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In the last years, hypersexual behavior has been broadly scientifically studied. The interest in this topic, belonging to psycho-sexology and sexual medicine, has been due to its still unclear aetiology, nature, and its manifestation in relationship with several organic and psychopathological conditions. So, the specialist (the psychologist, psychiatrist, endocrinologist, neurologist) may encounter some difficulties in diagnosing and managing this symptom. The first main objective of this position statement, which has been developed in collaboration between the Italian Society of Andrology and Sexual Medicine (SIAMS) and the Italian Society of Psychopathology (SOPSI) is to give to the reader evidence about the necessity to consider hypersexuality as a symptom related to another underlying condition. Following this consideration, the second main objective is to give specific statements, for the biopsychosocial assessment and the diagnosis of hypersexual behavior, developed on the basis of the most recent literature evidence. To develop a psycho-pharmacological treatment tailored on patients' needs, our suggestion is to assess the presence of specific comorbid psychopathological and organic conditions, and the impact of pharmacological treatments on the presence of an excess of sexual behavior. Finally, a suggestion of a standardized psychometric evaluation of hypersexuality will be given.

Objective. To decipher brain network dynamic remodeling from electroencephalography (EEG) during a complex postural control (PC) task combining virtual reality and a moving platform. Approach. EEG (64 electrodes) data from 158 healthy subjects were acquired. The experiment is divided into several phases, and visual and motor stimulation is applied progressively. We combined advanced source-space EEG networks with clustering algorithms to decipher the brain networks states (BNSs) that occurred during the task. Main results. The results show that BNS distribution describes the different phases of the experiment with specific transitions between visual, motor, salience, and default mode networks coherently. We also showed that age is a key factor that affects the dynamic transition of BNSs in a healthy cohort. Significance. This study validates an innovative approach, based on a robust methodology and a consequent cohort, to quantify the brain networks dynamics in the BioVRSea paradigm. This work is an important step toward a quantitative evaluation of brain activities during PC and could lay the foundation for developing brain-based biomarkers of PC-related disorders.

Background: Psychotic-like experiences index an increased risk for subsequent psychotic disorders. A risky family environment is a well-established risk factor for psychotic-like experiences, however different contextual and personal factors may differentially mediate their effect on psychotic-like experiences, including different aspects of resilience. Objective: In this study we propose a two-dimension model of resilience. Our aim is to address separately the mediational role of personal and contextual resilience factors between a risky family environment and PLE in a community sample. Methods and Materials: Five hundred University students completed an on-line questionnaire including the Resilience Scale for Adults, the 16-item version of the Prodromal Questionnaire and the Risky Family Questionnaire. Mediation was assessed using Structural Equation Modelling with bootstrapping estimation of indirect effect. Results: Direct effect of Personal and Contextual resilience on Psychotic-like experiences were respectively -0.69 [- 0.97, -0.41] (p

Vagal Nerve Stimulation (VNS) is an effective treatment for Drug-Resistant (DR) epilepsy. Albeit the corroborated effectiveness of VNS, little is known about how VNS works. We aim to leverage quantitative Electroencephalography (qEEG) to study how the brain responds to VNS cycles.Eighteen subjects with DR epilepsy were enrolled in our study. 64-channel EEG was recorded during VNS stimulation. Periods of stimulation (VNS), preceding (preVNS) and following stimulation (postVNS) were identified via an electrode placed on the stimulator. We used qEEG analysis to assess changes in spectral and network activity that characterize these conditions. Graph theory metrics were used to calculate differences in network connectivity.No differences were found in spectral activity between preVNS, VNS, and postVNS. Graph theory showed consistent changes in network organization expressed by Small World Index (SWI), Betweenness Centrality (BtwC), and Global Efficiency (gE). These changes were most significant in the slow EEG bands.In DR epilepsy, VNS has a significant effect on brain network activity, as assessed by EEG connectivity, acting on widespread network distribution rather than band-power.Our findings support the hypothesis that VNS acts on epilepsy by influencing diffuse network connectivity in the brain.

Nowadays it is known that the European building stock is energy-intensive and insecure: constructions need interventions both to solve performance and structural deficiencies and to reduce the current unsustainable energy waste. An intelligent retrofit for existing structures should offer an intervention integrating all the different performance requirements, such as structural safety, energy efficiency and architectural quality together with optimization of construction processes and costs. To this purpose, it is, therefore, essential to improve knowledge on the composition of the existing building stock . In this work, by analysing and processing the quantitative and qualitative data available from different countries, it has been possible to define an accurate building technologies map showing both the seismic-resistant structures and the envelope systems, the latter to evaluate also the environmental behaviour of buildings in terms of Life Cycle Assessment (LCA) and energetic consumptions. Afterwards, the seismic and climatic characteristics of all the European countries have been considered, so leading towards the definition of zones with different combined hazard conditions. Through all the possible combinations between these seismic and climatic zones, it has been conceived a hazard matrix, where different case studies can be placed aiming at showing potentialities of different retrofit solutions from seismic and energy viewpoints. The investigation of these case studies, which will be analysed in a companion paper, allows to cover all the possible constructions and hazards detected at European level, so to implement an analysis method to be used in every Countries in Europe.

Objective. To define a new neurophysiological signature from electroencephalography (EEG) during a complex postural control task using the BioVRSea paradigm, consisting of virtual reality (VR) and a moving platform, mimicking the behavior of a boat on the sea. Approach. EEG (64 electrodes) data from 190 healthy subjects were acquired. The experiment is composed of 6 segments (Baseline, PRE, 25%, 50%, 75%, POST). The baseline lasts 60 s while standing on the motionless platform with a mountain view in the VR goggles. PRE and POST last 40 s while standing on the motionless platform with a sea simulation. The 3 other tasks last 40 s each, with the platform moving to adapt to the waves, and the subject holding a bar to maintain its balance. The power spectral density (PSD) difference for each task minus baseline has been computed for every electrode, for five frequency bands (delta, theta, alpha, beta, and low-gamma). Statistical significance has been computed. Main results. All the bands were significant for the whole cohort, for each task regarding baseline. Delta band shows a prefrontal PSD increase, theta a fronto-parietal decrease, alpha a global scalp power decrease, beta an increase in the occipital and temporal scalps and a decrease in other areas, and low-gamma a significant but slight increase in the parietal, occipital and temporal scalp areas. Significance. This study develops a neurophysiological reference during a complex postural control task. In particular, we found a strong localized activity associated with certain frequency bands during certain phases of the experiment. This is the first step towards a neurophysiological signature that can be used to identify pathological conditions lacking quantitative diagnostics assessment.

AIM The aim of the present study was to detect factors associated with duration of untreated illness (DUI) in bipolar disorder (BD). METHOD A total of 1575 patients were selected for the purposes of the study. Correlation analyses were performed to analyse the relation between DUI and quantitative variables. The length of DUI was compared between groups defined by qualitative variables through one-way analyses of variance or Kruskal-Wallis's tests according to the distribution of the variable. Linear multivariable regressions were used to find the most parsimonious set of variables independently associated with DUI: to this aim, qualitative variables were inserted with the numeric code of their classes by assuming a proportional effect moving from one class to another. RESULTS An inverse significant correlation between length of DUI and time between visits in euthymic patients was observed (r = -.52, P

Background Previous researches highlighted among patients with schizophrenia spectrum disorders (SSD) a significant presence of autistic traits, which seem to influence clinical and functional outcomes. The aim of this study was to further deepen the investigation, evaluating how patients with SSD with or without autistic traits may differ with respect to levels of functioning, self-esteem, resilience, and coping profiles. Methods As part of the add-on autism spectrum study of the Italian Network for Research on Psychoses, 164 outpatients with schizophrenia (SCZ) were recruited at eight Italian University psychiatric clinics. Subjects were grouped depending on the presence of significant autistic traits according to the Adult Autism Subthreshold Spectrum (AdAS Spectrum) instrument (“AT group” vs “No AT group”). Other instruments employed were: Autism Spectrum Quotient (AQ), Specific Levels of Functioning (SLOF), Self-Esteem Rating scale (SERS), Resilience Scale for Adults (RSA), and brief-COPE. Results The “AT group” reported significantly higher scores than the “No AT group” on SLOF activities of community living but significantly lower scores on work skills subscale. The same group scored significantly lower also on SERS total score and RSA perception of the self subscale. Higher scores were reported on COPE self-blame, use of emotional support and humor domains in the AT group. Several correlations were found between specific dimensions of the instruments. Conclusion Our findings suggest the presence of specific patterns of functioning, resilience, and coping abilities among SSD patients with autistic traits.

IntroductionThe deficiency of polyunsaturated fatty acids (PUFAs) and an alteration between the ratio of omega-6 and omega-3 PUFAs may contribute to the pathogenesis of depressive disorders.ObjectivesTo investigate the levels of omega-3 and omega-6 in red cell membranes (mPUFAs) and plasma (pPUFAs) of patients with treatment-resistant (TRD) and non-treatment resistant depression (non-TRD).MethodsTRD and non-TRD consisted of 75 patients enrolled at the Psychiatric and Clinic Psychology Unit of the University of Rome Tor Vergata, Rome, Italy, and met the DSM-IV criteria for major depressive disorder (MDD). A group of healthy controls (HC) matched for agender and age was enrolled. All blood samples were performed in conditions of an empty stomach between 07:00 am and 09:00 am. For each subject were obtained 5 ml of whole blood with the use of tubes for plasma with EDTA as an anticoagulant. Eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) for omega-3 and arachidonic acid (AA) for omega-6 were measured.ResultsLevels of pPUFAs did not differ between the three groups. The mPUFAs were altered in the MDD. TRD and non-TRD had lower EPA and AA values respect to the HC. DHA in red cell membranes was lower in TRD than non-TRD and HC.ConclusionsChanges in levels of PUFAs in red cell membranes, but not in plasma, may be an important factor to evaluate the resistance to the pharmacological treatment.

In this study, we report on mental health outcomes among health workers (HWs) involved with the COVID-19 pandemic in Italy.Data on mental health on 1379 HWs were collected between March 27th and March 31th 2020 using an on-line questionnaire spread throughout social networks, using a snowball technique along with sponsored social network advertisement. Key mental health outcomes were Post-Traumatic Stress Disorder symptoms (PTSD), severe depression, anxiety, insomnia and perceived stress.PTSD symptoms, severe depression, anxiety and insomnia, and high perceived stress were endorsed respectively by 681 (49.38%), 341 (24.73%), 273 (19.80%), 114 (8.27%) and 302 (21.90%) respondents. Regression analysis show that younger age, female gender, being a front-line HWs, having a colleague deceased, hospitalised or in quarantine were associated with poor mental health outcomes.This is the first report on mental health outcomes and associated risk factors among HWs associated with the COVID-19 pandemic in Italy, confirming a substantial proportion of health workers involved with the COVID-19 pandemic having mental health issues, in particular young women, first-line HWs.

BACKGROUND: Basophils, eosinophils and monocytes may be involved in BCG-induced immune responses and be associated with outcomes of bladder cancer patients receiving intravesical BCG. Our objective was to explore the association of baseline counts of basophils, eosinophils and monocytes with outcomes of patients with high-grade T1 bladder cancer receiving a standard course of intravesical BCG. METHODS: We retrospectively reviewed medical records of patients with primary T1 HG/G3 bladder cancer. After re-TURBT, patients were treated with a 6-week course of intravesical BCG induction followed by intravesical BCG every week for 3 weeks given at 3, 6, 12, 18, 24, 30 and 36 months from initiation of therapy The analysis of potential risk factors for recurrence, muscle invasion and cancer-specific and overall survival was performed using univariable Cox regression models. Those factors that presented, at univariate analysis, an association with the event at a liberal p

This paper investigates the feasibility of a recently proposed building energy community scheme where the energy of a single rooftop photovoltaic system is shared by costumers with a open and democratic participation. A Simulink/Matlab model is developed where we focus on the implementation and control aspects of all the relevant components, e.g., voltage source inverters for ac grid connection, dc/dc converter with maximum power point tracking strategy, inverters control for energy sharing among end-user. Preliminary results confirm the efficiency and flexibility of the proposed scheme.

The performance of Organic Rankine Cycles (ORC) plants is subject to uncertainties deriving from several factors. Such uncertainties are unavoidably propagated through the model to the outputs, affecting predictions of the commercial-scale performance and cost of this technology. The aim of this work is to analyse how the uncertainties associated with the performance of the expander, one of the main ORC components, propagate to the relevant thermodynamic and economic outputs and affect their final value. The analysis was performed for three different expander options (a single-stage turbine, a twin screw and a two-stage turbine) to generate a full spectrum of possible outputs rather than exact figures. Overall, a considerable variability of the output metrics was highlighted compared to the results from the deterministic analysis.

Background: The COVID-19 pandemic has dramatically changed lifestyles and quality of life (QoL) of the global population. Little is known regarding the psychological impact of the COVID-19 outbreak on patients with gastroenteropancreatic (GEP) or bronchopulmonary (BP) neuroendocrine tumors (NETs). Methods: We prospectively evaluated seven specific constructs (depression, anxiety, stress, QoL, NET-related QoL, patient-physician relationship, psychological distress) by using validated screening instruments including the Depression anxiety stress scale-21 (DASS-21), the EORTC QLQ-C30, the EORTC QLQ GI.NET21, the patient doctor relationship questionnaire 9 (PDRQ9) and the Impact of event scale-revised (IES-R). Mental symptoms and concerns of patients with any stage, well-differentiated GEP or BP-NET were surveyed twice, during the plateau phase of the first (W1) and second epidemic waves (W2) in Italy. Results: We enrolled 197 patients (98 males) with a median age of 62 years (G1/G2: 96%;pancreas: 29%;small bowel: 25%;active treatment: 38%). At W1, the prevalence of depression, anxiety and stress was 32%, 36% and 26% respectively. The frequency of depression and anxiety increased to 38% and 41% at W2, with no modifications in the frequency of stress. By ordinal logistic regression analysis, female patients showed more severe forms of stress at W1 (OR=0.45±0.14;p=0.01), while the educational status was associated with the levels of anxiety at both W1 (OR=1.33±0.22;p=0.07) and W2 (OR=1.45±0.26;p=0.03). An improvement of the physical (p=0.03) and emotional functioning domains (p=0.001) was observed over time. Both nausea/vomiting (p=0.0002), appetite (p=0.02), treatment-related symptoms (p=0.005), disease-related worries (p=0.0006) and sexual function (p=0.02) improved between W1 and W2, suggesting that NET patients were able to cope with the perturbations caused by the pandemic. No difference was seen between W1 and W2 in the mean score (>4/5) of the PDRQ9. By IES-R, post-traumatic stress disorder was observed in 53% of patients at W2. Conclusions: The implementation of psychological interventions within NET clinics might favor functional coping strategies, attenuating the psychological distress caused by the COVID-19 pandemic. Legal entity responsible for the study: The authors. Funding: Has not received any funding. Disclosure: All authors have declared no conflicts of interest.

IntroductionDespite innovative treatments, the impairment in real-life functioning in subjects with schizophrenia (SCZ) remains an unmet need in the care of these patients. Recently, real-life functioning in SCZ was associated with abnormalities in different electrophysiological indices. It is still not clear whether this relationship is mediated by other variables, and how the combination of different EEG abnormalities influences the complex outcome of schizophrenia.ObjectivesThe purpose of the study was to find EEG patterns which can predict the outcome of schizophrenia and identify recovered patients.MethodsIllness-related and functioning-related variables were measured in 61 SCZ at baseline and after four-years follow-up. EEGs were recorded at the baseline in resting-state condition and during two auditory tasks. We performed Sparse Partial Least Square (SPLS) Regression, using EEG features, age and illness duration to predict clinical and functional features at baseline and follow up. Through a Linear Support Vector Machine (Linear SVM) we used electrophysiological and clinical scores derived from SPLS regression, in order to classify recovered patients at follow-up.ResultsWe found one significant latent variable (pConclusionsA combination of electrophysiological markers, age and illness-duration might predict clinical and functional outcome of schizophrenia after 4 years of follow-up.

IntroductionAmongst different subtypes of Conversion Disorder (CD), DSM-V lists the Psychogenic Non-epileptic seizures (PNES). PNES are defined as episodes that visually resemble epileptic seizures but, etiologically, they are not due to electrical discharges in the brain.ObjectivesOur study aims to explore the differences between PNES and other CDs. In particular, we studied the suicidality and its correlations with dissociation and alexithymia.MethodsPatients, recruited from the Psychiatry and Clinical Psychology Unit of the Fondazione Policlinico Tor Vergata, Rome, Italy, were diagnosed with PNES (n=22) and CD (n=16) using the DSM-5 criteria. Patients underwent the following clinical assessments: HAM-D, BDI, DES, BHS, TAS, CTQ.ResultsPNES showed significantly higher scores than CD in all assessments, except for BDI-somatic (p=0.39), BHS-feeling (p=0.86), and the presence of childhood trauma. PNES also showed significantly higher suicidality (p = 0.003). By controlling for the confounding factor “depression”, in PNES suicidality (and in particular the BHS-loss of motivation) appears to be correlated with DES-total score (p = 0.008), DES-amnesia (p = 0.002) and DES -derealization-depersonalization (p = 0.003). On the other hand, in CDs, the BHS-total score shows a correlation with the TAS-total score (p = 0.03) and BHS-Feelings with TAS-Externally-Oriented Thinking (p = 0.035), while only the BHS-Loss of motivation appears correlated with DES-Absorption (p = 0.011).ConclusionsOur study shows significant differences between PNES and CD, in several symptomatologic dimensions, including suicidality. Indeed, in PNES suicidality appears to be related to dissociation, while in CDs it appears mainly to be correlated with alexithymia.

IntroductionDifferent electrophysiological indices have been investigated to identify diagnostic and prognostic markers of schizophrenia (SCZ). However, these indices have limited use in clinical practice, since both specificity and association with illness outcome remain unclear. In recent years, machine learning techniques, through the combination of multidimensional data, have been used to better characterize SCZ and to predict illness course.ObjectivesThe aim of the present study is to identify multimodal electrophysiological biomarkers that could be used in clinical practice in order to improve precision in diagnosis and prognosis of SCZ.MethodsIllness-related and functioning-related variables were measured at baseline in 113 subjects with SCZ and 57 healthy controls (HC), and after four-year follow-up in 61 SCZ. EEGs were recorded at baseline in resting-state condition and during two auditory tasks (MMN-P3a and N100-P3b). Through a Linear Support Vector Machine, using EEG data as predictors, four models were generated in order to classify SCZ and HC. Then, we combined unimodal classifiers’ scores through a stacking procedure. Pearson’s correlations between classifiers score with illness-related and functioning-related variables, at baseline and follow-up, were performed.ResultsEach EEG model produced significant classification (p < 0.05). Global classifier discriminated SCZ from HC with accuracy of 75.4% (p < 0.01). A significant correlation (r=0.40, p=0.002) between the global classifier scores with negative symptoms at follow-up was found. Within negative symptoms, blunted affect showed the strongest correlation.ConclusionsAbnormalities in electrophysiological indices might be considered trait markers of schizophrenia. Our results suggest that multimodal electrophysiological markers might have prognostic value for negative symptoms.

Background Guidelines and position papers indicate that allergen immunotherapy (AIT) is the only disease-modifying treatment, including prevention of the onset of new allergen sensitizations. However, this preventive effect was shown by only a few observational studies. Our aim was to systematically review the efficacy of AIT in preventing the onset of new allergen sensitizations. Methods Computerized bibliographic searches of MEDLINE, EMBASE, and the Cochrane Library (through June 2015) were supplemented with manual searches of reference lists. Observational studies or randomized controlled trials with a long-term observation period were included. Paired reviewers extracted data about study characteristics and assessed biases. The end-point was the risk difference in the onset of new allergen sensitizations between patients treated with AIT and pharmacotherapy. The strength of the evidence was graded based on the risk of bias, consistency, and magnitude of effect, according to the GRADE Working Group's guide. Results Eighteen studies (1,049 children, 10,057 adults) met the inclusion criteria. The risk of bias was high in all but one study. Low evidence supports the position that AIT prevents the onset of new allergen sensitizations, with 10 out of 18 studies reporting a reduction of the onset of new sensitizations in patients treated with AIT vs. placebo. Small studies and studies with a shorter follow-up showed the highest benefit of AIT. Conclusions The overall evidence provides a low-grade level of the evidence supporting the efficacy of AIT in preventing the onset of new allergen sensitizations, but high-quality studies could change this estimate. This article is protected by copyright. All rights reserved

Background Inflammatory bowel diseases (IBD) are associated with mental disorders, which can negatively influence the course of IBD. Nonetheless, psychiatric disorder comorbidities (PDCs) remain undiagnosed in many IBD patients. The aim of this study was to assess the frequency of undiagnosed psychiatric comorbidities in IBD patients. Methods Two-hundred-thirty-seven adult IBD [136 Crohn’s disease (CD) and 101 with ulcerative colitis (UC)] outpatients were consecutively recruited in a single university hospital centre between January 2018 and June 2019. After the visit for IBD clinical evaluation, participants completed self-report questionnaires and then underwent a clinical interview by a trained psychiatrist. Results One-hundred-fourteen (48%) IBD patients had at least one undiagnosed psychiatric disorder. Forty-three (18%) patients presented a single PDC, 40 (16.8%) had two PDCs, 11 (4.6%) had 3 PDCs, 12 (5%) had 4 PDCs, 7 (2.9%) had 5 PDCs and 1 (0.4%) had 6 PDCs. PDCs were equally distributed among CD (72/136, 53%) and UC (42/101, 42%) patients. Mood disorders (54/114, 47%) and anxiety (27/114, 24%) disorders were the most common PDC; moreover, 23 (20%) patients suffered from post-traumatic stress disorder (PTSD), 3 (3%) had an obsessive-compulsive disorder, and 7 (6%) a substance abuse/dependence disorder. Fifty-nine per cent of IBD patients diagnosed with a psychiatric disorder during the study did not have a positive psychiatric anamnesis. PDCs were not related to activity, phenotype or localisation of IBD. Conclusion Psychiatric disorders are common in IBD but not related to activity, phenotype or localisation of bowel disease. Overall, these findings suggest the necessity to include psychiatric evaluation in the management of IBD patients.

Damage due to atmospheric corrosion on metal structures is a significant aspect for both the design of new construction and the maintenance of existing buildings. This problem is particular...

Cross concentrically braced frames are commonly used in seismic design of steel buildings at any seismicity, owing to their large lateral stiffness, simplicity of design and limited constructional cost. The seismic design criteria provided by current EC8 aim at assuring ductile global plastic mechanism occur, namely restraining the plastic deformation into the diagonals, while the remaining structural members and connections should elastically behave. However, several studies, show that the design process compliant to Eurocode 8 is affected by several criticisms, it entails several efforts and often leads to massive, uneconomical systems solution exhibiting poor seismic performance. EN1998-1 recommends estimating the lateral resistance of X-CBFs by performing structural analysis on a tension-only (T-O) diagonal scheme in which solely the tension braces resist the lateral loadings, while the contribution given by the compression diagonals is neglected. As highlighted by the comments given by European designers coming from the survey promoted by CEN TC 250/SC8 for the systematic review of EC8, this type of model can induce misleading interpretation of the structural behavior and relevant modelling of X-CBFs, leading to uneconomical and oversized systems characterized by heavy structural solutions and poor plastic engagement. The research presented in this paper is addressed to critically discuss and revise the detailing rules codified within the current EN 1998-1 for X-CBF, to simplify the design process and to improve the seismic behavior. Whit this aim, an extent set of nonlinear dynamic analyses has been performed on a set ow low, medium, and high-rise 2D frames extracted from residential steel buildings to assess the effectiveness of currently codified requirements and to validate the beneficial effects of the proposed revision.

Over recent decades, European Union countries have committed to increasing their electricity production from renewable energy sources (RESs). Wind energy plays a significant role in a sustainable future. This paper presents a political, economic, social, technological, legal and environmental analysis. Although these countries have made many improvements in their legal frameworks aiming to attract investors and boost the RE sector, there are still challenges. The UK focuses on offshore wind energy, adjusts the economic strategy and changes the legislation context. Germany has the healthiest economic conditions, as it keeps following its initiative to design a new programme for an energy transition from conventional to RESs with emphasis on the onshore. Greece has only a few installations and much room for development but needs to make further changes in the legislation and economy so as to attract more investors in the long term. The purpose of this research is to analyse, highlight and discuss vi...

BACKGROUND First-line sunitinib is recommended in metastatic renal cell carcinoma (mRCC), but it is frequently associated with relevant toxicities and subsequent dose reductions. Alternative schedules, such as 2-week-on treatment and 1-week-off (2/1 schedule), might improve tolerability. We evaluated the safety and outcomes of this schedule in a large multicenter analysis. PATIENTS AND METHODS Retrospective, multicenter analysis of mRCC patients treated with first-line sunitinib on a 2/1 schedule. Data of 249 patients were reviewed: 208 cases who started sunitinib on the 4/2 schedule (full dosage: 188/208, 90.4%) and thereafter switched to the 2/1 schedule for toxicity (group 4/2 → 2/1) and 41 patients who started first-line sunitinib with the 2/1 schedule because of suboptimal clinical conditions (group 2/1). A total of 211 consecutive patients treated with the 4/2 schedule in another institution served as external controls. Safety was the primary end point. Treatment duration (TD), progression-free survival (PFS) and overall survival (OS) were also analyzed. RESULTS In group 4/2 → 2/1, the overall incidence of grade ≥ 3 toxicities was significantly reduced (from 45.7% to 8.2%, P < 0.001) after the switch to 2/1 schedule. This advantage was maintained also in the 106/188 cases (56.4%) who maintained the full dosage. Fatigue, hypertension, hand-foot syndrome and thrombocytopenia were less frequent. The incidence of grade ≥ 3 adverse events in the negatively selected group 2/1 (only 73.2% starting at full dose) was 26.8%, similar to what observed in the external control group (29.4%). Median TD was 28.2 months in the 4/2 → 2/1 group (total time spent with both schedules), 7.8 months in the 2/1 group and 9.7 months in external controls. Median PFS was 30.2, 10.4 and 9.7 months, respectively. Median OS was not reached, 23.2 and 27.8 months, respectively. CONCLUSIONS mRCC patients who moved to a modified 2/1 schedule of sunitinib experience an improved safety profile compared with that observed during the initial 4/2 schedule.

This paper discusses the seismic vulnerability of Reinforced Concrete (RC) buildings designed to gravity loads only, which are representative of the Italian building stock mainly erected between ‘70s and ‘80s, and investigates the use of external steel concentric bracing systems to upgrade their seismic performance. A case study building has been selected and designed according to the codes and the current practice in force at the time of construction. The seismic performance has been evaluated through the so-called N2 method in the format of the Capacity Spectrum Method applied to three different models of the building, namely bare frame, full infilled frame and pilotis frame, to highlight the role of the infill walls arrangement. The three models have been retrofitted with the external bracing systems designed with an adopted rational methodology. The external arrangement of the bracing systems has been chosen in order to both minimize the impact on the existing building and avoid the local interaction between the RC structural elements and the steel bracings, as well as the additional loads on the existing foundations. The results have shown the strong role of the infills in the structural behaviour of the existing building and the efficiency of the external steel bracing systems as retrofitting technique of existing RC buildings.

Background Cabazitaxel (CAB) was marketed in 2012 in Italy, based on overall survival (OS) benefit demonstrated on the TROPIC study in mCRPC post-docetaxel. The efficacy and tolerability of CAB is overlapping in all age groups, though for very elderly patients (pts) it has never really been verified. Methods We conducted a retrospective, observational real-life study in 57 octogenarian pts, treated with CAB in eleven Italian cancer centers from 2012 to 2018. Feasibility of treatment has been investigated by duration of treatment and its tolerability. Duration of treatment and toxicity profile were also evaluated according to Results This retrospective cohort included 57 mCRPC pts (median age 83.5 years; 21% aged over 85 years), 24% with exclusive bone metastatic disease, 50% with high-volume bone disease, 15% with high volume bone disease and visceral disease. Thirty-nine (68%) received the CGA questionnaire assessment, 34 resulted fit and 5 vulnerable. Ten (14%) had an ECOG PS ≥ 2, 9% received CAB as second-line, 23 (40%) as third-line, 29 (51%) as forth or more line. CAB was administered at 25 mg/sqm in 30 (52%) pts, and 20 mg/sqm or adapted schedules in 27 (48%). These latter schedules were adopted mainly in the subgroups with age > 85 years (75%), PS ≥ 2 (87.5%) and vulnerable according CGA questionnaires (100%). The median duration of treatment with CAB in all pts was 4.8 months, range 1-19 months (mo); 4.5 mo in those aged > 85 years, 4.4 mo in the vulnerable pts and 3.5 mo in pts with PS ≥ 2. The most represented grade 3-4 toxicity in the whole cohort were neutropenia (14%) and diarrhea (10.5%). Six patients (10.5%) drop out the treatment for significant toxicities: 3 febrile neutropenia G4, 2 diarrhea G4 and 1 severe cardiotoxicity, 5 (83%) of these pts received the 25 mg/sqm schedule, and 4 pts (67%) aged between 80-84 yeras with ECOG PS = 0 did not performed the CGA assessment before treatment. One death due to intestinal perforation non-clearly treatment-related was reported. Conclusions Octogenarian patients may be treated with CAB with the 20 mg/sqm regimen associated with less treatment interruptions. The CGA could contribute to better select pts. Legal entity responsible for the study The authors. Funding Has not received any funding. Disclosure All authors have declared no conflicts of interest.

Parkinson, Alzheimer, Koreas and motor neuron disease affect today millions of people. These neurodegenerative diseases act on central nervous system causing the loss of brain functions as well as motor disturbances and sometimes cognitive deficits. In such scenario, monitor early symptoms is mandatory. Here the authors describe the development of a monitoring system for Parkinson subjects and other patients affected by neurodegenerative diseases. The developed device is based on an array of four accelerometers connected to an embedded development board. This system is able to monitor tremor/movement, accidental falls and, moreover, it can track the Alzheimer subjects' geographical position. A remote supervisor can collect data from the system through Bluetooth, Wi-Fi or GSM connections.

La Sindrome di Forestier (DISH: Diffuse idiopathic skeletal hyperostosis) è una patologia degenerativa sistemica a carico delle entesi, caratterizzata da alterata ossificazione dei punti di inserzione di legamenti, tendini e capsule articolari. È una patologia di riscontro a livello autoptico nel 18% della popolazione occidentale; aumenta di frequenza con l’età e coinvolge prevalentemente il sesso maschile (2:1). Interessa soprattutto il rachide toracico, seguito dal distretto cervicale nel 75% dei casi. La diagnosi è prettamente radiologica (Rx e TC); l’eziopatogenesi, incerta, è da ascriversi al microtraumatismo cronico associato alle più comuni alterazioni metaboliche dell’età adulta. Le manifestazioni cliniche, nelle forme di più alto grado possono alterare le funzioni aerodigestive, portando a disfonia, severa dispnea o disfagia, compromettendo la normale mobilità del sistema osteomuscolare del distretto cervicofacciale. La maggioranza dei pazienti è asintomatica o presenta lieve limitazione nei movimenti della colonna o dolore articolare