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Background Among the different CardioVascular (CV) manifestation of the COronaVIrus-related Disease (COVID) particular attention has been paid to arrhythmia and particularly to Atrial fibrillation (AF). The aim of our study was to assess the incidence of AF episodes in patients hospitalized for COVID and to evaluate its predictors and its relationship with in-hospital all-cause mortality. Methods We enrolled 3435 cases of SARS-CoV2 infection admitted in four hospitals in Northern Italy. We collected data on clinical history, vital signs, Intensive Care Unit (ICU) admission, laboratory tests and pharmacological treatment. AF incident and all-cause in-hospital mortality were considered as outcomes. Results 145 (4.2%) patients develop AF during hospitalization, with a median time of 3 days (IQR: 0, 11.5) from admission. Incident AF patients were older and had lower eGFR, lower platelet and lymphocytes count and higher C-Reactive Protein (CRP), were admitted more frequently to ICU and more frequently died compared to subjects that didn't present AF. At the Cox regression model significant determinants of incident AF were older age (HR 1.070; 95% CI: 1.048, 1.092), history of AF (HR 2.800; 95% CI: 1.465, 5.351), ischemic heart disease (HR 0.324; 95% CI: 0.130, 0.811) and ICU admission (HR 8.030; 95% CI: 4.511, 14.292). Incident AF was a predictor of all-cause mortality (HR 1.679; 95% CI: 1.170, 2.410), together with age (HR 1.053; 95% CI: 1.042, 1.065), dementia (HR 1.553; 95% CI 1.151, 2.095), platelet count (HR 0.997; 95% CI: 0.996, 0.999) higher CRP (HR 1.004; 95% CI: 1.003, 1.005) and eGFR (HR: 0.991; 95% CI: 0.986, 0.996) Conclusion AF present as the main arrhythmia in COVID-19 patients and its development during the hospitalization strongly relates with in-hospital mortality.

Hodgkin lymphoma (HL) has a bimodal age distribution curve, with a second peak in people aged more than 60 years. Interim PET/CT (iPET/CT) is highly predictive for PFS and OS in young HL, but it has not been sufficiently studied in the elderly. In this retrospective dual-center study, 82 patients with HL and aged 65 or more who performed iPET/CT were included. At iPET/CT, 60 patients had a complete metabolic response, 18 partial responses, and 4 progressions of disease. Baseline PET/CT metabolic features were not significantly correlated with the metabolic response at interim. In patients with interim complete metabolic response, PFS and OS were significantly longer than in patients without complete response(

Elderly Hodgkin lymphoma (HL) is an aggressive lymphoma subgroup with high 18F-FDG avidity at 18F-FDG-PET/CT but no shared criteria for PET/CT in treatment evaluation and prediction of outcome are available. The aim of our bicentric study was to investigate whether the metabolic baseline PET/CT parameters can predict treatment response and prognosis in elderly HL. We retrospectively included 123 patients who underwent baseline 18F-FDG-PET/CT and end of treatment PET/CT scans. The PET images were analyzed visually and semi-quantitatively by measuring the lesion to liver SUVmax ratio (L-L SUV R), lesion to blood-pool SUVmax ratio (L-BP SUV R), metabolic tumor volume (MTV), and total lesion glycolysis (TLG). Survival curves were plotted according to the Kaplan-Meier method. At a median follow-up of 40 months, the median PFS and OS were 29 and 37 months. L-BP SUV R, L-L SUV R, MTV, and TLG were significantly higher in patients with no complete response compared with complete response group at end of treatment. Moreover, these parameters were demonstrated to be independent prognostic factors for PFS together with tumor stage, while only L-L SUV R and L-BP SUV R for OS. End of treatment PET/CT results using Deauville criteria were significantly correlated with outcome survival. End of treatment PET/CT results (using Deauville criteria) and semiquantitative baseline PET/CT parameters were significantly correlated with response to treatment and long-term outcome.

Background: The prognostic impact of electrolyte disorders in hospitalized COVID-19 patients is unclear. Methods: The study included all adult patients hospitalized for COVID-19 in four hospitals in Northern Italy between January 2020 and May 2021 with at least one serum potassium and sodium measurement performed within 3 days since admission. Primary outcome was in-hospital death; secondary outcome was Intensive Care Unit (ICU) admission. A cause-specific Cox proportional-hazards regression model was used for investigating the association between potassium and sodium (as either categorical or continuous variables) and mortality or admission to ICU. Results: Analyses included 3,418 adult hospitalized COVID-19 patients. At multivariable analysis, both hyperkalemia (Hazard Ratio, [HR] 1.833, 95% Confidence Interval [CI] 1.371–2.450) and sK above the median (K 5.1 vs 4.1 mmol/L: HR 1.523, 95% CI 1.295–1.798), and hypernatremia (HR 2.313, 95%CI 1.772–3.018) and sNa above the median (Na 149 vs 139 mmol/L: HR 1.442, 95% CI 1.234–1.686), were associated with in-hospital death, whereas hypokalemia and hyponatremia were not. Hyponatremia was associated with increased hazard of ICU admission (HR 1.884, 95%CI 1.389–2.556). Conclusions: Electrolyte disorders detected at hospital admission may allow early identification of COVID-19 patients at increased risk of adverse outcomes.

Quantitative assessments of the relationship between health and medical treatment are of great importance to policy makers. To overcome endogeneity problems we formulate and estimate a tractable dynamic factor model where observed health outcomes are driven by the individual's latent health. The dynamics of latent health reflects both exogenous health deterioration and endogenous health investments. Our model allows us to investigate the effect of medical treatment on current health, as well as on future medical treatment and health outcomes. We estimate the model by maximum simulated likelihood and minimum distance methods using a rich longitudinal data set from Italy obtained by merging a number of administrative archives. These data contain detailed information on medical drug purchase, hospitalization, and mortality for a representative sample of elderly hypertensive patients. Our findings show that the observed autocorrelation in medical treatment reflects both permanent and time-varying observed and unobserved heterogeneity. They also show that medical drug purchase significantly maintains future health levels and prevents transitions to worse health. This suggests that policies aimed at increasing the awareness and the compliance of hypertensive patients help reduce cardiovascular risks and consequent hospitalization and mortality.

The most common arrhythmia associated with COronaVIrus-related Disease (COVID) infection is sinus tachycardia. It is not known if high Heart Rate (HR) in COVID is simply a marker of higher systemic response to sepsis or if its persistence could be related to a long-term autonomic dysfunction. The aim of our work is to assess the prevalence of elevated HR at discharge in patients hospitalized for COVID-19 and to evaluate the variables associated with it. We enrolled 697 cases of SARS-CoV2 infection admitted in our hospital after February 21 and discharged within 23 July 2020. We collected data on clinical history, vital signs, laboratory tests and pharmacological treatment. Severe disease was defined as the need for Intensive Care Unit (ICU) admission and/or mechanical ventilation. Median age was 59 years (first-third quartile 49, 74), and male was the prevalent gender (60.1%). 84.6% of the subjects showed a SARS-CoV-2 related pneumonia, and 13.2% resulted in a severe disease. Mean HR at admission was 90 ± 18 bpm with a mean decrease of 10 bpm to discharge. Only 5.5% of subjects presented HR > 100 bpm at discharge. Significant predictors of discharge HR at multiple linear model were admission HR (mean increase = β = 0.17 per bpm, 95% CI 0.11; 0.22, p < 0.001), haemoglobin (β = −0.64 per g/dL, 95% CI −1.19; −0.09, p = 0.023) and severe disease (β = 8.42, 95% CI 5.39; 11.45, p < 0.001). High HR at discharge in COVID-19 patients is not such a frequent consequence, but when it occurs it seems strongly related to a severe course of the disease.

BackgroundAn urgent need exists for an early detection of cases with a high-risk of SARS-CoV-2 infection, particularly in high-flow and -risk settings, such as emergency departments (EDs). The aim of this work is to develop and validate a predictive model for the evaluation of SARS-CoV-2 infection risk, with the rationale of using this tool to manage ED patients.MethodsA retrospective study was performed by cross-sectionally reviewing the electronical case records of patients admitted to Niguarda Hospital or referred to its ED in the period 15 March to 24 April 2020.Derivation sample was composed of non-random inpatients hospitalized on 24 April and admitted before 22 April 2020. Validation sample was composed of consecutive patients who visited the ED between 15 and 25 March 2020. The association between the dichotomic outcome and each predictor was explored by univariate analysis with logistic regression models.ResultsA total of 113 patients in the derivation sample and 419 in the validation sample were analyzed. History of fever, elder age and low oxygen saturation showed to be significant predictors of SARS-CoV-2 infection. The neutrophil count improves the discriminative ability of the model, even if its calibration and usefulness in terms of diagnosis is unclear.ConclusionThe discriminatory ability of the identified models makes the overall performance suboptimal; their implementation to calculate the individual risk of infection should not be used without additional investigations. However, they could be useful to evaluate the spatial allocation of patients while awaiting the result of the nasopharyngeal swab.Key Messages boxWhat is already known on this topic1 year after the onset of the coronavirus disease 2019 (COVID-19) pandemic, the trend of its spread has not shown a substantial global reduction. An urgent need exists for efficient early detection of cases with a high risk of SARS-CoV-2 infection and a number of diagnostic prediction models have been developed, but a few models were externally validated in high-flow and –risk settings, such as emergency departments (EDs).What this study addsThis study develops and validate predictive models for the evaluation of SARS-CoV-2 infection risk, with the rationale of using these tools to promptly manage patients who are afferent to the ED, allocating them accordingly to the risk of infection while awaiting swab result. History of fever, older age and low oxygen saturation showed to be significant predictors of the presence of SARS-CoV-2 infection. The use of laboratory findings, such as neutrophil count, showed to improve the discriminative ability of the model, even if its calibration and usefulness in terms of diagnosis is unclear.

SARS-CoV-2 infection determines a disease that predominantly affects lungs. However the cytokines storms, determined by the huge immune response to the infection, could affect also other organs and apparatus such as heart and vessels. Beyond the acute inflammation itself also hypercoagulative status has been linked to SARSCoV-2 infection and this surely relates to the increase seen in prevalence of pulmonary embolism and myocardial infarction. A number of cardiac abnormalities and pathologies have been observed, with special attention to cardiac arrhythmias and myocardial involvement. Furthermore, indirect damages determined by the reduction in acute and chronic cardiovascular care, results in a strong mortality and morbidity outcomes in cardiological patients. In this review we will summarise current knowledge on both direct and indirect cardiovascular damages determined by the SARS-CoV-2 pandemia.

Purpose To assess the presence and pattern of incidental interstitial lung alterations suspicious of COVID-19 on fluorine-18-fluorodeoxyglucose positron emission tomography (PET)/computed tomography (CT) ([18F]FDG PET/CT) in asymptomatic oncological patients during the period of active COVID-19 in a country with high prevalence of the virus. Methods This is a multi-center retrospective observational study involving 59 Italian centers. We retrospectively reviewed the prevalence of interstitial pneumonia detected during the COVID period (between March 16 and 27, 2020) and compared to a pre-COVID period (January–February 2020) and a control time (in 2019). The diagnosis of interstitial pneumonia was done considering lung alterations of CT of PET. Results Overall, [18F]FDG PET/CT was performed on 4008 patients in the COVID period, 19,267 in the pre-COVID period, and 5513 in the control period. The rate of interstitial pneumonia suspicious for COVID-19 was significantly higher during the COVID period (7.1%) compared with that found in the pre-COVID (5.35%) and control periods (5.15%) (p

BackgroundMost respiratory viruses show pronounced seasonality, but for SARS-CoV-2 this still needs to be documented.MethodsWe examined the disease progression of COVID-19 in 6,914 patients admitted to hospitals in Europe and China. In addition, we evaluated progress of disease symptoms in 37,187 individuals reporting symptoms into the COVID Symptom Study application.FindingsMeta-analysis of the mortality risk in seven European hospitals estimated odds ratios per one day increase in the admission date to be 0.981 (0.973-0.988, pInterpretationSeverity of COVID-19 in Europe decreased significantly between March and May and the seasonality of COVID-19 is the most likely explanation.

This chapter provides a description of the weighting and imputation strategies used to address problems of unit nonresponse, sample attrition and item nonresponse in the seventh wave of SHARE.

Kikuchi-Fujimoto disease, also known as histiocytic lymphadenitis is a rare and benign disease characterized by regional cervical lymphadenopathy with fever of unknown origin, affecting mainly young women. We describe a case of a young Asian female who was initially misdiagnosed as having tuberculous lymphadenitis because of multiple lymphadenopathies with 18-fluorodeoxyglucose uptake on positron emission tomography/computed tomography. Final histologic diagnosis of Kikuchi-Fujimoto disease was made after excisional biopsy of the affected lymph node. The cervical lymphadenopathy has reduced in size and lung lesions disappeared after 2 months without specific treatment.

Background and purpose Periventricular nodular heterotopias (PNHs) are frequently associated with drug-resistant epilepsy (DRE). Although magnetic resonance imaging (MRI) can define the morphological features of PNHs, still there is a need to assess their metabolic activity in order to provide useful information on epileptogenicity and long-term outcome. To that end, we investigated the ability of 18 F-FDG PET to identify seizure onset zone in order to assess the metabolic activity of the ectopic neurons and to provide prognostic information on the postsurgical outcome. Methods Sixteen patients (6 men and 10 women; ranging between 24 and 53 years of age) with PNHs-related DRE were evaluated. All patients underwent clinical evaluation, Stereo-electroencephalogram (SEEG), brain MRI, and 18 F-FDG brain PET/CT. PET images were superimposed on the patient-specific 3-dimensional-brain MRI. The metabolic activity of each nodule and of their cortex was visually and semiquantitatively assessed. The outcome after intervention was assessed in all patients using Engel classification. Results Thirty-one heterotopic sites were identified. Twenty-one of 23 nodules with detectable electric activity on SEEG were identified by PET (91.3%), while 5 of 8 of nodules without electric activity showed no metabolism on PET (62.5%). Overall, the concordance between SEEG and FDG-PET was 26/31 (83.9%). Furthermore, cortical metabolic alterations were depicted, correlating with epileptogenic areas. A favorable postsurgical outcome was reported in 13 patients (81.3%). The presence of a hypometabolic nodule significantly correlated with a worse outcome after surgical therapy (P = .036). Conclusions In PNHs-related epilepsy, FDG-PET more accurately identifies epileptogenic foci, which aids surgical planning and in postoperative seizure control.

Patients under hemodialysis (HD) have an increased risk of major adverse cardiac events (MACEs). In these patients, myocardial perfusion scintigraphy (MPS) provides useful prognostic information. Left ventricular mechanical dyssynchrony (LVD) has been proven to predict all-cause death in patients under HD. It remains unclear, whether the same prognostic value pertains also to the prediction of MACEs.Ninety patients under HD (duration range: 2-216 months) with neither history nor symptoms of coronary artery disease at the time of MPS were retrospectively evaluated. All underwent clinical evaluation and MPS with dipyridamole stress test. MPS was reprocessed to derive left ventricular ejection fraction (EF), perfusion scores [summed stress score (SSS) and summed difference score (SDS)] and LVD (phase histogram bandwidth and phase SD).ResultsMACEs were reported in 10 (11.1%) patients as assessed at more than 2 years of follow-up (median 29 months). At univariate analysis, a correlation was demonstrated between MACEs and LVD (P0.001), BMI (P=0.04), ECG changes during stress (P=0.03), dyspnea (P=0.02), SSS (P=0.04) and SDS (P=0.02). At stepwise multivariate analysis, only LVD (P0.001), SSS (P=0.01) and SDS (P=0.001) were independent predictors of MACEs. No thresholds of SSS or SDS showed predictive value (P=0.79 for SSS ≥4, P=0.10 for SSS8 and P=0.66 for SDS ≥2). At survival analysis, patients with LVD had a significantly shorter MACE-free survival (P0.001). This predictive value held true even in patients with an unremarkable pattern of perfusion.In asymptomatic patients without known coronary artery disease under HD, LVD is highly predictive of the onset of MACEs at more than 2 years of follow-up and provides incremental value over perfusion scores alone. A phase analysis on gated MPS should be routinely performed in these patients to yield useful prognostic information.

Objectives: Integrated fusion imaging modality Positron Emission Tomography Computed Tomography (PET/CT) using 18Fluorine-Fluoro Deoxy Glucose (18F-FDG) is commonly utilized in imaging oncology. We expand the role of this imaging modality in our study to demonstrate the appearance of active extra pulmonary tuberculosis (TB) lesions. Materials and methods: This study involved prospective evaluation of 8 patients using 18F-FDG PET/CT with confirmed diagnosis of extra pulmonary TB infection. Visually high intensity lesions in abnormal areas were studied where the mean and maximum standardized uptake value (SUVmean and SUVmax) were tabulated. The diagnosis of TB infection was confirmed by isolation of TB bacillus from these lesions or evidence of responding to anti TB treatment during post treatment evaluation using FDG PET/ CT at follow up. Results: The genders are equally affected. Majority of the group falls within young age below 50 years. Number of PET/CT studies demonstrating lesions either singly or multiple were equal in distribution. Nodal involvement is commonest in our study including mediastinum, paraaortic and inguinal groups. Other sites of infection include spine and bowel. The average SUVmax and SUVmean for all lesions were 7.7 and 5.2 respectively. Conclusion: Active TB lesions are FDG avid. Thus, FDG avid lesions should be interpreted with extra careful when FDG PET / CT is utilized in managing malignancy. Keywords: extra pulmonary tuberculosis, 18F-FDG PET/CT, SUVmax, false positive, malignancy, Amaç: 18Florin-Floro-Deoksi-glukoz (18F-FDG) kullanılarak yapılan, Pozitron emisyon tomografi bilgisayarlı tomografisi (PET/CT) birleşik füzyon görüntülemesi onkolojik görüntüleme için sıklıkla kullanılır. Biz çalışmamızda, bu görüntüleme yönteminin rolünü genişleterek, aktif akciğer dışı tüberküloz (TB) lezyonlarını göstermek amacıyla kullandık. Gereç ve yöntem: Bu çalışam doğrulanmış akciğer dışı TB enfeksiyonlu 8 hastada 18F-FDG PET/CT kullanılarak prospektif bir değerlendirme şeklinde gerçekleştirildi. Anormal bölgelerdekki görsel yüksek yoğunlukklu lezyonlar ortlama ve maksimum standardize tutlum değerleri (SUVort ve SUVmaks) elde edildi ve tabloalştırıldı. Tüberküloz tanısı, lezyonlardan TB basili izolasyonu veya tedavi sonrası takipte FDG PET/CT lezyonlarının tedavi cevabının görülmesiyle doğrulandı. Bulgular: Her iki cinse eşit oranda etkilenmişti. Her iki gruptakilerin çoğu 50 yaş altında idi. Lezyonları gösteren PET/CT çalışma sayısı hem tek hem de çoğul olarak eşit dağılım gösterdi. Çalışmada nodal tutulum en sık mediastinal, paraaortik ve inguinal bölge lenf bezlerinde görüldü. Diğer enfeksiyon bölgeleri, omurga ve barsaklar idi. Ortalama SUVmaks ve SUVort değerleri tüm lezyonlar için sırasıyla 7.7 ve 5.2 idi. Sonuç: Aktif TB lezyonları FDG\'yi tutma eğilimindedir. Bu nedenle FDG PET/CT görüntülemesi kanser tedavisinde yol gösterici olarak kullanılıyorsa, elde edilene FDG tutullum görüntüleri çok dikkatle yorumlanmalıdır.

(4 S )-1-[( S )-3-Mercapto-2-methylpropanoyl]-4-phenylthio- l -proline (Zofenoprilat, 2 ), the active metabolite of the potent ACE inhibitor Zofenopril Calcium ( 1 ), was labelled with carbon-11 ( t 1/2 =20.4 min) to evaluate its pharmacokinetics behaviour in human body using Positron Emission Tomography (PET). [ 11 C]2 labelling procedures were based on the use of immobilized Grignard reagent and the acylation of ( S )-4-phenylthio- l -proline methyl ester ( 5 ) with 11 C-labelled methacryloyl chloride, followed by a Michael addition with thiobenzoic acid. The radiochemical yield was 5–10% (EOB, decay corrected) and specific radioactivity ranged from 0.5 to 1.5 Ci/μmol (18.5–55.5 GBq/μmol). Preliminary in vivo human evaluation of [ 11 C] 2 showed that the drug accumulates in organs which express high levels of ACE, like lungs and kidneys, and in organs involved in drug metabolism such as the liver and gall bladder. Results of the distribution of [ 11 C] 2 showed a measurable concentration of the drug in the target tissues such as the kidney and to a minor extent, the heart, where it can afford organ protection.

Complementary information provided by Single Photon and Positron Emission Tomography (SPECT and PET) in nuclear cardiology allows a better comprehension of the physiopathology of the heart. In this work a surface matching registration technique is evaluated in the spatial correlation of SPECT and PET cardiac images. The method is based on matching correspondent anatomical surfaces extracted from transmission (TR) SPECT and PET studies, usually performed for attenuation correction. The accuracy of the technique was evaluated by phantom experiments and on patient data (201Tl SPECT and 13NH3 PET perfusion studies). An application of the method is presented for the correlation of SPECT 201Tl perfusion and PET 18FDG metabolic studies in the evaluation of myocardial viability.

This paper investigates labor supply and redistributive effects of in-work benefits for Italian married couples using a tax-benefit microsimulation model and a multi-sectoral discrete choice model of labor supply. We consider two in-work benefit schemes following the key principles of the Earned Income Tax Credit (EITC) and the Working Tax Credit (WTC) existing in the US and the UK, respectively. The standard design of these in-work benefits is however augmented with a new benefit premium for two-earner households in order to overcome the well-known disincentive effects that these welfare instruments may generate on secondary earners. In simulation, the proposed in-work benefits are financed through the abolition of Italian family allowances for dependent employees and contingent workers thus ensuring tax revenue neutrality. We show that our EITC and WTC reforms have strong positive effects on labor supply of wives, weak negative effects on labor supply of husbands, and strong positive effects on equity. The EITC is more effective than the WTC in boosting employment of wives, while the WTC is more effective than the EITC in fighting poverty. In both schemes, the trade-off between labor supply incentives and redistributive effects is crucially related to the new benefit premium for two-earner households. Other things being equal, tax revenue neutrality implies that a higher value of this policy coefficient yields stronger incentive effects and weaker redistributive effects.

Objectives. This study sought to investigate whether residual viability of infarcted myocardium may play a role in the pathogenesis of exercise-induced ventricular arrhythmias. Background. We previously showed that transient ischemia within partially infarcted areas often precipitates ventricular arrhythmias during exercise that are consistently obliterated by intravenous nitrates. Methods. We studied 60 patients with chronic stable angina and a previous myocardial infarction, All underwent at least two consecutive exercise stress tests, coronary angiography and stress/rest myocardial perfusion tomography by Tc-99m 2-methoxy isobutyl isonitrile (MIBI). In the last 26 consecutive patients, residual viability was assessed by single-photon emission computed tomography (SPECT) using fluorine (F)-18 fluorodeoxyglucose. Perfusion and metabolic data were evaluated qualitatively by three independent observers in blinded manner, Results. With exercise, 30 patients (group A) consistently developed ventricular arrhythmias (>10 ventricular ectopic beats/min, couplets, nonsustained ventricular tachycardia); the remaining 30 patients (group B) did not, The severity of coronary artery disease (Gensini score) was similar in the two groups. Posterercise SPECT shun ed partial reperfusion of an infarcted area in 28 of 30 patients of group A but in only 9 of 30 of group B (p < 0.0001). Uptake of F-18 fluorodeoxyglucose was observed within the infarcted zone in 10 of 13 and 1 of 13 patients in groups A and B, respectively (p = 0.0003). Conclusions. In patients with myocardial infarction, exercise-induced ventricular arrhythmias appear to be triggered by transient ischemia occurring within a partially necrotic area containing large amounts of viable myocardium. Therefore, occurrence of arrhythmias during exercise may represent a clue to the presence of residual viability within a previously infarcted area. RI Lucignani, Giovanni/C-6773-2008

Il presente contributo e un resoconto di alcuni studi di carattere geologico, geofisico e geomorfologico che il nostro gruppo di ricerca ha effettuato, nel periodo 2001-2008, sui depositi di travertino quaternario del Bacino delle Acque Albule. Alla formazione di questo grande plateau di travertino hanno contribuito, in un lasso di tempo di c. 100 ka, diversi fattori geologici: (1) il substrato carbonatico profondo, (2) la tettonica attiva, (3) l’anomalia geotermica regionale, con gli associati fluidi geotermali di natura vulcanica, ed infine (4) l’enorme disponibilita di acqua, le cui vaste aree di ricarica sono rappresentate dai rilievi carbonatici preappenninici delimitanti il bacino a nord e ad est. Le faglie attive e l’intensa fratturazione oltre a garantire un continuo afflusso di fluidi geotermali (acque e gas) in superficie hanno determinato su tutta l’area l’instaurarsi di fenomeni di pericolosita geologica: fenomeni di collasso repentino (sinkhole) e subsidenze dei terreni di superficie. E’ inoltre dimostrato che questi fenomeni subiscono accelerazioni o riattivazioni al verificarsi di eventi sismici, anche di bassa magnitudo. I fattori di pericolosita geologica associati all’intensa urbanizzazione dell’area hanno concorso a generare una situazione di rischio elevato, per il patrimonio abitativo e per la popolazione. L’integrazione dei dati geologici di superficie e del sottosuolo, l’analisi strutturale, la geofisica, l’analisi di foto aeree storiche e lo studio della sismicita storica, associati ai numerosi dati idrogeologici disponibili, hanno permesso di ricostruire con buona precisione l’assetto geologico del bacino. Tale assetto costituisce lo strumento indispensabile sia per la tutela delle due georisorse locali (acqua e travertino) che per una piu attenta e rigorosa pianificazione territoriale.

Summary Although surveys routinely ask respondents to evaluate various aspects of their life on an ordered scale, there is concern about interpersonal comparability of these self- assessments. Statistically, the problem is one of identification in ordered response models with heterogeneous thresholds. As a solution to the identification problem, King and his colleagues proposed the use of anchoring vignettes, namely brief descriptions of hypothetical people or situations that survey respondents are asked to evaluate on the same scale as they use to rate their own situation. Although vignettes have been introduced in several social surveys and are increasingly employed in a variety of fields, the reliability of this approach hinges crucially on the validity of the assumptions of response consistency and vignette equivalence. The paper proposes a joint test of these key assumptions based on the fact that the underlying statistical model is overidentified if the two assumptions hold. Monte Carlo results show that the test proposed has good size and power properties in finite samples. We apply our test to self- assessment of pain by using data from the first wave of the Survey of Health, Ageing and Retirement in Europe. We find that, when using only one of the three available vignettes, or when the test is carried out separately by subgroups of respondents, the overidentifying restrictions are less likely to be rejected.

We compare thallium-201 rest redistribution and fluorine-18 fluorodeoxyglucose ([F-18]FDG) for the assessment of myocardial viability within technetium 99m methoxyisobutylisonitrile (MIBI) perfusion defects in 27 patients with chronic stable coronary artery disease. The following studies were performed: (1) stress Tc-99m-MIBI, (2) rest Tc-99m-MIBI, (3) Tl-201 rest-redistribution single-photon emission tomography, (4) [F-18]FDG positron emission tomography. The left ventricle was devided into II segments on matched tomographic images, The segment with the highest activity at stress was taken as the reference (activity=100%). Perfusion defects at Tc-99m-MIBI rest were classified as severe (activity

A method has been developed to match corresponding heart regions from functional echocardiographic (Echo) and metabolic fluorine-18-fluoro-2-deoxy-D-glucose ([18F]FDG) positron emission tomography (PET) studies in individual patients. Echo and PET images are spatially correlated by determining homologous anatomical landmarks (the two papillary muscles and the inferior junction of the right ventricle), identifiable in images obtained by both acquisition modalities. Echo-PET image registration is first performed in the plane identified by the three landmarks, using a rigid rotate-translate scale model. The registration parameters are then used to transform the whole PET volume. This allows a consistent Echo-PET regional analysis, according to a segmental subdivision of the heart. The technique was tested on patients. The overlay of Echo and PET registered images proved the reliability of realignment of the three markers and a good spatial correlation of myocardial walls. This approach to image registration could be applied to other acquisition modalities (such as magnetic resonance imaging and single-photon emission tomography), provided that the three anatomical landmarks are visualized.

This paper investigates labor supply and redistributive effects of in-work benefits for Italian married couples using a tax-benefit microsimulation model and a multi-sectoral discrete choice model of labor supply. We consider in-work benefits based on the Earned Income Tax Credit (EITC) and the Working Tax Credit (WTC) existing in the US and the UK, respectively. The standard design of these income support mechanisms is however augmented with a premium for two-earner households to avoid potential disincentive effects on secondary earners. Revenue neutral policy simulations show that our reforms may greatly improve the current Italian tax-benefit system in terms of both incentive and redistributive effects. Furthermore, neglecting sector-specific attributes of the various job opportunities may lead to an oversimplified representation of the choice set that does not allow to capture some labor market transitions and thus results in attenuated labor supply responses.

We examined 17 angina-free patients with left ventricular dysfunction, referred for surgical decision-making, who presented with no or few signs and symptoms of myocardial ischemia according to treadmill stress test. On cardiac catheterization they were affected by severe multi-vessel coronary artery disease; the mean left end-diastolic pressure of this population was 26.3 +/- 5.5 mm Hg (mean +/- SD) and their mean ejection fraction was 27.6 +/- 4.9% (mean +/- SD). They all were investigated for the presence of viable myocardium by the combined assessment of cardiac perfusion and metabolism using single photon emission tomography with [99mTc] labelled hexakis-2-methoxy-isobutyl-isonitrile [99mTc]MIBI/SPET) and positron emission tomography with [18F]-2-fluoro-2-deoxy-D-glucose ([18F]FDG/PET), respectively. Patients were considered for coronary surgery when [18F]FDG was detectable in at least two cardiac segments with wall motion abnormalities and perfusion defects. Nine patients were operated on, six were medically treated and two were scheduled for heart transplantation. We recorded no in-hospital mortality. At a mean follow-up of 28.4 +/- 9.8 (mean +/- SD) months all surgical patients were alive and their NYHA functional classes have improved, except in one case. Among the patients refused for bypass surgery, three are in stable conditions, three have worsened clinical statuses and two died while waiting for heart transplantation. In conclusion, for patients with bypassable coronaries, left ventricular dysfunction and lack of angina, successful coronary revascularization may be predicted by the presence of viable myocardium demonstrated with positron emission tomography.

Of particular importance for education policy-makers is the possibility that teacher mobility adversely affects the quality of teaching in schools serving mainly disadvantaged and minority children. This paper examines the main drivers of the mobility of Italian teachers by using applications-to-transfer data. We find that teachers systematically try to move away from schools where teaching is likely to be more difficult because of the student mix or the social context of the school. Given the absence of any criteria other than seniority in regulating teachers’ allocation across schools, disadvantaged students frequently end up with less experienced teachers who are often just waiting to move elsewhere.

Areas of myocardial infarction may retain glycolytic activity and this finding is indicative of tissue viability and predictive of functional recovery after revascularization. In order to assess the relation between the time elapsed from the occurrence of acute myocardial infarction and persistence of myocardial metabolic activity in the infarcted tissue, we prospectively studied 65 patients with previous myocardial infarction diagnosed clinically and by electrocardiographic (Q wave) and enzymatic criteria. All patients underwent coronary angiography and contrast left ventriculography, evaluation of regional myocardial glucose metabolism (in the fasting state) by positron emission tomography (PET) with 2-[18F]fluoro-2-deoxy-D-glucose ([18F]FDG), and assessment of myocardial perfusion by single photon emission computed tomography (SPECT) with technetium-99m methoxyisobutyl isonitrile (99mTc-MIBI). Based on the regional metabolic and perfusion findings, patients were divided into 2 groups, depending on the absence (group 1, 26 patients) or presence (group 2, 39 patients) of [18F]FDG uptake in the underperfused regions. Areas of underperfusion at rest, consistent with the clinically identified myocardial infarction site, were observed in all patients. Severity of coronary artery disease, presence of collaterals, number of hypocontractile segments, and wall motion score did not differ significantly in the 2 groups. The time elapsed from the infarction was significantly greater (1,860 +/- 1,333 days) in group 1 than in group 2 (92 +/- 115 days; p0.0001). Exercise caused an increase in severity and/or extent of resting perfusion abnormalities in a greater proportion of patients of group 1 (53% vs 23%).(ABSTRACT TRUNCATED AT 250 WORDS)

In the Italian system teachers are allocated to schools according to a seniority-based centralized system with no role of individual schools in attracting, selecting and retaining teachers. Largely because of the rather limited pay scale, seniority-based rights to move to a particular school and geographical location represent one of the main career opportunities for tenured teachers. This paper examines the main drivers of the resulting (voluntary) mobility of Italian teachers. We find that the teachers' place of birth (after securing a tenured position, teachers try find work near their place of birth) and several features related to the student mix and the social context of the school are very important. Teachers systematically try to move away from schools where teaching is likely to be more difficult, for example where the students come from a lower socio-economic background and have poorer educational abilities even though teachers could have a more important role in boosting students' human capital accumulation. The centralized allocation system does not appear to equalize opportunities among different school environments. Furthermore, the absence of any criteria other than seniority in regulating teachers' locational preferences produces high staff turnover and a widespread lack of motivation among teachers who, all too often, are simply waiting in one school until they can move on to another.

We tested the possibility of identifying areas of hibernating myocardium by the combined assessment of perfusion and metabolism using single photon emission tomography (SPET) with technetium-99m hexakis 2-methoxyisobutylisonitrile (99mTc-MIBI) and positron emission tomography (PET) with fluorine-18 fluoro-2-deoxy-d-glucose (18F-FDG). Segmental wall motion, perfusion and 18F-FDG uptake were scored in 5 segments in 14 patients with coronary artery disease (CAD), for a total number of 70 segments. Each subject underwent the following studies prior to and following coronary arterybypass grafting (CABG): first-pass radionuclide angiography, electrocardiography gated planar perfusion scintigraphy and SPET perfusion scintigraphy with 99mTc-MIBI and, after 16 h fasting, 18F-FDG/PET metabolic scintigraphy. Wall motion impairment was either decreased or completely reversed by CABG in 95% of the asynergic segments which exhibited 18F-FDG uptake, whereas it was unmodified in 80% of the asynergic segments with no 18-FDG uptake. A stepwise multiple logistic analysis was carried out on the asynergic segments to estimate the postoperative probability of wall motion improvement on the basis of the preoperative regional perfusion and metabolic scores. The segments with the highest probability (96%) of functional recovery from preoperative asynergy after revascularization were those with a marked 18F-FDG uptake prior to CABG. High probabilities of functional recovery were also estimated for the segments presenting with moderate and low 18F-FDG uptake (92% and 79%, respectively). A low probability of functional recovery (13 %) was estimated in the segments with no 18F-FDG uptake. Despite the potential limitations due to the semiquantitative analysis of the images, the method appears to provide reliable information for the diagnostic and prognostic evaluation of patients with CAD undergoing CABG and confirms that the identification of hibernating myocardium with 18F-FDG is of paramount importance in the diagnosis of patients undergoing CABG.

This paper provides a set of new Stata commands for parametric and semiparametric estimation of an extended version of ordered response models that accounts for both sample selection problems and heterogeneity in the thresholds for the latent variable. The standard estimator of ordered response models is therefore generalized along three directions. First, we account for the presence of endogenous selectivity effects that may lead to inconsistent estimates of the model parameters. Second, we control for both observed and unobserved heterogeneity in response scales by allowing the thresholds to depend on a set of covariates and a random individual effect. Finally, we consider two alternative specifications of the model, one parametric and one semiparametric. In the former, the error terms are assumed to follow a multivariate Gaussian distribution and the model parameters are estimated via maximum likelihood. In the latter, the distribution function of the error terms is instead approximated by following Gallant and Nychka (1997), and the model parameters are estimated via pseudo–maximum likelihood. After discussing identification and estimation issues, we present an empirical application using the second wave of the Survey on Health, Ageing and Retirement in Europe (SHARE). Specifically, we estimate an ordered response model for self-reported health on different domains by accounting for both sample selection bias due to survey nonresponse and reporting bias in the self-assessments of health.

A 28-year-old immigrant presented with a 2-week history of throbbing headache. Contrast-enhanced computed tomography (CECT) examination showed multiple brain abscesses. He is a known defaulter from miliary tuberculosis treatment. 18 F-FDG PET/CT demonstrated multiple visually high metabolic activity lesions disseminated in the brain, thorax, abdomen and pelvis [1]. The maximum standard uptake values (SUVmax) of these lesions were substantially > 3.0 and comparable to the uptake of FDGavid malignant lesions. These findings demand careful image interpretation implicating false-positive results [2, 3]. Our case illustrates the usefulness of 18 F-FDG PET/CT in mapping active tuberculous lesions which can be used for baseline study [4].

Background. The aim of the study was to evaluate the clinical usefulness of 18F Fluorodeoxyglucose (FDG) positron emission tomography / computed tomography (PET/CT) in the management of nasopharyngeal carcinoma (NPC) in comparison to conventional imaging modalities. Methods. This retrospective study was done at Ospedale Niguarda, Milan, Italy. Data were acquired from 24 NPC patients between May 2003 and December 2006. They had FDG PET/CT and CT or MRI during the initial diagnosis and at follow-up. Each finding was tabulated and compared with tissue biopsy at diagnosis and clinical status during the follow up after the therapy. A statistical calculation was done to derive the value of each modality. Results. The sensitivity and accuracy of PET/CT and CT/MRI were equally high at diagnosis. At the follow up, a negative PET/CT finding suggested a complete remission with sensitivity and negative predictive value of 100%. Conclusions. 18F FDG PET/CT is a potential modality to be utilized in following up NPC patients for evaluating a response to therapy.

This paper shows that gender and regional differences in self-rated health in Europe are partly explained by differences in the prevalence of the various conditions. However, a non-negligible part of these differences is due to other causes, which may include differences in reporting own health. We employ the tool of "anchoring vignettes" to understand whether and how women and men living in different regions differently report levels in a number of health components or domains. We find that vignettes help identifying gender and regional differences in response scales. After controlling for these differences, both gender and regional variation in reported health is substantially reduced, although not entirely eliminated. Our results suggest that differences in response style should be taken into account when using self-assessment of health in socio-economic studies. Failing to do so may lead to misleading conclusions.

ARTICLE I NFO The depositional and erosional history of the Lapis Tiburtinus endogenic travertine located circa 25 km to the east of Rome, Central Italy, near the Colli Albani quiescent volcano, is interpreted through three-dimensional stratigraphy and uranium-series geochronology. Analyses of large exposures located in active quarries and of cores obtained from 114 industrial wells reveal that the travertine deposit is about 20 km 2 wide and 60 m thick on average. The travertine thickness is over 85 m toward its western N-S-elongated side, where thermal springs and large sinkholes occur aligned over a seismically-active N-striking fault. The travertine age was calculated using the U/Th isochron method. Results constrain the onset and conclusion of travertine deposition at about 115 and 30 ka, respectively. The three-dimensional study of the travertine shows that this deposit is characterized by a succession of depositional benches grown in an aggradational fashion. The benches are separated by five main erosional surfaces, which are associated with paleosols, conglomerates, and karstic features. This evidence shows that the travertine evolution was mostly controlled by water table fluctuations. Chronological correlations between travertine evolution and paleoclimate indicators suggest that the travertine deposition was partly modulated by climate conditions. Other influencing factors may have been fault-related deformation and volcanic events.

This paper studies the relationship between medical compliance and health outcomes - hospitalization and mortality rates - using a large panel of patients residing in a local health authority in Italy. These data allow us to follow individual patients through all their accesses to public health care services until they either die or leave the local health authority. We adopt a disease specific approach, concentrating on hypertensive patients treated with ACE-inhibitors. Our results show that medical compliance has a clear effect on both hospitalization and mortality rates: health outcomes clearly improve when patients become more compliant to drug therapy. At the same time, we are able to infer valuable information on the role that drug co-payment can have on compliance, and as a consequence on health outcomes, by exploiting the presence of two natural experiments during the period of analysis. Our results show that drug co-payment has a strong effect on compliance, and that this effect is immediate.

Aim To determine prospectively from the referring physician's point of view the impact of 1 8 F-fluorodeoxyglucose positron emission tomography ( 1 8 F-FDG PET) results on the management decisions in patients with known orsuspected lung cancer. Methods Seventy-five consecutive patients (58 men, 17 women; age range, 33-82 years; mean age, 64 years) with a diagnosis of a pulmonary lesion, obtained by means of morphological imaging studies and/or cytological sampling, were included in the study. The patient population consisted of three groups: (A) patients (n=18) with a solitary lung nodule; (B) patients (n=37) with untreated lung cancer; and (C) patients (n=20) with treated lung cancer. All were referred for whole-body 1 8 F-FDG PET within 15 days (mean, 11 days) of lung lesion detection. To determine whether and how PET findings could modify the treatment strategy, a questionnaire was sent to the referring physician before and after the PET results. With regard to the treatment strategy, four major options were recognized: (1) further diagnostic investigations; (2) medical therapy; (3) surgical treatment; (4) wait-and-see. For data analysis, intermodality changes, defined as changes between treatment strategies related to PET findings, were considered. Results Before the PET study, the planned management for the overall patient population was as follows: further diagnostic investigations in 44 cases (58%), medical therapy in 17 (23%), surgical treatment in nine (12%) and wait-and-see in five (7%). After the PET study, further diagnostic tools were indicated in 27 cases (36%), medical therapy in 17 (23%), surgical treatment in 28 (37%) and wait-and-see in three (4%). Relative to the initially planned strategy, changes in patient management after PET imaging occurred in 34 (45%) cases. Overall, the most relevant variation after PET concerned the surgical treatment strategy. The highest percentage (67%) of changes in management after PET was found in patients with a solitary pulmonary nodule; the percentages of changes of the three patient groups were significantly different (chi-squared test; P=0.021). Conclusions In patients with known or suspected lung cancer, 1 8 F-FDG PET results determined significant variations in major clinical management decisions.

The relationship between severity of coronary artery stenosis (CAS) and myocardial 18F-2-fluoro-2-deoxy-D-glucose (18F-FDG) uptake in the fasting state, assessed with positron emission tomography (PET), was examined in a series of 48 patients with CAS undergoing both studies for diagnostic purposes. The data analysis was based on the subdivision of the left ventricular myocardium into four segments defined in relation to ventricular vascularization: the anterior and septal segments, perfused by the left anterior descending artery; the lateral segment, perfused by the left circumflex; and the inferior segment, perfused by the right coronary artery. The 192 segments were grouped according to degree of CAS: I 0-50%, II 51-75%; III 76-90%; IV 91-99%; V and VI occluded coronary artery with good or poor collaterals, respectively. An 18F-FDG index was determined as the tissue/blood pool radioactivity ratio in each segment. The statistical analysis was performed by one-way ANOVA, multiple comparison tests and the chi-squared test. The proportion of segments with 18F-FDG uptake was also analysed for a linear trend across the ordered levels of CAS. The 18F-FDG index in groups I to V was significantly higher than in controls, but it was not different among the groups with CAS, except for group V versus I. However, the proportion of segments with enhanced 18F-FDG uptake was correlated to the degree of CAS. In cases of complete occlusion of a major afferent coronary artery, the proportion of segments with 18F-FDG uptake varied in relation to the presence of collaterals.(ABSTRACT TRUNCATED AT 250 WORDS)

Abstract 3120 Introduction Fluorodeoxyglucose positron emission tomography (FDG-PET) is a functional imaging tool routinely used for staging and response assessment in aggressive lymphomas. Even if mantle cell lymphoma (MCL) is considered FDG avid, current data on the use of PET in this histotype are scant. We retrospectively analysed 43 PET scans in 22 MCL patients (pts) and compared the results to standard contrast-enhanced computerized tomography (CT) in order to define PET sensitivity and specificity in this rare lymphoma. Patients and methods Twenty-two pts with biopsy proven diagnosis of MCL underwent PET in different phases of disease for a total of 43 scans. PET scans were co-registrated with a simultaneous CT and compared to standard contrast-enhanced CT performed within 4 weeks. Nineteen PET (44.2%) were performed for disease staging at diagnosis or relapse, while 24 (55.8%) for response assessment. Negative PET were included in the analysis for response assessment only if a previous positive scan was available. Results PET and standard CT results were concordant in 16/43 cases (37.2%). Discrepancies were found in 27/43 cases (62.8%) and were grouped in four categories: false negative PET (5 cases), PET positive with a disease extension minor or major than CT (7 and 9 cases, respectively) and PET positive with negative CT (6 cases). At staging PET was concordant with CT in 4/19 (21%) cases. In 5/19 cases (26.3%) PET was negative in all disease sites documented by standard CT. In the remaining 10 cases (52.7%) PET was positive but discordant with disease extension evaluation by CT, determining upstaging and downstaging in 5 scans (26.3%) each. Involvement of gastro-intestinal tract was detected only in 4/19 cases (21%). PET performed for response assessment was concordant with CT in 12/24 cases (50%). In 6/12 concordant cases (25%) both CT and PET were negative; in the remaining 6/12 cases (25%) PET was positive and disease extension evaluation was concordant with standard CT. Six out of 12 discordant cases (25%) presented different disease extension evaluation; in the other six cases standard CT was negative while PET documented minimal residual disease (MRD). PET sensitivity and specificity in the entire cohort were 86.5% and 100%, respectively; positive predictive value was 100%, while negative predictive value was 54.5%. No difference in PET sensitivity was found in nodal and extra-nodal sites. No statistical significant correlation was found between PET sensitivity and proliferation index; nevertheless, no pts with Mib-1>50% presented either false negative PET scan or disease extension underestimated by functional imaging. Conclusion This analysis shows a PET sensitivity (86.5%) lower than expected if compared with other aggressive lymphomas. High specificity registered in this cohort is likely to be ascribed to simultaneous CT co-registration, that allows identification of false positive cases. A false negative PET scan at initial staging was registered in 21% of cases. A gastro-intestinal tract involvement, expected to be near universal in advanced stage MCL, was detected by functional imaging only in 21% of pts at disease onset or relapse. Either downstaging or upstaging of disease burden seldom result in different therapeutic approach since localized MCL is a rare entity. Minimal residual disease, detected by functional imaging in half of standard CT negative pts at response assessment, has uncertain role in MCL, since the disease remains incurable and there is no clear evidence that MRD positivity requires treatment. All these findings advise against utilization of functional imaging for routine management of MCL. Considering heterogeneity of FDG-uptake in MCL, PET is likely to be more reliable in pts presenting high proliferation index. Moreover, current data suggest a prognostic value of baseline FDG-avidity. Further investigations are needed to confirm these preliminary data in larger prospective trial, separating MCL from other aggressive histotypes. Disclosures: No relevant conflicts of interest to declare.