Voluntary interruption of pregnancy (VIP) in Italy: interpretation of the current situation according to the report 2019-2020 of the Italian Ministry of Health.

Abstract: Voluntary interruption of pregnancy (VIP) in Italy is regulated by Law no. 194/1978. Its monitoring is carried out by the VIP Epidemio-logical Surveillance System, which periodically analyses the results of questionnaires compiled by the territorial healthcare structures and sent by each Region. The latest report, covering the years 2019 and 2020, highlights the adequacy of preventive and proactive strategies, an improvement in the quality and effectiveness of the service offered. Furthermore, considering the COVID-19 pandemic, the reorganization of the IVG application guidelines showed a considerable adaptation to the emergency context through measures such as the increase in pharmacological procedures compared to surgical procedures. The interpretation of the data shows that in Italy there is one of the lowest VIP rates in Europe, reflecting the effectiveness of campaigns that promote responsible procreation. Further implementations should be extended to the foreign population, which still shows a medium-high VIP rate. The efficiency of the service offered resulted to be high. The latter was assessed considering the waiting period required for the performance of the VIP procedure. Furthermore, the high percentage of conscientious objectors does not harm the healthcare service. The estimates show an adequate territorial coverage by the authorized structures compared to the female population of fertile age. In conclusion, the central action of planning, organization, and monitoring finds a valid ally in the territorial management entrusted to the Regions. The analyzed report reflects even more margins of efficiency and adequacy when considered within the particular historical context of the pandemic by COVID-19.

The recommended lifetime immunization schedule from the board of vaccination calendar for life in Italy: A continuing example of impact on public health policies.

The Vaccination Calendar for Life is an alliance of scientific and professional societies of public health physicians, paediatricians and general practitioners in Italy which provides a periodical update on the ideal, scientifically driven vaccination calendar throughout lifetime. Since 2012, the Lifetime Immunization Schedule has represented a benchmark for Regional and National Authorities to set up the updated list of vaccines provided actively and free of charge to infants, children, adolescents, adults and the elderly by inclusion in the Triennial National Vaccination Plan (TNVP), and in the Essential Levels of Care (LEA). The impact of the different editions of the Lifetime Immunization Schedule on the TNVP was deep, representing the inspiring source for the present vaccination policy. The 2019 edition called for more attention to pregnant women immunization; risk groups vaccination; uniform high coverage with the MMRV vaccine; extension of Meningococcal B vaccination also at adolescent age; use of quadrivalent conjugate meningococcal vaccine also at 1 year of life; progressive decrease of the age of free-of-charge offer of influenza to ≥ 60 and then to ≥ 50 year-old population; implementation of flu immunization ages 6 months-6 years; HPV vaccination also offered to 25-year old women at the time of the first screening (gender neutral immunization already offered); sequential PCV13-PPV23 pneumococcal vaccination in 65 year-old subjects; increased coverage with rotavirus vaccine in infants and zoster vaccine in the elderly.

Maintain and increase vaccination coverage in children, adolescents, adults and elderly people: Let's avoid adding epidemics to the pandemic: Appeal from the Board of the Vaccination Calendar for Life in Italy: Maintain and increase coverage also by re-organizing vaccination services and reassuring the population.

The Board of the Vaccination Calendar for Life (Bonanni et al., 2014, 2017) [1,2]), a coalition of four major scientific and professional societies of public health physicians, pediatricians and general practitioners in Italy, made an appeal to health authorities in order to sustain vaccination in COVID-19 times. The five pillars to maintain and increase vaccination coverage at all ages are described as follows: 1) Guarantee paediatric vaccination coverage to all newborns and paediatric boosters and adolescent immunizations, not interrupting active calls and scheduled sessions. 2) Re-organise the way paediatric and adolescent vaccinations are offered. 3) Set-up recovery programs for vaccinations not carried out after the start of the COVID-19 emergency. 4) Provide the preparation of tenders for the supply of flu vaccines with suitable quantities to increase coverage in all Regions and Autonomous Provinces with extreme urgency. 5) Prepare plans to increase coverage for influenza, pneumococcal, tetanus diphtheria and shingles. The Board of the Calendar for Life appeals to the National and Local Health Authorities for a strong and coordinated commitment in favor of the widest offer and acceptance of vaccinations, whose vital importance for collective health is now even more evident to all, in order to avoid that delays in the necessary initiatives should add damage from other epidemics to those suffered by our population due to the COVID-19 pandemic.

Triple point in correlated interdependent networks.

Many real-world networks depend on other networks, often in nontrivial ways, to maintain their functionality. These interdependent "networks of networks" are often extremely fragile. When a fraction 1-p of nodes in one network randomly fails, the damage propagates to nodes in networks that are interdependent and a dynamic failure cascade occurs that affects the entire system. We present dynamic equations for two interdependent networks that allow us to reproduce the failure cascade for an arbitrary pattern of interdependency. We study the "rich club" effect found in many real interdependent network systems in which the high-degree nodes are extremely interdependent, correlating a fraction α of the higher-degree nodes on each network. We find a rich phase diagram in the plane p-α, with a triple point reminiscent of the triple point of liquids that separates a nonfunctional phase from two functional phases.

Slow epidemic extinction in populations with heterogeneous infection rates.

We explore how heterogeneity in the intensity of interactions between people affects epidemic spreading. For that, we study the susceptible-infected-susceptible model on a complex network, where a link connecting individuals i and j is endowed with an infection rate ß(ij)=λw(ij) proportional to the intensity of their contact w(ij), with a distribution P(w(ij)) taken from face-to-face experiments analyzed in Cattuto et al. [PLoS ONE 5, e11596 (2010)]. We find an extremely slow decay of the fraction of infected individuals, for a wide range of the control parameter λ. Using a distribution of width a we identify two large regions in the a-λ space with anomalous behaviors, which are reminiscent of rare region effects (Griffiths phases) found in models with quenched disorder. We show that the slow approach to extinction is caused by isolated small groups of highly interacting individuals, which keep epidemics alive for very long times. A mean-field approximation and a percolation approach capture with very good accuracy the absorbing-active transition line for weak (small a) and strong (large a) disorder, respectively.

Intermittent social distancing strategy for epidemic control.

We study the critical effect of an intermittent social distancing strategy on the propagation of epidemics in adaptive complex networks. We characterize the effect of our strategy in the framework of the susceptible-infected-recovered model. In our model, based on local information, a susceptible individual interrupts the contact with an infected individual with a probability σ and restores it after a fixed time t(b). We find that, depending on the network topology, in our social distancing strategy there exists a cutoff threshold σ(c) beyond which the epidemic phase disappears. Our results are supported by a theoretical framework and extensive simulations of the model. Furthermore we show that this strategy is very efficient because it leads to a "susceptible herd behavior" that protects a large fraction of susceptible individuals. We explain our results using percolation arguments.

Quarantine-generated phase transition in epidemic spreading.

We study the critical effect of quarantine on the propagation of epidemics on an adaptive network of social contacts. For this purpose, we analyze the susceptible-infected-recovered model in the presence of quarantine, where susceptible individuals protect themselves by disconnecting their links to infected neighbors with probability w and reconnecting them to other susceptible individuals chosen at random. Starting from a single infected individual, we show by an analytical approach and simulations that there is a phase transition at a critical rewiring (quarantine) threshold w(c) separating a phase (w

Conservative model for synchronization problems in complex networks.

In this paper we study the scaling behavior of the interface fluctuations (roughness) for a discrete model with conservative noise on complex networks. Conservative noise is a noise which has no external flux of deposition on the surface and the whole process is due to the diffusion. It was found that in Euclidean lattices the roughness of the steady state W(s) does not depend on the system size. Here, we find that for scale-free networks of N nodes, characterized by a degree distribution P(k) approximately k(-lambda), W(s) is independent of N for any lambda. This behavior is very different than the one found by Pastore y Piontti [Phys. Rev. E 76, 046117 (2007)] for a discrete model with nonconservative noise, which implies an external flux, where W(s) approximately ln N for lambda<3 , and was explained by nonlinear terms in the analytical evolution equation for the interface [La Rocca, Phys. Rev. E 77, 046120 (2008)]. In this work we show that in these processes with conservative noise the nonlinear terms are not relevant to describe the scaling behavior of W(s).

[Tour operator liability in health protection for not informing travellers about health risks they could be exposed]. / Aspetti civili e penali della responsabilità del tour operator in caso di mancata informazione in merito alla possibile contrazione di malattie infettive.

Consumer-tourist is considered the weaker bargaining party in an "all included" travel contract, compared with tour organizer and tour vendor. That's why Statute Act protecting consumer's rights provides a specific discipline concerning this particular sector In front of widening of warrants for travellers, obligations for organizer and seller of the travel have been increased, and include now specific duty to inform travellers as well. According to the law such duties of information are consistent with travel contract performance itself. In such way, failing to inform client constitutes a breach of contract liable not only in the field of civil responsibility; the subject liable with such an omission may face criminal prosecution as well. More specifically we are in front of a breach of contract by the tour organizer who will respond of all damages concerned with such a breach. Damages will concern not only the price of the travel package, but also other damages connected with the illness suffered by traveller: compensation for spoiled holidays, biological damages, patrimonial damages (these last ones could include for instance expenses for medical treatments, just to quote the more likely one). In other words, tour organizer has to grant general organization of the tour which has to take place as specified on travel brochure, but traveller have to be provided also with any information, concerning documents necessary for the travel, whether passport or visa are needed or not, vaccinations peremptory or optional. It will be very difficult for tour operator be exempted from liability for damages if traveller hasn't been informed of health risks; the only possibility consists in managing to demonstrate that the obligation hasn't been compelled due to reason for which the operator couldn't be held responsible. Besides as we have already mentioned before, criminal relevance of such omission of information couldn't be excluded. In fact, it's true that such omission, notwithstanding its preventive nature, needs a specific statute provision to be criminally sanctioned. Anyhow a criminal court can consider such omission in a more articulated landscape, as one of highly symptomatic elements in a criminal behaviour within criminal offence of injuries, consumed or attempted, that could be performed through further actions or omissions.

Evolution equation for a model of surface relaxation in complex networks.

In this paper we derive analytically the evolution equation of the interface for a model of surface growth with relaxation to the minimum (SRM) in complex networks. We were inspired by the disagreement between the scaling results of the steady state of the fluctuations between the discrete SRM model and the Edward-Wilkinson process found in scale-free networks with degree distribution P(k) approximately k(-lambda) for lambda<3 [Pastore y Piontti, Phys. Rev. E 76, 046117 (2007)]. Even though for Euclidean lattices the evolution equation is linear, we find that in complex heterogeneous networks nonlinear terms appear due to the heterogeneity and the lack of symmetry of the network; they produce a logarithmic divergency of the saturation roughness with the system size as found by Pastore y Piontti for lambda<3.

Discrete surface growth process as a synchronization mechanism for scale-free complex networks.

We consider the discrete surface growth process with relaxation to the minimum [F. Family, J. Phys. A 19, L441 (1986)] as a possible synchronization mechanism on scale-free networks, characterized by a degree distribution P(k) approximately k;{-lambda} , where k is the degree of a node and lambda its broadness, and compare it with the usually applied Edward-Wilkinson process (EW) [S. F. Edwards and D. R. Wilkinson, Proc. R. Soc. London, Ser. A 381, 17 (1982)]. In spite of both processes belonging to the same universality class for Euclidean lattices, in this work we demonstrate that for scale-free networks with exponents lambda<3 the scaling behavior of the roughness in the saturation cannot be explained by the EW process. Moreover, we show that for these ubiquitous cases the Edward-Wilkinson process enhances spontaneously the synchronization when the system size is increased. This nonphysical result is mainly due to finite size effects due to the underlying network. Contrarily, the discrete surface growth process does not present this flaw and is applicable for every lambda .

[A descriptive analysis of a series of patients diagnosed with acute mediastinitis]. / Análisis descriptivo de una serie de casos diagnosticados de mediastinitis aguda.

Acute mediastinitis is one of the most aggressive chest diseases. The mortality rate ranges between 14% and 42%. We present a retrospective analysis of a series of 26 cases (20 men and 6 women) treated between January 1994 and March 2002 and review the literature. Mediastinitis originated in the esophagus in 17 patients (8 postoperative, 4 due to iatrogenic perforation, 4 due to noniatrogenic perforation, and 1 due to a foreign body) and in the oropharynx in 6 patients; mediastinitis was secondary to median sternotomy in 3. Twenty-five patients were treated surgically. In addition to radical debridement and drainage, which were carried out on all the patients, 10 also underwent esophagectomy or resection of the esophago-gastric reconstruction, 5 received primary sutures of the esophagus, 1 received reconstructive surgery with a pectoral muscle flap, and 1 underwent sternectomy plus intrathoracic omental transposition. Four patients died within 30 days of surgery (15.4%). The mortality rate in our practice is similar to that described in the literature. The results argue for early, aggressive treatment.

Análisis descriptivo de una serie de casos diagnosticados de mediastinitis aguda / A descriptive analysis of a series of patients diagnosed with acute mediastinitis

La mediastinitis aguda es una de las enfermedades torácicas más agresivas. La mortalidad varía entre el 14 y el 42 por ciento. Nuestro objetivo es presentar un análisis retrospectivo de una serie de 26 casos (20 varones y 6 mujeres) tratados entre enero de 1994 y marzo de 2002 y una revisión de la bibliografía. La mediastinitis fue de origen esofágico en 17 pacientes (8 posquirúrgicas, 4 por rotura iatrogénica, 4 por rotura no iatrogénica y una por cuerpo extraño), de origen bucofaríngeo en 6 pacientes y secundarias a esternotomía media en 3. Se trató quirúrgicamente a 25 pacientes; además del desbridamiento radical y los drenajes, que se hicieron en todos los pacientes, en 10 se practicó una esofaguectomía o resección de plastia gástrica; en 5, suturas primarias de esófago; en uno, plastia de pectoral mayor, y en otro, esternectomía más omentoplastia. Cuatro pacientes fallecieron en los 30 días después de la intervención (15,4 por ciento). La mortalidad en nuestro entorno es similar a la descrita en la bibliografía. Los resultados justifican el tratamiento agresivo y temprano (AU)

Stage-specific expression of a Schistosoma mansoni polypeptide similar to the vertebrate regulatory protein stathmin.

The ubiquitous vertebrate protein stathmin is expressed and phosphorylated in response to a variety of external and internal signals. Stathmin, in turn, controls cell growth and differentiation through its capacity to regulate microtubule assembly dynamics. This is the first report on the molecular cloning and characterization of a stathmin-like protein (SmSLP) in an invertebrate, the human blood fluke Schistosoma mansoni. SmSLP is first synthesized at high levels in the intermediate molluscan host and completely disappears 48 h after penetration into the mammalian host. The protein is preferentially iodinated in intact immature parasites using the Bolton-Hunter reagent, can be quantitatively extracted in high salt buffers, and remains soluble after boiling. Native SmSLP was partially sequenced, and its complete structure was derived from the cloning and sequencing of its cDNA. The sequence is up to 26% identical to vertebrate stathmin sequences and contains two potential phosphorylation sites. Native SmSLP is indeed phosphorylated because phosphatase digestion shifts its mobility in electrofocusing gels. SmSLP associates with tubulin, as suggested by immune co-precipitation results. In vitro experiments demonstrated that SmSLP inhibits tubulin assembly and causes the depolymerization of preassembled microtubules, thus probably fulfilling regulatory roles in critical steps of schistosome development.

Hypertonicity decreases basolateral K+ and Cl- conductances in rabbit proximal convoluted tubule.

Collapsed proximal convoluted tubules (PCT) shrink to reach a volume 20% lower than control and do not exhibit regulatory volume increase when submitted to abrupt 150 mOsm/kg hypertonic shock. The shrinking is accompanied by a rapid depolarization of the basolateral membrane potential (VBL) of 8.4 +/- 0.5 mV, with respect to a control value of -54.5 +/- 1.9 mV (n = 15). After a small and transient hyperpolarization, VBL further depolarizes to reach a steady depolarization of 19.5 +/- 1.5 mV (n = 15) with respect to control. In the post-control period, VBL returns to -55.8 +/- 1.5 mV. The basolateral partial conductance to K+ (tK) which is 0.17 +/- 0.01 (n = 5) in control condition, decreases rapidly to nonmeasurable values during the hypertonic shock and returns to 0.23 +/- 0.03 in the post-control period. The basolateral partial conductance to Cl- (tCl), which is 0.05 +/- 0.02 (n = 5) in control, also decreases in hypertonicity to a nonmeasurable value and returns to 0.03 +/- 0.01 in post control. The partial conductance mediated by the Na-HCO3 cotransporter (tNaHCO3), which is 0.48 +/- 0.06 (n = 5) in control condition, remains the same at 0.44 +/- 0.05 (n = 5) during the hypertonic period. Similarly, the membrane absolute conductance mediated by the Na-HCO3 cotransporter (GNa-HCO3) does not vary appreciably. Concomitant with cell shrinkage, intracellular pH (pHi) decreases from a control value of 7.26 +/- 0.01 to 7.13 +/- 0.02 (n = 12) and then remains constant. Return to control solution brings back pHi to 7.28 +/- 0.03. From these results, we conclude that in collapsed PCT, a sustained decrease in cellular volume leads to cell acidification and to inhibition of K+ and Cl- conductances.

[Bronchial carcinoid tumors. Retrospective analysis of 32 cases]. / Carcinoidi bronchiali. Analisi retrospettiva di 32 casi.

Thirty-two cases of bronchial carcinoids (rate m/f = 1, average age 50.33 years) had been treated from 1970 to 1993. 62.5% of patients were symptomatic, 6% with specific symptoms. 62.5% of tumors had a central growth. Thirty-one patients underwent surgical treatment, another one a laser Nd:YAG coagulation. The operative mortality and morbidity were respectively 3% and 0%. 84.4% of tumours were typical carcinoid, 11% of those had lymphonodal metastases. Atypical carcinoids were found in 15.6% of patients, 40% had lymphnodal metastases. The global actuarial survival to 1, 5, 10 years were respectively 96, 88 and 84%. Statistically the survival difference between the typical and atypical carcinoid is relevant. The authors underline the preoperative cytologic diagnosis to perform a minimal lung resection in typical bronchial carcinoids.

Delayed morbidity and mortality of albumin/SV40 T-antigen transgenic mice after insertion of an alpha-fetoprotein/herpes virus thymidine kinase transgene and treatment with ganciclovir.

The alpha-fetoprotein (AFP) gene is normally expressed in fetal liver and transcriptionally silent in adult tissues, but can be abnormally reactivated in hepatocellular carcinoma (HCC). We linked 7.6 kb of 5'-flanking DNA from the mouse AFP gene to the herpes simplex virus (HSV) thymidine kinase gene (tk), and a line of transgenic mice was produced that expressed TK in a pattern similar to endogenous AFP. When these AFP/tk transgenic mice were crossed to another transgenic line that develops multifocal HCC due to expression of a SV40 large T-antigen transgene under regulation of the albumin promoter/enhancer complex, a significant delay of tumor progression could be achieved by administration of ganciclovir (GCV), a cytotoxic compound that is a substrate for phosphorylation by viral, but not mammalian, TK. Control animals carrying only the tk gene were unaffected by GCV treatment. These results illustrate the feasibility of prophylactic gene therapy for ablation of cancer, utilizing a strategy in which the tk gene is regulated by a promoter expected to be active only in tumor cells.

Basolateral K+, Cl-, and HCO3- conductances and cell volume regulation in rabbit PCT.

The relationship between changes in cellular volume, intracellular pH (pHi), basolateral membrane potential (VBL), and membrane partial basolateral conductances to K+ (tK) and Cl- (tCl) and mediated by the Na-HCO3 cotransporter (tNaHCO3) was determined in the collapsed proximal convoluted tubule (PCT) submitted to a 125-mosmol/kg hypotonic shock. The shock that produces a rapid swelling followed by partial volume regulation was accompanied by a rapid and transient VBL hyperpolarization of 10.0 +/- 1.5 mV and a second gradual hyperpolarization of 5.0 +/- 0.7 mV with respect to a control value of -44.0 +/- 4.6 mV.tK was 0.12 +/- 0.03 in control, increased transiently to 0.15 +/- 0.03, and then gradually increased to reach 0.32 +/- 0.06 at the end of hypotonic shock. In contrast, tCl was 0.03 +/- 0.01 in control, increased rapidly to a maximum of 0.16 +/- 0.01, and then decreased slowly to 0.08 +/- 0.02. During the same period, tNaHCO3 decreased rapidly from 0.41 +/- 0.04 to a minimum of 0.11 +/- 0.02 and slowly reincreased to reach 0.16 +/- 0.01.pHi increased transiently from 7.09 +/- 0.03 in control to 7.24 +/- 0.05 to come back gradually to 7.15 +/- 0.05 at the end of the hypotonic period. The membrane absolute conductance mediated by the Na-HCO3 cotransporter was found to increase only slightly in hypotonic conditions, whereas that to K+ and Cl-, GK and GCl, increased by at least factors of 8 and 17, respectively, with the increase of GCl being much faster than that of GK. In addition, the temporal variations in GCl followed closely those of the cellular water efflux. We conclude that the hypotonic swelling leads to important increases in the conductive pathways for K+ and Cl- and that the Cl- conductance pathway appears to be the rate limiting step in triggering and supporting regulatory volume decrease.

Transgenic animals as tools for investigating hepatocyte gene regulation and liver disease.

Transgenic technology has been extensively used for studying regulation of expression of genes in the liver and for creating mouse models of liver diseases. The number and diversity of these studies is consistent with the myriad functions of the liver itself. Genes expressed in liver have been used to generate a variety of models for genetic engineering, with further promise for the future. Because of its size, diversity and extent of gene expression, and function as both an endocrine and exocrine tissue, the liver remains a focus of attention for transgenic experiments. Thus, although this tissue has already played a major role in the development and refinement of transgenic technology, it almost certainly will continue to be a tissue of major interest for gene transfer experiments. Because the liver is also a convenient target for somatic gene therapy vectors, transgenic mice will probably play an increasingly important role as tools for screening candidate vectors for somatic gene therapy, both for the efficiency of expression of the vectors and for the physiological consequences of such expression.

Antiproliferative effect of lonidamine on a human glioblastoma multiforme cell line.

Recent data from phase II trials have shown that lonidamine (LND) is effective in the treatment of tumors of various histogenesis, including gliomas. In the present work, we tested the antiproliferative effect of LND on a human glioblastoma cell line (LI) in different culture conditions. When LI are cultured in their standard conditions, a reduction of cell growth is seen after 3 days of treatment with 10(-4) M LND. It reaches 70% with respect to control after 6 days and is statistically significant. LND is ineffective at the other concentrations tested. In more stringent culture conditions, 10(-4) M LND determines a higher inhibition of cell proliferation both after 3 and 6 days of exposure, while other doses of LND are unable to affect cell growth.