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Valutazione tossicologica e genotossicologica degli estratti organici e acquosi di fanghi di depurazione e altri rifiuti biogenici: un aspetto del progetto SLURP
No full textClinical management and therapeutic optimization of patients with heart failure with reduced ejection fraction and low blood pressure. A clinical consensus statement of the Heart Failure Association (HFA) of the ESC
No full textDespite major advancements in heart failure (HF) management and guideline recommendations over the past two decades, real-world evidence highlights suboptimal implementation of guideline-directed medical therapy (GDMT) for HF with reduced ejection fraction (HFrEF). Low blood pressure (BP) is common in HFrEF patients and represents a major perceived barrier to implementing life-saving treatments in clinical practice, as physicians are often concerned about symptomatic hypotension and its consequences. Although low BP can be seen in those hospitalized with signs of shock, the most common scenario involves non-severe, asymptomatic hypotension in patients receiving foundational therapy for HFrEF, where premature down-titration or discontinuation of GDMT should be avoided. This clinical consensus statement provides a comprehensive overview of low BP in HFrEF, including its definition, risk factors, and effects of HF therapies on BP. We propose management pathways to optimize HFrEF treatment in the context of low BP, ultimately aiming to improve patient outcomes
The ENUBET neutrino cross section experiment and plans at CERN
Full text linkENUBET has pioneered a novel technique to control the neutrino flux and flavor composition with percent-level precision. This successful R&D effort has paved the way for a new generation of cross-section experiments designed to meet the precision requirements of current neutrino oscillation studies. In this talk, we will summarize ENUBET's key achievements and outline the plans for its implementation at CERN
Intermediate Care, Clinical and Economic Outcomes. Systematic Review
No full textIntroduction: Intermediate care is a healthcare model designed to bridge the gap between hospital care and home, focusing on the efficient treatment and rehabilitation of patients after hospitalization. Its primary goals include facilitating early discharge, promoting patient independence, and preventing hospital readmissions. While previous studies have shown promise regarding the effectiveness of intermediate care, they often report mixed results, underscoring the necessity for further investigation. This review aims to evaluate the efficacy of bed-based intermediate care services in enhancing patient outcomes during the post-hospital discharge process. Methods: A systematic search was conducted across major scientific databases to identify relevant literature. The inclusion criteria focused on primary experimental studies that reported outcomes related to mortality, post-discharge care settings, functional status, length of hospitalization, rates of hospital readmission, and both physical and psychological well-being, as well as cost-effectiveness. Results: A total of six articles met the inclusion criteria. The findings generally suggest a favorable impact of intermediate care facilities on patient outcomes. However, it is important to note that the data exhibited low statistical significance. The evidence indicates that intermediate care facilities are at least as effective as traditional hospital care, which carries a significantly higher financial burden. Conclusions: Although the statistical significance of the results is limited, the trends indicate that intermediate care facilities may serve as suitable and economically viable alternatives for post-hospital care. Further research with larger sample sizes and more robust methodologies is necessary to confirm these findings and fully understand the role of intermediate care in enhancing patient outcomes
Towards a phenotype profiling of the patients with heart failure and preserved ejection fraction
No full textThe prevalence of heart failure with preserved ejection fraction (HFpEF) is increasing and prognosis remains poor, with a high risk of mortality or hospitalizations for worsening heart failure events. Apart from sodium-glucose cotransporter-2 inhibitors and diuretics, the management of HFpEF is nowadays based on the different aetiologies and cardiovascular or non-cardiovascular comorbidities. A great heterogeneity of clinical profiles has been described in HFpEF, with several recent studies focused on the identification of different HFpEF phenotypes. In this review, we summarize available evidence on phenotype profiling in HFpEF, describing the different phenotypes with the relative therapeutic implications, and reporting other specific clinical conditions relevant for HFpEF differential diagnosis
Long-Term Impact of COVID-19 on Disorders of Gut-Brain Interaction: Incidence, Symptom Burden, and Psychological Comorbidities
Full text linkThe severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has highlighted the potential exacerbation of gastrointestinal symptoms in patients with disorders of gut-brain interaction (DGBIs). However, the distinct symptom trajectories and psychological burden in patients with post-COVID-19 DGBIs compared with patients with pre-existing irritable bowel syndrome (IBS)/functional dyspepsia (FD) and non-DGBI controls remain poorly understood. Objectives: To examine the long-term gastrointestinal symptom progression and psychological comorbidities in patients with post-COVID-19 DGBI, patients with pre-existing IBS/FD and non-DGBI controls. Methods: This post hoc analysis of a prospective multicenter cohort study reviewed patient charts for demographic data and medical history. Participants completed the Gastrointestinal Symptom Rating Scale at four time points: baseline, 1, 6, and 12 months, and the Hospital Anxiety and Depression Scale at 6 and 12 months. The cohort was divided into three groups: (1) post-COVID-19 DGBIs (2) non-DGBI, and (3) pre-existing IBS/FD, with the post-COVID-19 DGBIs group compared to the latter two control groups. Results: Among 599 eligible patients, 27 (4.5%) were identified as post-COVID-19 DGBI. This group experienced worsening abdominal pain, hunger pain, heartburn, and acid regurgitation, unlike symptom improvement or stability in non-DGBI controls (p < 0.001 for all symptoms, except hunger pain, p = 0.001). While patients with pre-existing IBS/FD improved in most gastrointestinal symptoms but worsened in constipation and incomplete evacuation, patients with post-COVID-19 DGBI exhibited consistent symptom deterioration across multiple gastrointestinal domains. Anxiety and depression remained unchanged in patients with post-COVID-19 DGBI, contrasting with significant reductions in controls (non-DGBI: p = 0.003 and p = 0.057; pre-existing IBS/FD: p = 0.019 and p = 0.007, respectively). Conclusions: COVID-19 infection is associated with the development of newly diagnosed DGBIs and distinct symptom trajectories when compared with patients with pre-existing IBS/FD. Patients with post-COVID-19 DGBI experience progressive gastrointestinal symptom deterioration and persistent psychological distress, underscoring the need for tailored management strategies for this unique subgrou
ANALYSING CORROSION OF REINFORCED CONCRETE ELEMENTS IN CRACKED STAGE UNDER SUSTAINED LOADS
Full text linkLa corrosione delle barre di armatura (ferri) nelle strutture in calcestruzzo armato (CA) è un fattore critico che influisce sulla durabilità a lungo termine e sulla vita utile,in particolare in ambienti aggressivi come gli ambienti marini o le aree esposte a sali de-ceranti. Queste condizioni facilitano l'ingresso di ioni cloruro, che accelerano il processo di corrosione fornendo un percorso diretto per la penetrazione del cloruro nell'armatura. La corrosione indebolisce la capacità portante dell'armatura e compromette l'integrità strutturale. Sebbene siano state condotte ricerche significative sulla corrosione nelle strutture in CA, l'influenza delle fessure sull'iniziazione e sulla propagazione della corrosione, in particolare negli ambienti
indotti dal cloruro, è ancora poco compresa. Questa tesi affronta questa lacuna investigando l'effetto della larghezza della fessura sul comportamento della corrosione, concentrandosi sulla cinetica della corrosione e sulle prestazioni meccaniche dell'armatura in elementi in CA esposti a condizioni di corrosione accelerate. A tale scopo, sono stati realizzati 31 provini a trazione (90 x 90 x 830 mm) in alcestruzzo di classe C30/37, armati con barre nervate Ø12 mm in acciaio laminato
a caldo. I provini sono stati pre-fessurati per indurre diverse larghezze di fessura e sottoposti a test di corrosione accelerata sotto cicli umido-secco, con esposizione a una soluzione di cloruro (35 g/l) simulante le condizioni di esposizione reali. I risultati hanno mostrato che l'iniziazione della corrosione è avvenuta in tutti i provini già dal primo ciclo, senza ritardi nell'inizio della corrosione ndipendentemente dalla larghezza della fessura. Durante la fase di propagazione della corrosione, non è emersa una relazione lineare chiara tra la larghezza della fessura e la profondità delle pitting, con una variabilità osservata. Tuttavia, sia la profondità massima della pitting che la profondità media della pitting tendono ad aumentare con l'aumento
della larghezza della fessura. Le pitting più profonde e le maggiori profondità medie delle pitting sono state osservate nei provini con barre di armatura cedute. I test meccanici sulle barre di armatura corrose hanno rivelato che la resistenza ultima è stata solo marginalmente influenzata, ma la duttilità è stata significativamente
ridotta, specialmente nei provini con fessure più larghe e quelli sottoposti a livelli di deformazione più elevati. Nei provini con deformazione del 5‰, la perdita di duttilità ha raggiunto il 74%, evidenziando un serio rischio di rottura fragile sotto carichi di servizio.The corrosion of reinforcement bars (rebars) in reinforced concrete (RC) structures is a critical factor affecting the long-term durability and service life, particularly in aggressive environments such as marine environments or areas exposed to de-icing salts. These conditions facilitate chloride ion ingress, which accelerates the corrosion process by providing a direct pathway for chloride penetration to reinforcement. Corrosion weakens the load-bearing capacity of reinforcement and compromises structural integrity. While significant research has been conducted on corrosion in RC structures, the influence of cracks on corrosion initiation and propagation, particularly in chloride-induced environments, remains poorly understood. This thesis addresses this gap by investigating the effect of crack width on corrosion behaviour, focusing on corrosion kinetics and the mechanical performance of reinforcement in RC elements exposed to accelerated corrosion conditions. For this purpose, A 31 tension tie specimens (90 x 90 x 830 mm) were cast using grade C30/37 concrete and reinforced with Ø12 mm hot-rolled ribbed bars. The specimens were pre-cracked to induce varying crack widths and subjected to accelerated corrosion testing under wet and dry cycles, with exposure to a chloride solution (35 g/l) simulating real-world exposure conditions. The results showed corrosion initiation occurred in all specimens from the first cycle, with no delay in corrosion start regardless of crack width. During the corrosion propagation phase, there was no clear linear relationship between crack width and pitting depth, with wide variability observed. However, both maximum pit depth and mean pit depth tend to increase as crack width increases. The deepest pits and highest average pit depths were observed in specimens with yielded rebar. The mechanical testing of corroded rebars revealed that the ultimate strength was only marginally affected, but ductility was significantly reduced, especially in specimens with wider cracks and those subjected to higher strain levels. In specimens with 5‰ strain, ductility loss reached up to 74%, highlighting a serious risk of brittle failure under service loads
Addressing gaps in asthma management during childbearing age and pregnancy: insights from a survey of Italian physicians and patients
Full text linkBackground: Asthma is a common condition among women of childbearing age, requiring careful management, particularly during pregnancy. Despite existing guidelines, significant gaps remain in asthma management during pregnancy, notably for women with moderate-to-severe asthma. Aim: This study aimed to explore the awareness, limitations, and challenges of asthma management during childbearing age and pregnancy from both asthmatic women (AW) and physician perspectives in Italy. Additionally, it sought to identify unmet needs and collect real-life experiences from Italian centers specialized in severe asthma care. Methods: An anonymous online survey was disseminated through scientific networks and patient associations. Separate questionnaires were developed for doctors and AW by a task force of specialists. Results: 76 doctors and 54 AW completed the survey, with 70% of AW reporting moderate-to-severe asthma. While most physicians had experience managing asthma in pregnancy, 40% lacked systematic collaboration with gynecologists recognizing the need for integrated care. Despite guidelines supporting asthma medication continuity, 60% of doctors reported discontinuing treatments due to perceived risks. However, surveyed AW generally expressed greater confidence in medication safety. Physicians and AW highlighted the lack of pre-pregnancy counseling, with 55% of AW reporting they had never discussed pregnancy plans when starting asthma treatment. Both groups emphasized the need for improved interdisciplinary collaboration and structured asthma care pathways during pregnancy. Conclusions: This study reveals significant gaps in asthma management for women of childbearing age and during pregnancy, especially those with moderate-to-severe asthma. Improving outcomes requires better education for patients and healthcare providers, along with a structured multidisciplinary network
La materia della Casa alle Zattere a Venezia. Forza e fragilità della modernità nell’ottica della sua tutela
No full textIgnazio Gardella’s Casa alle Zattere (1953-8) in Venice has been recognized by historiography as a cornerstone of post-World War II Italian architecture. The «Ca’ d’Oro of Modern architecture» represents, moreover, a significant point in the evolution of the Venetian urban context, usually repulsive to new graft.
Recent interventions in some of the building’s units – carried out under the oversight of the Superintendency – were an opportunity to explore some lesser-known features of this architecture, such as its constructive and material ones, and to ponder on some issues related to the debate of the preservation of Modern architecture
Precision and progress: minimally invasive surgery in gynaecologic cancer treatment
Full text linkMinimally invasive surgery (MIS), which comprises laparoscopy, robotic surgery, and vaginal transluminal natural endoscopic surgery (vNOTES), has gained notoriety in the setting of many gynaecologic diseases, including endometrial, ovarian, and cervical cancers. Over the years, several studies have conducted comparisons between MIS and laparotomic surgery. The predominant aspects of these techniques include less intraoperative bleeding, shorter hospitalization, accelerated postoperative recovery and lower incidence of peri-and postoperative adverse events. However, costs and operative time remain high. Articles comparing different minimally invasive surgical procedures for the management of gynaecologic cancer were reviewed. Although several articles have pointed out that the use of the surgical approach by MIS has not shown substantial differences in survival compared with laparotomy and has manifested excellent peri-and postoperative outcomes for endometrial cancer, the relevance of minimally invasive surgery for cervical and ovarian cancer remains controversial. Incipient indications suggest laparoscopic cytoreduction as an emerging procedure for appropriately selected patients following neoadjuvant chemotherapy treatment. Several scientific evidence have attested to the improved clinical parameters associated with the adoption of a minimally invasive surgical approach compared with open procedures. The preeminent goal of minimally invasive surgery should aim at optimizing oncologic outcomes and improving the health status of patients