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Objectives This study sought to establish worldwide and regional diagnostic reference levels (DRLs) and achievable administered activities (AAAs) for single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI). Background Reference levels serve as radiation dose benchmarks to compare individual laboratories against aggregated data, helping to identify sites in greatest need of dose reduction interventions. DRLs for SPECT MPI have previously been derived from national or regional registries. To date there have been no multiregional reports of DRLs for SPECT MPI from a single standardized dataset. Methods Data were submitted voluntarily to the INCAPS (International Atomic Energy Agency Nuclear Cardiology Protocols Study), a cross-sectional, multinational registry of MPI protocols. A total of 7,103 studies were included. DRLs and AAAs were calculated by protocol for each world region and for aggregated worldwide data. Results The aggregated worldwide DRLs for rest-stress or stress-rest studies employing technetium Tc 99m–labeled radiopharmaceuticals were 11.2 mCi (first dose) and 32.0 mCi (second dose) for 1-day protocols, and 23.0 mCi (first dose) and 24.0 mCi (second dose) for multiday protocols. Corresponding AAAs were 10.1 mCi (first dose) and 28.0 mCi (second dose) for 1-day protocols, and 17.8 mCi (first dose) and 18.7 mCi (second dose) for multiday protocols. For stress-only technetium Tc 99m studies, the worldwide DRL and AAA were 18.0 mCi and 12.5 mCi, respectively. Stress-first imaging was used in 26% to 92% of regional studies except in North America where it was used in just 7% of cases. Significant differences in DRLs and AAAs were observed between regions. Conclusions This study reports reference levels for SPECT MPI for each major world region from one of the largest international registries of clinical MPI studies. Regional DRLs may be useful in establishing or revising guidelines or simply comparing individual laboratory protocols to regional trends. Organizations should continue to focus on establishing standardized reporting methods to improve the validity and comparability of regional DRLs.

Objectives This study sought to describe worldwide variations in the use of myocardial perfusion imaging hardware, software, and imaging protocols and their impact on radiation effective dose (ED). Background Concerns about long-term effects of ionizing radiation have prompted efforts to identify strategies for dose optimization in myocardial perfusion scintigraphy. Studies have increasingly shown opportunities for dose reduction using newer technologies and optimized protocols. Methods Data were submitted voluntarily to the INCAPS (International Atomic Energy Agency Nuclear Cardiology Protocols Study) registry, a multinational, cross-sectional study comprising 7,911 imaging studies from 308 labs in 65 countries. The study compared regional use of camera technologies, advanced post-processing software, and protocol characteristics and analyzed the influence of each factor on ED. Results Cadmium-zinc-telluride and positron emission tomography (PET) cameras were used in 10% (regional range 0% to 26%) and 6% (regional range 0% to 17%) of studies worldwide. Attenuation correction was used in 26% of cases (range 10% to 57%), and advanced post-processing software was used in 38% of cases (range 26% to 64%). Stress-first single-photon emission computed tomography (SPECT) imaging comprised nearly 20% of cases from all world regions, except North America, where it was used in just 7% of cases. Factors associated with lower ED and odds ratio for achieving radiation dose ≤9 mSv included use of cadmium-zinc-telluride, PET, advanced post-processing software, and stress- or rest-only imaging. Overall, 39% of all studies (97% PET and 35% SPECT) were ≤9 mSv, while just 6% of all studies (32% PET and 4% SPECT) achieved a dose ≤3 mSv. Conclusions Newer-technology cameras, advanced software, and stress-only protocols were associated with reduced ED, but worldwide adoption of these practices was generally low and varied significantly between regions. The implementation of dose-optimizing technologies and protocols offers an opportunity to reduce patient radiation exposure across all world regions.

The design of an electrical system must consider the installation and for the operation plan the predictable sets as ordinary and alternative. The topology of the power system can allow by design operational performances for service continuity such as flexibility, fault selectivity, recoverability from failures, easy maintenance and reparability of the system on its parts. This paper formulates the basis for an operational language and a criteria guideline for safety and integrity procedures, which require continuous training and practice. It assumes as reference a MV distribution system with a general topology of at least two independent sections, provided powered simultaneously by two utility sources.

Duchenne muscular dystrophy (DMD) is an inherited X-linked recessive neuromuscular disease caused by mutations of the dystrophin gene, leading to early and progressive muscle deterioration and dilated cardiomyopathy. The aim of this investigation was to assess whether treatment with sacubitril/valsartan (S/V) is well tolerated and may have beneficial effects in DMD patients with left ventricle (LV) dysfunction.We administered S/V to 3 DMD patients (19-29 yeard old) with LV ejection fraction35% at echocardiography but no symptoms of heart failure. All patients were on optimal medical therapy. S/V was initiated at a very low dose of 12/13 mg/die, after withdrawal of angiotensin-converting enzyme inhibitor therapy, and slowly titrated to the dose of 49/51 mg twice daily or the maximally tolerated dose. Clinical and echocardiographic follow-up was performed after 3, 6 and 12 months.At baseline, the LV ejection fraction was 32±1%. A significant improvement of LV ejection fraction was observed at 3 months (44.0±6.0%; p0.05), which was maintained at 6 (45.7±5.0%) and 12 (43.3±3.2%) months (p0.05 for both). No relevant side effects were reported throughout the period of the study.Our preliminary data suggest that, in DMD patients with reduced LV ejection fraction, S/V is safe and may improve LV function.

Objectives The aim of this study was to investigate gender-based differences in nuclear cardiology practice globally, with a particular focus on laboratory volume, radiation dose, protocols, and best practices. Background It is unclear whether gender-based differences exist in radiation exposure for nuclear cardiology procedures. Methods In a large, multicenter, observational, cross-sectional study encompassing 7,911 patients in 65 countries, radiation effective dose was estimated for each examination. Patient-level best practices relating to radiation exposure were compared between genders. Analysis of covariance was used to determine any difference in radiation exposure according to gender, region, and the interaction between gender and region. Linear, logistic, and hierarchical regression models were developed to evaluate gender-based differences in radiation exposure and laboratory adherence to best practices. The study also included the United Nations Gender Inequality Index and Human Development Index as covariates in multivariable models. Results The proportion of myocardial perfusion imaging studies performed in women varied among countries; however, there was no significant correlation with the Gender Inequality Index. Globally, mean effective dose for nuclear cardiology procedures was only slightly lower in women (9.6 ± 4.5 mSv) than in men (10.3 ± 4.5 mSv; p Conclusions Despite significant worldwide variation in best practice use and radiation doses from nuclear cardiology procedures, only small differences were observed between genders worldwide. Regional variations noted in myocardial perfusion imaging use and radiation dose offer potential opportunities to address gender-related differences in delivery of nuclear cardiology care.

Rapporti di prova. Attività Laboratorio di Geotecnica.

Mediterranean climates are characterized by strong seasonal contrasts between dry summers and wet winters. Changes in winter rainfall are critical for regional socioeconomic development, but are difficult to simulate accurately1 and reconstruct on Quaternary timescales. This is partly because regional hydroclimate records that cover multiple glacial–interglacial cycles2,3 with different orbital geometries, global ice volume and atmospheric greenhouse gas concentrations are scarce. Moreover, the underlying mechanisms of change and their persistence remain unexplored. Here we show that, over the past 1.36 million years, wet winters in the northcentral Mediterranean tend to occur with high contrasts in local, seasonal insolation and a vigorous African summer monsoon. Our proxy time series from Lake Ohrid on the Balkan Peninsula, together with a 784,000-year transient climate model hindcast, suggest that increased sea surface temperatures amplify local cyclone development and refuel North Atlantic low-pressure systems that enter the Mediterranean during phases of low continental ice volume and high concentrations of atmospheric greenhouse gases. A comparison with modern reanalysis data shows that current drivers of the amount of rainfall in the Mediterranean share some similarities to those that drive the reconstructed increases in precipitation. Our data cover multiple insolation maxima and are therefore an important benchmark for testing climate model performance. © 2019, The Author(s), under exclusive licence to Springer Nature Limited.

Rapporti di prova. Attività Laboratorio di Geotecnica.

Rapporti di prova. Attività Laboratorio di Geotecnica.

Rapporti di prova. Attività Laboratorio di Geotecnica

Rapporti di prova . Attività Laboratorio di Geotecnica

Rapporti di prova (numero 20+15=35 (con CB) - Attività Laboratorio di Geotecnica

Rapporti di prova. Attività Laboratorio di Geotecnica

Introduction: The management of patient flow in the emergency department (ED) is crucial for the practice of emergency medicine (EM). However, this skill is difficult to teach didactically and is learned implicitly in the latter half of residency training. To help expedite the learning process, we developed the GridlockED board game as an educational tool to simulate ED patient flow. By having junior medical trainees play this game, we believe that they will develop a greater understanding of patient flow and resource management in the ED. Additionally, since GridlockED is a cooperative game, players may also benefit by improving their communication and teamwork skills. Methods: GridlockED was developed over twenty months of iterative gameplay and review. Feedback from attending emergency physicians, residents, and medical students was integrated into the game through a Plan-Do-Study-Act (PDSA) model. Emergency medicine nurses, physicians and residents at McMaster University were recruited to play GridlockED. Each player completed a pre-survey to collect demographic data and to assess their prior experience with playing board games. All play sessions were recorded for data collection purposes. Following each game session, a member of the research team conducted an exit interview with the players to gather information about their play experience and the educational value of the game. A post-survey was also sent to each participant for further feedback. Results: Eighteen gameplay sessions were conducted from June to August 2017. A total of thirty-two participants played the game (13 emergency physicians, 15 residents, and four nurses). Overall responses to the post-gameplay survey showed that players endorsed GridlockED as a useful potential teaching tool (75%, n=24/32) and the majority felt that it had the potential to improve patient flow in the ED (56%, n=18/32). Most participants found that the game was easy to play (91%, n=27/29), and that the instructions were clear (87.5%, n=28/32). Respondents also felt that the game reflected real life scenarios (56%, n=18) and that cases reflected the types of patients that they saw in the ED (78%, n=25). Conclusion: Our results have shown an overall positive response to GridlockED, with most participants supporting it as both an engaging board game and potential teaching tool. We believe that future studies with larger sample sizes and medical students will further validate the use of serious games in medical education.

Pollen data from twenty-six archaeological sites are reviewed to investigate the development of human-induced environments through the presence of selected Anthropogenic Pollen Indicators (API). The sites are located in six Italian regions - Veneto, Emilia Romagna, Tuscany, Basilicata, Calabria, and Sicily - and in the Republic of San Marino. Their chronology spans from the Bronze to the Renaissance ages, from approximately 4200 to 500 years BP. The API which are common in these sites are properly considered important markers of human activity and anthropization in the Mediterranean area. The most frequent API taxa in pollen spectra are seven: Artemisia, Centaurea, Cichorieae and Plantago are ubiquitous and therefore they have the major relevance, followed by cereals and Urtica, and by Trifolium type. The spread of plants producing these pollen grains is sometimes marked by high percentage values in pollen spectra. Pollen records show that, as expected, cereals and wild synanthropic herbs were widespread near archaeological sites but local differences are evident. Ecological and chrono-cultural reasons may be at the base of the observed differences. In general, the synanthropic plants well represent the xeric environments that developed as a result of the continuous human pressure and changes in soil compositions. These changes have occurred especially during the mid and late Holocene.

During the Mw 6.0 Amatrice earthquake, which struck Central Italy on the 24th August 2016, the accelerometric station IT.AMT, located at about 10km from the epicentre recorded the highest values of the ground motion (Peak Ground Acceleration of the east component reached 0.87 g). Was IT.AMT station affected also by local soil conditions? To understand the role played by the site effects in the ground motion observed at AMT, we performed a detailed geological - geotechnical characterization of the site. Then, numerical analyses of seismic site response were carried out using 2D approaches. In parallel, several analysis were also performed on seismic records, to infer empirical amplification functions, used to compare the results of the numerical simulations. This study was partially supported by the Italian Department of Civil Protection (DPC) of the Presidency of Council of Ministers. The INGV-CNR IGAG collaboration made possible the realization of this multidisciplinary study, which includes detailed seismological, geological and geophysical analyses.

A shortcut review was carried out to see if the abbreviated mental test score was better than other cognitive screening tools to diagnose delirium in the ED. Fourteen papers were identified reporting on 10 separate ED studies. Only one small study used the abbreviated mental test score and did not compare the diagnostic performance to any other test. There is very little published research on the use of the abbreviated mental test score in the ED setting.

Lake Ohrid is located at the border between FYROM and Albania and formed during the latest phases of Alpine orogenesis. It is the deepest, the largest and the oldest tectonic lake in Europe. To better understand the paleoclimatic and paleoenvironmental evolution of Lake Ohrid a deep drilling was carried out in 2013 within the framework of the Scientific Collaboration on Past Speciation Conditions (SCOPSCO) project that was funded by the International Continental Drilling Program (ICDP). Preliminary results indicate that lacustrine sedimentation of Lake Ohrid started between 1.2 and 1.9 Ma ago. Here we present new pollen data (selected percentage and concentration taxa/groups) of the uppermost ~200 m of the 569 m-long DEEP core drilled in the depocenter of Lake Ohrid. The study is the fruit of a cooperative work carried out in several European palynological laboratories. The age model is based on nine tephra layers and on tuning of biogeochemical proxy data to orbital parameters and to the global benthic isotope stack LR04. According to the age model the studied sequence covers the last ~500 000 years at a millennial-scale resolution (~1.6 ka) and record the major vegetation and climate changes that occurred during the last 12 (13 only pro parte) marine isotope stages (MIS). Our results indicate that there is a general good correspondence between forested/non-forested periods and glacial/interglacial cycles of marine isotope stratigraphy. Our record shows a progressive change from cooler and wetter to warmer and dryer interglacial conditions. This shift is visible also in glacial vegetation. The interglacial phase corresponding to MIS11 (pollen assemblage zone, PAZ OD-12, 488–455 ka BP and OD-19, 367–328 ka BP) is dominated by montane trees such as conifers. The two younger interglacial periods, MIS5 (PAZ OD-3, 126–70 ka BP) and MIS1 (PAZ OD-1, 12 ka BP to present) are marked by dominance of mesophilous elements such as deciduous and semi-deciduous oaks. Moreover, MIS7 (PAZ OD-6, 245–189 ka) shows a very high interglacial variability, with alternating expansions of montane and mesophilous arboreal taxa. Grasslands (open vegetation formations requiring relatively humid conditions) characterize the first glacial phases of MIS12 (PAZ OD-12, 488–455 ka), MIS10 (corresponding to PAZ OD-10, 421–367 ka) and MIS8 (PAZ OD-7, 285–245 ka). Steppes (open vegetation formations typical of dry environments) prevail during MIS6 (OD-5 and OD-4, 189–126 ka) and during MIS4–2 (PAZ OD-2, 70–12 ka). Our palynological results support the notion that Lake Ohrid has been a refugium area for both temperate and montane trees during glacials. Close comparisons with other long southern European and Near Eastern pollen records will be achieved through ongoing high-resolution studies.

Commercial forestry plantations as a postmining land use in the Upper Hunter Valley of New South Wales, Australia are restricted by both the poor nutrient availability of mining substrates and low regional rainfall. An experiment was conducted to investigate whether municipal waste products and saline groundwater from coal mining operations could improve early tree growth without impacting on the environment through salt accumulation and/or nutrient enrichment and changes in groundwater quality. Potential impacts were investigated by quantifying the nutrient cycling dynamics within the plantation using an input-output mass balance approach for exchangeable calcium (Ca(2+)), exchangeable magnesium (Mg(2+)), exchangeable potassium (K(+)), exchangeable sodium (Na(+)), nitrogen (N), and phosphorus (P). Measured inputs to and outputs from the available nutrient pool in the 0-30 cm of the overburden subsystem were used to estimate the net effect of unmeasured inputs and outputs (termed "residuals"). Residual values in the mass balance of the irrigated treatments demonstrated large leaching losses of exchangeable Ca, Mg, K, and Na. Between 96% and 103% of Na applied in saline mine-water irrigation was leached below the 0-30-cm soil profile zone. The fate of these salts beyond 30 cm is unknown, but results suggest that irrigation with saline mine water had minimal impact on the substrate to 30 cm over the first 2 years since plantation establishment. Accumulations of N and P were detected for the substrate amendments, suggesting that organic amendments (particularly compost) retained the applied nutrients with very little associated losses, particularly through leaching.

Background: Hamstring autograft size Purpose: To determine whether preoperative ultrasound (US) measurements of hamstring tendons can predict intraoperative graft diameter during ACL reconstruction. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: Twenty patients undergoing unilateral isolated ACL reconstruction were prospectively enrolled in the study (10 males, 10 females; mean ± SD age, 22.8 ± 6.6 years; height, 175.1 ± 7.1 cm; weight, 81.4 ± 14.2 kg; body mass index, 26.5 ± 4.1 kg/m2). Hamstrings were assessed by US, and double-looped semitendinosus-gracilis hamstring size was independently calculated with a freehand selection method on a nonmagnified US image by 2 orthopaedic surgeons. Intraoperative autograft size was determined with a standard graft-sizing tool. Intra- and interrater reliability was measured with intraclass correlation coefficients (ICCs) and standard error of the measure (SEM). A receiver operating characteristic curve was calculated to assess the ability of the US measurement to predict intraoperative measurements. Results: The mean autograft diameter by US was 8.9 ± 0.98 mm, while the mean intraoperative hamstring graft size was 8.1 ± 0.89 mm. There was excellent intrarater (ICC2,1 = 0.95, SEM = 0.32 mm) and interrater (ICC2,1 = 0.88, SEM = 0.55 mm) reliability for US measurements. Receiver operating characteristic analysis showed that US did not consistently quantify graft size. Graft size did not significantly correlate with height, weight, or body mass index in our sample ( P > .05). Conclusion: These results suggest that preoperative US imaging of the hamstring tendons is unreliable in predicting intraoperative graft diameter.

We have studied 560 patients with osteosarcoma of a limb, who had been treated by neoadjuvant chemotherapy, in order to analyse the incidence of local and systemic recurrence according to the type of surgery undertaken. Of these, 465 patients had a limb-salvage procedure and 95 amputation or rotationplasty. At a median follow-up of 10.5 years there had been 225 recurrences. The five-year disease-free survival and overall survival rates were 60.7% and 68.5%, respectively, with no significant difference between patients undergoing amputation and those undergoing resection. The incidence of local recurrence was the same for patients treated by either amputation or limb salvage and correlated significantly with the margins of surgical excision and the histological response to chemotherapy. The outcome for patients with a local recurrence was significantly worse than for those who had recurrent disease with metastases only. We conclude that limb-salvage procedures are relatively safe in osteosarcoma treated by neoadjuvant chemotherapy. They should, however, only be performed in institutions where the margins of surgical excision and the histological response to chemotherapy can be accurately assessed. If the margins are inadequate and the histological response to chemotherapy is poor an immediate amputation should be considered.

Summary According to the latest literature, the authors report epidemiological data, clinical observations, radiographic features and diagnostic findings of bone and soft tissue tumours of the foot. Observations on biopsy, principles of staging, treatment indications and data about prognosis are related to the literature.

We describe 25 patients who were treated for a tumour of the proximal femur by resection and replacement with an uncemented, bipolar, modular prosthesis. When followed up after more than ten years four prostheses (16%) had required revision. Two joints showed wear and another necrosis of the acetabulum. One patient with loosening of the stem had been treated by radiotherapy to the femur. Articular cartilage seemed to be a reliable barrier to acetabular wear. Very few signs of the formation of particulate debris were observed. The most obvious feature in the bone-stem relationship was stress shielding, seen as osteoporosis of the proximal part of the femur around the stem in 68%. Functional activity was satisfactory in 68% of the patients. A better system of reattachment of the soft tissues is needed to avoid pain and a persistent limp.

To report the imaging findings of 24 periosteal chondrosarcomas diagnosed, staged, treated and followed in a single institution, to analyze and define their pattern, and discuss their practical consequences.Plain films, 16 CT examinations and four MRI examinations were reviewed, and compared with the histological evaluation.There were 20 men and four women, aged from 17 to 65 years. Twelve lesions involved the distal femoral metaphyses (8 posteriorly), five the proximal humerus, two the proximal metaphyses of the femur and two of the tibia, two the humeral shafts and one the iliac wing. Size varied from 4 to 11 cm. The cortex was always involved (thick, 15; thin, 13). Typical cartilaginous calcifications and cartilaginous lobules were very frequent. Radial thick periosteal bone formations (n = 6) indicated calcifications between the lobules of cartilage. Medullary involvement was rare (n = 2). All patients are alive and free of disease.Recognizing periosteal chondrosarcoma is of paramount importance because the prognosis is excellent after adequate local surgery alone. The patterns of other surface tumors of bone are usually different.

The reaction of dimesityl telluride (2) with bis(pentafluorophenyl) diselenide (1), Br2 and AgSbF6 provides small amounts of crystalline [Mes2TeSeC6F5][SbF6] (3). The main products, however, are [Mes2TeTeMes][SbF6] (4) and MesSeC6F5 (5). Reactions of 2 with Br2 and AgSbF6 provide − depending on the stoichiometric ratio − 4 and [Mes3Te][SbF6] (6) or [Mes2TeBr][SbF6] (7). 2, Mes2Te2, Br2 and AgSbF6 provide 4 in a fair yield. Addition of 2 to 4 leads to the tritellurium salt [Mes5Te3][SbF6] (8). Cation−anion interactions due to the α-heteroatom electrophilicity of RSe-, RTe- and Br-substituted telluronium salts are followed by structure determinations of 3, 4, 6, 7 and 8 and by Raman-spectroscopic observations of the Te−Te vibrations in compounds 4 and 8.

The aim of this study was to determine in healthy consultees attending cancer genetics clinics their risk status, their pathways leading to the clinics, their expectations and perception of cancer risk. In 1994, the consultees at six French centres completed a questionnaire before their first oncogenetic consultation. The oncogeneticists subsequently filled in a standardised form giving their risk assessment. Among the 206 healthy consultees, 91.3% were women, 92.2% had at least one cancer-affected first-degree relative and 73% had a “cancer family risk” as assessed by the oncogeneticist. Sixty-nine per cent of the consultees were referred to the clinics by a physician, 10.4% by their family and 18.8% on their own initiative: 83.5% of the sample perceived their family risk of cancer as being high and this belief was confirmed in 74.3% of the cases studied by the oncogeneticist. The families of self-referred consultees were less often at risk than those of consultees referred by a physician or by their family ( P = 0.012). The majority (78%) expected to be informed about cancer prevention and screening, and this expectation depended on the consultee's level of education ( P = 0.001). This study shows that medical pathways are more effective than the media as a means of reaching the members of the general population who are genuinely at risk, and shows that fuller information about prevention needs to be provided at cancer genetic consultations.

The Sahara is more connected to the Mediterranean than often assumed and palynology, in particular, has provided evidence of past interrelations between the Mediterranean and the Sahara with pollen spectra from prehistoric Saharan deposits including Mediterranean taxa. In order to show human-environment relationships and populations’ strategies in response to changing environments, this paper presents a case study from the southern Sahara. This region offered a natural laboratory for the study of human/climate interaction as the range of environmental change extended from flood to drought, forcing people to cope with periodic environmental instability. When the tropical rainfall belt migrated northward, watertable outcropped in interdunal depressions and formed permanent lakes, which alternated with severe arid spells. As a case study, this paper presents the results of interdisciplinary investigations on climate changes, human adaptations and subsistence strategies at Gobero, in the southern Sahara of Niger. Gobero is a restricted archaeological area comprising 8 sites that surround the shores of a palaeolake. It was intermittently occupied between about 9500 cal years BP and 4500 BP. Due to alternating environmental conditions it could only be occupied at the beginning and at the end of the most humid periods.

This paper focuses on the archaeobotanical study of two Roman small farmhouses, San Martino and Poggio dell’Amore, located near Cinigiano, in the province of Grosseto-Tuscany. The sites were probably occupied during seasonal agricultural works, a peculiar typology of site that has not been usually identified in Roman sites of central Italy. The integrated analyses of pollen, non pollen palynomorphs, charcoal particles and seeds/fruits help to obtain interesting details on the site function, land use and palaeoenvironment of these archaeological contexts. The archaeobotanical reconstruction shows that the landscape was fairly treeless. Pastures surrounded the small buildings while cereal fields were probably less extended or further away than legume fields cultivated to forage. Shrubs and some fruit trees might mark boundaries of fields, while the woods, including oak woods, were distributed far from the sites. Anthropogenic pollen indicators, spores of coprophilous fungi and parasite eggs point to the presence of excrements in the sites suggesting that the small buildings were used as small barns for domestic animals, or a temporary shed.

Editorial to Notes

The European Lacidipine Study on Atherosclerosis (ELSA) has been designed to compare the effects of two antihypertensive agents, the calcium antagonist lacidipine and the beta-blocker atenolol, on the development of atherosclerosis in hypertensive patients stratified according to the presence of carotid plaques, or the presence or absence of carotid artery intima-media thickening. ELSA is a multinational, multicenter, randomized, double-blind, parallel group study that is to be conducted over a 5-year period. Recruitment and treatment will take place at 23 referral centers in seven countries. A total cohort of 3,660 patients, aged between 45 and 75 years, with diastolic blood pressure 95-115 mm Hg and systolic blood pressure < or = 210 mm Hg at enrollment, will be stratified into three groups according to a B-mode ultrasound analysis of the carotid wall morphology. After a 1-month placebo run-in period, patients will be randomized to receive either lacidipine (4-6 mg once daily) or atenolol (50-100 mg once daily). Nonresponders will be treated with hydrochlorothiazide (12.5 mg, eventually titrated to 25 mg if required), on an open basis. During the course of the study, patients will be monitored by carotid ultrasound assessment and ambulatory blood pressure monitoring. The results of this study should further understanding of the pathobiology of atherosclerosis, and its development and prevention.

Il villaggio di Fehwet è situato nella piccola oasi omonima, posta ca. 10 km a sud Ghat, in Libia sud-occidentale. Il sito archeologico è stato oggetto di scavo nel corso delle campagne 2002- 2006 della Missione Archeologica Italo-Libica diretta da Savino di Lernia e condotta da Sapienza Università di Roma e Dipartimento di Archeologia di Tripoli. La maggior parte dei reperti ha mostrato buono stato di conservazione. Dai dati raccolti emerge una larga predominanza di Tamarix (153 reperti-77%) che include T. tetragyna Ehrenb. (97 reperti), T. aphylla Karst. (26 reperti), e Tamarix sp. (30 reperti). Pure significativa è la presenza di Phoenix dactylifera L. (43 reperti - 22%), mentre rari sono Acacia sp. (1 reperto) e cf. Nerium oleander L. (1 reperto).

Between January 1988 and December 1990, 74 patients with localized Ewing's sarcoma of bone were treated with a new protocol that consisted of an initial 6-week period of chemotherapy with vincristine (VCR), adriamycin (ADM) and cyclophosphamide (EDX) followed by local therapy and additional chemotherapy with the same drugs previously indicated plus ifosfamide and VP-16. The rationale for the addition of ifosfamide and VP-16 to the four drugs of the standard chemotherapy of this tumor was that this drug combination was previously very effective in the treatment of metastases from Ewing's sarcoma even in patients who did not respond to cyclophosphamide. As local treatment all patients were offered surgery, when feasible (70 cases). Forty-three patients accepted and 27 refused. These patients, as the 4 patients in whom surgery was not considered feasible, were treated with radiation therapy alone (50-60 Gy). In the remaining patients amputation was performed in 4 cases, rotationplasty in 3 and resection in 36. Where conservative surgery was marginal or intralesional (30 cases), radiotherapy at lower doses (40-45 Gy) was also delivered. At a mean follow-up of 3.5 years (2-7), 43 patients (58%) remained continuously disease-free and 31 relapsed (29 with metastases and 2 with both metastases and local recurrences). These results do not differ from those obtained at our Institution in 98 patients treated between 1983 and 1988 with a neoadjuvant protocol in which only VCR, ADM, EDX and dactinomycin (DAC) were used (3-year continuously disease-free survival (CDFS) respectively of 54% and 55%). Despite the fact that these results came from a nonrandomized study, the Authors conclude that the addition of ifosfamide and VP-16 to the four-drug standard regimen did not improve the outcome of the patients with Ewing's sarcoma of bone which remains a lethal disease in about 50% of the cases. These findings stress the need to find more effective chemotherapeutic regimens for the associated treatment of this tumor.