Restoring the restoration: The Palaestra of the West Gymnasium of Kos

The contribution derives from a recent investigation held at the DICAR Department of the Polytechnic of Bari, under the scientific supervision of professor Giorgio Rocco, regarding the Palaestra and the Western Gymnasium of Kos. According to the research, the above mentioned Palaestra, one of the largest in the ancient world, is to be dated to the II century B.C. It was partially dug out in 1936 by L. Morricone during the Italian dominance over the Southern Sporades (1912-1948). At that time many restoration works were undertaken in the Italian Dodecanese and also the Palaestra was subjected to an anastylosis which had partially rised its oriental porch. The new search relies on new detailed drawings, complemented with a catalogue of architectural fragments and the analysis of the structures finalized to the reconstructive study. Afterwards the analysis has focused on the critical status of the same Italian restoration, carried on with integration of concrete cement, elaborating a derestoration project and a proposal for an anastylosis of a further section of the porch with the aim to enhancing the archaeological area. Starting from the results of this research, the purpose of our paper is to provide for a contribution to the controversial and highly-discussed topic of the architectural restoration in archaeological sites with a specific focus on the following points of interest: • The Italian restoration in Dodecanese: a synthesis (Antonello Fino); • The Italian restoration of the Palaestra of the West Gymnasium of Kos: an unfinished yard? (Rossella Martino); • Restoring the restoration. A new project for de-restoration and preservation (Daniele Mallardi); • A proposal for the accomplishment of the anastylosis and guide lines for the enhancement of the archaeological site (Claudia Lamanna)

Neutrophil/lymphocyte ratio predicts in‐hospital complications in Takotsubo syndrome. Results from a prospective multi‐center registry

n/

Prognostic role of neoplastic markers in Takotsubo syndrome

Takotsubo syndrome (TTS) is an acute heart failure syndrome with significant rates of in and out-of-hospital mayor cardiac adverse events (MACE). To evaluate the possible role of neoplastic biomarkers [CA-15.3, CA-19.9 and Carcinoembryonic Antigen (CEA)] as prognostic marker at short- and long-term follow-up in subjects with TTS. Ninety consecutive subjects with TTS were enrolled and followed for a median of 3 years. Circulating levels of CA-15.3, CA-19.9 and CEA were evaluated at admission, after 72 h and at discharge. Incidence of MACE during hospitalization and follow-up were recorded. Forty-three (46%) patients experienced MACE during hospitalization. These patients had increased admission levels of CEA (4.3 ± 6.2 vs. 2.2 ± 1.5 ng/mL, p = 0.03). CEA levels were higher in subjects with in-hospital MACE. At long term follow-up, CEA and CA-19.9 levels were associated with increased risk of death (log rank p < 0.01, HR = 5.3, 95% CI 1.9-14.8, HR = 7.8 95% CI 2.4-25.1, respectively, p < 0.01). At multivariable analysis levels higher than median of CEA, CA-19.9 or both were independent predictors of death at long term (Log-Rank p < 0.01). Having both CEA and CA-19.9 levels above median (> 2 ng/mL, > 8 UI/mL respectively) was associated with an increased risk of mortality of 11.8 (95% CI 2.6-52.5, p = 0.001) at follow up. Increased CEA and CA-19.9 serum levels are associated with higher risk of death at long-term follow up in patients with TTS. CEA serum levels are correlated with in-hospital MACE

Impact of intra-aortic balloon counterpulsation on all-cause mortality among patients with Takotsubo syndrome complicated by cardiogenic shock: results from the German-Italian-Spanish (GEIST) registry

Aims: Takotsubo syndrome (TTS) is an acute and reversible left ventricular dysfunction and can be complicated by cardiogenic shock (CS). However, few data are available on optimal care in TTS complicated by CS. Aim of this study was to evaluate short- and long-term impact of intra-aortic balloon pumping (IABP) on mortality in this setting. Methods and results: In a multi-centre, international registry on TTS, 2248 consecutive patients were enrolled from 38 centres from Germany, Italy, and Spain. Of the 2248 patients, 212 (9.4%) experienced CS. Patients with CS had a higher prevalence of diabetes (27% vs. 19%), male sex (25% vs. 10%), and right ventricular involvement (10% vs. 5%) (P < 0.01 in all cases). Forty-three patients with CS (20% of 212) received IABP within 8 h (interquartile range 4-18) after admission. No differences in terms of age, gender, cardiovascular risk factors, and admission left ventricular ejection fraction were found among patients with and without IABP. There were no significant differences in terms of 30-day mortality (16% vs. 17%, P = 0.98), length of hospitalization (18.9 vs. 16.7 days, P = 0.51), and need of invasive ventilation (35% vs. 41%, P = 0.60) among two groups: 30-day survival was not significantly different even after propensity score adjustment (log-rank P = 0.73). At 42-month follow-up, overall mortality in patients with CS and TTS was 35%, not significantly different between patients receiving IABP and not (37% vs. 35%, P = 0.72). Conclusions: In a large multi-centre observational registry, the use of IABP was not associated with lower mortality rates at short- and long-term follow-up in patients with TTS and CS

Neutrophil/lymphocyte ratio predicts in‐hospital complications in Takotsubo syndrome. Results from a prospective multi‐center registry

n/

Screening for colorectal cancer with FOBT, virtual colonoscopy and optical colonoscopy: study protocol for a randomized controlled trial in the Florence district (SAVE study)

BACKGROUND: Colorectal cancer (CRC) is the most frequent cancer in Europe. Randomized clinical trials demonstrated that screening with fecal occult blood test (FOBT) reduces mortality from CRC. Accordingly, the European Community currently recommends population-based screening with FOBT. Other screening tests, such as computed tomography colonography (CTC) and optical colonoscopy (OC), are highly accurate for examining the entire colon for adenomas and CRC. Acceptability represents a critical determinant of the impact of a screening program. We designed a randomized controlled trial to compare participation rate and diagnostic yield of FOBT, CTC with computer-aided diagnosis, and OC as primary tests for population-based screening. METHODS/DESIGN: A total of 14,000 subjects aged 55 to 64 years, living in the Florence district and never screened for CRC, will be randomized in three arms: group 1 (5,000 persons) invited to undergo CTC (divided into: subgroup 1A with reduced cathartic preparation and subgroup 1B with standard bowel preparation); group 2 (8,000 persons) invited to undergo a biannual FOBT for three rounds; and group 3 (1,000 persons) invited to undergo OC. Subjects of each group will be invited by mail to undergo the selected test. All subjects with a positive FOBT or CTC test (that is, mass or at least one polyp ≥6 mm) will be invited to undergo a second-level OC. Primary objectives of the study are to compare the participation rate to FOBT, CTC and OC; to compare the detection rate for cancer or advanced adenomas of CTC versus three rounds of biannual FOBT; to evaluate referral rate for OC induced by primary CTC versus three rounds of FOBT; and to estimate costs of the three screening strategies. A secondary objective of the study is to create a biological bank of blood and stool specimens from subjects undergoing CTC and OC. DISCUSSION: This study will provide information about participation/acceptability, diagnostic yield and costs of screening with CTC in comparison with the recommended test (FOBT) and OC. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01651624

Neurometabolic Features of Takotsubo Syndrome: A Brain 18F-FDG PET Case Control-Prospective Study

Takotsubo syndrome (TTS) is an acute heart failure syndrome featured by transient left ventricular systolic dysfunction. TTS pathophysiology is still unclear.1 A retrospective analysis using brain 18F-fluorodeoxyglucose (18F-FDG) positron emission tomographic (PET)–computed tomography (CT) showed higher amygdala activity in subjects who subsequently developed TTS, suggesting a premorbid state.2 The aim of this study was to evaluate potential features of brain metabolism in TTS patients compared with a control group