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Chemical (major and trace elements) and isotopic compositions (δD and δ18O in waters and δ13C in CO2 and 3He/4He in gases) of natural thermal (11) and cold (39) fluids (spring waters and gases) discharging from a tectonic window of Mesozoic limestones in central Italy, have proved to be the result of mixing processes inside the limestone formations. The limestones provide a preferential route for subsurface fluid migration and they gather both descending cold, Ca-HCO3, B-depleted groundwaters and rising convective Ca-SO4(HCO3), CO2-saturated, B-rich thermal waters. Atmospherically-derived descending gas components (N2, Ne, He), dissolved in rainfall that infiltrates the limestone system mix with N2, Ne, He-depleted hot rising waters. Boron in the liquid phase and N2 and Ne in the gas phase are the most useful elements to trace the mixing process. The deeper gas samples recognised in the area are associated with the hotter waters emerging in the area. In spite of being depleted in Ne and He and light hydrocarbons they have the higher measured 3He/4He ratios, suggesting a contribution of mantle 3He to the gas phase. This contrasts with deep circulation in the crust which would lead to increased concentration of 4He in the deeper gases. Paradoxically, there is more relative concentration of 4He in the more air-contaminated gas samples than in the deeper gas samples. A similar paradox exists when the δ13C of CO2 in the deeper gas samples is considered. The shallower air-contaminated gas samples, although they should be affected by the addition of soil-13C depleted organic C, have δ13C in CO2 more positive than the deeper gas samples recognized. Since any deep hydrothermal source of CO2 should generate CO2 with more positive values of δ13C than those measured at surface, a multiple (single) calcite precipitation process from hydrothermal solutions, with C isotopic fractionation along the rising path inside the Mesozoic limestone formations, is proposed. [Copyright &y& Elsevier]

Background and Aim: This study aims to measure the competencies of surgical and critical area nurses, and to compare the nurses' involved competencies in relation to the area to which they belong Methods: A cross-sectional study. The study was based on a convenience sample. The registered nurses were recruited from a hospital of the Friuli Western Health Authority. The Italian version of the Nurse Competence Scale composed from 58 items and validated in Italy in 2018 as a self-assessment tool for nursing competencies in the surgical and critical area, was self-administrated in October- November 2020., Results: The average competence level was found to be 68.7, with a median of 70 and a standard deviation of 19.7. The nurses felt more competent belongs to "Management of the care process", specifically in "Recognizing critical situations for the patient's life early" (82.0). Most deficient was found in "Raising problems to be deepened with research" (50.9)., Conclusions: The study found that nurses perceive a good level of competence with differences related to care settings. The results obtained from the study can provide nurses with the opportunity to reflect on their behaviours and periodically evaluate their knowledge and competencies, to promote professional development and continuing education. (www.actabiomedica.it).

Objective: We aimed to describe the prevalence and clinical-demographical features of patients with functional gait disorders (FGDs) and to compare them to patients with functional motor disorders (FMDs) without FGDs (No-FGDs)., Methods: In this multicenter observational study, we enrolled patients with a clinically definite diagnosis of FMDs in 25 tertiary movement disorders centers in Italy. Each subject with FMDs underwent a comprehensive clinical assessment, including screening for different subtypes of functional gait disorders. Multivariate regression models were implemented in order to estimate the adjusted odds ratio (OR; 95% confidence interval) of having FGDs in relation to sociodemographic and clinical characteristics., Results: Out of 410 FMDs, 26.6% (n = 109) of patients exhibited FGDs. The most frequent FGDs were slow gait (n = 43, 39.4%), astasia-abasia (n = 26, 23.8%), and knee buckling (n = 24, 22%). They exhibited single FGDs in 51.4% (n = 56) or complex FGDs (more than one type of FGDs) in 48.6% (n = 53) of cases. On multivariate regression analysis, the presence of FGDs was more likely associated with older age (OR 1.03, 95% CI 1.01-1.04), functional visual symptoms (OR 2.19, 95% CI 1.08-4.45), and the diagnosis of somatic symptoms disorder (OR 2.97, 95% CI 1.08-8.17). FGDs were also more likely to undergo physiotherapy (OR 1.81, 95% CI 1.08-3.03)., Conclusions: People with FMDs may present with different and overlapping types of FGDs, which may occur in older age. The association of FGDs with functional visual symptoms and somatic symptoms disorder opens up to new avenues to the understanding of the neural mechanisms of these disorders., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Background: Failure in the reprocessing of thermolabile flexible endoscopes has been reported as one of the most important threats to patient health. Method: A case report and observational study was conducted, from August 2014 to December 2019, in the Digestive Endoscopy Unit of a University Hospital in Italy, where two cases of Klebsiella pneumoniae carbapenemase ( KPC )-producing Klebsiella pneumoniae infections in patients undergoing endoscopic retrograde cholangio-pancreatography were observed. Following the risk/safety management practices, an epidemiological investigation was started, duodenoscopes were removed from use and the reprocessing practices reviewed. Moreover, microbiological surveillance of endoscopes was carried out according to the CDC guidelines. Results: In the first phase of sampling, 10/10 (100%) endoscopes were found to be non-compliant, of which 7 showed results for high-concern organisms (HCOs), such as KPC - K. pneumoniae, P. aeruginosa and E. coli . After implementing corrective actions, 12 out of 17 endoscopes were found to be non-compliant (70.5%), of which 8 showed results for HCOs, such as KPC-K. oxytoca and P. aeruginosa . During the last year of regular microbiological surveillance, only 23% of endoscopes (35/152) were found to be non-compliant, of which 7 showed results for HCOs, such as NDM-K. pneumoniae, P. aeruginosa and A. baumannii . The crucial issues were related to samples collected from the internal channels of duodenoscopes. Conclusion: Managing the risk associated with the reprocessing of digestive endoscopes, through risk assessment at every stage of the process, is important for the prevention of infections associated with the use of these device.

Microbiological surveillance carried out in order to verify the effectiveness of endoscope reprocessing does not include the research of viruses, although endoscopes may be associated with the transmission of viral infections. This paper reports the experience of the University Hospital of Pisa in managing the risk from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) during an endoscopy. A review of the reprocessing procedure was conducted to assess whether improvement actions were needed. To verify the reprocessing efficacy, a virological analysis was conducted both before and after the procedure. Five bronchoscopes and 11 digestive endoscopes (6 gastroscopes and 5 colonoscopes) were sampled. The liquid samples were subjected to concentration through the use of the Macrosep Advance Centrifugal Devices (PALL Life Sciences, Port Washington, NY, USA) and subsequently analyzed using the cobas ® SARS-CoV-2 Test (Roche Diagnostics, Basel, Switzerland), together with eSwab 490 CE COPAN swabs (COPAN, Brescia, Italy), which were used to sample surfaces. In accordance with the first ordinance regarding the coronavirus disease 2019 (COVID-19) emergency issued by the Tuscany Region in March 2020, a procedure dedicated to the management of the COVID-19 emergency in endoscopic practices was prepared, including the reprocessing of endoscopes. The virological analysis carried out on samples collected from endoscopes after reprocessing gave negative results, as well as on samples collected on the endoscopy column surfaces and the two washer-disinfectors that were dedicated to COVID-19 patients. The improvement in endoscope reprocessing implemented during the COVID-19 emergency was effective in ensuring the absence of SARS-CoV-2, thus reducing the risk of infections after an endoscopy on COVID-19 patients.

In Calabria, a study team form legal medicine emergency (LME) formed to initiate a Crisis Unit (CU) able to manage and deal LME with complicated operations and roles, people and technical aspects involvement. First steps are planning, scene study and organization. Everything connecting the first and second emergency to have practicable application.