Search

Abstract: The 2009-2010 L’Aquila seismic sequence is still slightly occurring along the central Apenninic Belt (August 2010), spanning more than one year period. The main- shock (Mw 6.3) occurred on April 6th at 1:32 (UTC). The earthquake was destructive and caused among 300 casualties. The hypocenter has been located at 42.35 °N, 13.38° at a depth of around 10 km. The main shock was preceded by a long seismic sequence starting several months before (i.e., March, 30, 2009 with Mw 4.1; April, 5 with Mw 3.9 and Mw 3.5, a few hours before the main shock). A lot of evidences stress the role of deep fluids pore-pressure evolution–possibly CO2 or brines - as occurred in the past, along seismically activated segments in Apennines. Our geochemical group started to survey the seismically activated area soon after the main-shock, by sampling around 1000 soil gas points and around 80 groundwater points (springs and wells, sampled on monthly basis still ongoing), to help in understanding the activated fault segments geometry and behaviour, as well as leakage patterns at surface (CO2, CH4, Radon and other geogas as He, H2, N2, H2S, O2, etc …), in the main sector of the activated seismic sequence, not far from a deep natural CO2 reservoir underground (termomethamorphic CO2 from carbonate diagenesis), degassing at surface only over the Cotilia-Canetra area, 20 km NW from the seismically activated area. The work highlighted that geochemical measurements on soils are very powerful to discriminate the activated seismogenic segments at surface, their jointing belt, as well as co-seismic depocenter of deformation. Mostly where the measured “threshold” magnitude of earthquakes (around 6), involve that the superficial effects could be absent or masked, our geochemical method demonstrated to be strategic, and we wish to use these methods in CO2 analogues/ CO2 reservoir studies abroad, after done in Weyburn. The highlighted geochemical - slight but clear anomalies are, in any case, not dangerous for the human health and keep away the fear around the CO2–CH4 bursts or explosions during strong earthquakes, as the L’Aquila one, when these gases are stored naturally/industrially underground in the vicinity (1–2 km deep). These findings are not new for these kind of Italian seismically activated faults and are very useful for the CO2–CH4 geological storage public acceptance: Not necessarily (rarely or never) these geogas escape abruptly from underground along strongly activated faults. [Copyright &y& Elsevier]

Abstract: Italy is one of the most promising prone areas to study the CO2 behavior underground, the caprock integrity to the CO2 leakage, mostly in presence of pervious/geochemically active faults, due to a wide availability of CO2 rich reservoirs at a depth between 1 and 10 km, as highlighted by recent literature. These deep CO2 reservoirs generate at least 200 leakage areas at surface throughout Italy which have been defined “Diffuse Degassing Structures” (DDS) by INGV. These are widely studied by INGV institutionally by a long term convention with the Civil Protection Department (DPC) with the aim to catalog, monitor and assess the Natural Gas Hazard (NGH, namely the probability of an area to become a site of poisonous peri-volcanic gas exhalation from soils). More than 150 researcher of INGV are involved in monitoring areas affected by the CO2 presence underground and at surface, by continuous monitoring on-line networks (around 40 stations throughout Italy, including the Etna area, Aeolian Islands, Umbria region, Piemonte region, etc.) and discretely (9 groups of research were involved in the last years to localize, define and monitor almost all the DDSs in Italy), by sampling and analyzing chemical and isotopic compounds, useful to discriminate the origin, evolution and natural gas hazards of the examined DDS. In this paper, we will discuss some DDS catalogued and studied by a Rome INGV Research Unit (UR 11) which focused its work in Central Italy, throughout different DDS, also in relation to the diverse seismotectonic settings, to discover buried faults as possible gas leakage pathways, mostly if they are “geochemically” activated. In particular we discuss, among the discrete monitoring techniques exploited by INGV, soil gas surveying, which consists in a collection of gas samples from the soil zone not saturated (dry zone) to measure the geogas gaseous species both in fluxes (CO2, CH4, 222Rn) and in concentration (He, H2, H2S, helium, hydrogen, CO2, CH4, 222Rn), that permeate the soil pores. The total CO2 flux budget was calculated as “baseline” degassing rate of these “ CO2 analogues”. A good discrete areal monitoring is prerequisite to design sound continuous monitoring network to monitor CO2 related parameters in liquid/gas phases, to review the protocol of the Annex II of the European Directivity on CCS. [Copyright &y& Elsevier]

Soon after the M W = 6.0 main event of May 20, 2012 that struck the central part of the Emilia-Romagna region (Italy), several geochemical surveys were carried out on groundwater within the epicentral area. A total of 20 water samples were periodically collected, from May 2012 to July 2014, from shallow (up to 6 m depth) to deep (down to 175 m depth) wells within both unconfined and confined aquifers and analyzed for major ions, trace elements, dissolved gases and stable isotopes (δ2H–H 2 O, δ18O–H 2 O and δ13C-TDIC). Geochemical data were compared with previous data collected and analyzed in 2006 in a phase of absence of significant seismic activity. Monitored waters showed concentration variations in post-earthquake sampling on a large number of geochemical parameters. Many of these variations were recorded during the co-seismic phase and were transient as the geochemical parameters returned towards pre-earthquake values over time. The most significant transient variations involved trace elements, which generally show high sensitivity even to small variations in the surrounding environment due to their usually low concentrations in groundwater. Physical-chemical parameters (water temperature, pH, TDS) and major ions provided less unambiguous indications, whereas among dissolved gases CH 4 and CO 2 showed a general post-seismic increase within the unconfined aquifer. Increased contents of such gas species in both aquifers (this study) and soils (previous studies) suggest that the seismic-induced overpressure on the ground had enhancing effects on soil permeability and porosity and triggered their co-seismic migration upwards from deeper reservoirs. Water isotopes showed the systematic post-seismic change in δ2H toward heavier compositions with no significant changes in the δ18O, which was interpreted as due to isotopic exchange between water and a H 2 -bearing gas phase (e.g., H 2 S, CH 4 , H 2) entering the system. Calculated δ13C data of CO 2 suggested a relatively shallow production from both plant-root respiration and microbial-driven degradation of organic matter while the almost pure crustal origin of He (R/R a values = 0.04–0.16 from the bubbling gas phase emitted by one of the monitored wells) reasonably excludes any evidence of both primary mantle 3He degassing and ascent of heavier CO 2 from deep (mantle, decarbonation) inorganic sources. Monitored waters which showed the most significant transient variations are aligned in the same E-W direction along which the seismicity and soil gas anomalies were distributed, at about 5 km S from the epicenter of the May 20th seismic event and along the main direction of the May 29th (M W = 5.8) event. This confirms that the transient variations have been activated by the seismic sequence in a sector of the crust where the presence of a fault/fracture system favors the intensification of processes affecting sediments and groundwater (variations of porosity/permeability of soils, the groundwater level, redox state, etc.) and which are able to explain the observed geochemical variations. Only one sample monitored, the one closest to the epicenter of the May 20th event, showed clear geochemical evidence suggesting the hypothesis of mixing between superimposed water bodies. • Groundwater was monitored in the area struck by the 2012 Emilia seismic sequence. • Geochemical data were compared with pre-earthquake collected data. • Transient changes affected all the parameters and samples analyzed in different ways. • Trace elements proved to be the best indicators of earthquake-related changes. • Samples with larger transient variations align in the direction of recorded seismicity. [ABSTRACT FROM AUTHOR]

Abstract: Reaction path modelling, coupled with preparatory inverse modelling, was applied to test this model''s ability to reproduce the wide compositional range of ground waters circulating in a restricted area in Piedmont, Italy. This approach is based on the assumption that the chemistry of groundwater evolves through a series of partial equilibria with secondary minerals until it reaches its final composition. PHREEQC [Parkhurst, D.L., Appelo, C.A.J., 1999. User''s guide to PHREEQC-A computer program for speciation, reaction-path, 1D-transport, and inverse geochemical calculations. U.S. Geological Survey Water-Resources Investigations Report, pp. 99-4259] and EQ3/6 [Wolery, T.J., Daveler, S.A., 1992. EQ6, A Computer Program for Reaction Path Modeling of Aqueous Geochemical Systems: Theoretical Manual, User''s Guide and Related Documentation (version 7.0). Report UCRl-MA-110662 PT IV. Lawrence Livermore National Laboratory, Livermore, California] software packages were used to effect simulations. Reaction-path modelling was performed in time mode, taking into account the different rates of dissolution of each dissolving mineral. Data from literature regarding the kinetic parameters of dissolving minerals and the mineralogical composition of the host-rock were used. The results of the reaction-path modelling show that the composition of the analysed water samples was adequately reproduced, notwithstanding the hydrogeological complexity of the studied area. Modelling results provided very different water compositions as an effect of the chemical maturity, the physico-chemical parameters (f CO2 , f O2 , and temperature) and the variable amounts of gypsum among dissolving rock-forming minerals, which occur in Miocene levels of the sedimentary sequence. Further variability is related to the occasional contribution of brackish waters trapped in euxinic marly sediments, locally sealed by overlying clays, that have assumed an artesian character. The composition of some of the water samples can only be predicted by simulation runs performed at a temperature higher than that of the outlet (40 °C). These warm waters probably circulate in a restricted area near the town of Nizza Monferrato. The same area has recently been affected by moderate seismicity, which has been accompanied by changes in either the temperature or chemistry, or both, of the ground waters. The changes recorded, interpreted as having been triggered by variations in the local/regional stress load and/or seismic activity, have to be ascribed to the vertical heterogeneity of the aquifers, where waters of different temperature, salinity and chemical composition circulate and occasionally mix. [Copyright &y& Elsevier]

Soil gas and Electrical Resistivity Tomography (ERT) surveys were performed in Medolla (Emilia-Romagna Region, northern Italy) within a farming area characterized by macroseeps, absence of vegetation and anomalous temperatures of soil to investigate the soil gas migration mechanism and verify the presence of a buried fault intersecting the macroseeps. Soil gas (222Rn, 220Rn, He and C 2 H 6) concentrations and flux (φCO 2 and φCH 4) measurements were carried out from 2008 to 2015, comprising the 2012 Emilia seismic sequence. Moreover, in 2016 a ERT survey, combined with new flux measurements, was performed along four profiles (ranging from 180 to 630 m long) centered on the main macroseep. We found that the seismic sequence sensibly influenced the soil gas distribution in the area. All investigated species, but He, increased their values early after the mainshocks, likely due to crustal deformation which promoted the geogas uprising. In 2015, when the stress has vanished, these concentrations gradually decreased toward pre-seismic values. Helium concentrations showed an opposite behavior as they decreased in May 2012 and then gradually increased over time. This trend may be reasonably due to the enhancement of the strain field which promoted the He dissipation from soil to the atmosphere, due to its high volatility. In all the geochemical surveys conducted from 2008 to 2015, soil gas high values around the main macroseeps were identified, delighting the presence of an alignment in the E-W direction. This trend, identified for several gas species, ultimately supports the theory of a hidden fault which favors the intensification of fluids migration along zones characterized by greater permeability. ERT results highlighted a sub-horizontal layering characterized by different resistivity intervals, roughly matching local stratigraphy. In most profiles we observed a slightly increase of resistivity and a sharp interruption of the electro-layering in correspondence of the main macroseep, both near the surface and at depth. This implies that a fracture zone due to the presence of a buried fault cannot be excluded. The combined use of geochemical and geophysical techniques in this study confirmed the usefulness of such multiparametric approach for mapping out hidden structures in tectonically active areas, allowing to better understanding the fluid migration processes through preferential leakage pathways. • Soil gas and CO 2 and CH 4 fluxes were measured between 2008 and 2015 in the Terre Calde di Medolla. • All geochemical data revealed higher gas values in the macroseeps zones. • The migration of investigated soil gas species is affected by the 2012 seismic sequence occurrence. • Geoelectrical survey provided the evidence of the intense fluid upraise in correspondence of the main macroseep. • Main goal is to delineate the presence of a buried fault by a multidisciplinary approach. [ABSTRACT FROM AUTHOR]

The urbanized area of Rome is largely built over volcanic deposits, characterized by a significant radionuclides content and consequently a high radon emanation potential. An accurate monitoring of workplaces and residential dwellings constitutes a first step towards mitigating the indoor radon exposure. Since radon diffusion dynamics involves complex interactions among many environmental parameters on different time scales, a proper assessment of radon concentration variations can be better achieved by means of active monitoring approaches. We present here the results of 1 year of continuous measurements conducted in six premises (five apartments and a basement) at different floors of the same building in the Esquilino district, in the historical center of Rome. Collecting annual series of radon concentration enables us to identify fluctuations over a seasonal scale, with radon generally decreasing in the warm season. The simultaneous tracking of different floors should cancel the influence of geogenic radon and of building characteristics like age, typology, and construction materials. While the basement shows the highest radon concentration, indicating a major contribution from the ground, we observe indoor radon levels comparable at all the upper floors, questioning the common belief that high-risk exposure be limited to the lowest storeys. The use of active devices makes it possible to discriminate between average indoor radon measured during the day and overnight, when residents are more likely to be at home. Our analysis provides the characterization of the dynamics of the gas emanation and transport inside the buildings and of its temporal fluctuations, in relation to the environmental and meteorological conditions. Since the experiment was performed in the Roman urban contest, we cannot ignore the specificity of the retrieved data, affected not only by endogenous factors like life habits relative to ventilation and conditioning of the apartments, but also by exogenous factors, among which the warmer microclimate compared to the surrounding suburban and rural areas, due to the effects of urbanization (urban heat island effect)., (© 2024. The Author(s).)

Radon ( 222 Rn) is the second most common cause of lung cancer after smoking. As radon poses a significant risk to human health, radon-affected areas should be identified to ensure people's awareness of risk and remediation. The primary goal of this research was to investigate the local natural radioactivity (in soils, groundwater, and indoors) because of the presence of tuff outcrops (from middle-lower Pleistocene volcanic activity) that naturally produce radioactive gas radon at Cerveteri (Rome, Central Italy). The results of the radon survey highlighted moderate (>16,000 Bq/m 3 ) but localized anomalies in soils in correspondence with a funerary site pertaining to the Etruscan Necropolis of Cerveteri, which extends over a volcanic rock plateau. Indoor radon measurements were performed at several tuff-made dwellings, and the results showed medium-low (<200 Bq/m 3 ) values of indoor radon except for some cases exceeding the reference level (>300 Bq/m 3 ) recommended by the 2013/59 Euratom Directive. Although no clinical data exist regarding the health effects of thoron ( 220 Rn) on humans, the study of 220 Rn average activity concentration in the soil gas survey reveals new insights for the interpretation of radon sources that can affect dwellings, even taking into account the considerable difference in the half-lives of 222 Rn and 220 Rn.

The Italian Association of Medical Oncology recommendations on thymic epithelial tumors, which have been drawn up for the first time in 2020 through an evidence-based approach, report indications on all the main aspects of clinical management of this group of rare diseases, from diagnosis and staging, to new available systemic treatments, such as targeted therapies and immunotherapies. A summary of key recommendations is presented here and complete recommendations are reported as Supplementary Materials, available at https://doi.org/10.1016/j.esmoop.2021.100188., Competing Interests: Disclosure The authors have declared no conflicts of interest., (Copyright © 2021 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Il "progetto Michelangelo" è nato dall'esigenza di rallentare la diffusione dei contagi da SARS-CoV-2 e alleggerire il carico a livello ospedaliero. Inizialmente, la maggior parte degli ospiti dell'hotel Michelangelo di Milano erano pazienti dimessi dagli ospedali con test molecolare ancora positivo che non avevano la possibilità di restare in isolamento domiciliare. Ben presto, però, il progetto è stato esteso e circa un ospite su quattro era un adulto/nucleo familiare in condizioni di grave disagio economico o sociale o una persona senza fissa dimora. Inoltre, la maggior parte degli ospiti era di nazionalità non italiana: persone che, a causa di barriere linguistiche, legali, culturali e sociali, hanno trovato maggiore difficoltà ad avere un rapido accesso ai servizi sanitari. Il "progetto Michelangelo" non ha solo contribuito a ridurre il sovraffollamento degli ospedali, ma è stato di supporto ai servizi rivolti al contrasto della grave marginalità.

Background: Autoimmune atrophic gastritis (AAG) diagnosis is based on specific histological findings and anti-parietal cell antibodies (PCA) considered the serological hallmark of AAG, although a subgroup of AAG patients may be seronegative., Objectives: To assess the occurrence and clinical features of seronegative compared to seropositive AAG., Methods: This is a cross-sectional study including 516 consecutive adult patients (age 59.6 ± 12.8 years, F:M = 2.2:1) with histologically proven AAG diagnosed in two Italian academic referral centers over the last 10 years. PCA were detected at AAG diagnosis. Variables related to the dependent variable of interest (i.e.PCA-negativity) were assessed by univariate/logistic regression analysis., Results: 109/516 AAG patients were seronegative. The mean age of seronegative AAG patients was significantly higher compared to PCA-positive (65.9 ± 14.1vs57.9 ± 15.1 years; p<0.0001). The proportion of patients aged 70-79 and ≥80 years were, respectively, lower for PCA-positivity (5.1vs12.8%;21.3vs38.5%;p<0.005). Seronegativity was associated with age ≥50 years (OR2.4;95%CI 1.1-5.2), while for other variables (gender, comorbidities, anemia, atrophy severity) no association was found. In a sub-cohort of 101 AAG patients, PCA levels detected by ELISA were inversely correlated with age at AAG diagnosis (rho=-0.250;p = 0.0118)., Conclusion: Roughly 20% of patients are seronegative at the time of AAG histological diagnosis and this is more common in elderly individuals., Competing Interests: Declaration of Competing Interest The Authors declare that there is no conflict of interest., (Copyright © 2020 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.)

Objectives - Rare tumors are diagnostic challenges for pathologists. Consultation or referral to Centers with expertise is crucial for the right diagnosis. This is particularly true for Thymic Epithelial Tumors (TETs), whose treatment strategies vary according to histological subgroup. We aimed at evaluating the accuracy of TET pathologic characterization in an Italian reference Center. Materials and methods - All the cases with diagnosis or suspicion of TETs, which underwent a pathological second opinion at Istituto Nazionale dei Tumori (INT), Milan, between 2015 and 2019 were retrospectively reviewed. All cases had been pathologically characterized through immunohistochemistry (IHC). Descriptive statistics were used for qualitative variables. Concordance was estimated through Cohen's kappa (k). Results - Out of 278 cases of TETs diagnosed in INT, 72 were referred to INT for a pathologic revision. The INT revision changed the diagnosis in 41 cases (56.9%), with a potential therapeutic shift in 32 (44.4%). In particular, 20 cases of thymoma were reviewed as a different subtype of thymoma (19/20) or lymphoma (1/20); nine cases of thymic carcinoma were reviewed as thymoma. On the other hand, three cases of lung carcinoma were reviewed as thymic carcinoma (2/3) or thymoma (1); eight cases of carcinoma Not Otherwise Specified were reviewed as thymic carcinoma; one case of lymphoma was reviewed as thymoma. Concordance between pathologists was moderate for thymoma (74.7%, k 0.447), inferior for thymic carcinoma (60.5%, k 0.139). Conclusion - A significant proportion of cases referred to INT for a presumptive TET received a different characterization. A potential shift in therapeutic indication was not rare. This underlines the importance for TETs to get a second pathological diagnosis by an expert pathologist and supports the need for networks on rare cancers., Competing Interests: Conflict of interest statement MCG declares personal financial interests with the following organizations: AstraZeneca, MSD International GmbH, BMS, Boehringer Ingelheim Italia S.p.A, Celgene, Eli Lilly, Ignyta, Incyte, Inivata, MedImmune, Novartis, Pfizer, Roche, Takeda; she also declares Institutional financial interests with the following organizations: Eli Lilly, MSD, Pfizer (MISP), AstraZeneca, MSD International GmbH, BMS, Boehringer Ingelheim Italia S.p.A, Celgene, Ignyta, Incyte, Inivata, MedImmune, Novartis, Pfizer, Roche, Takeda, Tiziana, Foundation Medicine; at the end, she has received research funding from the following organizations: AIRC, AIFA, Italian Moh, TRANSCAN. GG, LAD, MB, AT and AF have nothing to disclose., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Background: Primary tumor characteristics, which are readily available to all clinicians, may aid in selecting the optimal adjuvant therapy for patients with breast cancer (BC). Herein, we investigated the relationship between tumor size, hormone receptor and HER2 status, Ki67 and age with axillary lymph node metastases (ALNM) in early-BC patients., Methods: We analyzed data on consecutive 2600 early-BC cases collected in the registry of Fondazione IRCC Istituto Nazionale dei Tumori, Milano, Italy. Correlation between Ki67 and primary tumor size (T-size) was calculated by Spearman's rank correlation coefficient. Association of ALNM with Ki67 and other tumor characteristics was investigated by logistic regression. Adjusted odds ratios (ORs) with 95% confidence intervals (95% CIs) were estimated in all cases, and separately analyzed according to age, T-size and BC subtype., Results: Large tumor size strongly associated to ALNM, with an adjusted odds ratio (OR) for each 5-mm increase of 1.32 (95% CI 1.24-1.41), except for triple-negative BC (TNBC) cases. In tumors =10 mm, without lymphovascular invasion, representing the strongest predictor of ALNM (OR 6.09, 95% CI 4.93-7.53), Ki67 resulted particularly informative, with a fourfold increased odds of ALNM for values > 30%., Conclusions: These results raise the question whether axillary node status is redundant in cases with exceptionally good features, i.e., small tumors with low Ki67, or in those candidate to adjuvant systemic treatment/radiotherapy anyway including TNBC, and support the incorporation of primary BC tumor characteristics as stratification factors in ongoing trials aiming at de-escalating axillary surgical procedures.

Background: Pituitary tumours are common neoplasms of the sellar region in small animals. However, detailed information regarding the spectrum and severity of possible neurological signs are lacking. Objective: To retrospectively describe the neurological abnormalities in a population of dogs with a detectable pituitary mass (DPM) and relate them with the size of the mass and magnetic resonance imaging (MRI) signs of brain compression (BC). Client-owned dogs were included in the study if they had MRI showing a DPM and a detailed neurological examination. The neurological signs were evaluated in relation to the pituitary height/brain ratio (P:B ratio) and the presence/absence of brain compression. Results: Ninety-seven dogs were enrolled. Besides abnormal mentation and behaviour (77%), gait (61%) and cranial nerve abnormalities (44%), other unreported neurological signs observed included postural abnormalities (21%), pain and/or hyperesthesia (25%) and abnormal postural and proprioceptive reactions (49%). The majority of dogs with DPM had signs of BC. The presence of a high pituitary height/brain area and BC represented a risk factor for developing mental status abnormalities. Conclusion: Neurological signs recorded in DPM-affected dogs include not only the typical forebrain signs but also gait disturbances and hyperesthesia. Neurological signs are positively associated with increased P:B ratio and MRI signs of brain compression.

Previous works linked low sodium concentration with mortality risk in cancer. We aimed at weighing the prognostic impact of hyponatremia in all consecutive patients with metastatic solid tumors admitted in a two-years period at our medical oncology department. Patients were included in two cohorts based on serum sodium concentration on admission. A total of 1025 patients were included, of whom 279 (27.2%) were found to be hyponatremic. The highest prevalence of hyponatremia was observed in biliary tract (51%), prostate (45%) and small-cell lung cancer (38.9%). With a median follow-up of 26.9 months, median OS was 2 months and 13.2 months for the hyponatremia versus control cohort, respectively (HR, 2.65; P < 0.001). In the multivariable model, hyponatremia was independently associated with poorer OS (HR, 1.66; P < 0.001). According to the multivariable model, a nomogram system was developed and validated in an external set of patients. We weighed over time the influence of hyponatremia on survival of patients with metastatic solid tumors and pointed out the possibility to exploit serum sodium assessment to design integrated prognostic tools. Our study also highlights the need for a deeper characterization of the biological role of extracellular sodium levels in tumor development and progression.

Background: Longevity is considered the result of interactions between environmental and genetic factors. Aim: To investigate the possible association of body mass index and the frequencies of APOE , ACE , eNOS and FTO gene polymorphisms with longevity. Subjects and methods: In total, 1100 healthy volunteers aged 10-100 were recruited. Subjects were genotyped for APOE , ACE , eNOS and FTO gene polymorphisms. Data about height and weight were also collected. The sample was split into four age groups: 1-24, 25-49, 50-85 and 86-100 years. Results: Significant differences were found in BMI values between age groups. A significant decrease of the APOE4 , eNOS 393 and FTO A and allele frequencies was observed in the 86-100 age group compared to the younger groups. For ACE gene, no significant differences were found in the allele frequencies between groups. A similar trend was also observed when the sample was subdivided into two main age groups: 1-85 and 86-100 years. Conclusion: This study provides evidence for a role of APOE , eNOS and FTO gene polymorphisms in longevity. It has been estimated that the number of centenarians worldwide will double each decade until 2100, making population data about gene polymorphisms relevant for further studies about longevity.

An integration of laboratory radon and thoron exhalation data with gamma radiation mapping is applied to assess the geogenic radon and the exposure of people to natural radiation in a highly-urbanized city (Roma, Italy). The study area is a protected territory where ignimbrites from Colli Albani volcano and alluvial sediments largely crop out. A map of total gamma radiation, a gamma transect across Caffarella valley and 9 vertical gamma profiles have been carried out, showing that the main control of gamma levels is, of course, the lithological nature, without neglecting the simultaneous effect of other parameters such as slope morphology, erosion/weathering processes, occurrence of sinkholes or underground tunnels. The surveys allowed to distinguish the medians of ignimbrites (from 816 ± 16 cps to 936 ± 19 cps) from that of alluvial materials (611 ± 14) cps), but showed also that alluvial sediments with anomalously high radioactivity (769 ± 14 cps) can be locally recognized, providing valuable information on the interaction between sedimentation and erosion in fluvial valleys. Total gamma activity was converted into absorbed gamma dose rate ranging from 0.33 to 0.38 μSv/hr. Outdoor Annual Effective Dose Equivalents were also estimated between 0.58 and 0.67 mSv y -1 . Laboratory radon and thoron exhalation rates of collected material are positively correlated with gamma radiation. Volcanic and alluvial sediments are well-discriminated. The correlation between the two variables is evident, but not robust because of the variable concentration of 40  K, which is not contributing to radon and thoron exhalation rates. Anomalous data of soil samples located at the foot of a slope can be interpreted as due to reworking and accumulation processes. Similar gamma radiation data documents analogous concentration of radon and thoron parent-nuclides, but coexisting different radon and thoron exhalation rates provides an additional information on different grain size distributions which can be considered as a proxy for soil gas permeability. The integration of gamma mapping and radon and thoron exhalation measurements is a very useful tool to assess people exposure to natural radiation, in terms of dose rates and potential indoor radon. Gamma mapping, which provides data on the radiation source (the bedrock) is fast and not expensive. It allows to obtain very detailed pictures of a study area, but it needs to be combined with laboratory determination of radon and thoron release in order to definitely and correctly interpret variations of gamma signal. Furthermore, laboratory determination of soil radon exhalation gives information on the release of radon and is a good proxy for soil gas permeability. It has the great advantage over in-situ measurements of gas flow not to be influenced by seasonal pedoclimatic parameters and is affected by lower analytical uncertainties. These data are thus reproducible and precise and can be used to estimate potential radon hazard, which is the main source of exposure and thus the most important parameter for human protection from environmental radioactivity., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Background: Random biopsies are recommended to identify individuals at risk of gastric adenocarcinoma. Cumulative evidence suggests that narrow-band imaging (NBI) can be used to grade gastric intestinal metaplasia (GIM). We aimed to externally validate a classification of endoscopic grading of gastric intestinal metaplasia (EGGIM)., Methods: Consecutive patients in two centers were submitted to high resolution white-light gastroscopy followed by NBI to estimate EGGIM - a score (0 - 10) resulting from the sum of endoscopic assessments of GIM, scored as 0, 1, or 2 for no GIM, ≤ 30 %, or > 30 % of the mucosa, respectively, in five areas (lesser and greater curvature of both antrum and corpus, and incisura). If GIM was endoscopically suspected, targeted biopsies were performed; if GIM was not noticeable, random biopsies were performed according to the Sydney system to estimate the operative link on gastric intestinal metaplasia (OLGIM; the gold standard)., Results: 250 patients (62 % female; median age 55 years) were included. GIM was staged as OLGIM 0, I, II, III, IV in 136 (54 %), 15 (6 %), 52 (21 %), 34 (14 %), and 13 (5 %) patients, respectively. All patients with GIM except three were identifiable with targeted biopsies. For the diagnosis of OLGIM III/IV, the area under the ROC curve was 0.96 (95 % confidence interval [CI] 0.93 - 0.98) and by using the cutoff > 4, sensitivity, specificity, and positive likelihood ratio were 89 %, 95 %, and 16.5, respectively; results were similar (91 %, 95 %, and 18.1) when excluding patients with foveolar hyperplasia., Conclusions: For the first time, an endoscopic approach was externally validated to determine the risk of gastric cancer without the need for biopsies. This can be used to simplify and individualize the management of patients with gastric precancerous conditions., Competing Interests: None, (© Georg Thieme Verlag KG Stuttgart · New York.)

Objective: In dyspeptic patients, esophagogastroduodenoscopy is often negative for visible lesions. Biopsies of the normal-appearing mucosa for Helicobacter pylori detection are not routinely obtained. Diagnostic gain of routine biopsies is still debated. This study aimed to assess the occurrence of H. pylori infection and related gastric premalignant conditions in dyspeptic patients without visible lesions at esophagogastroduodenoscopy and whether the presence/absence of endoscopically visible lesions may address the endoscopist to obtain gastric biopsies., Materials and Methods: Post hoc study on endoscopic-histological data from 589 patients with dyspepsia (median age 57 years) obtained during a prospective nationwide study. Patients with dyspepsia as indication for esophagogastroduodenoscopy, never treated for H. pylori, were included. All the patients underwent esophagogastroduodenoscopy with biopsies according to Sydney system. Clinical data were collected using a structured questionnaire., Results: In 66.4% patients, the gastricduodenal mucosa appeared normal at esophagogastroduodenoscopy. In patients with or without visible lesions at esophagogastroduodenoscopy, H. pylori infection (51.5% vs. 50.1%, p = 0.82) and atrophic-metaplastic gastritis (33.3% vs. 27.6%, p = 0.18) were similar. Endoscopically visible lesions were poor predictors for H. pylori infection or gastric precancerous conditions showing positive and negative predictive values of 51.5% and 49.8% for H. pylori and 33.3% and 72.3% for atrophic-metaplastic gastritis. At logistic regression, the presence of H. pylori infection showed a negative association with ongoing antisecretory treatment (OR: 0.67), the presence of visible gastroduodenal lesions was not associated., Conclusions: Dyspeptic patients with or without visible endoscopic lesions had the same occurrence of H. pylori infection and related premalignant conditions, which might be missed without biopsies, in particular, in patients on anti-secretory treatment.

Background: Gastric carcinoids (GCs) represent 23% of all digestive neuroendocrine tumors (NETs). They can be distinguished into three types: type I (in the presence of atrophic body gastritis, ABG), type II (in the presence of Zollinger-Ellison/multiple endocrine neoplasia type I syndrome), type III (sporadic carcinoids, without any background pathology)., Aim: To describe a case of undetermined type of GCs in an Italian referral center for NETs and its prevalence among GCs during a 6-year period., Results: In a case series of 16 GCs seen at our unit between 2007 and 2012, 14 (83.3%) patients had type I carcinoid and 1 patient (6.2%) had type III carcinoid. One patient did not accomplish to the actual classification criteria. This patient had a well-differentiated carcinoid with low Ki67, but multiple gastric biopsies performed at 3-year follow-up gastroscopies excluded the presence of ABG. The patient had fundic cystic polyps, suggesting long-term use of proton pump inhibitors, possibly associated with GCs., Conclusions: This case shows that a GC may occur in the absence of ABG and with low Ki67 index, making classification according to actual criteria difficult. Further studies are needed to better understand the occurrence of this particular type of GCs.

Background: Many people on dialysis suffer a variety of conditions that can affect frailty (the condition or quality of being frail), such as comorbidities, disabilities, dependence, malnutrition, cognitive impairment and poor social conditions. Frailty is suspected to affect quality of life (QoL)., Objectives: The study aimed to evaluate the effect of the different components of frailty on the QoL of people on dialysis., Methods: We enrolled 203 out of 233 prevalent patients on dialysis in the Trieste area of Italy. We applied the Short-Form 36 (SF-36) questionnaire, Activities of Daily Living, Instrumental Activities of Daily Living, Subjective Global Assessment scales and Karnofsky Index. In addition we analysed their social conditions., Results: Dependence, malnutrition and disability had a negative role on QoL. Living with family and good social-economic conditions were significantly related to a better QoL., Conclusions: Dependence, malnutrition, disability, poor social and economic conditions have a significant effect on life quality. The role of comorbidities appears to be less important. Screening of patients, nutritional and functional rehabilitation and prevention of social isolation appear to be indispensable in guaranteeing a satisfactory life quality., (© 2013 European Dialysis and Transplant Nurses Association/European Renal Care Association.)

A tool such as a prosthetic device that extends or restores movement may become part of the identity of the person to whom it belongs. For example, some individuals with spinal cord injury (SCI) adapt their body and action representation to incorporate their wheelchairs. However, it remains unclear whether the bodily assimilation of a relevant external tool develops as a consequence of altered sensory and motor inputs from the body or of prolonged confinement sitting or lying in the wheelchair. To explore such relationships, we used a principal component analysis (PCA) on collected structured reports detailing introspective experiences of wheelchair use in 55 wheelchair-bound individuals with SCI. Among all patients, the regular use of a wheelchair induced the perception that the body's edges are not fixed, but are instead plastic and flexible to include the wheelchair. The PCA revealed the presence of three major components. In particular, the functional aspect of the sense of embodiment concerning the wheelchair appeared to be modulated by disconnected body segments. Neither an effect of time since injury nor an effect of exposure to/experience of was detected. Patients with lesions in the lower spinal cord and with loss of movement and sensation in the legs but who retained upper body movement showed a higher degree of functional embodiment than those with lesions in the upper spinal cord and impairment in the entire body. In essence, the tool did not become an extension of the immobile limbs; rather, it became an actual tangible substitution of the functionality of the affected body part. These findings suggest that the brain can incorporate relevant artificial tools into the body schema via the natural process of continuously updating bodily signals. The ability to embody new essential objects extends the potentiality of physically impaired persons and can be used for their rehabilitation.

Assessing psychosocial factors in occupational environment requires complicated procedures according to most methods. The project of Tuscany region has the aim to realize a free computerized instrument for a gradual risk assessment with two different modes, expert and beginner. A decisional flow chart helps to approach the risk assessment step by step on the basis of company features, management and organization problems and company symptoms of stress. This experience means a proposal of a computerized method for a quantitative assessment of psychosocial risks at workplace, but at the same time offers a detailed analysis of the problems in the organization suggesting different priority to solve them.

The rising awareness of psychosocial risks at workplace means that it is ever more important to prepare methods to assess psychosocial factors in occupational environment. This project of north west tuscany area has the aim to realize an instrument for a gradual risk assessment for this kind of factors without the support of specialists. A decisional flow chart helps to approach the risk assessment step by step on the basis of company features, management and organization problems and company symptoms of stress. The final assessment combines the evaluation of perceived risks with job analysis realizing a matrix containing 5 risk levels, which suggests the priority of preventive measures. The intermediate level (level three) represents the activation level for the medical surveillance. This experience means a proposal for a quantitative assessment of psychosocial risks at workplace.

A collaborative trial for the evaluation of blood cholesterol measurement in Italy was carried out, with the use of two lyophilized controls, whose target values, respectively 4.42 and 6.21 mmol/l, were established by means of "definitive" methodology (isotope dilution/mass spectrometry). Results from 480 participants showed a somewhat broad dispersion (CV 6.1% and 6.3% respectively), and a definite bias (-0.25 mmol/l and -0.61 mmol/l respectively) with respect to the target values. The different analytical systems were characterized by different combinations of inaccuracy and imprecision; however, the bias observed for the higher concentration sample was a constant finding. The behaviour of the control materials, in comparison with that exhibited by patients' sera, was assessed in a manual enzymatic procedure and in the Kodak Ektachem 700 and Technicon Chem 1 systems. The peculiar property of one control material to behave differently from patients' sera in some analytical systems, i.e. the lack of commutability, was found to be partially responsible for the observed bias in the three methods studied. The importance of testing for commutability of the control materials to be used for the control of accuracy is stressed.