Public health risk management during the Covid-19 pandemic, new amendments in the European Maritime and Fisheries Fund to meet fishers' needs.

The recent COVID-19 emergency has shaped economic performance across all sectors, and the fisheries and aquaculture sector did not come out unscathed. The need to protect against risks has always been primary for economic operators, but COVID-19 has accentuated the need to obtain coverage for health risks. In this regard, the European Union has moved quickly with an amendment art. 35 of European Maritime and Fisheries Fund (Regulation [EU] No. 508/2014), including "public health crises" among the causes considered valid for compensation in mutual funds. In this paper, we analyze the evolution of Regulation 508, focusing on Article 35 and its most recent amendments, to understand if the new reform is adherent to the needs of the fisheries sector in Italy, one of the only two States that have documented in their Operational Plans the intention to implement mutual funds. The work involved an empirical analysis through the use of multivariate statistics carried out on 61 Italian stakeholders. Several company profiles were identified and then the likelihood of subscribing to a mutual fund was estimated based on their focus on health crises. The work underlines that the amendments meet the demands of the sector for improved mutual fund clauses, but it's not yet an attractive tool for the Italian market.

Dose intercomparison at Italian hadrontherapy centers.

PURPOSE: To perform the first dosimetric intercomparison for proton beams in Italy using ionization chambers, according to the IAEA TRS-398 code of practice. METHODS: Measurement sites included: National Center for Oncological Hadron Therapy (CNAO, Pavia), Center for Proton Therapy (CTP, Trento) and Center for Hadron Therapy and for advanced Nuclear Applications (CATANA, Catania). For comparison we also included a 6 MV photon beam produced at Istituti Clinici Scientifici Maugeri (ICSM, Pavia). For proton beams, both single pseudo-monoenergetic layers (in order to obtain a planned dose of 2 Gy at the reference depth of 2 cm in a water phantom) and Spread-out Bragg peaks (SOBP) have been delivered. Measurements were performed with a PTW Farmer 30010-1 and a PTW Advanced Markus type 34,045 ionization chamber. RESULTS: Data obtained at CATANA, CNAO and CPT in terms of absorbed dose to water depth show good consistency within the experimental uncertainties, with a weighted mean of 1.99 ± 0.01 Gy and a standard error of 0.003 Gy, with reference to a nominal dose of 2 Gy as designed by the treatment planning system. CONCLUSIONS: The results showed a standard deviation of less than 1% for single layer and SOBP beams, for all chambers and a percent deviation less than 1.5% for single layer measurements. The weighted means of the absorbed doses for clinical proton beams (118.19 MeV and 173.61 MeV) are consistent within less than 1%. These results agree within the 1.5% difference considered acceptable for national dose intercomparison.

Rotational radiotherapy of breast cancer with polyenergetic kilovoltage X-ray beams: An experimental and Monte Carlo phantom study.

PURPOSE: We investigated the feasibility of kilovoltage rotational radiotherapy for breast cancer (kV-EBRT) via Monte Carlo simulations and measurements on phantoms. METHODS: We derived the dose distributions for X-ray beams at 150 kV, 300 kVp and 320 kV irradiating breast cylindrical phantoms of 14 cm diameter, mimicking the pendant breast. Simulations were based on the Geant4 toolkit. The point-like X-ray source was rotated either over a full circle or on a limited arc around the phantom. We studied the influence on the surface dose of the distance between the tumor lesion to the skin, of the irradiation protocol (full scan or partial scan) and of the X-ray tube current modulation. RESULTS: Rotational kV-EBRT permitted a periphery-to-center dose ratio from 13% to 9% in homogeneous breast phantoms. Dose distributions in phantoms with off-center simulated lesions, showed a skin-to-tumor dose ratio of 16% and 34% for lesions at 3.25 and 5.25 cm from cylinder axis, respectively. Simulation of the X-ray tube current modulation during the rotation, permits to reach a dose ratio of 20% for the lesion located at 5.25 cm from phantom axis. CONCLUSIONS: We showed the possibility of using low-energy X-ray spectra for kV-EBRT with collimated beams, for obtaining a periphery-to-center dose ratio in the same order of conventional accelerator based megavoltage radiotherapy, when the irradiated area is localized in the center of the breast. For tumors localized near the breast border, we showed that the tube current modulation can be a good solution in order to reduce the skin-to-tumor dose ratio.

[Radiation-induced carotid stenosis: A personnalized approach]. / Sténose carotidienne post-irradiation cervicale : une approche personnalisée.

INTRODUCTION: Surgical treatment of radio-induced carotid stenosis (RICS) is challenging and burdened by an elevated risk of local complications. Carotid artery stenting (CAS) may be a suitable alternative. The best approach is yet to be defined. We reviewed the results of both techniques following selection based on better-suitability characteristics (anatomic and clinical). METHODS: We retrospectively reviewed 38 patients treated for 43 RICS from a group of 1230 patients who had carotid interventions between 2008 and 2015 (5 bilateral). Primary endpoints were morbidity and mortality at 30 days (transient ischemic attack, stroke, myocardial infarction, or death). Secondary endpoints were technical success, wound complications, cranial nerve injury (CNI), restenosis (≥50%) and recurrent symptoms. RESULTS: RICS was symptomatic in 6 patients in the OR group and 3 in the CAS group. Lesions in the OR group were longer (P=0.02) and more calcified (P=0.08). Technical success rate was 100%. Cranial nerve injury rate was 14.2% (3/21). All injuries were completely resolved within several weeks. In the CAS group, technical success rate was 95% (21/22) with the one failure due to a residual stenosis exceeding 30%. Periprocedural stroke rates were 0% and 4.5% in the OR and CAS groups respectively (0/21 vs 1/22, P=0.32). There were no early deaths. Mean follow-up was 19.1 months (3-75). The restenosis rate was 9.5% (2/21) in the OR group and 9% (2/22) in the CAS group. CONCLUSION: Our results do not support a preferred treatment strategy. The choice of treatment should be considered on an individual basis.

[Preoperative and follow-up cardiac magnetic resonance imaging of candidates for surgical ventricular restoration]. / Resonancia magnética cardíaca prequirúrgica y de seguimiento en pacientes candidatos a endoventriculoplastia.

PURPOSE: To assess pre and post-operative cardiac MRI (CMR) findings in patients with left endoventriculoplasty repair for ventricular aneurysm due to ischemic heart disease. MATERIAL AND METHODS: Data were retrospectively gathered on 21 patients with diagnosis of ventricular aneurysm secondary to ischemic heart disease undergoing left endoventriculoplasty repair between January 2007 and March 2013. Pre and post-operative CMR was performed in 12 patients. The following data were evaluated in pre-operative and post-operative CMR studies: quantitative analysis of left ventricular ejection fraction (LVEF), left ventricular end-diastolic (LVEDV) and end-systolic (LVESV) volume index, presence of valvular disease and intracardiac thrombi. The time between surgery and post-operative CRM studies was 3-24 months. RESULTS: Significant differences were found in the pre and post-operative LVEF, LVEDV and LVESV data. EF showed a median increase of 10% (IQR 2-15) (p=0.003). The LVEDV showed a median decrease of 38 ml/m(2) (IQR 18-52) (p=0.006) and the LVESV showed a median decrease of 45 ml/m(2) (IQR:12-60) (p=0.008). Post-operative ventricular volume reduction was significantly higher in those patients with preoperative LVESV >110 ml/m(2) (59 ml/m(2) and 12 ml/m(2), p=0.006). CONCLUSION: In patients with ischemic heart disease that are candidates for left endoventriculoplasty, CMR is a reliable non-invasive and reproducible technique for the evaluation of the scar before the surgery and the ventricular volumes and its evolution after endoventricular surgical repair.

Síndrome Metabólico en pacientes con psoriasis de la Cátedra de Dermatología del Hospital de Clínicas / Metabolic syndrome in psoriatic patients of the Dermatology Service of Clinical Hospital

La psoriasis es una enfermedad inflamatoria crónica sistémica de la piel. Publicaciones de los últimos 10 años reportan una asociación entre la psoriasis y el síndrome metabólico, una agrupación de factores de riesgo que incluye la obesidad, hipertensión arterial, dislipidemia e insulinorresistencia. El objetivo del presente trabajo fue determinar la frecuencia del síndrome metabólico y las características clínicas de los pacientes con psoriasis. Para ello, se realizó un estudio observacional descriptivo de corte trasversal en pacientes con psoriasis que consultaron en la Cátedra de Dermatología del Hospital de Clínicas de mayo a diciembre del año 2013. Se estudiaron 52 pacientes con psoriasis, de los cuales 36 pacientes (69%) eran de sexo masculino. Presentaron síndrome metabólico 25 casos (48%), la hipertensión arterial fue el factor de riesgo más frecuente estando presente en 31 pacientes (60%), siguiéndole en frecuencia la obesidad en 31 pacientes (58%). Se encontró que tanto el síndrome metabólico como todos sus componentes en forma individual son más frecuentes en los pacientes con psoriasis moderada y severa. El síndrome metabólico es un hallazgo frecuente en los pacientes con psoriasis existiendo una relación directa entre la severidad de la psoriasis con el síndrome metabólico y cada uno de los factores de riesgo que lo componen, por lo cual se hace imperativa la búsqueda de esta patología en la evaluación dermatológica clínica para la prevención de complicaciones cardiovasculares.

Psoriasis is a chronic systemic inflammatory disease of the skin. Publications in the last10 years reported an association between psoriasis and the metabolic syndrome, agroupof risk factors including obesity, hypertension, dyslipidemia and insulin resistance. Todetermine the frequency of metabolic syndrome and the clinical characteristics of patientswith psoriasis we performed a descriptive cross-sectional study in psoriatic patients whoconsultedinthe Dermatology Department oftheClinicas Hospital from May to Decemberof 2013.We studied 52 psoriatic patients, of whom 36 (69%) were male and 16 (31%)were female.Twenty five(48%) patients had metabolic syndrome.Hypertension was themost common risk factor being present 31 cases (59,6%), followed in frequency obesityin 30 patients (57,7%).We found that both the metabolic syndrome and its componentsindividually are more frequent in patients with moderate and severe psoriasis.Metabolicsyndrome is a common finding in patients with psoriasis. There is a direct relationship between the severity of psoriasisand themetabolic syndrome and each of its risk factors,so it is imperativetosearch for this dermatological pathology intheclinical evaluation ofpatients for the prevention of cardiovascular complications.

Parenteral nutrition admixtures for pediatric patients compounded with highly refined fish oil-based emulsion: assessment of physicochemical stability.

Fish oil-based emulsion is increasingly used in pediatric patients receiving Parenteral Nutrition (PN). However, its unique use in children on long-term PN is nutritionally debatable as some patients are better off with a mixture of long-chain (LCT) or long-chain + medium-chain (LCT + MCT) triglycerides along with Fish Oil (FO). Lipid emulsions are safely infused when particle diameter ranges between 0.4 and 1.0 micron (like chylomicra), according to European guidelines. No data exist on Fish Oil stability when added to other PN components typically present in pediatric formulations such as other lipids or micronutrients. Our goal is to evaluate the stability of a highly refined FO-emulsion in PN admixtures containing LCT or LCT + MCT triglycerides and different calcium content. Stability studies were carried out on six PN admixtures having two levels of calcium concentration compounded with olive oil LCT + FO, LCT + MCT + FO emulsion and pure FO alone, respectively. The analyses were performed immediately at time 0 (t = 0) and 24, 48, 72, 96 (t = 96) hours after compounding. Particle diameters were determined by Light Scattering-Reverse Fourier Optics Technique by means of a Laser Granulometer. Every sample was stored at 4 °C and triple tested. Statistical significance was verified by f-test. In all admixtures, physicochemical stability did not change between t = 0 and t = 96 and particle diameters were in the expected range of 0.4-1.0 micron provided calcium concentration remained below 4.5 mmol/L. When calcium exceeded that level, 12% of particle diameters was larger than 1.0 micron and 2% exceeded 5.0 micron immediately after compounding. In particular, admixtures compounded with olive oil LCT + FO emulsion or FO emulsion alone showed lower particle diameters compared to admixture with olive/soybean LCT alone, probably due to a different steric encumbrance of oleic acid and omega-3 fatty acid. In the PN admixtures tested, containing FO-emulsion alone or in combination with olive LCT or LCT + MCT, the fat emulsion appears to be stable and safe for infusion when calcium concentration is maintained below 4.5 mmol/L. If calcium level exceeds 4.5 mmol/L, as often required in premature patients, it is advisable to infuse FO emulsion alone through a second intravenous line.

Cutis marmorata telangiectásico congénito o síndrome de van Lohuizen: descripción de un caso / Congenital telangiectatic cutis marmorata or Van Lohuizen syndrome: report of a case

El cutis marmorata telangiectásico congénito (CMTC) es una malformación vascular cutánea de bajo flujo que compromete vasos capilares y venosos y que se presenta con baja incidencia desde el nacimiento. Se presenta el caso de un recién nacido, de cuatro días de vida con diagnóstico de CMTC no asociado a otras malformaciones.

Congenital telangiectatic cutis marmorata (CTCM) is acutaneous low-flow vascular malformation that involves venous and capilary blood vessels that occurs with low incidence at birth.We present the case of a newborn, 4 days old, with this condition that was presented in isolation fashion not associated with other malformations.

Evolution of hypogammaglobulinemia in premature and full-term infants.

There are few data in the literature reporting the evolution of hypogammaglobulinemia in premature and full-term infants during the first years of life. The aim of this study was to assess the clinical and immunological evolution of premature and full-term infants with hypogammaglobulinemia. We included 24 children (11 premature and 13 full-term infants), aged 0-36 months, with hypogammaglobulinemia. Fifteen (62.5%) children had an isolated reduction in IgG, 7 (29.2%) had a decrease in both IgG and IgA and 2 (8.3%) a reduction in IgG and IgM. Normalization of IgG serum levels occurred in the premature infants at a mean age of 7.2 months. Full-term infants were divided into 3 groups based on age at normalization of IgG serum level: A) hypogammaglobulinemia with normalization within 12 months of life; B) with normalization within 36 months of life; C) normalization after 36 months. All the premature infants with hypogammaglobulinemia recovered, even though in the lower limits for age in the first years, while transient hypogammaglobulinemia observed in full-term infants has a different age of recovery.

Drug release from hydrogel: a new understanding of transport phenomena.

In tissue engineering, i.e., in combined advanced technologies to replace damaged or missing parts of living tissues, emerging strategies strongly point toward the use of hydrogels also for their ability of being vehicles for local controlled drug delivery. The investigation of drug release mechanisms in such matrices thus plays a key role in the design of smart system but literature is still very controversial on theoretical interpretations and understanding of available data. In this framework we used the new HRMAS-NMR DOSY technique to study the diffusive motions of sodium fluorescein, a drug mimetic small chromophoric molecule, loaded in a promising hydrogel developed for tissue engineering. While fluorescein behavior in water was as expected, also showing aggregation from mid concentrations, data collected within hydrogel samples surprisingly showed no aggregation and diffusion coefficients were always higher with respect to aqueous solution. Furthermore, the promotion of diffusion increased along with fluorescein concentration. The proportion of this effect was directly linked to hydrogel mesh size, thus carrying intrinsic novelty, but also complexity, and suggesting that not only strictly hydrodynamic effects should be considered but also electrostatic interactions between polymer chains and drug molecules might be key players in avoiding fluorescein aggregation and also affecting diffusivity.

Coupled-resonator-induced-transparency concept for wavelength routing applications.

The presence of coupled resonators induced transparency (CRIT) effects in side-coupled integrated spaced sequence of resonators (SCISSOR) of different radii has been studied. By controlling the rings radii and their center to center distance, it is possible to form transmission channels within the SCISSOR stop-band. Two different methods to exploit the CRIT effect in add/drop filters are proposed. Their performances, e. g. linewidth, crosstalk and losses, are examined also for random variations in the structural parameters. Finally, few examples of high performances mux/demux structures and 2 × 2 routers based on these modified SCISSOR are presented. CRIT based SCISSOR optical devices are particularly promising for ultra-dense wavelength division multiplexing applications.

Robust design of an optical router based on a tapered side-coupled integrated spaced sequence of optical resonators.

A novel (to our knowledge) scheme of an optical router/switch element, composed of a tapered side-coupled integrated spaced sequence of optical resonators, is proposed. It is based on a modified design of the ring sequence in which the resonance conditions are set by the single ring resonance and by the coherent feedback of the sequence of rings. This double condition yields robustness against fabrication defects, dense routing capability, and high switching efficiency.

Smart approach to evaluate drug diffusivity in injectable agar-carbomer hydrogels for drug delivery.

Hydrogels are commonly studied for tissue engineering applications and controlled drug delivery. In order to evaluate their reliability as scaffolds and delivery devices, literature describes many release studies performed involving different analytical techniques. However, these experiments can be expensive, time-consuming, and often not reproducible. In this study, two injectable agar-carbomer-based hydrogels were studied, both being loaded with sodium fluorescein, a harmless fluorophore with a steric hindrance similar to many small drugs, such as for example steroids and other neuroprotecting agents. Starting from simple, traditional, and inexpensive release experiments, it was possible to indirectly estimate the self-diffusion coefficient (D) of loaded sodium fluorescein. Such a parameter was also directly measured in the gel matrix by means of high resolution magic angle spinning (HRMAS) diffusion-ordered spectroscopy NMR. Because of the agreement between the calculated values and those measured by HRMAS-NMR spectroscopy, the latter approach can be considered as a simple and fast alternative to long analytic procedures.

[Regional programs and opportunities for the occupational health physician]. / Le politiche delle Regioni e delle Province Autonome e le nuove opportunità per il medico competente.

It is a well known fact that, in amending, Title V of the Italian Constitution, constitutional law no. 3/2001 inserted "Workplace health and safety" in paragraph 3 of article 117 as an issue assigned to the legal competence of regional governments. In this perspective, the role to be played by the regional governments, with due regard for the restrictions of national laws, is both broad and composite. Firstly, it is a active participatory role in the formulation of national legislation through the permanent conference for relations between central, regional and autonomous provincial governments. A second important level is adaptation, via the regional laws passed by the national parliament, to local economic and productive contexts. Thirdly, there is the planning and coordination, via the regional committees set up specifically for this purpose, of all health and safety measures.

Allergy is not the main trigger of urticaria in children referred to the emergency room.

BACKGROUND: Urticaria is the disease that has the highest impact on quality of life and requires the most visits to the emergency room. OBJECTIVE: To investigate the clinical presentation of acute urticaria in children referred to the paediatric emergency room of our hospital and to define possible related aetiologies. METHODS: We included 814 children consecutively referred to the emergency room between January 2006 and December 2007 with a diagnosis of acute urticaria, isolated or associated with other clinical symptoms. RESULTS: Only 2.0% of the cases studied were associated with severe clinical pictures. In 437 cases (53.7%), the cause of urticaria was not determined. The infections of the respiratory tract were the most frequently suspected aetiological factor. The diagnosis of allergic urticaria is more defined, but belongs to a minority group (10.8%). The first level treatment includes the use of non-sedating oral H1-antihistamine. CONCLUSION: The children with urticaria are frequently referred to the paediatric emergency room, but only in a few cases were associated with severe clinical manifestations or allergy. The evidence of an inverse relationship between the number of accesses and the patients' age may be explained by the higher prevalence of this disease in early childhood and possibly also by a higher concern of the parents of the younger patients.

A new model of resorbable device degradation and drug release: transient 1-dimension diffusional model.

In the framework of resorbable devices, an increased demand for a better reliability in drug delivery systems emerged, based on resorbable polymers degradation control. These points influenced researchers to replace the trial-and-error approaches with model-based ones. In this context, we developed a transient 1-dimension model for degradation and drug release of resorbable polymeric drug loaded systems. Such model is thought to be applied to design specific devices based on the expected degradation time and drug delivery rates. It is based on the detailed conservation equations taking into account main physical-chemical parameters involved in polymer degradation and in drug release, all independently estimated. The model leads to a system of partial differential equations solved numerically, which predictions were verified through both literature and our data. Data of different authors, various systems and directly generated data were matched by model predictions. Reliability of parameter estimation procedures was also confirmed by accelerated life tests.

Extruded ceramic microelectrodes for biomedical applications.

A new process, based on the micro-co-extrusion of preceramic precursors, has been studied for manufacturing ceramic microelectrodes to be used in biomedical applications. Commercially available silicon polymers were applied and proper doping resulted in electrically conductive ceramic filaments. Chemical reticulation and high-temperature pyrolysis were applied to convert the polymeric resins into Si-O-C ceramic materials. Circular microelectrodes were manufactured with diameters between 100 microm and 5 mm with a different number of inner conductive lines (from 1 to 80). The flexural strength of the filaments depended on the outer diameter size; doping with carbon black produced filaments with an average conductivity of approximately 0.4 S/cm for a 50% weight carbon black load. The results achieved by in vitro studies confirmed a good biological performance of Si-O-C ceramic structures with both hard and soft tissue cell models.