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The present study evaluated: (1) the effects of two training programs designed for promoting Theory of Mind (ToM) skills in children aged 7/8; and (2) the relations between second-order recursive thinking (II-order-RT), advanced-ToM (Adv_ToM) and metacognition. Ninety-one 7- to 8-year-old children were assigned to one of three training conditions: a II-order-RT, an Adv_ToM, and a control condition. Groups were equivalent at pretest for SES, executive functions and reading comprehension. The main effect of time was significant on II-order-RT, but not on Adv_ToM and metacognition. Children of the II-order-RT group improved their performance on over the training period II-order-RT while children of the control group did not) and they also outperformed children of the control condition at posttest. This positive effect generalized to Adv_ToM. Children of the Adv_ToM group improved over the training period their performance on both Adv_ToM and II-order-RT (while children of the control group did not); moreover, they outperformed children of the control condition at posttest on Adv_ToM, but not on II-order-RT. The benefits of both ToM training programs extended to metacognitive knowledge. Our findings throw light upon generative mechanisms of acquisition that explain the relation between II-order-RT and Adv_ToM, and between these mature ToM skills and metacognition.

This paper focuses on system concept use in teaching either chemical core concepts or interdisciplinary chemistry-related topics. The system concept is important in order to develop global competences, and chemistry teaching plays a key role in this context. A questionnaire has been administered to two different samples, Italian teachers and International Baccalaureate (IB) teachers, in order to investigate their opinions about the issues involved. The most significant differences and similarities emerging from the survey have been analyzed mostly by dendrograms and then commented on. With due caution, it is possible to suppose similar attitudes in the two groups of teachers except for some aspects. For example, the analysis of system concept knowledge within pure chemistry highlights some deficiencies: Italian teachers in particular show a low level of epistemological awareness about the systemic character of chemistry, whereas its knowledge would allow not only a chemistry teaching improvement but also a productive use of chemical explanations in other scientific and nonscientific fields, especially in the social sciences; as a consequence, it would facilitate interdisciplinary teaching. Therefore, science teachers need epistemological insight into chemical systemic aspects, that may be provided by high quality textbooks and training initiatives focusing on the systemic character of chemistry and its interdisciplinary connections. In an analysis of chemistry teachers only, Italian teachers support interdisciplinary teaching more strongly than IB teachers, despite the rigidity and the state of crisis of the Italian education system, often attributed to a lack of broad-minded teachers. This evidence indicates a promising resource for the Italian education system. Moreover, a similar kind of questionnaire can be utilized by other education researchers in order to isolate and analyze some teachers' attitudes regardless the very different education systems in which every sample works.

The study of social cognition involves the attribution of states of mind to humans, as well as, quite recently, to nonhuman creatures, like God. Some studies support the role of social cognition in religious beliefs, whereas others ascribe religious beliefs to an ontological knowledge bias. The present study compares these distinct approaches in 37 catholic children aged 4 to 10 years, who were administered an adapted version of the unexpected content task assessing false beliefs of different agents: a human, a dog, a robot, and God. The children were also administered an intentionality understanding task, a component of mentalization abilities, and an interview on ontological knowledge assessing emotions, intentions, imagination, and epistemic knowledge. In line with previous research, the results showed that children did not attribute false beliefs to God as they did to the human and to other nonhuman agents. Importantly, while false-belief attribution to the human was associated with the children's ability to attribute mental states (intentionality understanding), false-belief attribution to God was related to children's ontological knowledge. We conclude that, contrary to false-belief attribution to the human and to other nonhuman agents, children's understanding of God's mind is largely a function of ontological knowledge about God, rather than of children's social cognitive functions.

Educating future scientists and citizens is more effective if students are guided to correctly apply what they learned in school to their daily lives. This experience-based work is focused on the study of a well-known commercial product: cat litter. This material offers different starting points for a critical examination. Questions related to physical properties at the origin of the litter's efficacy, to information on chemical composition provided in the packaging, and to environmental features and possible noxiousness of cat litter were asked to be investigated by secondary school 14-15 year old students, through laboratory experiments based on problem solving approach, analysis of tag claims of different cat litter brands and cooperative learning activities. This multidisciplinary approach gives the chance to learn effectively chemistry core concepts and to avoid the typical students' lack of attention.

An association between climatic conditions and asthma incidence has been widely assumed. However, it is unclear whether climatic variations have a fingerprint on asthma dynamics over long time intervals. The aim of this study is to detect a possible correlation of the Summer North Atlantic Oscillation (S-NAO) index and the self-calibrated palmer drought severity index (scPDSI) with asthma incidence over the period from 1957 to 2006 in Italy. To this aim, an analysis of non-stationary and non-linear signals was performed on the time series of the Italian databases on respiratory health (ISAYA and GEIRD) including 36,255 individuals overall, S-NAO, and scPDSI indices to search for characteristic periodicities. The ISAYA (Italian Study on Asthma in Young Adults) and GEIRD (Gene Environment Interactions in Respiratory Diseases) studies collected information on respiratory health in general population samples, born between 1925 and 1989 and aged 20–84 years at the time of the interview, from 13 Italian centres. We found that annual asthma total incidence shared the same periodicity throughout the 1957–2006 time interval. Asthma incidence turned out to be correlated with the dynamics of the scPDSI, modulated by the S-NAO, sharing the same averaged 6 year-periodicity. Since climate patterns appear to influence asthma incidence, future studies aimed at elucidating the complex relationships between climate and asthma incidence are warranted. [ABSTRACT FROM AUTHOR]

Copyright of SCENARIO: Official Italian Journal of ANIARTI is the property of ANIARTI and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Multiple environmental stressors threaten the environmental quality in urban areas.Several policies were implemented in Italy to improve environmental quality, following the rationale that the more populated municipalities need high intervention priority and funds. Nevertheless, this approach not necessarily ensures to address real environmental challenges. This study aims to provide an innovative approach to explore interventions' priority at the national scale, based on Environmental Quality Standards (EQS) of five factors related to three environmental stressors, air pollution (O 3 , PM 10 , NO 2), thermal stress (heatwave days), and hydraulic vulnerability (flooding events). A multi-criteria analysis assessed the cumulative effect of factors by combining them into a single Aggregate Index of Challenge (AIC), and a hotspot analysis identified AIC spatial aggregation through the territory. Finally, the spatial mismatch between Italian environmental policies and the co-occurrence of factors was explored. Results evidenced EQS exceedances in the national territory of O 3 for 89%, PM 10 for 8%, NO 2 for less than 1%, heatwaves for 45%, and hydraulic vulnerability for 10%. AIC highlighted that 43% of the national surface shows the coexistence of at least two factors in EQS exceedance. Results highlighted that administrative boundaries are not sufficient to delimit an area of analysis and intervention as opposed to an evidence-based approach which seems promising for enhancing the costeffectiveness of funds allocation as well as their return in terms of human wellbeing. This study provides a novel approach to enhance environmental policies and planning, giving insight for future research, especially for Nature-Based Solutions implementation, performance, and multifunctionality. • Multi-criteria analysis was performed to assess co-occurrence of stressors. • Intervention priority was identified based on aggregate indices of challenge. • 43% of the Italian territory is simultaneously threatened by multiple stressors. • High stressors heterogeneity is found within the analyzed administrative domains. • Evidence-based approach can improve cost-effectiveness of policies in urban areas. [ABSTRACT FROM AUTHOR]

Aims: To evaluate the association between the C-reactive protein (CRP)/albumin (ALB) ratio and survival in dogs with acute pancreatitis and its use as a prognostic marker for survival. Methods: Medical records of a veterinary referral hospital in Italy were retrospectively searched for dogs that were admitted with acute pancreatitis between January 2015 and April 2019, in which the concentrations of CRP and ALB in serum were measured at admission. The CRP/ALB ratio was calculated and the time between admission and discharge or death was recorded. Mortality rates overall and for dogs that died within 2 days of admission were calculated. A univariable Cox proportional hazard model was used to assess the relationship between survival time and CRP/ALB ratio. Results: Seventy-one dogs were included in the study. Of these, 19 died within 2 days of presentation; an early mortality rate of 26.8%, while 27 died before discharge for an overall mortality rated of 38%. Dogs with higher CRP/ALB ratio had a significantly greater mortality rate than dogs with lower CRP/ALB ratio: for every 1-unit increase in CRP/ALB ratio, the hazard of death over the study period increased by 130% (hazard ratio = 2.34; 95% CI = 1.53–3.58; p < 0.001). The optimal CRP/ALB ratio cut-off point for predicting mortality was 0.56, with a sensitivity and specificity of 88.9% and 68.2%, respectively (AUC = 0.82; p < 0.001). Conclusions: As in humans, the CRP/ALB ratio, may be a promising, though not particularly specific, prognostic marker for increased risk of death in dogs with acute pancreatitis. [ABSTRACT FROM AUTHOR]

Agricultural marginality is a multifaceted issue, being related to place-specific socioeconomic contexts and highly-variable technological conditions. The coexistence of different classification systems of these variables makes hard any attempt to have a general definition of agricultural marginality. Moreover, the spatially explicit identification of marginal lands is still challenging mostly due to the lack of reliable data sources at both country and regional scale. Accordingly, this paper evaluates the degree of economic marginality of agricultural land, using Italy as a representative case study for southern Europe. A spatial analysis of farmland profitability and constraints for agricultural activities (topography and biodiversity conservation) is proposed to identify three classes of agricultural land, namely ‘unsuitable’, ‘supramarginal’ and ‘marginal’ lands. Results show that almost 39% of agricultural land in Italy can be classified as ‘marginal'; its spatial distribution and characteristics are also analyzed and discussed in relation to different background conditions. The proposed approach provides a valuable methodology supporting land-use planning and decision-making under restricted geo-spatial data availability. [ABSTRACT FROM AUTHOR]

Purpose: The use of the regenerative dermal matrix consists in the bridge between the debridement and the coverage of the lesion by means of a skin graft. We describe our experience where healing was achieved without further wound coverage in a patient in whom leg amputation was indicated. Methods: 89-year-old patient arriving in ED with a critical ischemic picture of the left lower limb Rutherford 6 with nutritional status MNA score <17. History of arterial hypertension. Weight 50 kg Height 1.60 cm. Undergoing CT angiography, revascularization was indicated with transformation of wet gangrene into dry gangrene, but with ample loss of substance of the forefoot for which the treating physician indicated leg amputation. After collective evaluation, an attempt was made to rescue the limb and she underwent necrosectomy surgery, amputation of the 2nd and 2nd toe, coverage with regenerative dermal matrix of the forefoot. After the intervention, the patient was taken in charge during the hospitalization in nursing consultancy for the outpatient continuum of care. In treatment with Clavulanic acid *Amoxicillin 1grx2 x os Wound specialist nurse (WSN) treatment. Due to an accidental fall, the patient was admitted to another facility where the local treatment continued. Results: Almost complete healing of the lesion after less than a year, despite the interruption due to hospitalization in another facility. Conclusions: Ulcer healing and limb salvage were achieved even though the lesion was not definitively covered thanks to advanced dressings and the regenerative capacity of the dermal matrix. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the outcomes of patients with vascular ulcers in outpatient settings after the implementation of the integrated computerized medical record. The computerization of care pathways can influence the clinical outcomes of hospitalized patients and represent a useful tool in the continuity of care of patients from hospitalization to the specialist outpatient clinic, filling an information and communication gap, up to promoting home management. Method: A computerized medical-nursing outpatient file was implemented at a university hospital, containing initial assessments, re-evaluations, treatments, photographs with vascular lesions, elaborated on the current TIMERS ® guidelines and principles and shared with the vascular surgeon. It also includes medical history, allergies, diagnostic reports, drug therapy, blood tests, pain assessment (NRS scale), lesion size and specialist advice. Results: 80 patients were taken care of from discharge in the Nursing Outpatient Clinic for continuity of care from September 2022 to December 2022. The sharing of clinical-assistance information between the two services and healthcare professionals (vascular surgeon and nurses specialized in wound care) creating a direct communication bridge between the professionals involved and allowed users to benefit from continuity, reducing treatment times and outpatient visits and improving the wound healing process. Conclusions: The patients benefited from a clinical and organizational integration of their treatment path, allowing constant monitoring of the vascular lesion and directly collecting the information necessary for the continuation of the therapeutic process. Finally, it allows the professionals involved to analyze aggregated data of the followed users in real time. [ABSTRACT FROM AUTHOR]

Aim: Angiogenesis aims to counteract the progression of atherosclerotic disease. The aim of this study is to characterize the role, safety and efficacy of the local therapy that must be associated with this procedure in a dedicated nursing service. Method: From 2014 to 2022, 400 operations were performed in our center for obstructive arterial disease of the lower limbs, caused by PAD. In 30 cases they were patients in stage I (7.7%), 244 operations in stage I 2 (61%), 32 operations for arterial disease in stage II 4 (8%) and in 76 cases in stage III 5 (19 %), 19 patients with a mean age of 74.75 (SD 9.4) were considered nonrevascularizable (4.8%). 48 treatments were performed (2.5 treatments/patient, min2/max 4). This was a first therapeutic approach in 55%, while it was proposed as a therapeutic alternative in patients who had already undergone previous operations and/or revascularization attempts in 45%. After treatment, all patients with trophic lesions underwent periodic medications with checkups in the dedicated nursing clinic. Results: In the 19 non-revascularizable patients or with failure of revascularization therapy that were considered, limb salvage was observed in 14/19, 73.6%, major amputation in 1/19 case (5,2%), and in 4/19 cases (21.2%) unrelated death. Conclusions: Treatment with mononuclear cells by selective filtration is an effective procedure, in a selected patients. The association of advanced medications, carried out at the dedicated service, has made it possible to obtain the good results obtained. [ABSTRACT FROM AUTHOR]

Purpose The everolimus and exemestane combination represents a treatment option for the endocrine sensitive metastatic breast cancer (MBC) patients. The toxicity profile reported in the Bolero 2 trial showed the feasibility in the selected patients. Few data are available for the unselected population. Methods In order to evaluate the safety in the unselected population of the clinical practice and to evaluate a possible association of toxicities with previous treatments, clinical data from 181 consecutive patients were retrospectively collected. Results Due to toxic events, everolimus dosage was reduced to 5 mg in 27% of patients. No association was found in the analysis between toxicity and number of prior therapies, neither between toxicity and response. In the multivariate analysis the previous exposure to anthracyclines for advanced disease represents the only predictive factor of developing grade ≥2 toxicity (OR = 2.85 CI 95% 1.07–7.59, p = 0.036). Conclusions The association of everolimus and exemestane has confirmed to be a safe and effective treatment for endocrine sensitive MBC patients even in routine clinical practice. The rate of treatment discontinuation due to toxicity is low and none association between previous number of treatments and response or between toxicity and response was found. [ABSTRACT FROM AUTHOR]

Copyright of Environmental Impact Assessment Review is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background Studies on the prevalence of eczema and atopic dermatitis ( AD), and on the factors associated with these diseases, have been mostly performed in children, whereas studies on adult populations are lacking. Objectives To determine the prevalence of eczema and AD in the Italian adult population, and to investigate risk factors associated with the disease. Methods A postal screening questionnaire was administered to 18 357 randomly selected subjects aged 20-44 years in the Gene-Environment Interaction in Respiratory Diseases study, which involved seven centres distributed across northern, central and southern Italy. The questionnaire included items on the occurrence of doctor-diagnosed eczema, asthma and hay fever, socio-demographic characteristics and environmental exposures. Results In all, 10 464 (57.0%) subjects responded to the questionnaire. The prevalence of current eczema was 8.1% (95% CI: 7.6-8.7%), while the prevalence of eczema with asthma and/or hay fever ( EAH), which was adopted as proxy of AD, was 3.4% (95% CI: 3.1-3.8%). About 60% of the subjects with current eczema reported the onset of the disease in adulthood. In multi-variable models, the prevalence of eczema was significantly associated with female sex, older age, living close to industrial plants, high levels of heavy traffic near home and living in central-southern Italy. Conclusions Eczema and EAH are highly prevalent in Italian young adults, especially in women. Our results suggest that adult onset is not unusual, and that environmental factors may influence the occurrence of eczema and EAH. [ABSTRACT FROM AUTHOR]

The article presents the biography of writer Giuseppe Arnaud (1797-1869) from Piedmont region in Italy. Arnaud is known for his Piedmont poems with moral background. It discusses his Mocalieri origin and argues that his family does not appear to be original Moncalieri. It discusses some clues from documents notary suggesting the family came from San Benign and that Joseph was orphaned when he was still a minor.

Background:Retreatment with ipilimumab has been shown to re-establish disease control in some patients with disease progression. Here, we report the efficacy and safety of retreatment with ipilimumab 3 mg kg−1 among patients participating in an expanded access programme in Italy.Methods:Patients who achieved disease control during induction therapy were retreated with ipilimumab upon progression (3 mg kg−1 every 3 weeks for up to four doses), providing they had not experienced toxicity that precluded further dosing. Tumour assessments were conducted after retreatment, and patients were monitored throughout for adverse events.Results:Of 855 patients treated with ipilimumab, 51 were retreated upon disease progression. Of these, 28 (55%) regained disease control upon retreatment and 42% were alive 2 years after the first induction dose of ipilimumab; median overall survival was 21 months. Eleven patients (22%) had a treatment-related adverse event of any grade during retreatment. These were generally mild-to-moderate and resolved within a median of 4 days. No new types of toxicity were reported.Conclusions:For patients who meet predefined criteria, retreatment with ipilimumab is generally well tolerated and can translate into clinical benefit. This strategy should be compared with other therapeutic options in randomised controlled trials. [ABSTRACT FROM AUTHOR]

The acquisition of information about growing stock is a fundamental step in the framework of forest management planning and scenario modeling, besides being essential for assessing the amount of carbon stored within forest ecosystems. Gallaun et al. (2010) produced a pan-European map of forest growing stock by the combination of ground and remotely sensed data. The first objective of the current paper is to assess the accuracy of this map versus the ground data collected during the latest Italian National Forest Inventory (INFC). Next, a new wall-to-wall estimation of growing stock is obtained by combining ground measurements of four regional forest inventories with the CORINE land cover map of Italy and the global canopy height map derived from Geoscience Laser Altimeter System (GLAS) and Moderate Resolution Imaging Spectroradiometer (MODIS) data. More particularly, the growing stock measurements of the four inventories are stratified by ecosystem type and extended over all Italian forest areas through the application of locally weighted regressions to the GLAS/MODIS canopy height map. When compared to the INFC measurements, the new map shows higher accuracy than that by Gallaun et al., particularly for high growing stock values. The coefficient of determination between estimated and INFC growing stocks is improved by about 0.5, whilst the mean square error is reduced from 90 to 48 m 3 ha −1 . [ABSTRACT FROM AUTHOR]

Abstract: The aim of the present study was to fill the void in data related to hematological and biochemical parameters of donkey foals. Whole-blood and plasma samples were obtained from 16 Amiata donkey foals at birth, at 24 and 48 hours, and at 1, 2, 3, 4, 6, and 8 weeks of age. RBC, WBC, hemoglobin concentration (Hgb), mean corpuscular volume, mean corpuscular hemoglobin, mean corpuscular hemoglobin concentration, platelet count, glucose, creatinine, blood urea, triglycerides, total cholesterol, total bilirubin, aspartate aminotransferase, γ-glutamyl transferase, creatine-phosphokinase, alkaline phosphatase, total calcium, potassium, sodium, phosphorus, and albumin were measured. Similar to equine foals, values of RBC, Hgb, and Hct decreased significantly after the first 48 hours of life in Amiata donkey foals, reaching values similar to adult donkeys. No changes were found for mean corpuscular volume and mean corpuscular hemoglobin concentration during the study period. The WBC was low at birth when compared with subsequent measurements, but significantly increased in the subsequent surveys. Platelet count was lower in the first week, with a secondary peak 2 weeks later, and then a decline again up to the eighth week. In agreement with equine foals, electrolyte concentrations, triglycerides, and total cholesterol did not show significant differences. Creatinine, total bilirubin, and blood urea showed a trend similar to RBC, Hgb, and Hct. For the first time, data of hematological and biochemical parameters in Amiata donkey foals are provided. [Copyright &y& Elsevier]

The article discusses the work of 18th to 19th century Piedmontese author Carlo Giovanni Casalis of Moncalieri, Italy. Topics discussed include biographical information on Casalis, his academic training in Turin, Italy, and his work as a university professor in multiple subjects, including theology and Latin.

Abstract: The authors reviewed the medical records of patients who had undergone endoscopic endonasal craniotomy in our department between 2005 and 2009. Thirteen patients were included in this study: 12 males and 1 female. Patients were affected by ethmoidal malignancies abutting or involving the anterior skull base. In all the patients the anterior skull base was drilled down. Nine patients underwent dural resection. The procedure always included a skull base reconstruction. Postoperative complications included CSF leak, subdural haematoma and pneumocephalus. Our results show that endoscopic endonasal surgery can be a viable alternative to anterior craniofacial resection in the management of selected ethmoidal malignancies. The limited morbidity and high success rate fit well with the data in the literature and make this treatment option advisable. [Copyright &y& Elsevier]

The article discusses the history of the Italian region of Testona, in Piedmont with reference to a map of Testona in 1708, designed by 18th century Italian land surveyor and cartographer, Francesco Antonio Appiano. Topics discussed include background on the work of Appiano and previous maps of the region, cartographically significant changes in the region previous to and during this period, including changes in division and usage of land; and analysis of the map. The article includes a reproduction of Appiano's map of Testona in 1708.

A selection of samples, obtained from a particular copper-alloy domestic artefact of Roman style from Pompeii, has been analysed by using different techniques (IR, Raman, SEM-EDX, FAAS), in order to investigate the chemical nature and composition of the metals utilised for such manufacturing pieces. The surface analysis of the bright red metallic microfragments conducted by different analytical techniques, emphasises the presence of pure unalloyed copper and confirms the absence of other metallic species on the upper layers. On the contrary, the mapping analysis of the section of the laminar metal of the investigated sample shows a consistent enrichment in tin content. Finally, destructive analysis by FAAS confirms that the artefact looks like a bronze metal alloy, with a medium Sn content of about 6.5%. [ABSTRACT FROM AUTHOR]

The type II transmembrane glycoprotein CD38 (ADP-ribosyl cyclase/cyclic ADP-ribose hydrolase) has been proposed as a mediator of insulin secretion from pancreatic beta-cells and as a candidate for autoimmune reactions in type 2 diabetes. We evaluated the presence of anti-CD38 autoantibodies in Caucasian patients with diabetes and investigated the effect of these antibodies on insulin secretion from isolated human pancreatic islets. The presence of anti-CD38 autoantibodies was evaluated by using Western blot analysis in 236 patients with type 2 diabetes (mean age 63 years), in 160 patients with type 1 diabetes (mean age 38 years), and in 159 nondiabetic subjects. Anti-CD38 autoantibody titers at least 3 SD above the mean value of the control group were found in 9.7% of type 2 diabetic patients and in 13.1% of type 1 diabetic patients (chi2 = 15.9, P = 0.0003 vs. 1.3% of control subjects). No significant differences were observed in sex distribution, current age, age at diabetes onset, BMI, fasting serum glucose, or glycemic control between anti-CD38+ and anti-CD38-diabetic patients in either the type 2 or type 1 diabetic groups. The effect of 23 anti-CD38- and 13 anti-CD38+ sera on insulin secretion at low (3.3 mmol/l) or high (16.7 mmol/l) medium glucose concentrations was evaluated in isolated human pancreatic islets. Data are medians (interquartile range). The anti-CD38+ sera potentiated insulin release both at low [95 (64) vs. 23 (12) microU/ml of control incubations, respectively, P < 0.0001] and high [271 (336) vs. a control of 55 (37) microU/ml, respectively, P = 0.001] medium glucose concentrations, whereas the anti-CD38- sera did not. Furthermore, in the pooled data from all 36 tested sera, insulin levels in the islet incubation medium were directly related to the anti-CD38 antibody titer. We conclude that autoantibodies to CD38 are associated with both type 1 and type 2 diabetes in Caucasian subjects. These autoantibodies exert a stimulatory effect on insulin secretion by cultured human islets. The role of this autoimmune reaction in the pathogenesis of diabetes remains to be elucidated. [ABSTRACT FROM AUTHOR]

Oxaliplatin-based adjuvant chemotherapy is the standard treatment of high-risk colon cancer (CC). A shorter duration (3 months) can achieve a similar outcome [in terms of relapse-free survival (RFS)] to a longer duration. This study reports the overall survival (OS) analysis of the three or six colon adjuvant (TOSCA) phase III study. It assessed different adjuvant chemotherapy durations in patients with resected high-risk stage II and stage III CC. TOSCA was an open-label, phase III, multicentre, non-inferiority trial conducted in 130 Italian centres. Patients were randomly assigned, in a 1 : 1 ratio, to receive 3 months of standard doses of FOLFOX/CAPOX, or 6 months of FOLFOX/CAPOX. Patients with histologically confirmed high-risk stage II and III CC were included, with RFS being the primary end point. OS was a secondary end point. From June 2007 to March 2013, 3759 patients were accrued. At a median follow-up of 7 years, the hazard ratio (HR) for RFS of the 3-month versus 6-month arms was 1.13; 95% confidence interval (CI) 0.99-1.29, P for non-inferiority = 0.380, P for superiority = 0.068, crossing the non-inferiority limit of 1.20. This result did not allow us to reject the null hypothesis of the inferiority of the 3-month arm. The HR for OS of the 3-month versus 6-month arms was 1.09 (95% CI 0.93-1.26, P for superiority = 0.288). At the last follow-up analysis, the absolute OS difference between arms was <1%. The present analysis of the TOSCA trial does not indicate any significant difference in OS between the treatment groups. The extra benefit provided by the longer treatment should be balanced against the extra toxicity of more prolonged therapy. The trial is registered with ClinicalTrials.gov , registration number: NCT0064660. • TOSCA trial compared 3 or 6 months of adjuvant chemotherapy. • We here provided the updated results of OS at 7 years of median follow up. • The HR for OS of the 3-month versus 6-month arms was 1.09 (95% CI 0.93-1.26, P for superiority = 0.288). • At the last follow-up analysis, the absolute OS difference between arms was <1%. • The present analysis of the TOSCA trial does not indicate any significant difference in OS between the treatment groups. [ABSTRACT FROM AUTHOR]

• Surface contamination by GEM and 5-FU in 68% and 42% of wipes/swaps respectively. • GEM deposition on workers' pads. • Higher induction of geno-cytotoxicity on administrators by BMCyt assay. • XRCC1399 polymorphism could be a susceptibility factor for MN in buccal cells. Health-care personnel handling antineoplastic drugs could be at risk for adverse health effects. We aimed to evaluate genotoxic and cytotoxic effects of antineoplastic drug exposure of personnel preparing and administering such drugs in three Oncology Hospitals in Italy enrolling 42 exposed subjects and 53 controls. Furthermore, we aimed to study the possible influence of XRCC1 and hOGG1 DNA repair genes polymorphisms on genotoxicity induced on buccal cells. We performed workplace and personal monitoring of some drugs and used exposure diary informations to characterize the exposure. Urinary 5-FU metabolite (α-fluoro-β-alanine) was measured. Buccal Micronucleus Cytome (BMCyt) assay was used to evaluate DNA damage and other cellular anomalies. GEM and 5-FU contamination was found in 68% and 42% of wipe/swab samples respectively. GEM deposition was found on workers' pads while no α-fluoro-β-alanine was found. BMCyt-assay showed higher genotoxicity and cytotoxicity on nurses administering antineoplastics than on preparators and controls. Among micronucleus (MN) positive (with MN frequency higher than 1.5‰) exposed subjects, the percentage of those carrying XRCC1 mut/het genotype was higher than in MN positive-controls. Using the sensitive BMCyt assay, we demonstrated that handling antineoplastics still represents a potential occupational health risk for workers that should be better trained/informed regarding such risks. [ABSTRACT FROM AUTHOR]

Background Several studies highlighted a great variability, both between and within countries, in the prevalence of asthma and chronic airways diseases. Aim To evaluate if geo-climatic variations can explain the heterogeneity in the prevalence of asthma and respiratory diseases in Italy. Methods Between 2006 and 2010, a postal screening questionnaire on respiratory health was administered to 18,357 randomly selected subjects, aged 20–44, living in 7 centers in northern, central, and southern Italy. A random-effects meta-analysis was fitted to evaluate the between-centers heterogeneity in the prevalence of asthma, asthma-like symptoms, allergic rhinitis, and chronic bronchitis (CB). A principal component analysis (PCA) was performed to synthetize the geo-climatic information (annual mean temperature, range of temperature, annual rainfalls, global solar radiations, altitude, distance from the sea) of all the 110 Italian province capital towns. The associations between these geo-climatic components obtained with PCA and the prevalence of respiratory diseases were analyzed through meta-regression models. Results 10,464 (57%) subjects responded to the questionnaire. There was a significant between-centers heterogeneity in the prevalence of asthma (I 2 = 59.5%, p = 0.022) and CB (I 2 = 60.5%, p = 0.019), but not in that of asthma-like symptoms or allergic rhinitis. Two independent geo-climatic components explaining together about 80% of the overall geo-climatic variability were identified: the first principally summarized the climatic variables; the second the topographic ones. Variations in the prevalence of asthma across centers were significantly associated with differences in the climatic component (p = 0.017), but not with differences in the topographic one. Conclusions Our findings suggest that climate play a role in determining the between-center heterogeneity in the prevalence of asthma in Italy, with higher prevalence in dry-hot Mediterranean climates, and lower in rainy-cold northern climates. [ABSTRACT FROM AUTHOR]

: BackgroundAlthough the use of Celsior has been recently described for heart, lung, liver, and kidney transplantation, no data are available on its use for clinical pancreas preservation.: MethodsWe herein describe the results of 112 pancreas transplants preserved with either University of Wisconsin (UW; (n = 56) or Celsior (n = 56) solution at two Italian transplant centers. The groups were comparable with regard to all donor and recipient characteristics.: ResultsMean cold and warm ischemia times were 10.1 ± 2.2 hours and 37.2 ± 8.2 minutes for UW compared to 10.8 ± 2.4 hours and 38.3 ± 6.7 minutes for Celsior (P = NS). Delayed endocrine pancreas function was recorded in two UW-preserved grafts (3.6%). Actuarial 1-year patient survival was 94.6% for UW as compared with 100% for Celsior (P = NS). Equivalent graft survival figures were 91.0% for UW as compared with 96.4% for Celsior (P = NS).: ConclusionsWithin the range of cold ischemia times reported in this study, UW and Celsior solutions have similar safety profiles for pancreas transplantation. [Copyright &y& Elsevier]

: BackgroundThe attitude toward living donation varies widely in the world, for economic and cultural reasons. In Italy, as in other Mediterranean settings, the role of living kidney donation is minor.: AimTo analyze the reasons for this attitude, we gathered data in a general population sample of high school students in a large northern Italian industrial city (Torino, about 900,000 inhabitants).: MethodsSemistructured questionnaires (n = 1676), gathered in 2001 to 2002 in 14 high schools, in the context of an educational program on dialysis, renal transplantation, and organ donation, were analyzed presumably reflecting opinions gathered before the educational intervention.: ResultsMost students, in the case of a close relative or partner needing dialysis, answer that they would donate a kidney (yes: 78.2%, no: 2.9%, uncertain—blank: 18.9%); receiving a living donor kidney is felt as disturbing: only 57.5% of the students would accept it (no: 5.9%, uncertain—blank: 36.6%), mainly because of fear of long-term problems for the donor. Donation from an older to a younger person is seen more positively than vice versa.: ConclusionIn our settings, the attitude of the teenagers on living donation is positive; however, while “giving” is positively seen, the presence of unresolved fears is witnessed by the lower acceptance of the idea of “taking.” These data suggest to focus on the risks of kidney donation in educational campaigns and in patient-physician information. The positive attitude shared by the teenagers supports the working hypothesis that lack of information is one of the determinants of the low living donor transplantation rate in our area. [Copyright &y& Elsevier]

Limited research has assessed the accuracy of imputation methods in aerobiological datasets. We conducted a simulation study to evaluate, for the first time, the effectiveness of Gappy Singular Value Decomposition (GSVD), a data-driven approach, comparing it with the moving mean interpolation, a statistical approach. Utilizing complete pollen data from two monitoring stations in northeastern Italy for 2022, we randomly generated missing data considering the combination of various proportions (5%, 10%, 25%) and gap lengths (3, 5, 7, 10 days). We imputed 4800 time series using the GSVD algorithm, specifically implemented for this study, and the moving mean algorithm of the "AeRobiology" R package. We assessed imputation accuracy by calculating the Root Mean Square Error and employed multiple linear regression models to identify factors independently affecting the error (e.g. pollen variability, simulation settings). The results showed that the GSVD was as good as the well-established moving mean method and demonstrated its strong generalization capabilities across different data types. However, the imputation error was primarily influenced by pollen characteristics and location, regardless of the imputation method used. High variability in pollen concentrations and the distribution of missing data negatively affected imputation accuracy. In conclusion, we introduced and tested a novel imputation method, demonstrating comparable performance to the statistical approach in aerobiological data reconstruction. These findings contribute to advancing aerobiological data analysis, highlighting the need for improving imputation methods., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Tagliaferro et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

At the beginning of the COVID-19 pandemic, an ad hoc organisational framework was established between academic, local government and community partners to implement the "Sentinella - Identify, Trace and Prevent" screening programme in Verona, north-east Italy. Between September 2020 and May 2021, key populations not covered by any screening policies at the local and national level were screened for SARS-CoV-2. Target populations were: older adult residents (males >65 years and females >75 years), bus and taxi drivers, social workers, supermarket employees, hospital cleaning and catering staff, researchers working in the local hospitals, students, and people experiencing homelessness (PEH). Five dedicated swab clinics, home testing facilities, and one mobile clinic were activated to collect nasopharyngeal swabs. Molecular analysis was performed for all the subjects; an antigen-rapid diagnostic test (Ag-RDT) was also implemented as a point-of-care test for PEH. Medical follow-up, psychological support, and quarantine facilities were organised for subjects who tested positive for SARS-CoV-2. Overall, 2075 subjects participated in the surveillance programme. Amongst these, 1,572 were residents/workers, whilst 503 were PEH. A total of 127 (6.2%) participants tested positive for SARS-CoV-2. Sixty-nine were residents, 58 PEH. The incidence rate was 4 per 10.000 person/day (95% CI 3.1-5.0). The highest prevalence and incidence rates were found amongst supermarket employees (9.7% and 8.5 per 10.000 person/day, 95% CI 3.81-18.86, respectively), followed by hospital cleaning staff (8.1%, 7.6 per 10.000 person/day, CI 95% 4.9-11.7). Regarding PEH, the prevalence of SARS-CoV-2 was 11.5%. All PEH identified as positive were isolated in dedicated shelter facilities. Amongst the 69 residents/workers who were quarantined, 53 were reached for initial psychological support for assessing the presence of any psychological distress or psychiatric pathology. Amongst the subjects evaluated, 10 (18.9%) presented clinically significant psychological discomfort and accessed the stepped-care psychological intervention. The community partnerships played a pivotal role in optimising early case detection. Promotion of testing helped to prevent and contain more efficiently potential clusters through strategic planning, especially for PEH. Insights from the study highlight the importance of community partnerships in public health emergencies, particularly in the context of highly transmissible diseases pathways., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The author(s) declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision., (Copyright © 2024 Tebon, Davis, Savoldi, Soriolo, Walters, Nosè, Barbui, Turrini, Danese, Lippi, Cecchetto, Mazzariol, Gibellini, Caliskan, Marchetti, Verlato, Princivalle, Porru, Tacconelli and De Nardo.)

Background: Exposure to air pollution has been proposed as one of the potential risk factors for leukaemia. Work-related formaldehyde exposure is suspected to cause leukaemia., Methods: We conducted a nested register-based case-control study on leukaemia incidence in the Viadana district, an industrial area for particleboard production in Northern Italy. We recruited 115 cases and 496 controls, frequency-matched by age, between 1999 and 2014. We assigned estimated exposures to particulate matter (PM 10 , PM 2.5 ), nitrogen dioxide (NO 2 ), and formaldehyde at residential addresses, averaged over the susceptibility window 3rd to 10th year prior to the index date. We considered potential confounding by sex, age, nationality, socio-economic status, occupational exposures to benzene and formaldehyde, and prior cancer diagnoses., Results: There was no association of exposures to PM 10 , PM 2.5 , and NO 2 with leukaemia incidence. However, an indication of increased risk emerged for formaldehyde, despite wide statistical uncertainty (OR 1.46, 95%CI 0.65-3.25 per IQR-difference of 1.2 μg/m 3 ). Estimated associations for formaldehyde were higher for acute (OR 2.07, 95%CI 0.70-6.12) and myeloid subtypes (OR 1.79, 95%CI 0.64-5.01), and in the 4-km buffer around the industrial facilities (OR 2.78, 95%CI 0.48-16.13), although they remained uncertain., Conclusions: This was the first study investigating the link between ambient formaldehyde exposure and leukaemia incidence in the general population. The evidence presented suggests an association, although it remains inconclusive, and a potential significance of emissions related to industrial activities in the district. Further research is warranted in larger populations incorporating data on other potential risk factors., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Alessandro Marcon reports financial support was provided by ATS della Val Padana. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: Immunotherapy has revolutionized the approach to metastatic triple-negative breast cancers. Atezolizumab was approved for patients with metastatic triple-negative breast cancers whose tumors express PD-L1, determined by SP 142 assay. To assess the availability and practice of SP142 test we administered a survey to all the 15 pathology departments of the Lazio Region during a six-month period., Methods: The survey comprised 12 questions regarding the availability of SP142 in the pathology departments, the percentage of positive tests, the difficulties of pathologists in cases close to cut-off value and the tested samples., Results: The SP142 assay was available in only eight centers. In case of positive result, most centers (5/8, 62.5%) reported values of PD-L1 expression ranging from > 1 to ⩽ 5%, with values close to the cut-off point (⩾ 1% or < 1%) being the greatest challenge.Most of the centers (6/8, 75%) tested material from both their own and other hospitals. In most centers, the evaluations were performed either on primary tumors or metastasis, in particular lymph nodes (5/8, 62.5%), followed by lung (3/8, 37.5%) and liver (1/8, 12.5%) metastasis., Conclusion: Our results raise some important issues concerning the evaluation of PD-L1 in the "real-life" setting, providing strategies for its implementation., Competing Interests: Declaration of conflicting interestsThe authors declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Paolo Marchetti (PM) has/had a consultant/advisory role for BMS, Roche- Genentech, MSD, Novartis, Amgen, Merck Serono, Pierre Fabre, Incyte. The other authors declare they have no competing interests.

(1) Background: Mucosal melanoma (MM) is a rare tumor, accounting for about 1% of all diagnosed melanomas. The etiology and pathogenesis of this tumor are unknown. It is characterized by an aggressive phenotype with poor prognosis and a low response rate to approved treatments. (2) Methods: We retrospectively analyzed the clinical features, treatments and outcomes of patients diagnosed with MM from different sub-sites (head and neck, gynecological and gastro-intestinal region) between 2013 and 2023 at our Institute. Survival times were estimated with the Kaplan-Meier method. Multivariate Cox regression was used to test the independence of significant factors in univariate analysis. (3) Results: Twenty-five patients were included in this study; the disease was equally distributed among females and males. The median age at diagnosis was 74 years old. The majority had MM originating from the head and neck (56%), particularly from the nasal cavity. BRAF V600 mutations were detected in 16% of the study population, limited to gastro-intestinal and gynecological MM. At diagnosis, at least half the patients (52%) had the disease located also at distant sites. The median overall survival (OS) in the whole study population was 22 months, with a longer OS for patients diagnosed at an early stage (38 months, p < 0.001). Longer OSs were reported for head and neck MM compared to other anatomic regions (0.06). Surgery of the primary tumor and radiotherapy were performed in 64% and 36% of the study population, respectively. Radiotherapy was performed only in head and neck MM. At multivariate analysis, the single factor that showed a reduced hazard ratio for death was radiotherapy. (4) Conclusions: The overall survival of MM from different sub-sites treated at our Italian Institution was 22 months, with better outcomes for early-stage disease and head and neck MM. Performing radiotherapy may have a protective effect on OS for head and neck MM. New treatment strategies are urgently needed to improve the outcome in this disease.

Objectives: occupational exposure to vapours, gases, dusts and fumes (VGDF) plays an important role in the development and exacerbation of respiratory diseases. The aim of this study is to evaluate the possible association of occupational exposure to airborne pollutants and chronic respiratory diseases., Design: multicase-control study., Setting and Participants: cases of chronic respiratory diseases and controls from the Italian multicentric study Gene Environment Interaction in Respiratory Diseases (GEIRD)., Main Outcome Measures: the occurrence of rhinitis, asthma, chronic bronchitis/chronic obstructive pulmonary disease (COPD), asthma severity, spirometry data, exhaled nitric oxide (FeNO) were examined in relation to chronic and acute occupational exposures to airborne pollutants using multiple regression models., Results: 2,943 subjects were enrolled in the study. Regularm exposure to VGDF was associated with a higher prevalence of chronic bronchitis/COPD (OR 1.40, 95%CI 0.98-1.99), especially in those also having asthma (OR 1.80, 95%CI 1.14-2.85), a lower prevalence of remittent asthma (OR 0.53, 95%CI 0.29-0.96) and, in those with asthma, an increased activity of the disease (severity score) (OR 1.77, 95%CI 1.20-2.60). No associations were observed between occupational exposure and prevalence of rhinitis, spirometry and FeNO data. Finally, an association was found between acute exposure to airborne pollutants (occupational and non-occupational) and the respiratory diseases investigated, in particular active asthma and asthma associated chronic bronchitis/BPCO., Conclusions: these data confirm a significant role of occupational exposure to airborne pollutants on respiratory health, underlying the importance of workplace exposure prevention, in particular for more susceptible subjects, as those with respiratory diseases.

Long-term exposure to air pollution has adverse respiratory health effects. We investigated the cross-sectional relationship between residential exposure to air pollutants and the risk of suffering from chronic respiratory diseases in some Italian cities. In the BIGEPI project, we harmonised questionnaire data from two population-based studies conducted in 2007-2014. By combining self-reported diagnoses, symptoms and medication use, we identified cases of rhinitis (n = 965), asthma (n = 328), chronic bronchitis/chronic obstructive pulmonary disease (CB/COPD, n = 469), and controls (n = 2380) belonging to 13 cohorts from 8 Italian cities (Pavia, Turin, Verona, Terni, Pisa, Ancona, Palermo, Sassari). We derived mean residential concentrations of fine particulate matter (PM 10 , PM 2.5 ), nitrogen dioxide (NO 2 ), and summer ozone (O 3 ) for the period 2013-2015 using spatiotemporal models at a 1 km resolution. We fitted logistic regression models with controls as reference category, a random-intercept for cohort, and adjusting for sex, age, education, BMI, smoking, and climate. Mean ± SD exposures were 28.7 ± 6.0 μg/m 3 (PM 10 ), 20.1 ± 5.6 μg/m 3 (PM 2.5 ), 27.2 ± 9.7 μg/m 3 (NO 2 ), and 70.8 ± 4.2 μg/m 3 (summer O 3 ). The concentrations of PM 10 , PM 2.5 , and NO 2 were higher in Northern Italian cities. We found associations between PM exposure and rhinitis (PM 10 : OR 1.62, 95%CI: 1.19-2.20 and PM 2.5 : OR 1.80, 95%CI: 1.16-2.81, per 10 μg/m 3 ) and between NO 2 exposure and CB/COPD (OR 1.22, 95%CI: 1.07-1.38 per 10 μg/m 3 ), whereas asthma was not related to environmental exposures. Results remained consistent using different adjustment sets, including bi-pollutant models, and after excluding subjects who had changed residential address in the last 5 years. We found novel evidence of association between long-term PM exposure and increased risk of rhinitis, the chronic respiratory disease with the highest prevalence in the general population. Exposure to NO 2 , a pollutant characterised by strong oxidative properties, seems to affect mainly CB/COPD., Competing Interests: Declaration of competing interest Sara Maio reports financial support was provided by National Institute for Insurance against Accidents at Work., (Copyright © 2023 The Authors. Published by Elsevier B.V. All rights reserved.)

Background: air pollution is a complex mixture; novel multipollutant approaches could help understanding the health effects of multiple concomitant exposures to air pollutants., Aim: to assess the relationship of long-term air pollution exposure with the prevalence of respiratory/allergic symptoms and diseases in an Italian multicenter study using single and multipollutant approaches., Methods: 14420 adults living in 6 Italian cities (Ancona, Pavia, Pisa, Sassari, Turin, Verona) were investigated in 2005-2011 within 11 different study cohorts. Questionnaire information about risk factors and health outcomes was collected. Machine learning derived mean annual concentrations of PM 10 , PM 2.5 , NO 2 and mean summer concentrations of O 3 (μg/m 3 ) at residential level (1-km resolution) were used for the period 2013-2015. The associations between the four pollutants and respiratory/allergic symptoms/diseases were assessed using two approaches: a) logistic regression models (single-pollutant models), b) principal component logistic regression models (multipollutant models). All the models were adjusted for age, sex, education level, smoking habits, season of interview, climatic index and included a random intercept for cohorts., Results: the three-year average (± standard deviation) pollutants concentrations at residential level were: 20.3 ± 6.8 μg/m 3 for PM 2.5 , 29.2 ± 7.0 μg/m 3 for PM 10 , 28.0 ± 11.2 μg/m 3 for NO 2 , and 70.9 ± 4.3 μg/m 3 for summer O 3. Through the multipollutant models the following associations emerged: PM 10 and PM 2.5 were related to 14-25% increased odds of rhinitis, 23-34% of asthma and 30-33% of night awakening; NO 2 was related to 6-9% increased odds of rhinitis, 7-8% of asthma and 12% of night awakening; O 3 was associated with 37% increased odds of asthma attacks. Overall, the Odds Ratios estimated through the multipollutant models were attenuated when compared to those of the single-pollutant models., Conclusions: this study enabled to obtain new information about the health effects of air pollution on respiratory/allergic outcomes in adults, applying innovative methods for exposure assessment and multipollutant analyses., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Maria Beatrice Bilò had speaking and lecture fees supported by Astra Zeneca, GSK, Novartis, Sanofi. The other authors have no competing financial interests or personal relationships to disclose., (Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: Chipboard production is a source of wood dust, formaldehyde, and combustion-related pollutants such as nitrogen dioxide (NO 2 ) and particulate matter (PM). In this cohort study, we assessed whether exposures to NO 2 , formaldehyde, PM 10 , PM 2.5 , and black carbon were associated with adverse respiratory and allergic outcomes among all 7525 people aged 0-21 years residing in the Viadana district, an area in Northern Italy including the largest chipboard industrial park in the country., Methods: Data on hospitalizations, emergency room (ER) admissions, and specialist visits in pneumology, allergology, ophthalmology, and otorhinolaryngology were obtained from the Local Health Unit. Residential air pollution concentrations in 2013 (baseline) were derived using local (Viadana II), national (EPISAT), and continental (ELAPSE) exposure models. Associations were estimated using negative binomial regression models for counts of events occurred during 2013-2017, with follow-up time as an offset term and adjustment for sex, age, nationality, and a census-block socio-economic indicator., Results: Median annual exposures to NO 2 , PM 10 , and PM 2.5 were below the European Union annual air quality standards (40, 40, and 25 μg/m 3 ) but above the World Health Organization 2021 air quality guideline levels (10, 15, and 5 μg/m 3 ). Exposures to NO 2 and PM 2.5 were significantly associated with higher rates of ER pneumology admissions (13 to 30 % higher rates per interquartile range exposure differences, all p < 0.01). Higher rates of allergology and ophthalmology visits were found for participants exposed to higher pollutants' concentrations. When considering the 4-km buffer around the industries, associations with respiratory hospitalizations became significant, and associations with ER pneumology admissions, allergology and ophthalmology visits became stronger. Formaldehyde was not associated with the outcomes considered., Conclusion: Using administrative indicators of health effects a priori attributable to air pollution, we documented the adverse impact of long-term air pollution exposure in residential areas close to the largest chipboard industries in Italy. These findings, combined with evidence from previous studies, call for an action to improve air quality through preventive measures especially targeting emissions related to the industrial activities., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. AM is member of the scientific committee of ATS Val Padana, an advisory board for environmental studies commissioned or conducted by ATS Val Padana., (Copyright © 2022 Elsevier B.V. All rights reserved.)

Purpose: Lymphedema is one of the most recurrent problems reported by breast cancer survivors, which negatively affects quality of life (QoL). The Upper Limb Lymphedema Quality of Life Questionnaire (ULL-27) is a tool that assesses the QoL in patients with breast cancer-related lymphedema. At present, an Italian adaptation does not exist. The aim of this study is to perform a preliminary cross-cultural validation of the Italian version of the ULL-27. Materials and Methods: A forward-backward translation and cross-cultural adaptation have been performed. One hundred twenty women with lymphedema were evaluated using the Italian version of the ULL-27. The mean age was 60.25 (±11.88) years, and mean body-mass index was 26.35 (5.13) kg/m 2 . The Functional Assessment of Cancer Therapy-Breast (FACT-B) was analyzed using Pearson's correlation analysis with the ULL-27 to indicate convergent and external construct validity. Cronbach's alpha and factor analysis were used to assess the questionnaire's structure. Results: The internal consistency for the total score of the Italian ULL-27 was high (0.90). Content validity was good because items were understandable for all participants. The alpha coefficients for subscale scores were high. External construct validity was confirmed by expected correlations with comparator scales. However, the factor structure of ULL-27 does not seem to completely reflect the original scale. Conclusions: The Italian version of ULL-27 has good internal consistency and validity. It is a reliable tool for evaluating the QoL of these patients, but additional data should be collected to clarify the factorial structure and test-retest reliability of the scale.

The development of innovative technologies and the advances in the genetics and genomics, have offered new opportunities for personalized treatment in oncology. Although the selection of the patient based on the molecular characteristics of the neoplasm has the potential to revolutionize the therapeutic scenario of oncology, this approach is extremely challenging. The access, homogeneity, and economic sustainability of the required genomic tests should be warranted in the clinical practice, as well as the specific scientific and clinical expertise for the choice of medical therapies. All these elements make essential the collaboration of different specialists within the Molecular Tumor Boards (MTBs). In this position paper, based on experts' opinion, the AIOM-SIAPEC/IAP-SIBioC-SIC-SIF-SIGU-SIRM Italian Scientific Societies critically discuss the available molecular profiling technologies, the proposed criteria for the selection of patients candidate for evaluation by the MTB, the criteria for the selection and analysis of biological samples, and the regulatory and pharmaco-economic issues., (Copyright © 2021. Published by Elsevier B.V.)

Purpose: Despite advances in supportive care, cancer-related symptoms tend to be persistent regardless of cancer type, stage of disease, or treatment received. There is an increasing prescription for complementary and alternative medicines, such as medical cannabis (MC). Knowledge and attitudes of Italian medical oncologists and palliative care physicians toward medical cannabis in cancer care remain unknown., Methods: We conducted a cross-sectional study to investigate the knowledge and attitude toward MC prescription among cancer care professionals in Italy. All invited participants received an email with the electronic questionnaire accessible through a direct link., Results: Among the 2616 members who received the invitation, 475 replied to the questionnaire and were considered for the survey analysis. The most prescribed formulations among those available in Italy were cannabis FM2. The most frequent clinical indications for the use of MC were pain, gastrointestinal, and mood disorders. Only 9 responders reported MC-related side effects like anxiety insomnia and muscle spasms. The question regarding the normative references for MC prescription and use in Italy had conflicting results: only 14% indicated the exact legislative reference., Conclusion: Our study highlights a significant discrepancy between personal attitudes, prescription levels, and actual knowledge on MC. This represent a critical issue that should be systemically faced, building educational programs and national guidelines that sublimate personal physicians' beliefs and predispositions, resulting in a robust science-based MC practice. Only through coordinated interventions on science and health policy of MC, there will be success of safety and efficacy, ensuring the best knowledge for the best outcomes., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: The favourable safety profile and the increasing confidence with immune checkpoint inhibitors (ICIs) might have boosted their prescription in frail patients with short life expectancies, who usually are not treated with standard chemotherapy., Methods: The present analysis aims to describe clinicians' attitudes towards ICIs administration during late stages of life within a multicenter cohort of advanced cancer patients treated with single agent PD-1/PD-L1 checkpoint inhibitors in Italy., Results: Overall, 1149 patients with advanced cancer who received single agent PD-1/PD-L1 checkpoint inhibitors were screened. The final study population consisted of 567 deceased patients. 166 patients (29.3%) had received ICIs within 30 days of death; among them there was a significantly higher proportion of patients with ECOG-PS ≥ 2 (28.3% vs 11.5%, p < 0.0001) and with a higher burden of disease (69.3% vs 59.4%, p = 0.0266). In total, 35 patients (6.2%) started ICIs within 30 days of death; among them there was a higher proportion of patients with ECOG-PS ≥ 2 (45.7% vs 14.5%, p < 0.0001) and with a higher burden of disease (82.9% vs 60.9%, p = 0.0266). Primary tumors were significantly different across subgroups (p = 0.0172), with a higher prevalence of NSCLC patients (80% vs 60.9%) among those who started ICIs within 30 days of death. Lastly, 123 patients (21.7%) started ICIs within 3 months of death. Similarly, within this subgroup there was a higher proportion of patients with ECOG-PS ≥ 2 (29.3% vs 12.8%, p < 0.0001), with a higher burden of disease (74.0% vs 59.0%, p = 0.0025) and with NSCLC (74.0% vs 58.8%, p = 0.0236)., Conclusion: Our results confirmed a trend toward an increasing ICIs prescription in frail patients, during the late stages of life. Caution should be exercised when evaluating an ICI treatment for patients with a poor PS and a high burden of disease.

Chipboard production is a source of ambient air pollution. We assessed the spatial variability of outdoor pollutants and residential exposure of children living in proximity to the largest chipboard industry in Italy and evaluated the reliability of exposure estimates obtained from a number of available models. We obtained passive sampling data on NO 2 and formaldehyde collected by the Environmental Protection Agency of Lombardy region at 25 sites in the municipality of Viadana during 10 weeks (2017-2018) and compared NO 2 measurements with average weekly concentrations from continuous monitors. We compared interpolated NO 2 and formaldehyde surfaces with previous maps for 2010. We assessed the relationship between residential proximity to the industry and pollutant exposures assigned using these maps, as well as other available countrywide/continental models based on routine data on NO 2 , PM 10 , and PM 2.5 . The correlation between NO 2 concentrations from continuous and passive sampling was high (Pearson's r = 0.89), although passive sampling underestimated NO 2 especially during winter. For both 2010 and 2017-2018, we observed higher NO 2 and formaldehyde concentrations in the south of Viadana, with hot-spots in proximity to the industry. PM 10 and PM 2.5 exposures were higher for children at < 1 km compared to the children living at > 3.5 km to the industry, whereas NO 2 exposure was higher at 1-1.7 km to the industry. Road and population densities were also higher close to the industry. Findings from a variety of exposure models suggest that children living in proximity to the chipboard industry in Viadana are more exposed to air pollution and that exposure gradients are relatively stable over time.

Oncological patients increasingly require second medical opinions to feel more likely confident with their oncologists and treatments, although this could lead to wrong opinions and delay in the start of treatments. Second opinions can be required also by physicians to obtain advices, especially in case of rare tumors. The request of new opinions is documented in radiology and pathology settings too, with not negligible discrepancy rate. Conversely, the role in general medical/surgical conditions has not been well established. Literature is poor of studies relative to second opinions or they are more focused on patient's motivations. For these reasons, AIOM (Italian Association of Medical Oncology) and AIOM Foundation faced this topic during the 7th Annual Meeting on Ethics in Oncology (Ragusa, 4-5 t h May 2018). In this position paper we report reasons, limits, advantages and outcomes of second medical opinion and the respective Decalogue in the oncological setting., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Young adults exhibit greater sensitivity than adults to nicotine reinforcement, and Attention Deficit Hyperactivity Disorder (ADHD) increases the risk for early-onset smoking. We investigated the correlation between ADHD Self-Report Scale (ASRS) scores and smoking, evaluated the prevalence of ADHD symptomatology (not diagnoses) in smokers and non-smokers and its comorbidity with benzodiazepine and gambling addictions. A total of 389 young adults from 14 schools in Northern Italy fill out a survey and the Adult ADHD Self-Report Scale (ASRS). A total of 15.2% of subjects tested positive at the ASRS, which correlated with smoking; moreover, smokers had twice the probability of testing positive at the ASRS. ADHD symptomatology, especially when comorbid with tobacco abuse, is an important condition to monitor because early nicotine exposure could be a gateway for other addictive behaviors.

Background: Gastroesophageal reflux disease (GERD) has been reported to be significantly associated with chronic rhinosinusitis, but the strength of the association is still debated., Aims: To evaluate the strength of the association between gastritis/GERD and non-allergic rhinitis (NAR)/allergic rhinitis (AR)/sinusitis., Methods: We investigated 2887 subjects aged 20-84 years, who underwent a clinical visit in seven Italian centres (Ancona, Palermo, Pavia, Terni, Sassari, Torino, Verona) within the study on Gene Environment Interactions in Respiratory Diseases, a population-based multicase-control study between 2008 and 2014. Subjects were asked if they had doctor-diagnosed "gastritis or stomach ulcer (confirmed by gastroscopy)" or "gastroesophageal reflux disease, hiatal hernia or esophagitis". The association between NAR/AR/sinusitis and either gastritis or GERD was evaluated through relative risk ratios (RRR) by multinomial logistic regression., Results: The prevalence of gastritis/GERD increased from subjects without nasal disturbances (22.8% = 323/1414) to subjects with AR (25.8% = 152/590) and further to subjects with NAR (36.7% = 69/188) or sinusitis (39.9% = 276/691). When adjusting for centre, sex, age, education level, BMI, smoking habits and alcohol intake, the combination of gastritis and GERD was associated with a four-fold increase in the risk of NAR (RRR = 3.80, 95% CI 2.56-5.62) and sinusitis (RRR = 3.70, 2.62-5.23) with respect to controls, and with a much smaller increase in the risk of AR (RRR = 1.79, 1.37-2.35).., Conclusion: The study confirmed the association between gastritis/GERD and nasal disturbances, which is stronger for NAR and sinusitis than for AR.

Objectives: Wheat flour exposure in bakers can elicit respiratory and skin symptoms. Scarce data are available on the prevalence of such conditions in bakers. We investigated the prevalence of work-related rhinitis, asthma-like symptoms and dermatitis in bakers according to job task and type of allergens involved., Methods: Of the 229 traditional bakeries in Verona area who were invited to participate in a cross-sectional survey, 211 (92%) accepted; 727 employees in these bakeries answered a modified version of a questionnaire on job tasks; allergen exposure within the bakery; and work-related nasal, asthma-like and skin symptoms during 2010-2014. Determinants of work-related nasal, asthma-like or skin disorders were separately evaluated using different logistic models., Results: The prevalence of work-related nasal and asthma-like symptoms was, respectively, 15.1% and 4.2% in bakery shop assistants, increasing to 25.7% and 9.5% in bakers using only wheat flour, and further to 31.8% and 13.6% in bakers using flour and additives, and then to 34.1% and 18.2% in bakers using flour with additives and multigrain (p<0.001). The risk of work-related asthma-like symptoms was more than doubled in bakers using additives without or with multigrain than in shop assistants (OR 2.3, 95% CI 1.0 to 5.5 and OR 3.4, 95% CI 1.1 to 10.8, respectively). Making bread with additives alone or with multigrain significantly increased the risk of work-related nasal symptoms in shop assistants, while the risk of skin symptoms was not significantly affected., Conclusions: Bakers using additives alone or with multigrain are at a high risk of experiencing nasal and asthma-like symptoms., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. No commercial re-use. See rights and permissions. Published by BMJ.)