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Simple Summary: In situ/microinvasive adenocarcinoma of the uterine cervix represents the majority of cervical glandular lesions and can be treated conservatively. In contrast to squamous lesions, approximately 15–20% of glandular disease may be HPV-negative and therefore associated with a worse prognosis. Furthermore, up to 4% of cases may show recurrence after three years of follow-up. Given the abovementioned risk, knowing the predictive factors of disease recurrence becomes crucial for post-treatment management. In the present study, HPV testing in follow-up was the best predictor for recurrences in women with in situ/microinvasive AC undergoing conservative treatment. So, its use in clinical practice is of pivotal importance. However, attention should be paid to non-high-risk HPV women in follow-up with non-usual-type histopathology, given that it seems to represent a sub-population at increased risk of recurrences. Objective: The present study aimed to assess long-term follow-up outcomes in women with in situ/microinvasive adenocarcinoma (AC) of the uterine cervix treated conservatively. Methods: Retrospective multi-institutional study including women with early glandular lesions and 5-year follow-up undergoing fertility-sparing treatment. Independent variables associated with recurrence were evaluated. Logistic regression analysis and Kaplan–Meier survival analysis with Logrank test were performed. Results: Of 269 women diagnosed with in situ/microinvasive AC, 127 participants underwent conservative treatment. During follow-up, recurrences were found in nine women (7.1%). The only factor associated with recurrence during follow-up was positive high-risk Human Papillomavirus (hr-HPV) testing (odds ratio 6.21, confidence interval 1.47–26.08, p = 0.012). HPV positivity in follow-up showed a recurrence rate of 21.7% against 3.8% in patients who were HPV-negative (p = 0.002, Logrank test). Among women with negative high-risk HPV tests in follow-up, recurrences occurred in 20.0% of non-usual-type histology vs. 2.1% of usual-type cases (p = 0.005). Conclusion: HPV testing in follow-up is of pivotal importance in women with early glandular lesions undergoing conservative treatment, given its recurrence predictive value. However, women who are high-risk HPV-negative in follow-up with non-usual-type histopathology may represent a sub-population at increased risk of recurrences. Further studies should confirm these findings. [ABSTRACT FROM AUTHOR]

Here we present FOCA (Italian FlOod and Catchment Atlas), the first systematic collection of data on Italian river catchments for which historical discharge time series are available. Hydrometric information, including the annual maximum peak discharge and average daily annual maximum discharge, is complemented by several geomorphological, climatological, extreme rainfall, land-cover and soil-related catchment attributes. All hydrological information derives from the most recently released datasets of discharge and rainfall measurements. To enhance the reproducibility and transferability of the analysis, this paper provides a description of all the raw data and the algorithms used to build the basin attribute dataset. We also describe the approaches adopted to solve problems encountered during the digital elevation model elaboration in areas characterized by a complex morphology. Details about the data quality-control procedure developed to detect and correct errors are also reported. One of the main novelties of FOCA with respect to other national-scale datasets is the inclusion of a rich set of geomorphological attributes and extreme rainfall features for a large set of basins covering a wide range of elevations and areas. Using this first nationwide data collection (available at 10.5281/zenodo.10446258, Claps et al., 2023), a wide range of environmental applications, with a particular focus on flood studies, can be undertaken within the Italian territory. [ABSTRACT FROM AUTHOR]

In this work the attenuation potential of flood peaks of 265 large reservoirs all over Italy is analysed, considering a flood management that excludes gates opening and then configures strictly unsupervised attenuation effects. Key factors of dams and related basins are considered to develop a ranking method that can emphasize the interplay between dam geometry and the hydrological processes acting in the upstream watershed. To maintain a homogeneous approach in such a wide geographic area, the attenuation index is computed applying the numerical solution of the differential equation of lakes and only two different standardized hydrograph shapes have been used. An index design flood from the rational method is used as the incoming peak value for each dam, enhancing the use of the results of a recent analysis of all Italian rainfall extremes. Even with a very simple approach, twenty-four different design incoming floods are derived, by varying the shape of the incoming hydrograph and the parameters of the rational method. Exploring the ranking results in all the alternatives, the attenuation potential obtained for all dams demonstrates to be strongly sensitive to the assumptions on the time of concentration and to some rainfall features. On the other hand, the hydrograph shape seems to exert much less influence on the ranking outcome. Results obtained can be useful to studies of wide-area flood frequency analyses, as we highlighted the sensitivity of the rank of attenuation efficiency to hydrologic parameters widely used in the assessment of the design flood peaks in ungauged basins. [ABSTRACT FROM AUTHOR]

We here present FOCA (Italian FlOod and Catchment Atlas), the first systematic collection of data of Italian river catchments for which discharge historical time series are available. Hydrometric information, including annual maximum peak discharge and average daily annual maximum discharge, is complemented by several geomorphological, climatological, extreme rainfall, land cover and soil-related catchment attributes. All hydrologic information derives from the most recently released datasets of discharge and rainfall measurements. This paper provides a description of all the raw data and the algorithms used to build the basin attributes dataset, to enhance reproducibility and transferability of the analysis. We also describe the approaches adopted to solve problems encountered during the Digital Elevation Model elaboration in areas characterized by complex morphology. Details about the data quality-control procedure developed to detect and correct errors is also reported. One of the main novelties of FOCA with respect to other national-scale datasets is the inclusion of a rich set of geomorphological attributes and of extreme rainfall features spatially averaged over the watershed. With this first nationwide data collection (available at https://doi.org/10.5281/zenodo.8060737), a wide range of environmental applications, with particular reference to flood studies, can be undertaken on the Italian territory. [ABSTRACT FROM AUTHOR]

Simple Summary: The aim of this study was to investigate whether baseline [18F]Fluorodeoxyglucose ([18F]FDG) positron emission computed tomography/computed tomography (PET/CT) could predict pathological complete response (pCR) after neoadjuvant chemotherapy (NAC) and survival outcomes in patients affected by different molecular subtypes of breast cancer (BC). Semiquantitative parameters, extracted from baseline [18F]FDG PET/CT, seem to be promising in the prediction of response to NAC in Luminal B and Luminal B + HER-2 patients and in the survival prediction of triple negative BC patients achieving pCR after NAC. PET/CT scan with advanced parameter analysis could carve out a synergic role, together with other imaging tools, for a more accurate evaluation of these patients at diagnosis. Pathological complete response (pCR) after neoadjuvant chemotherapy (NAC) is a strong prognostic factor in breast cancer (BC). The aim of this study was to investigate whether semiquantitative parameters derived from baseline [18F]Fluorodeoxyglucose ([18F]FDG) positron emission computed tomography/computed tomography (PET/CT) could predict pCR after NAC and survival outcomes in patients affected by different molecular subtypes of BC. We retrospectively retrieved patients from the databases of two Italian hospitals (Centre A: University Hospital of Ferrara; Centre B: University of Padua) meeting the following inclusion criteria: (1) diagnosis of BC; (2) history of NAC; (3) baseline [18F]FDG PET/CT performed before the first cycle of NAC; (4) available follow-up data (response after NAC and survival information). For each [18F]FDG PET/CT scan, semiquantitative parameters (SUVmax, SUVmean, MTV and TLG) related to the primary tumor (B), to the reference lesion for both axillary (N) and distant lymph node (DN), and to the whole-body burden of disease (WB) were evaluated. Patients enrolled were 133: 34 from centre A and 99 from centre B. Patients' molecular subtypes were: 9 luminal A, 49 luminal B, 33 luminal B + HER-2, 10 HER-2 enriched, and 32 triple negative (TNBC). Luminal A and HER-2 enriched BC patients were excluded from the analysis due to the small sample size. pCR after NAC was achieved in 47 patients (41.2%). [18F]FDG PET/CT detected the primary tumor in 98.3% of patients and lymph node metastases were more frequently detected in Luminal B subgroup. Among Luminal B patients, median SUVmean_B values were significantly higher (p = 0.027) in responders (7.06 ± 5.9) vs. non-responders (4.4 ± 2.1) to NAC. Luminal B + HER-2 non-responders showed a statistically significantly higher median MTV_B (7.3 ± 4.2 cm3 vs. 3.5 ± 2.5 cm3; p = 0.003) and TLG_B (36.5 ± 24.9 vs. 18.9 ± 17.7; p = 0.025) than responders at baseline [18F]FDG PET/CT. None of the semiquantitative parameters predicted pCR after NAC in TNBC patients. However, among TNBC patients who achieved pCR after NAC, 4 volumetric parameters (MTV_B, TLG_B, MTV_WB and TLG_WB) were significantly higher in patients dead at follow-up. If confirmed in further studies, these results could open up a widespread use of [18F]FDG PET/CT as a baseline predictor of response to NAC in luminal B and luminal B + HER-2 patients and as a prognostic tool in TNBC. [ABSTRACT FROM AUTHOR]

Simple Summary: Adrenocortical carcinoma (ACC) is a rare and malignant disease with a poor prognosis in advanced disease. The complexity of ACC management requires a multidisciplinary approach, an emerging model of treatment, suitable for oncological diseases. Our study aims to determine the role of multidisciplinary team evaluation in affecting the overall survival and progression-free survival in ACC patients. We perform a retrospective analysis of ACC patients treated in Padova, with particular reference to their discussion in the multidisciplinary group of adrenal disease, definitively established in 2013 and defined as a collegial meeting between physicians involved in adrenal diseases. We describe a positive impact on survival rates in ACC patients after the multidisciplinary meeting. We aimed to evaluate the role of adrenal multidisciplinary team evaluation (MTE) in affecting the overall survival (OS) and progression-free survival (PFS) in patients with adrenocortical carcinoma (ACC). We included in a retrospective monocentric study 47 patients with ACC. We divided our cohort into group 1 (without adrenal-MTE discussion, ACC diagnosis from 2004 to 2012, n = 14) and group 2 (diagnosis and beginning of treatments after 2013, all discussed in the adrenal MTE, n = 33). OS was defined by the survival between the first and the last visit, while PFS as the time from the first visit to the progression of the disease. Kaplan–Meier curves were used to compare OS and PFS between Group 1 and Group 2. Group 1stages III–IV (n = 10) presented a shorter median OS than Group 2stages III–IV (25 patients, 4 vs. 31 months, p = 0.023). Likewise, the median PFS was lower in Group 1 as compared to Group 2 (2.9 vs. 17.2 months, p < 0.001). The gain in PFS (6 months) was also confirmed in stage III-IV patients (2.9 vs. 8.7 months, respectively, for Group 1 and Group 2, p = 0.02). Group 1 presented a median PFS of 4 months, while the median PFS of Group 2 was 14.7 months (p = 0.128). In conclusion, we found a significant gain in terms of survival in patients after the MTE discussion in 2013. Therefore, ACC patients should be referred to a tertiary center, ideally from the time of diagnosis, to promptly apply all available treatments, according to the single patient's clinical history and based on multidisciplinary management. [ABSTRACT FROM AUTHOR]

Simple Summary: Buffalo milk has good dairy properties that allow its transformation into excellent cheeses, in particular mozzarella. What greatly influences the quality of buffalo milk, and its properties is the diet administered; for this reason, we wanted to test whether a supplement of antioxidants (SOD, Zn, and Se) in the diet of lactating buffaloes could affect the quantity and quality of their milk. The experiment was carried out on sixty-six lactating buffaloes on a farm in central Italy. Individual milk samples were collected every four weeks at morning and evening milking. The results obtained showed that treatment had no effect on feed intake, feeding behaviour, and feed efficiency and improved milk yield and milk clotting properties (MCP). Buffaloes are raised mainly to obtain milk that is nutritionally very rich. The technological characteristics of buffalo milk are optimal for processing into cheese, and it is mainly used to produce mozzarella cheese. Under stressful conditions, buffaloes, like other animals, produce milk qualitatively poorly. The stressors that can affect the quality of production are, in addition to other factors, deficiencies in nutrients such as vitamins, antioxidants, and minerals. In this study, we evaluated the effect of antioxidant supplementation on the quality of buffalo milk. Sixty-six buffaloes were enrolled and subdivided into two balanced groups of 33 each. The ZnSe group received 0.2 kg/head/day of Bufalo Plus® containing antioxidants and barley meal, CaCO3 and MgCO3 mix; the control group was supplemented with 0.2 kg/head/day of barley meal, CaCO3 and MgCO3 mix. The two groups were fed ad libitum with a total mixed ration (TMR). The amount of diet distributed was recorded daily, and the residue in the trough manger was recorded three times per week. TMR samples were taken every two weeks for each group. Daily milk yield was recorded twice a week. Milk samples were collected every four weeks and analysed for chemical and technological properties. Furthermore, milk total antioxidant capacity was determined. The results obtained showed that the antioxidant supplement had no effect on feed intake, feeding behaviour, and feed efficiency. The treatment positively influenced milk production while it did not affect the chemical characteristics of the milk. In addition, the supplement of antioxidants improved the milk clotting properties (MCP). The supplement did not affect the antioxidant activity of the milk. [ABSTRACT FROM AUTHOR]

Open in new tab Download slide Open in new tab Download slide OBJECTIVES The goal of this multicentre retrospective study was to compare long-term clinical and haemodynamic outcomes of the Carpentier-Edwards Magna Ease (CEME) bioprosthesis by patient age. METHODS We included consecutive patients who underwent isolated and combined surgical aortic valve replacement (AVR) with CEME valve between January 2008 and March 2020 at 4 cardiac surgery centres in Italy. Survival distribution was evaluated at follow-up according to age and surgery type (combined or isolated AVR), together with freedom from structural valve deterioration (SVD), reoperation and combined events, i.e. SVD, reoperation, endocarditis and thromboembolic events. RESULTS A total of 1027 isolated and 1121 combined AVR were included; 776 patients were younger than 65 years whereas 1372 were 65 years or older. The 30-day Valve-Academic-Research-Consortium mortality was 2% (<65 years) and 6% (≥ 65 years) (P  < 0.001), whereas it was 3% for isolated AVR and 7% for combined AVR (P  < 0.001). The 12-year survival was 81% for those younger than 65 years vs 45% for those equal to or older than 65 years (P  < 0.001), whereas they were 61% vs 49% for isolated and combined AVR (P  = 0.10). The 12-year freedom from combined events, excluding death, was 79% for those younger than 65 years vs 87% for those equal to or older than (P  = 0.51), whereas they were 83% for isolated and 86% for combined AVR (P  = 0.10). The 12-year freedom from SVD was 93% and 93% in patients younger than 65 and those equal to or older than 65 years (P  = 0.63), and the results were comparable even in cases with isolated and combined AVR (92% vs 94%, P  = 0.21). A multivariable Cox analysis including gender, presence of patient–prosthesis mismatch, isolated AVR and age showed that only the age was an independent risk factor for the incidence of SVD (P  = 0.029). CONCLUSIONS Outcomes from this large multicentre analysis demonstrated that a CEME bioprosthesis provides good clinical results and long-term durability even in patients younger than 65 years. Furthermore, the hazard for SVD has been shown to be lower for older age. Clinical trial registration number 105n/AO/21. [ABSTRACT FROM AUTHOR]

The aim of this study is to provide updates on the characteristics of chronic HBsAg carriers in Italy before the advent of new drugs eliminating or functionally inactivating the genome HBV reservoirs. HBV endemicity has greatly decreased in Italy over the past decades. A not negligible number of chronic HBsAg carriers are still alive in the country. Chronic HBsAg carriers consecutively referring to 9 units in Italy were prospectively enrolled for a 6-month period in 2019. Multiple logistic regression analysis was performed to identify independent predictors of treatment. A total of 894 cases was recruited (sex ratio 1.6; mean age 53.7 ± 13.5 years). The proportion of subjects born abroad was 19.0%; only 1% of cases reported current heavy alcohol intake (> 4 units/day). Chronic HBV infection, chronic HBV hepatitis, and subjects with liver cirrhosis and/or HCC represented 24.8%, 55%, and 19.3% of cases, respectively. After exclusion of the 222 subjects with chronic HBV infection, the proportion of subjects under therapy was as high as 89.3%. A more severe liver disease (OR 2.52; 95% CI = 1.25–5.14) resulted an independent predictor of the likelihood of treatment; male sex was marginally associated (OR 1.67; 95% CI = 1.02–2.76) to the chance of treatment. People born abroad had same chance than Italians native to be treated (OR 2.12; 95% CI = 0.9–4.97). The high proportion of subjects under treatment and the absence of gender and ethnic barrier against treatment sound good news. These updated figures may represent reference data for evaluating the potential impact of forthcoming new therapy against HBV-related disease. [ABSTRACT FROM AUTHOR]

Osteoporosis and nephrolithiasis are common multifactorial disorders with high incidence and prevalence in the adult population worldwide. Both are associated with high morbidity and mortality if not correctly diagnosed and accurately treated. Nephrolithiasis is considered a risk factor for reduced bone mineral density. Aim of this retrospective longitudinal study was to evaluate if osteoporosis is a predictive factor for the nephrolithiasis occurrence. Free-living subjects referring to "COMEGEN" general practitioners cooperative operating in Naples, Southern Italy. Twelve thousand seven hundred ninety-four Caucasian subjects (12,165 female) who performed bone mineral density by dual-energy X-ray absorptiometry and have a negative personal history for nephrolithiasis. Subjects aged less than 40 years or with signs or symptoms suggestive of secondary osteoporosis were excluded from the study. In a mean lapse of time of 19.5 months, 516 subjects had an incident episode of nephrolithiasis. Subjects with osteoporosis had an increased risk of nephrolithiasis than subjects without osteoporosis (Hazard Ratio = 1.33, 95% Confidence Interval 1.01–1.74, p = 0.04). Free-living adult subjects over the age of 40 with idiopathic osteoporosis have an increased risk of incident nephrolithiasis, suggesting the advisability of appropriate investigation and treatment of the metabolic alterations predisposing to nephrolithiasis in patients with osteoporosis. The study protocol was approved by the ASL Napoli 1 Ethical Committee, protocol number 0018508/2018 [ABSTRACT FROM AUTHOR]

In Italy, HDV infection endemicity has greatly decreased overtime. Migratory flow may change this scenario as migrants often come from high HDV endemicity areas. Here, we studied characteristics of HDV infection in Italy, particularly addressed to the birth area of subjects. Chronic HBsAg carriers consecutively referring to 9 units in Italy prospectively enrolled for a six‐month period in 2019 were tested for anti‐HDV by ELISA. Multiple logistic regression analysis was performed to identify anti‐HDV positivity independent predictors. A total of 894 HBsAg‐positive subjects were enrolled. Of them, 786 (87.9%) were tested for anti‐HDV. Anti‐HDV overall prevalence was 9.9% (6.4% in Italian natives and 26.4% in non‐natives; P <.001). HDV‐RNA was checked in 63 (80.8%) of the 78 anti–HDV+ subjects, and 49 (77.8%) tested positive. Compared to non‐natives, Italians were more likely males (male/female 1.6 vs 0.6; P <.05) and older (median age 57 years vs 46 years; P <.05). Multivariate analysis showed that non‐natives (OR = 6.02; CI 95% = 3.06‐11.84) and cirrhosis (OR 9.6; CI 95% = 5.39‐17.30) were independently associated with anti‐HDV positivity. A remarkable changing pattern in some characteristics of anti–HDV‐positive subjects was observed over 1987‐2019: a decreasing male/female ratio, an increasing mean age and proportion of cirrhotic subjects. Anti‐HDV prevalence decreased from 7.4% to 6.4% among Italians, increasing from 12.2% to 26.4% among non‐natives during 2001‐2019. Hence, HDV infection in Italians is further decreasing and mostly affects old people and subjects with advanced disease reflecting a survival effect. Conversely, non‐natives are sixfold more likely anti–HDV‐positive with an increasing trend. Migratory flow may be a new challenge for HDV infection at the beginning of the third millennium. [ABSTRACT FROM AUTHOR]

To assess the HIV -1subtypes distribution in HIV-1 positive migrants living in Milan we studied 77 HIV-1 patients followed at the San Raffaele Hospital of Milan. Twenty subjects were born in Europe, 43 in the Americas, 10 in Africa and 4 in Asia. Unsafe heterosexual activity prevailed in migrants born in Africa and male homosexuality in those born in European, American and Asian countries (p = 0.05). The phylogeny showed that 38/77 (49.3%) subjects carried HIV-B subtype while the remaining strains were classified as not pure HIV-1 B subtypes 13/77 (16.9%) or recombinant forms 26/77 (33.8%). Female gender more frequently showed HIV-1 non-B strains and rarely HIV-1 B subtypes (12/39, 30.8% vs. 3/38, 7.9%, p = 0.02). Transmitted drug resistance was identified in 10/77 (13%) patients predominately with B subtype. Our data underscore a large heterogeneity in HIV-1 subtypes and a large proportion of recombinant forms. [ABSTRACT FROM AUTHOR]

Purpose: Various suggested paths for greening logistics and supply chains often address the specific perspectives of single supply chain actors. Drawing on stakeholder theory, the purpose of this paper is to develop a deeper understanding of the alignment between logistics service providers (LSPs) and shippers in the context of adopting more environmentally sustainable logistics practices. Design/methodology/approach: With a case study approach, a dual perspective is taken in which both LSPs and shippers were researched. The cases comprise eight LSPs and six shipper companies in Sweden, Italy and Ireland. Information was first analysed in relation to levels of environmental awareness, customer requirements and provider offerings and critical success factors (CSFs) and inhibitors. In a second step, the findings were analysed using stakeholder theory. Findings: LSPs demonstrate higher ambition levels and more concrete offerings compared to shippers' requirements for green logistics services. Paradoxically, customers are an important CSF and also an inhibitor for both LSPs and shippers. Both LSPs and shippers perceive financial factors and senior management priorities as important CSFs. The application of stakeholder theory helps to illuminate the importance of the many secondary stakeholders vs that of one or a relatively small number of primary stakeholders. Originality/value: The three-dimensional analysis of environmental alignment between LSPs and shippers reinforces existing knowledge and provides new insights. A novel use of stakeholder theory in a supply chain context underlines its usefulness in research of this kind. [ABSTRACT FROM AUTHOR]

• We studied the link of education with the etiology and stage of chronic hepatitis. • 11,107 subjects with chronic hepatitis were prospectively recruited. • A low educational level was associated with alcohol etiology and HCV etiology. • A low educational level was associated with the presence of cirrhosis. The potential link between educational level and chronic liver diseases (CLD) were explored using the mortality records of liver cirrhosis, which lack accuracy and are unable to identify the different etiological factors of liver cirrhosis. Information on the association of low educational level with the severity of CLD is lacking. To evaluate the potential association linking education level to etiology and clinical stage of CLD cases. Consecutive enrolment of 11,107 subjects with CLD aged≥18 years prospectively recruited in two national surveys in 2001 and 2014 at one of the participating Italian liver units throughout the country. Subjects were pooled in two groups: low education level (less than high school) and high education level (completed high school or beyond). The association of demographic, etiological, and clinical stage of subjects with educational level was assessed using logistic regression analysis. In the analysis low educational level was the outcome variable. A total of 11,107 subjects born in Italy (mean age 55.5 years, sex ratio 1.5) were evaluated. Multiple logistic regression analysis shows that chronic HCV infection (O.R.1,38:95%,C.I.1.23-1.55), risky alcohol intake (O.R.1.96;95%,C.I.1.73-2.21) and liver cirrhosis (O.R.1.65;95%,C.I.1.46-1.85) all resulted independently associated with less than a completed high school education. HBV infection resulted independently associated with high education level (O.R.0.74;95%,C.I.0.64-0.86), reflecting changes in HBV modes of transmission in recent decades. No association was found with CLD related to non-alcoholic fatty liver disease (O.R.1.03;95%, C.I.0.81-1.30). These findings show an independent association linking education level with viruses and alcohol-related CLD. Low educational level is associated with the severity of CLD. [ABSTRACT FROM AUTHOR]

Background: Treatment with onabotulinumtoxin A (BT-A) is safe and effective for chronic migraine (CM). Several studies assessed possible predictors of response to treatment with BT-A, but there is little knowledge on the frequency and predictors of sustained response. The aim of this study was to evaluate sustained response to BT-A in patients with CM. Main body: In this prospective open-label study, 115 patients with CM and treated with BT-A were consecutively enrolled in two Italian headache centers and followed up for 15 months. Anytime responders were defined as those patients who achieved a ≥ 50% reduction in headache days during any three-month treatment cycle compared with the 3 months prior to initiation of BT-A treatment. Sustained responders were defined as those who achieved a ≥ 50% reduction in headache days within the third treatment cycle and maintained response until the end of follow-up. Non-responders were defined as those patients who never achieved a ≥ 50% reduction in headache days during the follow-up. Headache characteristics prior to BT-A treatment were assessed in order to evaluate their ability in predicting treatment response. The 115 enrolled patients (84.3% female; median age 50 years) had a median migraine duration of 30 years (interquartile range 22–38). At the end of follow-up, 66 patients (57.4%) were classified as anytime responders. Among the 51 patients who achieved a clinical response within the third month of treatment, 33 (64.7%) were sustained responders. Patients with sustained response had a lower CM duration (median 31 vs 65 months; P = 0.030) and a lower number of headache days (median 25 vs 30; P = 0.013) at baseline compared with non-responders. Conclusions: About two thirds of patients who gain ≥50% response to BT-A within the third cycle of treatment maintain this positive response over time. More recent onset of CM and more headache-free days at baseline are associated with sustained response. We suggest not to delay preventive treatment of CM with BT-A, in order to increase the likelihood to achieve sustained clinical response. [ABSTRACT FROM AUTHOR]

Background: The epidemiology of hepatocellular carcinoma (HCC) is characterized by a dynamical temporal trend of well-established and emerging risk factors. Methods: We evaluated the temporal trend of aetiological factors of HCC over the last two decades in Italy. HCC cases were recruited from two previously published national studies in 1996 and in 2008 and HCC cases were also enlisted from two national surveys in 2001 and in 2014 enrolling consecutive subjects with chronic liver disease (CLD) referring to more than 80 liver units scattered all over the country for a 6-month period. Results: Out of the 9997 subjects with CLD recruited in 2001 and the 2408 recruited in 2014, 3.3% and 5.7% (P < 0.001), respectively, had HCC. The temporal trend of HBsAg −/HCV + HCC cases significantly linearly decreased from 71.1% in 1996 to 57.2% in 2014 (P < 0.001). Conversely, that of virus-negative cases significantly linearly increased from 12.1% to 28.3% (P < 0.001). The proportion of HBV-related HCC cases showed a steady low rate, reflecting the reduced endemicity of the infection in Italy. The proportion of HCC with compensated cirrhosis (i.e., Child–Pugh A) linearly increased over time from 55.6% in 1996 to 76.0% in 2014 (P < 0.001) reflecting the growing effectiveness of semi-annual ultrasound surveillance for early detection of HCC. Conclusion: In conclusion, with decreasing viral aetiology, an overall decrease in the incidence of HCC might be expected in the future. The proportion of metabolic diseases is conversely increasing being considered as an aetiology. The growing prevalence of metabolic disorders in the general population may further increase this trend in the years to come. [ABSTRACT FROM AUTHOR]

Abstract Background The information on the geographical characteristics of chronic liver diseases (CLD) in Italy is out-dated. Aim To provide up-dated information on the geographical pattern of patients with CLD born in Italy. Methods Patients with CLD were enrolled in two national surveys performed in 2001 and 2014, which prospectively recruited subjects aged ≥18 years referring to Italian liver units located throughout the country that apply a similar clinical approach and analytical methods. Results The total number of patients enrolled was 11,676. Alcohol-related CLD was more frequently observed in northern/central areas (25.0% vs. 20.7%, p <.001), while HBV-related (15.4% vs. 13.3%, p =.02) and HCV-related (71.2% vs. 67.1%, p <.001) CLD prevailed in southern areas/main islands (Sicily and Sardinia). These differences were stable over time. Liver cirrhosis without HCC was diagnosed more frequently in southern area/islands than in northern/central areas (23.7% vs. 18.8%, p <.01). Moreover, an increased proportion over time of patients with cirrhosis without HCC was observed both in northern/central areas (17.3% vs. 27.4%, p <.01) and in southern area/islands (22.6% vs. 27.9%, p <.01). Conclusions These up-dated findings show different geographical patterns of CLD in Italy, reflecting different behavioural habits and socio-economic conditions across the country. They may be useful to apply more adequate preventive measures and to allocate economic resources. Highlights • Alcohol-related CLD prevails in North/Central Italy (N/C) (p <.001). • HBV-CLD and HCV-CLD prevail in South Italy/Sicily/Sardinia (SI/S/S) (p =.02; p <.001) • Differences in aetiology were stable over time. • Cirrhosis was diagnosed more frequently in SI/S/S than in N/C (p <.01). • The proportion of cirrhosis increased overtime in N/C (p <.01) and SI/S/S (p <.01). [ABSTRACT FROM AUTHOR]

• Input data for 29 empirical and semi-empirical formulas are carefully detailed. • A velocity-based approach to estimate response time ungauged sites is proposed. • An objective assessment basis to be used for calibrating new formulas is suggested. When investigating the wide literature dealing with the assessment of the critical time scale for basin hydrological response, several aspects still to be clarified can be acknowledged. Despite the high sensitivity of design flood peaks to the estimated time parameter value, there is still no agreement on the conceptual and operational definitions of the basin response time, resulting in several different approaches and formulations available. In our work, we suggest a conceptual approach to either reject or recommend formulas of the characteristic basin response time for ungauged basins, with the aim of devising some practical steps in the choice of a robust formulation to be used in hydrological modelling and flood hydrograph design. To this end, 29 empirical and semi-empirical formulas, all containing a basin length and slope, have been carefully selected and their structure compared in dimensional terms, using a simple hydraulic reasoning (e.g., the Chezy formula) as indicator of hydraulic consistency. 13 hydraulically consistent formulas have been identified. Starting from wave celerities and using the river network morphology of 135 watersheds in north-western Italy, we have then investigated and compared the variability of the average flow velocities estimated using all formulas whose input data are available within the study area. By comparing the magnitude and basin scale dependence of the inferred velocities with the values observed in the literature, which generally increase with basin size, some formulas are considered not reasonable, while 5 of them are identified as more robust, i.e. consistent with the observations. These are the formulas of Chow (1962), NERC (1975), SCS (1954), McEnroe and Zhao (1999) and Watt and Chow (1985). Our findings lead to identify analytically the relationships between the exponents of each formula and those of the scaling law linking the length and slope of the basin. These relationships, driving the increase or decrease in the velocity values with basin size, allow us to identify the range of length and slope exponents in the characteristic time formulas for which velocity increases with basin area, as literature suggests. Based on the same relationships, one of the 5 formulas above can be adopted in practical applications and a guideline for calibrating new formulations can be followed. [ABSTRACT FROM AUTHOR]

Introduction: We investigated 170 HBsAg-positive immigrants living in Italy for 1-7 years to ascertain whether they may have become infected in the host country.Methods: Of 2032 adult immigrants interviewed, 1727 (85%) voluntarily adhered to a screening program for bloodborne or sexually transmitted infections. HBsAg was detected in 170 (9.8%) screened immigrants who completed the diagnostic, clinical and therapeutic process at the nearest clinic of infectious diseases. HBV molecular biology was performed applying a homemade technology. Phylogenetic signal of the datasets was obtained by a likelihood-mapping analysis using TreePuzzle.Results: Of the 170 HBsAg-positive immigrants, 133 were inactive carriers, 29 had chronic hepatitis and 8 compensated cirrhosis. HBV genotype was identified in 109 of the 113 HBV-DNA-positive immigrants and HBV-genotype-E predominated (68.9%). Of these 109, 6 (5.5%) subjects showed an HBV genotype absent or extremely rare in their native country: HBV-genotype-E in three from Eastern Europe and in one from Sri Lanka, possibly acquired from other immigrants from sub-Saharan countries, HBV-genotype-D1 in one from Burkina Faso and one from Senegal, possibly acquired in Italy.Conclusion: The data suggest that immigrants may acquire HBV infection in Italy and, therefore, HBV vaccination programs should be extended to all immigrants living in Italy. [ABSTRACT FROM AUTHOR]

Purpose This paper aims to explore knowledge management (KM) practices implemented by third-party logistics service companies (3PLs) and the main barriers slowing down the adoption of such practices.Design/methodology/approach The methodological approach used in this paper is based on a multiple case study analysis involving a set of 3PLs operating in Italy and Sweden. The empirical analysis has explored the KM practices used by 3PLs and the main barrier hindering their adoption.Findings In spite of some adoption, the findings suggest that 3PLs are not sufficiently realizing the full potential of KM. The evidence also indicates that there is a link between the type of 3PL company (in terms of the breadth and complexity of the services supplied) and the sophistication of KM tools adopted.Research limitations/implications From a research point of view, further research should focus on the validation of the link between the number and sophistication of KM tools used and the breadth of services supplied. Further research should also focus on exploring how KM can support 3PL companies in enhancing their performance.Practical implications From a practical point of view, the findings may help the management of 3PL companies to take a more strategic approach to KM and thus its contribution to the firms’ overall goals. Additionally, it is critical to conduct a careful analysis of current and future KM needs to identify the most suitable KM solutions linked to the specific characteristics of the business in which 3PLs operate.Originality/value This study provides fresh insights into the adoption of KM practices in logistics service organizations. The findings advance the limited body of knowledge regarding this topic and contribute to the further development of the study of KM. [ABSTRACT FROM AUTHOR]

Background: Gender differences in chronic liver disease (CLD) have been partially investigated. To extend the present knowledge, we evaluated 12,263 patients with CLD enrolled in two national surveys (9997 in 2001 and 2557 in 2014).Methods: The two surveys prospectively recruited patients aged ≥ 18 referring to Italian liver units throughout the country using a similar clinical approach and analytical methods.Results: The overall male to female ratio (M/F) was 1.4 (7138/5124). Compared with females, males were significantly more likely to be younger (52.9 vs. 58.7 yrs.), with HBV infection alone (13.2% vs. 9.2%) and with alcoholic liver disease alone (11.4% vs. 6.9%), but less likely to show HCV infection alone (48.0% vs. 67.9%). A male preponderance was observed in HBV-related cases (1.99) and in alcoholic-related cases (2.3), a preponderance observed both in the 2001 and in 2014 cases. In HCV-related cases, however, females predominated in 2001 (M/F 0.9) and males in 2014 (M/F 1.5).The rate of cirrhosis in alcohol-related etiology was close to 36% in both genders, a finding much higher than that observed for both sexes in HBV and HCV etiologies.Both males and females enrolled in 2014 were older (p < 0.001) and with a higher rate of cirrhosis and/or HCC (p < 0.001) than those investigated in 2001. There was a remarkable increase over time in the proportion of male abstainers (36.7% in 2001 and 64.3% in 2014).Conclusion: This study highlights important inter- and intra-gender differences in the characteristics and etiological factors of patients with CLD in Italy. [ABSTRACT FROM AUTHOR]

Background: Information on hepatitis B virus (HBV) genotypes in immigrant populations living in Italy is rare. Objectives: This study aimed at assessing the epidemiological and clinical needs to detect HBV genotypes in immigrants with HBV infection. Methods: Amulticenter screening to identifymigrantswithHBV infectionwas performed in 5 first-level clinical centers insouthern Italy. HBsAg-positive subjects were further investigated at a tertiary unit of infectious diseases. Results: Of 1727 immigrants investigated, 170 (9.8%) were HBsAg-positive. These 170 subjects were prevalently males (86.5%), aged 31.0-8.5 years and living in Italy for nearly 2.5 years, andmost commonly (80%) fromsub-Saharan Africa. TheHBVDNAwas detected in 113 (66.5%) andHBV genotype in 109 cases: genotype-Ewas found in 69.9%, genotype-A in 16.5%, genotype-Din 11.9%, and genotype-C in 2.7%. Genotype-E was detected in 70 (83.3%) of 84 migrants from sub-Saharan Africa and in 5 of the other areas. Of these 75, 16% were HBeAg-positive (hepatitis B e antigen) and none circulated anti-HDV, 69.3% were inactive HBV carriers, and 22.7% were chronic hepatitis and 8% cirrhosis patients (withmultifocal hepatocellular carcinoma (HCC) in 2 patients). The 18 subjects with genotype-A were commonly from sub-Saharan Africa (61%); half of them were inactive HBV carriers, 7 had chronic hepatitis, and 1 had liver cirrhosis. Of the 13 subjects with genotype-D, commonly fromEastern-Europe or India-Pakistani subcontinent, 8 were HBV inactive carriers and 5 had chronic hepatitis. Conclusions: The data indicate the need to extend HBV screening and vaccination programs to all immigrants fromareas at intermediate or high HBV endemicity. [ABSTRACT FROM AUTHOR]

Background: The endemicity of hepatitis delta virus infection in Italy has decreased in the last decades. Aim: To evaluate the current epidemiology of chronic delta infection in Italy and to compare the present findings with the corresponding figures from the previous studies. Methods: A cross-sectional study involving 16 referral centres scattered all over the country in 2014. Results: Out of the 513 hepatitis B surface antigen-positive subjects enrolled, 61 (11.9%) were anti-delta positive, with a sex ratio (M/F) of 2.05. The majority (80.3%) of them was 50 years or older, while the proportion of subjects younger than 30 years of age was as low as 3.3%. No difference was detected by geographical area of residence. The presence of liver cirrhosis was diagnosed in 52.4% of cases. In comparison to previous studies, a further shift towards the oldest age groups and an increasing proportion of subjects having liver cirrhosis among all anti-delta-positive subjects are observed. Conclusions: Currently, hepatitis delta infection mostly affects old people who have an advanced but indolent liver disease, reflecting a survival effect. The defective hepatitis delta virus is near to disappear in the country, where it has been discovered in the second half of 70s. [ABSTRACT FROM AUTHOR]

Background Previous cross-sectional studies have shown that hepatitis C virus (HCV) infection had been the main agent associated with liver cirrhosis in Italy. Aim To assess epidemiological, laboratory and clinical features of liver cirrhosis in Italy in 2014. Patients Out of the 2557 consecutive subjects evaluated in 16 hospitals located throughout Italy in 2014, 832 (32.6%) had liver cirrhosis and were enrolled in this study. Results The mean age of subjects was 60.3 years, with a male/female ratio of 1.7; 74.9% of cases had Child A cirrhosis and 17.9% superimposed hepatocellular carcinoma. HCV infection, alone or in combination with other aetiologic agents, was responsible of 58.6% of cases, HBV aetiology accounted for the 17.6% and alcohol abuse for the 16.0%. Compared with virus-related cirrhotic patients, those alcohol-related more frequently showed decompensation (p = 0.02). Conclusions Compared to previous surveys performed in 1992 and in 2001, we observe a statistically significant (p < 0.05) decreasing role of both HCV infection and alcohol abuse as aetiologic agents of liver cirrhosis in Italy, explaining, at least in part, the slow, progressive decline of the mortality rate for liver cirrhosis in the last decades in this country (from 34.5 deaths/100,000 inhabitants in1980 to 10.8 in 2012). [ABSTRACT FROM AUTHOR]

In this paper we show 3D physics-based numerical simulations of ground motion during one of the most devastating earthquakes in the recent Italian history, occurred on Jan 13, 1915, Marsica, Central Italy. The results provide a realistic estimate of the earthquake ground motion and fit reasonably well both the geodetic measurements of permanent ground settlement, and the observed macroseismic distribution of damage. In addition, these results provide a very useful benchmark to improve the current knowledge of near-source earthquake ground motion, including evaluation of the best distance metrics to describe the spatial variability of the peak values of ground motion, the relative importance of fault normal vs fault parallel components, the conditions under which vertical ground motion may prevail, as well as the adequacy of 1D vs 3D modelling of site amplification effects. [ABSTRACT FROM AUTHOR]

A rational evaluation of the seismic risk of urban areas cannot neglect the variability of the ground motion due to site amplification and the induced effects, such as soil liquefaction and slope stability. In this framework, the microzonation maps certainly represent the most adequate tool to account for this element in the seismic risk and for planning mitigation strategies. This study shows the preliminary results of a multidisciplinary research, which deals with the seismic microzonation of the Western area of Napoli. The selected case study is a challenging choice, as the seismic hazard is affected by both tectonic and volcanic seismicity, which in historical time differently affected the urban setting. The latter, in turn, results highly heterogeneous, as consisting of a mixing of both masonry and concrete structures. The adopted approach followed the recommendations of both the National and International Guidelines, with reference to the multi-levels methods. The collection, homogenization and synthesis of a significant number of existing data permitted the development of reliable geological and geotechnical subsoil models, leading to Grade I and II seismic microzonation maps, characterized by different expected amplification of ground motion and instability due to the liquefaction. Such maps represent a key for a quantitative assessment of seismic performance of buildings and infrastructures, in view of the expected urban requalification of the area. [ABSTRACT FROM AUTHOR]

Patients transfers are an essential routine in care supplying and are considered a crucial form of inter-hospital collaboration in any Regional Health System. Previous organizational studies about the phenomenon adopted the resource dependency theory, demonstrating that transfers occur for because resources are not homogenously distributed between hospitals. More recently, it has been observed that patient transfers are driven by complex system of determinants and not only by the lack of resources. This paper, adopting a geographical view, observed that the theoretical lens of proximity are useful to better understand the phenomenon. Analyzing data on the patients transfers between the 35 hospitals of Abruzzo (Italy) Regional Health System through Multiple Regression-Quadratic Assignment Procedure, the study demonstrated that the different dimensions of proximity have a significant impact on the inter-hospitals patients transfers. Policy makers, health care executives and health geographers may take into account these logics in designing the territorial system of care. [ABSTRACT FROM AUTHOR]

Background: This study characterizes and defines the clinical value of hepatitis B virus (HBV) quasispecies with reverse transcriptase and HBV surface antigen (HBsAg) heterogeneity in patients with acute HBV infection.Methods: Sixty-two patients with acute HBV infection (44 with genotype D infection and 18 with genotype A infection) were enrolled from 2000 to 2010. Plasma samples obtained at the time of the first examination were analyzed by ultradeep pyrosequencing. The extent of HBsAg amino acid variability was measured by Shannon entropy.Results: Median alanine aminotransferase and serum HBV DNA levels were 2544 U/L (interquartile range, 1938-3078 U/L) and 5.88 log10 IU/mL (interquartile range, 4.47-7.37 log10 IU/mL), respectively. Although most patients serologically resolved acute HBV infection, only 54.1% developed antibody to HBsAg (anti-HBs). A viral population with ≥1 immune-escape mutation was found in 53.2% of patients (intrapatient prevalence range, 0.16%-100%). Notably, by Shannon entropy, higher genetic variability at HBsAg amino acid positions 130, 133, and 157 significantly correlated with no production of anti-HBs in individuals infected with genotype D (P < .05). Stop codons were detected in 19.3% of patients (intrapatient prevalence range, 1.6%-47.5%) and occurred at 11 HBsAg amino acid positions, including 172 and 182, which are known to increase the oncogenic potential of HBV.Finally, ≥1 drug resistance mutation was detected in 8.1% of patients (intrapatient prevalence range, 0.11%-47.5% for primary mutations and 10.5%-99.9% for compensatory mutations).Conclusions: Acute HBV infection is characterized by complex array of viral quasispecies with reduced antigenicity/immunogenicity and enhanced oncogenic potential. These viral variants may induce difficult-to-treat HBV forms; favor HBV reactivation upon iatrogenic immunosuppression, even years after infection; and potentially affect the efficacy of the current HBV vaccination strategy. [ABSTRACT FROM AUTHOR]

The article presents criticism and explores the history of the documentary film "The Battle of San Pietro," directed by John Huston. Emphasis is given to topics such as the role of the film in collective memory of the Allied invasion of Italy during World War II, the recreation of combat scenes after the actual battle, and the film as an anti-war statement for Italian audiences.

This article examines some of the social implications of Italy’s limited purge of the bureaucracy and Fascist political class following the Second World War. Using the postwar personal correspondence of former Fascist government ministers Giuseppe Bottai (1895–1959) and Dino Alfieri (1886–1966), the article analyses the informal networks that promoted the continued influence of these ex-Fascists with high-ranking bureaucrats and other prominent individuals (such as Pope Paul VI and Aldo Moro). Thanks to the long-standing social practice of theraccomandazione, Bottai and Alfieri maintained their Fascist-era connections well into the postwar period, often serving as intermediaries between ‘ordinary Italians’ and governmental, political and cultural elites. Although they no longer held political power, these ex-Fascists represented a class of ‘alternative elites’ unassociated with the democratic values of the new Republic. [ABSTRACT FROM AUTHOR]

Plastic pipes are widely used in pressurized water systems. Their viscoelastic behavior has to be taken into account in the design phase as well as in the interpretation of water-hammer signals for diagnostic purposes. The aim of the present paper is to experimentally investigate the transient waves' transmission and reflection in branched networks of high density polyethylene (HDPE) pipes and to test the efficacy of a viscoelastic model for the interpretation of the results. Two laboratory Y-shaped systems were built in the Water Engineering Lab of the University of Cassino and Southern Lazio (Italy) and a set of water-hammer tests was conducted on them. A significant variation of transmission and reflection coefficients at the pipe junction is observed in comparison with the values suggested in classical textbooks. The strong agreement between the experimental pressure values and those obtained using the viscoelastic model suggests that the differences from the classical theory are due to the viscoelastic behavior of the material, since unsteady friction effects are negligible in the investigated scenarios. [ABSTRACT FROM AUTHOR]

Background To evaluate the role of computed tomography ( CT) and positron emission tomography ( PET)/ CT in patients with thymic cancer and thymoma at initial staging. Methods We retrospectively reviewed CT and PET/ CT scans of 26 patients with a thymic cancer ( n = 9) or thymoma ( n = 17). Chest CT findings documented were qualitative and quantitative. Both qualitative and semiquantitative data were recovered by PET/ CT. The comparisons among histological entities, outcome, and qualitative data from CT and PET/ CT were made by non-parametric analysis. Results PET/ CT resulted positive in 15/17 patients with thymoma. CT was available in 5/9 (56%) patients with thymic cancer and in 3/17 with thymoma. All quantitative CT parameters were significantly higher in patients with thymic cancer than thymoma (maximum axial diameter: 45 vs. 20 mm, maximum longitudinal diameter: 69 vs. 21 mm and volume: 77.91 vs. 4.52 mL; all P < 0.05). Conversely, only metabolic tumor volume ( MTV) and total lesion glycolysis were significantly different in patients with thymic cancer than thymoma (126.53 vs. 6.03 cm3 and 246.05 vs. 20.32, respectively; both P < 0.05). After a median follow-up time of 17.45 months, four recurrences of disease occurred: three in patients with thymic cancer and one with a type B2 thymoma. CT volume in patients with recurrent disease was 102.19 mL versus a median value of 62.5 mL in six disease-free patients. MTV was higher in the recurrent than disease-free patient subset (143.3 vs. 81.13 cm3), although not statistically significant ( P = 0.075). Conclusion Our preliminary results demonstrated that both morphological and metabolic volume could be useful from a diagnostic and prognostic point of view in thymic cancer and thymoma patients. A large multi-center clinical trial experience for confirming the findings of this study seems mandatory. [ABSTRACT FROM AUTHOR]

MUBIL is an international research project aiming at establishing a novel learning framework based on Virtual Environments technologies in order to disseminate the content of libraries archives, especially ancient manuscripts. The project, lead by the Gunnerus Library of Trondheim, Norway, and participated by the NTNU (Norway) and Scuola Sant'Anna (Italy), has the secondary objective of testing the extent to which distinctive features of Virtual Environment, such as immersion and interaction, impact on the involvement of the public, especially youngster, and therefore on the efficacy of the transmission of content, such as old books, traditionally challenging to disseminate to such a public. The framework includes three different levels of development, described in this paper, and is expected to establish a methodology for the evaluation of the achieved results in the last stages of the project, ending in October 2013. [ABSTRACT FROM AUTHOR]

Background: A survey was performed in 2008 to evaluate the profiles of patients with chronic hepatitis B cared for by Italian Infectious Diseases Centers (IDCs). This analysis describes: i) factors associated with access to the anti-HBV treatment in a cohort of HIV/HBV coinfected patients cared for in tertiary centers of a developed country with comprehensive coverage under the National Health System (NHS); ii) consistency of current anti-HBV regimens with specific European guidelines in force at the time of the study and factors associated with the receipt of sub-optimal regimens. Methods: The study focuses on 374 (87.6%) treated patients at some point in their life out of the 427 tested HIV/HBV positive. It is multicentre, cross-sectional in the design. To account for missing values, a Multiple Imputation method is used. Results: Three hundred and thirty-four (89.3%) patients were currently treated. The most common current regimen was combination therapy of tenofovir (TDF) plus LAM/FTC (lamivudine/emtricitabine) (n = 235, 70.4%), as part of antiretroviral treatment. In the multivariate analysis, an increased chance of getting treated was independently associated with increasing years since HBV diagnosis (2-10 years, p <0.001; >10 years, p <0.001). Patients consistently treated with European AIDS Clinical Society (EACS) 2008 guidelines were 255 (76.6%), of whom 202 (79.2%) with an indication to an anti-HIV treatment, 30 (11.8%)without an indication, and 21 (8.2%) with cirrhosis. Among the 78 not-consistent patients, LAM mono-therapy (n = 60, 76.9%) was the most common regimen, 34 (56.7%) of them showing HBV DNA load below 1×10³ IU/mL. Previous anti-HBV treatment (p = 0.01) and a triple HDV co-infection (p = 0.03) reduced the chance of not-consistent regimens. Conversely, HCV co-infection was independently associated with an increased odds ratio of being inconsistently treated (p = 0.004). Conclusion: Our study shows that Italian IDCs treat for HBV infection the vast majority of HIV/HBV co-infected patients with no disparities limiting access to antiviral therapy. In approximately two-thirds of the patients on treatment, anti-HBV regimens are consistent with 2008 EACS guidelines. Finally, our study identifies scenarios in which clinical practice deviates from recommendations, as in case of sub-optimal regimens with effective anti-HBV response. [ABSTRACT FROM AUTHOR]

The article discusses the use of positron emission tomography (PET) with fluorodeoxyglucose (FDG)/Computed Tomography in monitoring the response to hormonal therapy among patients with breast cancer in Italy. It notes that the findings reveal that serum calcium (CA)-15.3, an assay used to assess therapy response in breast cancer patients must be associated with diagnostic imaging including FDG PET/CT. This imaging system could help in obtaining disease stabilization and prolonged palliation.

Knowledge Management (KM) is a critical area for small business managers in today's competitive environment. However, there is a general consensus in relation to the fact that the benefits of KM have not been fully exploited by small firms. In fact, despite the wide literature on KM, there is an abundance of research describing how large companies are successfully practising KM, but little contributions on the critical success factors for KM adoption in SMEs. Indeed, empirical studies have been rarely conducted on this topic. The main aim of this paper is to shed light on the KM practices in small firms. To this purpose, the paper presents the preliminary results of an empirical investigation carried out in a cluster of 25 high-technology SMEs located in the eastern area of Naples City (Italy). The methodology adopted is based on the following two main stages: a) a literature review on knowledge management and its usage in small business has been carried out; b) a semi-structured questionnaire has been set up and validated in a number of focus group discussions. The questionnaire survey has been conducted through interviews with managers of small firms belonging to the cluster investigated. Survey findings highlight the following points: - the surveyed companies show significant KM needs, but they adopt mainly internal KMSs that involve relatively simple ICT tools; - knowledge exchanged is mainly tacit and it requires KM tools based on personal relationships and interactions such as work teams; - ENS firms express the need for both internal and external KMSs enabling collaborative relationships with other firms for developing common projects; - there are some relevant factors motivating the adoption of internal and external KMSs in firms investigated (such as innovation, operational management and market features) but also significant barriers (such as the protection of intellectual capital and cultural barriers). [ABSTRACT FROM AUTHOR]

A relatively small number of freshwater dinoflagellates are involved in symbiotic association with cryptophytes. The chloroplasts of the cryptophytes are retained by the dinoflagellate and give it the characteristic phycobilin pigmentation, either phycoerythrin or phycocyanin. The pigment characterization of the retained chloroplasts can give precise and accurate information about the type of cryptophyte preyed upon by the dinoflagellate. For this purpose, we performed microspectrophotometric evaluation of the pigments of Gymnodinium acidotum Nygaard and three different cryptophytes present in samples collected from a tributary of the river Arno, in Tuscany (Italy). The comparison of the different spectroscopic data allowed us to discriminate effectively among the cryptophytes preyed upon by the dinoflagellate. [ABSTRACT FROM AUTHOR]

Abstract  In recent years, rock fall phenomena in Italy have received considerable attention for risk mitigation through in situ observations and experimental data. This paper reports the study conducted at Camaldoli Hill, in the urban area of Naples, and at Monte Pellegrino, Palermo, Italy. The rocks involved are volcanic Neapolitan yellow tuff (NYT) in the former area and dolomitic limestone in the latter. Both rocks, even though with different strength characteristics, have shown a significant tendency towards rock fragmentation during run out. This behavior was first investigated by comparing the volumes of removable blocks on the cliff faces (V 0) and fallen blocks on the slopes (V f). It was assumed that the ratio V f/V 0 decreases with the distance (x f) from the detachment area by an empirical law, which depends on a coefficient α, correlated with the geotechnical properties of the materials involved in the rock fall. Finally, this law was validated by observation of well-documented natural rock falls (Palermo) and by in situ full-scale tests (Naples). From the engineering perspective, consideration of fragmentation processes in rock fall modeling provides a means for designing low-cost mitigation measures. [ABSTRACT FROM AUTHOR]

We evaluated 1336 hepatitis B surface antigen-positive subjects consecutively observed in 79 Italian hospitals over a 6-month period. The proportion of hepatitis B e antigen-negative cases was 86.4%, that of patients coinfected with hepatitis D virus was 9.7%, and the rate of patients coinfected with hepatitis C virus was 16.8%. Multiple logistic regression analysis showed that age >49 years, alcohol abuse, and anti- hepatitis D virus and anti-hepatitis C virus positivity were independent predictors of progression to liver cirrhosis. [ABSTRACT FROM AUTHOR]

Background: Trastuzumab is a monoclonal antibody selectively directed against Her2 and approved for the treatment of Her2 overexpressing breast cancer patients. Its proposed mechanisms of action include mediation of antibody-dependent cellular cytotoxicity (ADCC) by triggering FcγRIII on natural killer (NK) cells. This study addresses the correlation between overall NK function and trastuzumab's clinical activity. Subjects and methods: Clinical and immunological responses were assessed in 26 patients receiving trastuzumab monotherapy as maintenance management after chemotherapy (8 mg/kg load and then standard doses of 6 mg/kg every 3 weeks). Cytotoxic activity against the MHC class I-negative standard NK target K562 cell line and HER2-specific ADCC against a trastuzumabcoated Her2-positive SKBR3 cell line were assessed in peripheral blood mononuclear cells (PBMC) harvested after the first standard dose. After six months, seventeen patients were scored as responders and nine as non-responders according to the RECIST criteria, while Progression-Free Survival (PFS) was calculated during a 12 months follow-up. Results: The responders had significantly higher levels of both NK and ADCC activities (p < 0.05) that were not different from those of eleven normal controls. The NK activity of the nonresponders was significantly (p < 0.05) lower than that of the normal controls. At twelve months, there was a marked correlation between PFS and NK activity only. PFS was significantly longer in patients with high levels of NK activity, whereas its pattern was unrelated to high or low ADCC activity. Conclusion: One of the mechanisms of action of trastuzumab is NK cell-mediated ADCC lysis of the Her2-positve target cell. We show here that its potency is correlated with the short-term response to treatment, whereas longer protection against tumor expansion seems to be mediated by pure NK activity. [ABSTRACT FROM AUTHOR]

Objectives. Cholesteryl ester transfer protein (CETP) plays a key role in the metabolism of high-density lipoprotein (HDL), a strong, inverse, independent risk factor for cardiovascular disease. We sought to investigate the relationship between a common variant of CETP gene, the Taq1 B polymorphism, that has been previously associated with CETP blood concentrations, and the risk of ischaemic stroke in a genetically homogenous population from the Sardinia island, Italy. This population has been previously shown to be a highly conservative sample. Design. A total of 215 cases of ischaemic stroke and 236 controls were selected and characterized for the CETP Taq1 B polymorphism. Allele and genotype frequencies were compared amongst cases and controls. Results. Age, hypertension and hypercholesterolaemia were independent risk factors for stroke in this cohort. We found that presence of the CETP Taq1 B2 allele was associated with a significantly decreased risk of ischaemic stroke when assuming a recessive mode of inheritance (OR 0.55, 95% CI = 0.34–0.90, P = 0.017). This result was confirmed by multivariate analysis, after adjustment for age, presence of hypertension and hypercholesterolaemia (OR 0.53, 95% CI = 0.32–0.88, P = 0.014). By performing separate analysis for gender we found that the effect was present in females but not in males, with a significant sex-CETP gene variant interaction for both recessive ( P = 0.005) and additive ( P = 0.029) modes of inheritance. Conclusions. Our data suggest that the Taq1 B2 allelic variant of the CETP gene may be associated, as a protective factor, with occurrence of ischaemic stroke. Further studies are needed to further elucidate the clinical implications of our finding. [ABSTRACT FROM AUTHOR]

Purpose -- In today's supply chain management practices, a successful strategy depends increasingly on the performance of third party logistics (3PLs) providers as they play a key integrative role linking the different supply chain elements more effectively. Information and communications technology (ICT) has become an important element of 3PL competitive capability as it enables higher levels of supply chain integration. Recent industry developments have widened the technological gap between large and small 3PLs. This is critical particularly for those markets populated by a large number of small 3PLs such as the Italian logistics industry. The purpose of this paper is to provide an overview of ICT adoption in small logistics service providers. The focus of the study is the Italian 3PL market. Design/methodology/approach -- The methodology adopted in this paper is based on the action research framework and it is a combination of theoretical analysis and empirical findings (focus groups and surveys). Firstly, a literature review on ICT dissemination in the international and Italian 3PL industry has been carried out. Then, a field survey has been developed preceded by two focus groups. The empirical investigation examined a sample of 153 small Italian 3PLs on the base of a definition and taxonomy proposed by the authors. Findings -- The results provide a useful technological profile of the surveyed companies, as well as an analysis of the role of ICT in customising services and of the factors influencing ICT adoption. Research limitations/implications -- To give a more robust scientific justification of the survey results, it would be useful to carry out an additional large-scale analysis including other countries with a high presence of small logistics service companies. Furthermore, a complementary case-study analysis would be of help in defining the role of specific factors in different types of 3PL. Further investigations in this field are needed to better understand innovation paths, and how ICT can improve the competitive capabilities of 3PLs and of the wider supply chain. Practical implications -- Managers of small 3PLs can use the findings to set-up guidelines for improving a company's technology innovation. Technology vendors can use the findings to better market their service/product into the small logistics service provider segment. Originality/value -- Despite the fact that much has been written about the dissemination of ICT, there is still a shortage of research in the field of small 3PLs with little empirical investigation into the usage of ICT by small 3PLs. This paper provides a contribution to filling this void and suggests some possible research directions. [ABSTRACT FROM AUTHOR]

The aim of the study is to evaluate the efficacy and tolerability of the five triptans that are commercially available in Italy (zolmitriptan 2.5 mg, rizatriptan 10 mg, sumatriptan 100 mg, almotriptan 12.5 mg and eletriptan 40 mg). The study was conducted in single-blind versus placebo and its duration was 18 months. At the Headache Centre of the ‘Agostino Gemelli’ Hospital in Rome we selected 42 patients, suffering from headache with and without aura (International Headache Society Committee on Headache Classification, 1988 Cephalalgia 8:1–96), whose headache frequency ranged between 1- and 4-monthly crises. For a total of 25 crises, for every five consecutive crises, a different triptan was taken. The end-points of the study were as follows: response at 2 h, ‘pain free’ at 2 h and ‘sustained pain free’ (at 24 h). The intra-patient consistency and the tolerability were also evaluated. Thirty patients completed the study and the statistical analysis was only applied to these patients. No substantial difference in terms of the efficacy of the triptans was noted; all triptans were well tolerated. These results suggest the possibility of testing different triptans in the same patient in order to identify the ideal drug for every patient. [ABSTRACT FROM AUTHOR]

OBJECTIVE:: Nutritional status and lifestyle can have profound effects on health. To analyse behaviour patterns in population subgroups of public health importance, we compared lifestyle, dietary intake of energy and selected nutrients, and nutritional biomarkers of type 1 diabetes (T1DM) patients and nondiabetic first-degree relatives against control subjects with no family history of T1DM. DESIGN:: A cross-sectional study. SETTING:: Department of Internal Medicine, University of Pisa, Italy. SUBJECTS:: A total of 209 individuals including 38 type 1 patients, 76 relatives, and 95 healthy subjects. INTERVENTIONS:: We used the European Prospective Investigation of Cancer and Nutrition questionnaires to assess dietary intake and lifestyle. Anthropometric indices and nutritional biomarkers (such as plasma levels of albumin, iron, lipids, homocysteine, vitamin B9 and vitamin B12 as well as urinary outputs of nitrogen, sodium and potassium) were evaluated. RESULTS:: Emerging health issues:(1) In total, 45%of controls were overweight. Increasing age was associated with increasing body mass and decreasing activity in sport in front of an unchanged energy intake.(2) The distribution of energy sources was incorrect. The proportion of caloric intake derived from total fat and cholesterol did not match general guidelines. Total dietary fibre consumption was assessed to be adequate (25?g/day) in only 27%of all the participants.(3) Estimated daily intakes of water-soluble vitamin B9 and fat-soluble vitamin D and vitamin E were deficient in comparison with dietary reference intakes.(4) The prevalence of adoption and maintenance of healthful eating and physical activity habits was higher in women and T1DM patients (probably as a consequence of the medical educational intervention). On the contrary, supportiveness of the family in term of changing the undesirable behaviours at home seemed to fail. CONCLUSIONS:: This study provides first evidence indicating unhealthy dietary behaviours, which could even predispose to the development of diabetes and cardiovascular complications, in subjects living in Pisa. The combination of vitamin B9 and vitamin E deprivation could be deleterious for endothelial function, since these antioxidants have been implicated in the modulation of nitric oxide and eicosanoid signalling. SPONSORSHIP:: This study was supported by a grant from the Ministry of Education, University and Research, Italy.European Journal of Clinical Nutrition (2005) 59, 114-122. doi:10.1038/sj.ejcn.1602047 Published online 1 September 2004 [ABSTRACT FROM AUTHOR]

The empirical target of this article is two-fold: exploring the variety of regional innovative patterns in Italy; and assessing whether innovation systems can be found, and how they operate, at a sub-national scale. The empirical analysis is based on an in-depth analysis of the data provided by the first Community Innovation Survey (CIS). The article shows that the traditional north-south distinction does not give full account of the wider spectrum of regional patterns in Italy. In particular, regional innovative patterns differ not only according to the specific strategies and technological performances of firms, but also according to the relevance of systemic interactions and the presence of contextual factors favourable to innovation. However, proper regional systems of innovation are found only in a few well-defined areas. In most regions, systemic interactions and knowledge flows between the relevant actors are simply too sparse and too weak to reveal the presence of systems of innovation at work. [ABSTRACT FROM AUTHOR]

In this paper, the role of Italian shipping firms in the logistic services market is defined in light of major changes under way. The first part analysed the structural characteristics of the supply and demand for logistic and transport services, in which a situation of substantial weakness emerged. This situation has favoured the large-scale entry of foreign operators on the Italian market which perceive Italy as a key node within the international scenario of transport and logistics. The second part of the paper focused on the analysis of individual areas in Italian shipping and their capacity to differentiate service by supplying value added logistic services beyond transport. The analysis showed a position of substantial marginality for Italian shipping, a position which gives rise to several doubts regarding its capacity to face the challenge of international competition successfully. [ABSTRACT FROM AUTHOR]

Examines characteristics underlining the export activities undertaken by footwear firms in the Naples, Italy area and considers strategies for recovering international competitiveness based on broader interactive collaboration between producers and commercial intermediaries. Commercial intermediaries and internationalization of small and medium-sized enterprises (SME).