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The potential of game-based experiential workshops to complement focus groups in identifying drivers/barriers to environmentally sustainable food systems was explored. Sixty adults from an Italian bio-district answered to a questionnaire; among them, nineteen and twenty-one people participated in a game-based experiential workshop and in a focus group, respectively. The experiential workshop involved games, image theater, and on-the-spot feedback. The body language recorded during the workshop captured information on the transparency of producers and on the oppression from public institutions as perceived by citizens. Experiential workshops may have advantages over focus groups in terms of diagnostic potential.

This article highlights the multianalytical study of exuded liquid from an ancient Egyptian sealed alabaster vase by Master's students in an applied chemistry for cultural heritage course. Master students are introduced to the field of Archaeometry that see the collaboration of experts in different areas of research such as conservators, curators of museums, physicists, chemists, etc. The sample is a residue exuded on the linen strip sealing an ancient Egyptian alabaster vase (inventory number S.8448) from the collection of the Museo Egizio in Turin (Italy). The students start to plan the noninvasive investigation by X-ray fluorescence (XRF), transmission electron microscopy (TEM), and energy-dispersive X-ray spectroscopy (EDS) for the inorganic compounds characterization, followed by the extraction of the organic components (such as oils, fats, and waxes) to be analyzed by high-resolution [superscript 1]H and [superscript 13]C nuclear magnetic resonance (NMR) spectroscopy and 2D NMR correlation spectroscopy (COSY), heteronuclear single quantum coherence (HSQC), and long-range heteronuclear correlation (HMBC) techniques and by gas chromatography coupled with mass spectrometry (GC/MS). Reference standards, spectral databases, and published data on similar artifacts served as the basis for the interpretation of the instrumental results. The approach was introduced in the course of Applied Chemistry for Cultural Heritage for Master students in Archaeology (University of Palermo, Italy), where the need is to know how to approach the scientific investigation together with the conservation scientists and how to manage with a very low amount of sample. Pedagogically, the approach introduces students to the main techniques currently used in the field of Archaeometry while reinforcing fundamental concepts in sample collecting and multicomponent microsample analysis. This interdisciplinary approach provides a unique experience that demonstrates chemistry's broad applicability outside of the traditional laboratory. Students are guided to identify the inorganic and organic components of the exudate liquid: the first one is ascribable to clay minerals iron oxides, which could impart the brown color to the sample; the second one is ascribed to triglycerides of various kinds, which probably comes from vegetable oil.

Introduction: ExtraCorporeal Membrane Oxygenation (ECMO) in pediatric patients with COVID-19 has a survival rate similar to adults. Occasionally, patients may need to be cannulated by an ECMO team in a referring hospital and transported to an ECMO center. The ECMO transport of a COVID-19 patient has additional risks than normal pediatric ECMO transport for the possible COVID-19 transmissibility to the ECMO team and the reduction of the ECMO team performance due to the need of wearing full personal protective equipment. Since pediatric data on ECMO transport of COVID-19 patients are lacking, we explored the outcomes of the pediatric COVID-19 ECMO transports collected in the EuroECMO COVID_Neo/Ped Survey. Methods: We reported five European consecutive ECMO transports of COVID-19 pediatric patients collected in the EuroECMO COVID_Neo/Ped Survey including 52 European neonatal and/or pediatric ECMO centers and endorsed by the EuroELSO from March 2020 till September 2021. Results: The ECMO transports were performed for two indications, pediatric ARDS and myocarditis associated to the multisystem inflammatory syndrome related to COVID-19. Cannulation strategies differed among patients according to the age of the patients, transport distance varied between 8 and 390 km with a total transport duration between 5 to 15 h. In all five cases, the ECMO transports were successfully performed without major adverse events. One patient reported a harlequin syndrome and another patient a cannula displacement both without major clinical consequences. Hospital survival was 60% with one patient reporting neurological sequelae. No ECMO team member developed COVID-19 symptoms after the transport. Conclusion: Five transports of pediatric patients with COVID-19 supported with ECMO were reported in the EuroECMO COVID_Neo/Ped Survey. All transports were performed by an experienced multidisciplinary ECMO team and were feasible and safe for both the patient and the ECMO team. Further experiences are needed to better characterize these transports and draw insightful conclusions. [ABSTRACT FROM AUTHOR]

Background: Non-steroidal anti-inflammatory drugs (NSAIDs) have well-known adverse effects, and numerous studies have shown inappropriate behaviors regarding their use. The primary aim of this study was to analyze the knowledge, attitudes, and behaviors regarding the use of NSAIDs simultaneously in one of the largest and most populated areas of Italy, Naples. Methods: From 2021 December 14th to 2022 January 4th, a cross-sectional survey study was conducted among community centers, working places, and universities using a snowball sampling method. For inclusion in the study, the participants were required to be at least 18 years old and residents in the metropolitan area of Naples. Three multiple linear regression analysis (MLRA) models were developed by including variables that could potentially be associated with the following outcomes of interest: knowledge (Model I), attitudes (Model II), and behavior (Model III) regarding the use of NSAIDs. Results: Data were acquired from 1,012 questionnaires administered to subjects evenly divided by gender with an average age of 36.8 years and revealed that only 7.9% of the participants self-admittedly did not take NSAIDs, while approximately half the participants (50%) admitted to occasionally using them. The results showed a statistically significant correlation between attitudes regarding the appropriate use of NSAIDs and less knowledge. The regression analyses indicated that behaviors regarding the appropriate use of NSAIDs were statistically significant in younger respondents, non-smokers, and those without children. These interesting results showed that behaviors regarding the appropriate use of NSAIDs were significantly higher among respondents with less knowledge and more positive attitudes. Conclusion: According to the collected data and statistical analysis results, it is possible to identify factors that can greatly affect inappropriate behaviors regarding the use of NSAIDs and establish targeted prevention programs. [ABSTRACT FROM AUTHOR]

Background: In the region of Piedmont, in Northern Italy, formal monitoring of antimicrobial stewardship (AMS) programs has been in place since 2012. The objective of our study was to provide an updated assessment of AMS programs operating in our region, and to assess the impact of the COVID-19 pandemic on stewardship activities. Methods: A retrospective observational study was conducted to investigate AMS programs implemented in acute-care trusts participating in a broader healthcare-associated infections and antimicrobial resistance (AMR) prevention and control program, promoted by the regional health department. Within this program, structure, process, and outcome indicators of AMS programs were investigated, using a previously developed scoring system. Differences between scores prior to (2019) and during the pandemic (2021) were assessed. Linear regression was used to assess whether the 5-year trends (2017–2021) in outcome measures in relation to structure and process scores were statistically significant. Compound annual growth rates (CAGR) for each outcome were calculated to illustrate changes in outcome rates over time. Results: All public trusts in the Region (20) and a small number of private institutions (3) provided data for this study. A modest, non-significant improvement was found for 2021 structure, process, and total scores compared to respective 2019 scores. A significant improvement was found concerning the definition of a formal mission statement, whereas significantly less trusts included monitoring adherence to antimicrobial policy or treatment guidelines in their programs. Overall consumption of antibiotics for systemic use saw an increase in 2021, with 2021 recording the highest median overall consumption compared to all previous years considered in this study. Methicillin-resistant Staphylococcus aureus (MRSA) and carbapenem-resistant enterobacteria (CRE) rates decreased over the 5-year period. Significant downwards trends in MRSA rates were identified for high-outlier structure and process groups. Conclusions: Results of this study suggest AMS programs in Piedmont were not set back following the pandemic. This outcome was possible thanks to well-established programs, coordinated within a regional framework. Continued efforts should be dedicated to supporting AMS programs and contrasting AMR, even when the focus is shifted towards other public health emergencies. [ABSTRACT FROM AUTHOR]

This paper proposes a new multi-step approach for sensitivity assessment of surface runoff parameters. The procedure has been tested on a peri-urban basin in southern Italy, interested by intense urbanization. The basin has limited data about land characteristics, and nearby precipitation measurements are not available. Accordingly, rainfall events are defined based on depth-duration-frequency curve valid for the area. The main novelties of the work are to provide a general framework for assessing the influence of runoff parameters (i.e. depression storage and surface roughness) for a basin model in SWMM in relation to rain events of various intensity/duration, and to provide a ranking of crucial parameters significantly affecting peak discharge and total volume of the hydrograph, for an ungauged basin, by means the Fourier Amplitude Sensitivity Test (FAST). Results indicate the dependence on rainfall characteristics of the relative importance of the parameters describing the pervious and impervious areas. Notably, the peak discharge of the shortest considered event is influenced only by the two parameters of the impervious area, while the opposite holds for the longest rain event. The total runoff volume is mostly influenced by the depression storage of impervious areas, with the parameters of pervious areas becoming more influential for longer rain events. Results allow a clear interpretation of the modelled physical processes variability within the basin and their relationship with rainfall/areas features, thus providing useful insights for key parameter definition in other contexts and for other models. [ABSTRACT FROM AUTHOR]

Pertussis continues to be a highly contagious respiratory infection, especially in children, with cyclical peaks of disease spread every three to five years. Here, we report relevant cases of B. pertussis infection between August 2023 and January 2024, and compare them with B. pertussis prevalence in pediatric patients admitted to the Reference Italian Pediatric Hospital, located in Rome, from January 2015 to July 2023. A total of 5464 tests for B. pertussis were performed during the study period, and 6.9% were positive. At the time of the COVID-19 pandemic, there was a sharp decrease in the presence of B. pertussis, which reappeared only in August 2023, recording five new cases. All five children presented with paroxysmal cough 5 to 10 days before admission. Four patients had other mild respiratory symptoms and moderate B. pertussis DNA levels (Ct mean: 26). Only one child, with very high B. pertussis DNA levels (Ct: 9), presented with severe respiratory failure. The patients with mild/moderate infection achieved clinical recovery while the patient with the severe manifestation died of cardiac arrest. These observations highlight the reemergence of pertussis even in vaccinated countries and its association with morbidity and mortality especially in young children. This emphasizes the importance of rapid diagnosis to immediately implement appropriate treatment and monitoring of immune status. [ABSTRACT FROM AUTHOR]

Background: In November 2022, Italy participated in the third edition of the European Centre for disease prevention and control (ECDC) point prevalence survey (PPS) of healthcare-associated infections (HAIs) in acute-care hospitals. A questionnaire based on the WHO infection prevention and control assessment framework (IPCAF) was included, which aims to investigate multimodal strategies for the implementation of IPC interventions. Methods: A PPS was conducted using the ECDC PPS protocol version 6.0. The Regional health authority of the region of Piedmont, in north-western Italy, chose to enlist all public acute-care hospitals. Data were collected within one day per each ward, within 3 weeks in each hospital, at hospital, ward and patient level. A score between 0–1 or 0–2 was assigned to each of the 9 items in the IPCAF questionnaire, with 14 points representing the best possible score. HAI prevalence was calculated at the hospital-level as the percentage of patients with at least one HAI over all included patients. Relations between HAI prevalence, IPCAF score, and other hospital-level variables were assessed using Spearman's Rho coefficient. Results: In total, 42 acute-care hospitals of the region of Piedmont were involved, with a total of 6865 included patients. All participant hospitals reported they employed multimodal strategies to implement IPC interventions. The median IPCAF overall score was 11/14 (interquartile range, IQR: 9.25–12). The multimodal strategy with the highest level of adherence was education and training, followed by communication and reminders. Strategies with the lowest level of adherence were safety climate and culture of change, and system change. Overall HAI prevalence was 8.06%. A weak to moderate inverse relation was found between IPCAF score and HAI prevalence (Spearman's Rho -0.340, p 0.034). No other significant correlation was found. Conclusions: This study found a high self-reported overall level of implementation of multimodal strategies for IPC in the region. Results of this study suggest the relevance of the multimodal approach and the validity of the IPCAF score in measuring IPC programs, in terms of effectiveness of preventing HAI transmission. [ABSTRACT FROM AUTHOR]

A nationwide survey conducted in Italy by the Italian Society of Pediatric Gastroenterology, Hepatology, and Nutrition (SIGENP) aimed to analyze the management of food protein-induced allergic proctocolitis (FPIAP). The survey found that there is a lack of standardized guidelines for managing FPIAP, leading to variations in diagnostic and treatment approaches. Milk was identified as the most common trigger for FPIAP, and the survey highlighted the importance of eliminating cow's milk proteins from the mother's diet for breastfeeding infants. The survey also emphasized the need for further research and the development of specific guidelines to improve the management of FPIAP. [Extracted from the article]

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Background: Real-world data on early treatment of coronavirus disease 2019 (COVID-19) outpatients with newly approved therapies are sparse. Aim: To explore the pattern of use of monoclonal antibodies (mAbs)/antiviral therapies approved for early COVID-19 treatment in non-hospitalized patients from England and Italy from December 2021 to October 2022. Methods: Public national dashboards on weekly mAb/antiviral use and/or severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection diagnoses from the Italian Medicines Agency, the Italian National Institute of Health, National Health Service in England and the UK Government were explored. Prevalence of antiviral use in outpatients during the entire study period and every two weeks was calculated, as a whole and by class and compounds. An interrupted time-series (ITS) analysis was carried out to assess the impact of predominant SARS-CoV-2 variants over time on the prevalence of use of mAbs/antivirals in England and Italy. Results: Overall, 77,469 and 195,604 doses of mAbs/antivirals were respectively administered to a total of 10,630,903 (7.3 per 1000) and 18,168,365 (10.8 per 1000) patients diagnosed with SARS-CoV-2 infection in England and Italy. Prevalence of use every two weeks increased from 0.07% to 3.1% in England and 0.9% to 2.3% in Italy during the study period. Regarding individual compounds, sotrovimab (prevalence of use, 1.6%) and nirmatrelvir/ritonavir (1.6%) in England, and nirmatrelvir/ritonavir (1.7%) and molnupiravir (0.5%) in Italy, reported the highest prevalence during a 2-week period. In the ITS analysis, the transition from Delta to Omicron variant predominance was associated with a significant increase in the use of sotrovimab, molnupiravir, remdesivir and nirmatrelvir/ritonavir in both England and Italy, with a reduction of other marketed mAbs. The extent of the increase was higher in England than in Italy for all these drugs except for nirmatrelvir/ritonavir. Conclusions: In this dual nationwide study, the prevalence of use of mAbs/antivirals against SARS-CoV-2 for early outpatients' treatment increased slowly up to 2.0–3.0% of all patients diagnosed with SARS-CoV-2 infection in both England and Italy from December 2021 to October 2022. The trend of individual drug use varied in relation to predominant SARS-CoV-2 variants with some differences across countries. In line with scientific societies' guidelines, nirmatrelvir/ritonavir was the most frequently prescribed antiviral in both countries in the most recent period. [ABSTRACT FROM AUTHOR]

New psychoactive substances (NPS) are present on the Italian illicit markets, but data from the analysis of biological samples to evaluate their real consumption are rare. For this reason, an epidemiological study was carried out by means of a ultra performance liquid chromatography–tandem mass spectrometry (UPLC–MS-MS) method for the determination of 115 NPS on the keratin matrix. A total of 847 hair samples were collected in 2020 and 2021 and analyzed. The sample donors were in the age range of 18–40 years, from both genders, and were tested either for driving relicensing or for drug withdrawal monitoring. The UPLC–MS-MS system consisted of a Waters ACQUITY UPLC® I-Class, coupled with a Waters XEVO TQ-XS triple quadrupole mass spectrometer. The method was developed and fully validated according to international guidelines. Limits of detection were set as the minimum criterion to identify positive samples. Overall, 56 samples resulted positive for ketamine, 35 for norketamine, 6 for fentanyl, 3 for norfentanyl, 3 for 4-ANPP, 3 for MDMB-4en-PINACA, 2 for N , N -DMT, 2 for 5-chloro AB-PINACA, 1 for α-PHP and 1 for methcathinone. NPS were detected in a small part of samples (8.4%), which seems in contrast with their apparent wide diffusion in Italy, yet it is congruent with similar investigations based on hair analysis. Future studies will be performed to expand the investigated population, especially in terms of age and origin. [ABSTRACT FROM AUTHOR]

Gilteritinib has been approved as monotherapy in adults with acute myeloid leukemia (AML) FLT3 mutated with relapsed or refractory disease, in light of its advantages in terms of survival and the favorable safety profile. Hepatobiliary disorders and musculoskeletal and connective tissue disorders represent the most frequent adverse reactions associated with gilteritinib, whereas the most frequent serious adverse reaction is acute kidney injury. In the summary of product characteristics, gastrointestinal (GI) events are indicated as very common, in particular diarrhea, nausea and stypsis. Furthermore, serious GI disorders have been observed with gilteritinib in clinical trials, including GI hemorrhage, GI perforation and GI obstruction. However, the association with the FLT3 inhibitor has not been confirmed. Nevertheless, serious GI AEs have been recognized as an important potential risk to be monitored in postmarketing surveillance. We present three cases of serious self-limiting GI events observed in patients on gilteritinib treatment for AML, and an analysis of relevant available postmarketing surveillance data. [ABSTRACT FROM AUTHOR]

Background: GLUT1 deficiency syndrome is a rare, genetically determined neurological disorder for which Ketogenic Dietary Treatment represents the gold standard and lifelong treatment. Patient registries are powerful tools providing insights and real-world data on rare diseases. Objective: To describe the implementation of a national web-based registry for GLUT1-DS. Methods: This is a retrospective and prospective, multicenter, observational registry developed in collaboration with the Italian GLUT1-DS association and based on an innovative, flexible and configurable cloud computing technology platform, structured according to the most rigorous requirements for the management of patient's sensitive data. The Glut1 Registry collects baseline and follow-up data on the patient's demographics, history, symptoms, genotype, clinical, and instrumental evaluations and therapies. Results: Five Centers in Italy joined the registry, and two more Centers are currently joining. In the first two years of running, data from 67 patients (40 females and 27 males) have been collected. Age at symptom onset was within the first year of life in most (40, 60%) patients. The diagnosis was formulated in infancy in almost half of the cases (34, 51%). Symptoms at onset were mainly paroxysmal (mostly epileptic seizure and paroxysmal ocular movement disorder) or mixed paroxysmal and fixed symptoms (mostly psychomotor delay). Most patients (53, 79%) are currently under Ketogenic dietary treatments. Conclusions: We describe the principles behind the design, development, and deployment of the web-based nationwide GLUT1-DS registry. It represents a stepping stone towards a more comprehensive understanding of the disease from onset to adulthood. It also represents a virtuous model from a technical, legal, and organizational point of view, thus representing a possible paradigmatic example for other rare disease registry implementation. [ABSTRACT FROM AUTHOR]

Simple Summary: In recent years, mounting evidence has recognized the key role of the crosstalk between immune system and cancer cells. Several data have suggested that gender-related immune system composition could impact on both immune response, efficacy of chemotherapy, and immunotherapy and risk of immune-related adverse events. Based on these premises, the present study aimed to evaluate the role of monocyte-to-lymphocyte ratio (MLR), representing the immune suppression cells, in the first place, and immune activating cells, in the second. The analysis, conducted on 490 patients with metastatic colorectal cancer, showed that males and females have a different profile of immune response. Of note, high MLR, both in males and females, is an unfavorable independent prognostic factor. Background: Emerging data suggest that gender-related immune system composition affects both immune response and efficacy of immunotherapy in cancer patients (pts). This study aimed to investigate the sex-related prognostic role of MLR in metastatic colorectal cancer (mCRC) pts. Methods: We analyzed a retrospective consecutive cohort of 490 mCRC patients treated from 2009 to 2018 at the Oncology Departments of Aviano and Pordenone (training set) and Udine (validation set), Italy. The prognostic impact of MLR on overall survival (OS) was evaluated with uni- and multivariable Cox regression models. The best cut-off value to predict survival was defined through ROC analyses. Results: Overall, we identified 288 males (59%) and 202 females (41%); 161 patients (33%) had a right-sided, 202 (42%) a left-sided primary, and 122 (25%) a rectal tumor. Interestingly, gender was associated with MLR (p = 0.004) and sidedness (p = 0.006). The obtained cut-off value for MLR in females and males was 0.27 and 0.49, respectively. According to univariate analysis of the training set, MLR (HR 9.07, p ≤ 0.001), MLR > 0.27 in females (HR 1.95, p = 0.003), and MLR > 0.49 in males (HR 2.65, p = 0.010) were associated with poorer OS, which was also confirmed in the validation set. In multivariate analysis, MLR > 0.27 in females (HR 2.77, p = 0.002), MLR > 0.49 in males (HR 5.39, p ≤ 0.001), BRAF mutation (HR 3.38, p ≤ 0.001), and peritoneal metastases (HR 2.50, p = 0.003) were still independently associated with worse OS. Conclusions: Males and females have a different immune response. Our study showed that high MLR, both in males and females, is an unfavorable Independent prognostic factor. Further prospective studies are needed to confirm these data. [ABSTRACT FROM AUTHOR]

Background: Cyclic Vomiting Syndrome (CVS) is a rare functional gastrointestinal disorder, which has a considerable burden on quality of life of both children and their family. Aim of the study was to evaluate the diagnostic modalities and therapeutic approach to CVS among Italian tertiary care centers and the differences according to subspecialties, as well as to explore whether potential predictive factors associated with either a poor outcome or a response to a specific treatment. Methods: Cross-sectional multicenter web-based survey involving members of the Italian Society of Pediatric Gastroenterology, Hepatology and Nutrition (SIGENP) and Italian Society of Pediatric Neurology (SINP). Results: A total of 67 responses were received and analyzed. Most of the respondent units cared for less than 20 patients. More than half of the patients were referred after 3 to 5 episodes, and a quarter after 5 attacks. We report different diagnostic approaches among Italian clinicians, which was particularly evident when comparing gastroenterologists and neurologists. Moreover, our survey demonstrated a predilection of certain drugs during emetic phase according to specific clinic, which reflects the cultural background of physicians. Conclusion: In conclusion, our survey highlights poor consensus amongst clinicians in our country in the diagnosis and the management of children with CVS, raising the need for a national consensus guideline in order to standardize the practice. [ABSTRACT FROM AUTHOR]

Wastewater treatment plants (WWTPs) efficiently retain microplastic particles (MPs) generated within urban areas. Among the wastewater treatment steps, disinfection has not been characterized for its potential MPs retention activity, although it has been reported that processes used to abate the bacterial load could also affect MPs concentration. For this reason, we evaluated the MPs concentration across the overall wastewater treatment process and before and after the disinfection step in four small/medium WWTPs located in the north of Italy. Most of the MPs found in the samples were fibers or fragments, smaller than 500 μm, mainly composed of polyethylene, polypropylene, or polyethylene terephthalate. The retention efficiency at the outlets was higher than 94% in all the plants analyzed. More interestingly, the disinfection treatments adopted by the different WWTPs reduced MPs concentration from a minimum of 9.1% (UV treatment) to a maximum of 67.6% (chlorination), promoting a further increase of the overall retention efficiency of the WWTPs from 0.4 to 0.7%. Quantitatively, the disinfection contributes to the MPs reduction in the outlets by retaining 0.5–6.7 million MPs per day, in WWTPs that discharge 2.7–12 million MPs per day. The results of the present work underline the importance of a careful choice of the steps that constitute the wastewater treatment, including disinfection, in order to minimize MPs discharge into the natural ecosystems. [ABSTRACT FROM AUTHOR]

Objective: The aim was to assess the awareness and real-life use of biosimilars in inflammatory bowel disease (IBD) among the members of the Italian Society of Pediatric Gastroenterology, Hepatology and Nutrition (SIGENP). Methods: An anonymous web survey involving all SIGENP IBD units which can prescribe biosimilars was conducted between July 1st and December 1st, 2020. The questionnaire included 18 questions addressing the most relevant aspects of biosimilars in pediatric IBD, i.e., advantages, disadvantages, costs, traceability, general knowledge, and real-life use. A descriptive analysis of responses was performed. Results: Responses came from 26 pediatric IBD units in Italy, with representation of the North, the Center, and the South of Italy. The majority of participants (n = 20) had spent > 10 years caring for pediatric IBD patients, and worked in a center which had between 100 and 500 registered pediatric IBD patients (n = 14). Most participants (n = 18) reported they were aware that biosimilars have similar efficacy and safety to those of the originator, and all regarded cost-sparing as the main advantage of biosimilars. Most respondents (n = 20) reported they switch from originator to biosimilar in their everyday clinical practice, mostly during the maintenance phase. Most respondents (n = 20) registered no acute adverse events. Nearly all participants felt totally or very confident in using biosimilars. Conclusions: A few years after the introduction of the first biosimilar into the market, real-life data coming from the major IBD units in Italy confirm a favorable and confident position on the use of biosimilars in pediatric IBD. [ABSTRACT FROM AUTHOR]

Introduction: Acute pediatric poisoning is an emerging health and social problem. The aim of this study is to describe the characteristics of a large pediatric cohort exposed to xenobiotics, through the analysis of a Pediatric Poison Control Center (PPCc) registry. Methods: This study, conducted in the Pediatric Hospital Bambino Gesù of Rome, a reference National Pediatric Hospital, collected data of children whose parents or caregivers contacted the PPCc by phone (group "P"), or who presented to the Emergency Department (group "ED"), during the three-year period 2014–2016. Data were prospectively and systematically collected in a pre-set electronic registry. Comparisons among age groups were performed and multivariable logistic regression models used to investigate associations with outcomes (hospital referral for "P", and hospital admission for "ED"group). Results: We collected data of 1611 children on group P and 1075 on group ED. Both groups were exposed to both pharmaceutical and non-pharmaceutical agents. Pharmaceutical agent exposure increased with age and the most common route of exposure was oral. Only 10% among P group were symptomatic children, with gastrointestinal symptoms. Among the ED patients, 30% were symptomatic children mostly with gastrointestinal (55.4%) and neurologic symptoms (23.8%). Intentional exposure (abuse substance and suicide attempt), which involved 7.7% of patients, was associated with older age and Hospital admission. Conclusions: Our study describes the characteristics of xenobiotics exposures in different paediatric age groups, highlighting the impact of both pharmacological and intentional exposure. Furthermore, our study shows the utility of a specific PPCc, either through Phone support or by direct access to ED. PPCc phone counselling could avoid unnecessary access to the ED, a relevant achievement, particularly in the time of a pandemic. [ABSTRACT FROM AUTHOR]

Introduction: Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) has been described to treat hepatocellular carcinoma (HCC) but burdened, in its pioneering phase, by high morbidity and mortality. With the advent of minimally invasive (MI) techniques in liver surgery, surgical complications, including posthepatectomy liver failure (PHLF), have been dramatically reduced. The primary endpoint of this study was to compare the short-term outcomes of MI- versus open-ALPPS for HCC, with specific focus on PHLF. Methods: Data of patients submitted to ALPPS for HCC between 2012 and 2020 were identified from the ALPPS Italian Registry. Patients receiving an MI Stage 1 (MI-ALPPS) constituted the study group, whereas the patients who received an open Stage 1 (open-ALPPS) constituted the control group. Results: Sixty-six patients were enrolled from 12 Italian centers. Stage 1 of ALPPS was performed in 14 patients using an MI approach (21.2%). MI-ALPPS patients were discharged after Stage 1 at a significantly higher rate compared with open-ALPPS (78.6% versus 9.6%, P < .001). After Stage 2, major morbidity after MI-ALPPS was 8.3% compared with 28.6% reported after open-ALPPS. Mortality was nil after MI-ALPPS. Length of hospital stay was significantly shorter in MI-ALPPS (12 days versus 22 days, P < .001). Univariate logistic regression analysis (Firth method) found that both MI-ALPPS (odds ratio [OR] = 0.05, P = .040) and partial parenchymal transection (OR = 0.04, P = .027) were protective against PHLF. Conclusion: This national multicenter study showed that a less invasive approach to ALPPS first stage was associated with a lower overall risk of PHLF. [ABSTRACT FROM AUTHOR]

This work presents the geomorphology of the Anversa degli Abruzzi badlands (also called calanchi, a typical italian landform) area, located in the Abruzzo Region (Central Apennines, Italy). The map is the result of morphometric and geomorphological analyses, performed at the badland scale, and incorporates three main sections including orography and hydrography, main geomorphological map, and multi-temporal photogeological analysis. The aim of this work is to provide the basis for the recognition of geomorphological features linked to the fluvial environment. Specifically, the study is focused on the Anversa degli Abruzzi calanchi system and it contributes to improving the understanding of this landscape evaluating the geomorphological processes that control its morphometric features and its spatial and temporal evolution. [ABSTRACT FROM AUTHOR]

The Tomb of the Diver has been subject for many decades of fierce debate among archaeologists and classicists. Since its discovery in 1968, some scholars have considered it a unique example of the lost tradition of Greek painting, others have emphasized Etruscan or Italic parallels. More recently, a possible local production has been suggested. With the aim of trying to solve the archaeological question, an archaeometric comparison among this well-known artwork and several frescoed tombs coming from Hellenistic and Lucan necropolis was carried out. The multi-analytical study was focused on the identification of peculiar features of executive techniques and raw materials since the first period of the archaeological site. The analytical investigation has been preliminary based on a non-destructive approach, performed in-situ by portable equipment including imaging diagnostics and compositional spectroscopic techniques for identifying pigments and the conservation state of original painted surface; subsequently, a further deepening by using destructive techniques was performed in-lab for the mortar-based supports characterization. Archaeometric study suggested that technological choices slightly changed in a time span of about two centuries, highlighting important markers that allow clustering the contemporary artistic productions. Moreover, a comparison with mortars from temples decorations was provided to better understand the whole artistic context. The archaeometric data showed that the Tomb of the Diver could be traced back to a local artisanal tradition and therefore is neither Etruscan nor Greek, but the first and foremost an expression of the local elite culture of Paestum. [ABSTRACT FROM AUTHOR]

Abstract Reverse painting on glass is an old decorative technique used since the Roman time consisting in applying a cold paint layer on the reverse side. The Sicilian Regional Museum of forestry and pastoral traditions in Mistretta (Messina, Italy) houses the largest collection of reverse glass paintings in Italy with a total of 195 artworks. The artworks are attributed to the different Italian geographic area from north to south Italy. A combination of non-invasive analysis by using complementary portable spectroscopic instrumentations (mainly XRF and Raman Spectrometers) was applied on some selection of reverse glass paintings. The goal of the work is the characterization of the nature of pigments and of binders used in the realization of the paints. The composition of glasses used as substrate has been also investigated. Highlights • Combined XRF, Raman and FTIR data acquisition and analysis • Pigments and binders characterization • Non-invasive approach • Handheld instrumentation [ABSTRACT FROM AUTHOR]

Background: GENetics of mOyaMoyA (GEN-O-MA) project is a multicenter observational study implemented in Italy aimed at creating a network of centers involved in moyamoya angiopathy (MA) care and research and at collecting a large series and bio-repository of MA patients, finally aimed at describing the disease phenotype and clinical course as well as at identifying biological or cellular markers for disease progression. The present paper resumes the most important study methodological issues and preliminary results.Methods: Nineteen centers are participating to the study. Patients with both bilateral and unilateral radiologically defined MA are included in the study. For each patient, detailed demographic and clinical as well as neuroimaging data are being collected. When available, biological samples (blood, DNA, CSF, middle cerebral artery samples) are being also collected for biological and cellular studies.Results: Ninety-eight patients (age of onset mean ± SD 35.5 ± 19.6 years; 68.4% females) have been collected so far. 65.3% of patients presented ischemic (50%) and haemorrhagic (15.3%) stroke. A higher female predominance concomitantly with a similar age of onset and clinical features to what was reported in previous studies on Western patients has been confirmed.Conclusion: An accurate and detailed clinical and neuroimaging classification represents the best strategy to provide the characterization of the disease phenotype and clinical course. The collection of a large number of biological samples will permit the identification of biological markers and genetic factors associated with the disease susceptibility in Italy. [ABSTRACT FROM AUTHOR]

The following paper presents a method to optimise a discontinuous permeable adsorptive barrier (PAB-D). This method is based on the comparison of different PAB-D configurations obtained by changing some of the main PAB-D design parameters. In particular, the well diameters, the distance between two consecutive passive wells and the distance between two consecutive well lines were varied, and a cost analysis for each configuration was carried out in order to define the best performing and most cost-effective PAB-D configuration. As a case study, a benzene-contaminated aquifer located in an urban area in the north of Naples (Italy) was considered. The PAB-D configuration with a well diameter of 0.8 m resulted the best optimised layout in terms of performance and cost-effectiveness. Moreover, in order to identify the best configuration for the remediation of the aquifer studied, a comparison with a continuous permeable adsorptive barrier (PAB-C) was added. In particular, this showed a 40% reduction of the total remediation costs by using the optimised PAB-D. [ABSTRACT FROM AUTHOR]

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A few hydrogeological studies have been carried out worldwide in peridotite aquifer systems, despite their wide distribution. The ophiolites are one of the main groundwater reservoir within the northern Apennines (Italy). This paper suggests the graphical solution to set the hydrogeological map of heterogeneous, multi-layered ophiolitic aquifers mapped on large scale (1:1600). The site investigation area is an ophiolite outcrop of the External Ligurian of the northern Apennines: the Mountain Prinzera rock complex area (44°38′30″N, 10°5′E; Parma Province, Emilia-Romagna Region). The hydrogeological characteristics of the tested aquifer system do not allow setting a hydrogeological map by applying usual graphical approaches. The hydrogeological map in such complex aquifer systems will show the classic hydrogeological data but must put in evidence above all (i) the main heterogeneities of the system, from the hydraulic point of view and (ii) the modifications of groundwater scenarios and pathways over time. The hydrogeological database of Mt Prinzera aquifer was managed in ESRI ArcGIS 10.0 software. [ABSTRACT FROM PUBLISHER]

This work presents an innovative configuration of a permeable adsorptive barrier (PAB) for thein situremediation of benzene-contaminated groundwater in the area of Naples (Italy). A PAB is a type of permeable reactive barrier (PRB) made with adsorbing materials (e.g. activated carbon). This particular PAB is a discontinuous permeable adsorptive barrier (PAB-D), consisting in an array of deep passive adsorptive wells whose hydraulic conductivity is higher than the surrounding soil. The design was based on COMSOL Multi-physics®simulations, which allow for the description of pollutant transport in groundwater and adsorption onto the barrier by means of a 2D model solved using a finite element approach. Based on a hydrological and geotechnical characterization of the entire polluted aquifer, the design and optimization of PAB-D parameters (location, orientation, number of wells and dimensions) were defined. The influence of hydraulic conductivity and dispersivity on the total number of wells for a complete aquifer remediation was investigated. Finally, a comparison with a continuous barrier (PAB-C), i.e. a wall of adsorptive material, in terms of total adsorbing material needed, is presented. [ABSTRACT FROM PUBLISHER]

Background: Mortality among critically ill children requiring continuous renal replacement therapy (CRRT) is high. Several factors have been identified as outcome predictors. Many studies have specifically reported a positive association between the fluid overload at CRRT initiation and the mortality of critically ill pediatric patients. Methods: This study is a retrospective single-center analysis including all patients admitted to the pediatric intensive care unit (PICU) of our hospital who received CRRT between 2000 and 2012. One hundred thirty-one patients were identified and subsequently classified according to primary disease. Survival rates, severity of illness and fluid balance differed among subgroups. The primary outcome was patient survival to PICU discharge. Results: Overall survival to PICU discharge was 45.8 %. Based on multiple regression analysis, mortality was independently associated with onco-hematological disease [odds ratio (OR) 11.7, 95 % confidence interval (CI) 1.3-104.7; p = 0.028], severe multiple organ dysfunction syndrome (MODS) (OR 5.1, 95 % CI 1.7-15; p = 0.003) and hypotension (OR 11.6, 95 % CI 1.4-93.2; p = 0.021). In the subgroup analysis, a fluid overload (FO) of more than 10 % (FO>10 %) at the beginning of CRRT seems to be a negative predictor of mortality (OR 10.9, 95 % CI 0.78-152.62; p = 0.07) only in children with milder disease (renal patients). Due to lack of statistical power, the independent effect of fluid overload on mortality could not be analyzed in all subgroups of patients. Conclusions: In children treated with CRRT the underlying diagnosis and severity of illness are independent risk factors for mortality. The degree of FO is a negative predictor only in patients with milder disease. [ABSTRACT FROM AUTHOR]

This cross-sectional study has investigated the diagnostic and therapeutic management of patients suffering from multiple sclerosis (MS) in the Campania Region (Italy). A survey involving all the reference centers for MS in Campania Region was conducted from March to August 2011. Centers responded to a web-administered questionnaire on management and clinical characteristics of MS patients. In the study period, 3263 patients (mean age 37 years, 66 % females) accessed the centers. Patients received a first diagnosis of MS in 161 cases (4.9 %). About 37 % of the subjects without a previous diagnosis came to the centers on their own initiative. All patients underwent a complete neurological examination and expanded disability status scale. The other most common investigations were magnetic resonance imaging (44.0 %) and evoked potentials (22.1 %). The number of treated patients was 2797 (87.1 %). The most used drugs were interferon β and glatiramer acetate. The time between diagnosis and initiation of therapy exceeded 6 months in 32 % of cases. Second-line drugs were under-used: 16 % of patients who might benefit from them show high clinical and radiological disease activity despite treatment with immunomodulant drugs. The MS care management of the surveyed centers showed consistent margins for improvement in 2011. Even though these data do not represent the current situation, they can be used to monitor improvements in MS care. [ABSTRACT FROM AUTHOR]

Purpose: Recurrence of tuberculosis (TB) can be the consequence of relapse or exogenous reinfection. The study aimed to assess the factors associated with exogenous TB reinfection. Methods: Prospective cohort study based on the TB database, maintained at the Division of Infectious Diseases, Luigi Sacco Hospital (Milan, Italy). Time period: 1995-2010. Inclusion criteria: (1) ≥2 episodes of culture-confirmed TB; (2) cure of the first episode of TB; (3) availability of one Mycobacterium tuberculosis isolate for each episode. Genotyping of the M. tuberculosis strains to differentiate relapse and exogenous reinfection. Logistic regression analysis was used to assess the influence of risk factors on exogenous reinfections. Result: Of the 4682 patients with TB, 83 were included. Of these, exogenous reinfection was diagnosed in 19 (23 %). It was independently associated with absence of multidrug resistance at the first episode [0, 10 (0.01-0.95), p = 0.045] and with prolonged interval between the first TB episode and its recurrence [7.38 (1.92-28.32) p = 0.004]. However, TB relapses occurred until 4 years after the first episode. The risk associated with being foreign born, extrapulmonary site of TB, and HIV infection was not statistically significant. In the relapse and re-infection cohort, one-third of the patients showed a worsened drug resistance profile during the recurrent TB episode. Conclusions: Exogenous TB reinfections have been documented in low endemic areas, such as Italy. A causal association with HIV infection could not be confirmed. Relapses and exogenous reinfections shared an augmented risk of multidrug resistance development, frequently requiring the use of second-line anti-TB regimens. [ABSTRACT FROM AUTHOR]

Conclusions: Despite the innovations in cochlear implant (CI) technology in recent years, some auditory tasks remain difficult for CI recipients. This work proposes the creation of specific maps for telephone communication (via conventional phone and via Internet protocol, VoIP). In light of our preliminary results, we believe that our experimental maps might improve conventional telephone and Internet communications for CI recipients. Objectives: This study aimed to: (1) analyze the spectro-temporal characteristics of the signals; (2) evaluate speech recognition scores using two different types of telephone communication; and (3) change some map parameters on the basis of the previous signal analysis, to obtain a specific map for telephone use. Methods: Eleven Cochlear™ Nucleus® CI recipients were tested for bisyllabic word recognition in quiet using reproduced voice and transmitted voice via conventional telephone and Skype® using the habitual-ACE (SLB) map, and two experimental maps (F- and V-Map). Results: The results showed a worsening of word recognition scores with SLB-Map via telephone (30.5%) and VoIP (18.6%) compared with those achieved with the same map in an anechoic booth. In the experimental listening conditions, 65% and 54% of patients performed better with F- and V-Map, respectively, up to a maximum of performance improvement by 35% via telephone and 25% via VoIP. [ABSTRACT FROM AUTHOR]

Purpose – The current research aims to investigate what Italian state universities consider as intellectual capital (IC) in their performance plans. Universities assume a specific responsibility in the production and dissemination of knowledge and in the investment in research and human resources; consequently, a central role has been given to IC approaches in managing universities. Drawing from this, in 2009 Italy required state universities to issue a performance plan with a section devoted to IC. Design/methodology/approach – A content analysis was conducted to discover the type and extent of IC strategies in a group of 44 contemporary Italian state university performance plans issued in 2011. Findings – The findings show a variable focus on IC items, with a particular emphasis on aspects related to the development of relationships with external partners, supporting the idea that nowadays the university sector is strongly investing in the development of relational capital to achieve its third mission. Practical implications – In assessing practices of IC planning in Italian state universities, the current study highlights the path of development that will be undertaken by the Italian university system in the near future. This path allows us to evaluate the strategic position that the Italian university system will cover in the European higher education arena. Originality/value – The paper makes an original contribution to research on IC strategies in universities, given the lack of empirical studies on such issues. It represents one of the first attempts to analyse IC in Italian state universities' planning processes. [ABSTRACT FROM AUTHOR]

The links between Stn DBS and advanced Parkinson disease, and between GPi DBS and dystonia are nearly universally accepted by the neurologists and neurosurgeons. Nevertheless, in some conditions, targets such as the ventral thalamus and the Zona Incerta may be considered to optimize the results and avoid the side effects. Positive and negative aspects of current DBS treatments justify the research of new targets, new stimulation programs and new hardware. Since 1993, at the Istituto Nazionale Neurologico 'Carlo Besta' in Milan, 580 deep brain electrodes were implanted in 332 patients. 276 patients were affected by movement disorders. The DBS targets included Stn, GPi, Voa, Vop, Vim, CM-pf, cZi, IC. The long-term follow-up is reported and related to the chosen target. DBS gave a new therapeutic option to patients affected by severe movement disorders, and in some cases resolved life-threatening pathological conditions that would otherwise result in the death of the patient, such as in status dystonicus, and post-stroke hemiballismus. Nevertheless, the potential occurrence of severe complications still limit a wider use of DBS. At today, the use of DBS in severe movement disorders is strongly positive even if further investigations and studies are needed to unveil potential new applications, and to refine the selection criteria for the actual indications and targets. The experience of different targets may be useful to guide and tailor the target choice to the individual clinical condition. [ABSTRACT FROM AUTHOR]

Abstract: Three hundred and ninety-seven randomly selected households were interviewed by telephone to determine the numbers and management of owned cats and dogs in the Teramo Province of Italy. The households were selected using stratified random sampling for each municipality; municipalities were combined into coastal, central hills and mountain regions for analysis. The interviews were completed during May and June of 2004 with a response rate of 74% (397/536). Forty-six percent of households (n =181) owned pets; 15% of all households (n =60) owned cats and 33% (n =130) owned dogs. Twenty-seven of these households (7%) owned both cats and dogs. Data were provided on 91 cats evenly divided between males and females. The median age was 3 years (range 0.2–10 years). Forty-one percent of cats (36/87) entered the household as strays. Nearly half lived entirely outside. Seventy percent (62/88) had visited a veterinarian at least once; 43% (39/91) were sterilized. About 1/3 had had a litter and all litters were considered accidental rather than planned. Age, indoor/outdoor status, veterinarian visit and region were all associated with sterilization. Age, confined to a yard, veterinary visit and region were associated with allowing the cat to roam freely. Data were provided on 182 dogs. Sixty-two percent (113/181) were male, with a median age of 4 years (range newborn to 17 years) and 40% (72/181) were purebred. Almost half were acquired as a gift. Sixty-two percent (112/180) were kept entirely outside despite the fact that 82% (147/180) were considered companions rather than working dogs. Almost all of the dogs had been to a veterinarian at least once; only 20% (n =29) were sterilized. Male dogs were significantly less likely to be sterilized than females. Almost half the dogs had had at least one litter. Seventy-six percent (137/180) of dogs knew some basic commands. Sex, source and training to sit/stay/come were significantly associated with whether the dog was sterilized. Dog size, confinement to a yard, trained to leash walk, veterinary visit and region were predictors of roaming freely. Source and trained to leash walk were associated with dog registration. For cats and dogs, education about sterilization seemed to be critically important. For dogs, factors relating to training, which may reflect the strength of the human–animal bond, were also important. [Copyright &y& Elsevier]

Abstract: A cross-sectional telephone survey of randomly selected households examined the extent and types of problems associated with free-roaming dogs and cats in the Teramo province of Italy. The households were sampled randomly within each municipality; municipalities were combined into coastal, central hills and mountain regions for analysis. The survey was conducted in May and June of 2004 with a response rate of 74% (397/536). Ninety percent of respondents (N =356) believed that free-roaming dogs and cats were a problem. They were most commonly concerned about personal safety, followed by animal welfare, public health and environmental sanitation. Sixty-nine percent of respondents (274) actually saw free-roaming dogs or cats where they live. While dogs were most commonly seen, cats were seen in greater numbers. Overall, 10% (39/297) and 5% (21/397) of respondents cared for free-roaming cats and dogs, respectively. Two-thirds of the respondents (251/397) believed that animals were abandoned because the owners lost interest. About 2/3 of respondents (251/397) reported that the community government should have the responsibility for dealing with free-roaming dogs and cats. The respondents supported the idea of building more shelters and controlling the birth rate as control measures rather than euthanizing dogs and cats. The results suggest that free-roaming dogs and cats are a very common sight in this part of Italy with substantial concerns by the residents. However, concerns about the animals’ welfare were clearly raised, supporting the laws that make it illegal to euthanize a healthy dog or cat in Italy. Using the information from this study, research on the underlying causes of abandonment of dogs and cats or failing to sterilize them should be undertaken to begin to address this problem. Further, national and regional funding must be provided to support existing laws which should help protect and eventually decrease the numbers of free-roaming and homeless dogs and cats. [Copyright &y& Elsevier]

Abstract: A spreadsheet population dynamics model was constructed to evaluate the impact of female dog sterilization on the domestic dog population for the province of Teramo, Italy. Baseline owned dog population structure as well as the annual number of births, adoptions, abandonments, and purchases were estimated based on regional managed kennel data in addition to a telephone questionnaire administered to members of the local population. Age- and gender-dependent death rates were based on domestic dog life tables. The model predicts that at the current female dog sterilization rate of 30%, the owned dog population will most probably continue to increase. After 20 years, a mean annual increase of 2.6% (median: 2.5%, 95% CI: −3.2% to 8.8%) is projected assuming that the average age at sterilization is 3 years. A sterilization rate of at least 55% is estimated to be needed to halt population growth if the current age structure for female dog sterilization is maintained. However, if the province of Teramo were to focus on sterilizing female dogs less than 1 year of age, the required sterilization rate to arrest population growth could be reduced to as low as 26%. [Copyright &y& Elsevier]

OBJECTIVE:: To test whether ghrelin variants could play a role in modulating some aspects of the obese phenotype during childhood. DESIGN:: We screened the ghrelin gene in 300 Italian obese children and adolescents (mean age 10.5±3.2?y; range 4-19?y) and 200 controls by using the single-strand conformation polymorphism and the restriction fragment length polymoprhism analysis. RESULTS:: No mutations were detected with the exception of two previously described polymorphisms, Arg51Gln and Leu72Met. For both variations, allelic frequencies were similar between patients and controls. Interestingly, we showed that the Leu72Met polymorphism was associated with differences in the age at obesity onset. Patients with the Met72 allele became obese earlier than homozygous patients for the wild Leu72 allele. The logrank test comparing the plots of the complement of Kaplan-Meier estimates between the two groups of patients was statistically significant (P<0.0001). CONCLUSION:: It is unlikely that ghrelin variations cause the obesity due to single-gene mutations. The Leu72Met polymorphism of the ghrelin gene seems to play a role in anticipating the onset of obesity among children suggesting, therefore, that ghrelin may be involved in the pathophysiology of human adiposity.International Journal of Obesity (2004) 28, 447-450. doi:10.1038/sj.ijo.0802572 Published online 13 January 2004 [ABSTRACT FROM AUTHOR]

Objective: To investigate the relationship between beliefs of physicians relative to intensive metabolic control in type 2 diabetes and levels of HbA1c obtained in a sample of their patients.Research Design and Methods: Physicians' beliefs were investigated through a questionnaire sent to a sample of self-selected clinicians participating in a nationwide initiative aimed at assessing the relationship between the quality of care delivered to patients with type 2 diabetes and their outcomes. At the same time, physicians were asked to collect clinical data on a random sample of their patients, stratified by age (<65 vs. > or = 65 years). Mean HbA1c levels in the study population were thus evaluated according to target fasting blood glucose (FBG) used by their physicians.Results: Of 456 physicians, 342 (75%) returned the questionnaire. Among the responders, 200 diabetologists and 99 general practitioners (GPs) recruited 3,297 patients; 2,003 of whom were always followed by the same physician and 1,294 of whom were seen by different physicians in the same structure on different occasions. Only 14% of the respondents used target FBG levels < or = 6.1 mmol/l, whereas 38% pursued values >7.8 mmol/l, with no statistically significant difference between diabetologists and GPs. The analysis of the relationship between FBG targets and metabolic control, restricted to those patients always seen by the same physician, showed a strong linear association, with mean HbA1c values of 7.0 +/- 1.6 for patients in the charge of physicians pursuing FBG levels < or = 6.1 mmol/l and 7.8 +/- 1.8 for those followed by physicians who used target values >7.8 mmol/l. After adjusting for patients' and physicians' characteristics, the risk of having HbA1c values > 7.0% was highly correlated with physicians' beliefs. Patients followed by different physicians in the same unit showed a risk of inadequate metabolic control similar to that of patients followed by physicians adopting a nonaggressive policy.Conclusions: Doctors adopt extremely heterogeneous target FBG levels in patients with type 2 diabetes, which in turn represent an important independent predictor of metabolic control. To improve patient outcomes, physicians-centered educational activities aimed at increasing the awareness of the potential benefits of a tight metabolic control in patients with type 2 diabetes are urgently needed. [ABSTRACT FROM AUTHOR]

In the coming years, Italy will need to take on a great challenge concerning the digitization of its archaeological and architectural heritage, one of the richest and most problematic in the world. The aim is to improve the knowledge, conservation, enhancement and accessibility of cultural assets and to make them a resource for national and local development. In this process, the next generation of 3D survey methods (laser scanning and photogrammetry), in combination with diagnostic techniques (spectroscopy analyses) and GIS/BIM (Geographic Information System/Building Information Modeling) solutions, represent a valid support. This work, part of a broader intervention launched by the Municipality of Reggio Calabria for the requalification of some archaeological sites located within its urban and metropolitan area, is focused on the study case of Motta S. Agata. The ancient settlement is located 8 km from Reggio C. in a hilly area difficult to reach and preserves numerous structures in a state of ruin. Among these, two interesting medieval churches are proposed for examination: the church of San Nicola, characterized by five hypogeal funeral crypts, and the chapel of San Basilio, which preserves the traces of a wall painting. A multi-methodological approach including close-range photogrammetry, laser scanning and chemical and thermal analyses was adopted in order to fulfill different tasks: creating a topographic model of the hillfort, mapping the archaeological evidence, digitizing and returning 3D models of the churches, characterizing materials through chemical analyses and monitoring the surfaces with thermal imaging. These combined applications have contributed to reaching the planned goals, i.e., study, conservation, diagnostics, preparation for restoration interventions, development of digital media and dissemination. In this way, a type of interactive museum (made up of virtual tours and informative digital models) has been made available in order to improve the site's accessibility and inclusivity as well as to test the effect of digitization in attracting tourists and local people toward a place located outside of the usual tourist circuits. [ABSTRACT FROM AUTHOR]

Advances in the epidemiological tracing of pathogen transmission have been largely driven by the increasing characterisation of whole-genome sequence data obtained at a finer resolution from infectious disease outbreaks. Dynamic models that integrate genomic and epidemiological data further enhance inference on the evolutionary history and transmission dynamics of epidemic outbreaks by reconstructing the network of 'who-infected-whom'. Swine Vesicular Disease (SVD) was present in Italy from 1966 until 2015, and since the mid-1990s, it has mainly been circulating within Italy's central-southern regions with sporadic incursions to the north of the country. However, a recrudescence of SVD in northern Italy was recorded between November 2006 and October 2007, leading to a large-scale epidemic that significantly affected the intensive pig industry of the Lombardy region. In this study, by using whole-genome sequence data in combination with epidemiological information on disease occurrences, we report a retrospective epidemiological investigation of the 2006–2007 SVD epidemic, providing new insights into the transmission dynamics and evolutionary mode of the two phases that characterised the epidemic event. Our analyses support evidence of undetected premises likely missed in the chain of observed infections, of which the role as the link between the two phases is reinforced by the tempo of SVD virus evolution. These silent transmissions, likely resulting from the gradual loss of a clear SVD clinical manifestation linked to sub-clinical infections, may pose a risk of failure in the early detection of new cases. This study emphasises the power of joint inference schemes based on genomic and epidemiological data integration to inform the transmission dynamics of disease epidemics, ultimately aimed at better disease control. [ABSTRACT FROM AUTHOR]

Background: Ultra-protective lung ventilation in acute respiratory distress syndrome or early weaning and/or avoidance of mechanical ventilation in decompensated chronic obstructive pulmonary disease may be facilitated by the use of extracorporeal CO2 removal (ECCO2R). We tested the CO2 removal performance of a new ECCO2R (CO2RESET) device in an experimental animal model. Methods: Three healthy pigs were mechanically ventilated and connected to the CO2RESET device (surface area = 1.8 m2, EUROSETS S.r.l., Medolla, Italy). Respiratory settings were adjusted to induce respiratory acidosis with the adjunct of an external source of pure CO2 (target pre membrane lung venous PCO2 (PpreCO2): 80–120 mmHg). The amount of CO2 removed (VCO2, mL/min) by the membrane lung was assessed directly by the ECCO2R device. Results: Before the initiation of ECCO2R, the median PpreCO2 was 102.50 (95.30–118.20) mmHg. Using fixed incremental steps of the sweep gas flow and maintaining a fixed blood flow of 600 mL/min, VCO2 progressively increased from 0 mL/min (gas flow of 0 mL/min) to 170.00 (160.00–200.00) mL/min at a gas flow of 10 L/min. In particular, a high increase of VCO2 was observed increasing the gas flow from 0 to 2 L/min, then, VCO2 tended to progressively achieve a steady-state for higher gas flows. No animal or pump complications were observed. Conclusions: Medium-flow ECCO2R devices with a blood flow of 600 mL/min and a high surface membrane lung (1.8 m2) provided a high VCO2 using moderate sweep gas flows (i.e., >2 L/min) in an experimental swine models with healthy lungs. [ABSTRACT FROM AUTHOR]

Background: circulating tumor DNA (ctDNA) is a source of tumor genetic material for EGFR testing in NSCLC. Real-word data about liquid biopsy (LB) clinical practice are lacking. The aim of the study was to describe the LB practice for EGFR detection in North Eastern Italy. Methods: we conducted a multi-regional survey on ctDNA testing practices in lung cancer patients. Results: Median time from blood collection to plasma separation was 50 min (20–120 min), median time from plasma extraction to ctDNA analysis was 24 h (30 min–5 days) and median turnaround time was 24 h (6 h–5 days). Four hundred and seventy five patients and 654 samples were tested. One hundred and ninety-two patients were tested at diagnosis, with 16% EGFR mutation rate. Among the 283 patients tested at disease progression, 35% were T790M+. Main differences in LB results between 2017 and 2018 were the number of LBs performed for each patient at disease progression (2.88 vs. 1.2, respectively) and the percentage of T790M+ patients (61% vs. 26%). [ABSTRACT FROM AUTHOR]

Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease with no recognized clinical prognostic factor. Creatinine kinase (CK) increase in these patients is already described with conflicting results on prognosis and survival. In 126 ALS patients who were fast or slow disease progressors, CK levels were assayed for 16 months every 4 months in an observational case-control cohort study with prospective data collection conducted in Italy. CK was also measured at baseline in 88 CIDP patients with secondary axonal damage and in two mouse strains (129SvHSD and C57-BL) carrying the same SOD1G93A transgene expression but showing a fast (129Sv-SOD1G93A) and slow (C57-SOD1G93A) ALS progression rate. Higher CK was found in ALS slow progressors compared to fast progressors in T1, T2, T3, and T4, with a correlation with Revised Amyotrophic Lateral Sclerosis Functional Rating Scale (ALSFRS-R) scores. Higher CK was found in spinal compared to bulbar-onset patients. Transgenic and non-transgenic C57BL mice showed higher CK levels compared to 129SvHSD strain. At baseline mean CK was higher in ALS compared to CIDP. CK can predict the disease progression, with slow progressors associated with higher levels and fast progressors to lower levels, in both ALS patients and mice. CK is higher in ALS patients compared to patients with CIDP with secondary axonal damage; the higher levels of CK in slow progressors patients, but also in C57BL transgenic and non-transgenic mice designs CK as a predisposing factor for disease rate progression. [ABSTRACT FROM AUTHOR]

The Italian law 40/2004 regulating the use of assisted conception will remain on the statutes after the failure of the referendum in June 2005. Italy is now one of the most restrictive countries in the world in the field of assisted conception. It is thought that the new regulations, which have already increased 'reproductive tourism' in Italian subfertile couples, will also have clinical and research implications. [ABSTRACT FROM AUTHOR]

Introduction and Aim: Patients with colorectal cancer (CRC) may develop liver metastases. Surgical resection remains the best treatment of choice for colorectal liver metastases (CRLM) according to resectability criteria, with a long-term survival of 25% up to 41% after 5 years. Advanced age is associated with a higher incidence and co-morbidity, particularly cardiovascular disease, as well as deteriorating physiological reserves. The aim of this study was to analyse the overall and disease-free survival for patients with CRLM according to their chronological age.Methods: Patients with CRLM were enrolled in the study. Data on gender, age, co-morbidity, metastasis characteristics (number, size and total metastatic volume (TMV)), use of perioperative chemotherapy and operative and post-operative complications were collected. Then, according to recent World Health Organization (WHO) guidelines, the patients were grouped by age. Statistical analysis was performed using the software R (ver. 2.14.1).Results: Hepatic resection was performed in 149 patients (21 patients in the very elderly group, 79 in the elderly group and 49 in the younger group). The three groups were comparable in terms of operative duration, transfusion rate, length of high-dependency unit (HDU) stay and post-operative hospital stay. The very elderly group showed a non-significant increase in post-operative morbidity. The 30-day and 60-day/inpatient mortality rates increased with age without any significant statistically difference between the three groups (very elderly group 4.8% and 4.8%; elderly group: 2.5% and 3.8%; and younger group 0% and 2%). At 5 years, the overall survival was 28.6% for very elderly patients (≥75 years), 33.3% for elderly patients (≥65 to <75 years) and 43.5% for younger patients (≤65 years). The 1-, 3- and 5-year disease-free survival was similar across the groups.Conclusions: Liver resection for CRLM in carefully selected patients above the age of 75 can be performed with acceptable morbidity and mortality rates, similar to those in younger patients. Moreover, the severity of CRLM in elderly patients is proven to be lesser than in younger patients. Thus, we can conclude that advanced chronological age cannot be considered a contraindication to hepatic resection for CRLM. [ABSTRACT FROM AUTHOR]

Introduction: Progressive functional impairment with age has a significant impact on perioperative risk management. Chronic liver diseases induce a strong oxidative stress; in the elderly, in particular, impaired elimination of free radicals leads to insufficient DNA repair. The events associated with a weak response to growth factors after hepatectomy leads to a decline in liver regeneration. Hypercholesterolemia is highly prevalent in the elderly, which may alter the coenzyme Q10 (CoQ) levels and in turn the cellular energy balance. This condition is commonly treated with statins. The aim of this study is to investigate the role of preoperative cellular energy balance in predicting hepatocellular carcinoma (HCC) postresection outcomes.Materials and Methods: In a 5-year period (2009-2013), elderly patients with hypercholesterolemia, cardiovascular disease, and diabetes mellitus, undergoing HCC resection, were recruited and grouped by age (<75 and ≥ 75 years old). All patients were previously treated with statins. The risk factors associated with hospital morbidity/mortality and prolonged length of stay (LOS) were evaluated.Results: Forty-five elderly patients were recruited and grouped according to their treatment: Group 1 (n = 23) was treated with statins alone (control group), whereas Group 2 (n = 22) was treated with statins and a CoQ analogue, 3 weeks from the surgery and at least a month later (experimental group). The majority of our patients were treated with atorvastatin [n = 28 (53.84%)] and the minority with simvastatin [n = 17 (32.69%)], 20 mg/day, for at least 3 years before the surgery. Perioperative mortality was observed in one patient of Group 1 (4.3%). Morbidities were noted in 13 patients of Group 1 (56.5%) and four patients of Group 2 (18.2%). The control group showed delayed functional recovery, muscle weakness, increased infection rate, and pleural effusion due to prolonged bed rest (hospital stay 13 days (7-19) vs. 8.5 days (5-12)), compared with the experimental group. The overall survival at 5 years was similar for both groups (n = 10 patients (43%) in Group 1 vs. n = 10 patients (45%) in Group 2).Conclusion: In the elderly population, survival is closely linked to postoperative morbidity and mortality. In our study, prolonged LOS was found to be related to delayed bioenergetic recovery. When limited, risk factors such as infections, neutropenia, and red blood cell transfusions could lower LOS and mortality of elderly patients with HCC. Higher age was associated with greater postoperative morbidity and successful hospital stay. [ABSTRACT FROM AUTHOR]

Abstract: Background: We retrospectively reviewed our experience in combined liver–kidney (L-KT) and heart–kidney (H-KT) transplantations. Patients and Methods: Between January 1997 and April 2007, we performed 25 L-KT and 5 H-KT. Patient mean age was 51 ± 8 years in L-KT and 43 ± 11 years in H-KT. The main cause of liver failure was chronic viral hepatitis (14 cases). Etiology of heart failure was dilated cardiomyopathy and hypertrophic cardiomyopathy (4 and 1 patients, respectively). The main causes of renal failure in L-KT were chronic glomerulonephritis (n = 8) and polycystic disease (n = 7). Etiology of renal failure in H-KT was interstitial nephropathy (n = 2), vascular nephropathy (n = 2), and chronic glomerulonephritis (n = 1). Results: Mean follow-up was 32 ± 26 months in L-KT and 24 ± 17 months in H-KT. Immunosuppression was cyclosporine-based (n = 4) or tacrolimus-based (n = 21) in L-KT and cyclosporine-based in H-KT. Acute rejection rate was 8% for both liver and kidney in L-KT; 80% (mild) for heart and 40% for kidney in H-KT. In the L-KT group, there was no primary graft nonfunction (PGNF). Two patients experienced liver delayed graft function (DGF); 1 patient required postoperative dialysis. One-year graft and patient survivals were both 84% and overall graft and patient survival was 76%. In the H-KT group, 3 patients needed postoperative dialysis and 1 required a cardiac assistance device for 48 hours; overall graft and patient survival was 100% with good cardiac and renal functions. Conclusion: Our experience confirmed that H-KT and L-KT are safe procedures, offering good long-term results. [Copyright &y& Elsevier]

Background The HPB district tumour includes a high incidence between the 6th and the 8th decade of life. ISTAT information from the 1st January 2009 confirm that people over the age of 65 represent 20.1% of the population. In Calabria they represent 18,7% of the population, according to the national tendency. Materials and methods From November 2007 to October 2009,185 HPB patients from our Institute were observed and divided as follows: 39 for pancreatic tumours, 21 for HCC;39 for neoplasm of the CBD, 41 for liver MTS; 45 for benign liver pathology. Results Operative mortality, disease -- free survival and overall survival are very similar to the deducible information of the whole survey and they seem to be influenced by tactics and surgical technique. As the elderly can present comorbidity, cognitive defects and less life expectancy, appropriate therapeutical options require a significant selection by the candidate for major resective surgery. Conclusions Our information indicates that seniority is not an aggravating risk in terms of outcome, not only by the significant patient selection but also by the surgeon experience and it doesn't condition major surgical options. The HPB resective surgery, in selected elderly patients, can be done maintaining an acceptable morbidity and an appropriate survival level in terms of life. [ABSTRACT FROM AUTHOR]