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Objective: Hidradenitis suppurativa (HS) is a chronic inflammatory disease of the hair follicle. Its treatment often requires a surgical approach. The aim of our study was to evaluate the occurrence of post-surgical complications following a new standard of surgical management. This included presurgical lesion mapping by ultra-high frequency ultrasound (UHFUS) with a 70MHz probe. Postoperative management was based on the principles of HS-TIME (time, inflammation/infection, moisture, edges). Method: A single-centre, retrospective study was conducted by the Department of Dermatology of the University of Pisa. Patients with moderate and severe HS, refractory to previous medical and surgical therapies, were enrolled. All of the patients were treated with wide surgical excision of lesions, previously explored through a UHFUS evaluation with VEVO MD (Fujifilm VisualSonics, Inc., Canada) using a 48MHz and a 70MHz ultrasound probe. Following surgery, all patients were treated with secondary intention healing following the principles of HS-TIME. For each patient, we assessed the occurrence of post-surgical complications at follow-up visit six months after surgery. For each patient we assessed the occurrence of early post-surgical complications at every follow-up visit after surgery until complete wound healing. The occurrence of delayed complications was then assessed in all patients with an observation time after complete healing of >3 months (n=23). Results: A total of 26 patients were enrolled in the study. There were no reported cases of post-surgical bleeding or haematoma occurrence, while three (11.5%) patients developed minor surgical site infection. The average severity of pain decreased from a numerical rating scale of 5.3 immediately after surgery to 1.3 after four weeks. The average healing time was 33.3±16.8 days, and only five (19.2%) patients reported a complete wound healing time of >6 weeks. Focusing on delayed complications: 1/23 (4.3%) patient had hypertrophic scarring; 2/23 (8.7%) patients reported dysaesthesia; and 2/23 (8.7%) cases of clinical relapse were reported. No cases of limited mobility at the surgery site were registered. Conclusion: The findings of the study demonstrated the efficacy of a novel surgical protocol, including a preoperative ultrasound evaluation and appropriate postoperative wound management. Further prospective studies are needed to validate the observed results; however, we conclude that the low recurrence rates and post-surgical complications confirmed that our proposed protocol would represent an effective strategy for the management of patients with HS eligible for surgical therapy. [ABSTRACT FROM AUTHOR]

Objectives: Remission in systemic lupus erythematosus (SLE) is defined through a combination of 'clinical SLE Disease Activity Index (cSLEDAI)=0', 'physician's global assessment (PGA) <0.5' and 'prednisone (PDN) ≤5 mg/day'. We investigated the performance of these items, alone or in combination, in defining remission and in predicting SLICC/ACR Damage Index.Methods: We tested seven potential definitions of remission in SLE patients followed-up for ≥5 years: PDN ≤5 mg/day; PGA <0.5; cSLEDAI=0; PGA <0.5 plus PDN ≤5 mg/day; cSLEDAI=0 plus PGA <0.5; cSLEDAI=0 plus PDN ≤5 mg/day; cSLEDAI=0 plus PDN ≤5 mg/day plus PGA <0.5. The effect of these definitions on damage was evaluated by Poisson regression analysis; the best performance was identified as the lowest Akaike and Bayesian information criterion (AIC and BIC). Positive and negative predictive values in identifying no damage increase were calculated.Results: We included 646 patients (mean±SD disease duration 9.2±6.9 years). At multivariate analysis, ≥2 consecutive year remission according to all definitions protected against damage (OR, 95% CI: PGA <0.5 0.631, 0.444 to 0.896; cSLEDAI=0 0.531, 0.371 to 0.759; PGA <0.5 plus PDN ≤5 mg/day 0.554, 0.381 to 0.805; cSLEDAI=0 plus PGA <0.5 0.574, 0.400 to 0.826; cSLEDAI=0 plus PDN ≤5 mg/day 0.543, 0.376 to 0.785; cSLEDAI=0 plus PDN ≤5 mg/day plus PGA <0.5 0.532, 0.363 to 0.781, p<0.01 for all), except PDN ≤5 mg/day, which required four consecutive years (OR 0.534, 95% CI 0.325 to 0.877, p=0.013). Positive and negative predictive values were similar; however, cSLEDAI=0 showed the best performance (AIC 1082.90, BIC 1109.72, p<0.0001). Adding PGA <0.5 and/or PDN ≤5 mg/day to cSLEDAI=0 decreased remission duration (-1.8 and -1.5 year/patient, respectively) without increasing cSLEDAI=0 performance in predicting damage accrual.Conclusions: cSLEDAI=0 is the most attainable definition of remission, while displaying the best performance in predicting damage progression in the short-to-mid-term follow-up. [ABSTRACT FROM AUTHOR]

Apulia (southeast of Italy) has always been an agricultural region in the Italian landscape. Nowadays, the countryside is a mix of natural environments and artificial landscapes. From 2014 to 2016, the region has been the object of a project aimed to collect information about geographic position and surface devoted to legume and/or cereal landrace cultivation. The collection missions carried out allowed the acquisition of 352 samples belonging to eight legumes and six cereal species. Chickpeas predominated among legumes, while durum and common wheat landraces prevailed among cereals. The cultivation of these landraces was mainly located in the marginal areas of central and southern Apulia region. The geographical information system technology, used in order to geo-reference the collection sites, allowed investigating the changes in land cover/land use (LCLU) occurred over the last three decades at each collecting site. In addition to the evidences collected at field level, the comparison of old ortho-photos and recent satellite images, available on Copernicus Land Monitoring Service of European Environment Agency, shown that very limited changes of LCLU have occurred. Near the collection sites, the agrarian landscape is remained highly fragmented as it was three decades ago. The cultivation side by side of irregular patches with legumes, cereals, olive trees, and grapevine characterise the agricultural landscape. Based on these evidences it can be infer that the absence of significant changes in LCLU has play a positive role in the safeguard of on farm conservation of Apulian landraces. [ABSTRACT FROM AUTHOR]

Objective. To investigate the role of acetylsalicylic acid (ASA) in reducing the incidence of cardiovascular (CV) events in an Italian multicentre rheumatoid arthritis (RA) inception cohort. Methods. The clinical charts of RA patients consecutively admitted to 4 Italian centres for their 1st visit from November 1, 2000, to December 31, 2015, and followed up till December 2016 were retrospectively investigated for the incidence of CV events. Patients were subdivided into two groups, namely, ASA- and non-ASA-treated groups. The Kaplan–Meier curve and log-rank test were used to investigate differences in event-free survival. Cox regression analysis was carried out to identify factors associated with CV event occurrence. Results. Seven hundred forty-six consecutive RA patients were enrolled and followed up for a median of 5.6 years (range 2.9–8.9 years). The incidence rate (IR) of CV events was 8/1000 person-years (p-ys) in the overall cohort. The IR of CV events was significantly lower in the ASA-treated group with respect to the non-ASA-treated group (IR 1.7 vs. 11.8/1000 p-ys; p=0.0002). The CV event-free rate was longer in ASA-treated patients than in non-ASA-treated patients (log-rank test 12.8; p=0.0003). At multivariable analysis, arterial hypertension (HR 9.3) and hypercholesterolemia (HR 2.8) resulted to be positive predictors and ASA (HR 0.09) and hydroxychloroquine (HCQ) (HR 0.22) to be negative predictors. Conclusion. The IR of CV events in our Italian multicentre cohort was lower than that reported in other European and non-European cohorts. Low-dose ASA may have a role in the primary prophylaxis of CV events in RA patients. [ABSTRACT FROM AUTHOR]

Aim. The aim of the study is to evaluate the therapeutic efficacy of a probiotic containing Lactobacillus reuteri DSM 17938 and Lactobacillus reuteri ATCC PTA 5289 in a sample of adult subjects affected by chronic periodontitis, associated with the periodontal treatment of Scaling and Root Planing (SRP). Methods. The enrolment of 40 patients, aged between 18-70 years (mean age 46.55±14.33), was carried out at Department Diagnosis, Hygiene and Oral Prevention, University of Rome "Tor Vergata", Rome, Italy. The subjects were assessed at baseline (T0) and after 1 month from the SRP (T1). The periodontal evaluation included: last data of Supportive Periodontal Therapy (SPT), Bleeding on Probing (BOP), Pocket Probing Depth (PPD), Clinical Attachment Level (CAL). The sample of the subjects was randomly divided into two groups: Group 1 (case group), who received the probiotic, and Group 2 (control group). Statistics. A randomized, single centre, controlled, parallel-group clinical study was conducted. Chi-Square test was used to evaluate statistical differences between gender and Groups. The Anova's one-way analysis and Paired Sample t-test were applied to interpret the changes observed between the groups and in pre and post probiotic assumption for the clinical variables. The significance level was accepted 0.05. All statistical analyses were performed with the SPSS package. Results. 40 patients aged between 18 and 70 years, with mean age of 46.55±14.33 were analysed. The Groups 1 and 2 were homogeneous, equal distributed for sex (p=0.21) and last data of SPT (p=0.09). There was a statistically significant difference, between the clinical parameters examined at T0 and T1, for Group 1 and 2: BOP (p=<0.001), PPD (p=<0.001), CAL (p=<0.001). The analysis of the Groups 1 and 2, in relation to the three clinical parameters, at the time T1, shows that for the BOP and PPD there were statistically significant differences (BOP p<0.001), (PPD p=0.02). There was no statistically significant difference between the Groups 1 and 2 in relation to CAL at the time T1 (CAL p=0.11). Conclusions. The subjects with CP, treated with SRP and probiotic, show some beneficial effect of Lactobacillus reuteri with significant reduction of BOP and PPD. [ABSTRACT FROM AUTHOR]

Aim: Chronic wounds represent a clinical challenge of considerable complexity, given the articulated pathophysiology underlying their origin and the burden of long-term management with local dressings. Monoclonal antibodies (mAbs) are emerging as a novel therapeutic choice in clinical experiences of difficult to heal wounds, but no data are still available as a comprehensive view of their use in wound care. The goal of our work was then to review the use of those drugs in the existing literature. Method: We performed a comprehensive literature review of 167 articles examining clinical cases of chronic wounds treated with mAbs. Inflammatory pathologies with possible ulcerative outcomes, such as hidradenitis suppurativa, were excluded from the analysis. Results / Discussion: mAbs were found to be effective in treating wounds from 16 different etiopathogenesis. The most represented diseases were pyoderma gangrenosum treated with 12 different mAbs, necrobiosis lipoidica and cutaneous vasculitis treated with 3 different mAbs. The total number of different mAbs analyzed from the literature was 14. Rituximab was effective in 7/16 diseases (43.75%), followed by Tocilizumab used in 4/16 (25%) diseases and Etanercept and Adalimumab, both applied for 3/16 (18.75%) conditions. Conclusion: mAbs represent a therapeutic opportunity in cases of chronic wounds recalcitrant to standard treatments. Due to the complex molecular landscape of wound healing, it is not possible to identify a single target molecule and for this reason the use of mAbs should be interpreted as a translational application to limited cases of multi-resistant conditions. [ABSTRACT FROM AUTHOR]

Aim: Photobiomodulation has been studied in animal models and in humans where it has elicited stalled wounds' inflammation overcoming and stimulated tissue regeneration. The aim of this clinical trial is to evaluate the use of the Blue Light Photobiomodulation in terms of healing rate, quality of life and cost-effectiveness in patient with venous or mixed leg ulcers. Method: As primary objective, the trial aims to compare the healing rate between the control group, treated twice a week with standard of care (SoC) only, and the experimental group, treated once a week with Soc and Photobiomodulation therapy over a follow-up of 16 weeks. Blue Light treatment is performed for 60 seconds on the entire lesion's area with a portable, rechargeable medical device (EmoLED) that uses Blue LED Light. For primary and secondary objectives, the lesion size, the pain (VAS scale), quality of life as well as the direct (health and non-health) and indirect costs are prospectively collected. Patients from Pisa, Italy, are considered for these results. Results / Discussion: We observed a reduction in the bacterial colonization levels of the wound bed and perilesional skin by 67% and 57.15% for group A and 71.16% and 61.54% for group B. We obtained a reduction in Numerical Rating Scale (NRS) for pain of 65% and 67% for group A and group B, respectively. Conclusion: Currently, 23 patients (12 control group, 11 treated group) have been analyzed. Preliminary data show that the results of the ulcers treated with blue light (50% size reduction; 88% pain reduction) and the control ulcers (57% size reduction; 80% pain reduction) can be considered equivalent. [ABSTRACT FROM AUTHOR]

Aim: Pyoderma Gangrenosum (PG) is a neutrophilic dermatosis that represents a clinical challenge because of the frequent recurrence of the disease. The aim of our work was to evaluate the use of Baricitinib, an oral JAK1/2 inhibitor, as a third-line biologic agent for the treatment of a multi-refractory PG case. Method: A 70-year old woman was admitted to our clinic in February 2022 with right foot lesions diagnosed as PG. The patient was affected by chronic lymphoid leukemia in remission and was unsuccessfully treated with Guselkumab, Adalimumab and cyclophosphamide. Because of the absence of clinical improvement, Baricitinib 8 mg/day and Prednisone 25 mg/die were started (T0). Proper local wound management was carried out and at T7 we performed an homologous graft. At each visit, Wound Bed Score (WBS) was assessed and pain was evaluated with Numerical Rating Scale (NRS). Results / Discussion: At T0 the Wound Bed Score (WBS) was 8, while pain measured through the Numerical Rating Scale (NRS) was assessed at 9. At T7 there was an improvement of pain and a similar wound severity (WBS 8; NRS pain 6), while at T21 pain was further reduced (NRS pain 5) and no signs of clinical worsening appeared at the graft site. Conclusion: In clinical cases of multi refractory PG, homologous graft combined with Baricitinib and Prednisone therapy could represent a further therapeutic choice which, in our short experience, allows better management of local pain and determines an arrest of the inflammatory component. [ABSTRACT FROM AUTHOR]

Aim: Pyoderma Gangrenosum (PG) is a neutrophilic dermatosis that represents a clinical challenge because of the frequent occurrence of the disease. The aim of our work was to evaluate the effectiveness of a combination of local and systemic therapy in achieving and maintaining therapeutic response. Method: A 38-year old woman was admitted to our clinic in September 2022 with circumferential left lower limb lesions diagnosed as PG. The patient was affected by Systemic lupus erythematosus (SLE) and recalcitrant PG, previously remitted with Rituximab, but reactivated during the years of the COVID-19 pandemic. Results / Discussion: At the first visit, the wound was painful and surrounded by a lilac ring, with an adherent fibrinous layer and signs of major colonization by Pseudomonas Aeruginosa. Corticosteroids were initially administered 1 mg/ kg / day then progressively tapered to total daily 8 mg. Local management was based on the principles of PG-TIME and consisted of silver hydrofiber and antiseptic polyurethane foam, which led the wound bed to move from a green color, hallmark of Pseudomonas aeruginosa colonization, to a yellow fibrinous one. After an enzymatic debridement, Negative Pressure Wound Therapy (NPWT) with polyurethane foam and compression bandage was applied. After obtaining granulation tissue, we performed an homologous skin graft which resulted in complete wound healing. Conclusion: Our case report shows that a combined approach based on the association between systemic and local therapy is the best therapeutic strategy for the management of recurrent PG and it emphasizes the importance of proper wound bed management. [ABSTRACT FROM AUTHOR]

Aim: The aim of our study was to evaluate the effectiveness of an oxygen-enriched oil-based medical device with prolonged release of Reactive Oxygen Species (ROS) in post-surgical wounds healing time. Method: 5 patients were treated with surgical excision of head and neck lesions (4 suspected squamous cell carcinomas and 1 draining fistulas caused by hydrosadenitis suppurativa). The lesions were treated with an oxygen-enriched oil-based medical device with prolonged release of ROS and polyurethane foam. Patients were evaluated once a week for 4 weeks. During each visit a comprehensive wound assessment was provided. Wound area, perimeter and maximum depth of post-surgical wounds were evaluated by a 3D imaging system. Wound bed and surrounding skin features were evaluated with the Wound Bed Score (WBS). Results / Discussion: An average improvement in WBS was observed over a mean observation time of 28 days, moving from 8 at week 0 to 14 after 4 weeks; the results in terms of area, perimeter and maximum wound depth are shown in the figures below. One patient achieved complete wound resolution after 28 days. The wound dressings were well tolerated without adverse events by all the patients. Conclusion: The gel's oleic composition provided a correct moist microenvironment, while the sustained-release of ROS improved the process of angiogenesis, cell proliferation and collagen synthesis. Moreover, the constant and prolonged release of ROS appeared to be able to inhibit bacterial and fungal proliferation. The results obtained from this study demonstrated the preliminary effectiveness of oxygen-enriched olive oil in postsurgical wounds, to be confirmed through a future randomized controlled trial. [ABSTRACT FROM AUTHOR]

Aim: Pyoderma Gangrenosum (PG) is a neutrophilic dermatosis that represents a challenge to the clinician in terms of diagnosis and treatment. Current research data are focused on the use of monoclonal antibodies (mAbs) directed against target molecules involved in the pathogenesis of PG. We reported the clinical cases of three patients affected by multi refractory PG, who were treated with a new approach based on both local and systemic therapies. Method: The off-label use of a mAb directed against the p19 subunit of IL-23, Risankizumab (150 mg at week 0, 150 mg after four weeks and 150 mg every 10 weeks) was combined with proper local management of ulcers, based on the principles of PG-TIME applied to the inflammatory and non-inflammatory phases of PG. The efficacy of the therapy was evaluated through the use of the Wound Bed Score (WBS) system. Results / Discussion: Patient 1 obtained a complete resolution at week 24 (WBS=7 vs WBS=16), while lesions of patient 2 were resolved at week 16 (WBS=5 vs WBS=16). The results obtained were maintained until the date of the last visit, at week 40, without side effects or recurrence of disease. Patient 3 moved from a WBS of 5 at week 0 to a WBS of 10 during the last visit at week 12. Conclusion: In conclusion, our clinical cases demonstrated how Risankizumab can be a viable systemic therapy for recalcitrant PG, particularly when associated with local wound management. [ABSTRACT FROM AUTHOR]

Aim: Hidradenitis suppurativa (HS) is a chronic inflammatory disease that often requires a surgical approach with secondary intention closure. The aim of our case report was to explore the clinical improvement obtainable through the use of a new ultraportable NPWT device in the post-surgical management of HS lesions. Method: A 23-year-old male patient affected by axillary and intergluteal HS with Hurley IIC was admitted at our clinic in August 2022. The presence of a scarring area with a fistula in the right axilla was assessed, for which surgery was scheduled in October 2022. After the wide local excision, closure by secondary intention was planned and application of a silver hydrofiber and a thin polyurethane foam was performed twice a week. Due to the slow progression of wound healing, an ultraportable NPWT was applied at T28 and it was changed at T30, T34 and T38. At each visit, the wound was evaluated in terms of area, perimeter, depth, Wound Bed Score (WBS) and Numerical Rating Scale (NRS) for pain quantification. Results / Discussion: NPWT resulted in higher WBS improvement compared to advanced dressings (ΔWBS 6 vs ΔWBS 2). Furthermore, it determined a greater reduction of area (ΔArea 4 vs ΔArea 5), perimeter (Δperimeter 18 mm vs Δperimeter 14mm) and maximum depth (Δdepth 2mm vs Δdepth 0mm) as well as a better improvement of NRS pain (ΔNRS 4 vs ΔNRS 3). Conclusion: Ultra-portable NPWT represents a highly effective therapeutic strategy in the management of post-surgical HS wounds, allowing a fast improvement in terms of wound size and pain reduction, resulting in an overall gain of quality of life. [ABSTRACT FROM AUTHOR]

Aim: A novel fluorescence imaging device has recently allowed real-time detection of bacteria in different types of wounds through endogenous autofluorescence. The fluorescence signals detected by the device provide health workers with a visual indication of the presence, load and distribution of bacteria. The aim of our study was to evaluate the level of bacterial colonization in venous leg ulcers and perilesional skin of patients treated with two different types of bandages: compressive multilayer bandage and zinc oxide bandage. Method: We enrolled 14 patients with venous insufficiency, divided in two groups: group A was treated with compressive multilayer bandage and group B with zinc oxide bandage. We evaluated patients 2 times a week for 3 weeks using a fluorescent device able to detect potentially harmful bacteria in wound bed and perilesional skin. Evaluations were performed in a qualiquantitative way by two experienced operators on the frames taken at individual injuries. Results / Discussion: We observed a reduction in the bacterial colonization levels of the wound bed and perilesional skin by 67% and 57.15% for group A and 71.16% and 61.54% for group B. We obtained a reduction in Numerical Rating Scale (NRS) for pain of 65% and 67% for group A and group B, respectively. Conclusion: Our study demonstrates that the application of zinc oxide bandage provides a higher reduction in bacterial load in the wound bed and perilesional skin. On the other hand, we found no difference between the two bandages in terms of pain symptom reduction. [ABSTRACT FROM AUTHOR]

Aim: Wound healing process is affected by physiological and biological parameters, including temperature and pH. Several papers describe how pH modifies matrix metalloproteinases (MMPs) and their tissue inhibition activity, as well as keratinocyte and microbial proliferation. The aim of our study was to evaluate the effectiveness of a new elastic bandage made of cotton and polyamide, impregnated with an oxygen-enriched oleic matrix, in subjects affected by chronic venous insufficiency. Method: We enrolled 7 patients with lower extremity ulcers and stasis eczema. The patients were treated with the elastic bandage and were evaluated at time (T)0 and T7. pH measurements were performed on the lower limb at 3 points (ankle, pretibial and subpatellar region) and on the wound bed. Wound bed was assessed using the Wound Bed Score (WBS), while pain was evaluated with Numerical Rating Scale (NRS). Results / Discussion: After one week a reduction in lower extremity pH measurement of 26.22%, 28.6 %, 27.5 % for ankle, pretibial surface, and subpatellar region, respectively was observed with a mean decrease in wound pH measurement of 17.85%. Finally, an objectifiable clinical improvement in stasis eczema, wound bed (ΔWBS=2.3) and pain NRS (ΔNRS=2) was detected. Conclusion: The prolonged release of reactive oxygen species, acting on microbial contamination, created a microenvironment unfavorable to pathogen's proliferation because of the pH reduction. This could be explained through the molecular role played by pH in wound healing and biofilm formation process. [ABSTRACT FROM AUTHOR]

Alien insects usually adapt their phenology and their needs to the environment into which they are introduced. During 2010, the red gum lerp psyllid, Glycaspis brimblecombei, was accidentally introduced into Italy, becoming an invasive pest of Eucalyptus L'Hér. Eucalyptus are very common in Italy as ornamental and forest species. The seasonal adaptation of the Psyllidae was studied at three field sites. G. brimblecombei showed a seasonal population dynamic, suggesting that many generations occur during the year and the species overwinters in all stages without diapause. The population size in the new area of colonization is affected by low winter temperatures, but also by high temperatures in the absence of rainfall. In Lazio, the specific parasitoid Psyllaephagus bliteus was collected for the first time. [ABSTRACT FROM AUTHOR]

The control exerted by the hydrostratigraphic structure on aquifer recharge, groundwater flow and discharge along the coastal areas of a Mediterranean basin (Salento peninsula, about 5,000 km wide, southern Italy) is assessed through the development and application of a groundwater flow model based on the reconstruction of the hydrostratigraphic architecture at the regional scale. The hydrostratigraphic model, obtained by processing surface and subsurface data, is applied to map the top of the main aquifer, which is hosted in the deep hydrostratigraphic unit corresponding to Cretaceous and Oligocene limestones with complex geometrical relationships with the sea. It is also used to estimate the aquifer recharge, which occurs by percolation through overlying younger sediments with low permeability. These data are completed with information about the soil use to estimate water abstraction for irrigation and with literature data to estimate the water abstraction for drinking and industrial purposes. The above-sketched conceptual model is the basis for a finite difference groundwater 2D pseudo-stationary flow model, which assumes the following fundamental approximations: the fractured and karst limestone hydrostratigraphic unit can be approximated, at the model scale, as a continuous medium for which the discrete Darcy's law is valid; the transition zone between salt and fresh water is so small with respect to the grid spacing that the Ghyben-Herzberg's approximation for a sharp interface can be applied. Along the coastline different boundary conditions are assigned if the top of the limestone hydrostratigraphic unit lies either above the sea level (the aquifer has a free surface and fresh water is drained), or below the sea level (the aquifer is under pressure and the contact with sea occurs off-shore). The groundwater flow model correctly predicts the areas where the aquifer is fully saturated with salt water. [ABSTRACT FROM AUTHOR]

Sinkholes and land subsidence are among the main coastal geologic hazards. Their occurrence poses a serious threat to the man-made environment, due to the increasing density of population, pipelines and other infrastructures along the coasts, and to the catastrophic nature of the phenomena, which generally occur without any premonitory signs. To assess the potential danger from sinkholes along the coast, it is important to identify and monitor the main factors contributing to the process. This article reports a methodology based on sequential stratigraphic, hydrogeological and geophysical investigations to draw up a susceptibility map of sinkholes in coastal areas. The town of Casalabate situated in the Apulia region (southern Italy), affected by a long history of sinkhole phenomena, is here presented as an example. The approach proposed is based on sequential stratigraphical, geomorphological and geophysical surveys to identify the mechanisms of sinkhole formation and to provide a zonation of the areas in which further sinkhole phenomena may likely occur. Interpretation of the ground penetration radar and electrical tomography profiles has enabled us to identify the potentially most unstable sectors, significantly improving the assessment of the sinkhole susceptibility in the area. The proposed methodology is suitable to be exported in other coastal areas where limestone bedrock is not directly exposed at the surface, but covered by a variable thickness of recent deposits. [ABSTRACT FROM AUTHOR]

Peptic ulcer disease incidence is decreasing. Both s1m1 and s1m2 vacA gene combinations of Helicobacter pylori have been associated with the development of major gastroduodenal diseases. This study assessed whether H. pylori vacA gene arrangement changed over 15 years in a Southern Italy area. H. pylori-positive patients observed in January-June 1989 and January-June 2005 were selected. Histological specimens were retrieved to extract DNA for vacA arrangement characterization (mid-m and peptide signal-s regions) by using the polymerase chain reaction. Fifty-nine patients in the first period and 56 matched patients in the second period were evaluated. A correlation between s1 presence and intestinal metaplasia at histology was found. Overall, the s1m1 combination increased (P < 0.01) and s2m2 decreased (P < 0.001) during the study period. In detail, s1m1 (P < 0.05) and s1m2 (P < 0.01) increased, and s2m2 decreased (P < 0.001) in dyspeptic patients, while only s1m1 increased (P < 0.01) in peptic ulcer patients. Finally, few cases of s2m1 combination in both series were found. Our results show some unexpected aspects that require confirmation. In detail, the increased prevalence of potential more virulent H. pylori strains contrasts with peptic ulcer incidence reduction. [ABSTRACT FROM AUTHOR]

Background : Although Helicobacter pylori DNA sequences have been detected in cholecystic bile and tissue of patients with gallstones, controversial results are reported from different geographic areas. Aim : To detect H. pylori in cholecystic bile and tissue of patients with gallstones from a previously uninvestigated geographic area, southern Italy. Detection included both the bacterial DNA and the specific antigen ( H. pylori stool antigen) identified in the stools of infected patients for diagnostic purposes. Patients and methods : The study enclosed 33 consecutive patients undergoing laparoscopic cholecystectomy for gallstones. DNA sequences of H. pylori were detected by polymerase chain reaction in both cholecystic bile and tissue homogenate. Moreover, we assayed H.pylori stool antigen on gall-bladder cytosolic and biliary proteins after their extraction. Bacterial presence in the stomach was assessed by urea breath test in all patients and Δ δ13CPDB value assumed as marker of intragastric load. Fisher's exact probability and Student's t-tests were used for statistical analysis. Results : DNA sequences of H. pylori in bile were found in 51.5% and significantly correlated with its presence in cholecystic tissue homogenate ( P < 0.005), H. pylori stool antigen in gall-bladder ( P = 0.0013) and bile ( P = 0.04) proteins, gastric infection ( P < 0.01) and intragastric bacterial load ( P < 0.001). No correlation was found, however, with sex and age of the patients. Conclusions : Our prevalence value of bacterial DNA in bile and gall-bladder of patients with gallstones agreed with that of the only other Italian study. The simultaneous presence of both bacterial DNA and proteic antigen suggests that the same prototype of bacterium could be located at both intestinal and cholecystic level and, therefore, the intestine represents the source of biliary contagion. [ABSTRACT FROM AUTHOR]

A randomly selected study population of 118 male subjects (> or = 40 years) living on the Mediterranean island of Pantelleria (southwest of Sicily, Italy) was examined for the presence of oral mucosal lesions, with particular emphasis on the early diagnosis of oral precancerous and cancerous lesions. The study population was interviewed for socioeconomic and behavioural information, and clinically examined using WHO criteria. The prevalence of oral mucosal lesions observed, and data obtained about oral hygiene, tobacco smoking, alcohol drinking and exposure to actinic radiation, were analysed. Alcohol drinking was the most common habit in the study population (73%), followed by tobacco smoking (58.5%, of whom 96% were cigarette smokers). Only 3% showed good oral hygiene and 25% were edentate. Oral lesions were observed in 81.3% of the study group, mainly coated tongue (51.4%), leukoplakia (13.8%), traumatic oral lesions (traumatic ulcers and frictional white lesions) in 9.2%, actinic cheilitis (4.6%), and squamous cell carcinoma in one case (0.9%). Statistically significant associations were found between the prevalence of coated tongue and tobacco smoking (P<0.0001), and between the prevalence of actinic cheilitis and tobacco smoking/alcohol drinking (P<0.05). Analysis of clinical and anamnestic data underlined the effective presence, in the population examined, of the behavioural risk factors for oral precancerous and cancerous lesions, and the lack of cultural motivation towards primary prevention activities, such as the elimination of risk habits. [ABSTRACT FROM AUTHOR]

The Salento Peninsula is a part of the larger Apulia Carbonate Platform, one of the carbonate platforms that have developed along the southern margin of the Tethys Ocean since the Triassic, above the Adria microplate. This peninsula represents the culmination of a lithospheric anticline formed due to the subduction of the Adria Plate beneath two mountain belts migrating in opposite directions: the Dinarides-Albanides-Hellenides (DAH) chain, moving from NE to SW, and the southern Apennines (SA) chain, moving from SW to NE. Consequently, the Salento Peninsula represents the foreland sector of these two mountain belts, whose different migration rates, deeply influenced the carbonate sedimentation and paleogeographic evolution of this area over the last 60 Myr. In our study field analysis, a database of 350 wells, and 90 seismic lines calibrated with 3 exploration wells were employed to characterize the physical stratigraphy and depositional setting of the Salento Peninsula and define its paleogeographic evolution during the Paleogene and Neogene. Our results suggest that temporal variations in sedimentation rates and types as well as the reduced thickness (maximum 200 m) of the Cenozoic stratigraphic succession in the internal sectors and both along the Adriatic and Ionian margins of the Salento Peninsula are directly or indirectly linked to the migration rates of the DAH and SA chains. These migration rates played a role in determining changes in subsidence rates, the occurrence of soft-sediment deformation, and the influx of Plio-Pleistocene fine-grained terrigenous sediments, especially along the Ionian margin. Although the investigated succession exhibits a reduced thickness, it comprises several lithostratigraphic units bounded by unconformity surfaces. Within these units, a stack of complete and incomplete simple and composite high- and low-rank depositional sequences has been recognized. Our data suggest that these units are the result of a multifold cyclicity, reflecting the close interaction between eustatic sea-level changes and the tectonic setting of the area. • Stratigraphy of the Salento Peninsula. • Cenozoic onshore stratigraphic cross-sections and paleogeographic reconstruction. • Seismic profiles and construction of land-sea stratigraphic cross-sections. • Relationships between tectonics and sedimentation in a foreland setting. • Sequence-stratigraphy framework of the Cenozoic sedimentary succession of the Salento Peninsula. [ABSTRACT FROM AUTHOR]

Abstract: STRs are today one of the most effective tools for individual and populational genetic characterization. This paper presents the results of a population study of 15 STR loci included in AmpFlSTR Identifiler kit (Applied Biosystems) that has the aim of creating a local database. Blood or oral swab samples were obtained from 100 unrelated individuals, who were born in Terni (in the center of Italy) and lived there for at least two generations. DNA was extracted from blood, using QIAamp, miniKit of Qiagen and from oral swab, using Chelex method. For each locus allele frequency was calculated and Hardy–Weinberg equilibrium was evaluated. The Expected Heterozygosity (He), the Observed Heterozygosity (Ho), the Polymorphic Information Content (PIC), the Power of Discrimination (PD) and the Power of exclusion (PE) were also calculated. [Copyright &y& Elsevier]

Abstract: ChrX markers represent an efficient supplementation of autosomal and Y-chromosomal STR analysis and ChrX haplotyping can elucidate complicated kinship situations. This is the reason why it needs to increase the population data for ChrX STR allelic frequencies and to create national or local databases. An esaplex PCR was developed to amplify DXS6789, HumARA, DXS7423, DXS6807, DXS101 and DXS8377 in some Italian samples from Perugia and Terni. This system represents a protocol for the ChrX analysis with a shorter procedure. The DNA was extracted from 100 blood samples using the QIAmp DNA Minikit produced by Qiagen. The samples were detected on an ABI PRISM 310 Genetic Analyzer (Applied Biosystems), using the same dye labels, run conditions, standard (GeneScan 500 Liz) and matrix file of AmpFlSTRIdentifiler. We performed statistical analysis for all the loci. [Copyright &y& Elsevier]

Objectives: To identify clinical outcomes and variables associated with 6-month mortality in very elderly patients admitted for nonacidotic acute exacerbation of chronic obstructive pulmonary disease (AECOPD)., Design: Prospective cohort study., Setting: General medicine acute care ward., Participants: Two hundred forty-four elderly patients with COPD (mean age+/-standard deviation 82+/-7, 55.7% female) admitted to the hospital because of non-acidotic AECOPD., Measurements: Cognitive and mood status and physiological variables were measured. Self-reported comorbidities were assessed using the Charlson Comorbidity Index. In-hospital and long-term mortality and clinical outcomes were recorded., Results: At admission, this elderly population with AECOPD had low cognitive performance (mean Mini-Mental State Examination score 21+/-5), no presence of significant depressive symptoms (Geriatric Depression Scale score 4+/-3), good nutritional status (body mass index (BMI) 25.1+/-5.5), moderate comorbidity (Charlson Comorbidity Index 4.0+/-1.9), high functional disability (Barthel Index (BI) 52+/-34), and moderate severity of acute exacerbation (Acute Physiology and Chronic Health Evaluation (APACHE) II score 9.7+/-4.2). Two hundred twenty-five inpatients with AECOPD were successfully discharged, whereas 15 were transferred to the intensive care unit, and four died in the hospital. The 6-month cumulative mortality rate in discharged patients with AECOPD was 20%. Multivariate Cox analysis shows that lower BMI (beta=-0.16; 95% confidence interval (CI)=0.73-0.99), higher APACHE II score (beta=0,17; 95% CI=1.03-1.36), and lower BI at discharge (beta=-0.02; 95% CI=0.96-0.99) were independently associated with 6-month mortality., Conclusion: Malnutrition, severity of exacerbation and disability status could be identified as risk factors associated with 6-month mortality of elderly patients admitted for nonacidotic AECOPD.

Background and Aims: The treatment of Alzheimer's disease (AD) is a challenge for physician, families, and patients. An individualized, multimodal treatment plan addressing the treatment of cognitive, behavioural and functional decline is essential. Aim of the paper is to describe the principal components of the treatment plan of AD patients., Methods: A review of the recent literature was performed., Results: Acetylcholinesterase inhibitors (AChEIs) play an important role in the improvement of cognitive decline in mild to moderate AD, even if the improvement is not permanent. Data obtained from the CRONOS project (involving about 500 Alzheimer Evaluation Units) replicate in the real world those obtained in controlled trials, confirming that AD patients may benefit from AChEI treatment. Treatment of behavioral and psychological symptoms of dementia (BPSD) requires education of caregivers, non pharmacological interventions, identification and treatment of medical illnesses or environmental precipitating conditions, specific pharmacological treatment. Traditional neuroleptics are widely used for BPSD treatment, but limited data support their use, and side-effects are frequent and severe. Atypical antipsychotics are effective in treating BPSD, and safer than traditional neuroleptics. However, the increased risk of cerebrovascular accident in patients taking risperidone or olanzapine limited currently their use in demented subjects. The use of antidepressant drugs, as well as behavioral approach, may improve depressive symptoms frequently accompanying AD., Conclusions: Although at present there is no cure for AD, several drug treatments and care strategies may improve or stabilize cognitive and behavioral symptoms, and improve the quality of life of patients and families.