The Italian Pension Gap: a Stochastic Optimal Control Approach

We study the gap between the state pension provided by the Italian pension system pre-Dini reform and post-Dini reform. The goal is to fill the gap between the old and the new pension by joining a defined contribution pension scheme and adopting an optimal investment strategy that is target-based. We find that it is possible to cover, at least partially, this gap with the additional income of the pension scheme, especially in the presence of late retirement and in the presence of stagnant career. Workers with dynamic career and workers who retire early are those who are most penalised by the reform. Results are intuitive and in line with previous studies on the subject

Dynamic programming principle for classical and singular stochastic control with discretionary stopping

We prove the dynamic programming principle (DPP) in a class of problems where an agent controls a $d$-dimensional diffusive dynamics via both classical and singular controls and, moreover, is able to terminate the optimisation at a time of her choosing, prior to a given maturity. The time-horizon of the problem is random and it is the smallest between a fixed terminal time and the first exit time of the state dynamics from a Borel set. We consider both the cases in which the total available fuel for the singular control is either bounded or unbounded. We build upon existing proofs of DPP and extend results available in the traditional literature on singular control (e.g., Haussmann and Suo, SIAM J. Control Optim., 33, 1995) by relaxing some key assumptions and including the discretionary stopping feature. We also connect with more general versions of the DPP (e.g., Bouchard and Touzi, SIAM J. Control Optim., 49, 2011) by showing in detail how our class of problems meets the abstract requirements therein

Relationship between Pre-Implant Interleukin-6 Levels, Inflammatory Response, and Early Outcome in Patients Supported by Left Ventricular Assist Device: A Prospective Study

Purpose: The immune response is crucial in the development of multi-organ failure (MOF) and complications in end-stage heart failure patients supported by left ventricular assist device (LVAD). However, at pre-implant, the association between inflammatory state and post-LVAD outcome is not yet clarified. Aim of the study was to assess the relationship among preimplant levels of immune-related cytokines, postoperative inflammatory response and 3-month outcome in LVAD-patients. Methods: In 41 patients undergoing LVAD implantation, plasma levels of interleukin (IL)-6, IL-8, crucial for monocyte modulation, and urine neopterin/creatinine ratio (Neo/Cr), marker of monocyte activation, were assessed preoperatively, at 3 days, 1 and 4 weeks post-LVAD. MOF was evaluated by total sequential organ failure assessment (tSOFA) score. Intensive care unit (ICU)-death and/or post-LVAD tSOFA $11 was considered as main adverse outcome. Length of ICU-stay, 1 weektSOFA score, hospitalisation and 3-month survival were considered additional end-points. Results: During ICU-stay, 8 patients died of MOF, while 8 of the survivors experienced severe MOF with postoperative tSOFA score$11. Pre-implant level of IL-6 $ 8.3 pg/mL was identified as significant marker of discrimination between patients with or without adverse outcome (OR 6.642, 95% CI 1.201-36.509, p = 0.030). Patients were divided according to pre-implant IL-6 cutoff of 8.3 pg/ml in A [3.5 (1.2-6.1) pg/mL] and B [24.6 (16.4-38.0) pg/mL] groups. Among pre-implant variables, only white blood cells count was independently associated with pre-implant IL-6 levels higher than 8.3 pg/ml (OR 1.491, 95% CI 1.004-2.217, p = 0.048). The ICU-stay and hospitalisation resulted longer in B-group (p = 0.001 and p = 0.030, respectively). Postoperatively, 1 week-tSOFA score, IL-8 and Neo/Cr levels were higher in B-group. Conclusions: LVAD-candidates with elevated pre-implant levels of IL-6 are associated, after intervention, to higher release of monocyte activation related-markers, a clue for the development of MOF, longer clinical course and poor outcome

Non-Invasive Brain Stimulation for the Modulation of Aggressive Behavior—A Systematic Review of Randomized Sham-Controlled Studies

Intro: Aggressive behavior represents a significant public health issue, with relevant social, political, and security implications. Non-invasive brain stimulation (NIBS) techniques may modulate aggressive behavior through stimulation of the prefrontal cortex. Aims: To review research on the effectiveness of NIBS to alter aggression, discuss the main findings and potential limitations, consider the specifics of the techniques and protocols employed, and discuss clinical implications. Methods: A systematic review of the literature available in the PubMed database was carried out, and 17 randomized sham-controlled studies investigating the effectiveness of NIBS techniques on aggression were included. Exclusion criteria included reviews, meta-analyses, and articles not referring to the subject of interest or not addressing cognitive and emotional modulation aims. Conclusions: The reviewed data provide promising evidence for the beneficial effects of tDCS, conventional rTMS, and cTBS on aggression in healthy adults, forensic, and clinical samples. The specific stimulation target is a key factor for the success of stimulation on aggression modulation. rTMS and cTBS showed opposite effects on aggression compared with tDCS. However, due to the heterogeneity of stimulation protocols, experimental designs, and samples, we cannot exclude other factors that may play a confounding role

Galvanic Deposition of Calcium Phosphate/Bioglass Composite Coating on AISI 316L

Calcium phosphate/Bioglass composite coatings on AISI 316L were investigated with regard to their potential role as a beneficial coating for orthopedic implants. These coatings were realized by the galvanic co-deposition of calcium phosphate compounds and Bioglass particles. A different amount of Bioglass 45S5 was used to study its effect on the performance of the composite coatings. The morphology and chemical composition of the coatings were investigated before and after their aging in simulated body fluid. The coatings uniformly covered the AISI 316L substrate and consisted of a brushite and hydroxyapatite mixture. Both phases were detected using X-ray diffraction and Raman spectroscopy. Additionally, both analyses revealed that brushite is the primary phase. The presence of Bioglass was verified through energy-dispersive X-ray spectroscopy, which showed the presence of a silicon peak. During aging in simulated body fluid, the coating was subject to a dynamic equilibrium of dissolution/reprecipitation with total conversion in only the hydroxyapatite phase. Corrosion tests performed in simulated body fluid at different aging times revealed that the coatings made with 1 g/L of Bioglass performed best. These samples have a corrosion potential of −0.068V vs. Ag/AgCl and a corrosion current density of 8.87 × 10−7 A/cm2. These values are better than those measured for bare AISI 316L (−0.187 V vs. Ag/AgCl and 2.52 × 10−6 A/cm2, respectively) and remained superior to pure steel for all 21 days of aging. This behavior indicated the good protection of the coating against corrosion phenomena, which was further confirmed by the very low concentration of Ni ions (0.076 ppm) released in the aging solution after 21 days of immersion. Furthermore, the absence of cytotoxicity, verified through cell viability assays with MC3T3-E1 osteoblastic cells, proves the biocompatibility of the coatings

Relationship between Early Inflammatory Response and Clinical Evolution of the Severe Multiorgan Failure in Mechanical Circulatory Support-Treated Patients

Background. The mechanical circulatory support (MCS) is an effective treatment in critically ill patients with end-stage heart failure (ESHF) that, however, may cause a severe multiorgan failure syndrome (MOFS) in these subjects. The impact of altered inflammatory response, associated to MOFS, on clinical evolution of MCS postimplantation patients has not been yet clarified. Methods. Circulating cytokines, adhesion molecules, and a marker of monocyte activation (neopterin) were determined in 53MCStreated patients, at preimplant and until 2 weeks. MOFS was evaluated by total sequential organ failure assessment score (tSOFA). Results. During MCS treatment, 32 patients experienced moderate MOFS (tSOFA< 11; A group), while 21 patients experienced severe MOFS (tSOFA? 11) with favorable (B group) or adverse (&#55349;&#56411; = 13, C group) outcomes. At preimplant, higher values of left ventricular ejection fraction (LVEF) and estimated glomerular filtration rate (eGFR) were the only parameter independently associated with A group. In C group, during the first postoperative week, high levels of interleukin-8 (IL-8) and tumor necrosis factor (TNF)-&#55349;&#57084;, and an increase of neopterin and adhesionmolecules, precede tSOFA worsening and exitus. Conclusions.TheMCS patients of C group show an excessive release to IL-8 and TNF-&#55349;&#57084;, and monocyte-endothelial activation after surgery, that might contribute to the unfavourable evolution of severe MOFS

Radioresistance in rhabdomyosarcomas: Much more than a question of dose

Management of rhabdomyosarcoma (RMS), the most common soft tissue sarcoma in children, frequently accounting the genitourinary tract is complex and requires a multimodal therapy. In particular, as a consequence of the advancement in dose conformity technology, radiation therapy (RT) has now become the standard therapeutic option for patients with RMS. In the clinical practice, dose and timing of RT are adjusted on the basis of patients' risk stratification to reduce late toxicity and side effects on normal tissues. However, despite the substantial improvement in cure rates, local failure and recurrence frequently occur. In this review, we summarize the general principles of the treatment of RMS, focusing on RT, and the main molecular pathways and specific proteins involved into radioresistance in RMS tumors. Specifically, we focused on DNA damage/repair, reactive oxygen species, cancer stem cells, and epigenetic modifications that have been reported in the context of RMS neoplasia in both in vitro and in vivo studies. The precise elucidation of the radioresistance-related molecular mechanisms is of pivotal importance to set up new more effective and tolerable combined therapeutic approaches that can radiosensitize cancer cells to finally ameliorate the overall survival of patients with RMS, especially for the most aggressive subtypes

Morphometric evaluation of the pedicles of the lumbar spine according to L5 lateral tilt classification

A classification of the lumbar spine according to the pedicle lateral tilt (PLT) of L5 pedicle was recently proposed [1]. In this work the sample was divided into three categories, the first or Wing Type (WT) includes people with a PLT >36° (41,8%), the second or V Type (VT) includes people with a PLT between 30° and 36° (48%) and the third or U Type (UT) includes people with a PL

Does Pelvic Incidence Influence the Morphology of the Sacroiliac Joint?

Pelvic Incidence is defined as the angle between the perpendicular line to the upper plate of S1 at its midpoint and the line between this point and the center of bicoxofemoral line, it describes the position of femural heads in relation to sacrum. Recently some authors described a direct correlation between high values of PI and large AP pelvic axis (horizontal pelvis) and a wide pelvic ring [1]. Also the acetabular orientation is influenced by PI ; high values of PI means a more vertical acetabulum. Having regard to the relationship between PI and the main structures involved in the load transfer, to date no studies that correlate the morphology of the Sacroiliac Joint (SiJ) and PI were performed. The aim of this study is to evaluate the different morphology of the auricular surface of the sacrum comparing two groups of healthy young people with low (40°) PI. We retrospectively analysed 51 consecutive young (between 20 and 35 y.o.) people. After the evaluation of PI the sample was divided into two groups: 31 people belong to the group A (PI 40°). The following morphological parameters of the SiJ were analysed: length of long axis (LLA), length of short axis (LSA), length of oblique axis (LOA), ratio between long and short axis (RLSA), angle between axis (ABA) and surface; global shape of the joint was evaluated; two new parameters were introduced, SiJ Tilt (SiJT), defined as the angle between the vertical line and the long axis of the SiJ and SiJ Slope (SiJS), defined as the angle between the horizontal line and the short axis of the SiJ. We found a strong statistically significant correlations (p-value 0.05) between PI and RLSA, shape, ABA, SiJT and SiJS; a weaker correlations (p-value 0.10) between PI and LLA, LSA were observed; no statistically significant correlation between PI and LOA and surface were observed. The results underline that there is a strong correlation between pelvic morphology and SiJ anatomy. Further studies, about the different pattern of forces distribution among SiJ, will need to be performed to have a better knowledge that could help to understand the biomechanics and pathophysiology of normal and pathological SiJ

MS-275 (Entinostat) Promotes Radio-sensitivity in PAX3-FOXO1 Rhabdomyosarcoma cells

Rhabdomyosarcoma (RMS) is the most common soft tissue sarcoma of childhood. About 25% of RMS expresses fusion oncoproteins such as PAX3/PAX7‐FOXO1 (fusion‐positive, FP) while fusion‐negative (FN)‐RMS harbors RAS mutations. Radiotherapy (RT) plays a crucial role in local control but metastatic RMS is often radio‐resistant. HDAC inhibitors (HDACi) radio‐sensitize different cancer cells types. Thus, we evaluated MS−275 (Entinostat), a Class I and IV HDACi, in combination with RT on RMS cells in vitro and in vivo. MS−275 reversibly hampered cell survival in vitro in FN‐RMS RD (RASmut) and irreversibly in FP‐RMS RH30 cell lines down‐regulating cyclin A, B, and D1, up‐regulating p21 and p27 and reducing ERKs activity, and c‐Myc expression in RD and PI3K/Akt/mTOR activity and N‐Myc expression in RH30 cells. Further, MS−275 and RT combination reduced colony formation ability of RH30 cells. In both cell lines, co‐treatment increased DNA damage repair inhibition and reactive oxygen species formation, down‐regulated NRF2, SOD, CAT and GPx4 anti‐oxidant genes and improved RT ability to induce G2 growth arrest. MS−275 inhibited in vivo growth of RH30 cells and completely prevented the growth of RT‐unresponsive RH30 xenografts when combined with radiation. Thus, MS−275 could be considered as a radio‐sensitizing agent for the treatment of intrinsically radio‐resistant PAX3‐FOXO1 RMS