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The concept of rebalanced hemostasis in cirrhosis challenges the policy of transfusing plasma or platelets before invasive procedures in patients with prolonged PT or severe thrombocytopenia. Recent guidelines recommend against plasma transfusion and suggest avoiding/minimizing platelet transfusions.We assessed how hepato-gastroenterologists manage prolonged PT/INR or severe thrombocytopenia before invasive procedures.On May 2021, AISF members were sent a questionnaire addressing the PT/INR and platelet thresholds required before invasive procedures, the use of other markers of bleeding risk or other hemostatic treatments and the burden of pre-emptive plasma and platelet transfusions.Of 62 respondents, 94% and 100% use PT/INR and platelet count to assess bleeding risk, respectively. Only 37% and 32% require less conservative PT/INR or platelet counts thresholds for low-risk procedures, respectively. As for those applying single thresholds, 68% require PT/INR1,5 and 86% require platelet counts ≥50 × 10the survey indicates lack of compliance with guidelines that advise against plasma and platelet transfusions before invasive procedures and the need for prospective studies and inter-society consensus workshops.

Background and purpose Coronary microvascular dysfunction (CMD) has been proposed as a key driver in the etiopathogenesis of Takotsubo syndrome (TTS), likely related to an “adrenergic storm” upon a susceptible microvascular circulation. The aim of our manuscript was to assess and quantify CMD in patients with TTS through angiography-derived index of microcirculation (IMR) and evaluate its correlation with clinical presentation. Methods Coronary angiograms of 41 consecutive TTS patients were retrospectively offline analyzed to derive angiography-based indices of CMD. Three recently developed indices (NH-IMRangio, AngioIMR and A-IMR) were calculated and compared based on Quantitative Flow Reserve (QFR) analysis. CMD was defined as an IMRangio ≥25 units. The correlation between CMD and clinical presentation and outcomes was then assessed. Results Median age was 76 years, 85.7% were women and mean left ventricular ejection fraction (LVEF) at first echocardiogram was 41.2%. Angiography-derived IMR was higher in Left Anterior Descending artery (LAD) than Circumflex artery (LCX) and Right Coronary artery (RCA) with either NH-IMRangio (52.7 vs 35.3 vs 41.4), AngioIMR (47.2 vs 31.8 vs 37.3) or A-IMR (52.7 vs 36.1 vs 41.8). All patients presented CMD with angiography-derived IMR ≥25 in at least one territory with each formula. Angiography-derived IMR in LAD territory was significantly higher in patients presenting with LVEF impairment (≤40%) than in those with preserved ventricular global function (NH-IMRangio: 59.3 vs 46.3, p. value=0.030; AngioIMR: 52.9 vs 41.4, p-value=0.037; A-IMR: 59.2 vs 46.3, p-value=0.035). Conclusion CMD, assessed with angiography-derived IMR, is a common finding in TTS and it is inversely correlated with LV function. The available formulas have a substantial superimposable diagnostic performance in assessing coronary microvascular function. Funding Acknowledgement Type of funding sources: None.

Background Right ventricular (RV) function demonstrated a strong impact on survival of patients with advanced heart failure with reduced ejection fraction (HFrEF). In particular, increased RV pulsatile afterload (RVPA) was associated with poor prognosis. Several right heart catheterization-derived parameters have been proposed to characterize RVPA, including pulmonary artery compliance (PAC), elastance (PAE) and pulsatile index (PAPi). However, among these indices, the best prognostic indicator is undetermined. Purpose To assess the prognostic relevance of RVPA parameters in patients with advanced HFrEF evaluated for heart transplantation. Methods 149 patients with end-stage HFrEF underwent right heart catheterization during the evaluation for heart transplantation. All patients were clinically followed up until death or any censoring events including heart transplantation, left ventricular assist device (LVAD) and hospitalization for acute heart failure. Cox regression and ROC-curve analysis were used to test the prognostic value of RVPA determinants. Multivariate regression models with C-statistics were used to test the independent predictive value of RVPA indices. Results The mean age of the study population was 56.6±10.1 years and 85.2% were male. The most frequent aetiology of HFrEF was ischemic cardiomyopathy (52.3%). Mean LV ejection fraction was 25.7±10.2%. During a mean follow up time of 17±15 months, 29 (19.5%) patients met the primary endpoint: 9 (6%) patients died, 4 (2.68%) patients underwent an urgent heart transplantation, 11 (7.3%) patients underwent urgent LVAD implantation (as bridge to transplantation therapy) and 5 (3.3%) were hospitalized for HF. Patients who met the primary endpoint were significantly older patients (61.2±7.8 vs 55.4±10.2, p=0.006) and with worse hemodynamic profile than event-free survivors (PAC [1.8±0.8 vs. 2.7±2.0, p=0.01], mPAP [33.5±11.3 vs. 29.3±11.0, p=0.05], PVR [3.0±1.6 vs. 2.6±2.0, p=0.09] and PAE [1.12±0.5 vs. 0.98±0.6, p=0.04]). Among the RVPA parameters PAC0.9 mmHg/mL (HR 2.5, 95% CI 1.1–5.2, p=0.02) were associated with the primary endpoint. On the contrary, PAPi was not significantly associated with the outcome. PAC demonstrated a superior predictive value for the composite adverse outcome compared with pulmonary vascular resistances (PVR) (AUC comparison p=0.019) and PAPi (p=0.03) but similar compared with PAE (p=0.19) and mPAP (p=0.51). In multivariable regression models, PAC, but not PAE showed incremental prognostic value compared with cardiac index (p=0.02). Conclusions Hemodynamic indices of RVPA are associated with worse survival in patients with end-stage heart failure. In particular, PAC and PAE demonstrated superior prognostic value compared with PAPi and steady-state PVR. Moreover, PAC showed incremental prognostic value compared with cardiac index in patients awaiting heart transplantation. Funding Acknowledgement Type of funding sources: None.

Introduction Coronary microvascular dysfunction (CMD) has been proposed as a key driver in the etiopathogenesis of Takotsubo syndrome (TTS), likely related to an “adrenergic storm” upon a susceptible microvascular circulation. The aim of our manuscript was to assess and quantify CMD in patients with TTS through non–invasive angio–derived index of microcirculation (IMRangio) and evaluate its correlation with clinical and instrumental presentation. Methods 41 consecutive TTS patients were retrospectively analyzed. Three different formulas for compute Non–Hyperemic IMRangio (NH–IMRangio) derived by 3D–Quantitative Coronary Angiography (3D–QCA) and Quantitative Flow Reserve (QFR) analysis were used according to each fluidodynamic mathematical expression as reported by respective authors. CMD was defined as an IMRangio ≥ 25. The correlation between NH–IMRangio and clinical presentation and the comparation between the three formulas were provided. Results Median age was 76 years, 85.7% were women and mean left ventricular ejection fraction (LVEF) at first echocardiogram was 41.2%. NH–IMRangio was higher in Left Anterior Descending artery (LAD) than Circumflex artery (CX) and Right Coronary artery (RCA) with either NH–IMRangio 1 (52.7 vs 35.3 vs 41.4), NH–IMRangio 2 (47.2 vs 31.8 vs 37.3) or NH–IMRangio 3 (52.7 vs 36.1 vs 41.8). All patients presented CMD with NH–IMR angio ≥ 25 in at least one territory with each formula. NH–IMRangio in LAD territory was significantly higher in patients presenting with LVEF impairment (≤40%) than in those with preserved ventricular global function (NH–IMRangio LAD 1: 59.3 vs 46.3, p. value=0.030; NH–IMRangio LAD 2: 52.9 vs 41.4, p–value=0.037; NH–IMRangio LAD 3: 59.2 vs 46.3, p–value=0–035). Association between NH–IMRangio computed in LAD and LVEF showed a moderate correlation (NH–IMRangio 1: r = –0,3485, Rho = 0,1214, p = 0,0256; NH–IMRangio 2: r = –0,3513; Rho = 0,1234, p = 0,0256; NH–IMRangio 3: r = –0,3326, Rho = 0,1106, p = 0,0336). Finally, Bland–Altman plot analysis showed good agreement between NH–IMRangio 1 and 3, while NH–IMRangio 2 showed a consistent bias of –5 units against both NH–IMRangio 1 and NH–IMRangio 2 with increasing difference at higher absolute values. Conclusion CMD, assessed with NH–IMRangio, is a common finding in TTS and it is inversely correlate with LVEF dysfunction. The available formulas for NH–IMRangio computation have a substantial superimposable diagnostic performance in assessing CMD.

Rationale In the clinical setting, and particularly in the cardiovascular field, an exponential increase of non–invasive diagnostic tests has been observed. Between these, the exercise stress test represents a low–sensitivity and low–specificity diagnostic approach and its use has been less and less recommended in national and international guidelines. However, in the Italian clinical common practice it continues to be extensively prescribed both for chronic coronary syndrome (CCS) follow–up and for screening of coronary artery disease (CAD) in asymptomatic patients with multiple cardiovascular risk factors. Materials and Methods A retrospective cohort single–center study was conducted and 968 consecutives patients undergoing ECG stress test at our Department between October 2018 and March 2019 were included. Appropriateness of prescription and impact on the following diagnostic and therapeutic pathway has been analyzed. Results In this series, the main indication for exercise stress test was subclinical ischemia detection in CCS follow–up (312 pts, 32.3%). 181 tests (18.2%) were undertaken for CAD detection in patients symptomatic for chest pain and 171 (17.7%) for CAD detection in asymptomatic patients with multiple cardiovascular risk factors. At last, 97 tests (10%) were prescribed for arrhythmic burden evaluation and exercise response in patients with documented hyperkinetic arrhythmias. 590 tests (61%) were considered significative for reaching heart rate significance threshold (85% of target heart rate); between these 53 (9%) were positives for symptoms or ECG modifications. Among the positive tests, 25 patients (2.6%) went to the catheterization laboratory for coronary angiography: the indications for the exercise stress testing were chest pain for 14 of these patients while 7 undertook the examination for CCS follow–up. No asymptomatic patient presented for CAD screening undertook coronary angiography. At the end of the diagnostic pathway, 9 patients (0.9% of the complete cohort) received percutaneous or surgical revascularization. Conclusions Routinary and extensive use of exercise stress test can lead to dispersion of resources with many inappropriate examinations. Accurate clinical evaluation and appropriate prescription, especially regarding chest pain evaluation, are the foundations for a significative impact on clinical history of patients.

The Municipal Theater is one of the main artistic symbols of Bologna. Although it is recognized worldwide for its musical history, its construction peculiarities are less known. The original building was designed by the architect Antonio Galli Bibiena in 1763 in a masonry and wood structure. Then, the stage tower, burnt away in 1931, was rebuilt with a reinforced concrete structure, which currently is a significant landmark in the heart of the University district with about 35 m height. The reconstruction project, designed by engineer Armando Villa, had to face complex issues for the emerging but still inexperienced Italian reinforced concrete technique, such as the installation of a large span roof at considerable heights. The archival research and the digital documentation made it possible to analyze the structural concept of this construction, a significant example of the building culture of the '30s, tracing the evolution of this specific construction system and contextualizing it on the international scene.

Il paper presenta le attività connesse alla ricerca etnografica adattata alle esigenze del progetto TripleA-reno (Affordable, Attractive, Accessible deep renovation). L’etnografia è una metodolo-gia tipica dell’antropologia. Si basa primariamente sull’osservazione dei partecipanti, durante la quale il ricercatore partecipa alle attività quotidiane, alle interazioni e agli eventi di un gruppo di persone come un mezzo per imparare gli aspetti espliciti e nascosti della loro vita quotidiana. L’obiettivo specifico è comprendere le interazioni tra gli occupanti dell’edificio e l’edificio stesso, così come le loro relazioni e i loro ruoli all’interno dei processi di ristrutturazione. Attuare questa ricerca sul caso di studio italiano ha consentito di formare una base di conoscenza delle opinioni dei soggetti coinvolti sul piano nazionale analizzando le risposte a un questionario, opportuna-mente studiato, veicolato sia attraverso il web sia in formato cartaceo. I dati raccolti vengono poi confrontati con le interviste raccolte presso i singoli residenti dell’edificio oggetto di studio, che sarà sottoposto a una prossima ristrutturazione, per verificare come si modifichi l’atteggiamen-to degli abitanti rispetto ai processi di rinnovamento energetico quando coinvolti direttamente. L’obiettivo è quello di capire quali siano i fattori più stimolanti da tenere in considerazione per rendere maggiormente accettabile, attraente e accessibile qualsiasi progetto di rinnovamento.

The present paper is focused on the theoretical and experimental analysis of a three-axes MEMS gyroscope, developed by ST Microelectronics, implementing an innovative feedforward PI quadrature compensation architecture. The gyroscopes structure is explained and equations of motion are written; modal shapes and frequencies are obtained by finite element simulations. Electrostatic quadrature compensation strategy is explained focusing on the design of quadrature cancellation electrodes. A new quadrature compensation strategy based on feedforward PI architecture is introduced in this device to take into account variations of device parameters during lifetime. Obtained results show a significant reduction of the quadrature error resulting in a improved performance of the device. Fabrication and test results conclude the work.

BACKGROUND: The Liver Match is an observational cohort study that prospectively enrolled liver transplantations performed at 20 out of 21 Italian Transplant Centres between June 2007 and May 2009. Aim of the study is to investigate the impact of donor/recipient matching on outcomes. In this report we describe the study methodology and provide a cross-sectional description of donor and recipient characteristics and of graft allocation. METHODS: Adult primary transplants performed with deceased heart-beating donors were included. Relevant information on donors and recipients, organ procurement and allocation were prospectively entered in an ad hoc database within the National Transplant Centre web-based Network. Data were blindly analysed by an independent Biostatistical Board. RESULTS: The study enrolled 1530 donor/recipient matches. Median donor age was 56 years. Female donors (n = 681, median 58, range 12-92 years) were older than males (n = 849, median 53, range 2-97 years, p < 0.0001). Donors older than 60 years were 42.2%, including 4.2% octogenarians. Brain death was due to non-traumatic causes in 1126 (73.6%) cases. Half of the donor population was overweight, 10.1% was obese and 7.6% diabetic. Hepatitis B core antibody (HBcAb) was present in 245 (16.0%) donors. The median Donor Risk Index (DRI) was 1.57 (>1.7 in 35.8%). The median cold ischaemia time was 7.3h (≥ 10 in 10.6%). Median age of recipients was 54 years, and 77.7% were males. Hepatocellular carcinoma (HCC) was the most frequent indication overall (44.4%), being a coindication in roughly 1/3 of cases, followed by viral cirrhosis without HCC (28.2%) and alcoholic cirrhosis without HCC (10.2%). Hepatitis C virus infection (with or without HCC) was the most frequent etiologic factor (45.9% of the whole population and 71.4% of viral-related cirrhosis), yet hepatitis B virus infection accounted for 28.6% of viral-related cirrhosis, and HBcAb positivity was found in 49.7% of recipients. The median Model for End Stage Liver Disease (MELD) at transplant was 12 in patients with HCC and 18 in those without. Multivariate analysis showed a slight but significant inverse association between DRI and MELD at transplant. CONCLUSIONS: The deceased donor population in Italy has a high-risk profile compared to other countries, mainly due to older donor age. Almost half of the grafts are transplanted in recipients with HCC. Higher risk donors tend to be preferentially allocated to recipients with HCC, who are usually less ill and older. No other relevant allocation strategy is currently adopted at national level.

Malaysia is a medium endemic country for hepatitis B virus (HBV) infection but little is known about HBV strains circulating in Malaysian blood donors. Viral load, HBsAg concentrations and nested PCR products from 84 HBV surface antigen (HBsAg) positive samples were analysed in detail. Median viral load was 3050 IU/mL and median HBsAg 1150 IU/mL. Fifty-six full genome, 20 pre-S/S, 1 S gene and six basic core promoter/precore-only sequences were obtained. Genotypes B and C were present at a ratio of 2:1, and two genotype D samples were obtained, both from donors of Indian background. Phylogenetically, genotype B was more diverse with subgenotypes B2-5, B7 and B8 present, while most genotype C strains were from subgenotype C1. Genotypes B and C were equally frequent in ethnic Malays, but 80% of strains from Chinese were genotype B. HBsAg concentrations were higher in genotype C than in genotype B, in Chinese than Malays and in donors under the age of 30. HBV vaccine escape substitutions (P120S/T, I126N and G145G) were present in six strains. In the large surface protein, immuno-inactive regions were more mutated than CD8 epitopes and the major hydrophilic region. Strains of genotype B or from ethnic Malays had higher genetic diversity than strains of genotype C or from Chinese donors. Hence HBV strains circulating in Malaysia are phylogenetically diverse reflecting the ethnic mix of its population. Ethnic Malays carry lower HBsAg levels and higher genetic diversity of the surface antigen, possibly resulting in more effective immune control of the infection.

Usually, therapeutic decisions in patients with acute chest pain are based on the 12-lead electrocardiogram because ST-segment elevation is highly specific for myocardial infarction, but the presence of pacing-induced repolarization changes makes electrocardiogram interpretation difficult. The authors report an acute myocardial infarction patient with ventricular paced rhythm successfully treated by thrombolytic therapy. The aim of this work aims to highlight the difficulty with electrocardiographic diagnosis and timely treatment of myocardial infarction in the presence of ventricular pacing.

Subjects with minimal-to-mild chronic hepatitis C may suffer long-term consequences of hepatitis C virus (HCV) infection. Nonetheless, they are not candidates for antiviral treatment, mainly because little data are available concerning the efficacy and safety of therapy. Thirty-two HCV RNA positive individuals aged 18-45 years, who had a histological activity index scoreor = 8 and alanine aminotransferase (ALT) levelsor = 1.5 times lower than the normal limit for at least 1 year, were prospectively enrolled among a cohort of 35358 candidate blood donors, and treated with 4.5 mega units (MU) of recombinant interferon-alpha2a (IFN-alpha2a) thrice weekly for 6 months, and for an additional 6 months if a virological response was observed. Twelve months after the completion of treatment, 13 of 31 evaluable patients were HCV RNA negative, accounting for a sustained response rate of 42%. Patients without fibrosis had a lower response rate than those with mild fibrosis (two of 14 vs 11 of 17; P=0.012). In responders, median aminotransferase levels were significantly lower after therapy than before (11.04 +/- 3.98 vs 27.3 +/- 12.32 U l-1, respectively; P0. 005). When the analysis was limited to the six responders whose pretreatment aminotransferase levels were consistently normal, this difference was still significant (9.33 +/- 4.12 vs 20.58 +/- 6.73 U l-1; P=0.002). In conclusion, a durable suppression of viraemia can be obtained by IFN monotherapy in a relatively high proportion of young subjects with minimal-to-mild chronic hepatitis C, especially when portal fibrosis is found on liver biopsy. The disappearance of viraemia always leads to a reduction in the degree of hepatocellular necrosis.

In the pre-alpine region of Europe numbers and sizes of populations of the clonal lake shore plant Ranunculus reptans have declined because of the regulation of lake water levels. We investigated genetic variation among and within 17 populations of different size (cover 1-10 000 m) in R. reptans with RAPD (random amplified polymorphic DNA) profiles. We sampled 127 rosettes in 14 populations at Lake Constance and three populations at or near Lake Como. There was significant genetic variation between plants from the two lake regions (5.9%, analysis of molecular variance [AMOVA], P0.001), among populations within lake regions (20.4%, P0.001), and within populations (73.7%, P0.001). Under the assumptions of Wright's island model the variation among populations corresponds to a gene flow of N(e)m = 0.70. Within the 14 Lake Constance populations we detected significant genetic variation among subpopulations separated by only a few metres (4.0% of the within-population variation; P0.05). Molecular variance was 24% smaller in small populations covering100 m area than in larger ones (P0.03), indicating that samples from large populations were genetically more variable than samples representing comparable areas of smaller populations. We conclude that gene flow among populations is very limited and that genetic drift has caused reduced genetic variability of smaller populations. Conservation of genetic variability in R. reptans requires persistence of large and also of small populations (because of population differentiation), and it could be enhanced by increasing the size of small populations (to counter genetic drift).

Preliminary epidemiological and histological studies from Japan suggested that hepatitis C virus (HCV) infection has a role in the development of dilated cardiomyopathy (DCM). This multicenter study was conducted to verify this hypothesis on a large cohort of Italian patients with end-stage heart failure. Antibodies to HCV were determined in the 752 consecutive patients (608 males and 144 females; age, 53 +/- 13 years) who entered the waiting list for cardiac transplantation from 1995 to 1997 at the six cardiac surgery centers participating in the North Italy Transplant program. Three hundred and nine patients (41%) had dilated, 9 (1%) restrictive, and 4 (0.5%) hypertrophic cardiomyopathy; 284 patients (38%) had ischemic, 65 (9%) valvular, and 22 (3%) congenital heart disease; 5 patients (0.5%) had primary pulmonary hypertension; 54 patients (7%) had other or nonspecified heart disease. Overall, 41 of 752 patients (5.4%) resulted anti-HCV-reactive. Serological evidence of HCV infection was found in 12 of 309 patients with DCM (3.9%; 95% CI, 1.7-6.0), and in 29 of 443 without DCM (6.5%; 95% CI, 4.2-8.8), without statistical difference (difference of prevalence rate: 2.6%; 95% CI, -4.9 to 5.8). In conclusion, HCV does not seem to have a primary role in the pathogenesis of DCM. However, since our findings are in disagreement with those obtained in smaller series of patients of other ethnicity, large studies from different countries should be conducted.

To conduct a multicenter, prospective survey within the program of the Cooleycare Cooperative Group to evaluate the rate of transfusion-transmitted infections with human immunodeficiency virus (HIV) and human T-lymphotropic virus (HTLV) in a cohort of patients who were homozygous for beta thalassemia and underwent multiple transfusions during the 6-year follow-up.One thousand three hundred eighty-four patients with beta thalassemia from 36 centers were enrolled from December 1989 to March 1990. Serum samples were tested at regular intervals during the period from December 1989 to March 1996 for anti-HIV and anti-HTLV antibodies in 1 laboratory. Samples from 1073 and 1001 of the 1384 patients were available for evaluation also during the periods from December 1992 to March 1993 and December 1995 to March 1996, respectively. The risk of acquiring infection was calculated by the ratio between the number of patients who experienced seroconversion and the number of red blood cell units administered to the patients during the study period.The prevalence of HIV infection found in the period from December 1989 to March 1990 was 2.9% (40 of 1384 patients). During follow-up, 1 of 1001 patients showed anti-HIV seroconversion. The incidence of HIV infection was 1.7 per 10,000 person-years (upper boundary of the 95% confidence interval, 5 per 10,000). The risk of HIV infection was 1 in 190,000 U (upper boundary of the 95% confidence interval, 1 in 67,000). At baseline, 4 patients were infected with HTLV (3 with HTLV-1 and 1 with HTLV-2). No seroconversions were observed during follow-up; the risk of HTLV infection was less than 1 in 190,000 U.The application of reliable screening procedures for donor selection reduced the transmission of transfusion-associated HIV infection in 1989-1995 to fewer than 2 cases in 10,000 person-years or 1 case per 190,000 units of red blood cells.

Mass gatherings are special situations for which mass medical care must be preplanned. Acute emergencies occur at public gatherings and medical coverage on site has proven benefit. Responsibility of general plan, management of specific problems, transport planning, communications system, guidelines and protocols, special situations management, ancillary supports, sources of extra help for unforeseen needs are the most important items to consider. In mass gatherings the whole emergency medical service (EMS) planning and management has to depend on the emergency department direction, with its authority on all aspects of patient care in the EMS system. This report concerns the planning of EMS and of medical care in a situation at risk for mass casualties at the Formula I Grand Prix-Championship Racing 'San Marino' of Imola.

The clinical significance of single band reactivity (indeterminate pattern) at anti-hepatitis C virus (HCV) second-generation recombinant immunoblot assay (RIBA-2) was investigated in symptomless subjects with normal liver function tests to obtain data for their counseling and clinical management. Serum and hepatic HCV RNA were determined by the nested polymerase chain reaction, and liver histology was evaluated in 40 symptomless blood donors with stable indeterminate RIBA-2 pattern, including 38 reactive to c22-3. All but one had normal alanine aminotransferase (ALT) levels. Two new immunoblot tests, RIBA-3 and INNO-LIA HCV Ab III (LIA-III), which incorporate additional HCV antigens, were also done to assess whether they could identify the viremic subjects. Ten cases (25%, confidence interval 12 to 38) were HCV RNA positive. Three of the HCV RNA-positive and none of the HCV RNA-negative subjects had chronic hepatitis. RIBA-2 strong intensity of reaction (score2+) was observed in all the HCV RNA-positive and in 12 HCV RNA-negative subjects. RIBA-3 and LIA-III gave positive results in 9 of 10 and 10 of 10 HCV RNA-positive, but also in 8 of 30 and 24 of 30 HCV RNA-negative subjects. A c-22-3 reactivity score of 4+ by RIBA-3 and E2/NS1 reactivity by LIA-III were both strongly associated with HCV RNA (P.001). Based on relatively high prevalence of chronic hepatitis in our series (30%), apparently healthy subjects with stable indeterminate RIBA-2 pattern and HCV RNA positivity should be considered for liver biopsy independently of ALT profile.(ABSTRACT TRUNCATED AT 250 WORDS)

The use of digital technological tools for the architectonic and the archeological survey is increasingly widespread, and, in recent years, it is gaining importance due to the many exploitable applications, from 3D modeling to the cultural heritage safeguarding. This paper aims to illustrate the potential of the complementary use of terrestrial phase-shift laser scanning with UAV air photogrammetry to set up a workflow in order to produce vulnerability and safety analysis of remains belonging to the archeological sites starting from a 3D geometrical model. The proposed approach has been applied to the medieval tower located on the top of “Monte Lucio” (309 m. above mean sea level), one of the four peaks situated on the southern municipal border of “Quattro Castella”, in the province of “Reggio Emilia” (Italy). This building is part of a small medieval archeological site dating from the end of the 13th century. The 2011 excavations in the area surrounding the tower brought to light the remains of various medieval constructions, including a small religious building, known as Saint Leonard church. In order to perform an in-depth vulnerability analysis of this ancient tower, an interdisciplinary collaboration between different professional figures as archeologists and chemists was established to get all-around information. First of all, an exhaustive stratigraphic analysis was carried out through laboratory tests on the mortar that made it possible to date the different construction phases of the tower. This allowed fine-setting the material characterization parameters then embedded into structural models, usually the most complex operation in masonry archeological buildings. Alongside the analysis, a geometrical survey identified the tower dimensions. A very accurate dimensional data of the basement was obtained with a terrestrial laser scanner; More detailed information on the tower top, inaccessible to laser equipment, was acquired using UAV photogrammetry, a particularly effective technology when the surveyed building is in difficult-to-access zones, in order to preserve the safety of operators. Complementary data coming from the two surveys were joined to obtain a comprehensive 3D model to be used for structural analysis. This complementary survey allowed a deep understanding of the masonry stratigraphy, highlighting with high accuracy: wall thicknesses, openings, putlog holes, masonry irregularities, out of plane walls, etc. All this kind of information has been relevant for the realization of the structural modeling matrixes. After the survey, the point cloud registration, and the generation of the surface mesh, the inner and outer elevations were drawn, and the walls have been classified by the different bricks typologies and characteristics. This quality mapping was then transformed in a 10x10 cm pixel matrix to identify each slice uniquely by using different colors. The matrix has been imported in MATLAB, assigning coordinates and mechanical characteristics to each pixel, according to material typology. Finally, the model has been imported in Abaqus Unified Fea to perform Pushover analysis and to calculate the horizontal forces distribution causing the tower collapse in order to evaluate possible prevention measures to be taken. The restoration design aims to revitalize the archeological site using reversible elements that resolve the structural issues minimizing the effects on the ruins. A steel truss-tower was built within the masonry walls and connected through tie bars hidden inside the putlog holes to absorb the horizontal loads. In conclusion, this paper introduces a well-defined working pipeline oriented to the digital simulation of structural behaviors that influence remains belonging to the Cultural Heritage domain. Through the adoption of different combined digital survey technologies and multidisciplinary data sharing, the proposed workflow proved to be efficient in the archaeological case study presented.

The paper describes an operational working methodology to be applied for surveys with phase-shift laser scanning, which allows defining a guidelines system to optimize in-field data collection. While reducing the number of scan positions still using the same quality, it is possible to obtain smaller files, in order to limit the computational requirements during editing and post-production. Nonetheless, this methodology guarantees results that are qualitatively comparable to the standard data collection process. Consequently, the angle ranges have been analyzed to find a value that guarantees for the survey a point cloud lighter and more manageable and, at the same time, that maintains a reasonable accuracy. Subsequently, two parameters were defined, “redundancy” and “closeness”, to find an operational process that allows to schematize what is usually achieved with the help of experience in the field: to evaluate the minimum number of scan points that can ensure the necessary overlap for optimal coverage of the entire building surveyed. After defining the study of the ideal situation, the model is applied in a case study, situated in a densely built context, typical of European historical urban centers: the main façade of the G. Ciamician Institute of Chemistry of the University of Bologna (Italy).

Il Porto Vecchio di Trieste rappresenta un importante esempio di architettura del periodo della rivoluzione industriale. Il potenziamento del porto divenne una necessità durante il XIX secolo. Le criticità incontrate nella realizzazione furono risolte con soluzioni tecniche all’avanguardia. Di particolare interesse risulta la sperimentazione di tecniche innovative del Calcestruzzo Armato. La rivoluzione dei traffi ci commerciali nel XX secolo e la realizzazione del “Porto Nuovo” nella zona Est della città, segnarono il declino del Porto Vecchio. Oggi l’area complessiva è oggetto di un’iniziativa che ha l’obiettivo di restituirla alla città. In una visione di recupero complessivo, questo contributo si pone l’obiettivo di valorizzazione le tecniche costruttive utilizzate, tramite proposte per il recupero delle stesse.

Il Porto Vecchio di Trieste rappresenta un esempio di architettura riferibile al patrimonio archeologico industriale di sicuro interesse per il suo contenuto culturale e storico. Si è sviluppata una visione metaprogettuale, declinata alle scale urbanistica ed architettonica, che si è posta l’obiettivo di restituire tale patrimonio alla città, valorizzando gli elementi caratteristici degli edifici e, al contempo, in una visione di coerente sostenibilità del recupero stesso. I risultati della ricerca acquistano valore in considerazione alle analogie formali e costruttive riscontrate negli edifici e, quindi, alla possibilità una ripetibilità delle azioni progettuali e di intervento per il recupero di tale patrimonio.

La normativa tecnica individua, all’interno del complesso quadro della sostenibilità, le esigenze ed i requisiti connotanti, partendo dagli aspetti energetici ed allargandosi poi ai temi ambientali, seguendo un processo di strutturazione che comprende anche gli aspetti economici e sociali. Si delineano, perciò, quadri di requisiti volti a determinare processi edilizi “sostenibili” ed a certificare la qualità degli stessi. La ricerca svolta, a partire dalla normativa tecnica inerente la sostenibilità ambientale e l’efficienza energetica degli edifici, ne affronta i requisiti connotanti, indagando le caratteristiche e le possibilità offerte da strumenti tecnici che, capaci di definire determinate prestazioni, possono essere impiegati come valido strumento progettuale.

Genome-wide association studies (GWAS) have successfully identified several loci associated with primary biliary cirrhosis (PBC) risk. Pathway analysis complements conventional GWAS analysis. We applied the recently developed linear combination test for pathways to datasets drawn from independent PBC GWAS in Italian and Canadian subjects. Of the Kyoto Encyclopedia of Genes and Genomes and BioCarta pathways tested, 25 pathways in the Italian dataset (449 cases, 940 controls) and 26 pathways in the Canadian dataset (530 cases, 398 controls) were associated with PBC susceptibility (P

We report the evidence-based Italian Association for the Study of Liver guidelines for the appropriate diagnosis and management of patients with nonalcoholic fatty liver disease in clinical practice and its related research agenda. The prevalence of nonalcoholic fatty liver disease varies according to age, gender and ethnicity. In the general population, the prevalence of nonalcoholic fatty liver disease is about 25% and the incidence is of two new cases/100 people/year. 2-3% of individuals in the general population will suffer from nonalcoholic steatohepatitis. Uncomplicated steatosis will usually follow a benign course. Individuals with nonalcoholic steatohepatitis, however, have a reduced life expectancy, mainly owing to vascular diseases and liver-related causes. Moreover, steatosis has deleterious effects on the natural history of HCV infection. Nonalcoholic fatty liver disease is usually diagnosed in asymptomatic patients prompted by the occasional discovery of increased liver enzymes and/or of ultrasonographic steatosis. Medical history, complete physical examination, etiologic screening of liver injury, liver biochemistry tests, serum lipids and insulin sensitivity tests should be performed in every patient. Occult alcohol abuse should be ruled out. Ultrasonography is the first-line imaging technique. Liver biopsy, the gold standard in diagnosis and prognosis of nonalcoholic fatty liver disease, is an invasive procedure and its results will not influence treatment in most cases but will provide prognostic information. Assessment of fibrosis by composite scores, specific laboratory parameters and transient elastography might reduce the number of nonalcoholic fatty liver disease patients requiring liver biopsy. Dieting and physical training reinforced by behavioural therapy are associated with improved nonalcoholic fatty liver disease. Diabetes and the metabolic syndrome should be ruled out at timed intervals in nonalcoholic fatty liver disease. Nonalcoholic steatohepatitis patients should undergo periodic evaluation of cardiovascular risk and of advancement of their liver disease; those with nonalcoholic steatohepatitis-cirrhosis should be evaluated for early diagnosis of hepatocellular carcinoma.