Prevalence of and secular trends in diagnosed diabetes in Italy: 1980-2013.

BACKGROUND AND AIMS: The aim of this research was to examine the prevalence of diabetes in Italy over a 34-year period. METHODS AND RESULTS: Self-reported diabetes was assessed in eight health interview surveys of representative samples of Italian population aged 20 years and over. Crude and standardised prevalence were calculated by age, sex, educational level and area of residence. Logistic models were fitted to calculate the contribution of age and BMI to the trend in prevalence. In 2013 nearly 3.4 million Italians had a diagnosis of diabetes, more than twice as many as in 1980. The crude prevalence of diabetes in men rose from 3.3% in 1980 to 7.1% in 2013 (+115%), and from 4.7% to 6.8% in women (+45%). The prevalence was almost stable during the eighties, and started to rise from the beginning of the nineties. One third of the increase in men and two thirds in women is due to the ageing of the population, since the age-standardised prevalence increased by 79% in men and 14% in women. The prevalence of overweight and obesity increased less steeply than diabetes, and their contribution to the trend in diabetes is less relevant than age. Prevalence rose more in the elderly, in low-educated men, and in high-educated women. CONCLUSION: Given that the ageing population plays a considerable role in explaining the trend, and that the number of people in the oldest age groups will continue to grow, the rise in the number of individuals with diabetes will represent a severe challenge for the national health system.

Solvent-tunable morphology and emission of pyrene-dipeptide organogels.

Two pyrene based organogelators in which the pyrene moiety has been linked to the diphenylalanine dipeptide have been synthesized. We show how the solvent can tune both the morphology and the optical properties of the organogels: spherical aggregates with quenched emission were obtained in acetonitrile, whereas an entangled fibrillar network with enhanced emission was formed in o-dichlorobenzene. Fourier transform infrared spectroscopy, circular dichroism and nuclear magnetic resonance spectroscopy experiments suggest that both π-π stacking and hydrogen bonding contribute to the formation of the supramolecular networks. Ultraviolet-visible and steady state emission studies demonstrated the formation of I-aggregates in acetonitrile. In contrast, in o-dichlorobenzene, the formation of J-type aggregates leads to assemblies with enhanced emission. These results give some insight into the important role of the gelling solvent in the morphology of the supramolecular gels and may help in the design of new soft-materials.

Synthesis of luminescent 3D microstructures formed by carbon quantum dots and their self-assembly properties.

We report in this communication the synthesis of star-shaped carbon quantum dots-(poly-γ-benzyl-L-glutamate) conjugates that self-assemble into microstructures and retain the characteristic emission properties of the native dots. Dots were used either as an initiator to give a daisy-like peptide-polymer structure or as capping agents towards more elaborated hybrid nanostructures.

Recursive neural networks for processing graphs with labelled edges: theory and applications.

In this paper, we introduce a new recursive neural network model able to process directed acyclic graphs with labelled edges. The model uses a state transition function which considers the edge labels and is independent both from the number and the order of the children of each node. The computational capabilities of the new recursive architecture are assessed. Moreover, in order to test the proposed architecture on a practical challenging application, the problem of object detection in images is also addressed. In fact, the localization of target objects is a preliminary step in any recognition system. The proposed technique is general and can be applied in different detection systems, since it does not exploit any a priori knowledge on the particular problem. Some experiments on face detection, carried out on scenes acquired by an indoor camera, are reported, showing very promising results.

Pisa syndrome in a cohort of Alzheimer's disease patients.

Three Alzheimer's disease patients with Pisa syndrome were presented. These patients were treated with cholinesterase inhibitors within a post-marketing surveillance study. The clinical and pharmacological histories of these patients suggest a relation between cholinesterase inhibitors and the pleurothotonus. The diffuse use of cholinesterase inhibitors in the treatment of dementia may cause an increasing number of Pisa syndrome cases.

Secondary prevention of coronary artery disease in high-risk diabetic patients.

BACKGROUND AND AIM: To compare guideline implementation and the actual delivery of secondary prevention for coronary artery disease in the cohort of Italian diabetic patients enrolled in the DAI study. METHODS AND RESULTS: The DAI study is a multicentre cohort study of the prevalence and incidence of macroangiopathic events among 19,570 type 2 diabetic patients attending 201 Diabetic Care Units. For this study, we selected 1,475 subjects with a history of myocardial infarction, coronary artery bypass graft or percutaneous transluminal coronary angioplasty at enrollment. Only 25% of the coronary patients in secondary prevention were receiving lipid-lowering drugs, and 20% were receiving beta-blockers. None of the patients in 54/185 Diabetic Care Units were on statins, and none in 82/185 Units were on beta-blockers. Multivariate analysis showed a positive correlation between the number of treatments and the taking of statins, and a negative correlation with age. CONCLUSION: Our data highlight a gap between the therapeutic guidelines and actual treatment, with wide variability in the delivery of secondary prevention across Units. The out-of-pocket cost of medication, daily treatment burden and geographic area can be ruled out as possible explanatory factors. Physicians' prescription attitudes may be a possible reason.

EEG signal processing in anaesthesia. Use of a neural network technique for monitoring depth of anaesthesia.

BACKGROUND: The Bispectral Index (BIS) is a proprietary index of anaesthesia depth, which is correlated with the level of consciousness and probability of intraoperative recall. The present study investigates the use of a neural network technique to obtain a non-proprietary index of the depth of anaesthesia from the processed EEG data. METHODS: Two hundred patients, who underwent general abdominal surgery, were recruited for our trial. For anaesthesia we used a total i.v. technique, tracheal intubation, and artificial ventilation. Fourteen EEG variables, including the BIS, were extracted from the EEG, monitored with an EEG computerized monitor, and then stored on a computer. Data from 150 patients were used to train the neural network. All the variables, excluding the BIS, were used as input data in the neural network. The output targets of the network were provided by anaesthesia scores ranging from 10 to 100 assigned by the anaesthesiologist according to the observer's assessment of alertness and sedation (OAA/S) and other clinical means of assessing depth of anaesthesia. Data from the other 50 patients were used to test the model and for statistical analysis. RESULTS: The artificial neural network was successfully trained to predict an anaesthesia depth index, the NED (neural network evaluated depth), ranging from 0 to 100. The correlation coefficient between the NED and the BIS over the test set was 0.94 (P<0.0001). CONCLUSION: We have developed a neural network model, which evaluates 13 processed EEG parameters to produce an index of anaesthesia depth, which correlates very well with the BIS during total i.v. anaesthesia with propofol.

A photosensitizer dinuclear ruthenium complex: intramolecular energy transfer to a covalently linked fullerene acceptor.

A fullerene derivative (5) in which a dinuclear ruthenium complex is covalently linked to a fulleropyrrolidine (FP) through a rigid spacer has been prepared through azomethine ylide cycloaddition to C60. Electrochemical and photophysical studies revealed that ground-state electronic interactions between the bimetallic ruthenium chromophore and the FP moiety are small. The absorption spectrum of 5 displays a metal-to-ligand charge transfer (MLCT) transition at about 620 nm in CH2Cl2 which is shifted by nearly 160 nm relative to that of a previously reported mononuclear dyad (8). The photophysical investigations have also shown that both in dichloromethane and acetonitrile the photoexcited MLCT state of dyad 5 transforms into the fullerene triplet excited state with a quantum yield of 0.19 and that, contrary to mononuclear dyad 8, electron transfer, if any under the applied conditions, is negligible relative to energy transfer.

Use of amoxicillin and amoxicillin-clavulanic acid and hospitalization for acute liver injury.

Increase of acute liver injury in patients taking amoxicillin-clavulanic acid (co-amoxiclav) as compared to those taking amoxicillin has been suggested. To further investigate the potential hepatotoxicity of the two drugs a historical cohort study was conducted in the Italian region of Friuli-Venezia Giulia. One hundred and eighteen potential cases of acute liver injury were identified through the regional hospital information system and medical records were reviewed for all of them. Overall, 12 cases of acute liver injury were identified: 3 cases occurred in the amoxicillin exposure category, 2 among co-amoxiclav group, and 7 in the non-use category. The adjusted estimate of the rate ratio was 5.7 (CI 95% 1.5-22.1) among users of amoxicillin alone and 6.2 (CI 95% 1.3-29.7) among users of co-amoxiclav.

Ketorolac use in outpatients and gastrointestinal hospitalization: a comparison with other non-steroidal anti-inflammatory drugs in Italy.

OBJECTIVE: To compare the risk of hospitalization for gastroduodenal ulcer associated with the use of ketorolac and other non-steroidal anti-inflammatory drugs (NSAIDs). METHODS: A cohort and a nested case-control study were carried out. All residents in the region of Umbria (Italy), aged 35-84 years, who had been given at least one NSAID prescription in 1993 and 1994 were identified. Exposure to drugs was ascertained through a drug prescription database. We estimated rate ratios of hospitalization for gastroduodenal ulcer with or without complications in the current, recent or past period according to exposure to different NSAIDs. RESULTS: Rate ratio estimates, adjusted for age and sex, were 2.8 for any current NSAID and 1.4 for any recent NSAID. The highest rate ratios of lesions of any severity for current NSAID use were observed for piroxicam (RR: 4.6) and ketorolac (RR: 3.4). For gastrointestinal haemorrhage or perforation the highest rate ratios were those for ketorolac (RR: 5.9) and piroxicam (RR: 4.8). Rate ratio estimates did not change after adjustment for concomitant use of gastrotoxic drugs, use of gastroprotective agents not associated with NSAIDs and prior use of NSAIDs. CONCLUSION: Our study demonstrates the need to adhere to the restrictions relating to the indications and duration of use of ketorolac. At present piroxicam represents a greater public health concern since it is confirmed to be among the most gastrotoxic NSAIDs and is one of the most commonly prescribed NSAIDs in Italy.

Trans-cis amide bond isomerization in fulleroprolines.

The 1H NMR study of fulleroproline derivative Ac-Fpr-OtBu and its Pro analogue Ac-L-Pro-OtBu over a range of temperatures in toluene-d8 solution has enabled the comparison of their equilibrium and activation parameters for the trans/cis interconversion around the amide partial double bond.

Inductive inference from noisy examples using the hybrid finite state filter.

Recurrent neural networks processing symbolic strings can be regarded as adaptive neural parsers. Given a set of positive and negative examples, picked up from a given language, adaptive neural parsers can effectively be trained to infer the language grammar. In this paper we use adaptive neural parsers to face the problem of inferring grammars from examples that are corrupted by a kind of noise that simply changes their membership.We propose a training algorithm, referred to as hybrid finite state filter (HFF), which is based on a parsimony principle that penalizes the development of complex rules.We report very promising experimental results showing that the proposed inductive inference scheme is indeed capable of capturing rules, while removing noise.

Beta-turn induction by C60-based fulleroproline: synthesis and conformational characterization of Fpr/Pro small peptides.

We have recently described the preparation of Fpr (C60-based fulleroproline). In this paper the synthesis and a conformational characterization of heterochiral di- and tripeptides containing this new alpha-amino acid are reported. A folded structure, induced by the -L-Fpr-D-Ala-sequence in chloroform solution and detected by Fourier transform infrared absorption and 1H nuclear magnetic resonance, has been compared with the known propensity of the cognate -L-Pro-D-Ala-sequence to adopt a beta II-turn conformation, which has also been confirmed in this work. The beta II-turn structure is retained in the crystal state by the Pro-peptides, as shown by the X-ray diffraction structures of Ibu-L-Pro-D-Ala-NHtBu and Z-L-Pro-D-Ala-L-Ala-OtBu.

[Patterns of use of hormone replacement therapy in 2 Italian populations]. / Profilo d'uso della terapia ormonale sostitutiva in due popolazioni italiane.

We analysed the pattern of hormone replacement therapy (HRT) use, over the period 1990-92, in a random sample of 76,537 women (45-74 years old) resident in the province of Rome, and in 1994 among all women (45-74 years old) resident in the Umbria region; data were collected through the regional drug prescription monitoring systems. During the three-year period an estimated 3.8% of women were prescribed HRT, among these 42% received estrogen with concomitant progestin therapy. The prevalence of use increased from 1.5% in 1990 to 2.2% in 1992 mainly because of an increased use of skin patches. In the Umbria region, out of the 166,112 women, 2.1% received at least one estrogen prescription. The prevalence of use increased in younger age classes but is almost unchanged over the sixties.

Drug prescription in Italy.

Drug use in Italy in the period 1983-1991 has been analysed. The twenty most used substances accounted for about 20% of the sold packages. The effect of marketing of new drugs is worth noting: new and more expensive drugs are preferred even when effective, safe and less expensive alternatives are available. Prescribers have to face a highly dynamic pharmaceutical market in which 30% of substances (among the 300 most sold) changes every five years. Other than a more rational formulary, independent information and continuing education have to be considered as tools to improve a more rational prescribing.

Optimal convergence of on-line backpropagation.

Many researchers are quite skeptical about the actual behavior of neural network learning algorithms like backpropagation. One of the major problems is with the lack of clear theoretical results on optimal convergence, particularly for pattern mode algorithms. In this paper, we prove the companion of Rosenblatt's PC (perceptron convergence) theorem for feedforward networks (1960), stating that pattern mode backpropagation converges to an optimal solution for linearly separable patterns.