Application of latent class analysis in assessing the awareness, attitude, practice and satisfaction of paediatricians on sleep disorder management in children in Italy.

AIM: To identify subgroups regarding paediatricians' awareness, attitude, practice and satisfaction about management of Sleep-Disordered Breathing (SDB) in Italy using Latent Class Analysis (LCA). METHODS: A cross-sectional study was conducted on a large sample of Italian paediatricians. Using a self-administered questionnaire, the study collected information on 420 Paediatric Hospital Paediatricians (PHPs) and 594 Family Care Paediatricians (FCPs). LCA was used to discover underlying response patterns, thus allowing identification of respondent groups with similar awareness, attitude, practice and satisfaction. A logistic regression model was used to investigate which independent variables influenced latent class membership. Analyses were performed using R 3.5.2 software. A p-value<0.05 was considered statistically significant. RESULTS: Two classes were identified: Class 1 (n = 368, 36.29%) "Untrained and poorly satisfied" and Class 2 (n = 646, 63.71%) "Trained and satisfied." Involving paediatric pneumologists or otorhinolaryngologists in clinical practice was associated with an increased probability of Class 2 membership (OR = 5.88, 95%CI [2.94-13.19]; OR = 15.95, 95% CI [10.92-23.81] respectively). Examining more than 20 children with SDB during the last month decreased the probability of Class 2 membership (OR = 0.29, 95% CI [0.14-0.61]). FCPs showed a higher probability of Class 2 membership than PHPs (OR = 4.64, 95% CI [3.31-6.55]). CONCLUSIONS: These findings suggest that the LCA approach can provide important information on how education and training could be tailored for different subgroups of paediatricians. In Italy standardized educational interventions improving paediatricians' screening of SDB are needed in order to guarantee efficient management of children with SDB and reduce the burden of disease

The Volsci Volcanic Field (central Italy). Eruptive history, magma system and implications on continental subduction processes.

Here, we report on the Quaternary Volsci Volcanic Field (VVF, central Italy). In light of new 40Ar/39Ar geochronological data and compositional characterization of juvenile eruptive products, we refine the history of VVF activity, and outline the implications on the pre-eruptive magma system and the continental subduction processes involved. Different from the nearby volcanic districts of the Roman and Campanian Provinces, the VVF was characterized by small-volume (0.01–0.1 km3) eruptions from a network of monogenetic centers (mostly tuff rings and scoria cones, with subordinate lava occurrences), clustered along high-angle faults of lithospheric depth. Leucite-bearing, high-K (HKS) magmas (for which we report for the first time the phlogopite phenocryst compositions) mostly fed the early phase of activity (∼761–539 ka), then primitive, plagioclase-bearing (KS) magmas appeared during the climactic phase (∼424–349 ka), partially overlapping with HKS ones, and then prevailed during the late phase of activity (∼300–231 ka). The fast ascent of primitive magma batches is typical of a tectonically controlled volcanic field, where the very low magma flux is a passive byproduct of regional tectonic strain. We suggest that the dominant compressive stress field acting at depth was accompanied by an extensional regime in the upper crust, associated with the gravity spreading of the Apennine chain, allowing the fast ascent of magma from the mantle source with limited stationing in shallow reservoirs

Predictive and prognostic value of inflammatory markers in locally advanced rectal cancer (PILLAR) – A multicentric analysis by the Italian Association of Radiotherapy and Clinical Oncology (AIRO) Gastrointestinal Study Group

Background: Patients (pts) affected with locally advanced rectal cancer (LARC) may respond differently to neoadjuvant chemoradiotherapy (nCRT). The identification of reliable biomarkers able to predict oncological outcomes could help in the development of risk-adapted treatment strategies. It has been suggested that inflammation parameters may have a role in predicting tumor response to nCRT and survival outcomes and in rectal cancer, but no definitive conclusion can be drawn at present. The aim of the current study is to evaluate the role of baseline inflammatory markers as prognostic and predictive factors in a large multicentric Italian cohort of LARC pts. Methods: Patients diagnosed with LARC from January 2002 to December 2019 in 9 Italian centers were retrospectively collected. Patients underwent long-course RT with chemotherapy based on fluoropyrimidine ± oxaliplatin followed by surgery. Inflammatory markers were retrieved based on a pre-treatment blood sample including HEI (hemo-eosinophils inflammation index), SII (systemic index of inflammation), NLR (neutrophil-to-lymphocyte ratio), PLR (platelet-to-lymphocyte ratio) and MLR (monocyte-to-lymphocyte ratio). Outcomes of interest were pathological complete response (pCR), disease-free survival (DFS), and overall survival (OS). Results: 808 pts were analyzed. pCR rate was 22 %, 5yOS and 5yDFS were 84.0% and 63.1% respectively. Multivariate analysis identified that a NLR cut-off value >1.2 and SII cut-off value >500 could predict pCR (p = 0.05 and 0.009 respectively). In addition to age, extramesorectal nodes and RT dose, MLR >0.18 (p = 0.03) and HEI = 3 (p = 0.05) were independent prognostic factors for DFS. Finally, age, RT dose, MLR with a cut-off >0.35 (p = 0.028) and HEI = 3 (p = 0.045) were independent predictors of OS. Conclusions: Higher values of baseline composite inflammatory markers can serve as predictors of lower pCR rates and worse survival outcomes in LARC patients undergoing nCRT. More reliable data from prospective studies could lead to the integration of these inexpensive and easy-to-derive tools into clinical practice

Pleistocene tephrostratigraphy and palaeoclimatology in the central Mediterranean region: ongoing research in Fucino Basin (central Apennines, Italy)

Palaeoclimatic records spanning beyond the radiocarbon range generally derive their chronologies from orbital tuning strategies. These chronologies can introduce a priori assumptions that are difficult to test and, possibly, circular arguments in palaeoclimatic reconstructions. We elaborate two high-resolution, multi-proxy and tephrochronologically-constrained records (F1-F3 and F4-F5) of past environmental and climatic changes in the central Mediterranean region. We perform geochemical (X-ray fluorescence scanning, carbon, nitrogen and sulphur elemental analysis through combustion), isotopic (C and O stable isotope mass spectrometry on bulk carbonates and organic matter), mineralogical (X-ray powder diffraction) and grain-size analyses on lacustrine marls recovered from palaeolake Fucino (Abruzzo, central Italy). Lacustrine sediments were acquired during two scientific drilling campaigns (F1-F3 and F4-F5) interesting the first ca. 85 m of the 1 km-thick and 2 Ma-old Fucino sedimentary succession. We make use of detailed tephrostratigraphic and tephrochronological frameworks to produce robust and independent chronologies based on new and published 40Ar/39Ar and 14C dating of tephra layers. On the basis of our chronologies, the F1-F3 and F4-F5 records continuously span over the last two glacial-interglacial cycles and over the last five glacial-interglacial cycles, respectively. We combine our geological data into proxies for catchment- and regional-scale environmental processes. Our proxy time-series depict prominent orbital and sub-orbital environmental changes that can be tracked in other lacustrine, marine and speleothem records across the Mediterranean and North Atlantic regions. Thanks to tephrostratigraphic correlations and chronological matching, we produce spatially coherent palaeoclimatic reconstructions recognising a complex interplay between regional environmental processes and broad-scale climatic events. We highlight strong orbital forcing for past climate changes

Genomic and functional regulation of TRIB1 contributes to prostate cancer pathogenesis

Prostate cancer is the most frequent malignancy in European men and the second worldwide. One of the major oncogenic events in this disease includes amplification of the transcription factor cMYC. Amplification of this oncogene in chromosome 8q24 occurs concomitantly with the copy number increase in a subset of neighboring genes and regulatory elements, but their contribution to disease pathogenesis is poorly understood. Here we show that TRIB1 is among the most robustly upregulated coding genes within the 8q24 amplicon in prostate cancer. Moreover, we demonstrate that TRIB1 amplification and overexpression are frequent in this tumor type. Importantly, we find that, parallel to its amplification, TRIB1 transcription is controlled by cMYC. Mouse modeling and functional analysis revealed that aberrant TRIB1 expression is causal to prostate cancer pathogenesis. In sum, we provide unprecedented evidence for the regulation and function of TRIB1 in prostate cancer

Mediterranean winter rainfall in phase with African monsoons during the past 1.36 million years

Mediterranean climates are characterized by strong seasonal contrasts between dry summers and wet winters. Changes in winter rainfall are critical for regional socioeconomic development, but are difficult to simulate accurately1 and reconstruct on Quaternary timescales. This is partly because regional hydroclimate records that cover multiple glacial–interglacial cycles2,3 with different orbital geometries, global ice volume and atmospheric greenhouse gas concentrations are scarce. Moreover, the underlying mechanisms of change and their persistence remain unexplored. Here we show that, over the past 1.36 million years, wet winters in the northcentral Mediterranean tend to occur with high contrasts in local, seasonal insolation and a vigorous African summer monsoon. Our proxy time series from Lake Ohrid on the Balkan Peninsula, together with a 784,000-year transient climate model hindcast, suggest that increased sea surface temperatures amplify local cyclone development and refuel North Atlantic low-pressure systems that enter the Mediterranean during phases of low continental ice volume and high concentrations of atmospheric greenhouse gases. A comparison with modern reanalysis data shows that current drivers of the amount of rainfall in the Mediterranean share some similarities to those that drive the reconstructed increases in precipitation. Our data cover multiple insolation maxima and are therefore an important benchmark for testing climate model performance

A survey around the Italian pediatric units on current clinical practice for Sleep Disordered Breathing (SDB)

Background: During recent years, interest on Sleep Disordered Breathing (SDB) in pediatric age has increased, due to the impact on quality of life, psycho-physical attitude and other serious morbidities if undiagnosed and untreated. Methods: Italian Pediatric Respiratory Diseases Society (SIMRI) SDB-Working Group carried out an exploratory surve in Italy, from January to December 2016, to assess the diagnostic and therapeutic pathways, perception and relevance of SDB in Italian Hospitals. Results: A questionnaire was sent to 180 Pediatric Units (PUs) distributed throughout the Italy; 102 Pediatric Units (PUs; 56.6%) answered and among them 57% dealt with SDB, and 94% recognized SDB as a major problem. Instrumental tests performed by the PUs were saturimetry (66%), nocturnal polygraphy with complete cardiorespiratory monitoring (46%) and full polysomnography (23%). In addition, hospital pediatricians reported that 54% of parents were unaware of the SDB and 84% did not know their complications. In the Northern Italy, the diagnosi was frequently performed with instrumental tools and the treatment was often surgical. In the Southern Italy the diagnosis was clinical, and the treatment was usually with drugs. Conclusions: The results of our study showed a heterogeneity in the diagnosis and treatment of SDB throughout Italy. Parents know little about SDB and their complications. The operator satisfaction was associated with the availability of tools for diagnosing SDB

A survey around the Italian pediatric units on current clinical practice for Sleep Disordered Breathing (SDB)

Background: During recent years, interest on Sleep Disordered Breathing (SDB) in pediatric age has increased, due to the impact on quality of life, psycho-physical attitude and other serious morbidities if undiagnosed and untreated. Methods: Italian Pediatric Respiratory Diseases Society (SIMRI) SDB-Working Group carried out an exploratory surve in Italy, from January to December 2016, to assess the diagnostic and therapeutic pathways, perception and relevance of SDB in Italian Hospitals. Results: A questionnaire was sent to 180 Pediatric Units (PUs) distributed throughout the Italy; 102 Pediatric Units (PUs; 56.6%) answered and among them 57% dealt with SDB, and 94% recognized SDB as a major problem. Instrumental tests performed by the PUs were saturimetry (66%), nocturnal polygraphy with complete cardiorespiratory monitoring (46%) and full polysomnography (23%). In addition, hospital pediatricians reported that 54% of parents were unaware of the SDB and 84% did not know their complications. In the Northern Italy, the diagnosi was frequently performed with instrumental tools and the treatment was often surgical. In the Southern Italy the diagnosis was clinical, and the treatment was usually with drugs. Conclusions: The results of our study showed a heterogeneity in the diagnosis and treatment of SDB throughout Italy. Parents know little about SDB and their complications. The operator satisfaction was associated with the availability of tools for diagnosing SDB