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This multisite study was conducted to compare the efficacy and tolerability of combination treatment with clozapine plus aripiprazole versus combination treatment with clozapine plus haloperidol in patients with schizophrenia who do not have an optimal response to clozapine. Patients continued to take clozapine and were randomly assigned to receive daily augmentation with aripiprazole or haloperidol. Physicians prescribed the allocated treatments according to usual clinical care. Withdrawal from allocated treatment within 3 months was the primary outcome. Secondary outcomes included severity of symptoms on the Brief Psychiatric Rating Scale and antipsychotic subjective tolerability on the Liverpool University Neuroleptic Side Effect Rating Scale. A total of 106 patients with schizophrenia were randomly assigned to treatment. After 3 months, we found no difference in the proportion of patients who discontinued treatment between the aripiprazole and haloperidol groups (13.2% vs 15.1%, P = 0.780). The 3-month change of the Brief Psychiatric Rating Scale total score was similar in the aripiprazole and haloperidol groups (-5.9 vs -4.4 points, P = 0.523), whereas the 3-month decrease of the Liverpool University Neuroleptic Side Effect Rating Scale total score was significantly higher in the aripiprazole group than in the haloperidol group (-7.4 vs -2.0 points, P = 0.006). These results suggest that augmentation of clozapine with aripiprazole offers no benefit with regard to treatment withdrawal and overall symptoms in schizophrenia compared with augmentation with haloperidol. However, an advantage in the perception of adverse effects with aripiprazole treatment may be meaningful for patients.

BACKGROUND; Heart failure (HF) represents an important health issue in western countries, especially for the elderly, frail population. A number of HF patients must usually be assisted at home. No information is available about the usual care of HF patients in Italy. The aim of this study was to describe the characteristics of HF patients receiving homecare in the Italian general practice. METHODS: A questionnaire was sent to 320 general practitioners (GPs) involved in the Health Search project. Among these, 148 (46.2%) answered and 376 home-ridden HF patients (60.3% women, median age 85 years) were identified. RESULTS: 257 (57%) patients were in NYHA class III or IV. Multiple relevant concomitant diseases occurred in 326 (86.7%) subjects. Only 140 (37.2%) patients were able to take their pills without any help; caregivers, mainly family members, were required 24 hours a day in 78.7% of cases. The length of homecare was > 1 year in 84.5% of cases. CONCLUSIONS: According to our data, thousands of HF patients are usually assisted at home for long periods in Italy. This is a very old group of subjects with heavy co-morbidity and a high need for continuous, prolonged assistance. Studies specifically aimed at the care of HF patients are needed.

The safeguard genetic resources of persimmon in the Mediterranean basin is limited. Some European institutions have contributed, through EC GENRES29 Project 'Conservation of minor fruit tree species', to the safeguarding and conservation of a number of persimmon accessions collected in clonal orchards. Cryopreservation could be an advanced technique to reduce serious implications and risks in the management of germplasm collections and preserve Diospyros kaki cultivars. To optimize cryopreservation procedure for shoot tips from dormant buds of persimmon, mainly used in the Mediterranean area, several experiments were carried out by one-step vitrification method. Vegetative dormant buds were taken, during the winter, from twigs of persimmon cultivars ('Kaki Tipo', 'Jiro', 'Triumph', 'Hiratanenashi' and 'Rojo Brillante'). Shoot tips (2-3 mm) were dissected from sterilized buds and precultured on MS medium (modified with half-strength NH4NO3 and KNO3) with 0.3 M sucrose for 48h. To induce osmodehydration, the shoot tips were loaded in Plant Vitrification Solution 2 (PVS2), for different times (20 min in the first experiment; 30, 60, 90 min in the following experiments) and two treatment temperatures (0°C and 25°C). The explants were rapidly frozen to -196°C by direct immersion in liquid nitrogen (LN). For recovery, they were quickly rewarmed in a waterbath at 40°C for 1 min, then the shoot tips were transferred on the regrowth medium (MS modified with 0.06 M sucrose, 22.2 mM BA, 2 g/l gerlite) and maintained at 24°C with 16h photoperiod. Survival of cryopreserved shoot tips was assessed after 3 weeks. By applying a treatment with PVS2 for 20 min at 25°C on shoots tips from dormant buds, the survival rate observed in cv 'Triumph' (25%), 3 weeks after cryopreservation, is lower than those reported by Matsumoto et al. (2001). In a subsequent experiment on cv 'Kaki Tipo', where we applied a longer exposure time to PVS2, a higher shoot tip survival rate was obtained, in particular with PVS2 treatment for 90 min (73%). The same protocol applied on other cultivars confirmed the effectiveness of this vitrification procedure and with 90 min PVS2 treatment, the survival percentage in three cultivars ('Jiro', 'Triumph' and 'Rojo Brillante') was recorded between 56-80%. Whereas, in cv 'Hiratanenashi', the best survival (86%) was observed with 60 min PVS2 treatment before explant immersion in LN. Molecular assays were performed with fresh material, in vitro-cultured and cryopreserved shoots tips of three persimmon cultivars ('Kaki Tipo', 'Jiro', 'Triumph') in order to validate both the micropropagation procedure and the optimized cryopreservation technique. In our experiments, no morphological deviation was observed in the development of persimmon cryopreserved plantlets.

Background The PERSEO study (psychiatric emergency study and epidemiology) is a naturalistic, observational clinical survey in Italian acute hospital psychiatric units, called SPDCs (Servizio Psichiatrico Diagnosi e Cura; in English, the psychiatric service for diagnosis and management). The aims of this paper are: (i) to describe the epidemiological and clinical characteristics of patients, including sociodemographic features, risk factors, life habits and psychiatric diagnoses; and (ii) to assess the clinical management, subjective wellbeing and attitudes toward medications. Methods A total of 62 SPDCs distributed throughout Italy participated in the study and 2521 patients were enrolled over the 5-month study period. Results Almost half of patients (46%) showed an aggressive behaviour at admission to ward, but they engaged more commonly in verbal aggression (38%), than in aggression toward other people (20%). A total of 78% of patients had a psychiatric diagnosis at admission, most frequently schizophrenia (36%), followed by depression (16%) and personality disorders (14%), and no relevant changes in the diagnoses pattern were observed during hospital stay. Benzodiazepines were the most commonly prescribed drugs, regardless of diagnosis, at all time points. Overall, up to 83% of patients were treated with neuroleptic drugs and up to 27% received more than one neuroleptic either during hospital stay or at discharge. Atypical and conventional antipsychotics were equally prescribed for schizophrenia (59 vs 65% during stay and 59 vs 60% at discharge), while atypical drugs were preferred in schizoaffective psychoses (72 vs 49% during stay and 70 vs 46% at discharge) and depression (41 vs 32% during stay and 44 vs 25% at discharge). Atypical neuroleptics were slightly preferred to conventional ones at hospital discharge (52 vs 44%). Polypharmacy was in general widely used. Patient attitudes toward medications were on average positive and self-reported compliance increased during hospital stay. Conclusion Results confirm the widespread use of antipsychotics and the increasing trend in atypical drugs prescription, in both psychiatric in- and outpatients.

Purpose: After regulatory restrictions for terfenadine and astemizole in ‘90s, only scarce evidence on proarrhythmic potential of antihistamines has been published. We evaluate the risk of ventricular tachyarrhythmia (VA) related to the use of individual antihistamines. Methods: A matched case-control study nested in a cohort of new users of antihistamines was conducted within the EU-funded ARITMO project. Data on 1997–2010 were retrieved from seven healthcare databases: AARHUS (Denmark), GEPARD (Germany), HSD and ERD (Italy), PHARMO and IPCI (Netherlands) and THIN (UK). Cases of VA were selected and up to 100 controls were matched to each case. The odds ratio (OR) of current use for individual antihistamines (AHs) was estimated using conditional logistic regression. Results: For agents largely used to prevent allergic symptoms, such as cetirizine, levocetirizine, loratadine, desloratadine and fexofenadine, we found no VA risk. A statistically significant, increased risk of VA was found only for current use of cyclizine in the pooled analysis (ORadj, 5.3; 3.6–7.6) and in THIN (ORadj, 5.3; 95% CI, 3.7–7.6), for dimetindene in GEPARD (ORadj, 3.9; 1.1–14.7) and for ebastine in GEPARD (ORadj, 3.3; 1.1–10.8) and PHARMO (ORadj, 4.6; 1.3–16.2). Conclusions: The risk of VA associated with a few specific antihistamines could be ascribable to heterogeneity in pattern of use or in receptor binding profile.