Accuracy of needle biopsy of breast lesions visible on ultrasound: audit of fine needle versus core needle biopsy in 3233 consecutive samplings with ascertained outcomes.

Abstract Introduction Core needle biopsy (CNB) has progressively replaced fine needle aspiration cytology (FNAC) in the diagnosis of breast lesions. Less information is available on how these tests perform for biopsy of ultrasound (US) visible breast lesions. This study examines the outcomes of CNB and FNAC in a large series ascertained with surgical histology or clinical-imaging follow-up. Materials and methods Retrospective five-year audit of 3233 consecutive US-guided needle samplings of solid breast lesions, from self-referred symptomatic or asymptomatic subjects, performed by six radiologists in the same time-frame (2003–2006): 1950 FNAC and 1283 CNB. The probability of undergoing CNB as a first test instead of FNAC was evaluated using logistic regression. Accuracy and inadequacy were calculated for each of CNB and FNAC performed as first test. Accuracy measures included equivocal or borderline/atypical lesions as positive results. Results The probability of CNB as a first test instead of FNAC increased significantly over time, when there was a pre-test higher level of suspicion, in younger (relative to older) women, with increasing lesion size on imaging, and for palpable (relative to impalpable) lesions. Inadequacy rate was lower for CNB (B1 = 6.9%) than for FNAC (C1 = 17.7%), p vs . C1 = 4.5%; p vs . 74.4%; p vs . 93.8%; p = 0.001), however specificity was lower for CNB than FNAC (88.3% vs . 96.4%; p vs . 71.9; p complete diagnostic accuracy (95.4% vs . 93.2; p Conclusion FNAC and CNB were generally performed in different patients, thus our study reported indirect comparisons of these tests. Although FNAC performed well (except for relatively high inadequacy), CNB had significantly better performance based on measures of sensitivity, but this was associated with lower specificity for CNB relative to FNAC. Overall, CNB is the more reliable biopsy method for sonographically-visible lesions; where FNAC is used as the first-line test, inadequate or inconclusive FNAC can be largely resolved by using repeat sampling with CNB

Serum concentrations of perfluorinated alkyl substances in farmers living in areas affected by water contamination in the Veneto Region (Northern Italy)

Abstract Human exposure to per- and polyfluorinated alkyl substances (PFASs) is a major public health concern because in the last decades several cases of overexposure of people to PFASs, in particular through contaminated water, occurred worldwide. In 2013–2017 a PFAS drinking water contamination was discovered and investigated in northern Italy (Veneto region) and high PFAS serum levels were detected in exposed people. 629 subjects were enrolled: 257 residing in municipalities in the areas under impact, 250 residing in municipalities in areas at presumed background exposure and 122 farmers living in contaminated rural areas producing and consuming own livestock and vegetables and frequently using well water. The highest PFAS serum concentrations (median PFOA concentrations 40 ng/g) were found in the subgroup of farmers. The main factors influencing PFAS serum levels of farmers were residence area and the related extent of drinking water contamination, gender, years of residence in the municipalities, well water consumption and consumption of own produced food. PFOA serum concentrations in farmers residing in the areas of the Veneto region impacted by PFAS contamination are among the highest found worldwide

Scuola, diritti umani e cittadinanza europea. Percorsi di formazione e ricerca-azione nelle scuole del Piemonte

Educare nella scuola ai diritti e ai doveri dei futuri cittadini, alla ricerca di un senso civico e della cosa pubblica di cui oggi abbiamo molto bisogno: temi importanti e difficili, che ricadono fra le tante responsabilità della scuola italiana e dei suoi insegnanti e su cui la Fondazione Agnelli ha avviato un percorso di collaborazione con l’Ufficio Scolastico Regionale del Piemonte che il volume documenta.- Indice #5- Prefazione, Anna Maria Dominici #9- Prefazione, Marco Demarie #13- Introduzione al progetto Educazione alla cittadinanza e alla solidarietà: cultura dei diritti umani, Luigi Catalano #15- Il progetto nazionale, Simonetta Fichelli #17- Il progetto regionale, Carla Fiore #23- Guida alla lettura #29- Saggi #31- La protezione internazionale dei diritti umani, Edoardo Greppi #33- La protezione europea dei diritti umani nella Carta di Nizza, Jörg Luther #45- Scuola e società multietnica, Lorenzo Fischer #57- Scuola, islam e il dibattito sui diritti dell’uomo, Andrea Pacini #65- I progetti delle scuole piemontesi #75- Appendici #157- Appendice A Scheda progetto nazionale 2003 Educazione alla cittadinanza e alla solidarietà: cultura dei diritti umani #159- Appendice B Diritti in mostra, Gemma Re #171Appendice C L’Osservatorio sulla Convenzione Europea, Stefano Milia #17

Genomic and phenotypic insights from an atlas of genetic effects on DNA methylation

Characterizing genetic influences on DNA methylation (DNAm) provides an opportunity to understand mechanisms underpinning gene regulation and disease. In the present study, we describe results of DNAm quantitative trait locus (mQTL) analyses on 32,851 participants, identifying genetic variants associated with DNAm at 420,509 DNAm sites in blood. We present a database of >270,000 independent mQTLs, of which 8.5% comprise long-range (trans) associations. Identified mQTL associations explain 15–17% of the additive genetic variance of DNAm. We show that the genetic architecture of DNAm levels is highly polygenic. Using shared genetic control between distal DNAm sites, we constructed networks, identifying 405 discrete genomic communities enriched for genomic annotations and complex traits. Shared genetic variants are associated with both DNAm levels and complex diseases, but only in a minority of cases do these associations reflect causal relationships from DNAm to trait or vice versa, indicating a more complex genotype–phenotype map than previously anticipated

Methodology used in studies reporting chronic kidney disease prevalence: a systematic literature review

Background Many publications report the prevalence of chronic kidney disease (CKD) in the general population. Comparisons across studies are hampered as CKD prevalence estimations are influenced by study population characteristics and laboratory methods. Methods For this systematic review, two researchers independently searched PubMed, MEDLINE and EMBASE to identify all original research articles that were published between 1 January 2003 and 1 November 2014 reporting the prevalence of CKD in the European adult general population. Data on study methodology and reporting of CKD prevalence results were independently extracted by two researchers. Results We identified 82 eligible publications and included 48 publications of individual studies for the data extraction. There was considerable variation in population sample selection. The majority of studies did not report the sampling frame used, and the response ranged from 10 to 87%. With regard to the assessment of kidney function, 67% used a Jaffe assay, whereas 13% used the enzymatic assay for creatinine determination. Isotope dilution mass spectrometry calibration was used in 29%. The CKD-EPI (52%) and MDRD (75%) equations were most often used to estimate glomerular filtration rate (GFR). CKD was defined as estimated GFR (eGFR) <60 mL/min/1.73 m2 in 92% of studies. Urinary markers of CKD were assessed in 60% of the studies. CKD prevalence was reported by sex and age strata in 54 and 50% of the studies, respectively. In publications with a primary objective of reporting CKD prevalence, 39% reported a 95% confidence interval. Conclusions The findings from this systematic review showed considerable variation in methods for sampling the general population and assessment of kidney function across studies reporting CKD prevalence. These results are utilized to provide recommendations to help optimize both the design and the reporting of future CKD prevalence studies, which will enhance comparability of study result

Acute Delta Hepatitis in Italy spanning three decades (1991–2019): Evidence for the effectiveness of the hepatitis B vaccination campaign

Updated incidence data of acute Delta virus hepatitis (HDV) are lacking worldwide. Our aim was to evaluate incidence of and risk factors for acute HDV in Italy after the introduction of the compulsory vaccination against hepatitis B virus (HBV) in 1991. Data were obtained from the National Surveillance System of acute viral hepatitis (SEIEVA). Independent predictors of HDV were assessed by logistic-regression analysis. The incidence of acute HDV per 1-million population declined from 3.2 cases in 1987 to 0.04 in 2019, parallel to that of acute HBV per 100,000 from 10.0 to 0.39 cases during the same period. The median age of cases increased from 27 years in the decade 1991-1999 to 44 years in the decade 2010-2019 (p &lt; .001). Over the same period, the male/female ratio decreased from 3.8 to 2.1, the proportion of coinfections increased from 55% to 75% (p = .003) and that of HBsAg positive acute hepatitis tested for by IgM anti-HDV linearly decreased from 50.1% to 34.1% (p &lt; .001). People born abroad accounted for 24.6% of cases in 2004-2010 and 32.1% in 2011-2019. In the period 2010-2019, risky sexual behaviour (O.R. 4.2; 95%CI: 1.4-12.8) was the sole independent predictor of acute HDV; conversely intravenous drug use was no longer associated (O.R. 1.25; 95%CI: 0.15-10.22) with this. In conclusion, HBV vaccination was an effective measure to control acute HDV. Intravenous drug use is no longer an efficient mode of HDV spread. Testing for IgM-anti HDV is a grey area requiring alert. Acute HDV in foreigners should be monitored in the years to come

- S. Boesch Gajano, Profilo di Eugenio Duprè Theseider- S. Bernardi,il contributo di Eugenio Duprè Theseider alla storia marchigiana- M. T. Caciorgna, Eugenio Duprè Theseider e Roma. La città e il distretto- A. Volpato, Le lettere di Santa Caterina da Sie

Il volume 'La storiografia di Eugenio Dupré Theseider', è stato pubblicato a seguito del convegno (Rieti 28-30 marzo 1988) incentrato sulla rivisitazione degli apporti metodologici e storiografici negli ambiti di ricerca in cui il prof. Dupré, uno dei più insigni storici del Medioevo del Novecento, docente nella Facoltà di Magistero dalla quale ha avuto origine la Facoltà di Lettere di Roma Tre, aveva dato le prove più significative. Il volume appare in occasione del centenario della nascita di Eugenio Dupré Theseider (1898-1975) e si presenta articolato in diciannove saggi di carattere storiografico che analizzano aspetti e momenti particolarmente significativi del suo vario e ricco itinerario di studioso e di docente universitario, e della sua produzione scientifica connotata prevalentemente in senso medievistico e orientata soprattutto ad approfondire importanti tematiche, relative all'idea imperiale, la riconquista dell'Albornoz, gli studi sulla corona d'Aragona, le eresie, gli studi sulla città medioevale e Roma nel Medioevo, le lettere di Santa Caterina, il rapporto tra geografia e storia, l'araldica. Il recupero della sua intensa attività cinquantennale di storico, maturata, attraverso rinnovati e difficili mutamenti epocali, nel pieno del secolo scorso, ha consentito di definire la singolare posizione del Duprè nel quadro della storiografia italiana ed europea, di misurarne in molteplici ambiti di ricerca l'apporto scientifico e di valutarne in prospettiva i risultati. Il significato della sua presenza di storico, versatile, elegante e insieme coerente, di eccellente didatta soprattutto sul piano metodologico e storiografico, trova una convincente illustrazione e spiegazione in particolare negli ultimi saggi tesi a individuare nella sua personalità di studioso il profilo di uomo e di credente. La sinergia tra l'Università di Roma Tre, l'Università di Bologna e l'Istituto storico italiano per il Medio Evo ha permesso la realizzazione del volume a cui hanno partecipato illustri studiosi italiani e stranieri con relazioni centrate sui temi cari allo storico e seguendone i successivi sviluppi storiografici

La figura dell'infermiere forense: la situazione italiana ed il confronto con le realtà estere [The forensic nurse: comparison between foreign countries and Italy]

L’infermiere forense è il professionista specializzato che, grazie alle specifiche competenze, intersecanti il sistema sanitario con quello giuridico, può gestire situazioni che richiedono peculiari conoscenze, a sostegno del medico legale e dell’Autorità Giudiziaria. Tale figura professionale gode di riconoscimento ufficiale in diverse realtà estere da svariati anni, tuttavia in Italia non si è ancora provveduto ad un suo pieno riconoscimento formale. Nel presente elaborato si illustreranno le mansioni dell’infermiere forense in alcuni Paesi esteri, con particolare riferimento all’assistenza specializzata alle vittime di violenze e di abusi, alla gestione degli aspetti clinico-legali correlati all’assistenza del paziente ed alla collaborazione con i medici in sala settoria o sulla scena di un crimine. Sarà precisato l’inquadramento attuale dell’infermiere forense in Italia, offrendo spunti di riflessione in merito alle possibili prospettive future di tale disciplina.Forensic nurses are Registered or Advanced Practice nurses who have received specific education and training. They play an integral role in bridging the gap between law and medicine. Forensic nurses have been officially recognized in various foreign countries, where they work in a variety of fields, including sexual assault, domestic violence, child abuse, neglect, and death investigation. However, forensic nurses are not currently fully recognized in Italy. In this paper, concrete examples of how forensic nurses are employed in some foreign countries will be discussed, and prospects for forensic nursing in Italy will be analyzed