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.

[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.

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.

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.

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.

[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.

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.

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.

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.

Engineering injured spinal cord with bone marrow-derived stem cells and hydrogel-based matrices: a glance at the state of the art.

Concerning the broad topic of neural tissue engineering, we present a review relating to the state of the art in spinal cord injury repair strategies. Particular attention is given to spinal cord damage causes and effects, in neural and mesenchymal stem cell therapeutic approaches, in the use of hydrogels as cell carriers and in the mathematical modeling of involved phenomena. High importance is given to multidisciplinary strategies applied to spinal cord repair, since new research frontiers are believed to be now on 3D gel/cells and neuroprotective agent constructs for neural reconstruction purposes.

[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.

Two miniaturised TEPCS in a single detector for BNCT microdosimetry.

Microdosimetry with tissue-equivalent proportional counters (TEPC) has proven to be an ideal dosimetry technique for mixed radiation fields as those ones used in boron neutron capture therapy (BNCT). A new counter, composed of two twin cylindrical mini TEPCs inserted in a slim titanium sleeve of 2.7 mm external diameter, has been constructed. The detector has been designed to perform dosimetry and microdosimetry in intense radiation fields. The two mini TEPCs work in gas flow mode. They have right cylinder sensitive volumes of 0.9 mm. In spite of gas line tiny sizes, the gas pressure inside the two counters is well established with <1% of uncertainty. The counter has been calibrated in a secondary standard photon fields. The mean of the effective sensitive volume sizes has been measured to be 0.86 mm. The twin TEPC acquisition system processes properly the signals up to about 30 kHz of counting rate. Therefore, twin TEPC can perform dosimetric measurements in photon field with intensities of some tens of Gy h(-1).

Relationship between Bet v 1 and Bet v 2 specific IgE and food allergy in children with grass pollen respiratory allergy.

Grass allergy is the most common pollinosis in Northern Italy. Some patients with grass allergy show polysensitization against other pollens and plant-derived foods. In these patients oral allergic syndrome (OAS) is frequently associated. To evaluate the correlation between food allergy or food sensitization and specific IgE against panallergens such as Bet v 1 and Bet v 2, we studied 56 children (mean age: 8 years 5 months) suffering from respiratory allergy due to grass pollens were enrolled. Specific IgE against the most important food, inhalant allergen and Bet v 1, Bet v 2 were performed by ImmunoCAP technology (UniCAP 1000, Pharmacia Diagnostics, Uppsala, Sweden). We found 14 children (25%) sensitized to Bet v 1 and 13 (23%) to Bet v 2; in 24 cases (42.3%) a sensitization to at least one of the 2 panallergens was observed. Five of the 14 cases (36%) sensitized to Bet v 1 showed food allergy and 8 (57%) food sensitization; 6 (46%) of the 13 children sensitized to Bet v 2 showed food allergy and 7 (54%) food sensitization; only one case of Bet v 1 specific IgE without food allergy or sensitization was seen. Sixteen subjects (29%) showed food allergy (group A); 20 children (35.5%) multiple sensitizations to inhalant and at least one plant-derived food (group B); 20 subjects (35.5%) only inhalant allergens (group C). Sensitization to Bet v 1 (P<0.03) and Bet v 2 (P<0.009) is from a statistical point of view significantly higher in groups A and B than in group C. In the 16 patients with food allergy hazelnut was the major triggering food (50%), followed by peanut (38%), kiwi (31%), apple and walnut (19%). Specific IgE for Bet v 1 is more associated with nuts and legumes, while Bet v 2 is more related to fresh fruit and vegetables. In conclusion grass pollinosis is frequently associated with polysensitization to other pollen and food allergens. Bet v 1 and Bet v 2 specific IgE are significantly higher in these patients than in patients with grass monosensitization, and this sensitization may be considered a possible risk factors to evolve later into food allergy. Among the offending foods, legumes and the nut group are mostly related to Bet v 1, while vegetables and fresh fruits to Bet v 2.

[Prevention in regional policy]. / La prevenzione nelle politiche regionali.

Prevention, safety and health promotion represent fondamental issues in the Regional policy. With this regard, the implementation of the Regional policy has been thought as the promotion of an integrated system which links different fields such as health, work-related information and education, job orientation and work in general. It is recommended that a good standard of prevention is achieved through the synergic actions and the collaborations among all the different actors playing a role in safety and prevention in workplace, including occupational physicians, safety and prevention operators, safety representatives for workers, trade unions, employers associations and public institutions. It is also necessary to adopt a strategy in order to decrease the number of misdiagnosed occupational diseases as well as to promote the "culture of safety in workplaces", increasing the awareness of all figures, with special focus on employers category. All this has to be set in the new scenario of the nowadays work characterized by the progressive increase of atypical job contracts, renewing the emphasis on the necessity of keeping joined "the right to a job with the right to health".

Point of view of Italian regions.

The tragic chain of mortal events, that have happened to workers and people who have been exposed to asbestos, proposes clearly an accentuation of the efforts that have been undertaken up to now, even in absence of precise national directives, in order to give an answer to worries and, sometimes, to real consequences of citizens' and workers' asbestos exposure. Region of Tuscany, following the initiatives which have been carried out in national and regional field for the formerly asbestos-exposed or other carcinogenic agents workers, performed a guideline that was just titled "Guidelines on sanitary surveillance of formerly exposed to occupational carcinogens workers". The debate, which had risen around the sanitary surveillance of the formerly-exposed to occupational carcinogenic agents workers, had induced indeed many institutions to take decisions on issues which were not yet explicitly regulated by the national law. For example the guidelines provided suggestions regarding what bodies--either public or private--should be appointed to this task, or the kind of protocols should be adopted with all the related collective and individual consequences.

Secondary prevention of latex allergy in children: analysis of results.

OBJECTIVE: Latex allergy has become an increasing and clinically important problem. Several recommendation for secondary preventive measures have been advised. The aims of the study were to illustrate the results of the latex-safe protocol and to evaluate in allergic patients the role of risk factors for the development of latex allergy. METHODS: Latex-safe treatment was divided into the following phases: anamnestic identification, allergologic assessment, patient selection, intervention programme, preventive medication, operating room equipment, postoperative management, patient and family training, follow-up. RESULTS: Between 1998 and 2004, 6.832 patients underwent 7.333 operations. Anamnestic and diagnostic tests showed that 26 patients had latex allergy. 44 secondary perioperative latex-safe management have been accomplished in 26 children. No allergic event or complications linked to the procedure occurred. Atopy, congenital malformations frequently associated with latex allergy and the presence of 5 or more surgical procedures were the major risk factors recognized. Six out of the 26 patients (23%) had only one risk factor (atopy). Twenty out of 26 children (77%) had several associated risk factors: 8 of them had simultaneously 9 of the 10 analysed risk factors. Our data shows that, the higher their number, the higher the gravity of the allergy. CONCLUSIONS: Although latex allergy is a limited phenomenon, it is nevertheless quite frequent within risk groups. Most patients have simultaneously many risk factors for the development of such an allergy, and the occurrence of several risk factors increases severity of the allergy. Latex-safe perioperative management offers guarantees of safety against latex allergy phenomena.

All-trans retinoic acid and low-dose cytosine arabinoside for the treatment of 'poor prognosis' acute myeloid leukemia.

Thirty-three patients with 'poor prognosis' acute myeloid leukemia, no longer suitable for aggressive chemotherapy, were treated with daily oral all-trans retinoic acid (45 mg/m2) daily and subcutaneous cytosine arabinoside (20 mg standard dose twice a day, day 1 to 10, every 4 weeks). Seventeen patients were males and 16 females, the median age was 67 (range 39-82 years). Eleven patients were at onset of disease, 15 were refractory to previous conventional therapies, three were in first relapse and three in second relapse and one patient had a secondary AML. Seventeen patients had a bone marrow blast infiltration < 50% and 16 > or = 50%. A total of 16 (48%) patients entered complete remission; the rate of complete remission increased to 88% in those patients (n = 17) with < 50% blast infiltration at the time of entering the study. Seventeen patients (52%) were resistant. The difference in response to therapy, according to bone marrow blast percentage (< or > or = 50%), was statistically significant (P < 0.001). Median duration of complete remission was 34.4 weeks (range 6.4-62.8). Mild to moderate hematologic toxicity was the most common side-effect. In conclusion all-trans retinoic acid and low-dose cytosine arabinoside appears to be an effective regimen for inducing complete remission in 'poor prognosis' acute myeloid leukemia and patients with < 50% bone marrow infiltration are likely to represent the ideal target to receive this combination therapy.