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The paper proposes a methodology to assess the potential impact of salinity gradient power technology in urban contexts. The idea to employ such energy source in urban contexts derives from the observation that, among the energy districts outputs, low-salinity treated wastewater can be used to produce electricity if a suitable source of high salinity feed (seawater of a salt-works) is also available. The methodology uses the HOMER software for assessing the district’s electric energy production, consumption and exchange with the main grid. Then, starting from the total gross surface and the number of inhabitants of the district, some possible realistic scenarios characterized by different wastewater flow rate are defined. Finally, for each scenario the size and the yearly energy production of the salinity gradient power system are calculated thanks to a simulator carried out by the same authors. An application example, considering three different scenarios, shows that urban density plays a crucial role in the process and that the most promising realistic scenarios are those including treated wastewater and brine and unlimited seawater and brine. The economic feasibility of the salinity gradient power technology is evaluated by a comparison with classical renewable technologies such as photovoltaic and wind systems.

Public Administrations are frequently entitled to intervene in building stocks with energy rehabilitation actions. Unfortunately, the monetary budget at their disposal is generally limited and, consequently, a prioritization criterion is needed to optimize its allocation. The classification of the building energy performance is increasingly used by Public Administrations for this purpose. Here we argue that a proper prioritization criterion should depend upon the potential subjects to which the rehabilitated buildings are given back. If the energy rehabilitation is conducted on buildings that will be assigned to new dwellers, it would be preferable to use the energy class – which is based on a standardized energy consumption – because a change of the building users will occur with a consequent plausible change of the building energy usage profile. Instead, if same dwellers will occupy the retrofitted building, a criterion based on a usage profile – that is actually the one established by these occupants – seems to be more appropriate. The priority orders of 23 buildings of the Sicilian stock, obtained using their energy class and real energy consumption, are presented and compared. Results show at which extent these two rankings differ, thus warning Public Administrations about prioritization criteria to adopt.

The energy retrofit of the existing building stocks is considered a preeminent strategy to lowering the energy consumption of the building sector. Other than the definition of the most successful combination of energy saving measures, the definition of a suitable ranking of all the buildings of the stock, on which implementing established energy retrofit measures, is quite a relevant issue. The most eligible criterion for prioritizing the buildings seems their energy consumption because it combines the building energy performance and their size. To investigate the role played by the building dimension in determining the order of priority of all the buildings of a given stock, this paper presents and compares different hierarchical orders of 25 existing buildings that were obtained with and without consideration of the size of the buildings. Results show that, when the size of buildings is covered in the calculations, the generated prioritized order differs significantly. In addition, it has found that the entity of the variations compared to the hierarchy that does not contemplate the size of buildings, is logarithmically correlated with the net surface. Additionally, some concerns have arisen regarding the role of the EP index for the building energy classification.

The “Smart Cities & Communities Initiative” of the Strategic Energy Technology Plan is the strategic European response to lead cities and regions to a carbon free future. In this contest energy efficiency in buildings has a crucial role and must be considered in a holistic approach to the urban planning. In order to implement the minimum requirements stated by the European Directive about the Energy Performance of Buildings, and in order to consider different planning layers with the view to a smart city planning, local regulations are a key factor aiming at sustainable territorial planning. This paper investigates the possibility to draft a basic structure of Municipal Building Regulations in order to guide local administrators and technicians and to limit discretionary power of bureaucracy. The paper is organized as follows. First, a review of the most common practices for building regulations in Europe is proposed, then the basic structure of a municipal building regulation for the city of Palermo (Southern Italy) accounting for sustainability is discussed.

The aim of this study was to report clinical outcomes in patients treated with paclitaxel-coated balloons (PCB) for in-stent restenosis (ISR) in both bare metal (BMS) and drug-eluting stent (DES).Between May 2009 and December 2015, we treated 155 ISR in 140 patients. At recruitment, 35% of patients had diabetes. Among the lesions, 125 were first occurrence (55 within BMS and 70 within DES) and 30 recurrent; 24 ISR were multi-metal layered. Mean reference diameter was 2.79 ± 0.52 mm and mean lesion length 13.2 ± 7.1 mm. PCB use included 32 Dior I, 97 InPact Falcon, 18 Panthera Lux, and 8 Restore DEB.At a median follow-up of 442 days, we observed 18 target lesion revascularizations (TLR), one myocardial infarction, 3 cardiac deaths, and 5 non-cardiac deaths. TLR occurrence differed according to type of ISR (4% within BMS, 14% within DES, 28% within recurrent ISR; p0.05). TLR was associated with PCB type (35% Dior I, 9% InPact Falcon, 0% Panthera Lux and Restore DEB; p0.05). Multivariable analysis revealed that first-generation PCB without a carrier (hazard ratio [HR] 2.50, 95% confidence interval [CI] 0.96-6.50; p=0.06) and recurrent ISR (HR 7.76, 95% CI 1.56-38.66; p=0.01) correlated with subsequent TLR.Our results confirm the safety and efficacy of PCB for ISR treatment both within BMS and DES. PCB type and recurrent ISR correlate with subsequent TLR.

The “Smart Cities & Communities Initiative” of the Strategic Energy Technology Plan is the strategic European response to lead cities and regions to a carbon free future. In this contest energy efficiency in buildings has a crucial role and must be considered in a holistic approach to the urban planning. In order to implement the minimum requirements stated by the European Directive about the Energy Performance of Buildings, and in order to consider different planning layers with the view to a smart city planning, local regulations are a key factor aiming at sustainable territorial planning. This paper investigates the possibility to draft a basic structure of Municipal Building Regulations in order to guide local administrators and technicians and to limit discretionary power of bureaucracy. The paper is organized as follows. First, a review of the most common practices for building regulations in Europe is proposed, then the basic structure of a municipal building regulation for the city of Palermo (Southern Italy) accounting for sustainability is discussed.

La gestione intelligente dell'abitare nelle città e delle tradizionali funzioni urbane riassume il modello smart city. Attraverso un approccio integrato generato dall'uso dell'ICT e del web, che assume il ruolo di tecnologia abilitante per il cambiamento, le città contemporanee stanno prepotentemente cambiando. L'età digitale crea infatti le condizioni per l'emergere di nuovi strumenti e nuovi servizi per i cittadini, basati sulla comunicazione e sulla condivisione e le pratiche di partecipazione. Il capitolo contestualizza questi cambiamenti focalizzando su alcuni esempi su cosa può essere definito come servizi dematerializzati delle città contemporanee, visti come nuovi servizi urbani e nuove pratiche dell'abitare delle comunità nelle città intelligenti. The “intelligent management” of living in cities and of the traditional urban functions, summarizes the model of smart city. Through new integrated approaches generated from the use of Information and Communication Technology (ICT) and of the web, which take the role of enabling technology for change, contemporary cities are strongly changing. The digital age creates, in fact, the conditions for the emergence of new tools and new services for citizens, based on communication and on sharing and participation practices. The chapter contextu- alizes these changes by focusing on some examples of what can be defined as “dematerialized services” of contemporary cities, seen as new urban services and new practices of community’s living in smart cities.

In this chapter, we try to connect the urban design features with energy consumption and consequent pollution parameters. After a review of a selected set of approaches to Urban Energy Systems study with a special focus on electrical power systems, urban energy systems are proposed as networks of multi-source hybrid energy hubs, where different energy flows are collected at the same bus and can be stored, delivered or transformed as needed. Resources at the hub and infrastructures interact with each other; therefore, both definition and boundaries of such energy systems at urban level are difficult to be clearly outlined. Similarly, the possibility to generate new operational models based on existing critical urban infrastructures is also challenging. This contribution proposes a preliminary study of urban energy hubs. Operations of thermal, electrical and mobility infrastructures are considered as qualifying features of the hub, but still the interconnected operation is not taken into account. The application part shows, indeed, the analysis and optimized design of the energy system serving two different urban districts. The related optimized parametric design of power generation infrastructures is considered as a function of urban features. The results about emissions and costs provide some interesting conclusions about the linkage between energy planning and urban features at district level, thus allowing, as possible application of this work, an energy-based territorial planning for urban contexts.

Il capitolo mostra alcuni esempi di smart cities. Nel capitolo i casi di studio sono divisi in aree geografiche, che a livello macroscopico si riferiscono a diversi tipi di città e comunità in relazione a diversi livelli di innovazione tecnologica e tipo di capitale umano, che sono fattori chiave per raggiungere uno sviluppo smart. Le città di nuova costruzione sono città appartenenti all'area asiatica pianificate da zero per limitare emissioni nocive ed alzare la qualità della vita dei cittadini. Nel paragrafo sulle città del Nord Europa e quelle del Mediterraneo sono descritte città che possiedono alte caratteristiche storiche. Talvolta queste hanno poche possibilità - per le loro caratteristiche specifiche - di avere applicate elevate misure di innovazione tecnologica, però possiedono un alto livello di sviluppo per capire e implementare i driver ICT riferiti al Concept smart city. L'ultimo paragrafo mostra alcuni esempi di città in via di sviluppo - le developing cities - che spesso sono città con un bassa preparazione ai temi inerenti la sostenibilità però con una grandissima crescita economica e sociale. This chapter shows some examples of smart cities. In the chapter, case studies have been divided into geographical categories (Middle East cities; North-European cities; Mediterranean cities and the Asian ones) which, macro- scopically, refer to three different types of city and communities especially in relation to different levels of technological innovation and type of human capital, which are key factors in the achievement of a smart development. The chapter is divided into four main paragraphs. The newly built cities, in the Middle East paragraph, are cities where everything has been planned from scratch on white paper to limit emissions and increase the quality of life of citizens. In the paragraphs about the North-European cities and the Mediterranean cities, the cities with strong historic value are described. In this section, many European cities, which have specific features like limited possibility to apply technology, but still an adequate level of development to understand and correctly implement the ICT driven choices are described with reference to the smart city concept. The last paragraph shows some example of “developing city” that often are cities with low awareness about sustainable settlement issues, but with a great economic and social growth.

This chapter outlines the concept of intelligent and multi-service infrastructures, addressing the interesting aspects of multi operability, potential of cogeneration and multi-carrier energy hubs, whose basic concepts were only recently described in [1]. The infrastructures that serve a community, such as energy distribution, water and waste piping, mobility and ICT networks are, in fact, the most important means for efficient operation of cities. The chapter, after outlining the contents of the document ISO TR 37150: 2014 concerning the Smart Community Infrastructures, highlights the different approaches needed to implement them within existing cities and newly built cities. At the end, the chapter presents the concept of Energy Hub and some cases study of urban districts (existing district and new built district) modelled as Energy Hubs.

Town Administrations are increasingly facing the challenge to identify smart planning actions to reduce the cities' energy demand by improving the efficiency of the urban energy systems. Buildings play an important role in this regarding both the demand and supply energy. In this scenario, the neighborhood or district scale seems to be the most appropriate to implement a multi-disciplinary approach on which smart planning relies. This paper shows the application, to a district of the city of Palermo (Sicily, Italy), of a methodology for architectural-energy classification of existing buildings. Such methodology provides, regarding the building sector, an easy tool that can support smart planning at district scale using data available to the municipalities. The work also shows a first experimental approach for the neighborhoods' characterization. The basic idea guiding this work is to identify possible features and subsequent intervention actions for energy refurbishment in neighborhoods clusters.

The history of prisons is full of contradictions in every historical period and the evolution of prison buildings expresses many faces in the history of each country. The concept of punishment imposed on the offender has undergone several changes over the centuries, related to culture, politics, and to the evolution of the human thought. For centuries, tiny closed spaces have been adapted for the offenders' detention, without ever thinking to create an ad hoc functional distribution of spaces. The issue of the design of prisons has often been a reason of debate, and it is still an open field of discussion. From a legal point of view, in recent years there has been a rethinking of the problem. From a social point of view, detention should be seen as a time for change and transformation of the offender into a rehabilitated subject, and the EU is forcing the Countries to make important steps ahead. But, to achieve this goal, we all as a high level cultural society need a change in the way of thinking and approaching the problem and adequate structures, to support individuals by offering them the opportunity, “which in civil life they did not have or have not been able to exploit”. The Smart Cities “revolution” could represent the right opportunity to introduce a change of perspective and technical design thinking approach also in this kind of buildings. In this work, we describe a preliminary step of an emblematic case study of a recent prison building, which has many common characteristics to most Italian prison buildings. We propose a completely new approach to understand and deal with the prisons' environments and users.

Il capitolo introduce alla tematica smart city attraverso un exscursus storico che ne traccia i passaggi salienti: la nascita delle politiche globali ambientali sino al livello della maturità raggiunto con il Protocollo di Kyoto (1997); poi ancora il Pacchetto Clima 20-20-20 redatto dalla Commissione Europea nel 2008 che traccia un'altro punto cruciale che prelude ai progetti e alle iniziative in ambito smart cities. La Strategia Energetica Europea al 2050 rappresenta il quadro di riferimento a cui tendere. Il capitolo si conclude con una rassegna dei sistemi di ranking più popolari e con una proposta di analisi. The chapter introduces to smart city issue through a historical excursus, which traces the main steps: the birth of global environmental policies up to the stage of maturity reached in Europe after the Kyoto Protocol (1997); then the Climate Package 20-20-20, edited by European Commission in 2008 marks another crucial point which preludes smart cities initiatives and projects; the 2030 Energy Strategy and finally the 2050 European Energy Strategy. The chapter is concluded with a review of the most popular smart cities ranking systems and with a proposal for a ranking based on context features.

Acute thrombus formation on disrupted atherosclerotic plaques plays a key role during the onset of acute coronary syndromes. Lesion disruption facilitates the interaction between circulating blood and prothrombotic substances, such as tissue factor (TF) present within the atherosclerotic lesion. For a long period of time, vessel-wall TF has been considered the major determinant of thrombosis. However, this old dogma has been recently changed owing to the discovery of a different pool of TF that circulates in flowing blood (blood-borne TF). Several studies have shown that blood-borne TF circulates in different pools that are associated with selected blood cells, such as monocytes, granulocytes and platelets in cell-derived microparticles, and as a soluble protein generated by alternative splicing of its full-length mRNA. Recent studies have identified a hypercoagulable state associated with an increased circulating TF activity, leading to the concept of 'vulnerable blood'. Part of the blood-borne TF circulates in an 'inactive' form and it is required to be 'activated' to exert its thrombogenic potential. Certain pathological conditions, such as smoking, hyperlipidemia and diabetes, show a higher incidence of thrombotic complications. These conditions are also characterized by the presence of high levels of circulating TF activity. Recent evidence may also suggest that an increased circulating TF activity may potentiate the initial thrombogenic stimulus represented by vessel wall-associated TF, leading to the formation of larger and/or more stable thrombus, and thus more severe acute coronary syndromes. It has been reported that inflammation increases TF expression and activity by different cell types. On the other hand, TF upregulation may facilitate inflammation by enhancing intravascular fibrin deposition, formation of proinflammatory fragments of fibrin, and by generating coagulation proteases, including FVIIa, FXa and thrombin, that activate protease-activated receptors. Furthermore, the biology of TF is know known to be more complex than previously thought by the demonstration that this protein, apart from its known effects on blood coagulation, can also function as a signaling receptor.

Migraine with aura (MA) is a contraindication to the use of combined oral contraceptives (COCs) because of the increased risk of ischemic stroke. Progestogen-only contraceptive pill (POP) is a safe alternative to COCs and it is preferable in women with cerebrovascular diseases or risk factors for stroke.Prospective diary-based pilot study. Thirty women with MA (n = 15 who have never used COCs and n = 15 who had previously used COCs were diagnosed according to the International Headache Society criteria. The observational period lasted 9 months during which women filled in a diary with the clinical characteristics of headache attacks. After a 3-month run-in period, each subject received an estrogen-free desogestrel (DSG) (75 mcg/day)-containing OC (Cerazette(®); Schering-Plough, formerly NV Organon, Oss, The Netherlands). Follow-up evaluations were planned at the end of the third and sixth month of treatment.The number (mean±S.D.) of migraine attacks was significantly reduced both in previous COCs users (from 3.9±1.0 to 2.9±0.8; p.001) and nonusers (from 3.2±0.9 to 2.6±1.3; p.02) following 6 months of POP use in comparison with the run-in period. Duration of headache pain did not differ significantly in both groups throughout the study. Interestingly enough, a beneficial POP effect on the duration (mean±S.D.) of visual aura (from 16.3±9.5 to 11.4±5.6 min) and on the total duration (mean±S.D.) of neurological symptoms (from 33.6±23.3 to 18.6±18.0 min) was only significantly reported by previous COCs users (p.001, for both) by the end of the study period. The POP was well tolerated by each woman and the bleeding pattern was variable with a tendency towards infrequent bleeding.The present study supports the use of the POP containing desogestrel in a population of women with MA and underlines a positive effect on symptoms of aura, especially in MA sensitive to previous use of COCs.

The smart city is increasingly becoming a concept of reference for what concerns the planning and the spatial development of cities. The concept of smart city cannot be easily standardized. It is based on a multi-service and multi-sectorial planning regarding various urban functions (energy, mobility, waste, etc.) and places them under a common denominator: the use of advanced technologies for minimizing resources consumption and simultaneously increase the quality of life of the citizens. This paper aims to give an overview on the concept of smart city and outline what, at present, are the main intervention areas considered at European level. Then the paper focuses on the public lighting that is among the sectors most affected by “smart actions” by the Public Administrations. The work concludes with a proposal for a retrofit of the public lighting system in a small town in Sicily (Italy).

Microalbuminuria, a powerful predictor of cardiovascular events, is thought to reflect widespread subclinical vascular abnormalities. To explore the pathogenesis of increased urinary albumin excretion in primary hypertension we evaluated systemic capillary permeability and ambulatory blood pressure (BP) measurement in two groups of matched untreated patients with (n = 11) and without (n = 29) microalbuminuria.Albuminuria was measured as the mean of albumin-to-creatinine ratio (ACR) in three nonconsecutive first morning urine samples. Systemic capillary permeability was evaluated by transcapillary escape rate of albumin (TERalb) (ie, the 1-h decline rate of intravenous (125)I-albumin). Twenty-four-hour ambulatory BP, renal hemodynamics, and hormones of the renin-angiotensin-aldosterone system (RAAS) were also assessed.Patients with microalbuminuria showed greater body mass index (BMI) (P.04), higher 24-h systolic and diastolic BP levels (P = .02), and higher capillary permeability to albumin (P.02) as compared to normoalbuminurics. Renal hemodynamics and RAAS hormones were similar in the two groups. Univariate analysis showed that urinary ACR was related to ambulatory pressure components (P.02), TERalb (r = 0.31, P.05), smoking habits (r = 0.36, P = .02), and left ventricular mass index (LVMI) (r = 0.57, P.001) among the whole study group. Logistic regression analysis showed that each 1% increment in TERalb or 10 mm Hg increase in systolic BP entailed an almost three times higher risk of having microalbuminuria.Microalbuminuria is associated with greater systemic BP load and increased vascular permeability in patients with primary hypertension.

Background Urinary albumin excretion and left ventricular mass are related to each other and to the risk of cardiovascular events in patients with primary hypertension. We aimed to identify a lower threshold for albuminuria that might improve detection of patients with left ventricular hypertrophy (LVH) and cost-effectiveness in cardiovascular risk assessment. Methods Albuminuria and left ventricular mass index were assessed in 448 untreated, nondiabetic patients with primary hypertension. The impact that lower albuminuria cut-off levels might have on detecting LVH was evaluated with regard to test cost and sensitivity. This was done by a diagnostic algorithm consisting of albuminuria evaluation followed by echocardiography in the presence of normoalbuminuria. Results The area under the ROC curve of albuminuria in predicting LVH was 0.73. Using a lower albumin to creatinine ratio threshold than what is recommended by the guidelines (ie, 11.5 mg/g), the sensitivity and specificity of albuminuria in identifying patients with LVH was 39% and 92%, respectively, which translated to positive and negative predictive values of 76% and 69%, respectively. When considering only patients without electrocardiographically detected LVH, routine screening for albuminuria, followed by echocardiography in the presence of albuminuria ≤11.5 mg/g, allowed us to decrease the number of echocardiograms by 23%. Conclusion Adopting a lower threshold to define microalbuminuria could prove to be cost-effective for assessing cardiovascular risk in hypertensive patients.

The optimal management of cardiac allograft vasculopathy (CAV) remains unknown. Percutaneous coronary intervention (PCI) has been considered palliative due to high restenosis rates, but still remains an alternative to the definitive therapy of re-transplantation. Drug eluting stents (DES) were shown

The frame within which the work is placed refers to the actions necessary to achieve the objectives of the coverage of the consumption of energy from renewable sources compared to the gross final consumption, posed to Regions by 2020, and that can be implemented through various actions involving local gov-ernments including the revision of the Building Regulations municipalities in a sustainable view. Theseactions are increasingly being recognized as energy plan-ning tools for the territories where administrations have committed to the Euro-pean project Covenant of Mayors. The discussion shows how the adoption by the Regions of Guidelines for sustainable Municipal Building Regulations can be a practical tool for raising the energy performance of buildings and the achievement of common goals of sustainability at regional scale. The work also aims at showing a concrete example of the definition of guidelines for the revision of the municipal Building Regulations for cities within the Sicilian Region.

Based on a recent technical–economical analysis on the island of Pantelleria, a policy feasibility study for a complete upgrading of the energy system of this Mediterranean Island is carried out. Pantelleria, situated between Sicily and Africa, owns a large potential in terms of renewable energy resources, although there are some obstacles in turning it into a Near Zero Energy system. Starting from a deep energy system audit, the study proposes the project for a near zero energy island, through the efficient transformation of the different existing natural energy resources into electrical energy and heat: the solar, the wind-based and the geothermal systems. In this way, the island can be turned into an almost autonomous system. The main difficulties connected to the implementation of the project can be identified in the national energy policies as well as in the specific local situation, characterized by a strong private monopole on generation and distribution of electrical energy which has no incentive for supporting the costs connected to the energy requalification of the island. On the other hand, the local administrations, involved in the project through bottom-up European policies, do not have the cultural and economic tools to go on with the implementation.

The building sector is still one of the most energy consuming sectors in Italy, like developed countries in Europe. At European level, the main policy driver related to the energy use in buildings is the Energy Performance of Buildings Directive (EPBD, 2002/91/EC) and its recast. Through the EPBD in- troduction, requirements for certification, inspections, training or renovation are now imposed in Member States. In order to fulfill the expected changes, local regulations are a key factor aiming at sustainable territorial planning. It is thus required support the issue of local rules at municipal level in order to guide local administrators and technicians and to limit discretional power of bureaucracy. In this paper, a review of the most common practices for building regulations in Europe and in Italy is proposed, then the role and the framework of a municipal building regulation for the Southern European area accounting for sustainability features is discussed.

Microalbuminuria, i.e., abnormal urinary excretion of albumin, which is detectable by low cost and widely available tests, is a first-line tool for identifying hypertensive patients who are at higher cardiovascular (CV) risk. Numerous studies have provided evidence that microalbuminuria is a concomitant of cardiac and vascular damage as well as a strong, independent predictor of CV events. An important, emerging issue is that the risk for CV morbidity and mortality is linearly related to urinary albumin excretion and persists well below the currently used cutoff for defining microalbuminuria. Furthermore, late-breaking evidence suggests that a reduction of albuminuria under antihypertensive treatment is paralleled by changes in CV risk. The routine search for target organ damage by means of microalbuminuria could lead to a significant improvement in the evaluation and treatment of patients with primary hypertension.

Starting from a previous technical and economical feasi-bility study, this paper analyzes the integration of Renewable Energy Sources into an existing territory with specified features of the natu-ral landscape and of the built environment. The work puts into evi-dence that territories development must use suitable tools and rules based on integrated knowledge, since technical feasibility studies do not assess the sustainability of the proposed infrastructures within the built environment and landscape. The studied system is in the is-land of Pantelleria situated between Sicily and northern Africa.

This article investigates the efficacy of acupuncture for the maintenance of breastfeeding during the first 3 months of a newborn's life.After written informed consent was obtained, 90 women were randomly divided into two groups: acupuncture treatment or observation. Acupuncture sessions were performed twice weekly for 3 weeks (total six sessions). The control group made weekly visits to the clinic and the midwife observed their breastfeeding, giving routine care. In both groups, a semistructured clinical assessment of breastfeeding quality was carried out by the midwife at enrollment and after 3 weeks. Moreover, in both groups a telephone interview was conducted by the midwife at the third month of the infants' lives, regarding the continuation of breastfeeding.No significant difference in the exclusive breastfeeding rate before treatment was observed between acupuncture and observation groups (51.2% versus 48.8%). However, at 3 weeks post-enrollment, exclusive breastfeeding was significantly lower in the observation group than in the acupuncture group (60% versus 100%; p 0.03). At the third month of the newborns' lives, breastfeeding was reported in 35% of the acupuncture group, compared to 15% of the observation group (p 0.03).Such preliminary data suggest that 3 weeks of acupuncture treatment were more effective than observation alone in maintaining breastfeeding until the third month of the newborns' lives.

Glow-worms in the night. Street prostitutions and prevention projects - Traditionaly, sexual-work conflict and street partnership have been studied separately. This study examined the impact of sexual-work conflict and health. The results show that there are a significant relationship between sexual-work conflict and health especially with inter-role conflict. The scale have been applied to a Sicilian sample of 114 prostitutes in a social project of prevention. Key words: Sexual-work conflict, helath, health belief, partnership.

Objective. The objective of this study was to assess the relationship between active smoking as well as environmental tobacco smoke (ETS) exposure and severe small for gestational age (SGA) at term in a sample of pregnant Italian women. Methods. A case-control study was conducted in nine cities in Italy between October 1999 and September 2000. Cases of severe SGA were singleton, live born, at term children with a birth weight5th percentile for gestational age. Controls (10:1 to cases) were enrolled from among singleton at term births that occurred in the same hospitals one or two days after delivery of the case, with a birth weight10th percentile for gestational age. A total of 84 cases of severe SGA and 858 controls were analyzed. A self-administered questionnaire was used to assess active smoking and ETS exposure, as well as potential confounders. Results. Multivariate logistic regression analysis showed a relationship between active smoking during pregnancy and severe SGA (adjusted odds ratio (OR) 2.10, 95% confidence interval (CI) 1.13-3.68). ETS exposure was associated with severe SGA (adjusted OR 2.51, 95% CI 1.59-3.95) with a dose-response relationship to the number of smokers in the home.

Hurthle cell follicular carcinoma (HCFC) of the thyroid gland is a malignant tumour composed predominantly or entirely of oncocytes (also called “Hurthle” or “Askenazy” cells),1 arranged in a follicular/trabecular pattern without the cytological changes found in papillary carcinoma.1,2 Although most studies have demonstrated that HCFC and follicular thyroid carcinoma share similar clinical behaviour and prognosis,3 recently the World Health Organization (WHO) has classified HCFC as a separate and distinct entity.4 Anaplastic thyroid carcinoma accounts for 5–10% of all thyroid cancers and represents the most aggressive thyroid tumour almost invariably associated with a fatal outcome.5 Most anaplastic thyroid carcinoma cases show evidence of a pre-existing differentiated, or poorly differentiated, thyroid carcinoma.2,5 At present, to our knowledge, the secondary leptomeningeal localisation of thyroid HCFC has not yet been reported in the literature. We describe the case of a 56-year-old woman who was admitted to the hospital due to a 3-day history of partial seizures, unsteady walk with frequent falls and dysarthria. She had no history of either neck irradiation or thyroid diseases in her family. Fifteen years before, laboratory and imaging investigations disclosed a euthyroid goitre with a 15 mm hypoechoic, scintigrafically “cold”, nodule in the left thyroid lobe. She was not submitted to fine-needle aspiration biopsy, …

Increased arterial stiffness and the presence of metabolic syndrome (MS) have been shown to predict cardiovascular events in patients with primary hypertension. We investigated the relationship between a recently proposed index of arterial stiffness derived from ambulatory blood pressure (BP) monitoring and MS in 156 untreated, non-diabetic patients with primary hypertension. Ambulatory arterial stiffness index (AASI) was defined as 1 minus the regression slope of diastolic over systolic BP readings obtained from 24-h recordings. A modified National Cholesterol Education Program definition for MS was used, with body mass index replacing waist circumference. The prevalence of MS was 23%. Patients with MS were more frequently male (0.0291) and had increased serum uric acid (P=0.0005), high-sensitivity C-reactive protein (P=0.0259), as well as total and low-density lipoprotein (LDL)-cholesterol (P=0.0374 and P=0.0350, respectively) as compared to those without MS. After adjusting for these confounders, the association between AASI and the presence of MS was statistically significant (P=0.0257). Moreover, the prevalence of increased AASI (upper tertile, that isor=0.550) was greater in patients with MS (P=0.0156). After adjusting for age and 24-h mean BP, the presence of MS entailed a more than twofold greater risk for increased AASI (0.0280). MS is associated with increased AASI in non-diabetic patients with primary hypertension. These data support the role of this new index of arterial stiffness as a marker of risk and help to explain the high cardiovascular morbidity and mortality that is observed in hypertensive patients with MS.

Objective Arterial stiffness is a predictor of cardiovascular mortality in the general population as well as in hypertension and end-stage renal disease. We investigated the relationship between a recently proposed ambulatory blood pressure monitoring-derived index of arterial stiffness and early signs of renal damage in patients with primary hypertension. Design and setting A total of 168 untreated patients with sustained primary hypertension were studied. Ambulatory arterial stiffness index (AASI) was calculated based on 24-h ambulatory blood pressure readings. Albuminuria was measured as the albumin to creatinine ratio. Creatinine clearance was estimated using the Cockcroft-Gault formula, and the interlobar resistive index was evaluated by renal ultrasound and Doppler examination. Results AASI was positively related to urinary albumin excretion and resistive index, and was negatively related to estimated creatinine clearance and renal volume to the resistive index ratio. Patients with AASI above the median (i.e. > 0.51) showed a higher prevalence of microalbuminuria and a mild reduction in creatinine clearance. Moreover, patients with microalbuminuria or a mild reduction in creatinine clearance had significantly higher AASI values compared with those without, and the greater the renal involvement, the greater the AASI. After adjusting for several potentially confounding variables, we found that each standard deviation increase in AASI (i.e. 0.16) entails an almost twofold greater risk of renal involvement. Conclusion Increased AASI is independently associated with early signs of renal damage in patients with sustained primary hypertension. These results strengthen the usefulness of AASI and ambulatory blood pressure monitoring in cardiovascular risk assessment.

Increased arterial stiffness has been shown to predict cardiovascular mortality in patients with primary hypertension. Asymptomatic organ damage is known to precede cardiovascular events. We investigated the relationship between a recently proposed index of stiffness derived from ambulatory blood pressure (BP) and target organ damage in 188 untreated patients with primary hypertension. Ambulatory arterial stiffness index was defined as 1 minus the regression slope of diastolic over systolic BP readings obtained from 24-hour recordings. Albuminuria was measured as the albumin:creatinine ratio, left ventricular mass index was assessed by echocardiography, and carotid abnormalities were evaluated by ultrasonography. The prevalence of microalbuminuria, left ventricular hypertrophy (LVH), and carotid abnormalities was 12%, 38%, and 19%, respectively. Ambulatory arterial stiffness index was positively related to age, triglycerides, office and 24-hour systolic BP, 24-hour pulse pressure, urinary albumin excretion, and carotid intima-media thickness. Patients with microalbuminuria, carotid abnormalities, or LVH showed higher ambulatory arterial stiffness index as compared with those without it. After adjusting for confounding factors, each SD increase in ambulatory arterial stiffness index entails an &2 times higher risk of microalbuminuria, carotid abnormalities, and LVH and doubles the risk of the occurrence of ≥1 sign of organ damage. Ambulatory arterial stiffness index is associated with organ damage in patients with primary hypertension. These data strengthen the role of this index as a marker of risk and help to explain the high cardiovascular mortality reported in patients with high ambulatory arterial stiffness index.

The metabolic syndrome can be found in approximately one third of patients who do not have diabetes but have primary hypertension. Its presence has been associated with a wide range of traditional and nontraditional cardiovascular risk factors and early signs of cardiovascular and renal damage. Moreover, it was emphasized recently that the metabolic syndrome predicts an increased probability of sustaining a cardiovascular event or dying. In the clinical setting of insulin resistance, attention should be paid to the metabolic side effects of antihypertensive drugs; therefore, preference should be given to renin-angiotensin system inhibitors and calcium channel blockers rather than to beta blockers and diuretics.

Leoncini G, Ratto E, Viazzi F, Vaccaro V,Parodi D, Parodi A, Falqui V, Tomolillo C, DeferrariG, Pontremoli R (University of Genoa, Genoa, Italy).Metabolic syndrome is associated with early signs oforgan damage in nondiabetic, hypertensive patients.J Intern Med 2005; 257: 454–460.Objectives. Hypertensive patients with metabolicsyndrome (MS) are at greater risk for cardiovasculardisease. To get a better understanding of the patho-physiology underlying this association, we evaluatedthe relationship between MS and subclinical organdamage in essential hypertensive patients.Design and setting. A total of 354 untreated,nondiabetic patients with primary hypertensionwere included in the study. A modified ATP IIIdefinition for MS was used, with body mass indexreplacing waist circumference. Albuminuria wasmeasured as albumin to creatinine ratio, leftventricular mass index (LVMI) was assessed byechocardiography and carotid abnormalities byultrasonography.Results. The prevalence of MS was 25%. Patientswith MS were more likely to be smokers (P ¼ 0.004)and had higher serum uric acid levels (P ¼ 0.004).Moreover, they showed higher urinary albuminexcretion (P ¼ 0.0004) and LVMI (P ¼ 0.0006),increased intima-media thickness (P ¼ 0.045), aswell as higher prevalence of microalbuminuria(P ¼ 0.03) and left ventricular hypertrophy (LVH;P ¼ 0.003). After adjusting for age, gender andduration of hypertension, we found that thepresence of MS entails a twofold greater risk formicroalbuminuria (P ¼ 0.04), LVH (P ¼ 0.003)and carotid abnormalities (P < 0.05). Whenpatients were stratified according to the number ofcomponents of MS, albuminuria (P ¼ 0.002) andLVMI (P ¼ 0.005) increased progressively acrosscategories.Conclusions. Metabolic syndrome is associated withsubclinical organ damage in nondiabetic, essentialhypertensive patients. These data may, in part,explain the high cardiovascular morbidity andmortality that is observed in hypertensive patientswith MS.Keywords: hypertension, left ventricular hypertrophy,metabolic syndrome, microalbuminuria.

Accurate assessment of cardiovascular risk is a key step toward optimizing the treatment of hypertensive patients. We analyzed the impact and cost-effectiveness of routine, thorough assessment of target organ damage (TOD) in evaluating risk profile in hypertension. A total of 380 never-treated patients with essential hypertension underwent routine work-up plus evaluation of albuminuria and ultrasonography of cardiac and vascular structures. The impact of these tests on risk stratification, as indicated by European Society of Hypertension-European Society of Cardiology guidelines, was assessed in light of their cost and sensitivity. The combined use of all of these tests greatly improved the detection of TOD, therefore leading to the identification of a higher percentage of patients who were at high/very high risk, as compared with those who were detected by routine clinical work-up (73% instead of 42%; P < 0.0001). Different signs of TOD only partly cluster within the same subgroup of patients; thus, all three tests should be performed to maximize the sensitivity of the evaluation process. The diagnostic algorithm yielding the lowest cost per detected case of TOD is the search for microalbuminuria, followed by echocardiography and then carotid ultrasonography. Adopting lower cut-off values to define microalbuminuria allows us to optimize further the cost-effectiveness of diagnostic algorithms. In conclusion, because of its low cost and widespread availability, measuring albuminuria is an attractive and cost-effective screening test that is especially suitable as the first step in the large-scale diagnostic work-up of hypertensive patients.

Mild renal dysfunction (MRD) is an often overlooked but relatively common condition in patients with primary hypertension (PH), and is associated with high cardiovascular morbidity and mortality. Whether MRD is also associated with abnormalities in renal vascular resistance is currently unknown.Two hundred ninety-one untreated patients with PH were studied. The MRD was defined as a creatinine clearanceor=60 mL/min but90 mL/min (Cockcroft-Gault formula) or the presence of microalbuminuria. Albuminuria was measured as the albumin-to-creatinine ratio in first morning urine samples. Renal resistive index (RI) was evaluated by ultrasound Doppler of the interlobar arteries.The prevalence of MRD in our cohort was 63%. Patients with MRD were older, had higher mean blood pressure (BP), pulse pressure, and total cholesterol, longer history of hypertension, and were more likely to be men. Renal RI was positively related to female gender, age, systolic BP, pulse pressure, total cholesterol, albuminuria, and to carotid wall thickness and cross-sectional area, whereas it was inversely related to diastolic BP and creatinine clearance. Patients with the highest renal resistance (upper quartile,or=0.63) showed a greater prevalence of renal dysfunction (P=.0005). After adjusting for age, pulse pressure, and LDL-cholesterol, we found that the risk of MRD increased twofold (P=.04) when renal RI wasor=0.63.A reduction in creatinine clearance and the presence of microalbuminuria are associated with increased renal vascular impedence, as well as with signs of extrarenal arterial stiffness.

A reduction in renal function is associated with high cardiovascular morbidity and mortality in hypertension. The aim of the present study was to investigate the relationship between creatinine clearance and subclinical organ damage in 957 never previously treated, middle-aged patients with primary hypertension. Renal function was estimated by means of the serum creatinine level using the Cockcroft-Gault formula; left ventricular hypertrophy (LVH) was determined according to electrocardiographic criteria; and retinal vascular changes were evaluated by direct ophthalmoscopy. Creatinine clearance was, on the average, 83+/-21.2 ml/min, and the prevalence of LVH and retinopathy was 13 and 49%, respectively. Creatinine clearance was inversely related to the duration of disease (r=-0.132, P

Objective To assess the impact and cost-effectiveness of microalbuminuria and cardiovascular ultrasonography in evaluating the risk profile in primary hypertension. Methods Four hundred and five untreated patients with primary hypertension underwent a routine, traditional work-up plus evaluation of albuminuria and ultrasound (US) assessment of cardiac and vascular structures. Albuminuria was measured as the albumin to creatinine ratio in three non-consecutive first-morning urine samples. Left ventricular mass index was assessed by MB-mode echocardiography and carotid intima–media thickness by high-resolution US scan. The impact of these tests on patient risk classes, as indicated by European Society of Hypertension–European Society of Cardiology (ESH–ESC) guidelines, was assessed with respect to their cost and sensitivity. Results The prevalence of microalbuminuria, left ventricular hypertrophy and carotid intima–media thickening or carotid plaque was 13, 49 and 32%, respectively. The combined use of albuminuria, cardiac and vascular ultrasonography led to the detection of a significantly higher percentage of patients at high/very high risk. The three tests differ in sensitivity (albuminuria, 20%; echocardiography, 65%; and carotid ultrasound, 41%). The signs of target organ damage (TOD) only partly cluster within the same subgroup of patients and, thus, all three tests should be performed in order to maximize the sensitivity of the evaluation process. The diagnostic algorithm yielding the lowest cost per detected case of TOD is the search for microalbuminuria followed by cardiac and carotid ultrasound assessment. Conclusions Ultrasonographic detection of TOD is a sensitive tool in the identification of high-risk patients, but should be preceded by a routine search for microalbuminuria in order to optimize the cost-effectiveness of the diagnostic work-up.

Mild renal dysfunction, defined as GFR