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La locuzione “regione culturale” associa due termini che in geografia, così come in altre discipline sociali e umanistiche, sono stati messi in profonda discussione. Fino ad almeno tutti gli anni Sessanta del secolo scorso, tale espressione aveva una sua ragione d’essere ed era fulcro di studi e ricerche specifiche, sia sul piano teorico che applicativo. Ma con il passare del tempo, grazie alla terziarizzazione e informatizzazione dell’economia, all’intensificazione dei movimenti migratori, ai processi di urbanizzazione, alla diffusione capillare di tecnologie digitali, così come all’emergere di nuovi approcci scientifici che hanno rivoluzionato ontologie ed epistemologie consolidate, il concetto di regione culturale ha perso molto della sua ragione d’essere. Ha ancora senso, dunque, parlare oggi di regione culturale? In riferimento a quali aspetti e in quali termini? Questo capitolo intende dare risposta a tali interrogativi, dapprima esaminando il concetto di regione culturale nella sua evoluzione e nei suoi attuali possibili significati, quindi analizzando in profondità gli aspetti linguistici.

La lingua si manifesta nel paesaggio attraverso forme testuali (insegne di negozi, pubblicità, toponomastica, ecc) che contribuiscono a configurare lo spazio pubblico, il cui studio evidenzia da un lato l’identità dei luoghi, dall’altro promuove una riflessione territoriale sui processi di globalizzazione culturale, sulle migrazioni e sulle società multiculturali e multilinguistiche che da tali fenomeni derivano. La distribuzione dei segni linguistici nello spazio – soprattutto quello urbano - produce infatti paesaggi linguistici e culturali che rappresentano le relazioni territoriali e le dinamiche sociali dei diversi gruppi. Dopo una riflessione sul ruolo dei segni linguistici nello studio dei paesaggi della contemporaneità, specificamente in ambito urbano, il contributo vuole proporre un focus sul valore pedagogico di tale prospettiva, attraverso un’esperienza didattica presso l’Università di Bologna, volta a mettere in luce il ruolo che tale approccio di studio al paesaggio può giocare nella riflessione sul multiculturalismo, sull’integrazione e, in breve, sul ben-essere dei soggetti che quel paesaggio linguistico lo abitano, costruiscono e vivono.

Background Laboratory data and computed tomography (CT) have been used during the COVID-19 pandemic, mainly to determine patient prognosis and guide clinical management. The aim of this study was to evaluate the association between CT findings and laboratory data in a cohort of COVID-19 patients. Methods This was an observational cross-sectional study including consecutive patients presenting to the Reggio Emilia (Italy) province emergency rooms for suspected COVID-19 for one month during the outbreak peak, who underwent chest CT scan and laboratory testing at presentation and resulted positive for SARS-CoV-2. Results Included were 866 patients. Total leukocytes, neutrophils, C-reactive protein (CRP), creatinine, AST, ALT and LDH increase with worsening parenchymal involvement; an increase in platelets was appreciable with the highest burden of lung involvement. A decrease in lymphocyte counts paralleled worsening parenchymal extension, along with reduced arterial oxygen partial pressure and saturation. After correcting for parenchymal extension, ground-glass opacities were associated with reduced platelets and increased procalcitonin, consolidation with increased CRP and reduced oxygen saturation. Conclusions Pulmonary lesions induced by SARS-CoV-2 infection were associated with raised inflammatory response, impaired gas exchange and end-organ damage. These data suggest that lung lesions probably exert a central role in COVID-19 pathogenesis and clinical presentation.

Invasive candidiasis (IC) is a challenging clinical condition, burdened by relevant mortality and morbidity. There is limited knowledge on the occurrence and management of IC in Internal Medicine Units (IMUs). Aim of this study was to provide real-world data on this topic. Consecutive objectively diagnosed cases of IC were collected in this prospective registry, which involved 18 IMUs in Italy. Patients were followed-up to 90 days from the diagnosis of candidemia. A total of 111 patients were observed (median age 78, IQR 67–83) for an overall incidence of infection of 1.89 cases/1000 hospital admissions. Candida albicans was the most frequent isolated species (62%), followed by Candida parapsilosis (17%) and Candida glabrata (13%). Echinocandins and fluconazole were used as initial therapy in 56.8 and 43.2% of patients, respectively. Antifungal therapy was started within 24 h in 18.9% of patients, in 40.6% in the period 1–3 days, and in 40.5% of patients more than 3 days after blood cultures. Death rate was 19.8% at 30 days and 40.5% at 90 days. At multivariable analysis concomitant bacteremia (i.e. polymicrobial sepsis), and fluconazole as the initial therapy were associated with an increased risk of death at 90 days. The incidence of IC is not negligible, and our registry confirmed that these patients have a relevant mortality rate at 90 days. Concomitant bacteremia, featuring polymicrobial sepsis, and starting antifungal treatment with fluconazole instead of echinocandins independently increase the risk of death. Efforts are needed to improve the awareness and management of IC in IMUs.

Objective The aims of this study were to develop a multiparametric prognostic model for death in COVID-19 patients and to assess the incremental value of CT disease extension over clinical parameters. Methods Consecutive patients who presented to all five of the emergency rooms of the Reggio Emilia province between February 27 and March 23, 2020, for suspected COVID-19, underwent chest CT, and had a positive swab within 10 days were included in this retrospective study. Age, sex, comorbidities, days from symptom onset, and laboratory data were retrieved from institutional information systems. CT disease extension was visually graded as < 20%, 20–39%, 40–59%, or ≥ 60%. The association between clinical and CT variables with death was estimated with univariable and multivariable Cox proportional hazards models; model performance was assessed using k-fold cross-validation for the area under the ROC curve (cvAUC). Results Of the 866 included patients (median age 59.8, women 39.2%), 93 (10.74%) died. Clinical variables significantly associated with death in multivariable model were age, male sex, HDL cholesterol, dementia, heart failure, vascular diseases, time from symptom onset, neutrophils, LDH, and oxygen saturation level. CT disease extension was also independently associated with death (HR = 7.56, 95% CI = 3.49; 16.38 for ≥ 60% extension). cvAUCs were 0.927 (bootstrap bias-corrected 95% CI = 0.899–0.947) for the clinical model and 0.936 (bootstrap bias-corrected 95% CI = 0.912–0.953) when adding CT extension. Conclusions A prognostic model based on clinical variables is highly accurate in predicting death in COVID-19 patients. Adding CT disease extension to the model scarcely improves its accuracy. Key Points • Early identification of COVID-19 patients at higher risk of disease progression and death is crucial; the role of CT scan in defining prognosis is unclear. • A clinical model based on age, sex, comorbidities, days from symptom onset, and laboratory results was highly accurate in predicting death in COVID-19 patients presenting to the emergency room. • Disease extension assessed with CT was independently associated with death when added to the model but did not produce a valuable increase in accuracy. Supplementary Information The online version contains supplementary material available at 10.1007/s00330-021-07993-9.

Objective To assess sensitivity/specificity of CT vs RT-PCR for the diagnosis of COVID-19 pneumonia in a prospective Italian cohort of symptomatic patients during the outbreak peak. Methods In this cross-sectional study, we included all consecutive patients who presented to the ER between March 13 and 23 for suspected COVID-19 and underwent CT and RT-PCR within 3 days. Using a structured report, radiologists prospectively classified CTs in highly suggestive, suggestive, and non-suggestive of COVID-19 pneumonia. Ground-glass, consolidation, and visual extension of parenchymal changes were collected. Three different RT-PCR-based reference standard definitions were used. Oxygen saturation level, CRP, LDH, and blood cell counts were collected and compared between CT/RT-PCR classes. Results The study included 696 patients (41.4% women; age 59 ± 15.8 years): 423/454 (93%) patients with highly suggestive CT, 97/127 (76%) with suggestive CT, and 31/115 (27%) with non-suggestive CT had positive RT-PCR. CT sensitivity ranged from 73 to 77% and from 90 to 94% for high and low positivity threshold, respectively. Specificity ranged from 79 to 84% for high positivity threshold and was about 58% for low positivity threshold. PPV remained ≥ 90% in all cases. Ground-glass was more frequent in patients with positive RT-PCR in all CT classes. Blood tests were significantly associated with RT-PCR and CT classes. Leukocytes, lymphocytes, neutrophils, and platelets decreased, CRP and LDH increased from non-suggestive to suggestive CT classes. Conclusions During the outbreak peak (in a high-prevalence setting), CT presented high PPV and may be considered a good reference to recognize COVID-19 patients while waiting for RT-PCR confirmation. Key Points • During the epidemic peak, CT showed high positive predictive value and sensitivity for COVID-19 pneumonia when compared with RT-PCR. • Blood tests were significantly associated with RT-PCR and CT classes. Electronic supplementary material The online version of this article (10.1007/s00330-020-07050-x) contains supplementary material, which is available to authorized users.

Tutti i rapporti internazionali confermano che l’Africa è il continente che subirà gli effetti più drammatici dei cambiamenti climatici, nonostante il suo limitato contributo, sia passato sia presente, all’emissione di gas serra. Secondo il Quinto Assessment Report dell’IPCC, pubblicato nel 2014 (Niang, 2014), tali impatti dipenderanno dall’aumento delle temperature medie ben al di sopra dei 2° C entro i due ultimi decenni di questo secolo, ma presenteranno situazioni molto diversificate, con ampie aree del continente che soffriranno significative riduzioni delle precipitazioni mentre altre dovranno fare i conti con eventi climatici più estremi quali inondazioni causate da piogge molto violente e frequenti. Si stima che tutti questi fenomeni colpiranno duramente gli ecosistemi africani e la vita delle popolazioni che li abitano, e che questi eventi climatici interagiranno con altri fattori di stress territoriale, andando così ad esacerbare la vulnerabilità dell’agricoltura, dell’allevamento e della pesca. Secondo i dati forniti dal White Paper of the AAA Initiative, l’Africa presenta il più alto numero di paesi (27) esposti a rischi estremi per quanto riguarda il Climate Change Vulnerability Index, con circa il 65% della popolazione dell’intero continente direttamente colpita dagli impatti dei cambiamenti climatici . Molti di questi impatti territoriali – quali siccità estrema o piogge severe, perdita di terra fertile, foreste e biodiversità, crescita di parassiti, insetti nocivi e malattie, solo per citarne alcuni – condizioneranno anche lo sviluppo turistico sia costiero sia terrestre del continente.

Si stima che i cambiamenti climatici indurranno cambiamenti territoriali molto consistenti nel prossimo futuro, andando a colpire non solo tutto il pianeta, ma anche tutti i settori economici, tra cui il turismo. Nello specifico, discuteremo qui del ruolo che essi avranno nel ridisegnare le geografie turistiche a scala planetaria, ma con un focus sul continente africano, che si stima essere quello che subirà gli impatti più duri, non solo a causa della sua vulnerabilità fisica, ma soprattutto come conseguenza della sua debolezza economica e scarsa capacità di adattamento. Tali impatti si presenteranno in modalità molto diverse nel continente, andando a interagire in modi complessi con le società che lo popolano. Obiettivo primario di questo studio è quindi quello di individuare come l’Africa si stia preparando ad affrontare le ripercussioni dei cambiamenti climatici, in particolare nel settore turistico, con azioni di capacity building ed empowerment ottenute attraverso la cooperazione con soggetti locali e internazionali che promuovono un approccio partecipativo allo sviluppo locale. Tali interazioni verranno analizzate con un approccio multiscalare: partendo dalla scala continentale africana, si scenderà al livello della scala regionale, quello della dimensione transnazionale dei paesi lusofoni africani, per arrivare alla scala nazionale dei singoli paesi che costituiscono questo gruppo.

Background and study purpose: to describe the comorbidity of celiac disease among a large cohort of multiple sclerosis patients in Tuscany. Methods: the association of celiac disease among multiple sclerosis adult patients (n=2050) was retrospectively evaluated. Results: 13 patients were diagnosed with celiac disease, the female:male ratio was 3.3:1 and the median age at diagnosis was 34.2 years (SD 13). Seventy-seven per cent of subjects complained about gastrointestinal symptoms. IgA anti- transglutaminase was positive in 85 % of cases and there was 70 % of villous atrophy. Conclusions: the frequency of celiac disease among multiple sclerosis patients examined was lower than in the general population, 0.6 % vs 1 %)(p = 0.65).

In this retrospective, multicenter, real-world study we collected clinical and magnetic resonance imaging (MRI) data of all patients (n = 40) with relapsing-remitting multiple sclerosis (RRMS) treated with alemtuzumab according to a "free-of-charge" protocol available before the drug marketing approval in Italy. Almost all (39/40) started alemtuzumab after discontinuing multiple disease-modifying treatments (DMTs) because of either lack of response or safety concerns. We considered the proportion of alemtuzumab-treated patients who had no evidence of disease activity (NEDA-3) and disability improvement over a 36-month follow-up period. NEDA-3 was defined as absence of relapses, disability worsening, and MRI activity. Disability improvement was defined as a sustained reduction of ≥ 1-point in Expanded Disability Status Scale (EDSS) score. At follow-up, 18 (45%) patients achieved NEDA-3, 30 (75%) were relapse-free, 33 (82.5%) were EDSS worsening-free, and 25 (62.5%) were MRI activity-free. Eleven (27.5%) patients had a sustained disability improvement. We found no predictor for the NEDA-3 status, while the interaction of higher EDSS score by higher number of pre-alemtuzumab relapses was associated with a greater chance of disability improvement (odds ratio 1.10, p = 0.049). Our study provides real-world evidence that alemtuzumab can promote clinical and MRI disease remission, as well as disability improvement, in a significant proportion of patients with RRMS despite prior multiple DMT failures. The drug safety profile was consistent with data available from clinical trials.

The paragraph collect, compare and disseminate updated data related to the Pan-European indicators for Sustainable Forest Management, with a particular emphasis on those indicators related to carbon cycle/sequestration and biodiversity.

In questo lavoro viene investigata la rimozione di ozono dovuta alla apertura stomatica da parte di tre specie arboree: pioppo, leccio e pino, utilizzando una tecnica di misura che prevede di misurare la concentrazione di ozono in contatto con le foglie sia a stomi aperti che a stomi chiusi ed evidenziando così il contributo dell'effetto stomatico sulla sua distruzione.