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Diabetes confers an excess risk of death to COVID-19 patients. Causes of death are now available for different phases of the pandemic, encompassing different viral variants and COVID-19 vaccination. The aims of the present study were to update multiple causes of death data on diabetes-related mortality during the pandemic and to estimate the impact of common diabetic comorbidities on excess mortality. Diabetes-related deaths in 2020–2021 were compared with the 2018–2019 average; furthermore, age-standardized rates observed during the pandemic were compared with expected figures obtained from the 2008–2019 time series through generalized estimating equation models. Changes in diabetes mortality associated with specific comorbidities were also computed. Excess diabetes-related mortality was +26% in 2020 and +18% in 2021, after the initiation of the vaccination campaign. The presence of diabetes and hypertensive diseases was associated with the highest mortality increase, especially in subjects aged 40–79 years, +41% in 2020 and +30% in 2021. The increase in diabetes-related deaths exceeded that observed for all-cause mortality, and the risk was higher when diabetes was associated with hypertensive diseases. Notably, the excess mortality decreased in 2021, after the implementation of vaccination against COVID-19. • Diabetes-related mortality was strongly increased during the COVID-19 pandemic. • Further excess mortality was observed for diabetes plus hypertensive diseases. • A vaccination campaign was followed by a reduction of excess diabetes-related deaths. [ABSTRACT FROM AUTHOR]

Peripheral arterial disease (PAD) is one of the most prevalent cardiovascular diseases with more than 230 million people being affected worldwide. As highlighted by the recent European Society of Cardiology guidelines, data on the epidemiology of PAD is urgently needed. We accessed the vital registration data of the Veneto region (Northern Italy, approximately five millions inhabitants) covering the period 2008–2019. We computed annual age-standardized rates for PAD reported as the underlying cause of death (UCOD) or as one of multiple causes of death (MCOD). Age-adjusted odds ratios (OR) served to study the association between PAD and cardiovascular comorbidities. The age-standardized mortality rate for PAD as MCOD slightly declined from 19.6 to 17.8 in men and from 10.8 to 9.1 deaths per 100,000 population-years in women. The age-standardized PAD-specific mortality rate (UCOD) remained stable: 3.1 to 3.7 per 100,000 person-years in women (Average Annual Percent Change 1.3, 95% CI -0.8; 3.4%) and 4.4 to 4.3 per 100,000 person-years (Average Annual Percent Change -0.2, 95% CI -3.6; 3.4%) in men. PAD contributed to 1.6% of all deaths recorded in the region. Ischemic heart disease, diabetes mellitus and neoplasms were the most prevalent UCOD among PAD patients. PAD was associated with diabetes mellitus (OR 3.79, 95%CI 3.55–4.06) and chronic kidney diseases (OR 2.73, 95%CI 2.51–2.97) in men, and with atrial fibrillation (OR 2.26, 95%CI 2.10–2.44) in women. PAD remains a substantial cause of death in the general population of this high-income region of Western Europe with marked sex-specific differences. • PAD is one of the most prevalent cardiovascular diseases with 230 million patients affected worldwide, but mortality data is urgently needed. • In the Veneto region, the age-standardized mortality rate for PAD as multiple cause of death slightly declined in men and women over the past decade. • The age-standardized mortality rate for PAD as underline cause of death declined in men, but increased in women. • Ischemic heart disease, diabetes mellitus, and cancer were the most prevalent underline causes of death among PAD patients. • PAD remains a substantial cause of death in the general population of this high-income European region with marked sex-specific differences. [ABSTRACT FROM AUTHOR]

Climate crisis is dramatically changing life on earth. Environmental sustainability and waste management are rapidly gaining centrality in quality improvement strategies of healthcare, especially in procedure-dominant fields such as gastroenterology and digestive endoscopy. Therefore, healthcare interventions and endoscopic procedures must be evaluated through the 'triple bottom line' of financial, social, and environmental impact. The purpose of the paper is to provide information on the carbon footprint of gastroenterology and digestive endoscopy and outline a set of measures that the sector can take to reduce the emission of greenhouse gases while improving patient outcomes. Scientific societies, hospital executives, single endoscopic units can structure health policies and investment to build a "green endoscopy". The AIGO study group reinforces the role of gastrointestinal endoscopy professionals as advocates of sustainability in digestive endoscopy. The "green endoscopy" can shape a more sustainable health service and lead to an equitable, climate-smart, and healthier future. [ABSTRACT FROM AUTHOR]

• Surgeon eye lens dose measured in eight different interventional procedure types. • Dosemeters read by an iSO-17025 accredited service. • Median eye lens H p (3) range, with ceiling shield: 20–60 μSv per single procedure. • CT-guided lung biopsy median eye lens H p (3): 150μSv per single procedure. • H p (3)/KAP shows a statistically significant dependency on the surgeon's height. This study investigated the radiation dose to surgeon eye lens for single procedure and normalised to exposure parameters for eight selected neuroradiology, cardiovascular and radiology interventional procedures. The procedures investigated were diagnostic study, Arteriovenous Malformations treatment (AVM) and aneurysm embolization for neuroradiology procedures, Coronary Angiography and Percutaneous Transluminal Coronary Angioplasty (CA-PTCA), Pacemaker and Implantable Cardioverter-Defibrillator implantation (PM-ICD), Endovascular Aortic Repair (EVAR) and Fenestrated Endovascular Aortic Repair (FEVAR) for cardiovascular and electrophysiology procedures. CT-guided lung biopsy was also monitored. All procedures were performed with table-mounted and ceiling-suspended shields (0.5 mm lead equivalent thickness), except for FEVAR and PM-ICD where only a table mounted shield was present, and CT-guided lung biopsy where no shield was used. Dose assessment was performed using a dosemeter positioned close to the most exposed eye of the surgeon, outside the protective eyewear. The surgeon most exposed eye lens median H p (3) equivalent dose for a single procedure, without protective eyewear contribution, was 18 μSv for neuroradiology diagnostic study, 62 μSv for AVM, 38 μSv for aneurysm embolization, 33 μSv for CA-PTCA, 39 μSv for PM-ICD, 49 μSv for EVAR, 2500 μSv for FEVAR, 153 μSv for CT-guided lung biopsy. In interventional procedures, the 20 mSv/year dose limit for surgeon eye lens exposure might be exceeded if shields or protective eyewear are not used. Surgeon eye lens doses, normalised to single procedures and to exposure parameters, are a valuable tool for determining appropriate radiation protection measures and dedicated eye lens dosemeter assignment. [ABSTRACT FROM AUTHOR]

Purpose: to assess the burden of epilepsy as the underlying or contributory cause of death, to investigate time trends in mortality with epilepsy, and to examine the main associated comorbidities.Methods: All deaths from January 1, 2008 to December 31, 2019 with any mention of epilepsy were retrieved from the mortality register of the Veneto Region (Italy). The average annual percent change (AAPC) in age-standardized mortality rates was estimated by log-linear models. The association between mention of epilepsy and of selected disease categories in death certificates was assessed by conditional logistic regression.Results: Any mention of epilepsy was reported in 5,907 death certificates; of these, epilepsy was selected as the underlying cause in 1,020 decedents. Deaths with epilepsy represented 0.8% of total mortality in 2008-2011, increasing to 1.3% in 2016-2019. The AAPC was 4.7% for males (95% CI 3.0-6.4, p<0.001) and 6.2% for females (95% CI 4.5-7.9, p<0.001). A strong association was found between mention of epilepsy and meningitis/encephalitis, congenital anomalies/cerebral palsy and other paralytic syndromes, central nervous system tumours, cerebrovascular diseases, and dementia/Alzheimer.Conclusions: The present analysis from Southern Europe confirms recent reports limited to the UK and the US on increasing epilepsy-related mortality rates. aging of the population and the growing prevalence of neurological disorders are among long-term causes of this unfavorable trend; further studies on mortality data and other health archives are warranted. [ABSTRACT FROM AUTHOR]

The purpose of the present document is to provide detailed information on the correct and optimal use of digital media to ensure continuity of care for gastroenterological patients in everyday clinical practice, in health emergencies and/or when the patient cannot reach the hospital for other reasons. During the recent COVID-19 pandemic, telemedicine has allowed many patients with chronic diseases to access remote care worldwide, proving to be the ideal solution to overcome restrictions and carry out non-urgent routine follow-ups on chronic patients. The COVID-19 pandemic has therefore made organizational and cultural renewal essential for the reorganization of healthcare in order to ensure greater continuity of care with a minimum risk of spreading the virus to users, practitioners and their families. These AIGO recommendations are intended to provide Italian gastroenterologists with a tool to use this method appropriately, in compliance with current legislation, in particular the proper approach and procedures for conducting a remote examination using a video conferencing tool, the so-called televisit. In the near future, telemedicine may contribute to a possible reorganization of healthcare systems, through innovative care models focusing on the citizen and facilitating access to services throughout the entire Country. [ABSTRACT FROM AUTHOR]

Background and Aims: Diabetes conveys an increased risk of infectious diseases and related mortality. We investigated risk of ascertained SARS-CoV-2 infection in diabetes subjects from the Veneto Region, Northeastern Italy, as well as the risk of being admitted to hospital or intensive care unit (ICU), or mortality for COVID-19.Methods and Results: Diabetic subjects were identified by linkage of multiple health archives. The rest of the population served as reference. Information on ascertained infection by SARS-CoV-2, admission to hospital, admission to ICU and mortality in the period from February 21 to July 31, 2020 were retrieved from the regional registry of COVID-19. Subjects with ascertained diabetes were 269,830 (55.2% men; median age 72 years). Reference subjects were 4,681,239 (men 48.6%, median age 46 years). Ratios of age- and gender-standardized rates (RR) [95% CI] for ascertained infection, admission to hospital, admission to ICU and disease-related death in diabetic subjects were 1.31 [1.19-1.45], 2.11 [1.83-2.44], 2.45 [1.96-3.07], 1.87 [1.68-2.09], all p < 0.001. The highest RR of ascertained infection was observed in diabetic men aged 20-39 years: 1.90 [1.04-3.21]. The highest RR of ICU admission and death were observed in diabetic men aged 40-59 years: 3.47 [2.00-5.70] and 5.54 [2.23-12.1], respectively.Conclusions: These data, observed in a large population of ∼5 million people of whom ∼250,000 with diabetes, show that diabetes not only conveys a poorer outcome in COVID-19 but also confers an increased risk of ascertained infection from SARS-CoV-2. Men of young or mature age have the highest relative risks. [ABSTRACT FROM AUTHOR]

The purpose of this multicenter phantom study was to exploit an innovative approach, based on an extensive acquisition protocol and unsupervised clustering analysis, in order to assess any potential bias in apparent diffusion coefficient (ADC) estimation due to different scanner characteristics. Moreover, we aimed at assessing, for the first time, any effect of acquisition plan/phase encoding direction on ADC estimation. Water phantom acquisitions were carried out on 39 scanners. DWI acquisitions (b-value = 0–200-400–600-800–1000 s/mm2) with different acquisition plans (axial, coronal, sagittal) and phase encoding directions (anterior/posterior and right/left, for the axial acquisition plan), for 3 orthogonal diffusion weighting gradient directions, were performed. For each acquisition setup, ADC values were measured in-center and off-center (6 different positions), resulting in an entire dataset of 84 × 39 = 3276 ADC values. Spatial uniformity of ADC maps was assessed by means of the percentage difference between off-center and in-center ADC values (Δ). No significant dependence of in-center ADC values on acquisition plan/phase encoding direction was found. Ward unsupervised clustering analysis showed 3 distinct clusters of scanners and an association between Δ-values and manufacturer/model, whereas no association between Δ-values and maximum gradient strength, slew rate or static magnetic field strength was revealed. Several acquisition setups showed significant differences among groups, indicating the introduction of different biases in ADC estimation. Unsupervised clustering analysis of DWI data, obtained from several scanners using an extensive acquisition protocol, allows to reveal an association between measured ADC values and manufacturer/model of scanner, as well as to identify suboptimal DWI acquisition setups for accurate ADC estimation. [ABSTRACT FROM AUTHOR]

• Characterization of eye lens X-ray protection efficacy of different eyewear models. • Study of the influence of eyewear shape and ergonomics. • Combination of dosimetric measurements and geometrical modeling. • Introduction of the concept of Eye Protection Effectiveness, an "a priori" evaluation of the Dose Reduction Factor. Radioprotection of the eye lens of medical staff involved in Surgical procedures is a subject of international debates since ICRP recommended, on 2011, a lower equivalent dose limit for the lens of the eye. In this work we address the effectiveness of different models of X-ray protective eyewear by relating actual dosimetry measurements to an ad hoc developed mathematical model, in order to disentangle the contribution of geometrical factors and shield capabilities. Phantom irradiation was carried out in fixed exposure conditions in angiographic room: we found that measured Dose Reduction Factors (DRF) strongly depend on the ergonomics of the investigated eyewear. Actually a very poor DRF was observed in the case of a glass model in spite of its high nominal attenuation, whereas a protective tool with low shielding capabilities such a visor resulted much more effective as a consequence of is shape (i.e. extended geometric protection of the eye lens). Our work highlights the need of the introduction of a specific parameter to quantify the effectiveness of the protection tools and able to predict their DRF by taking into account the geometry of the clinical condition of exposure. Aiming at making steps forward the standardization of the guidelines concerning the features of eye protective tools, we developed a simple mathematical model describing the eye lens irradiation geometry which allows the introduction, for each eyewear, of a comprehensive parameter, the Eye Protection Effectiveness (EPE), that, for any defined clinical irradiation condition and glass shielding capabilities and shape, defines the overall effective X-ray protection of the eyewear. [ABSTRACT FROM AUTHOR]

• Cardiologists in catheterization procedures can receive high eye-lens equivalent doses. • Individual eye-lens dosimetry is recommended for highly exposed workers. • Accurate uncertainty assessment is needed in eye-lens dosimetry. To perform a multi-centre survey on the eye lens equivalent dose absorbed by primary interventionalist during catheterization procedures, using a personal dosimeter placed close to the eye lens. 15 different cardiologists working in 3 different centers, for a total of 5 operating rooms were enrolled. All of them were provided with a single thermoluminescent dosimeter positioned on the inner side of the temples of eyeglasses. The dose monitoring, performed on a two-months basis, started in 2016 and is still running. All dose measurements were performed by a ISO 17025 standard accredited dosimetry service thus providing certified uncertainties as well. Correlation of eye lens and wrist dose with KAP was also investigated. A total number of 101 eye lens measurements were performed. Annual eye lens dose estimation was obtained for all 15 surgeons (mean, mode, range, standard deviation: 10.8, 8, 4.9–27.3, 5.6 mSv, respectively). Uncertainties on annual eye lens dose estimations ranged between 10% and 20%. No significant correlation was found between eye lens dose and KAP. Cardiologists involved in catheterization procedures may receive annual eye lens doses close to the ICRP 118 dose limit and thus individual monitoring with a dedicated dosimeter should be carried out. Uncertainty assessment play a relevant role in eye lens equivalent dose estimation to ensure not to exceed dose limit. [ABSTRACT FROM AUTHOR]

Abstract Background Growing evidence suggests that colorectal cancer (CRC) screening based on the fecal immunochemical test (FIT) reduces CRC incidence and surgical resection rates. Aims To compare trends in surgery for proximal and distal CRC among Italian regions at different stages of screening implementation. Methods From the National Hospital Discharge Database we selected hospitalizations with CRC resection of residents aged 50–74 years during 2002–2014, and computed surgery rates for the 8 most populous Italian regions with/without a screening program. Results In regions with screening, implemented around 2006–2007, the annual percent change (APC) of distal CRC resection was +1.7 (95% confidence interval −1.0, 4.4) during 2002–2007 and −9.1 (−10.6, −7.7) during 2007–2014. No significant change was observed in regions without screening. The APC for proximal colon resection in regions with screening was +5.8 (2.5, 9.0) during 2002–2007 and −4.1 (−5.8, −2.4) during 2007–2014, while in regions without screening surgical rates increased through the whole study period. Compared to 2002, in 2014 distal CRC resection rates were greatly reduced in regions with screening, reaching values similar to proximal CRC resection. Conclusion Following the implementation of screening programs surgery rates steeply decreased, confirming the deep impact of FIT-based screening on the burden of CRC. [ABSTRACT FROM AUTHOR]

Highlights • Radiation Protection in Ru-106 brachytherapy ophthalmic plaque surgery. • Ru-106 material shielding properties and build-up factors. • Ru-106 numerical simulation of bremsstrahlung X-ray radiation spectra. Abstract Pre and post-operative exposure levels of medical staff and people from public in intra-operative Ru-106 ophthalmic brachytherapy are reported, together with attenuation properties of selected shielding materials. In particular radiation exposure of workers during plaque transportation and during medical assistance of implanted plaque patient was measured. Taking into account dose rates and considering standard assistance procedure of hospitalized patients, the exposure of medical staff and people of the public were evaluated for a given workload. In order to provide tools to optimize radiation protection, considering social and economic aspects due to possible hospital discharge or hospital stay, the attenuation properties of common shielding materials (lead, concrete, red brick, PMMA and gypsum) were measured, considering both narrow and broad beam setups. The eye was simulated using a water equivalent phantom and plaque was fixed on it. All measurements were performed with calibrated survey meters. Results were compared with numerical simulation of bremsstrahlung X-ray radiation spectra emitted from patient eye. Exposure levels measured at 1 m distance in front of the implanted eye are 0.05 µSv/h/MBq, at 10 cm from patient head, 0.44 µSv/h/MBq (plaque side), 0.4 µSv/h/MBq (front), 0.25 µSv/h/MBq (lateral, opposed to plaque), 0.2 µSv/h/MBq (back). Average exposure levels, under conservative assumptions, for medical staff is 17 µSv/patient and less than 23 µSv/patient for careers and comforters. TVLs in lead and concrete are about 1.6 cm and 11.5 cm respectively. [ABSTRACT FROM AUTHOR]

Highlights • ADC inter-center assessments. • ADC spatial variation across different scanners. • ADC bias in LR an HF directions. • ADC quality assurance protocol. Abstract Purpose To propose an MRI quality assurance procedure that can be used for routine controls and multi-centre comparison of different MR-scanners for quantitative diffusion-weighted imaging (DWI). Materials and methods 44 MR-scanners with different field strengths (1 T, 1.5 T and 3 T) were included in the study. DWI acquisitions (b-value range 0–1000 s/mm2), with three different orthogonal diffusion gradient directions, were performed for each MR-scanner. All DWI acquisitions were performed by using a standard spherical plastic doped water phantom. Phantom solution ADC value and its dependence with temperature was measured using a DOSY sequence on a 600 MHz NMR spectrometer. Apparent diffusion coefficient (ADC) along each diffusion gradient direction and mean ADC were estimated, both at magnet isocentre and in six different position 50 mm away from isocentre, along positive and negative AP, RL and HF directions. Results A good agreement was found between the nominal and measured mean ADC at isocentre: more than 90% of mean ADC measurements were within 5% from the nominal value, and the highest deviation was 11.3%. Away from isocentre, the effect of the diffusion gradient direction on ADC estimation was larger than 5% in 47% of included scanners and a spatial non uniformity larger than 5% was reported in 13% of centres. Conclusion ADC accuracy and spatial uniformity can vary appreciably depending on MR scanner model, sequence implementation (i.e. gradient diffusion direction) and hardware characteristics. The DWI quality assurance protocol proposed in this study can be employed in order to assess the accuracy and spatial uniformity of estimated ADC values, in single- as well as multi-centre studies. [ABSTRACT FROM AUTHOR]

Highlight • Eighteen clinical scanners were enrolled in an MR-spectroscopy intercomparison study. • The feasibility of a quality control protocol for routine MR-spectroscopy was proved. • The water linewidth at isocenter was less than 0.03 ppm for 1.5 T and 3 T scanners. • The area under the water peak varied linearly with the acquisition voxel volume. • The coefficient of variation for repeated measurements of phantom T 2 was less than 9%. Abstract Purpose The aim of this study was to propose and validate across various clinical scanner systems a straightforward multiparametric quality assurance procedure for proton magnetic resonance spectroscopy (MRS). Methods Eighteen clinical 1.5 T and 3 T scanner systems for MRS, from 16 centres and 3 different manufacturers, were enrolled in the study. A standard spherical water phantom was employed by all centres. The acquisition protocol included 3 sets of single (isotropic) voxel (size 20 mm) PRESS acquisitions with unsuppressed water signal and acquisition voxel position at isocenter as well as off-center, repeated 4/5 times within approximately 2 months. Water peak linewidth (LW) and area under the water peak (AP) were estimated. Results LW values [mean (standard deviation)] were 1.4 (1.0) Hz and 0.8 (0.3) Hz for 3 T and 1.5 T scanners, respectively. The mean (standard deviation) (across all scanners) coefficient of variation of LW and AP for different spatial positions of acquisition voxel were 43% (20%) and 11% (11%), respectively. The mean (standard deviation) phantom T 2 values were 1145 (50) ms and 1010 (95) ms for 1.5 T and 3 T scanners, respectively. The mean (standard deviation) (across all scanners) coefficients of variation for repeated measurements of LW, AP and T 2 were 25% (20%), 10% (14%) and 5% (2%), respectively. Conclusions We proposed a straightforward multiparametric and not time consuming quality control protocol for MRS, which can be included in routine and periodic quality assurance procedures. The protocol has been validated and proven to be feasible in a multicentre comparison study of a fairly large number of clinical 1.5 T and 3 T scanner systems. [ABSTRACT FROM AUTHOR]

Background and Aims: To investigate the risk of mortality from infections by comparing the underlying causes of death versus the multiple causes of death in known diabetic subjects living in the Veneto region of Northern Italy.Methods and Results: A total of 185,341 subjects with diabetes aged 30-89 years were identified in the year 2010, and causes of death were assessed from 2010 to 2015. Standardized Mortality Ratios (SMRs) with 95% confidence intervals (CIs) were computed with regional mortality rates as reference. The underlying causes of death and all the diseases reported in the death certificates were scrutinized. At the end of the follow-up, 36,382 subjects had deceased. We observed an increased risk of death from infection-related causes in subjects with diabetes with a SMR of 1.83 (95% CI, 1.71-1.94). The SMR for death from septicemia was 1.91 (95% CI, 1.76-2.06) and from pneumonia was 1.47 (95% CI, 1.36-1.59). The use of the multiple causes of death approach emphasized the association of infectious diseases with mortality.Conclusion: The results of the present study demonstrate an excess mortality due to infection-related diseases in patients with diabetes; more interestingly, by routine mortality analyses, the results show a possible underestimation of the effect of these diseases on mortality. [ABSTRACT FROM AUTHOR]

In order to assess the actual ability of planned infrastructure investments to satisfy the required demand of service, railway engineers also need to plan the new offer of train services. In turn, this requires a full re-planning of the line system and of the frequency of each line. In cooperation with the Sales and Network Management department of the Italian infrastructure manager, we developed a model to determine an optimal set of lines and the corresponding train frequencies. The model has been successfully applied to evaluate alternative infrastructure enhancements in the metropolitan rail network of Rome. A set of computational experiments has been carried out, providing interesting insights on the effects of different infrastructural intervention policies. [ABSTRACT FROM AUTHOR]

Primary pulmonary Ewing sarcoma (PES) is a rare malignancy with only sporadic cases reported in the scientific literature. We performed a systematic review of the cases published in the last decade on PubMed, with the aim to describe the clinical, pathological, therapeutic, and prognostic data of PES. Forty-two articles reporting on 50 cases have been reviewed. Globally, 60 % of the patients were males, and the mean age at diagnosis was 30.5 years, with only a few cases diagnosed after 50 years of age. The most common clinical manifestations at diagnosis were dyspnea, cough and chest pain. The most common immunohistochemistry findings were staining for CD99 and (less frequently) for vimentin, and no staining for TTF-1, cytokeratin, desmin and S-100. ESWR1-FL1 translocation was tested in less than half of the cases. The disease was often locally advanced, treated generally with multidisciplinary treatment combining surgery, chemotherapy and radiation therapy. Among patients with follow-up data, approximately 40 % were dead at the time of publication, with the median survival being 11.5 months. Among those who were alive, only 8.3 % was free from disease at 48 months from diagnosis. • Primary pulmonary Ewing sarcomas (PES) are only sporadically reported. • We performed a systematic review of PES cases published in the recent literature. • CD99 and vimentin immunostaining with ESWR1-FL1 translocation are typical in PES. • Most cases show poor prognosis despite multidisciplinary treatments. [ABSTRACT FROM AUTHOR]

Objective: To characterize changes in lung mechanics and right ventricular output (RVO) during incremental/decremental continuous distending pressure (CDP) maneuvers in newborn infants receiving high-frequency oscillatory ventilation, with the aim of evaluating when open lung maneuvers are needed and whether they are beneficial.Study Design: Thirteen infants on high-frequency oscillatory ventilation were studied with a median (IQR) gestational age of 261 (253-291) weeks and median (IQR) body weight of 810 (600-1020) g. CDP was increased stepwise from 8 cmH2O to a maximum pressure and subsequently decreased until oxygenation deteriorated or a CDP of 8 cmH2O was reached. The lowest CDP that maintained good oxygenation was considered the clinically optimal CDP. At each CDP, the following variables were evaluated: oxygenation, respiratory system reactance (Xrs), and RVO by Doppler echocardiography.Results: At maximal CDP reached during the trial, 19 [1] cmH2O (mean [SEM]), oxygenation markedly improved, and Xrs and RVO decreased. During deflation, oxygenation remained stable over a wide range of CDP settings, Xrs returned to the baseline values, and RVO increased but the baseline values were not readily restored in all patients.Conclusion: These results suggest that Xrs and RVO are more sensitive than oxygenation to overdistension and they may be useful in clinical practice to guide open lung maneuvers. [ABSTRACT FROM AUTHOR]

The development of recreational trails has gained popularity in recent years and therefore many scholars have studied various aspects of them. However, the recreational trail theoretical framework lacks an understanding of the relationship between the stage of trail development and income multiplier value. This research aims to examine this relationship and thus advance the traditional theory of recreational trail economic impact by providing an explanation of the relationship between the stage of trail development and the income multiplier. This study applied a combined approach of Recreation Opportunity Spectrum (ROS) to assess the stage of trail development and the Ad hoc model to estimate the income multiplier and economic impact. The results of this study reveal that there is a strong correlation between the stage of trail development and income multiplier and provide a novelty in traditional recreational trail management and economic impact theory thus enriching the topical literature. • The traditional recreational trail and economic impact theories are advanced in this study. • Recreational trail development is a significant determinant of local economic development. • Provision of trail-related recreation services can increase trail visitor expenditure. • Higher trail developments in places with large existent tourist influx are more economically successful. [ABSTRACT FROM AUTHOR]

Background Data are lacking on mortality from chronic liver diseases of different aetiology by education level. Aims To investigate the association between education level and mortality from alcoholic, viral, and non-viral/non-alcoholic chronic liver disease. Methods Proportional mortality was investigated in 2011–2013 in the Veneto Region (Italy). Odds ratios were estimated by conditional logistic regression with deaths from liver cirrhosis, liver cancer, and viral hepatitis as cases, and all other deaths as controls. Disease aetiology was determined from all conditions mentioned in the death certificate. Results Overall chronic liver disease proportional mortality was higher in males (OR 1.37, 95% CI 1.18–1.60) and females (OR 1.72, 95% CI 1.29–2.30) with primary education than in subjects with higher educational level. The risk for alcohol-related and non-viral/non-alcohol-related disease significantly increased with lower education in both genders. Conclusions Proportional mortality analysis of multiple causes of death records showed an association between education and chronic liver diseases with alcoholic and non-viral/non-alcoholic aetiology. [ABSTRACT FROM AUTHOR]

Dentigerous cysts (DCs) and odontomas are lesions of odontogenic origin and are relatively common in the oral cavity, with rare recurrence after treatment. The purpose of this study is to describe a case of association of odontoma with DC of a young patient. A 16-year-old male patient presented with a well-defined unilocular radiolucent lesion associated with an impacted mandibular right canine. Mesially, there was another lesion, mixed with small radiopaque structures similar to dental structures, surrounded by a radiolucent halo. Microscopic examination revealed a fragment of fibrous connective tissue partially covered by stratified squamous epithelial tissue exhibiting the suprabasal layer loosely arranged and fragments of pulp-like tissue surrounded by dentinoid tissue. The diagnosis of DC associated with compound odontoma was made. This case report highlights that DC associated with odontoma is rare and further studies are needed to investigate the probable etiology of this association. [ABSTRACT FROM AUTHOR]

Background and Aims: Type 2 diabetes, one of the most important non-communicable diseases, represents a major health problem worldwide. Immigrants may contribute relevantly to the increase in diabetes. The aim of the study was to investigate variability in diabetes prevalence across different immigrant groups in the Veneto Region (northeastern Italy).Methods and Results: Diabetic subjects on January 2013 were identified by record linkage of hospital discharge records, drug prescriptions, and exemptions from medical charges for diabetes. Immigrant groups were identified based on citizenship. Age-standardized prevalence rates were obtained for residents aged 20-59 years by the direct method, taking the whole regional population as reference. Prevalence rate ratios (RR) with 95% Confidence Intervals (CI) were computed with respect to Italian citizens. Among residents aged 20-59 years, 45280 Italian and 7782 foreign subjects affected by diabetes were identified. Prevalence rates were highest among immigrants from South-East Asia, RR 4.9 (CI 4.7-5.1) among males, and 7.6 (7.2-8.1) among females, followed by residents from both North and Sub-Saharan Africa. Citizens from Eastern Europe (the largest immigrant group) showed rates similar to Italians. Most South-Asian patients aged 20-39 years were not insulin-treated, suggesting a very high risk of early onset type 2 diabetes in this ethnic group.Conclusion: Large variations in diabetes prevalence by ethnicity should prompt tailored strategies for primary prevention, diabetes screening, and disease control. An increased demand for prevention and health care in selected population groups should guide appropriate resource allocation. [ABSTRACT FROM AUTHOR]

Abstract: Objective: Lymphopenia is associated with toxicity and outcomes in several cancer types. We assessed the association between pre-treatment lymphopenia, toxicity, and clinical outcomes in elderly patients with metastatic renal cell cancer (mRCC) treated with first-line sunitinib. Prognostic factors in these patients were also evaluated. Patients and Methods: We reviewed the clinical records of 181 patients with mRCC aged ≥70years treated with first-line sunitinib in 17 Italian Oncology Units from February 2006 to September 2011. Baseline lymphopenia was defined as lymphocyte counts <1000/μL. Results: Twenty-nine (16%) patients had a baseline lymphocyte count <1000/μL (group A) and 152 (84%) patients had a lymphocyte count ≥1000/μL (group B). Although no differences between the two groups were reported in terms of overall response rate (P=0.207), dose reductions (P=0.740), discontinuation due to adverse events (P=0.175) or overall incidence of grade 3–4 toxicities (P=0.112), more patients in the lymphopenia group had grade 3–4 neutropenia (P=0.017), grade 3–4 thrombocytopenia (P=0.017) and grade 3–4 diarrhea (P=0.006). In multivariate analysis, performance status and Heng score were predictors of progression-free survival (P=0.015 and P=0.0006, respectively), while performance status, Heng score, and lymphopenia were found to be significantly associated with overall survival (P=0.007, P<0.0001 and P=0.023, respectively). Conclusions: Sunitinib appears to be safe and active in elderly patients with lymphopenia. Lymphocyte count is an independent prognostic factor for overall survival in elderly patients with mRCC treated with first-line sunitinib. [Copyright &y& Elsevier]

Case fatality rate is considered a main determinant of stroke mortality trends. We applied the World Health Organization's Stroke STEPS to identify case fatality rates in a community hospital in Brazil. We evaluated all patients with first-ever stroke seeking acute care at the hospital's emergency ward between April 2006 and December 2008 to verify early and late case fatality according to stroke subtype. We used years of formal education as a surrogate for socioeconomic status. Of 430 first-ever stroke events, 365 (84.9%) were ischemic and 65 (15.1%) were intracerebral hemorrhage. After 1 year, we adjudicated 108 deaths (86 ischemic; 22 hemorrhagic). Age-adjusted case fatality rates for ischemic stroke and intracerebral hemorrhage were 6.0% v 19.8% at 10 days, 10.6% v 22.1% at 28 days, 17.6% v 29.1% at 6 months, and 21.0% v 31.5% at 1 year. Illiteracy or no formal education was a predictor of death at 6 months (odds ratio [OR], 4.31; 95% confidence interval [CI] 1.34-13.91) and 1 year (OR, 4.21; 95% CI, 1.45-12.28) in patients with ischemic stroke, as well as at 6 months (OR, 3.19; 95% CI, 1.17-8.70) and 1 year (OR, 3.30; 95% CI, 1.30-8.45) for all stroke patients. Other variables, including previous cardiovascular risk factors and acute medical care, did not change this association to a statistically significant degree. In conclusion, case fatality, particularly up to 6 months, was higher in hemorrhagic stroke, and lack of formal education was associated with increased stroke mortality. [ABSTRACT FROM AUTHOR]

The interruption of the VAT chain at national borders makes several types of tax fraud possible. One is the multi stages black VAT chain in the domestic markets of various countries, which facilitates the development of a black economy favouring the evasion of income tax, social security contributions and other market regulations, including the protection of intellectual property and of brands. We devise a stylised model of Nash equilibrium-black chain for the "VAT-free goods", depicting its effects on both market prices and illegal gains for fraudsters. The policy implications of the model aiming to contrast the black economy are analysed. [ABSTRACT FROM AUTHOR]