. In Italy, the management of CF is regulated by national law, which has instituted regional centers for care and follow-up of all CF patients. LT has been performed since 1992 in only nine LT certified centers. The structured national organization has led to a unified database for LT for CF. As of December 2006, 197 bilateral LT (96 male and 94 female patients; 7 retransplants) have been performed. Of these, four had also liver or heart and liver transplantation, and three are long-term survivors. Overall median survival is 7 years. Mean age at transplantation is 26.5 years, and the mortality on the waiting list is 33.6%. Patients listed for transplant either received a suitable donor within a mean of 10 months or died within a mean of 5.5 months. The most frequent cause of death is bronchiolitis obliterans syndrome (BOS). Our nationwide database indicates the excellent results obtained by LT in FC. Still, mortality on the waiting list remains a challenge and long-term outcome is limited by BOS. [Copyright &y& Elsevier]

We analyzed cytogenetic data at diagnosis in 395 primary myelofibrosis (PMF) patients to evaluate any possible association between karyotype and WHO 2017 classification and its impact on prognosis. All the cases were diagnosed and followed at five Italian Hematological Centers between November 1983 and December 2016. An abnormal karyotype (AK) was found in 69 patients and clustered differently according to bone marrow fibrosis grade as it was found in 31 (27.0%) cases with overt fibrotic and 38 (13.6%) with pre-fibrotic PMF (p = 0.001). Sex, anemia, thrombocytopenia, circulating blasts ≥1%, higher lactate dehydrogenase, and International Prognostic Scoring System risk classes were all significantly associated with karyotype. At a median follow-up of >6 years, 101 deaths were recorded. Survival was different between AK and normal karyotype (NK) patients with an estimated median overall survival (OS) of 11.6 and 25.7 years, respectively (p = 0.0148). In conclusion, in our cohort around 20% of patients had an AK, more frequently in subjects with an advanced bone marrow fibrosis grade and clinical-laboratory features indicative of a more aggressive disease. This study shows that an AK confers a more severe clinical phenotype and impacts adversely on OS, thus representing an additional parameter to be considered in the evaluation of PMF prognosis., (© 2020 John Wiley & Sons Ltd.)

The majority of parechovirus A type 5 (PeV-A5) infections have been reported in patients with gastrointestinal syndromes. In contrast, a sepsis-like illness associated with PeV-A5 infection has been reported only anecdotally. Herein, we report the first case in Italy of a PeV-A5 neurological infection presenting in a neonate with a sepsis-like syndrome. The patient, a healthy male infant born at 41 weeks of gestation, was highly distressed and inconsolable, and had been crying persistently, with poor breastfeeding, since the previous day. From day 2 to day 4, the newborn was feverish with mild irritability; breastfeeding was preserved and regularly supported. His clinical condition progressively improved, with defervescence on day 4. He was discharged after 7 days, and neurological examination results indicated only mild impairment in visual fixation and vertical eye tracking and mild axial hypotonia. The Italian PeV-A5 strain was phylogenetically related to three strains detected in Denmark in 2012, as well as to one detected in Australia and one in Greece in 2015, with an average nucleotide identity of 97.9% (range 95.9-100.0%). Enterovirus/PeV infection in the newborn should be ruled out in cases of infants with unexplained fever and/or a sepsis-like syndrome and/or meningoencephalitis. An aetiological diagnosis is essential to avoid the unnecessary administration of antibiotics and to plan long-term follow-up until schooling., (Copyright © 2019 The Authors. Published by Elsevier Ltd.. All rights reserved.)

There are no adequate studies that have formally tested the performance of different estimating formulas in patients with type 2 diabetes both with and without overt nephropathy. Here we evaluated the agreement between baseline GFRs, GFR changes at month 6, and long-term GFR decline measured by iohexol plasma clearance or estimated by 15 creatinine-based formulas in 600 type 2 diabetics followed for a median of 4.0 years. Ninety patients were hyperfiltering. The number of those identified by estimation formulas ranged from 0 to 24:58 were not identified by any formula. Baseline GFR was significantly underestimated and a 6-month GFR reduction was missed in hyperfiltering patients. Long-term GFR decline was also underestimated by all formulas in the whole study group and in hyper-, normo-, and hypofiltering patients considered separately. Five formulas generated positive slopes in hyperfiltering patients. Baseline concordance correlation coefficients and total deviation indexes ranged from 32.1% to 92.6% and from 0.21 to 0.53, respectively. Concordance correlation coefficients between estimated and measured long-term GFR decline ranged from -0.21 to 0.35. The agreement between estimated and measured values was also poor within each subgroup considered separately. Thus, our study questions the use of any estimation formula to identify hyperfiltering patients and monitor renal disease progression and response to treatment in type 2 diabetics without overt nephropathy.