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Simple Summary: Total thyroidectomy and dissection of cervical lymph node compartments, depending on serum calcitonin levels and ultrasound findings, is standard treatment for patients with medullary thyroid cancer. The aim of this study was to evaluate whether pre-operative calcitonin and CEA levels can be useful as biomarkers of the extent of lymph node metastases at diagnosis. Results indicate that pre-operative serum calcitonin and CEA levels can predict presence, number, and site of lymph node metastases and, more specifically, values of 90 pg/mL for calcitonin and 17 ng/mL for CEA accurately indicate the N1b status. Since surgery is the only curative treatment for medullary thyroid cancer and there is not a strong indication regarding the extent of lymphadenectomy, these findings may help in the choice of the extent of neck dissection. Background: In medullary thyroid cancer (MTC), lymph node metastases are often present at diagnosis and the extent of surgery is usually based upon pre-operative calcitonin and CEA levels as well as ultrasound findings. The aim of this study was to evaluate the role of pre-operative calcitonin and CEA levels as predictive markers of the burden of lymph node metastases at diagnosis. Methods: we conducted a retrospective study analyzing 87 MTC patients. Results: The median levels of calcitonin and CEA were 88.4 pg/mL and 7.0 ng/mL, respectively, in patients with no lymph nodes metastases; 108.0 pg/mL and 9.6 ng/mL, respectively, in patients with metastases to 1–5 lymph nodes; 520.5 pg/mL and 43.2 ng/mL, respectively, in patients with metastases to >5 lymph nodes. There were no significant differences in pre-operative calcitonin and CEA values between N0 and N1a patients, whereas they were significantly higher in N1b patients. Pre-operative cut-off levels distinguishing N0/N1a from N1b patients were 90 pg/mL for calcitonin (sensitivity 100%, specificity 59.3%, AUC = 0.82) and 17 ng/mL for CEA (sensitivity 100%, specificity 75%, AUC = 0.89). Conclusions: in patients with MTC, pre-operative serum calcitonin and CEA levels may drive the decision-making process to better define the extent of surgery. [ABSTRACT FROM AUTHOR]

Mapping soil organic carbon (SOC) stock can serve as a resilience indicator for climate change. As part of the carbon dioxide (CO2) sink, soil has recently become an integral part of the global carbon agenda to mitigate climate change. We used hyperspectral remote sensing to model the SOC stock in the Sele River plain located in the Campania region in southern Italy. To this end, a soil spectral library (SSL) for the Campania region was combined with an aerial hyperspectral image acquired with the AVIRIS–NG sensor mounted on a Twin Otter aircraft at an altitude of 1433 m. The products of this study were four raster layers with a high spatial resolution (1 m), representing the SOC stocks and three other related soil attributes: SOC content, clay content, and bulk density (BD). We found that the clay minerals' spectral absorption at 2200 nm has a significant impact on predicting the examined soil attributes. The predictions were performed by using AVIRIS–NG sensor data over a selected plot and generating a quantitative map which was validated with in situ observations showing high accuracies in the ground-truth stage (OC stocks [RPIQ = 2.19, R2 = 0.72, RMSE = 0.07]; OC content [RPIQ = 2.27, R2 = 0.80, RMSE = 1.78]; clay content [RPIQ = 1.6 R2 = 0.89, RMSE = 25.42]; bulk density [RPIQ = 1.97, R2 = 0.84, RMSE = 0.08]). The results demonstrated the potential of combining SSLs with remote sensing data of high spectral/spatial resolution to estimate soil attributes, including SOC stocks. [ABSTRACT FROM AUTHOR]

The authors present the outcomes of three parent training experiences carried out at the Research Institute "OASI MARIA SS" in Troina, Italy, which were designed to facilitate the acquisition of specific competencies and to promote educational effectiveness within the family. Some 30 families (all with a member with autistic disorder or with severe and profound intellectual disability) were followed for a four-week period. Treatments were carried out according to a multidisciplinary approach (a social worker, physician, psychologist, pedagogist, and educator were involved). The main objectives of the training were to promote families' willingness to collaborate, to improve educational abilities, to foster problem solving, and to create a local support network. To assess change, a pre- and post-questionnaire was administered to families. In the three different training models, relevant improvements in coping abilities as well as development of educational self-confidence were noted.

This real-world analysis aims to estimate the epidemiology and economic burden related to early-stage non-small-cell lung carcinoma (eNSCLC) in the clinical practice Italian setting. An observational analysis was performed using administrative databases linked to pathological anatomy data, covering around 2.5 mln health-assisted individuals. From 2015 to mid-2021, eNSCLC patients staged II–IIIA treated with chemotherapy after surgery were included. Patients were stratified into those presenting loco-regional or metastatic recurrence during follow-up and annualized healthcare direct costs covered by the Italian National Health System (INHS) were estimated. In 2019–2020, the prevalence of eNSCLC was 104.3–117.1/million health-assisted subjects, and the annual incidence was 38.6–30.3/million. Data projected to the Italian population estimated 6206 (2019) and 6967 (2020) prevalent and 2297 (2019) and 1803 (2020) incident cases. Overall, 458 eNSCLC patients were included. Of them, 52.4% of patients had a recurrence (5% loco-regional-recurrence, 47.4% metastatic-recurrence). Healthcare total direct costs/patient averaged EUR 23,607, in particular, in the first year after recurrence, costs averaged EUR 22,493 and EUR 29,337 in loco-regional and metastatic-recurrence patients, respectively. This analysis showed that about one-half of eNSCLC patients stage II–IIIA experience a recurrence, and in recurrence patients, total direct costs were almost two-fold those of no-recurrence patients. These data highlighted an unmet clinical need, as the therapeutic optimization of patients at early stages. [ABSTRACT FROM AUTHOR]

The COVID-19 global pandemic has changed considerably the way time-sensitive disorders are treated. Home isolation, people's fear of contracting the virus and hospital reorganisation have led to a significant decrease in contacts between citizens and the healthcare system, with an expected decrease in calls to the Emergency Medical Services (EMS) of the Friuli-Venezia Giulia (FVG) region. However, mortality in clinical emergencies like acute ST-elevation myocardial infarction (STEMI), stroke and out-of-hospital cardiopulmonary arrest (OHCA) remained high. An observational retrospective cross-sectional study was carried out in FVG, taking into account the period between March 1, 2020, and May 31, 2020, the first wave of the COVID-19 pandemic, and comparing it with the same period in 2019. The flow of calls to the EMS was analysed and COVID-19 impact on time-sensitive disorders (STEMIs, ischemic strokes and OHCPAs) was measured in terms of hospitalisation, treatment and mortality. Despite a −8.01% decrease (p value ˂0.001) in emergency response, a 10.89% increase in calls to the EMS was observed. A lower number of advanced cardiopulmonary resuscitations (CPR) (75.8 vs 45.2%, p=0.000021 in April) and ROSC (39.1 vs 11.6%, p=0.0001 in April) was remarked, and survival rate dropped from 8.5 to 5%. There were less strokes (−27.5%, p value=0.002) despite a more severe onset of symptoms at hospitalisation with NHISS˃10 in 38.47% of cases. Acute myocardial infarctions decreased as well (−20%, p value=0.05), but statistical significances were not determined in the variables considered and in mortality. Despite a lower number of emergency responses, the number of calls to the EMS was considerably higher. The number of cardiac arrests treated with advanced CPR (ALS) was lower, but mortality was higher. The number of strokes decreased as well, but at the time of hospitalisation the clinical picture of the patient was more severe, thus affecting the outcome when the patient was discharged. Finally, STEMI patients decreased; however, no critical issues were observed in the variables taken into account, neither in terms of response times nor in terms of treatment times. [ABSTRACT FROM AUTHOR]

Background: Stroke is one of the most significant social and health issues at the global level. In industrialized countries, stroke is the main cause of disability, the second cause of dementia and the third cause of death after cardiovascular diseases and cancer, accounting for 10–12% of all deaths. The incidence of stroke increases progressively with age: 75% of cerebrovascular events affect people over 65 years old (with a predominance in males). Objective: The aim of this paper was to review the literature on economic evaluation of stroke treatment from 2007 to 2016. The research question is: 'What is the economic evaluation more used?' Methods: The systematic review was conducted following the PRISMA methodology. We systematically reviewed studies published since 2007. The databases used were PubMed and Scopus. Results: A total of 16 studies met the inclusion criteria. Of these, 4 are in Italian and 12 are in English. Twelve articles were published between 2009–2014, two in 2007, one in 2015 and one in 2016. Eleven articles performed cost analyses and economic assessments referring only to an Italian context while the other articles considered both an Italian and international context. Thanks to the identification of the most used economic technique it is possible to establish the treatment to be privileged in the management of the stroke, both at a preventive and rehabilitative level. Conclusions: The type of analysis mainly used was the Cost-effectiveness analysis as a demonstration of the importance given to the incremental costs arising from health technologies introduced to contain the debilitating effects of strokes. Quantifiable savings could be created by reducing the number of beds needed to assist in the case of stroke events. and, as a result of minor disability and dependence, in terms of reduction of rehabilitative, assistance and social expenditures in the long term. [ABSTRACT FROM AUTHOR]

The responses of river macroinvertebrates to hydromorphological alteration are often considered weak or unclear. It is therefore crucial to verify if and how existing invertebrate-based approaches can reveal the effects of hydromorphological modification. We analyzed the responses of benthic metrics to morphological impairment, with emphasis on the STAR_ICM index, legally required for macroinvertebrate-based ecological status assessment in Italy. A Principal Component Analysis (PCA) was run to condense information on morphological impairment. The major gradient (Component 1) expressed a combination of bank and channel modifications opposed to tree-related features indicating the presence of comparatively unmodified habitats. Jointly, habitat descriptors including Habitat Modification Score (HMS) derived from the application of a habitat survey method were calculated. Spearman rank correlations between biological metrics and morphological impairment indicators (PCA scores and HMS) were significant. A linear mixed-effects regression approach was applied to relate HMS and STAR_ICMi across a wide geographical context. HMS explained > 60% of STAR_ICMi variability, in the absence of apparent water pollution. Results demonstrated that morphological information resumed with habitat survey methods is meaningful for the biological community and that HMS can support the interpretation of ecological status across rivers' types and in different environmental settings. [ABSTRACT FROM AUTHOR]

Objective. To investigate CT morphologic and densitometric features and 18-FDG PET findings of surgically excised lung adenocarcinomas "mixed subtype" with predominant lepidic component, appearing as solid solitary pulmonary nodules (SPNs) on CT scan. Materials and Methods. Approval for this study was given from each local institutional review board according to its retrospective nature. Nodules pathologically classified as lung adenocarcinoma mixed subtype with bronchioloalveolar otherwise lepidic predominant component, in three different Italian institutions (Napoli; Varese; Parma), were retrospectively selected. Results. 22 patients were identified. The number of SPNs with smooth margins was significantly lower with respect to the number of SPNs with spiculated margins (p: 0.033), radiating spiculations (p: 0.019), and notch sign (p: 0.011). Mean contrast enhancement (CE) was 53.34 HU (min 5.5 HU, max 112 HU); considering 15 HU as cut-off value, CE was positive in 20/22 cases. No significant correlation was found between size and CE. Mean SUVmax was 2.21, ranging from 0.2 up to 7.5 units; considering 2.5 units as cut-off, SUVmax was positive in 7/22 cases. The number of SPNs with positive CE was significantly higher than the number of SPNs with positive SUVmax (p: 0.0005). Conclusion. CT generally helps in identifying solid SPN suspicious for malignancy but 18-FDG PET may result in false-negative evaluation; when 18-FDG PET findings of a solid SPN are negative even though CT morphology and CE suggest malignancy, radiologist should consider that lepidic component may be present inside the invasive tumor, despite the absence of ground glass. [ABSTRACT FROM AUTHOR]

Background: The Human Body Posturizer (HPB), an innovative therapeutic tool able to correct postural changes dynamically, fits perfectly in this framework.Objective: The aim of this paper is to consider the potential economic benefits of using the Human Body Posturizer both in terms of direct and indirect cost reduction in one year.Methods: This study was carried out using an estimation method in order to investigate the possible economic impact related to the adoption of the HBP in subjects with low back pain as an attempt to quantify the costs (direct and indirect) generated at different levels of the path therapeutic.Results: The use of therapy with HBP would generate a saving of € 971.40/year in case of sub-acute LBP and amounted to € 2,922.90/year in case of chronic low back pain.Conclusion: This paper provides guidance on the potential economic benefits resulting from the adoption of the Human Body Posturizer as an innovative therapeutic approach by the Italian Health System. [ABSTRACT FROM AUTHOR]

The river typology 'volcanic rivers' represents a unique typology in the Mediterranean eco-region in Europe but its type-specific diatom assemblages are still poorly investigated. The main aims of this study were (i) to analyse the diatom diversity of this river type, (ii) to investigate the relationships between diatom diversity and environmental variables and (iii) to identify the characterizing diatom community structure of different environmental groups. To this end, we selected 13 streams located in central Italy, belonging to a single river type and covering the whole quality range from human impacted sites to those in 'reference conditions'. Most frequent and abundant diatom species found were Cocconeis placentula var . lineata, Planothidium lanceolatum, Rhoicosphenia abbreviata and Amphora pediculus. Species richness in reference and less impacted sites was not higher than in intermediate and heavily degraded ones, but non-metric multidimensional scaling (N-MDS) analysis revealed a substantial difference among their diatom community structure. The indicator species analysis defined the characteristic species of three environmental groups identified by N-MDS. The findings of this study represent a contribution to the knowledge on diatom communities of Mediterranean volcanic-siliceous rivers and provide information for a data-driven implementation of the Water Framework Directive in Italy for this specific river typology. [ABSTRACT FROM AUTHOR]

Abstract: In this paper, we focus on the archaeometric characterisation of some pottery remains dated to the 8th and early 7th centuries BC. The sherds examined come from excavations carried out by the Groningen Institute of Archaeology (GIA) on the acropolis of Timpone della Motta, an archaeological site located in Francavilla Marittima, near the well-known Greek colony of Sybaris (Calabria, southern Italy). As the site was one of the most important sanctuaries in the area during the 8th century BC, pottery from the sanctuary is one of the main sources of evidence for cultural and technological transformations which occurred within the indigenous Oinotrian society. However, in order to evaluate the significance of the individual classes of pottery, their provenance needs to be better understood. A first step in this direction was to clarify which pottery classes were produced locally at Timpone della Motta. We focus here on three ceramic classes frequently found in the sanctuary: a) matt-painted pottery; b) Oinotrian-Euboean style; and c) colonial ware (hydriskoi), for further information on the probable provenance area and the technological features of these ceramic categories. A multi-analytical approach was used, including petrographic, mineralogical and chemical investigations by means of optical and scanning electron microscopy, X-ray powder diffraction (XRD) and X-ray fluorescence spectroscopy (XRF). The results are compared with those deriving from minero-chemical and granulometric characterisation of some clay sediments sampled from outcrops near the study site, representing the potential source of clay used for ceramic production in this area. Preliminary data indicate that the matt-painted and Oinotrian-Euboean sherds were probably locally produced, since their chemical composition markedly resembles that of the clay sediments. As regards the hydriskoi, some chemical differences were observed with respect to local clays and the other two classes, perhaps indicating a different production centre for this type of pottery. However, local manufacture exploiting the Fe- and Mg-richer clay layers in the sampled outcrop cannot be excluded for this group. [Copyright &y& Elsevier]

Mineralogical, petrographic and chemical analyses were carried out on black crusts covering the stone surface of monuments and buildings of the historical city centre of Catania, one of the most beautiful Baroque places in eastern Sicily. Black crusts were studied through the careful and synergic employment of traditional techniques, including polarizing optical microscopy (POM), scanning electron microscopy coupled with energy-dispersive X-ray spectrometry (SEM-EDS), and infrared spectroscopic techniques (FT-IR), in combination with an innovative technique, i.e.laser ablation inductively coupled mass spectrometry (LA-ICP-MS). The validity of such an integrated approach to study black crusts has been recently demonstrated by the authors. The main goal of this study was to develop and test the reliability of the LA-ICP-MS method on black crusts in order to evaluate the degree of chemical contamination of examined stones and to determine the role of the different sources of pollution in Catania, both anthropogenic (domestic heating, industrial combustion, vehicular traffic) and natural (emissions by Mt Etna) in the formation of crusts. Results obtained demonstrated that this innovative approach has a double potential in the study of black crusts, since it allows the analysis of alteration and degradation processes induced by migration of specific chemical elements from the crust to substrate, and, at the same time, it represents a reliable indicator of the environmental pollution. [ABSTRACT FROM AUTHOR]

Noto is an important Baroque urban center in south-eastern Sicily, which was completely reconstructed after the severe earthquake of 1693. Most of its monuments and historic buildings were built in Pietra di Noto stone, a pale cream calcarenite, quarried in outcrops located near the city. This stone, still currently used as building material, is undergoing many forms of alteration and degradation, which cause significant damage to monuments. In this study, three commercial protective products were tested on some Noto calcarenite samples from quarries, with the aim of assessing their protective effectiveness. In particular, petrographic analyses by optical microscopy were carried out for textural characterization of the stone materials. Capillary water absorption, porosimetric and colorimetric procedures, UV radiation and salt crystallization aging tests were performed to better evaluate interactions between protective products and substrate. [ABSTRACT FROM AUTHOR]

This paper presents new petro-chemical data on some typical mortars found in many buildings in the historic city centre of Catania (Eastern Sicily). Extensively used in the architecture of the city from the second half of the nineteenth century until the mid-twentieth century, these mortars are characterised by a particular aggregate locally known as “ agghiara” or “ ghiara”. This is the product of thermal transformation induced by the heating undergone by palaeo-soils, originally rich in organic matter, covered by lava flows, which change their colour to reddish nuances. The volcanic origin of ghiara is a peculiar feature of the Etnean area. Mixed with lime, it gives to mortars an intense reddish colour, as well as hydraulic properties, which are comparable with those of the historically used pozzolana. This work aimed at complete characterisation of these ghiara mortars, for providing information on several important technological aspects. In order to get information on used raw materials, sampling of some ancient underground quarries, located both in the historic city centre and at the periphery, was also performed. Results led to the complete characterisation of the selected ghiara mortars and yielded information on some technological features and the composition of both newly formed and secondary phases, these latter due to alteration processes. The hydraulic properties of mortars have been related to the occurrence of amorphous phases within the ghiara aggregate, which were identified by means of SEM morphological observations. These phases, formed during the “firing” process of palaeo-soils, react with lime producing hydraulic compounds (C–S–H and C–A–H), which are responsible for the mortars durability. [ABSTRACT FROM AUTHOR]

The Baroque monuments of several cities in eastern Sicily, built of local calcarenitic stone, are often subjected to conservation treatments, since they undergo many forms of alteration and degradation which can cause significant damage. However, a recent study of these building materials (Barone et al. in Environ. Geol. 54:1501, ) has demonstrated that some protective products, once applied, cause irreversible chromatic alterations. The façades of the monuments of the historic city centre of Modica are typically creamy yellow in colour, sometimes varying slightly due to the use of various pigments, such as clayey and gypseous earths (La Russa et al. in Appl. Phys. A 92:185, ). However, in some cases, these nuances are lost due to the application of protective products. This work provides a petrographic and colorimetric characterisation of the calcarenitic stone used to create the façades of the churches of S. Pietro, S. Maria del Soccorso and S. Maria dell’Annunziata in Modica, also by comparisons with locally quarried samples. In addition, it aims to identify protective substances which may have been used during previous restoration work. Analytical techniques included polarising optical microscopy, spectrophotometric colorimetric tests, Fourier-transform infrared spectroscopy (FTIR) and gas chromatography coupled with mass spectrometry (GC-MS). [ABSTRACT FROM AUTHOR]

Abstract: In this paper, volcanic-rich ceramic remains from the archaeological sites of Francavilla, Naxos and Taormina (Province of Messina, North-eastern Sicily) were studied by using inclusions as main provenance marker. Technological features, such as temper choice, vitrification degree and firing temperatures, were investigated by polarizing microscopy, X-ray diffractometry (XRD) and scanning electron microscopy (SEM). Information on the production centres was obtained through the identification of the source area of raw materials used as temper. Indeed, petrochemical analysis of the volcanic inclusions within the examined ceramics displayed strong affinities with structures/textures and compositions of the locally outcropping mugearitic products, probably ascribed to the eruptive activity of an eccentric vent of Mt. Etna (Mt. Mojo). A local production for the studied pottery samples has been therefore advanced, assuming that the used volcanic temper was easily available from the alluvial deposits along the Alcantara River stream, which is connected to the lava flow of Mt. Mojo. [Copyright &y& Elsevier]

The association of HLA-B27 with ankylosing spondylitis (AS) is the strongest among all inflammatory diseases. However, the exact role of these molecules in disease pathogenesis is still unknown. The existence of HLA-B27 variants rarely found in patients introduces a further level of complexity. It is now accepted that other genes of minor impact contribute to modify disease susceptibility and these genes might be diverse in different populations depending on the genetic background. We report here a study performed in Sardinia, an outlier population in which two major HLA-B27 subtypes are present, B *2705 strongly associated with AS and B *2709 which is not, and show the co-occurrence of the B *2705 allele with a single nucleotide polymorphism (SNP) mapping at 3′-UTR of the receptor 1 (VIPR1) for the vasoactive intestinal peptide (VIP), a neuropeptide with anti-inflammatory properties. This same SNP is associated with a different kinetics of down-modulation of the VIPR1 mRNA in monocytes after exposure to lipopolysaccharide (P=0.004). This particular setting, HLA-B *2705 and a functional polymorphism in VIPR1 gene, might be due to a founder effect or might be the result of a selective pressure. Irrespectively, the consequent downregulation of this receptor in the presence of a ‘danger’ signal might influence susceptibility to AS.Genes and Immunity (2008) 9, 659–667; doi:10.1038/gene.2008.60; published online 31 July 2008 [ABSTRACT FROM AUTHOR]

Background: Little attention has been paid to the consequences of the last landbridge between Africa and Sicily on Mediterranean biogeography. Previous paleontological and scarce molecular data suggest possible faunal exchange later than the well-documented landbridge in the Messinian (5.3 My); however, a possible African origin of recent terrestrial Sicilian fauna has not been thoroughly tested with molecular methods. To gain insight into the phylogeography of the region, we examine two mitochondrial and two nuclear markers (one is a newly adapted intron marker) in green toads (Bufo viridis subgroup) across that sea barrier, the Strait of Sicily. Results: Extensive sampling throughout the western Mediterranean and North Africa revealed a deep sister relationship between Sicilian (Bufo siculus n.sp.) and African green toads (B. boulengeri) on the mitochondrial and nuclear level. Divergence times estimated under a Bayesian-coalescence framework (mtDNA control region and 16S rRNA) range from the Middle Pliocene (3.6 My) to Pleistocene (0.16 My) with an average (1.83 to 2.0 My) around the Pliocene/Pleistocene boundary, suggesting possible land connections younger than the Messinian (5.3 My). We describe green toads from Sicily and some surrounding islands as a new endemic species (Bufo siculus). Bufo balearicus occurs on some western Mediterranean islands (Corsica, Sardinia, Mallorca, and Menorca) and the Apennine Peninsula, and is well differentiated on the mitochondrial and nuclear level from B. siculus as well as from B. viridis (Laurenti), whose haplotype group reaches northeastern Italy, north of the Po River. Detection of Calabrian B. balearicus haplotypes in northeastern Sicily suggests recent invasion. Our data agree with paleogeographic and fossil data, which suggest long Plio-Pleistocene isolation of Sicily and episodic Pleistocene faunal exchange across the Strait of Messina. It remains unknown whether both species (B. balearicus, B. siculus) occur in sympatry in northern Sicily. Conclusion: Our findings on green toads give the first combined mitochondrial and nuclear sequence evidence for a phylogeographic connection across the Strait of Sicily in terrestrial vertebrates. These relationships may have implications for comparative phylogeographic research on other terrestrial animals co-occurring in North Africa and Sicily. [ABSTRACT FROM AUTHOR]

Simple Summary: The COVID-19 pandemic has hit Northern Italy's regions hard in terms of deaths since February 2020. Containment measures have been applied to avoid contagion and reduce the patient infection rate. In this manuscript, we report the experience of the Pathology Department of the Fondazione IRCCS Istituto Nazionale Tumori in Milan, during the period of the first lockdown that occurred in Lombardy from March to May 2020, focusing on the variation in terms of exams between the pre-COVID-19 and COVID-19 periods and describing the measures applied to guarantee the safeguarding of workers. Moreover, we calculated if changes introduced within the workflow affected the average diagnosis time using Turn-Around-Time (TAT) metrics released by the Lombardy Region. We showed a sharp slowdown in exams during the first wave of COVID-19 and that the measures applied for the safeguarding of the personnel turned out to be feasible and did not affect the overall performance of the Pathology Department. Background: On December 2019, an outbreak of atypical pneumonia, known as COVID-19, was identified in Wuhan, China. This disease, characterized by the rapid human-to-human transmission of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has spread rapidly in more than 200 countries. Northern Italy's regions have been hit hard in terms of deaths. Here, we report the experience of the Pathology Department of the Fondazione IRCCS Istituto Nazionale Tumori (INT) in Milan, the first Italian public cancer center, in the period of the lockdown that took place in Lombardy from March to May 2020. Method: The variation in terms of exams was calculated in two different timeframes: December 2019–February 2020 (pre-COVID-19) and March–May 2020 (COVID-19). During these periods, Turn-Around-Time (TAT) metrics released by the Lombardy Region were calculated to assess if changes applied to guarantee the safeguarding of workers affected the average diagnosis time. Results: In the COVID-19 period, there was a decrease for all the performed exams. The most considerable decrease was observed for PAP tests (−81.6%), followed by biopsies (−48.8%), second opinions (−41.7%), and surgical (−31.5%), molecular (−29.4%) and cytological (−18.1%) tests. Measures applied within the Pathology Department, such as digital pathology, remote working, rotations and changes in operating procedures, improved the diagnostic performance as required by the guidelines of the Lombardy Region in terms of TAT. At the same time, the measures applied for the safeguarding of the personnel turned out to be feasible and did not affect the overall performance of the Pathology Department. Conclusions: The sharp slowdown in cancer screening during the first wave of COVID-19 could seriously endanger cancer prevention in the near future. [ABSTRACT FROM AUTHOR]

Presents morphological and electrophoretic evidence for a new species of Electrogena (Ephemeroptera: Heptageniidae) from central Italy. Differences from Electrogena lateralis; Identification of larvae by numerical methods; Loci that are diagnostic between syntopic populations.

Simple Summary: The objective of the manuscript was to assess the performance of the second reading of chest compute tomography (CT) examinations by expert radiologists in patients with discordance between the reverse transcription real-time fluorescence polymerase chain reaction (RT-PCR) test for COVID-19 viral pneumonia and the CT report. Double reading of CT could increase the diagnostic confidence of radiological interpretation in COVID-19 patients in a pandemic area. Using second readers and a structured report for COVID-19 diagnosis could reduce the rate of discrepant cases between RT-PCR result and CT diagnosis for COVID-19 viral pneumonia. To assess the performance of the second reading of chest compute tomography (CT) examinations by expert radiologists in patients with discordance between the reverse transcription real-time fluorescence polymerase chain reaction (RT-PCR) test for COVID-19 viral pneumonia and the CT report. Three hundred and seventy-eight patients were included in this retrospective study (121 women and 257 men; 71 years median age, with a range of 29–93 years) and subjected to RT-PCR tests for suspicious COVID-19 infection. All patients were subjected to CT examination in order to evaluate the pulmonary disease involvement by COVID-19. CT images were reviewed first by two radiologists who identified COVID-19 typical CT patterns and then reanalyzed by another two radiologists using a CT structured report for COVID-19 diagnosis. Weighted k values were used to evaluate the inter-reader agreement. The median temporal window between RT-PCRs execution and CT scan was zero days with a range of (−9, 11) days. The RT-PCR test was positive in 328/378 (86.8%). Discordance between RT-PCR and CT findings for viral pneumonia was revealed in 60 cases. The second reading changed the CT diagnosis in 16/60 (26.7%) cases contributing to an increase the concordance with the RT-PCR. Among these 60 cases, eight were false negative with positive RT-PCR, and 36 were false positive with negative RT-PCR. Sensitivity, specificity, positive predictive value and negative predictive value of CT were respectively of 97.3%, 53.8%, 89.0%, and 88.4%. Double reading of CT scans and expert second readers could increase the diagnostic confidence of radiological interpretation in COVID-19 patients. [ABSTRACT FROM AUTHOR]

Lack of accurate and up-to-date data associated with irrigated areas and related irrigation amounts is hampering the full implementation and compliance of the Water Framework Directive (WFD). In this paper, we describe the framework that we developed and implemented within the DIANA project to map the actual extent of irrigated areas in the Campania region (Southern Italy) during the 2018 irrigation season. For this purpose, we considered 202 images from the Harmonized Landsat Sentinel-2 (HLS) products (57 images from Landsat 8 and 145 images from Sentinel-2). Such data were preprocessed in order to extract a multitemporal Normalized Difference Vegetation Index (NDVI) map, which was then smoothed through a gap-filling algorithm. We further integrated data coming from high-resolution (4 km) global satellite precipitation Precipitation Estimation from Remotely Sensed Information using Artificial Neural Networks (PERSIANN)-Cloud Classification System (CCS) products. We collected an extensive ground truth in the field represented by 2992 data points coming from three main thematic classes: bare soil and rainfed (class 0), herbaceous (class 1), and tree crop (class 2). This information was exploited to generate irrigated area maps by adopting a machine learning classification approach. We compared six different types of classifiers through a cross-validation approach and found that, in general, random forests, support vector machines, and boosted decision trees exhibited the best performances in terms of classification accuracy and robustness to different tested scenarios. We found an overall accuracy close to 90% in discriminating among the three thematic classes, which highlighted promising capabilities in the detection of irrigated areas from HLS products. [ABSTRACT FROM AUTHOR]

This study investigated the effectiveness of infrared thermography to estimate water status in Merlot and Moscato grown in northeast Italy by comparing the crop water stress index (CWSI) and the stomatal conductance index (IG). The influence of the portion of the canopy in which the thermal images were captured (sunlit or shaded) was also investigated. During the 2018 growing season, potted vines were subjected to three irrigation treatments: T0 = 100% of daily water usage restored; T1 = 50% of daily water usage restored; and T2 = 30% of daily water usage restored. Measurements included stomatal conductance (gs), stem water potential (SWP), and thermal imagery. Results showed that both the CWSI and IG indices were effective in discriminating the irrigation treatments in Moscato and Merlot. CWSI showed higher correlations with gs and SWP compared to IG, especially in Moscato. CWSI was less influenced by the portion of the canopy the image was taken on. In general, Moscato showed greater differences in gs, SWP, and the thermal indices between the three irrigation treatments. This study suggests that the efficacy of thermography in estimating vine water status depends on the variety and its stomatal control physiology. [ABSTRACT FROM AUTHOR]

This work presents results from a petrographic, morphological and chemical study of the black crusts developing on monuments in three Italian cities, the Cathedral of Milan, the Cathedral of St. Maria del Fiore in Florence, and the Vittoriano Monument in Rome. Black crusts (BCs) were studied with traditional techniques such as optical microscopy (OM), scanning electron microscopy coupled with energy-dispersive X-ray spectrometry (SEM-EDS) and infrared spectroscopic techniques (FT-IR), in combination with laser ablation inductively coupled mass spectrometry (LA-ICP-MS), which has shown itself to be particularly useful in determining concentrations of heavy metals in BCs. Although the BCs of the three monuments show general enrichment in heavy metals with respect to the substrate (S), interesting differences were observed among them. The BCs from Milan are the richest in heavy metals, particularly Pb and Zn, reflecting the severe air pollution of this very large city, which, in addition to its intense traffic, is located in the most highly industrialized area of Northern Italy. The BCs from the south-eastern side of the Cathedral of St. Maria del Fiore in Florence, facing a pedestrian area, show little enrichment in heavy metals, and those from the Vittoriano Monument in Rome, which is exposed to intense road traffic, display variable enrichment, attributable to mobile emission sources. Results show that the various enrichment trends in heavy metals observed in the BCs of these three monuments are due to many factors: various sources of anthropogenic pollution, sampling height, exposure, orientation, and the shape of the deposition surface. [ABSTRACT FROM AUTHOR]

The improvement of performance of irrigation systems plays a fundamental role in increasing their efficiency in order to reach a sound use of irrigation water. The COPAM (Combined Optimization and Performance Analysis Model) has proven its usefulness in performance evaluation of on-demand irrigation systems; however, in many cases, input data, such as water volumes delivered by hydrants, is not readily available. To support a wider application of the COPAM, we tested the possibility of using irrigation volumes estimated by means of space-borne remote sensing. The Sentinel-2 (S2) constellation provides high spatial resolution images with a frequency between 2 and 5 days, which is compatible with COPAM input requirements. In the present work, an irrigation sector in the Capitanata irrigation network (Foggia Province, no. 6 of District 10) in Italy was chosen to assess its performance by using COPAM with volumes estimated from Sentinel-2 data. As an input of COPAM, the upstream discharge was determined after a proper transformation of the estimated irrigation water requirement volumes and the recorded volumes into flowrates. The estimation of the irrigation water requirement volumes was accomplished through the estimation of crop evapotranspiration, Etcrop, and effective precipitation, Pn, by combining crop parameters (leaf area index - LAI, fractional vegetation cover - fc, and Albedo) derived from S2 images and the meteorological data from the ERA5 single levels reanalysis dataset collected for the whole study period, from June 1st to September 30th, 2019. The study comprised a comparison of the estimated irrigation water volumes and the corresponding recorded volumes. The results showed a good agreement between the estimated and the registered volumes in a large time scale for 10 days and a one-month period, while a large difference was observed in a daily time scale. The performance analysis was carried out for the overall system and at hydrant level. The estimated discharge was lower than the registered discharge, indicating better performance. Last but not least, some recommendations were proposed for improving performance in critical zones. [ABSTRACT FROM AUTHOR]

To evaluate the occurrence of acute readmissions of patients in secondary prevention for Atherosclerotic Cardiovascular Disease (ASCVD) using Health Information Systems (HIS) in Italy. The high proportion of rehospitalizations in these patients, despite being treated with LLT, highlights the need to improve patient management in a population with a substantial unmet need. [Extracted from the article]

During the last decades, many studies have been carried out on environmental monitoring in specific sites aiming at their protection and conservation; however, researches focused on the direct implications, in terms of quantitative evaluation of stone deterioration, of these monitoring actions are still scarce. This experimental work aims at monitoring the degradation processes affecting historical buildings constituted by carbonate stones. Specifically, specimens of Carrara marble and two limestones largely used in the Sicilian Baroque architecture, namely Noto and Comiso stones, were exposed outdoor in two Italian sites (Catania and Palermo), which are characterized by different environmental conditions. The field exposure test lasted two years. Both the substrates and the deposited particulate collected at the end of the exposure underwent several analytical investigations including: i) optical microscopy, mercury intrusion porosimetry, colorimetric analysis and roughness analysis, for the characterization of stone substrates before exposure; ii) ion chromatography (IC), infrared spectroscopy analysis (FT-IR) and inductively coupled plasma mass spectrometry (ICP-MS), for the characterization of the particulate deposited on stone surfaces. The obtained results highlighted blackening and yellowing processes of the carbonate substrates, chiefly on those specimens exposed in Palermo where such processes were more noticeable. Furthermore, the high concentration of sulphates and heavy metals detected (mainly in Palermo site) pointed out that both cities are mainly interested by mobile emission sources such as vehicular traffic. Additionally, analyses demonstrated the key-role of intrinsic features of the lithotypes in the degradation processes. In this regard, the higher porosity and surface roughness of Noto stone explains the major deposition of particulate with respect to the other two examined carbonate rocks. [ABSTRACT FROM AUTHOR]

Abstract: The Palazzolo Formation calcarenite, commonly known as “Pietra di Noto”, has been widely used in the late Baroque monuments of the Val di Noto area. In this work, two different lithofacies have been identified through a minero-petrographic and physical–mechanical characterisation of the Noto stone samples. These latter have been taken out from three quarries, two of which are located near to Noto Antica (Porcari and Leone), and one next to Palazzolo Acreide (Camelio). Samples from Camelio have a white-cream colour and a higher sparry cement abundance than those from the Porcari and Leone quarries, which display a yellowish colour, a minor resistance and a more heterogeneous texture due to the presence of bioturbation (trace of fossils). The greater compactness of samples from Camelio compared to the other two is related to their higher ultrasonic velocities, better mechanical properties and reduced capability to absorb water by capillarity and total immersion which are related to the textural features. The existence of two lithofacies better explains the heterogeneity of degradation forms (chiefly consisting of differential degradation, alveolization, detachment and chromatic alteration) that can be observed on the monuments built in these stone materials. The main causes of deterioration have been related to bioturbation, as well as to the occurrence of expandable clay minerals (smectite) and to salt crystallization. The presence of bioturbation also affects the mechanical characteristics of these stones. [Copyright &y& Elsevier]

Ground-based in situ measurements of hydrofluorocarbons HFC-125, HFC-134a, and HFC-152a, which are regulated under the Kyoto Protocol, are carried out at four European sites within the SOGE (System of Observation of Halogenated Greenhouse Gases in Europe) program. Concentrations measured at the high mountain stations of Jungfraujoch (Switzerland) and Mte Cimone (Italy) together with back-trajectory statistical analysis are used in order to identify potential source regions on a European scale. Combining concentration data recorded at the two sites allows to reduce one of the problem which is inherent to the back-trajectory approach, i.e. the localisation of “ghost” sources in the wake of real sources. In this way, a more reliable picture of the location of European potential source regions is given. [Copyright &y& Elsevier]

• The ratio of lentic to lotic habitat features influences macroinvertebrate metrics. • Multi-metric indices respond to the lentic-lotic conditions at the time of sampling. • Ecological status classification changes if lentic-lotic features are considered. • Ignoring lentic-lotic information considerably increases bias in classification. • Site-specific tuning of reference conditions is needed for south European rivers. Biological quality in rivers based on benthic macroinvertebrates is typically assessed by comparison with expected reference conditions, which represent relatively undisturbed situations. Commonly, reference conditions are set in agreement with river typologies to handle major ecological differences and limit biological variability. Although natural hydrological variation can be highly influential, site-specific tuning of reference conditions is rare in Mediterranean countries. River flow and local hydraulics change continuously over time, shaping the occurrence of lentic and lotic habitat features. Thus, biological reference conditions might require site-specific adjustment based on the ratio of lentic to lotic habitats assessed at the time of sampling. This would help reducing systematic bias in ecological assessments, interpreting benthic invertebrate responses to pressures, and diminishing the amount of unexplained biological variability. In this study, the response to the lentic-lotic character of river reaches was assessed for nineteen macroinvertebrate metrics and indices commonly used for the classification of ecological status in South European rivers. The study sites, with a prevalent temporary character, were located in Sardinia, southwestern Italy. Most metrics were significantly related to the lentic-lotic habitat conditions, both in pool and riffle mesohabitats, and their response curves were either parabolic or linearly decreasing at increasing lentic conditions. Taxonomic richness, score-based metrics, ovoviviparous taxa and multi-metric indices related well to the lentic-lotic conditions, while abundance metrics correlated less. The potential impact on ecological status classification was tested for the method formally used in Italy, which had a major role in comparing and inter-calibrating European assessment methods for the Water Framework Directive. After adjusting for bias due to the ratio of lentic to lotic habitat features, quality classification shifted towards better ecological status for ≈ 23% samples. This highlighted the impact of ignoring lentic-lotic information when defining reference conditions for assessing ecological status, varying from difficulties in understanding the biological response to pressures, to largely biased ecological status classification. The observed response of macroinvertebrate metrics to lentic-lotic conditions should be a key consideration for realistic ecological status assessment and could further be a valuable input for evaluating the effects of human-induced hydrological alteration and for assessing environmental flows. [ABSTRACT FROM AUTHOR]

The efficient use of water in agriculture is one of the most significant agricultural challenges that modern technologies are helping to cope with through Irrigation Advisory Services (IAS) and Decision Support Systems (DSS). These last are considered powerful management instruments able to help farmers achieve the best efficiency in irrigation water use and to increase their incomes through obtaining the highest possible crop yield. In this context, within the project "An advanced low cost system for farm irrigation support – LCIS" (a joint Italian-Israeli R&D project), a fully transferable DSS for irrigation support, based on three different methodologies representative of the state of the art in irrigation management tools (W-Tens, in situ soil sensor; IRRISAT®, remote sensing; W-Mod, simulation modelling of water balance in the soil-plant and atmosphere system), has been developed. These three LCIS-DSS tools have been evaluated, in terms of their ability to support the farmer in irrigation management, in a real applicative case study on maize grown on Andosols in a private farm in southern Italy in the 2018 season. The evaluation considered the predictive performance of the tools and also the pros and cons of their application, due their different spatial scale applicability, costs and complexity of use. The results have shown that all three approaches are able to realise the maximum obtainable maize production. However, the method based on in situ soil sensor (W-Tens) supplied 40% more water compared to the other two methods, whereas the IRRISAT® and W-Mod approaches represent the best solution in terms of irrigation water use efficiency (IWUE). Moreover, IRRISAT® has the advantage of being able to work without soil spatial information, although unlike W-Tens both the latter methods need a high level of user expertise and consequently support of external service providers. Integration between different tools represents an opportunity for improved water use efficiency in agriculture (e.g., field sensors and remote sensing). Unlabelled Image • LCIS irrigation tools achieve similar maize production with different water supply. • IRRISAT and W-Mod approaches are the best solution to save water. • Integration of W-Tens and IRRISAT approaches to irrigation support is reccomended. [ABSTRACT FROM AUTHOR]

Private hospitals are an important pillar in many hybrid systems. In Italy they are bound to grow, but we have little knowledge of how they are coping with financial pressures. We use a configurational approach to determine the relationship between the macroprofiles of Italian private hospitals and their performance. We built a unique dataset with governance and financial statements data of all Italian private hospitals. We use a combination of partial triadic analysis (PTA) and clustering technique to identify both the main explicative financial dimensions and hospital configurations, and trace their evolutionary paths from the beginning of Regional Health Care Turnaround Plans (2008) to 2016. Understanding the evolution of configurations, our study entails also some implications for policy and practice., (Copyright © 2022 Elsevier B.V. All rights reserved.)

Familial adenomatous polyposis (FAP) is an autosomal-dominant hereditary condition associated with germline mutations in the adenomatous polyposis coli gene. Patient management involves prophylactic surgery and intensive life-long endoscopic surveillance. Diet is a major concern for patients with FAP, who are generally free of symptoms before surgery but tend to have issues related to bowel function postoperatively. We hypothesized that a low-inflammatory diet based on the principles and recipes of the Mediterranean diet would reduce markers of local and systemic inflammation. Twenty-eight patients with FAP over 18 years of age who underwent rectum-sparing prophylactic colectomy and were included in our surveillance program participated in a pilot dietary intervention study. Blood and stool samples at baseline (T0), at the end of the dietary intervention (T1, three months), and at the end of the study (T2, six months after T0) were collected. Gastrointestinal inflammation markers including fecal calprotectin, cyclooxygenase-2, and 15-hydroxyprostaglandin dehydrogenase were evaluated. Serum calprotectin, insulin, insulin-like growth factor-1, C-reactive protein, and glycated hemoglobin were also assessed. Significant changes in serum calprotectin, insulin, and insulin-like growth factor-1 levels occurred over time. Borderline significant changes were observed in the neutrophil-lymphocyte ratio. These changes were noticeable immediately at the end of the 3-month active dietary intervention (T1). A significant increase in 15-hydroxyprostaglandin dehydrogenase expression in the normal crypts of matched samples was also observed between T0 and T2. This pilot study supports the hypothesis that a low-inflammatory diet can modulate gastrointestinal markers of inflammation in individuals with FAP. PREVENTION RELEVANCE: Cancer is known to be related to inflammatory conditions. This study suggests that anti-inflammatory dietary intervention may potentially prevent adenomas and cancer in FAP patients by reducing systemic and tissue inflammatory indices., (©2021 American Association for Cancer Research.)

Background and Aims: A progressive decrease in muscle mass until full-blown sarcopenia may occur in patients on peritoneal dialysis (PD) and worsen their life quality and expectancy. Here we investigate the prevalence of obesity and obesity-associated muscle wasting in PD patients., Patients and Methods: The study design was observational, cross sectional. Body composition was assessed with BIA and BIVA in 88 PD patients (53.4 ± 13.1 years; 67% male). Patients with obesity and/or with reduced muscle mass were identified using FMI and SM/BW cutoff values, respectively. Inflammatory status was assessed by measuring CRP and fibrinogen blood levels., Results: A total of 44.3% of the patients showed a reduced muscle mass (37.5% moderate and 6.8% severe). The prevalence of obesity was 6.1%, 81.8%, and 100% in patients with normal, moderately, and severely reduced muscle mass, respectively (p < 0.05). Of the total, 15.2% of the patients with normal muscle mass, 18.4% of those with moderately reduced muscle mass, and 66.7% of those with severely reduced muscle mass had diabetes. The prevalence of severe muscle mass loss was higher in those with diabetes than in those without diabetes (22.2% vs. 2.8%, p < 0.05). Patients with obesity-associated muscle wasting showed higher fibrinogen (613.9 ± 155.1 vs. 512.9 ± 159.5 mg/dL, p < 0.05) and CPR (1.4 ± 1.3 vs. 0.6 ± 0.8 mg/dL, p < 0.05) blood concentrations than those with normal body composition., Conclusion: Obesity and diabetes were strongly associated with muscle mass loss in our PD patients. It remains to be established whether prevention of obesity with nutritional interventions can halt the occurrence of muscle mass loss in patients on PD., (Copyright © 2019 The Italian Society of Diabetology, the Italian Society for the Study of Atherosclerosis, the Italian Society of Human Nutrition, and the Department of Clinical Medicine and Surgery, Federico II University. Published by Elsevier B.V. All rights reserved.)

Primary aldosteronism (PA) causes cardiovascular damage in excess to the blood pressure elevation, but there are no prospective studies proving a worse long-term prognosis in adrenalectomized and medically treated patients. We have, therefore, assessed the outcome of PA patients according to treatment mode in the PAPY study (Primary Aldosteronism Prevalence in Hypertension) patients, 88.8% of whom were optimally treated patients with primary (essential) hypertension (PH), and the rest had PA and were assigned to medical therapy (6.4%) or adrenalectomy (4.8%). Total mortality was the primary end point; secondary end points were cardiovascular death, major adverse cardiovascular events, including atrial fibrillation, and total cardiovascular events. Kaplan-Meier and Cox analysis were used to compare survival between PA and its subtypes and PH patients. After a median of 11.8 years, complete follow-up data were obtained in 89% of the 1125 patients in the original cohort. Only a trend ( P =0.07) toward a worse death-free survival in PA than in PH patients was observed. However, at both univariate (90.0% versus 97.8%; P =0.002) and multivariate analyses (hazard ratio, 1.82; 95% confidence interval, 1.08-3.08; P =0.025), medically treated PA patients showed a lower atrial fibrillation-free survival than PH patients. By showing that during a long-term follow-up adrenalectomized aldosterone-producing adenoma patients have a similar long-term outcome of optimally treated PH patients, whereas, at variance, medically treated PA patients remain at a higher risk of atrial fibrillation, this large prospective study emphasizes the importance of an early identification of PA patients who need adrenalectomy as a key measure to prevent incident atrial fibrillation., (© 2018 American Heart Association, Inc.)

Background: Laparoscopic adjustable silicone gastric banding (LASGB) is a minimally invasive surgical procedure indicated for the treatment of patients with morbid obesity., Methods: From January 1996, eight patients successfully underwent the video-laparoscopic procedure., Results: Preoperative body mass index was 44.4 +/- 4.7 (range 37.9-53.3). Mean operative time was 255 +/- 73 minutes (range 150-360). Mean hospital stay was 3 +/- 1 days. Intraoperative complications were absent., Conclusion: Preliminary results have been satisfactory, and encourage us to continue with LASGB.

Purpose: We evaluated the frequency of thyroid cancer in patients with cold thyroid nodules in relation to iodine intake, sex, age, and multinodularity in a consecutive series of patients with nodular thyroid diseases., Patients: In the period from 1980 to 1990, 5,637 patients were studied: 4,176 patients were from an iodine-sufficient area (ISA) and 1,461 from an adjacent iodine-deficient area (IDA). Surgery was performed in 792 patients on the basis of a suspicious or malignant finding at fine-needle aspiration biopsy., Results: The overall thyroid cancer frequency was 4.6% (259 patients had cancer). Iodine intake affected the cancer rate in patients with cold nodules. The frequency of cancer in patients with cold thyroid nodules was 5.3% in the ISA and 2.7% in the IDA. This difference, however, was significant only in females. Sex had a major influence on the malignant rate of cold nodules; although female patients were more frequently observed (n = 5,028) than male patients (n = 609), the frequency of cancer was significantly lower in female patients with cold nodules (4.2%) than in males (8.2%). Age was an important factor in both sexes. The proportion of nodules that were malignant was smallest in patients of the 4th decade and was greatest in patients younger than 30 years or older than 60 years. Multivariate analysis showed that sex and age interact in determining the cancer risk in patients with thyroid nodules. Finally, the frequency of thyroid cancer in patients with a solitary nodule was not different from the frequency in patients with multiple nodules., Conclusion: Our study indicates that thyroid cancer risk in a patient with a nodular goiter varies markedly according to iodine intake, sex, and age but not in relation to multinodularity, as assessed by clinical examination. The knowledge of these epidemiologic aspects of thyroid cancer may increase the accuracy of the preoperative selection of patients with cold nodules of the thyroid.

Thyroid function was studied in newborn from 3 areas of Sicily in which iodine intake is normal (area A), moderately decreased (area B), and severely decreased (area C). In the latter 2 areas, there is a high incidence of goiter and in area C endemic cretinism is present. TSH and T4 were measured in the cord serum of 5673 newborn from area A, 2096 from area B, and 184 from area C. The mean TSH value was significantly higher in areas C (P less than 0.001) and B (P less than 0.005) when compared to area A; moreover, in both endemic goiter areas the mean cord serum T4 was significantly reduced (P less than 0.01). All infants with cord serum TSH levels above 50 microU/ml were recalled because of the suspicion of congenital hypothyroidism. Such values were found in 41 of the 7953 infants (0.52%) with an increasing frequency from area A (9:5673 = 0.16%) to area B (14:2096 = 0.67%) to area C (18:184 = 9.78%). At the time of the recall examination [mean age, 32 +/- 8 (SD) days], 3 of the 41 recalled infants had died. Of the remaining 38 infants, 3 patterns evolved: 1) 23 had normal serum TSH and T4 values and were not studied further (false positives). 2) Eleven had elevated serum TSH and normal T4 values. They were reevaluated again after 3-6 weeks: all had normal values (transient hyperthyropinemia ). 3) Four infants had both high serum TSH and low serum T4 values (2 from area A and 2 from area C). They were diagnosed as having congenital hypothyroidism and treated with T4. At 10-13 months of age, after treatment withdrawal, the 2 infants from area A had permanent congenital hypothyroidism due to thyroid agenesis whereas the 2 infants from area C were euthyroid (transient congenital hypothyroidism). The present studies indicate, therefore, that in newborn from areas of iodine deficiency there is a higher frequency of elevated TSH levels and low T4 values than is found in areas where iodine intake is normal. This frequency is correlated to the degree of the iodine deficiency. The data suggest that the impairment of thyroid function at birth may be a transient phenomenon. The duration and the severity of the transient neonatal hypothyroidism, however, is greatly variable and its evolution unpredictable.

Newborn infants have elevated serum thyroglobulin (Tg) levels and reduced iodination of Tg. To determine whether a relationship exists between serum Tg levels and the degree of Tg iodination, 699 newborn infants were studied in 3 areas of Sicily: a normal iodine-sufficient (control) area and 2 iodine-deficient areas. In the iodine-sufficient area, the mean cord serum Tg level was 25.8 ng/ml (median, 18.0; n = 183). In the iodine-deficient areas, the serum Tg levels in newborns were significantly higher, with mean levels of 43.4 ng/ml (median, 29.7; n = 304; P less than 0.01) and 60.1 ng/ml (median, 48.0; n = 212; P less than 0.005), respectively. The higher serum Tg level at birth was not entirely due to increased cord serum TSH levels, since newborns from the iodine-deficient areas with serum TSH levels at birth similar to those in infants from the control area had higher serum Tg levels. Serum Tg levels correlated with the serum T3 to T4 ratio, but not with serum TSH, T4, or T3 levels. These data suggest that iodine availability, which affects the degree of thyroid Tg iodination, partially determines serum Tg levels at birth.

We have characterized the GH clinical preparation available in Italy (Grorm, Serono) by gel chromatography and immunoreactivity. Only 50-60% of this preparation can be identified with the active GH monomeric form. Both higher and lower molecular weight compounds are present as well. Then, using a radioimmunoassay technique, we looked for anti-GH antibodies in 21 subjects under Grorm treatment and found them in 6 paitents (28.6%). Two subjects having anti-GH antibodies with high affinity had a lower growth rate. These data suggest that anti-GH antibodies measurement is clinically useful in patients treated with this GH preparation. A more purified preparation should be used when a slowing down of the growth rate is observed in the presence of anti-GH antibodies.