Mottness at finite doping and charge-instabilities in cuprates.

The influence of the Mott physics on the doping-temperature phase diagram of copper oxides represents a major issue that is subject of intense theoretical and experimental effort. Here, we investigate the ultrafast electron dynamics in prototypical single-layer Bi-based cuprates at the energy scale of the O-2p→Cu-3d charge-transfer (CT) process. We demonstrate a clear evolution of the CT excitations from incoherent and localized, as in a Mott insulator, to coherent and delocalized, as in a conventional metal. This reorganization of the high-energy degrees of freedom occurs at the critical doping pcr ≈0.16 irrespective of the temperature, and it can be well described by dynamical mean field theory calculations. We argue that the onset of the low-temperature charge instabilities is the low-energy manifestation of the underlying Mottness that characterizes the p < pcr region of the phase diagram. This discovery sets a new framework for theories of charge order and low-temperature phases in underdoped copper oxides.

Photo-enhanced antinodal conductivity in the pseudogap state of high-Tc cuprates.

A major challenge in understanding the cuprate superconductors is to clarify the nature of the fundamental electronic correlations that lead to the pseudogap phenomenon. Here we use ultrashort light pulses to prepare a non-thermal distribution of excitations and capture novel properties that are hidden at equilibrium. Using a broadband (0.5-2 eV) probe, we are able to track the dynamics of the dielectric function and unveil an anomalous decrease in the scattering rate of the charge carriers in a pseudogap-like region of the temperature (T) and hole-doping (p) phase diagram. In this region, delimited by a well-defined T*neq(p) line, the photoexcitation process triggers the evolution of antinodal excitations from gapped (localized) to delocalized quasiparticles characterized by a longer lifetime. The novel concept of photo-enhanced antinodal conductivity is naturally explained within the single-band Hubbard model, in which the short-range Coulomb repulsion leads to a k-space differentiation between nodal quasiparticles and antinodal excitations.

Disentangling the electronic and phononic glue in a high-Tc superconductor.

Unveiling the nature of the bosonic excitations that mediate the formation of Cooper pairs is a key issue for understanding unconventional superconductivity. A fundamental step toward this goal would be to identify the relative weight of the electronic and phononic contributions to the overall frequency (Ω)-dependent bosonic function, Π(Ω). We performed optical spectroscopy on Bi(2)Sr(2)Ca(0.92)Y(0.08)Cu(2)O(8+δ) crystals with simultaneous time and frequency resolution; this technique allowed us to disentangle the electronic and phononic contributions by their different temporal evolution. The spectral distribution of the electronic excitations and the strength of their interaction with fermionic quasiparticles fully account for the high critical temperature of the superconducting phase transition.

Role of congenital rubella reference laboratory: 21-months-surveillance in Liguria, Italy.

INTRODUCTION: Rubella is generally a mild rush fever disease when acquired in childhood, but when infection occurs during the first months of pregnancy, high risk of trans-placental transmission to the foetus and of congenital anomalies exists. In November 2003, a National Plan for measles and congenital rubella elimination was approved in Italy. The aim was to reduce and maintain Congenital Rubella Syndrome incidence lower than 1 case per 100,000 live births/year by 2007. Since June 2006, Liguria Administrative Region recognized U.O. Hygiene, "San Martino" University Hospital, Genoa, as regional reference laboratory for diagnosis of rubella infection during pregnancy and post-partum. METHODS: Twenty-one-month virological-surveillance results between April 2007 and December 2008 were reported in terms of demographic data, risk factors, access reasons, clinical picture, vaccination, previous rubella disease, laboratory results of pregnant women and newborns. RESULTS AND CONCLUSION: Since the beginning of surveillance, 65 pregnant women with suspected virus infection and 18 newborns with suspected congenital rubella were followed up. The results of laboratory surveillance highlighted (i) the importance of an early screening, (ii) the suboptimal specificity of chemiluminescent assays, that often yield false positive IgM results and (iii) the fundamental role of second-level laboratory to confirm the serological diagnosis and to detect the virus by molecular techniques.

Influenza and respiratory syncytial virus in infants and children: relationship with attendance at a paediatric emergency unit and characteristics of the circulating strains.

A study was carried out on 2,696 Italian children, aged 0-14 years. The goals were: (1) to define the age-related impact of acute respiratory infections (ARI), measured as the risk of attendance at the Paediatric Emergency Room, (2) to better define the importance and proportion of influenza and respiratory syncytial virus (RSV) infections and (3) to acquire deeper knowledge of the influenza strains circulating in infants and children. A standardised emergency unit attendance risk (EUAR) was calculated, by age group for ARI. Specific EUARs were also calculated for the two pathogens. Pharyngeal swabs were tested by polymerase chain reaction (PCR) for influenza and RSVs. Isolation in Madine-Darby canine kidney cells (MDCK) and Hep cells, haemagglutination inhibition (HI) testing and HA1 gene sequence analysis were performed for influenza viruses. Most of the patients enrolled were aged 0-5 years, 1,139 (84.6%) and 1,061 (78.5%) in the two seasons, respectively. The most represented age class was that of 1 year olds (331 cases in 2001-2002 and 301 in 2002-2003). The highest EUAR for ARI was in patients aged 0-3 years (16.8 and 12.9 during the two seasons). The same was observed on calculating this risk by specific pathogens: 17.4 and 5.5 for influenza and 13.0 and 12.7 for RSV. Virological analysis was performed on 2,696 samples, 595 of which proved positive (22%). The highest number of isolates (326) came from patients aged 1-3 years. RSVs were more often identified than influenza viruses in infants aged up to 1 year (32 vs. 20 isolates). Of 265 strains isolated in 2001-2002, 103 were RSVs (87 type A, 16 B) and 162 were influenza (90 type A, 72 B). HI showed that influenza B viruses were related to two lineages, B/Victoria/2/87 (32%) and B/Yamagata/16/88 (68%). Of 330 strains isolated in 2002-2003, 102 were RSVs (91 type A, 11 B) and 228 were influenza viruses (220 type A, 8 B). A/H3N2 strains belonged to two clusters, A/Panama/2007/99-like and A/Fujian/411/02-like, a new variant. This paper discusses the possible role of the identified flu strains in determining EUARs among the population by age class.

Performance testing of two new one-step real time PCR assays for detection of human influenza and avian influenza viruses isolated in humans and respiratory syncytial virus.

INTRODUCTION AND METHODS: Two real time one-step RT-PCR assays were developed for simultaneous detection and typing of influenza A and B viruses and detection of Respiratory Syncytial Virus (RSV). As regard influenza, primers were designed to amplify specific sequences of gene M of A/H1N1, A/H3N2, A/H5N1, A/H7N7 and A/H9N2 viruses and of gene NP of type B viruses belonging both Yamagata and Victoria lineage. Specificity, analytical and clinical sensitivity, dynamic range, linearity of the new assays were evaluated. RESULTS: Dynamic ranges for Influenza A and B, and RSV were at least five logs and linearity was conserved. In order to evaluate the specificity, 80 nasopharyngeal swabs resulting Influenza and RSV negative by multiplex nested PCR and cell culture, were tested and 79 resulted negative. The detection limits for influenza A and B, calculated by 95% probit, was 0.008 and 0.09 PFU, respectively, resulting more sensible than nested PCR. A total of 75 specimens (10 A/H1N1, 3 A/H1N2, 8 A/H3N2 Johannesburg/94-like, 10 A/H3N2 Panama/2007/99-like, 10 A/H3N2 Fuijian/411/02-like, 2 A/H5N1, 2 A/H7N7 and 2 A/H9N2, 15 B/Yamagata-like and 13 B/Victoria-like) collected between 1994 and 2004 or received by WHO Influenza Centre, London, were chosen as representative of the circulating strains and tested. All samples resulted positive although one B/Victoria sample was not clear typed. Thirty swabs nested RT-PCR positive for RSV collected during the four seasons, were also analysed by realtime PCR, resulting positive. To evaluate the performance of the new assay on fresh material, 250 specimens, collected during the 2004/05 seasons, were tested by nested-PCR, cell culture and real-time PCR. DISCUSSION AND CONCLUSION: The new assays provide accurate and sensitive diagnosis of influenza and RSV infection and they represent a sensitive tool for virological surveillance and management of patient with ILI.

[Suicidal behavior in the North Varese province: a epidemiological analysis]. / La condotta suicidaria nel nord della provincia di Varese: un'indagine epidemiologica.

OBJECTIVE: Analysis of figures and characteristics of suicide behaviour in the area of Varese and the neighbouring northern towns (Valceresio, the valleys around Luino and northern Verbano), with the purpose of finding out preventing measures. DESIGN: Epidemiological-descriptive survey. The 1995-1997 ISTAT death cards, included in the death files of the former USSL of Varese have been taken into consideration. Only those people who were resident at the suicide moment have been included in the survey. Afterwards the psychiatric service archives were consulted, to find any possible contact between the subjects in the ISTAT files and the psychiatric services themselves. With regard to these patients, some information such as suicide attempts, psychiatric pathology and first contact with the psychiatric services have been pointed out. SETTING: Arcisate, Cittiglio, Luino and Varese districts, where the Community Mental Health Services 1 and 2 of "Azienda Ospedaliera Universitaria Macchi" of Varese operate. MAIN OUTCOME MEASURES: The suicide rates in the studied area have been reckoned and, through direct standardization, the rates of the single districts have been compared. RESULTS: There were 78 suicides (24 females and 54 males): rate of 8.2 per 100,000. In accordance with the national trend, there is evidence of a general reduction of the suicide phenomenon, except among the youngest. Districts of Luino and Arcisate are geographic areas to examine in the time, because a wider sample could reveal a higher risk. Young and elderly people are the most affected among the males and, 55/64-year-old people, both males and females, are at higher risk. Suicide methods vary with the age. A high percentage of subjects are not married and with low education. Less than one third of the subjects had come into contact with the psychiatric service. CONCLUSIONS: These data allow a comparison with the national survey and an analysis of the suicide features in the study area. The purpose is to elaborate preventing strategies with multi-dimensional approach whose efficacy may be proved in the future by setting up a provincial observatory.

An approach for the estimation of drug prescribing using the defined daily dose methodology and drug dispensation data. Theoretical considerations and practical applications.

OBJECTIVE: To test the hypothesis that comparison of defined daily dose (DDD) and drug user data may help to estimate drug exposure in a defined population and provide information about drug prescribing patterns. METHODS AND RESULTS: First, comparison of DDD figures with the number of apparent drug users (ADU, i.e., individuals for whom at least one prescription of the drug had been dispensed during a given time period) is demonstrated to correspond to the product of the prescribed daily dose (PDD) and the proportion of days in which the drug had been taken (days of treatment/days in a time period, D). The resulting equation (DDD/day)/ ADU in a time period = PDD x D is then applied to the analysis of different sets of drug dispensation data. Examples show that this approach may be helpful to monitor drug prescribing patterns over time. Moreover, in definite situations, it may provide reliable estimates of either PDD or D. CONCLUSIONS: Comparison of DDD and drug user data is suggested to be a cost-effective strategy to monitor drug prescribing patterns from an epidemiological perspective, which may be useful to researchers involved in drug utilisation studies as well as to health authorities for monitoring and regulatory purposes.

Seventeen-year-long follow-up of a family affected by type 2A multiple endocrine neoplasia (MEN 2A).

This paper reports the results of a 17-year-long follow-up covering 17 members of a family affected by multiple endocrine neoplasia (MEN) type 2A, first diagnosed in 1980. This family is enrolled in our screening program. The thyroid, parathyroid and adrenal glands of the family members were investigated using the most sophisticated and sensitive techniques which have become available during this period, and their DNA was genetically tested for detecting RET mutations. Thanks to the combination of these two approaches it was possible to confirm the diagnosis in the members concerned from the genetic point of view, and to achieve an early diagnosis in the young members of the last generation before the clinical onset of the disease. The detection of a RET mutation also prompted a prophylactic thyroidectomy in a four year-old boy, in a pre-tumoral stage of the disease. Lastly, evidence is provided that genetic analysis of the DNA of the chorionic villi can be carried out as a prenatal test during routine amniocentesis.

Attitudes to adverse drug reaction reporting by medical practitioners in a Northern Italian district.

Attitudes to adverse drug reaction (ADR) spontaneous reporting were investigated among all the National Health Service (NHS) doctors operating in the territory of the Area Health Authority n.1 of Varese (Italy), to assess their awareness of the reporting system and to identify reasons for under reporting. Three hundred and fifty doctors were sent questionnaires and 207 (59.1%) were returned completed. More than 77% of the responders stated to have noticed ADRs, which were mainly reported to the pharmaceutical manufacturers and, in a minority of cases, to the NHS. Fifty per cent did not report ADRs to anyone. Important factors for deciding to report were unusualness and severity of the reaction, and involvement of a new drug. The main reason for not reporting was the clinical negligibility of the reaction. There was little knowledge about the types of reactions to be preferentially reported and the purposes of ADR reporting systems. Nevertheless, nearly everyone asked for feed-back information about reported ADRs. NHS doctors in this district have little information concerning ADR reporting systems. Some effective measures to improve the situation could be: inclusion of pharmacovigilance into pre- and post-graduated continuing education programs, provision of guidelines for ADR spontaneous reporting and of feed-back information to reporters, implementation of regional pharmacovigilance units.

[Factors limiting adaptation to exercise after the Fontan operation: role of altered pulmonary function]. / Fattori limitanti l'adattamento allo sforzo dopo intervento di Fontan: ruolo di eventuali anomalie polmonari.

BACKGROUNDS: The abnormal adaptation to exercise after Fontan operation, is primarily due to a suboptimal increase in cardiac output. We postulated that abnormal pulmonary function could cooperate in reducing effort tolerance of these patients (pts). METHODS: We have evaluated 10 pts, mean age 15 +/- 8 yrs, with a mean postoperative follow-up of 6 +/- 2 yrs. Seven pts were asymptomatic while 3 had mildly decreased effort tolerance. These pts were evaluated with echocardiogram, cycle ergometer stress test, basal and effort spirometry and perfusion lungs scanning. RESULTS: Basal ejection fraction was normal in 9 pts and mildly depressed in 1 pt. Basal cardiac index was 1.8 + 2.2 l/min/m2 and increased to 4.8 + 5 l/min/m2 during exercise. Effort tolerance was 73% +/- 21% of predicted values, with maximal O2 consumption of 60% +/- 13% of predicted. Basal spirometry showed a mild restrictive pattern in 7 pts with a decrease in total pulmonary capacity and in forced vital capacity (mean values respectively 79% +/- 14% and 75% +/- 18% of predicted), otherwise respiratory reserve resulted normal in all pts. Carbon monoxide diffusion was impaired in all pts with a mean value of 49% +/- 10% of predicted. O2 saturation near normal in basal condition decrease during exercise (mean value 96% +/- 2% and 91% +/- 7%). The VE/VO2 and Vd/Vt ratio were both abnormally increased (respectively 111% +/- 28% and 186% +/- 39% of predicted). Lung scanning was abnormal in 6 pts with defects of perfusion localized prevalently in left lung (5/6) especially in upper lobe (4/6). CONCLUSIONS: After Fontan operation exercise tolerance is reduced as consequence of 1) a suboptimal increase in cardiac output and 2) abnormal gas diffusion probably due to a damage of alveolo-capillary membrane and/or to a ventilation/perfusion mismatch as showed by abnormalities in lungs perfusion and by increase Vd/Vt ratio.

Coronary artery disease after heart transplantation: non-invasive evaluation with exercise thallium scintigraphy.

In order to assess the value of exercise thallium scintigraphy for the detection and prognosis of graft coronary artery disease, 50 heart transplant patients (mean age 46.7 +/- 11.5 years) were studied within 48 h of their scheduled yearly coronary angiography and subsequently followed up for a mean of 13 +/- 3 months. Angiography revealed normal coronary arteries in 35 patients, and coronary artery disease in 15 (two with type A lesions, seven with type B lesions and six with both). Seven patients had one or more stenoses > or = 50%. Exercise thallium scintigraphy was negative in all patients with normal coronary arteries (100% specificity), and abnormal in 10 of 15 patients with coronary artery disease (67% sensitivity). Fixed defects were seen in six cases, transient defects in two and both in two; the results of the test were abnormal in all seven patients with > or = 50% lesions. During follow-up, none of the patients with a normal exercise thallium scintigraphy experienced any cardiac event; in the group with abnormal results, four cardiac events occurred. Although further studies are needed to confirm these results, exercise thallium scintigraphy seems to be useful in evaluating post-transplant coronary artery disease: it is accurate in detecting the most severe stenoses and provides some prognostic information.

Perception of bronchoconstriction in chronic asthma.

Twenty-nine asthmatic children were studied to assess their ability to detect the severity of their bronchoconstriction. First (STEP 0): each child was asked if he "felt asthma," inviting him to give a self-estimated obstruction score (SEOS) from 0 (no asthma) to 3 (severe asthma) and a baseline FEV1 was recorded. Then (STEP 1): methacholine was administered to all except 9 children with an FEV1 less than 80% of predicted who received saline nebulization and a second SEOS was recorded. Finally: salbutamol aerosol was administered and a third SEOS and FEV1 were obtained (STEP 2). Spearman's correlation coefficients r between SEOS and FEV1 were for the overall population -0.602, -0.517, and -0.104 at STEP 0, STEP 1, and STEP 2, respectively. The r values reduction during the trial can be due either to a decrease of children's concentration during the study or to a real difficulty in recognizing repeated changes in airway status. Some children tend to underestimate their bronchospasm. For these patients an accurate assessment of the severity of the bronchoconstriction requires an objective measurement during acute changes in asthmatic children.

The 99mTc-HMPAO leukocyte scan: an alternative to radiology and endoscopy in evaluating the extent and the activity of inflammatory bowel disease.

Seventy-eight patients, 47 with Crohn's disease and 31 with ulcerative colitis, were studied using 99mTc-HMPAO-labelled leukocytes, in order to assess the reliability of the scan in evaluating the location and activity of the disease. The granulocyte integrity was assessed by evaluating the lung wash-out and the early liver and spleen uptake using a 20 minute initial dynamic study. The results of the leukocyte scan revealed a high correlation with radiological and endoscopic findings in the diagnosis of the inflamed bowel segments. The disease activity correlated well with uptake in the bowel, graded from 0 to 3. The leukocyte scan exactly documented the activity in the 9 cases of Crohn's disease located in the ileum and in 5 cases in which the endoscopic exploration was hampered by scarring. Four fistulae were correctly visualized. Moreover, the change in activity after therapy in 6 patients was documented. This technique provides images of excellent quality, superior to those obtainable with indium-111.

[Importance of looking for specific IgM in serological investigations for syphilis]. / Importanza delle richerche delle IgM specifiche nelle indagini sierologiche per la lue.

Syphilis is still a quite common infection often lacking clinical symptoms and sometimes ignored. Serological tests have peculiar importance in order to settle the diagnosis and therapy. Traditional tests as VDRL and TPHA cannot clearly define the clinical pattern because these tests remain positive for a long period of time. Moreover they can prove the recovery of the patients only if they continue to give low titres. The immunofluorescence test FTA ABS, that raised interest at its outset, has low sensitivity against IgM specific antibodies and defines serological state of patients only in 50% of the cases. The reading of this test remains subjective. The authors intend to verify the importance to detect the IgM specific antibodies to assume medical and legal decisions in unknown subjects, without clinical knowledge. 20,000 sera of normal subjects and of risk group have been assayed. Specific IgM are absent in 60 clinically recovered subjects with VDRL and TPHA still positive, specific IgM are present in 15 cases of Syphilis under treatment and also in 15 subjects with unknown Syphilis. The results show that: 1) IgM specific antibodies for Syphilis are not detectable in patients under a long term antibiotic treatment while the traditional serological tests (VDRL, TPHA) are positive; 2) they are present in patients under treatment with still active infection; 3) they are also present in patients with ignored infection, never treated. In conclusion the Authors consider important to include in the panel of Syphilis testing new assays for the detection of specific IgM antibodies. This is particularly important in subjects under treatment and also in unknown subjects.

The role of radiopharmaceuticals MIBG and (V) DMSA in the diagnosis of medullary thyroid carcinoma.

The diagnostic value of 123/131I meta-iodo-benzylguanidine (MIBG) and 99mTc (V) dimercaptosuccinic acid (DMSA) was investigated in 12 patients with proven medullary thyroid carcinoma (MTC). Scintigraphic imaging with DMSA was negative in nine of 12 patients. Scintigraphy with MIBG was positive in only one case. In proven primary or recurrent disease, DMSA sensitivity was 50% and MIBG sensitivity was 25%. Such sensitivities become much lower in subjects with high calcitonin (CT) levels who have had negative surgical explorations: DMSA 17% and MIBG 0%. DMSA detected tumor in 25% of the patients and MIBG in only 8%. The positivity of these scintigraphies appears to be unrelated to carcinoembryonic antigen and CT plasma levels. Such data suggest that scintigraphies with MIBG and DMSA are only modestly useful in the diagnosis of MTC.

[Prognostic value of the equivalents of transitory myocardial ischemia evaluated by exercise thallium-201 myocardial scintigraphy in an ambulatory population of 367 patients with a maximum 5-year follow-up]. / Valore prognostico degli equivalenti di ischemia miocardica transitoria rivelabili con la scintigrafia miocardia da sforzo con Tallio-201 in una popolazione ambulatoriale di 367 soggetti con una osservazione massima di 5 anni.

From 1-1-1981 to 3-31-1985, 367 subjects (227 males and 140 females) were examined by means of TL-201 myocardial scintigraphy for diagnostic purpose. A follow-up period, 5 years maximum, was run in order to assess the prognostic value of the three equivalents of transient myocardial ischemia which can be demonstrated by the test (angina, reversible hypoperfusion, and ST-T segment changes). The end points were myocardial infarction and/or sudden death. Three-hundred fifty-four patients complied (96%). During the observation period 9 severe ischemic events (SIE) occurred: 5 myocardial infarctions and 4 sudden deaths. As far as the predictivity of SIE is concerned, the "t" test for independent samples showed a statistically significant difference between the group of patients with no signs of ischemia and the group with positive scintiscan (p less than 0.05) and with the three equivalents of ischemia all together (p less than 0.05). Moreover, in the sub-group of patients with pathological scintigraphic results the probability for SIE to occur was statistically different in the patients with no hypoperfusion in the region supplied by the anterior descending coronary artery and in those with pathological scintigraphic findings in that region (p less than 0.05). In our opinion, the above data demonstrate the pathological signs noticeable with stress myocardial TL-201 scintiscan to have prognostic value.