Long term mortality and morbidity of Italian soldiers after deployment in Iraq as related to biomarkers assessment: Results of the SIGNUM study.

INTRODUCTION: The health profile of military veterans deployed in foreign operative theatres was assessed by several international studies because of potential exposure to depleted uranium and other pollutants. Here we reported results of 15-year epidemiological surveillance assessing long-term health effects in a cohort of Italian soldiers deployed in Iraq in 2004-2005 and participating in a biomonitoring campaign to identify potential genotoxic exposure to environmental xenobiotics before and after deployment (n = 981, SIGNUM cohort). METHODS: We evaluated mortality and hospitalization risks of the SIGNUM cohort retrospectively until 2016 and 2018 respectively. A wide cohort of military personnel never deployed abroad (n = 114,260) and the general Italian population were used as control populations in risk assessment. Causes of death and diagnoses of hospitalization were derived through deterministic record linkage with official national databases of mortality and hospital discharge. Standardized Mortality Ratio (SMR) and Standardized Hospitalization Ratio (SHR) were computed adjusting according to sex, age, area of birth, and calendar year. Differential pre-post deployment in xenobiotics concentrations and early effect biomarkers (oxidative DNA alterations and micronuclei) measured in blood serum were analysed in relation to cancer hospitalization. RESULTS: Mortality risk due to pathologies was more than halved compared to the general population (SMR = 0.41, 95% CI 0.11-1.05) and not significantly different compared to soldiers never deployed abroad (SMR = 0.69, 95% CI 0.19-1.68). Similarly overall hospitalization risk due to pathologies was decreased with respect to the general population (SHR = 0.86, 95% CI 0.80-0.92) and comparable to the control military group (SHR = 0.99, 95% CI: 0.93-1.06). For haematological cancers a decreased hospitalization risk compared to the Italian general population was observed (SHR = 0.38, 95% CI 0-0.92). No statistically significant differences emerged in the patterns of biomarkers in association with cancer hospitalization. CONCLUSION: The study confirms the so called 'healthy warrior' effect for the SIGNUM veterans and showed no correlation between cancer occurrence and biomonitoring markers measured on field.

Quality and management care improvement of patients with chronic kidney disease: from data analysis to the definition of a targeted clinical pathway in an Italian Region.

BACKGROUND: Clinical Diagnostic Care Pathways (CDCP) are management tools widespread throughout the world to improve the quality of patient care through a well-organized care continuum and to enhance the patient's "risk-adjusted" outcomes; indeed they could optimize the management of resources. They are particularly effective in the management of patients with chronic degenerative diseases, such as chronic kidney disease, with increasingly incidence and prevalence, with an estimated 11-13% of the population being affected. The aim of this study is to apply the Health Services Research methods to estimate the relationship between need, demand and supply in patients with stage 5 Chronic Kidney Disease (CKD) for, then to describe the definition of a CDCP dedicated to patients in Lazio Region, so to allow an appropriate patient management, to reduce the likely complications and the patients' migration to facilities outside the region. METHODS: The study was conducted in 2017 in collaboration between the National Institute of Health, the University of Messina and the S. Giovanni Addolorata Hospital. RESULTS: We analyzed the data for the CKD in Roma and in the San Giovanni Addolorata Hospital Trust and we found a drop out in the patients' attendance towards other regions and/or hospitals. So we defined a CDCP to be adopted at the San Giovanni Addolorata hospital. CONCLUSIONS: To define management and care tools to provide adequate, efficient and patient centered care is a nowadays "must", to ensure the sustainability of the Italian NHS, which today is comparable to a "ship that is heading towards a perfect storm".

[Innovative materials in orthopaedics: the crosslinked polyethylene (XPE)]. / Materiali innovativi in ortopedia: il polietilene reticolato.

More than 150.000 hip and knee arthroplasties are performed every year in Italy. More than 50% of the patients receive a polyethylene component (Ultra High Molecular Weight PolyEthylene, UHMWPE). Polyethylene abrasive wear induces over time in vivo a foreign-body response and consequently osteolysis, pain and need of implant revision. Furthermore, oxidative wear due to gamma-rays sterilization caused in the '90ies several and severe failures. To solve these problems, since then, the orthopaedics research has been addressed to: 1) develop new cross linked polyethylene with a higher molecular mass than UHMWPE and, consequently, a higher abrasive wear resistance; 2) avoid the oxidative wear induced by gamma-rays sterilization, by using other sterilization methods and by stabilizing UHMWPE by means of antioxidants such as Vitamin E. According to the most recent studies, performed on limited cohorts and mostly funded by manufacturers, cross linked polyethylene shows a better abrasive wear resistance if compared to the conventional polyethylene but no significant differences have been detected in the clinical outcomes. Clinical follow up of Vitamin E stabilized PE are not yet available. The organization of national arthroplasties registries, able to trace and characterize the implanted devices and based on the whole patients population, will facilitate the early detection of devices that show a performance inferior than the expected one. In Italy, the National Institute of Health has been entrusted by the Ministry of Health to organize the national arthroplasty registry.

[Interregional mobility for total knee arthroplasty]. / Mobilità interregionale e chirurgia protesica del ginocchio.

45.049 primary total knee replacements were performed in Italy in 2005, with large distribution all over the country. However referral to centers of excellence far from the area of residency is still common with massive interregional mobility. Aim of this study is to define this issue both in quantitative and qualitative terms. For the timeframe 2001-2005 the SDO database was used to calculate the number of discharges of both residents and non residents for each Region and for each year and the ability of each region to attract patients from other regions or the tendency of the resident population to migrate. Only 8 Regions present an attraction index better than the escape index. Among those 4 are located in the North of Italy, 2 in the Center and 2 in the South. Migration from the North or Center to the South was never observed. Interregional mobility for knee replacement is noteworthy. Such phenomenon is comparable to migration for other major procedures, especially the steady tendency of a south to north mobility. An accurate analysis of potential causes of migration as well as the empowering of southern and central centers is needed.

[Echocardiographic visualization of the coronary arteries in endurance athletes]. / Visualizzazione ecocardiografica delle arterie coronarie in atleti di resistenza.

Visualization of left (LCA) and right coronary artery (RCA) by two-dimensional echocardiography (2-DE) was tried in 20 highly-trained endurance athletes and 20 normal sedentary controls using multiple echo planes. On the standard parasternal short axis aortic root view, the ostium of LCA was successfully visualized in all 20 athletes (100 percent) and in 18 controls (90 percent), the left main trunk in 19 athletes (95 percent) and 14 controls (70 percent) and a distinct bifurcation of the main trunk in 4 athletes (20 percent) and 2 controls (10 percent). In another 2 athletes, the initial tract of the left anterior descending artery and of the left circumflex branch could also be identified. With the same echo view, both from left or right sternal border, the ostium of RCA was visualized in 19 athletes (95 percent) and 16 controls (80 percent), the right main trunk in 18 athletes (90 percent) and 15 controls (75 percent) and a distinct bifurcation of RCA with one branch in 9 athletes (45 percent) and none of controls (p less than 0.025). Moreover, visualization of the distal tract of RCA was obtained on the parasternal long axis view of right ventricle in 15 athletes (75 percent) and 6 controls (30 percent, p less than 0.025). The very good quality of the 2-DE images allowed to measure the size of the ostia and initial tracts of both coronary arteries and the length for which the vessels could distinctly be followed.(ABSTRACT TRUNCATED AT 250 WORDS)