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L’Eco-design, ovvero una progettazione orientata ai principi della sostenibilità ambientale, rappresenta uno strumento di importanza strategica, in quanto consente di prevenire, invece di rimediare, le conseguenze ambientali negative della produzione, dell’uso e dello smaltimento dei prodotti, contribuendo a definirne, oltre che la configurazione formale e tecnica, il profilo ambientale complessivo (qualità e quantità dei materiali impiegati; tecnologie e processi di produzione; modalità d’uso e manutenzione; modalità e scenari di dismissione, ad esempio riuso, riciclo, recupero energetico, compostaggio, ecc.). Infatti definire gli obiettivi e i requisiti ambientali di un prodotto, fin dalla fase di “design”, di ideazione, determina significativi effetti positivi durante tutte le altre fasi del processo di sviluppo del prodotto stesso.

Treatment with peginterferon α-2a (PegIFN) for 48 weeks is the standard of care for selected HBeAg-negative patients chronically infected with hepatitis B virus (HBV), but with limited treatment efficacy. A study was undertaken to investigate whether treatment extension to 96 weeks improves the outcome in this patient population.128 HBeAg-negative patients (120 genotype D) were randomised to weekly 180 μg PegIFN for 48 weeks (group A, n=51), 180 μg PegIFN for 48 weeks followed by 135 μg weekly for an additional 48 weeks (group B, n=52) or 180 μg PegIFN plus lamivudine (100 mg/day) for 48 weeks then 135 μg PegIFN for 48 weeks (group C, n=25). Endpoints were alanine aminotransferase normalisation plus HBV DNA3400 IU/ml (primary), HBV DNA2000 IU/ml and HBsAg clearance at 48 weeks after treatment.Forty-eight weeks after treatment, six patients in group A and 13 in group B achieved alanine aminotransferase normalisation plus HBV DNA3400 IU/ml (11.8% vs 25.0%, p=0.08), 6 vs 15 patients had HBV DNA2000 IU/ml (11.8% vs 28.8%, p=0.03), 0 vs 3 achieved HBsAg clearance (0% vs 5.8%, p=0.24) and 0 vs 5 had HBsAg10 IU/ml (0% vs 9.6%, p=0.06). While extended PegIFN treatment was the strongest independent predictor of response, the combination with lamivudine did not improve responses. Discontinuation rates were similar among the groups (19.6%, 23.1%, 32.0%, p=0.81) and were mostly due to PegIFN-related adverse events.In HBeAg-negative genotype D patients with chronic hepatitis B, PegIFN treatment for 96 weeks was well tolerated and the post-treatment virological response improved significantly compared with 48 weeks of treatment.http://ClinicalTrials.gov registration number: NCT01095835.

Background and aim There is suspicion of a decrease in warning regarding the hepatitis B virus as a health problem both by the infected individuals and their doctors. The aim of this study was to investigate whether the clinical/virology investigation of chronic hepatitis B virus infected individuals is at present accurate. Methods The chronic hepatitis B virus surface antigen carriers consecutively attending 13 different hospital divisions in Calabria from July to December 2005 were evaluated to investigate the available information on the grade of their liver disease, their virologic profile and the hepatitis B virus status of their family members. Results Four-hundred-thirty hepatitis B virus surface antigen positive individuals were enrolled, 417 of whom were Calabrians. Most of them had a diagnosis of chronic liver disease, but a liver biopsy had been performed only in 13.5% of the cases, whereas more than 1/3 of them had not been tested for hepatitis Delta virus co-infection. The majority of these individuals were unaware of the hepatitis B virus status of their family members. Moreover, anti-hepatitis B virus vaccination procedures were not performed in most of the hepatitis B virus surface antigen carrier families. Conclusions This study revealed that fundamental clinical, virological, and epidemiological aspects of chronic hepatitis B virus infection are not investigated in many hepatitis B virus surface antigen carriers, suggesting that the general knowledge as regards hepatitis B virus is mostly inadequate.

Severe hemodilutional anemia on cardiopulmonary bypass increases morbidity and mortality after coronary surgery. The present study focuses on the lowest hematocrit values during extracorporeal circulation and on allogenic blood transfusions as mortality and morbidity risk factors. The records of 1,766 consecutive adult patients undergoing isolated coronary artery bypass graft surgery at 3 institutions have been analyzed retrospectively for in-hospital mortality and adverse outcomes. Clinical data were from the Italian National Cardioanesthesia Database. Multivariate analysis and analysis of receiver operating characteristic curves were applied. The lowest hematocrit value on cardiopulmonary bypass was an independent risk factor for postoperative low-output syndrome and renal failure. The hematocrit cutoff values were similar for renal failure (23%) and low-output syndrome (24%). Blood transfusions were significantly associated with both renal failure and low-output syndrome. The risk of renal failure doubled when the nadir-on-cardiopulmonary-bypass hematocrit occurred in transfused patients. Anemia upon cardiopulmonary bypass was not associated with death. Our findings confirm that both severe anemia and blood transfusions were significantly associated with renal failure and low-output syndrome.

Early extubation after cardiac surgery is a procedure recently gaining interest due to its ability to shorten intensive care unit and hospital stay and to limit the operation-related costs. Its use, however, raised new problems in terms of pain control in the early postoperative course, due to the need for limiting opioid analgesia. This study deals with non-opioid pain control after cardiac surgery and early extubation.Prospective, randomized trial aimed to investigate the effectiveness of three intravenous analgesic drugs (ketorolac, 60 mg i.v.; propacetamol, 2 g i.v.; tramadol, 200 mg i.v.) for the management of postoperative pain in early extubated cardiac surgical patients. Each treatment group comprised 20 patients.The pain assessment (5-item verbal scale) demonstrated a significant (p0.05) lower value in patients treated with ketorolac vs propacetamol, while patients treated with tramadol did not significantly differ from the other two groups. There was a significantly (p0.05) higher rate of patients with severe pain in propacetamol group. Patients treated with tramadol had a significantly (p0.01) higher PaCO2 (48 +/- 6 mmHg) versus patients treated with ketorolac (43.4 +/- 3.7 mmHg) or propacetamol (42.9 +/- 3.4 mmHg).Tramadol and ketorolac seem to be the best options for treating postoperative pain in the specific setting of early extubation after cardiac surgery; high doses of tramadol may result in a significant even if clinically not relevant respiratory depression.