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In the Alps global warming and change in land use, in particular the drastic reduction in cattle grazing, are causing a progressive treeline ecotone upwards shift. The colonization dynamics of woody species are modulated by high selective pressure on seedlings due to the extreme ecological conditions of this habitat. We studied the colonization dynamics of Norway spruce in a treeline plot, at the upper limit of the Paneveggio forest (Trentino, Italy). We have exhaustively sampled the study stand, collecting needle tissue from all the adults and the juveniles detected, and we have genotyped all the samples (376) with 4 SSR markers. Parentage relationships between the few adults presents in the stand (23) and the juveniles were established. Our results indicate that, in spite of extreme ecological condition of the treeline environment, local adaptations do not seem to favour local parents: only 4% of juveniles have both parents among local adult trees, while 96% of juveniles are completely or partially sired outside the sampling area. Assessing parentage relationship also allowed the estimation of relative reproductive success of local adult trees. Out of a total of 23 adult trees, 5 trees were involved in the 59% of successful reproductive events detected inside the sampling area.

Implications of extended gene flow is discussed under the light of new laws issued, regulating the admixtures among organic, traditional and biotec agriculture. Recent scientific literature is reviewed on the role of gene flow in gene escape in transgenic forest trees.

Inflammation plays an important role in cardiovascular disease. Growing evidence suggests a profound involvement of the inflammatory response in the development and progression of atherosclerosis and its complications. In patients with atherosclerotic cardiovascular disease (ASCVD), residual cardiovascular risk often remains high despite optimal medical therapy and the achievement of the therapeutic targets recommended by current guidelines. Among the multiple components of residual risk, residual inflammatory risk, assessed by plasma levels of high-sensitivity C-reactive protein, has shown a strong association with the incidence of cardiovascular events. Recent studies suggest that therapeutic modulation of inflammation, particularly the interleukin (IL)-1/IL-6 pathway, is a promising strategy for the prevention and treatment of cardiovascular and kidney diseases. This review aims to discuss pragmatically the interaction between inflammation and ASCVD, describe current evidence on anti-inflammatory therapies in patients with cardiovascular and renal diseases, and outline the potential implications of these new therapeutic approaches in contemporary and future practice.

Patients with atrial fibrillation (AF) undergoing percutaneous coronary intervention (PCI) with or without acute coronary syndromes (ACS) represent a subgroup with a challenging pharmacological management. Indeed, if on the one hand antithrombotic therapy should reduce the risk related to recurrent ischemic events and/or stent thrombosis, on the other hand care should be taken to avoid major bleeding events. In recent years, several trials, which overall included more than 12 000 patients, have been conducted demonstrating the safety of different therapeutic combinations of oral antiplatelet and anticoagulant agents. In the present ANMCO position paper we propose a decision-making algorithm on antithrombotic strategies based on scientific evidence and expert consensus to be adopted in the periprocedural phase, at the time of hospital discharge and in the long-term follow-up of patients with AF undergoing PCI with/without ACS.

Minimization of hospital lengths of stay has always been a key goal for healthcare systems. More so during the current COVID-19 pandemic. In fact, we have faced a reduction in no-COVID-19 admissions with the generation of huge backlogs. Low-risk patients undergoing elective percutaneous coronary intervention (PCI) can be candidate for short-term hospitalization, with consequent reduction of waiting lists. Several single-center and multicenter observational studies, multiple randomized trials and some meta-analyses have addressed this topic.In this position paper, we present a proposal for short hospitalization for elective PCI procedures in selected patients who present complications only exceptionally and exclusively immediately after the procedure, if the inclusion and exclusion criteria are met. Each Center can choose between admission in day surgery or one day surgery, extending hospital length of stay only for patients who present complications or who are candidate for urgent surgery. Short-term hospitalization considerably reduces costs even if, with the current model, it generally results in a parallel reduction in reimbursement. Hence, we present an actual model, already tested successfully in an Italian hospital, that warrants sustainability. This approach can then be tailored to single Centers.

Dual antiplatelet therapy (DAPT) is a cornerstone of antithrombotic treatment in patients undergoing percutaneous coronary intervention. The optimal duration of DAPT, i.e. the minimal period needed to ensure the best safety and efficacy, to prevent ischemic complications, including stent thrombosis, has been extensively explored in multiple randomized controlled trials over the last years. Accumulating evidence is supporting a clinical approach where there is a prevailing role of the risk of bleeding: in patients at high bleeding risk (HBR) it is generally advisable to reduce the duration of DAPT irrespective of their risk of thrombosis. In addition, among HBR patients, (i) new recommendations prefer direct oral anticoagulants (DOAC) over vitamin K antagonists in DOAC-eligible patients with atrial fibrillation and coronary artery disease; (ii) measures to minimize bleedings while on DAPT should be pursued, including de-escalation of P2Y12 receptor inhibitor therapy; and (iii) new studies are testing reversal strategies for short DAPT regimens, with early discontinuation of aspirin. In the present review, we discuss the rationale and decision-making considerations to reduce safely DAPT duration in HBR patients.

Background: Primary percutaneous coronary intervention (pPCI) is the treatment of choice in patients with ST-elevation myocardial infarction (STEMI) if performed by an experienced team within 120 min of first medical contact. The door to balloon time (DTB) has become a performance measure and is the focus of local, regional and national quality improvement initiatives. The primary objective of the present study was to evaluate whether the implementation of reperfusion strategies could result in shorter DTB times., Methods: In 2007, at the cath lab of the IRCCS Policlinico San Matteo (a hub of a network including 7 spoke centers), 245 pPCI were performed with a median DTB time of 116 (25th-75th percentile, 96-155) min, and <90 min only in 20% of cases. To improve time to reperfusion, the following strategies were adopted in 2010 and 2011: direct access to the cath lab without initial coronary care unit admission; activation of the cath lab based on pre-hospital ECG; a faster triage with ECG performed within 10 min and use of a dedicated ambulance for patients presenting directly to the emergency room (ER) of the hub., Results: Overall, 226 and 258 pPCI were performed in 2010 and 2011, respectively, with no differences in type of hospital admission (emergency medical service, ER, or spoke) compared with 2007. A significant DTB reduction was observed (2007 vs 2010 vs 2011: 116 [96-155] vs 99 [77-129] vs 97 [80-125] min, p<0.0001), with a significant improvement in the number of patients treated within 90 min (20 vs 41 vs 40%, p<0.0001) as a result of a significant reduction in the time from first medical contact to cath lab (86 [64-124] vs 66 [50-93] vs 62 [46-93] min, p<0.0001). By analyzing only data from 2010 and 2011, median DTB was 88 (73-104) min for patients arriving through the emergency medical service, 139 (116-179) min for patients presenting to spoke centers, and 96 (75-126) min for patients presenting to the ER, with pPCI performed within 90 min in 55%, 8% e 42% of cases, respectively. The longer DTB time of the spoke centers was solely due to transportation to the hub (emergency medical service vs spoke: 56 [42-68] vs 106 [86-147] min, p<0.0001), with no differences in time to reperfusion once the cath lab was reached., Conclusions: Based on our strategies and experience including 729 STEMI patients treated with pPCI in 2007, 2010 and 2011, a significant improvement in DTB time was achieved. The main factor affecting our results is transportation to the cath lab for patients with direct access to spoke centers. Further exploration and advocacy for DTB implementation in these patients are warranted.

Aim: Human leucocyte antigen (HLA) system plays an essential role in the human immune system activity and the expression of some specific HLA antigens could modify the immune response to vaccinations. Celiac disease is included among the diseases associated to specific HLA profiles, principally characterized by the expression of the HLA DQ2 antigen., Methods: Our study was a retrospective study, leaded on a group of celiac children, with the object to evaluate their immunological response to both obligatory and recommended vaccinations in childhood. It was a retrospective study, including 66 patients affected by celiac disease, between 3 and 15 years of age, and a control group of 50 children of the same age. All patients performed both obligatory and recommended vaccinations as indicated in the Italian standard regimen for vaccinations. The immunologic response to each vaccine was analysed and compared in the two groups. Moreover, authors also studied the immunologic response to vaccines in celiac children comparing patients whose diagnosis was made before 18 months of age with those whose disease was diagnosed after 18 months of age., Results: Our results showed that in celiac patients the immunological response to vaccine is similar to that one found in general population, except for HBV vaccine., Conclusion: The evaluation of immunological response to HBV vaccine should be regularly effectuated in celiac children and revaccination should be recommended.

Background: Mutations in the cystic fibrosis transmembrane conductance regulator (CFTR) gene are a relatively frequent cause of male infertility such as congenital absence of vas deferens. This finding suggests that CFTR could play a significant role in the etiopathogenesis of congenital absence of vas deferens., Methods: To assess how often CFTR mutations and 5-thymidine variant of the polythymidine tract of intron 8 are detected in congenital absence of vas deferens we selected 35 infertile male adults caused by congenital absence of vas deferens., Results: Frequency of mutations differs significantly from that in the general population (2% vs 40% respectively) and the delta F 508 mutation accounts for 35% of these mutations. Abnormal sweat test resulted in several patients with a mutation than in others and this difference was highly significant., Conclusions: This result confirms the role of CFTR protein in the pathogenesis of this malformation and suggests that CBAVD phenotype can represent a mild form of cystic fibrosis. Consequently genetic analysis should take into account the presence of an associated mutation and patients with bilateral agenesia and their partners should be screened for cystic fibrosis prior to any in vitro fertilization techniques.

The authors report a case of a child three years old, with severe malnutrition as complication of Ascaris lumbricoides infection. Intestinal nematodes infect many of the world's children and constitute a formidable public health problem. The infected children may suffer nutritional deficits, serious illness and occasionally death. Although infestation is uncommon in our country, it should be considered in children with low social life.

Authors describe a child affected by chickenpox, Schönlein-Henoch purpura and nephropathy. The ecchymotic lesions were diffused in buttocks and legs and they were associated with vesicular haemorrhagic injury in the back of hands and in pavilions of the ears. They suggest that varicella-zoster virus can play a "trigger" role in etiopathogenesis of Schönlein-Henoch purpura and that this syndrome worsens the renal failure. Steroids don't improve the renal disease in the acute phase but they seem to reduce the relapses.

The authors describe a sister and brother [correction of two brothers] affected by syndromic paucity of interlobular bile ducts in which a marked heterogeneity in the beginning of symptoms puts serious difficulties in differential diagnosis. The evident similarity to the mother and the presence of hypertelorism support the hypothesis of a genetic inherited autosomal dominant disorder at variable penetration and expressivity.

Forty-four polytransfused thalassemic patients were considered to evaluate hPH enzyme, involved in collagen synthesis. The aim of this investigation was to verify the usefulness of such assay in the follow-up of liver damage in thalassaemic patients. The patients were separated into two groups: one group with normal transaminase activity and another one with pathological values from more than two years. A group of 20 healty children was chosen for the control values of enzymatic activity. In all patients HCV-Ab was determined. Results obtained confirm the role of viral liver infection in inducing fibrosis in polytransfused thalassaemic patients and suggest the possibility to use hPH assay in their follow-up.

From 1980 to 1988, 25 cases of S.G.B. were diagnosed in children of ages between 2 and 12 years old at the Pediatric Clinic of Catania University. No seasonal or sexual prevalence was observed and only 5 children were less than 5 years old at the beginning of the disease. The diagnosis was based on 2 principal points: 1) pain at the inferior limbs with motor, sensitive and autonomous disturbances; 2) an increase of the globulins in the cerebrospinal liquid without a quantitative variation of the cells. The disease had a medium length of duration of 20 to 30 days; only in 2 children respiratory assistance was necessary, because of an ascending paresis, which included the respiratory muscles, while in 2 other aged 11 and 12 years old the disease presented itself as being diphasic with a short intermittent intervals, which made us think of a complete remission. In one of these 2 patients, the disease manifested itself in an unusual manner, hitting initially the muscles of the upper limbs, the III cranial nerve and with marked cephalgia. The E.M.G. taken on 7 children presented itself as being frankly neuropathic.

Fibrobronchoscopy, first used in pneumology with a diagnostic and therapeutic purpose, has been recently used in the therapy of "difficult intubations". After trismus, complex fracture, serious maxillofacial malformations and wide neoplasia, classic nose--orotracheal intubation through direct laryngoscopy may turn out difficulty. Some years ago blind intubation was used, which was stressing for the operator and very dangerous for the patient. In the most serious cases, tracheotomy was used. Thanks to flexible fibroscopes of suitable lenght and reduced diameter, nosetracheal intubations guided by fibroscope can be carried out today. Remembering the indications about fibrobronchoscope use in oral surgery, the Authors describe tre method they have used. They also underline the facility of this technique which allows to carry out a sure and not traumatic intubation without resorting to lisive medicines without producing lacerations or tumefactions in laryngotracheal mucosa.

The technical and dosimetric aspects are presented of high-dose intracavitary brachytherapy in gynecology. Fifty-five patients (203 insertions) were examined over two years with a remote loading Selectron HDR 60Co unit installed in a dedicated bunker. The dose to the rectal and bladder markers on AP and LL films was calculated before every irradiation, in order to allow the necessary corrections to be made. Uniform irradiation conditions were obtained at each treatment set-up for both tumoral target and bladder and rectal doses. High-dose intracavitary brachytherapy proved to be a safe, reliable and versatile method from the technical and dosimetric point of view both in the treatment of unoperated gynecological malignancies and in postoperative therapy.

A retrospective study of 112 infants admitted at Pediatric Clinic of Catania from 1970 to 1985 with diagnosis of "Cholestatic jaundice" shows two prevalent pathologies: neonatal hepatitis and biliary atresia. Some other disease like cystic fibrosis. Hereditary fructose intolerance, Galactosaemia, Paucity of bile duct were found rarely. Some laboratory parameters (Serum direct bilirubin, Alkaline Phosphatase, Alkaline Phosphatase/Transaminase (GOT) show a characteristic pattern. Therefore the analysis of these data could help us to make a probability diagnosis and anticipate the liver biopsy that remain the most sensitive diagnostic instrument. In fact it is known that the earlier diagnosis is very important for the prognosis of these infants.

Liver function has been evaluated in 74 patients (aged 9 months to 19 years) with beta-thalassemia major. They were selected from 212 patients because their transaminase levels were three times higher than normal for over three months. In 36 of these subjects BSF clearance test was performed. In the majority of patients (70%) average GPT serum values were increased (66.33 +/- 35.41 U/L) while only a few of the youngest age group exhibited normal values. The transaminase level showed a direct relationship with age, ferritin level and transfusional iron. Furthermore a direct correlation was found between iron and gamma globulin levels both being related to age. Test for viral hepatitis markers showed that 60% of all the subjects studied had had HBV infection. Twenty-six of the 36 patients who underwent BSF test had normal values in the first part of the clearance curve, 8 others showed moderate changes while only the 2 remaining revealed severe alterations. The second part of the curve was abnormal in 34 and markedly altered in 2 subjects. Mean GPT serum values correlated with the first part of BSF clearance curve and BSF 45' values correlated with transfused iron. Siderosis, fibrosis, chronic inflammatory infiltration and vacuolar degeneration were seen at liver biopsy. Histological findings of chronic aggressive hepatitis were shown in two patients with high transaminase and gammaglobulin levels who had markedly abnormal BSF curve.