Authors:Carlo Petrini Pages: 311 - 313 Abstract: The Constitutional Court handed down a judgment on 25 September 2019 following on from that Court’s Order No 207 of 24 October 2018. The issue of constitutionality of Article 580 of the Criminal Code, in the part about the punishment of the aid to suicide, was raised by the Court of Milan. According to the Court “under certain conditions, a person who facilitates the execution of the suicide intention, autonomously and freely formed, of a patient kept alive by life support treatments and affected by a irreversible pathology, source of physical or psychological suffering that he considers intolerable but fully capable of making free and conscious decisions”.According to the Court, a local ethics committee must provide an opinion in all cases involving a request for medically-assisted suicide. PubDate: 2019-12-18 Issue No:Vol. 55, No. 4 (2019)
Authors:Carlo Petrini, Silvio Brusaferro Pages: 314 - 318 Abstract: The legislation of Italy and the European Union requires a shift in terms of the organisation and national regulation of ethics committees and clinical trials. More generally, this affects the entire sphere of biomedical research. The first part of this article provides a brief review of the history of ethic committees in Italy. We then discuss certain considerations about the current situation and formulate some proposals in terms of the regulatory choices that must be made. There is a vital need for rules that promote efficiency, to guarantee that Italy’s position remains competitive and attractive within the European Union. PubDate: 2019-12-18 Issue No:Vol. 55, No. 4 (2019)
Authors:Sabrina Rossi Pages: 319 - 322 Abstract: On the international scene, the Multiple Chemical Sensitivity (MCS) is defined, by several experts, as a multisystem syndrome that develops following chronic exposures to low doses of common chemical contaminants. Its general characteristics are, however, the object of conflicting opinions and a source of debate and research aimed at the correct nosological and therapeutic framework. In the face of a potentially debilitating trend, both in the work and in the economical and social sphere, the scientific community has not found an agreement. This problem leads some patients and their associations to periodically claim some requests. The syndrome is also taken into consideration at a political level, especially due to the close connection with the problems related to environmental pollution and to any necessary measures in the field of control and prevention. For these reasons we believe it is appropriate for a widespread surveillance network to be set up in Italy, capable of intercepting possible cases, analyzing them at a multidisciplinary level, and following their evolution. PubDate: 2019-12-18 Issue No:Vol. 55, No. 4 (2019)
Authors:Walter Ricciardi, Stefania Marcheggiani, Camilla Puccinelli, Mario Carere, Tonino Sofia, Fabiola Giuliano, Eugenia Dogliotti, Laura Mancini, Umberto Agrimi, Enrico Alleva, Luca Busani, Paola De Castro, Simona Gaudi, Paola Michelozzi, Giovanni Rezza, Emanuela Testai, Stefano Vella Pages: 323 - 329 Abstract: Climate changes affect social and environmental health determinants such as clean air, ecosystems health, safe drinking water and safe sufficient food. Globally, people at greatest risk of adverse health effects associated with climate change include children, the elderly and other vulnerable groups. Temperature-related death and illness, extreme events, polluted or stressed ecosystems represent relevant issues raising concern for both health and economic consequences. The aim of the Symposium was to promote an inter-sectoral and multidisciplinary approach to estimate, and to prevent, climate change-related events as well as to call the authorities to put in place measures to reduce adverse health effects.At the end of the Symposium the Rome International Charter on Health and Climate Change was presented. It includes a series of actions and recommendations, discussed and shared by all the participants, intended to inform policy makers and all the stakeholders involved in the management of climate changes. PubDate: 2019-12-18 Issue No:Vol. 55, No. 4 (2019)
Authors:Mattia Palmieri, Ida Cariati, Manuel Scimeca, Gabriele Pallone, Elena Bonanno, Virginia Tancredi, Giovanna D’Arcangelo, Claudio Frank Pages: 330 - 337 Abstract: Background. Physical exercise can reduce the risk of developing chronic diseases and slow the onset of neurodegenerative diseases. Since it has not been assessed which kind of training protocol might positively modulate both synaptic and muscular plasticity in neurodegenerative diseases, we studied in a mouse model of Niemann Pick type C disease, a model of minimal Alzheimer’s Disease, the effect of a short term protocol. Methods. We evaluated the effect of a short term, aerobic uniform exercise training on synaptic and muscle plasticity in three different mice groups: WT controls, NPC1+/- and NPC1-/- animals. The results were compared with those obtained in the sedentary respective groups. We analyzed the effects on synaptic plasticity by in vitro extracellular recordings in hippocampal mouse slices; moreover hippocampal and muscle tissue morphological structure have been investigated by transmission electron microscopy, to highlight any structural and functional changes due to training. Results. The results indicate a rescue of long-term potentiation in homozygous but not in heterozygous mice slices and an induction of neuronal plasticity, observed by morphological analysis, both in homozygous and in heterozygous trained mice. Conclusions. Hence this protocol is adequate to improve long term potenti PubDate: 2019-12-18 Issue No:Vol. 55, No. 4 (2019)
Authors:Raimondo Maria Pavarin, Silvia Marani, Elsa Turino Pages: 338 - 344 Abstract: Introduction. Ketamine is an essential medicine used as an anesthetic in low and middle-income countries and in veterinary medicine. Recreational use is widespread throughout the world, especially owing to its lower price compared to other substances. In Western countries its use has been mainly linked to subpopulations of young people who use drugs recreationally. Ketamine misuse is associated with amnesia, dependence, dissociation, lower urinary tract dysfunction and poor impulse control. Regular ketamine use is associated with abdominal pains. Aims. The aims of this study are to analyze characteristics and main symptoms of ketamine abusers attending emergency departments (EDs) in the metropolitan area of Bologna, Emilia-Romagna Region, northern Italy. Methods. We identified 74 records of ketamine-related visits: 30% female; 22% nonnatives; mean age 25.6 years. Forty-two percent reported ketamine use alone, 46% reported the use of other illegal substance (cocaine 19%, heroin 18%), 26% alcohol misuse. Results. The most common reported symptoms were neurological (soporous state 18%, agitation 14%, confusion 7%, panic attacks 7%, mydriasis 7%, tremors 7%), gastro-intestinal (abdominal pain 15%, vomiting 11%), urological (6.8%) and cardiac (palpitations 5%, chest pain 5%). Complications secondary to falls and cuts (7%) were the most frequent trauma complications. We highlight a significant number of visits regarding suicide attempts (10%) and overdose (4%). Conclusions. The results highlight a particular population of problematic ketamine users identified using the hospital’s ICT system. In particular, poly-drug users who consume ketamine in combination with heroin or cocaine presenting to the ED represent a specific target for targeted prevention projects on non-lethal overdoses and suicide attempts. PubDate: 2019-12-18 Issue No:Vol. 55, No. 4 (2019)
Authors:Rossella Murtas, Anita Andreano, Maria Teresa Greco, Sara Tunesi, Antonio Giampiero Russo Pages: 345 - 350 Abstract: The Italian Institute for Environmental Protection and Research defines National Priority Contaminated Sites (NPCSs) as land where hazardous substances are likely to pose a risk to human health. SENTIERI was the first national project evaluating the health status of residents in NPCSs. We have extended, for the site of Sesto San Giovanni, the evaluation to cancer incidence and congenital anomalies (CAs). We have found an overall protective effect of living in the NPCS for overall cancer incidence in all ages and no association in paediatric, adolescent and young adults’ population. We have found an excess risk for bladder cancer, leukaemia, lymphoid leukaemia and chronic lymphocytic leukaemia in men and for lung and breast cancer in women. For the paediatric and adolescent population, we have found an excess in embryonic tumours. Total CAs were not different from expected, while we have found excesses regarding congenital ear, face and neck, digestive system and chromosomal defects. PubDate: 2019-12-18 Issue No:Vol. 55, No. 4 (2019)
Authors:Linda Sommese, Maria Rosaria De Pascale, Angela Belsito, Simona Signoriello, Antonio Sorriento, Maria Vasco, Concetta Schiano, Carmela Fiorito, Giueppe Durevole, Marina Casale, Silverio Perrotta, Fiorina Casale, Roberto Alfano, Giuditta Benincasa, Giovanni Francesco Nicoletti, Claudio Napoli Pages: 351 - 356 Abstract: Blood transfusion is a lifesaving procedure for patients affected by hematological diseases or hemorrhage risk. This retrospective study was aimed to evaluate clinical safety of pediatric transfusions by comparing the frequency of adverse events caused by apheretic blood components vs whole blood. From 2011 to 2015, 214 patients (blood malignancy patients, n=144 and thalassemic patients, n=70) received 12,531 units of blood components. The adverse acute reactions occurred during patient hospitalization were reported to the Hemovigilance system and assessed by fitting a logistic mixed-effect model. A total of 33 (0.3%) patients showed adverse acute events. Odds ratio (OR) of adverse events from apheresis vs whole blood transfusion adjusted by patient classification was not statistically significant (OR [95% CI], 0.75 [0.23–2.47]). Our findings showed no significant differences in the prevalence of adverse acute events between blood component collected by apheresis vs whole blood in our study center. PubDate: 2019-12-18 Issue No:Vol. 55, No. 4 (2019)
Authors:Elisabetta Manuali, Raffaello Antonio Morgante, Carmen Maresca, Leonardo Leonardi, Ivana Purificato, Maria Donata Giaimo, Gianni Giovannini Pages: 357 - 362 Abstract: The Umbria Canine Cancer Registry (CCR) is a web-based platform for cancer registration set up in order to estimate the incidence of spontaneous tumors. It is an integral part of the regional canine demographic registry in which veterinary practitioners and pathologists interact. Veterinary pathologists perform double-blind comparisons and classify neoplasms in an automated classification process using the WHO criteria for canine neoplasms and the ICD-O tumor topographical and morphological keys. Here we describe the organization, on-line procedures and the methods used to assess canine demography, a pre-requisite for accurately estimating the incidence of cancer. In its first 4 years the CCR recruited 4857 cases of suspected tumors, as diagnosed by practitioners, clinics and a veterinary hospital. After the first year the number of enrolled cases increased by 63%, suggesting growing interest from the regional veterinary community. PubDate: 2019-12-18 Issue No:Vol. 55, No. 4 (2019)
Authors:Serena Donati, Alice Maraschini, Stefania Dell'Oro, Ilaria Lega, Paola D'Aloja, Regional Maternal Mortality Working Grou Pages: 363 - 370 Abstract: Objective.To describe the Italian Obstetric Surveillance System (ItOSS) investigating maternal death through incident case reporting and confidential enquiries.Methods. All maternal deaths occurred in any public and private health facility in 8 Italian regions covering 73% of national births have been notified to the ItOSS. Every incident case is confidentially reviewed to assess quality of care and establish the cause and avoidability of the death.Findings. A total of 106 maternal deaths among 1.455.545 new-borns have been notified to the surveillance system in 2013-17. Haemorrhage, sepsis and hypertensive disorders of pregnancy are the leading causes of direct maternal deaths due to obstetric causes.Conclusions. A maternal mortality surveillance system, including incidence reporting and confidential enquiries along with a retrospective analysis of administrative data sources, emerged as the best option for case ascertainment and for promoting avoidable maternal deaths. PubDate: 2019-12-18 Issue No:Vol. 55, No. 4 (2019)
Authors:Elvira Pelosi, Germana Castelli, Ugo Testa Pages: 371 - 379 Abstract: The burden of cancer is increasing worldwide, with a continuous increase of the annual total cases. Although mortality rates due to cancer are declining in developed countries, the total number of cancer deaths continues to rise due to the increase in the number of aged people. Three main causes of cancer have been described, represented by environmental factors, hereditary factors and random factors related to defects originated during cell replication. The frequency of cancers is very different for the various tissues and there is great debate on the extent of the specific contribution of environmental factors and random factors (due to “bad luck”) to cancer development. However, there is consensus that about 50% of all cases of cancer are related to environment and are preventable. Although a part of cancers is related to intrinsic mechanisms non preventable of genetic instability, it is evident that implementation of primary and secondary prevention measures is the only affordable strategy to meet from a medical and economic point of view the tremendous pressure created on healthcare structures by the increased cancer burden. It is time to bypass the paradox of disease prevention: celebrated in principle, resisted in practice. PubDate: 2019-12-18 Issue No:Vol. 55, No. 4 (2019)
Authors:Maria Verrucci, Angelo Iacobino, Lanfranco Fattorini, Roberta Marcoaldi, Antonino Maggio, Giovanni Piccaro Pages: 380 - 385 Abstract: Probiotics, defined as “living microorganisms that, whether ingested in useful amount, may have beneficial effects on human body”, are widely used in various products for human use, such as dietary supplements, medical devices and pharmaceutical products. The European Directive on medical devices (MDs) (DDM 93/42), also includes those MDs containing live microorganisms, particularly probiotics, that may have various destinations of use, including that of assisting the therapy of several human pathologies. In this brief note we analyzed the use of probiotics in MDs and how probiotics administration could represent one of the new frontiers of scientific research on the prevention and treatment of various diseases. We’ll analyze the literature on probiotics based MDs, to review their major targets in the therapy of some of the most common human pathologies: bacterial vaginosis and vaginitis, atopic dermatitis, infant colic, obesity, type 2 diabetes, and pharyngotonsillitis. PubDate: 2019-12-18 Issue No:Vol. 55, No. 4 (2019)
Authors:Melissa Baggieri, Donatella Barbina, Antonella Marchi, Pietro Carbone, Paola Bucci, Debora Guerrera, Loredana Nicoletti, Alfonso Mazzaccara, Fabio Magurano Pages: 386 - 391 Abstract: Introduction. Since 2003, strategic plans for the elimination of measles and congenital rubella have been adopted in the World Health Organization European Region. In Italy, a network of reference laboratories for measles and rubella (MoRoNet) has been recently implemented to ensure high-quality laboratory investigation for the confirmation of cases and outbreaks. Training among health care workers (HCWs) is one of the tasks of MoRoNet and an e-learning course was produced to improve the knowledge on international and national elimination plans and laboratory surveillance for measles and rubella. Methods. The course, based on the problem based learning methodology, was offered free of charge. Data about all participants and those who completed the course have been collected and analysed. Results. 5822 participants enrolled and 3995 (69%) completed the course; comparison between pre- and post-test shows a significant improvement in knowledge. The average score obtained from the satisfaction questionnaire is 4.5 out of 5. Discussion and conclusions. Course’s results are satisfactory, and data show a significant improvement in knowledge among participants. Most of them were satisfied with content, learning methodology and platform. Moreover, this course represents one of the possible strategies to overcome resistance and mistrust about vaccinations among HCWs. PubDate: 2019-12-18 Issue No:Vol. 55, No. 4 (2019)
Authors:Maria Cristina Mammarella, Giovanni Grandoni Pages: 392 - 397 Abstract: Both the World Health Organization (WHO) with its 2015 "Climate and Health Country Profile Project" and the Istituto Superiore di Sanità (ISS) with its 2018 "Health and Climate Change", agree on the emergency generated by the climate change and concerning health problems. The mitigation strategy suggested by the Intergovernmental Panel On Climate Change (IPCC) against greenhouse gas emissions and their effects on climate change, has not yet yielded the desired results. It is therefore necessary to focus on adaptation strategies, to immediately counter the effects of Climate Change (CC) on most vulnerable people and environments, by increasing their resilience through local interventions and targeted resilience actions. Coordinated resilience actions are necessary to combat the effects of CC especially in urban areas. Useful tools to manage and optimize resilience actions are Artificial Neural Networks (ANN) in complex and dynamic domains as cities are. The case of ANN applied to a city is presented as an example to increase the climate resilience of health local systems. In the current state of knowledge, ANN prove to be the most advanced and global solution to coordinate and manage a set of resilience actions in urban areas. PubDate: 2019-12-18 Issue No:Vol. 55, No. 4 (2019)
Authors:Chantra Eskes Pages: 400 - 404 Abstract: It is currently well accepted that in general, more than one method is necessary to allow the full replacement of an animal experimentation. These so called partial replacement methods can be used within integrated strategy approaches that combine different methods and information sources. A number of integrated strategy approaches were implemented within recent years in different areas of safety and regulatory toxicology. Moreover, latest advances in biomedical research and bioengineering provide a major opportunity to make use of in vitro human-based and/or three-dimensional complex models that can contribute to achieve more physiologically-relevant models. Examples herein describe currently existing integrated strategy frameworks aiming at full or partial replacement purposes and/or at gaining mechanistic insights. Furthermore, a general concept is provided on how 3R methods might be integrated in a strategy approach in order to ensure that animal experimentation is conducted only as a last resort. PubDate: 2019-12-18 Issue No:Vol. 55, No. 4 (2019)
Authors:Axel Kornerup Hansen Pages: 405 - 408 Abstract: Elimination of pathogens by laboratory rodent commercial vendors has substantially improved standardized conditions as well as laboratory animal welfare. However, pathogens are also important for basic activation and functioning of the immune system with consequential influences on the symbiotic bacteria composition in the individual microbiota. One of the reasons for failures of translating results from preclinical research to the clinical phase in some studies could be due to unintentional selection processes. Some recommendations are provided to increase researchers’ awareness on this point, together with a practical checklist to optimize information from microbiota knowledge. PubDate: 2019-12-18 Issue No:Vol. 55, No. 4 (2019)
Authors:Luca Bonini Pages: 409 - 412 Abstract: Non-human primates (NHP) are widely considered an essential model for biomedical research because of their close genetic, anatomo-functional and cognitive similarities to humans. These same reasons also raise particular ethical concerns for the unavoidable harm caused to these animals, in particular to those involved in neuroscientific studies. Besides reducing the number of animals needed to the absolute minimum, it is therefore essential to implement procedures allowing, at the same time, to minimize the harm to the animals and maximize the quality and ecological validity of the data. Technological progresses have made possible, for example, to self-train monkeys in their home cage with positive reinforcement techniques and to adopt various types of telemetric systems for wirelessly recording neuronal activity in freely behaving animals. Example of full application of these techniques are still very limited in the literature, but different recent international projects and pioneering studies are paving the way for turning to the use of new technologies to get a more “ethically acceptable” NHP neuroscientific research. PubDate: 2019-12-18 Issue No:Vol. 55, No. 4 (2019)