Measure for Chaotic Scattering Amplitudes.

We propose a novel measure of chaotic scattering amplitudes. It takes the form of a log-normal distribution function for the ratios r_{n}=δ_{n}/δ_{n+1} of (consecutive) spacings δ_{n} between two (consecutive) peaks of the scattering amplitude. We show that the same measure applies to the quantum mechanical scattering on a leaky torus as well as to the decay of highly excited string states into two tachyons. Quite remarkably, the r_{n} obey the same distribution that governs the nontrivial zeros of Riemann ζ function.

Distinguishing Fuzzballs from Black Holes through Their Multipolar Structure.

Within general relativity, the unique stationary solution of an isolated black hole is the Kerr spacetime, which has a peculiar multipolar structure depending only on its mass and spin. We develop a general method to extract the multipole moments of arbitrary stationary spacetimes and apply it to a large family of horizonless microstate geometries. The latter can break the axial and equatorial symmetry of the Kerr metric and have a much richer multipolar structure, which provides a portal to constrain fuzzball models phenomenologically. We find numerical evidence that all multipole moments are typically larger (in absolute value) than those of a Kerr black hole with the same mass and spin. Current measurements of the quadrupole moment of black-hole candidates could place only mild constraints on fuzzballs, while future gravitational-wave detections of extreme mass-ratio inspirals with the space mission LISA will improve these bounds by orders of magnitude.

An Example of a Stroke Unit Reshaping in the Context of a Regional Hub and Spoke System in the COVID-19 Era.

During the COVID-19 outbreak, the Neurology and Stroke Unit (SU) of the hospital of Varese had to serve as a cerebrovascular hub, meaning that the referral area for the unit doubled. The number of beds in the SU was increased from 4 to 8. We took advantage of the temporary suspension of the out-patient clinic and reshaped our activity to guarantee the 24/7 availability of recombinant tissue Plasminogen Activator (rtPA) intravenous therapy (IVT) in the SU, and to ensure we were able to admit patients to the SU as soon as they completed endovascular treatment (EVT). In 42 days, 46 stroke patients were admitted to our hospital, and 34.7% of them underwent IVT and/or EVT, which means that we treated 0.38 patients per day; in the baseline period from 2016 to 2018, these same figures had been 23.5% and 0.23, respectively. The mean values of the door-to-first CT/MRI and the door-to-groin puncture, but not of the onset-to-door and the door-to-needle periods were slightly but significantly longer than those observed in the baseline period in 276 patients. On an individual basis, only one patient exceeded the door-to-groin puncture time limit computed from the baseline period by about 10 min. None of the patients had a major complication following the procedures. None of the patients was or became SARS-CoV2 positive. In conclusion, we were able to manage the new hub-and-spoke system safely and without significant delays. The reshaping of the SU was made possible by the significant reduction of out-patient activity. The consequences of this reduction are still unknown but eventually, this emergency will suggest ways to reconsider the management and the allocation of health system resources.

Transient osteoporosis of the hip: successful treatment with teriparatide.

A 62-year-old man presented with a 2-month history of increasing pain in the left hip. Magnetic resonance imaging (MRI) showed bone marrow edema (BME) of the left femur, dual energy X-ray absorptiometry (DXA) showed osteopenia at the same level, whereas pelvis X-rays failed to show any objective findings. After ruling out other possible causes of BME such as aseptic osteonecrosis, infectious arthritis, primary or metastatic malignancy, tuberculosis, osteomyelitis, rheumatoid arthritis, and seronegative spondyloarthropathies, a diagnosis of transient osteoporosis of the hip (TOH) was made, and treatment with teriparatide at a daily dose of 20 µg was started and continued for 4 weeks. Disappearance of the symptoms and normalization of MRI were obtained.

[Early diagnosis in acute mesenteric ischemia. Case series and clinical review]. / Diagnosi precoce nell'ischemia mesenterica acuta. Casistica e revisione clinica.

The AA report on 12 cases of intestinal infarction for acute mesenteric ischemia (IMA) in critical patients observed in the last 2 years. In this work some clinical data, blood tests and strumental considerations are described. IMA is a vascular emergency with severe prognosis and high rate morbidity and mortality, often correlated to a diagnostic delay. The discrepancy between symptoms and clinical objectivity must suggest the suspect, especially in patients with cardiac pathology, short lasting diarrhoea, bowel hemorrhage or only abdominal pain rebel to the analgesics; with the laboratory indexes and strumental data it can be carried out an early diagnosis and then begin the more opportune therapeutical treatment. The increase of blood sugar together to the triad leucocytosis--haemoconcentration and metabolic acidosis, in previously non diabetic patients, confirm the suspect of IMA in the very initial phases of this pathology.

[Acute mesenteric ischemia. Principles of treatment and surgical approach]. / Ischemia mesenterica acuta. Principi di trattamento e approccio chirurgico.

The AA report some considerations on the treatment and surgical approach during acute mesenteric ischemia (IMA) focusing some indications for a timely and suitable therapeutic approach. In the last 2 years, they treated 12 cases of IMA in critical patients. Early identification allows avoiding advanced phases of the intestinal infarct/bowel necrosis; in this phase the multidisciplinary approach for the hemodynamic stabilization is a priority, together with rianimatory support and surgery operation. The preservation of the intestinal vitality is essential to avoid the need of bowel resections or at least a major one. A suitable treatment permits a better survival and improvement of the quality of life. Surgical timing requires the intervention within 12 hours since the beginning of the symptoms to be more efficacious.

[PROVA E TRASPORTA Project: results of tele-transmission of the electrocardiogram from community hospitals and emergency service ambulances in the management of ST-elevation acute coronary syndromes]. / Progetto PROVA E TRASPORTA: rete territoriale di teletrasmissione dell'elettrocardiogramma da postazioni fisse e ambulanze Bls. Utilità nella gestione della sindrome coronarica acuta con sopraslivellamento del tratto ST.

BACKGROUND: Availability of a telematic system of electrocardiogram (ECG) transmission may improve the management of ST-elevation myocardial infarction (STEMI), by reducing time to treatment. The aim of this study was to show the effectiveness of telephone transmission of ECG in improving quality of care for patients with acute STEMI. METHODS: Since January 1, 2003, we activated a management program of STEMI in healthcare district of Varese, located in the North-West of Lombardy (Italy), comprising one fourth-level hospital, equipped with a cath lab on call 24/24 h for primary angioplasty since 1993 and cardiac surgery, and 2 community hospitals, placed in a mountain area approximately 30 km far from Varese. The emergency medical system (EMS) transport was activated 24/24 h and has 15 basic life support (BLS) ambulances with trained nurse staff and 2 mobile units with medical staff, all of them equipped with semiautomatic defibrillator Lifepack 12, enabling a GSM telephone transmission of a 12-lead ECG, coupled with 3-lead continuous rhythm recording and clinical data, if necessary. The ECGs were transmitted to a core unit placed in the coronary care unit (CCU) of the Hospital di Circolo of Varese, directly connected with the EMS core unit. RESULTS: From January 2003 to August 2005, a total of 2063 ECGs were transmitted, 538 of them (26%) recorded by EMS ambulances. Of 144 ECGs (7%) showing a persistent ST-elevation suggesting an acute STEMI (group A), 112 subjects underwent reperfusion: 73 were treated with angioplasty and 39 by lysis alone. By comparing data of group A with a group of 256 patients (180 reperfused) with acute STEMI, admitted to our hospital in the same period without ECG teletransmission (group B), we observed no statistical difference in mortality and reperfusion rates but a significative reduction in the pre-hospital and in-hospital times in group A patients treated by primary angioplasty and thrombolysis. CONCLUSIONS: Our study confirms previous results in that an early availability of a 12-lead ECG, transmitted from peripheral community hospitals and BLS ambulances, is able to reduce time to management of patients with an acute STEMI, thus improving quality of decision-making and treatment.

[Laparoscopic management of small-bowel obstruction]. / La laparoscopia nell'occlusione intestinale del tenue.

Laparoscopy is not generally accepted as an effective, advantageous alternative to formal laparotomy for abdominal emergencies. Its use in patients with previous surgery and intestinal obstruction is often debatable. A retrospective study was performed to analyse the results of the laparoscopic approach for acute small-bowel obstruction in terms of efficacy and safety. From January 2000 to December 2003, 44 non-consecutive patients underwent laparoscopic surgery for radiologically documented small-bowel obstruction. Thirty-nine (89%) had undergone previous abdominal operations (mean number of laparotomies: 2; range 1-5). Twelve were men and 32 women (mean age: 57 years; range 13-91). We retrospectively reviewed the patient data, analysing operative time, need for accessory incision or conversion, length of hospital stay, and intraoperative and postoperative morbidity and mortality. The aetiology was established in 40 patients (91%), and the procedures were completed laparoscopically in 28/44. Mean operative time was 58 min (range 25-160). Six patients required an accessory target incision and 10 patients were converted to formal laparotomy. The reasons for conversion were extent of adhesions (n = 3), problems with laparoscopic view (n = 2), gangrenous bowel (n = 2), locally advanced colon cancer (n = 1), haemoperitoneum (n = 1), and diffuse peritonitis (n = 1). The mean hospital stay was 6 days (range 2-28). Postoperative mortality and morbidity were 2% and 16%, respectively. In conclusion, this study suggest that laparoscopy should be considered early in the clinical course of patients presenting with acute small-bowel obstruction. In most patients definitive treatment is possible, effective and safe, thus justifying the early laparoscopic approach.

[Operative laparoscopy in the management of perforated peptic ulcer]. / La laparoscopia operativa nella gestione delle ulcere peptiche perforate.

The aim of this retrospective study was to assess the feasibility, safety and efficacy of the laparoscopic approach in the management of perforated peptic ulcers. From January 1997 to December 2002, all patients referred to our community hospital for abdominal surgical emergencies were routinely managed by laparoscopic surgery. A review was carried out on 39 consecutive patients suffering from perforated peptic ulcers with or without generalised peritonitis. The study population comprised 24 male and 15 female patients, aged 30 to 94 years (mean age: 62 +/- 18). Laparoscopic repair was attempted in all patients. Laparoscopy afforded the correct diagnosis in all cases. Laparoscopic peritoneal washout (irrigation and suction of the entire abdominal cavity) with simple suture of the perforation proved successful in 34 patients. An additional omental patching was performed in 15 of these cases. Conversion to conventional open surgery was necessary in 5 patients. The morbidity and mortality rates were 13% and 10%, respectively. The mean operative time was 77 minutes (range: 40-120) and the mean hospital stay 9 days (range: 3-22). Laparoscopic repair of perforated ulcers is technically feasible but requires sound experience in laparoscopic abdominal emergencies. This study shows that the mini-invasive procedure is safe and effective, offering a valid alternative to traditional laparotomy.

[Rituximab treatment of chronic idiopathic thrombocytopenic purpura. Results of a phase II study]. / Trattamento con rituximab della porpora trombocitopenica idiopatica cronica. Risultati di uno studio di fase II.

In a recent article we indicated that rituximab is an active and safe drug in patients with chronic ITP. We report now the updated results of this study. Twenty-five individuals with chronic ITP were treated with intravenous rituximab at the dose of 375 mg/m2 once weekly for 4 weeks. Rituximab infusion-related side effects were observed in 18 patients, but they were of modest intensity and did not require discontinuation of treatment. Long-term side effects included a decreased B-cell count of several months duration in most patients which, however, did not translate into a significant rate of infections. The overall response rate was 52%, with 7 cases showing a sustained response (6 months or longer). In 2 patients with relapsed disease, repeat challenge with rituximab induced a new response. In responders a significant rise in platelet concentrations was observed early during the course of treatment, usually 1 week after the first rituximab infusion. No clinical or laboratory parameter was found to predict treatment outcome. In conclusion, we confirm that rituximab can induce long-lasting responses in patients with chronic ITP and has a favorable side effect profile. Therefore, we suggest its use in refractory ITP cases.