3D structure of the Campi Flegrei caldera central sector reconstructed through short-period magnetotelluric imaging.

The Campi Flegrei caldera experienced an unrest phase dating to 2005, which primary expression is the impressive ground uplift, accompanied by increasing degassing and seismic activities. Such last two phenomena developed mainly in the caldera central sector, including the Solfatara-Pisciarelli complex. However, the inner structure of such an area is still not defined, and this originates a poor understanding of the ongoing unrest. This paper describes the results of a new magnetotelluric survey performed in the Campi Flegrei caldera central sector. Through the inversion of data collected in 47 independent soundings, a 3D model of the electrical resistivity has been retrieved, which evidenced a partition of the investigated structure. The Agnano-Astroni area seems to be associated with a liquid-dominated geothermal reservoir, whereas the Solfatara-Pisciarelli area seems to be characterized by a single mixed liquid and gasses-dominated geothermal reservoir, which supplies the main caldera fumaroles. The proposed reconstruction of the geometrical characteristics of the hydrothermal system and the primary fluid rising pathways gives substantial clues about the significance of the detected structures in the evolution of the caldera unrest.

The Pisciarelli main fumarole mechanisms reconstructed by electrical resistivity and induced polarization imaging.

Pisciarelli, together with the adjacent Solfatara maar-diatreme, represents the most active structure of the Campi Flegrei caldera (Italy) in terms of degassing and seismic activity. This paper aims to define the structure of the Pisciarelli hydrothermal system (down to a 20 m depth) through electrical resistivity and time-domain-induced polarization tomography and self-potential mapping. The retrieved 3D image of the area helps reconstruct the Pisciarelli subsurface in its area of maximum degassing, containing the main fumarole ("soffione") and the mud pool. In particular, a channel has been identified in which fluids stored in a deeper reservoir rise toward the surface. Such a structure seems to be surmounted by a clay-cap formation that could govern the circulation of fluids and the abundance of gases/vapors emitted by the soffione. Based on this new reconstruction of the Pisciarelli fumarolic field structural setting, the first conceptual model has been suggested that is capable of simultaneously explaining the mechanisms governing soffione activity and elucidating the role played by the fluid/gas of deeper origin in the shallow fluid circulation system. The proposed model can potentially help to better monitor the processes occurring throughout the Pisciarelli fumarolic field and provide an evaluation of the associated hazards.

Listening to the neurological teams for multiple sclerosis: the SMART project.

OBJECTIVE: Aim of the research was to define the quality of life of Italian neurologists and nurses' professional caring for multiple sclerosis, to understand their living the clinical practice and identify possible signals of compassion fatigue. MATERIAL AND METHODS: One hundred five neurologists and nurses from 30 Italian multiple sclerosis centres were involved in an online quali-quantitative survey on the organization of care, combined with the Satisfaction and Compassion Fatigue Test and a collection of narratives. Descriptive statistics of the quantitative data were integrated with the results obtained by the narrative medicine methods of analysis. RESULTS: Most of the practitioners were neurologists, 46 average years old, 69% women, 43% part time dedicated to multiple sclerosis. An increased number of patients in the last 3 years were referred in 29 centres. Differences were found between neurologists and nurses. Physicians showed higher risks of burnout, reporting intensive working paces, lack of medical personnel, and anxiety caused by the precarious employment conditions. Nurses appeared more satisfied, although the reference to the lack of spaces, and the cross professional roles risk of compassion fatigue. Both positive and negative relationships of care were depicted as influencing the professional quality of life. CONCLUSION: The interviewed neurological teams need to limit the risk of compassion fatigue, which appeared from the first years of the career. The prevalence of the risk among neurologists suggests more awareness among scientific societies and health care managers on the risk for this category, as first step to prevent it.

Publisher Correction: Deep Electrical Resistivity Tomography for a 3D picture of the most active sector of Campi Flegrei caldera.

An amendment to this paper has been published and can be accessed via a link at the top of the paper.

Deep Electrical Resistivity Tomography for a 3D picture of the most active sector of Campi Flegrei caldera.

The central sector of the Campi Flegrei volcano, including the Solfatara maar and Pisciarelli fumarole field, is currently the most active area of the caldera as regards seismicity and gaseous emissions and it plays a significant role in the ongoing unrest. However, a general volcano-tectonic reconstruction of the entire sector is still missing. This work aims to depict, for the first time, the architecture of the area through the application of deep Electrical Resistivity Tomography. We reconstructed a three-dimensional resistivity model for the entire sector. Results provide useful elements to understand the present state of the system and the possible evolution of the volcanic activity and shed solid bases for any attempt to develop physical-mathematical models investigating the ongoing phenomena.

Validation of a fast real-time PCR method to detect fraud and mislabeling in milk and dairy products.

Fast real-time PCR TaqMan assays were developed and validated for species identification in dairy products. Based on the amplification of 12S rRNA and cytB partial genes of mitochondrial DNA, the methods were demonstrated to be sensitive, fast, and species-specific for Bos taurus, Ovis aries, Bubalus bubalis, and Capra hircus. The limit of detection calculated was lower than 1%, and the efficiency was reported to be higher than 96% in every assay. An internal amplification control was used to detect possible false negatives. The method was validated by means of laboratory-prepared samples mixing different species. Moreover, 18 commercial dairy samples were analyzed by both real-time PCR and isoelectric focusing, the official European Union reference method. The 4 TaqMan assays were confirmed to be a useful tool for milk and dairy product authentication.

Cystolithiasis in a Syrian hamster: a different outcome.

A 14-month-old intact male Syrian hamster was admitted for lethargy and hematuria. A total body radiographic image and abdominal ultrasonography showed the presence of a vesical calculus. During cystotomy, a sterile urine sample was obtained and sent to the diagnostic laboratory along with the urolith for analysis. Urine culture was found negative for bacterial growth, and the urolith was identified as a calcium-oxalate stone. Diet supplementation with palmitoylethanolamide, glucosamine and hesperidin was adopted the day after discharge. One year follow up revealed no presence of vesical calculi. Although this is the report of a single clinical case, this outcome differs from the results reported in the literature characterized by recurrences after few months. Considering the positive outcome and the beneficial properties of palmitoylethanolamide, glucosamine, and hesperidin, these nutritional elements in Syrian hamsters, are recommended to reduce recurrence after surgical treatment of urolithiasis.

Ascertainment bias in dementias: a secondary to tertiary centre analysis in Central Italy and conceptual review.

BACKGROUND AND AIMS: Ascertainment bias (AB) indicates a bias of an evaluation centre in estimating the prevalence/incidence of a disease due to the specific expertise of the centre. The aim of our study was to evaluate classification of different types of dementia in new cases appearing in secondary and tertiary centres, in order to evidence possible occurrence of AB in the various (secondary to tertiary) dementia centres. METHODS: To assess the mechanism of AB, the rates of new cases of the different forms of dementia reported by different centres were compared. The centres involved in the study were 11 hospital-based centres including a tertiary centre, located in the University Department of Clinical Neurology. The tertiary centre is endowed with state-of-the-art diagnostic facilities and its scientific production is prominently focused on dementia with Lewy bodies (DLB) thus suggesting the possible occurrence of a bias. Four main categories of dementia were identified: Alzheimer's disease (AD), DLB, fronto-temporal dementia (FTD), vascular dementia (VaD), with other forms in a category apart. The classification rate of new cases of dementia in the tertiary centre was compared with rates reported by secondary centres and rates of recoding were calculated during a follow-up of 2 years. RESULTS: The study classified 2,042 newly diagnosed cases of dementia in a population of 1,370,000 inhabitants of which 315,000 were older than 65. AD was categorized in 48-52 % of cases, DLB in 25-28 %, FTD in 2-4 % and VaD in 17-28 %. During the 2-year follow-up the diagnosis was re-classified in 40 patients (3 %). The rate of recoding was 5 % in the tertiary centre, 2-8 % in referrals from secondary to tertiary centre, 2-10 % in recodings performed in secondary centres and addressed to tertiary centre. Recoding or percentages of new cases of AD or DLB were not different in the comparison between secondary or between secondary and tertiary centres. FTD and VaD were instead significantly recoded. CONCLUSION: The results of the study suggest that in a homogeneous area, AB is not interfering with diagnosis of AD or DLB.

Current indications for laparoscopy in day-case surgery.

Day-surgery setting allows to combine patients' satisfaction to cost-saving policies that seems to be more and more important for a modern hospital management. Minimally invasive surgery seems to be the ideal surgical approach for day-case procedures since, reducing trauma to a minimal level, allows patients to return quick to a normal life with minimal nursing assistance. Extensive review of the most recent article has been performed in this article in order to define the current evidences that support the use of laparoscopic surgery in a day-case setting. Laparoscopic cholecystectomy, anti-reflux procedure and hernia repair seems to be justified according to the results of the published data. Patients' selection and hospital organization seem to be mandatory in order to obtain successful results.

Pre-incision local infiltration with levobupivacaine reduces pain and analgesic consumption after laparoscopic cholecystectomy: a new device for day-case procedure.

All over the World laparoscopic cholecystectomy is the treatment of choice for symptomatic cholelithiasis; use of local long lasting anesthetics reduces post-operative pain. Levobupivacaine is one of the most effective local anesthetics. The aim of our study is to test the effectiveness of local anesthetics comparing pre- versus post-operative trocar site's infiltration. 50 patients were enrolled in our study and 25 five patients were randomized into pre-I group (pre-incisional infiltration) and 25 into post-I group (post-operative infiltration); all the operations were performed with the same technique (Anglo-Saxon with 4 accesses) by 4 expert laparoscopic surgeons; our results showed different analgesic consumption between the 2 groups of patients; in the pre-I group the mean intravenous dose of Ketorolac post-operative used was 124 mg while in the post-I group was 339 mg: this difference was statistically significant.; the mean VAS was 10.7 in the post-I group while in the pre-I group was 5.1, also the i-VAS score's difference was statistically significant: in fact in the post-I group i-VAS was 8.8 while in the post-I group 14.8. Our study demonstrated that infiltration of the trocar site with long lasting local anesthetic is extremely effective for the treatment of post-operative pain after laparoscopic cholecystectomy; pre-incisional local infiltration seems to be better in term of pain perception and intravenous post-operative analgesic consumption.

Hemorrhoidectomy in day surgery.

UNLABELLED: Day-case hemorrhoidectomy has shown to be safe and acceptable to patients. There are principally two procedures: Milligan-Morgan hemorrhoidectomy (MMH) and Longo stapled hemorrhoidopexy (SH). Furthermore great progress has been done in surgical technologies with the use of the Ligasure and the Doppler-guided hemorrhoidal artery ligation. The aim of this study is to analyze randomized controlled trials using all the major electronic databases (MEDLINE, EMBASE, CENTRAL) about hemorrhoidopexy and conventional excisional surgery, and randomized controlled trials about the Ligasure versus the conventional hemorrhoidectomy, and some reports about the use of a new device (Doppler transducer) in an outpatient setting. RESULTS: We found 17 studies from 2004 up to 2008, 1276 patients, 409 in the stapled group, 389 in the conventional group, 268 in hemorrhoidal artery ligation procedure and 210 in Ligasure hemorrhoidectomy group. This study confirms that SH is associated with less postoperative pain and shorter postoperative symptoms, compared with MMH. SH may be a viable alternative to the conventional surgical therapy for hemorrhoids with some advantages and some disadvantages in postoperative complications and costs. An other suitable alternative to conventional procedures is the use of Ligasure, although long-term evaluation of outcomes and morbidity is still needed. Hemorrhoidal artery ligation procedure is safe and easy to learn and to perform, even with a recurrence rate of 12, but randomized trials are mandatory.

Preliminary results of laparoscopic colorectal resections: does surgeon's age influences outcomes?

INTRODUCTION: Several randomized controlled trials demonstrated that laparoscopic colon resection is a safe and effective technique for colon and rectum diseases. In fact mini-invasive procedure required an adequate learning curve to safely perform it. Many studies confirm there is a comparatively long learning curve in laparoscopic surgery, with demonstrable decrease in conversion and complication rates with increasing experience. AIMS OF THE STUDY: In this study we want to demonstrate feasibility of laparoscopic colon resection performed by a junior surgeon, referring to short-term outcomes as primary end point. RESULTS: A total of 163 patients underwent colorectal resections of whom 88 were enrolled in the laparoscopic (LCR) and 75 in the open group, respectively. The mean operative time was 183.4 min in the LCR group and 151.2 min in the open group. The mean number of lymph nodes collected was 21.3 in the LCR group and 22.1 in the open group. 10.5% who underwent LCR developed postoperative complications compared with 16% of open group; this difference was statistically significant. Postoperative death occurred in one patient for each group. CONCLUSIONS: Our study demonstrate that results obtained by an under 35-year-old surgeon, fully trained in laparoscopic surgery but with limited overall experience in colorectal resections, can be at least as good as the ones obtained in open surgery. This seems to be true both in term of intra-postoperative complications as well as for oncological results.

Long-lasting complete remission of pulmonary metastases consequent to renal cell carcinoma obtained with interferon-beta therapy: review of the literature and a case report.

This case report describes a complete remission of pulmonary metastases, consequent to renal cancer, achieved with interferon-beta therapy. After nephrectomy (July 1990), this female patient was proposed for therapeutic assessment: vinblastine chemotherapy was carried out for 10 cycles, whereas concomitant immunotherapy of interferon-alpha was discontinued after 30 days owing to lack of tolerability. In replacement, interferon-beta administration from the 5th cycle of chemotherapy at the dose of 3 MIU 3 times a week was well tolerated. Interferon-beta was interrupted 27 months later, due to an increase in transaminase levels. Partial remission of pulmonary metastases was assessed after 9 months of interferon-beta therapy, and a complete remission was assessed after 1 and 2 years of therapy. In November 1994, the patient was still in good clinical conditions and disease-free after 37 months from the achievement of complete remission.

Continuing medical education through the videotex system in Italy.

Continuing education for medical doctors is not compulsory in Italy. The link with the university is lost shortly after the final medical examination, and there is no other teaching institution for structured continuing medical education (CME). Distance learning gives physicians the opportunity to use updating programs at home at their convenience. Videotel, the Italian videotex system, is the first telematic tool that, at low cost, can reach every home nationwide. Through this system information can be exchanged 24 hours a day, using the Videotel database as central memory, the telephone network as connecting system, and low-cost devices as peripherals. The authors evaluated the technical capacity and didactic efficacy of the Videotel system as a vehicle for CME (in both oncology and general medicine). In an exploratory phase they surveyed physicians of the Italian Province designated for the study, with the objective of promoting the initiative and enrolling physicians interested in this innovative approach to CME. Teachers at Italian universities provided the educational material: interactive lessons, clinical case discussions and problem solving, and multiple-choice questions. Twenty-nine physicians agreed to participate. Despite the interest shown by these physicians, they made very little use of the didactic database. The main reasons for failure to connect with the educational database were the lack of time and unfamiliarity with the instrument. Although the results of the study were discouraging, the authors believe that the resolution of technical problems linked with the system and an increasing familiarity of physicians with telematic and informatic tools in general, together with appropriate incentives, will make the videotex system a feasible, low-cost, efficient vehicle for CME.

Radiotherapy versus surgery in the treatment of cervix stage Ib cancer.

In the years 1971-77 we have treated 250 Stage Ib patients with cancers of the cervix. One hundred twenty-three (49.2%) underwent a radical surgery, 37 had a classical Wertheim-Meigs operation, and 86 had a lymphadenectomy that was extended to the lumbar-aortic region. When feasible, all patients received postoperative radium therapy on the vaginal vault. The remaining 127 patients received a complete course of radiotherapy. This was not a randomized clinical trial. In fact surgery was preferred for patients who were younger (mean age: 49.6 years) and more physically fit, while radiotherapy was the treatment chosen for those who were older (mean age: 57.7) and generally less fit or obese. The 5 year NED survival was 89.3% in the surgical group and 90.9% in the radiotherapy group (P less than .05). Four fatal complications were observed in the surgical group (3.2%). Rate and causes of failures or complications are analyzed in detail.