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Objectives To compare growth trajectories from second trimester to birth of standardized unified estimated fetal weight (EFW) or birthweight (BW) measurements in IVF/ICSI pregnancies obtained after thawed versus fresh blastocyst transfers (BT). Methods Prospective longitudinal cohort study performed in the Fetal Medicine and Obstetric Departments of San Raffaele Hospital in Milan, from 2016 to 2020. Singleton viable gestations conceived by autologous IVF/ICSI conceptions from fresh or thawed BT with BW measurements and ultrasound standard fetal biometry performed at 19-36 weeks by doctors blinded to the employment of cryopreservation. Twins, significant pre-gestational diseases, miscarriages, abnormalities and other types of medically assisted reproduction techniques were excluded. EFW and BW Z-scores and their trajectories were analyzed with general linear model (GLM) and logistic regression (LR) with a unified modelling methodology based upon the Fetal Medicine Foundation fetal and neonatal population weight charts and adjusting for major confounders. Differences between prenatal EFW and postnatal BW centiles were assessed and compared with contingency tables, X2 test and convension of prenatal to postnatal centiles. Results 631 IVF/ICSI pregnancies were considered (fresh BT n=263; thawed BT n=368) with a total of 1795 EFW observations (fresh BT n=715; thawed BT n=1080; median: 3 per patient). EFW and BW small for gestational age (SGA) 90 centile were significantly more frequent in thawed vs fresh BT group (p=0.042 and p=0.003). GLM showed significantly decreasing EFW Z-scores with advancing gestational age (GA) assuming equal effect of GA in both study groups (no significant interaction GA and x group was found). Both smoothed mean EFW Z-scores from 19 weeks to term and smoothed mean BW Z-scores were significantly greater in thawed vs fresh BT (EFW Z-scores: 0.70±1.29 vs. 0.28±1.43; p 90 centile was significantly greater in frozen (p 90th and >97th centile were nearly doubled in thawed vs. fresh (p Conclusions Robust novel unified prenatal-postnatal modelling in IVF/ICSI pregnancies after thawed or fresh BT from 19 weeks to birth showed non-divergent growth trajectories with greater EFW and BW Z-scores in frozen vs. fresh BT. Mean EFW Z-scores in both IVF/ICSI groups were greater as expected for natural conception up to 32 weeks in fresh BT and 35 weeks in thawed BT, with maximum effect at mid-trimester, decreasing with advancing gestation. Mean BW Z-scores were negative in both groups, with lower values in premature fetuses and increasing with advancing gestation. IVF/ICSI conceptions from thawed as compared to fresh BT present increased rate of LGA and reduced rate of SGA both prenatally or postnatally. The proportion of SGA fesuses across gestation increases rapidly in fresh and smoothly in thawed, whereas that of LGA fetuses decreases rapidly in thawed vs smoothly in fresh. Prediction models of SGA-LGA may be improved considering: 1. mode of conception with use of blastocyst cryopreservation; 2.unified prenatal-postnatal curves; 3. greater efficiency of prenatal prediction of SGA for fresh and for LGA in thawed. This article is protected by copyright. All rights reserved.

A case of severe fetal hydronephrosis due to isolated bilateral stenosis of the pyelo-ureteral junction was diagnosed at our centre. Surprisingly, a negative renal ultrasound scan was performed on the 3rd postnatal day. An ultrasound follow-up showed severe bilateral pyelectasis a few weeks later. The infant underwent bilateral pyeloplasty at six months of age with an excellent outcome. Such a neonatal picture may be due to the reduction of urinary output secondary to excessive postnatal weight loss and dehydration. In this case, prenatal ultrasound result was more reliable than postnatal ultrasound, emphasizing the importance of postnatal urologic follow-up after prenatal indication.

To compare first-trimester fetal crown-rump length (CRL) measurements in pregnancies obtained after thawed blastocyst transfer versus fresh blastocyst transfer after in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI).Prospective longitudinal cohort study of CRL Z scores with adjustment for major confounders.University-affiliated obstetrics, fetal medicine, and fertility units.Singleton gestations conceived via IVF/ICSI and fresh or thawed blastocyst transfer with ultrasound performed at 6-14 weeks of gestational age.None.CRL Z scores.A total of 365 IVF/ICSI pregnancies were recruited (fresh: 161; thawed: 204). The mean CRL Z score at 6-14 weeks was significantly greater in thawed versus fresh transfers. Different growth trajectories between thawed and fresh transfers were detected: Mean CRL Z score was 0 at 65 days in fresh versus 80 days in frozen. Comparisons of both fresh and thawed transfers with reference values from the general population confirmed significantly lower CRL Z scores in both IVF/ICSI groups (P.001). The risks of CRL5th percentile in fresh versus thawed were, respectively 68% vs. 40% at 6 weeks and 2% vs. 1% at 14 weeks. A significant positive correlation between CRL Z scores and birth weight Z scores was found only for fresh transfers, not for thawed.At 6-14 weeks, thawed blastocyst transfers after IVF/ICSI conceptions present greater CRLs compared with fresh, and both IVF/ICSI groups show smaller CRLs than the general population. This effect is particularly evident before 9 weeks and it may favor birth weight difference of thawed versus fresh BT pregnancies.

Preterm birth (PTB) is more frequent amongWeb-based databases search (PubMed/Medline, Scopus, Web of Science) from inception up to January 2019 looking for cohort studies comparing the risk of IPTB in singleton pregnancies obtained with IVF/ICSI (intervention group) or SC (control group). Only studies with clear distinction of spontaneous and indicated PTB were included. Primary outcome was IPTB before 37 weeks of gestation, defined as indicated delivery for any medical recommendation. All pertinent secondary outcomes were also included: IPTB34/32/28 weeks, abnormal cardiotocography (CTG), abruptio, placenta previa, pre-eclampsia, fetal growth restriction, any other available indication to IPTB. A meta-analysis calculated the pooled odds ratio (OR) for IPTB in IVF/ICSI and SC, using random effects model. Sensitivity analysis for study quality, methodology of case counting, use of cryotransfer, and secondary analyses for available indications of IPTB were also performed. Prospero RN: CRD42019117672.Pooled crude analysis showed a sample size of 9590 births with significant increase in IPTB37 weeks in IVF/ICSI pregnancies (nine studies, pooled proportion IPTB IVF/ICSI 4.73% vs. SC 1.81%; OR = 2.47; 95% CI: 1.46-4.18;The risk of IPTB37 weeks in singleton pregnancies achieved after IVF/ICSI is significantly greater than that occurring in SC. This is likely due to a multifactorial etiology, in which placental diseases are included. Full etiologic understanding of this association needs further clarification.The risk of IPTB below 37 weeks in singleton pregnancies achieved after IVF/ICSI is more than double than that occurring in natural conception.

Background and aim of the study: Pregnancies obtained by assisted reproductive technology (ART) are associated with an increased risk of complications and congenital anomalies, particularly congenital heart defects (CHDs). Therefore, our aim is to evaluate, retrospectively, the prevalence of CHD in ART pregnancies in our two centers and analyze their characteristics and outcomes. Methods: Observational study including fetuses conceived by ART referred between June 2011 and September 2020 and undergoing a fetal cardiac ultrasound scan. Cases with genetic, chromosomal abnormalities or extracardiac malformations were excluded. Population included 1511 pregnancies, which consisted of 269 twins and 1242 singletons, 547 IVF (in vitro fertilization), 773 ICSI (intracytoplasmic sperm injection) and 191 oocyte donations (OD). Results: CHDs were found in 29 fetuses, with an overall prevalence of 1.92% (29/1511), 1.85% (23/1242) in singletons and 2.23% in twins (6/269). Thirteen were IVF, eight ICSI and eight OD cases, with a greater risk of CHD after IVF and OD (IVF: 13/29 (44.8%)—one twin, ICSI: 8/29 (27.6%)—three twins), 22 had major and 7 minor defects. Two pregnancies with a hypoplastic left heart were terminated, the majority of live-born cases needed surgery. Three babies died (two post-surgery, one had a late death). Conclusions: Our data show an increased prevalence of CHD after ART with a heterogeneous spectrum of diagnoses, mainly major defects.

Human cytomegalovirus (HCMV) is the leading infectious agent causing congenital disabilities. The risk of HCMV transmission to the fetus in pregnant women receiving immunosuppressive agents is unknown. We describe two cases of pregnant women with evidence of pre-conception HCMV protective immunity receiving azathioprine for ulcerative colitis or systemic lupus erythematosus. Both women reactivated the HCMV and transmitted the infection to the fetuses. One newborn showed unilateral hearing deficits and brain abnormalities while the other was asymptomatic. The mother of the symptomatic newborn had low levels of total and HCMV-specific blood CD4+ T cells. Women receiving immunosuppressive agents deserve information about the risk of HCMV congenital infection and should be monitored for HCMV infection during pregnancy. Their newborns should be screened for HCMV congenital infection.

Objective: Pregnancies conceived by frozen blastocyst transfer (FBT) have higher gestational age and weight at birth as compared to those derived by fresh blastocyst transfer. The aim of this study was to evaluate uterine artery pulsatility index (UtA-PI) in pregnancies conceived by in-vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) techniques using fresh vs cryopreserved blastocysts. Methods: This was a prospective longitudinal study of viable singleton IVF/ICSI pregnancies conceived after FBT or fresh blastocyst transfer, that underwent serial ultrasound assessment at San Raffaele Hospital, Milan, Italy at 7–37 gestational weeks. We excluded pregnancies conceived using other assisted reproductive techniques such as egg donation, twin gestation, pregnancy with abnormality and those resulting in miscarriage. Pregnant women underwent ultrasound assessment at 7–10, 11–14, 18–25 and 26–37 weeks' gestation. Mean UtA-PI was measured using Doppler ultrasound according to The Fetal Medicine Foundation criteria. Pregnancy outcomes were recorded. The primary outcome was mean UtA-PI measurement and secondary outcomes were gestational age at birth, birth weight and fetal and maternal complications, including small-for-gestational age (SGA), pre-eclampsia and large-for-gestational age. UtA-PI values were made Gaussian after log10 transformation. Analysis of repeated measures using a multilevel linear mixed model (fixed effects and random effects) was performed. The possible effect of other covariates on UtA-PI Doppler values, including body mass index, SGA and pre-eclampsia, was also evaluated. Results: A total of 367 IVF/ICSI cycles, comprising 164 with fresh blastocyst transfer and 203 with FBT, were included and a total of 625 observations (median, 2.5 (range, 1–4)) were collected and analyzed. The FBT group had on average 14% lower UtA-PI compared with the fresh-blastocyst-transfer group. In pregnancies with SGA fetuses, UtA-PI was 18% higher compared to pregnancies without, irrespective of the study group. Pregnancies that underwent fresh blastocyst transfer had significantly lower birth-weight centile (43.4 ± 23.3 vs 50.0 ± 23.1; P = 0.007) and a higher rate of SGA (7.9% vs 2.0%; P = 0.008) compared to those that underwent FBT. No significant differences were found between the two groups with respect to gestational age at birth and rates of preterm birth, pre-eclampsia, gestational diabetes mellitus and large-for-gestational age. Conclusion: UtA-PI and the proportion of SGA are lower in IVF/ICSI pregnancies conceived after FBT as compared to fresh blastocyst transfer. Copyright © 2020 ISUOG. Published by John Wiley & Sons Ltd.

The increasing awareness of the potential threats acting on the coastal regions, combined with the intense anthropic pressure and the broad variety of socio-economic drivers acting on these systems, bestowed progressively stronger emphasis to the development of sound planning and management policies. The assessment and the formulation of plans for the response to coastal morphological vulnerability is a multidis- ciplinary challenge, in which different typology of information, approaches and scales need to be integrated and framed within a consistent dynamical description. To this aim, within the RITMARE National Flagship Project, a specific research line on "Coastal Vulnerability to Erosion and Relative Sea level rise in climate change scenarios" was activated with reference to the Adriatic-Ionian region (Eastern Mediterranean Sea). The activities, supported by the Italian Ministry of University and Research 2016-18, move along three interconnected branches, namely: 1) Assessment of vulnerability to relative sea level rise in the Adriatic-Ionian region, in present conditions and in different climate change scenarios; 2) Development of high-resolution oceanographic modelling tools for the description of meteo-marine climate and sediment transport at different scales and rapid response intervention protocols for the evaluation of the impact of erosive events on sandy sediments; 3) Identification of possible geomorphological setting scenarios and definition of intervention strategies, with spe- cial care to the exploitment of marine sand as a strategic resource. The work provides an overview of the strategy underlying the Research Line and present preliminary results and main achievements. Next steps will be aiming to pave the way towards a road map for an integrated observational and modelling approach for monitoring and managing the erosion and marine ingression risk throughout Italian coasts, striving to bridge the cultural and methodological gaps between the scientific and administrative sectors active in the coastal management field.

Introduction et but de l’etude Differentes etudes indiquent que les odeurs ambiantes peuvent influencer les comportements humains, et cela meme lorsque les personnes n’en sont pas conscientes. Dans le domaine alimentaire par exemple, il a ete montre que des odeurs alimentaires subliminales peuvent guider les choix alimentaires vers des aliments plus sains. Le but de cette etude etait de mettre en evidence les reseaux cerebraux impliques dans le traitement cerebral d’odeurs subliminales. Materiel et methodes Dix participants sains âges de 19 a 40 ans ont ete recrutes sous un pretexte ne faisant pas reference aux odeurs. Lors de l’acquisition d’IRM fonctionnelle (sequence EPI multiband, TR = 500 ms), les participants ont ete exposes discretement a deux odeurs (poire et jacinthe) et a un flux d’air non odorise (controle) en meme temps qu’ils realisaient une tâche visuelle simple. Le paradigme experimental evenementiel est divise en deux sessions : une premiere session pendant laquelle les odeurs sont diffusees a une intensite subliminale (IS), suivie par une deuxieme session pendant laquelle les odeurs sont diffusees a une intensite supraliminale clairement perceptible (ICP). Les questions posees a la fin de la premiere session confirment que les odeurs IS n’etaient pas attentivement percues par les participants. Des contrastes T (SPM) ont ete realises sur les IS et les ICP pour les deux odeurs. Les reseaux cerebraux impliques dans le traitement des odeurs ont ete explores en utilisant l’Analyse en composantes independantes. Resultats et analyse statistique Les premiers resultats en analyse individuelle montrent un traitement sensoriel differentiel entre les odeurs d’IS et d’ICP. L’insula gauche et le cortex cingulaire anterieur gauche s’averent par exemple specifiquement impliques dans le traitement de l’odeur de poire a intensite subliminale, suggerant qu’un processus de saillance pourrait survenir en olfaction subliminale. De plus, les patterns d’activations cerebrales apparaissent differents entre les odeurs de poire et de jacinthe aux deux intensites considerees. Conclusion Ces resultats montrent que des reseaux cerebraux sont actives en presence d’odeurs subliminales. Ils indiquent egalement que la qualite des odeurs est discriminee par le cerveau meme lorsqu’aucune attention n’est portee a ces odeurs. Ce dernier facteur pourrait expliquer l’effet cible et specifique des amorces olfactives alimentaires sur les choix alimentaires.

The present work aims to investigate the electroencephalographic (EEG) activity elicited by the observation of emotional pictures selected from the International Affective Picture System (IAPS) database. We analyzed the evoked activity within time intervals of increasing duration taking into account the related ratings of Valence and Arousal. The scalp statistical maps of Power Spectral Density (PSD), related to pictures with high valence, revealed an enhanced activity across frontal areas in the theta band and the involvement of fronto-parietal circuits in the alpha band. Difference in the processing of low and high arousing pictures, however, seems to be highly dependent on the valence dimension: for low valenced pictures, the difference in arousal was processed immediately after the observation of the picture, while for the high-valenced ones the processing took part in the second part of the observation. These results appear to be congruent with the literature, while the novelty of the current study is represented by the comparison of the activity elicited in different time windows by both the Arousal and Valence dimensions. It is possible, in this way, to observe how the processing of one variable influences the other, creating a dynamic description of the Valence- Arousal space.

An analysis is presented of positive and negative vacuum electrospray currents from the ionic liquid, [Emim][Im], wetted on a sharp tungsten needle. The source is operated in a cone–jet configuration established with a low extraction voltage of approximately ±1 kV. Emission current and mass flow are measured as a function of the emitter angle with respect to the instrument axis. Mass spectra of field evaporated ions and mass-resolved energy distributions of emitted charges are recorded as a function of emitter angle. The measurements at both source polarities indicate that the cone–jet emits a mixture of ions and charged droplets. While the charged droplets are emitted with a narrow angular distribution centered on axis, the angular distributions of ions are significantly broader than those of the droplets and centered off axis. Pure ion emission is observed at emission angles larger than ∼15°. The main mass spectral peaks are from X ± {[Emim][Im]} n ions (X = Emim or Im for positive and negative polarities, respectively) with n = 0, 1, and 2. Quantum chemical calculations of the n = 0 and 1 ions and the isolated ion pairs are presented, yielding thermochemical information on the observed ionic species. The present results demonstrate that the cone–jet emits droplets from the tip of the jet, and provide direct evidence that ions are produced in an Iribarne–Thomson field-evaporation mechanism at the transition region between the Taylor cone and jet. Electrochemical modification of the cone–jet emitter properties are observed when maintaining the emitter at a positive polarity for a prolonged (minutes to hours) period. New ions emerge consisting of clusters containing a neutralized Im − . The associated current suppression can be mitigated through polarity alternation at 1 Hz. Measurements are also presented with the tungsten needle heated to 373 K, thereby reducing the liquid viscosity and increasing the flow rate. The average mass of the droplets is observed to increase with temperature while the mass distributions of the ions are not found to change noticeably.

Nonlinear symmetries of finite dimensional dynamical systems are related to nonlinear normal forms and center manifolds in the neighbourhood of a singular point. Certain abstract results can be used algorithmically to construct the normal forms and/or the center manifold up to a given order in the perturbation expansion. We also argue that for this task, approximate symmetries are as useful as exact ones.

Symmetry methods for differential equations are a powerful tool to attack nonlinear problems, in particular for determining solutions with given symmetries to nonlinear PDEs. Since in real applications one is often interested in solutions which are asymptotically symmetric, we propose here an approach to asymptotic symmetry based on the methods of Lie theory. We adopt, translate in geometric language and develop the renormalization group approach recently proposed by Bricmont and Kupiainen (1992) for the Ginzburg-Landau equation.

The authors give some results on the problem of finding the Lie point-symmetries of autonomous systems of differential equations. In particular, they consider the case in which the nonlinear terms are resonant (in the sense of the Poincare procedure for reducing the system to normal form), and they show that Lie symmetries can be characterized in a useful form.

In this paper, we report on the realization of a capillary discharge soft x‐ray laser operating at 46.9 nm pumped by a 30 kA peak value, 150 ns half cycle duration current pulse (corresponding to a mean current slope of about 5 1011 A/s). The slope of the pumping current is sufficiently high to produce the plasma compression and laser amplification on the 3p‐3s, J=0–1 transition of Ne‐like Ar, in 2.4–4 mm in diameter alumina capillary channels. We have analyzed the output pulse characteristics of the produced laser beam, such as the lasing time and the pulse duration, the saturation and the output pulse energy, the near field image as a function of different experimental parameters. Using the same current pulse, the lasing effect has not been observed in polyacetal capillaries, demonstrating the damning role of the wall capillary ablation in the heating and in the stability of the plasma column during the z‐pinch compression.

During the past 20 years, several hundred peer-reviewed publications have documented the critical scientific steps in the determination of the usefulness of B-mode ultrasound measurements of the carotid artery intima-media thickness (IMT) for the detection and monitoring of artery wall atherosclerotic disease. Since the initial validation study of the IMT, carotid ultrasound IMT measurements have been performed in a large number of individuals with "traditional" and "non traditional" cardiovascular risk factors, have been shown to correlate with the severity of atherosclerotic lesions in other vascular territories, and have been used as outcome measures in clinical trials evaluating the various effects of treatment on the progression/regression of atherosclerosis. Furthermore, in longitudinal studies, carotid IMT has been shown to be an independent predictor of stroke and coronary events. However, before this powerful indicator of arterial wall atherosclerotic disease can be used in clinical settings as a routine test for the prediction of an individual's cardiovascular risk, some unresolved issues need to be addressed.

The relationship between anticardiolipin antibodies (aCL) and acute myocardial infarction (AMI) is still controversial. The purpose of this study was to investigate the prevalence of aCL in young patients (ageor = 45 years) with AMI; record the aCL titre during different days of disease; assess the relationship between aCL titres and in-hospital myocardial infarction complications. The aCL were measured in 108 consecutive patients and in 31 controls (ELISA method). High aCL levels (IgG or IgM) were found in 19/108 (17.6%) patients and 5/31 (16.1%) controls (NS); aCL titres were similar in different days after AMI and did not differ in controls and in patients with or without early myocardial infarction complications. In conclusion, the aCL levels are not elevated in AMI patients, do not change during the early stage of the disease and are not associated with in-hospital complications.

The Authors report the case of a 9 years old girl with acute intestitial nephritis. The clinical picture was characterized by the association of nonspecific systemic symptoms, poliuria, acute renal failure with signs of tubular disfunctions. There was no evident inciting agent of the disease. The patient experienced rapid improvement of both symptoms and laboratory parameters with normalization of the renal function.

The Authors describe the case of a 9 years old boy in whom the diagnosis of atypical Kawasaki disease was made. There was a rapid response to the treatment with i.v.I.G. The differences between the typical Kawasaki disease and the observed case are discussed.

Smoking is a major health hazard. Most cigarette smokers start by the age of 18 years. The purpose of this study was to assess the prevalence of the intention to smoke among the students of a metropolitan compared to a non-metropolitan high school. The influence of age, sex, demographic and socio-economic variables, and the role of smoking models of family members and friends, were examined. Nine hundred forty-five students (529 males and 416 females; mean age 15.8 +/- 1.5 years) attending a high school in Naples and 442 students (223 males and 219 females; mean age 16.1 +/- 1.6 years) in Capua, a small town 40 Km distant from Naples, filled in an extensive questionnaire on smoking. The prevalence of intention to smoke was 10.4% in Naples and 9.3% in Capua. It was related to age (p0.01) in Naples, but not in Capua. The prevalence of smokers was 24.2% in Naples (males 21.6%, females 27.6%; p = 0.038) and 24.1% in Capua (males 29.2%, females 19%; p = 0.017). As expected, in both cities intention to smoke was associated (p0.001) with the strength of existing smoking habit. Students smoking over 21 cigarettes/week were more likely to continue than students smoking less 21 cigarettes/week, both in Naples and in Capua. More than half of smoking students, in both cities, were irresolute about their habit in the subsequent year. In Naples, intention to smoke of male students was associated with mother's (p = 0.02) and siblings' (p0.0001) smoking habit; in female students intention to smoke was associated with father's (p = 0.02), mother's (p0.001), parents' (p0.01) and siblings' smoking habit (p = 0.0002). In Capua an association was evident, in male students, between intention to smoke and paternal smoking habit (p = 0.04); in female students, intention to smoke was associated with siblings' smoking habit (p = 0.03). In Naples and in Capua, for both sexes, intention to smoke was related to smoking habits of the best friend of the same sex (p0.0005), the best friend of the opposite sex (p0.00005) and friends (p0.00001). Multivariate analysis showed, in Naples, an independent relation between adolescent intention to smoke and age (p = 0.01), smoking status of student (p0.0001) and friends' smoking habit (p = 0.01). In male students intention to smoke was associated with age (p = 0.003), smoking habit of student (p0.0001), mother's (p = 0.02) and friends' (p = 0.02), whereas in females it was associated with smoking behavior of student (p0.0001). In Capua student intention to smoke was related to the smoking status of the student (p0.0001) and of the best friend of the opposite sex (p0.04); in male as in female students, intention to smoke was associated with smoking habit of the student (p0.0001). In conclusion, prevalence of adolescents' intention to smoke is similar in two distinct populations of high school students of a city and a small town. Smoking is at higher prevalence among females in the city and among males in the small town. Intention to smoke increases with age, in the great city, and is related to student's existing habit and peer models. More than half of smoking students, in both cities, were irresolute about their habit in the subsequent year. This study has identified some variables associated with adolescents' intention to smoke; we feel that these findings may contribute to a better understanding of smoking behavior among adolescents and may have preventive implications.

Smoking is the leading preventable cause of death. Most cigarette smokers take up the habit during adolescence. The purpose of this study was to assess the prevalence of cigarette smoking behavior among the students of a metropolitan high school as compared to those attending a non-metropolitan high school, examining age, sex and demographic and socioeconomic differences, as well as the influence of smoking models (family members and friends) on smoking behavior among adolescents.Nine hundred seventy-eight students (544 males, 434 females; mean age 15.8 +/- 1.5 years) attending a high school in the city of Naples and 467 students (235 males, 232 females; mean age 16 +/- 1.5 years) from a high school of Capua, a small town 40 kilometers away from Naples, filled out an extensive questionnaire on smoking. The prevalence of smokers was 24.2% (males 21.8%, females 28.2%; p = 0.02) in Naples and 23.8% in Capua (males 29.8%, females 19.2%; p0.001) and was related to age (p0.001) both in Naples and in Capua. In Naples, smoking behavior among male students was associated with smoking by sibling (p = 0.00005), whereas an association with father (p = 0.0003), mother (p = 0.00005), parental (p = 0.0002) and sibling (p = 0.00002) smoking was observed among females. In Capua, an association was evident only between smoking in female students and sibling smoking habits (p = 0.02). In both Naples and Capua, smoking status of the students was related to smoking habits of best friends of the same sex, best friends of the opposite sex and friends. Multivariate analysis showed an independent relationship in Naples between adolescent smoking behavior and smoking status of siblings (p = 0.01), best friends of the same sex (p0.001) and best friends of the opposite sex (p0.001). In males, smoking behavior was associated with the smoking behavior of best friends of the same (p0.001) and of the opposite sex (p = 0.01), whereas in females, it was linked with the smoking behavior of siblings (p = 0.05), mother (p0.05) and best friends of the same sex (p0.001). In Capua, student smoking was related to smoking among friends (p0.001) and this held true for both males (p = 0.05) and females (p0.0001).The prevalence of smoking habits among teenagers is similar in two distinct populations of high school students from a city and from a small town. Smoking showed a higher prevalence among females in the city and among males in the small town. It increases with age and is related to peer and family smoking models. This study has identified several variables associated with smoking status among adolescents. We thus feel that these findings may contribute to a better understanding of smoking behavior among teenagers and may have prevention implications.

The present report describes a case of right atrial thrombus in an active 49-year-old man with a primary antiphospholipid syndrome. In 1984, the patient was admitted for autoimmune hemolytic anemia; during the hospitalization it was diagnosed a chronic hepatitis B. In July 1991, the patient had fever, mild jaundice, splenomegaly and pancytopenia; a diagnosis of hairy cell leukemia was made but it was not subsequently confirmed. Interferon therapy was started and the patient's clinical course mildly improved. However, over the same year, he experienced again a clinical deterioration. Lumbar ischemic ulcers occurred. The patient underwent elective splenectomy. Bone marrow biopsy revealed mielodisplastic syndrome. Necrotizing vasculitis with granulomatosis was diagnosed. The patient's condition improved after splenectomy. Repeated laboratory tests showed positivity for antiphospholipid antibodies. Transthoracic and transesophageal echocardiography demonstrated the presence of a right atrial thrombus, confirmed by nuclear magnetic resonance. The patient was started on long-term anticoagulant therapy, that resulted effective in reducing thrombus size.

After an acute myocardial infarction (AMI), stunned myocardium may cause a reversible left ventricular dysfunction. Dipyridamole echocardiography (0.56 mg*kg-1 over 4' e 0.84 mg*kg-1 over 10') can identify viable myocardium but can also induce ischaemia.To evaluate the usefulness of "Infra-low" dose dipyridamole echocardiography for identification of myocardial viability.Of thirty-four consecutive in-hospital patients, thirty (26 males; mean age 59 +/- 11 years) with AMI separately underwent (40 +/- 12 hours from symptoms onset): 1. a baseline resting echo (BASELINE); 2. a low dose dobutamine (DOB) echotest (5-10 mcg*kg-1*m-1 for 5') (DOB5, DOB10); 3. an "infra-low" dose dipyridamole echotest (0.28 mg*kg-1 over 4') (DIP). A pre-discharge resting echo was performed 7 days after admission (follow-up). No patient developed echocardiographic or electrocardiographic signs of ischaemia after DIP, while 4 patients developed ischaemia after DOB. The systolic blood pressure (112 +/- 18 mmHg) did not change after both DOB and DIP. The heart rate was unchanged after DIP (BASELINE = 73 +/- 18 bpm', DIP = 75 +/- 14 bpm'), while it increased after DOB (BASELINE 69 +/- 11 bpm'; DOB5 = 71 +/- 11 bpm', p = 0.02; DOB10 = 74 +/- 12 bpm', p = 0.001). Wall motion score index (WMSI), in a 16-segment model (from 1 = normal to 4 = diskinetic) (BASELINE = 1.64 +/- 0.3), improved after DIP (1.56 +/- 0.36, p0.05 vs BASELINE) and after DOB10 (1.50 +/- 0.36, p0.05 vs BASELINE) while did not change after DOB5 (1.59 +/- 0.35, p = n.s.). WMSI decreased at follow-up (1.53 +/- 0.31, p0.05 vs BASELINE); DIP and DOB10, but not DOB5, correctly predicted the WMSI decrease observed at follow-up. Results of DOB5, DOB10 and DIP were fully concordant in 118 segments (67%) (kappa = 0.54): 13 (7%) with concordant positivity and 105 (60%) with concordant negativity; 58 (33%) segments showed different results. At follow-up 54 (30%) of the 178 segments with baseline dysfunction, observed in 29 survivors, showed an improvement of grade 1 or more (viable). Two patients did not undergo DOB10; therefore, of the 168 segments with baseline dysfunction, in 27 survivors who underwent all tests, 54 (32%) showed an improvement of grade 1 or more (viable) e 114 (68%) showed no improvement (not viable). Of 25 DOB5 "responders" segments, 11 (44%) showed spontaneous recovery at follow-up (true-positive); of 153 "non responders" segments, 110 (72%) showed no spontaneous recovery at follow-up (true-negative). Of 61 DOB10 "responders" segments, 29 (47%) showed spontaneous recovery at follow-up (true positive); of 107 "non responders" segments, 82 (77%) showed no spontaneous recovery at follow-up (true-negative). Of 36 DIP "responders" segments, 19 (53%) showed spontaneous recovery at follow-up (true positive); of 142 "non responders" segments, 107 (75%) showed no spontaneous recovery at follow-up (true-negative). The sensitivity of DOB5, DIP and DOB10 for predicting short-term spontaneous recovery was 20, 35 and 53% (DOB10 vs DOB5: p0.001), respectively; specificity was 88, 86 and 71% (DOB5 vs DOB10: p = 0.002; DIP vs DOB10: p = 0.01); the positive value was 44, 52 and 47% (p = n.s.) and the negative predictive value was 72, 75 and 76% (p = n.s.) while the diagnostic accuracy was 67, 70 and 85% (p = n.s.)."Infra-low" dose dipyridamole echocardiography appears to be a hemodynamically neutral stress which does not modify either heart rate or blood pressure. It allows to explore selectively the viability of stunned myocardium, without eliciting ischaemia; it shows a good overall concordance with low-dose dobutamine and a low sensitivity but an excellent specificity for predicting spontaneous recovery early after AMI.

Elevated concentrations of lipoprotein (a) have been shown to increase the risk of coronary artery disease, especially in females, and have been found to be elevated in white US children with parental myocardial infarction.To confirm the generality of this finding and to determine the influence of gender, we studied 143 children with parental myocardial infarction (cases), 71 males and 72 females, mean age 17 +/- 5 years, body mass index 22.1 +/- 3.8 and 102 controls, 50 males and 52 females, mean age 18 +/- 5 years, body mass index 23 +/- 4.3.The serum cholesterol and lipoprotein (a) levels were significantly higher, whereas the HDL level was significantly lower in cases than in controls; lipoprotein (a) levels30 md/dl were significantly more prevalent in cases than in controls. Among the males, serum HDL cholesterol was significantly lower in cases than in controls, whereas no significant differences were found in serum total cholesterol and in lipoprotein (a). Among the females, cases had lower HDL cholesterol level and higher serum total cholesterol and lipoprotein (a) levels in comparison to controls.Children with parental myocardial infarction, in particular the females, have a more unfavourable serum lipid profile than controls.

Irregular protein secondary structures are believed to be important structural domains involved in molecular recognition processes between proteins, in interactions between peptide substrates and receptors, and in protein folding. In these respects tight turns are being studied in detail. They also represent template structures for the design of new molecules such as drugs, pesticides, or antigens. Isolated alpha-turns, not participating in alpha-helical structures, have received little attention due to the overwhelming presence of other types of tight turns in peptide and protein structures. The growing number of protein X-ray structures allowed us to undertake a systematic search into the Protein Data Bank of this uncharacterized protein secondary structure. A classification of isolated alpha-turns into different types, based on conformational similarity, is reported here. A preliminary analysis on the occurrence of some particular amino acids in certain positions of the turned structure is also presented.

We describe the case of a 29-year-old male with a history of cocaine use who was hospitalized for a traumatic femur fracture. After spinal anesthesia with buprenorfin and bupivacain, he had electrocardiographic evidence of inferior myocardial ischemia. He was treated successfully with intravenous nitroglycerin. We conclude that not only cocaine addicts, but also subjects with a past history of cocaine use, may be at risk for transient myocardial ischemia when anesthetized with local cocaine-like anesthetics.

Temporary observation is a very short stay in Emergency Department, widely carried out in adult patients in our Country. No experience in childhood has been reported. In our emergency department children under 16 with acute diseases are admitted for 24-48 hours. From 1991 we carried out also temporary observation. Its effectiveness has been evaluated by studying our activity in 1992 (14.574 emergency room visits, with 664 admissions to our Department and 274 temporary observation) and 1993 (12820 emergency room visits, 573 admissions, 428 temporary observation). Compared to 1992, in 1993 there was a decrease of both emergency room visits (higher than expected from demographic lowering and in part due to payment for emergency room visits) and hospital admissions, and an increase of temporary observation. The stay in hospital was less than 6 hours in 94.2% of temporary observation patients. 18.2% of them were evaluated on clinical basis, 57% also by diagnostic examinations, 24.8% had some treatment. The 89% of the children were sent home following temporary observation, the others were admitted. Criteria for temporary observation were fairly similar to those for hospital admission, but not far as Central Nervous System and Renal Disease are concerned. Our study confirms the usefulness of temporary observation in childhood to reduce both the number of hospital admissions and the discomfort of the patient and his family. Nevertheless there is a need of criteria of appropriateness. Therefore we have elaborated guide lines for temporary observation and admission to our Department.

We describe the case of a patient with primary familiar antiphospholipid syndrome and acute myocardial infarction. A previously healthy 15-year-old adolescent was admitted with severe chest pain lasting from 1 hour associated with inferoposterolateral ST-segment elevation. The patient received intravenous thrombolysis. A 2-dimensional echocardiogram revealed an area localized in the basal posterolateral left ventricular myocardium, that was akinetic and abnormally thin throughout the cardiac cycle. Peak creatinine kinase level was 1461 U/I. Subsequent electrocardiogram revealed inferoposterior infarction. Plasma anticardiolipin (aCL) IgG antibodies resulted positive (24 U.GPL) in repeated determinations. A dypiridamole echocardiographic test resulted negative. The patient's parents refused cardiac catheterization. He continues to do well at home 28 months after discharge. The patient's sister is affected by primary antiphospholipid syndrome characterized by recurrent abortion, very low platelet count and lupus anticoagulant positivity. Plasma aCL antibodies resulted positive also in the mother who did not have clinical manifestations.