Clinical features and outcomes of elderly hospitalised patients with chronic obstructive pulmonary disease, heart failure or both

Background and objective: Chronic obstructive pulmonary disease (COPD) and heart failure (HF) mutually increase the risk of being present in the same patient, especially if older. Whether or not this coexistence may be associated with a worse prognosis is debated. Therefore, employing data derived from the REPOSI register, we evaluated the clinical features and outcomes in a population of elderly patients admitted to internal medicine wards and having COPD, HF or COPD + HF. Methods: We measured socio-demographic and anthropometric characteristics, severity and prevalence of comorbidities, clinical and laboratory features during hospitalization, mood disorders, functional independence, drug prescriptions and discharge destination. The primary study outcome was the risk of death. Results: We considered 2,343 elderly hospitalized patients (median age 81 years), of whom 1,154 (49%) had COPD, 813 (35%) HF, and 376 (16%) COPD + HF. Patients with COPD + HF had different characteristics than those with COPD or HF, such as a higher prevalence of previous hospitalizations, comorbidities (especially chronic kidney disease), higher respiratory rate at admission and number of prescribed drugs. Patients with COPD + HF (hazard ratio HR 1.74, 95% confidence intervals CI 1.16–2.61) and patients with dementia (HR 1.75, 95% CI 1.06–2.90) had a higher risk of death at one year. The Kaplan–Meier curves showed a higher mortality risk in the group of patients with COPD + HF for all causes (p = 0.010), respiratory causes (p = 0.006), cardiovascular causes (p = 0.046) and respiratory plus cardiovascular causes (p = 0.009). Conclusion: In this real-life cohort of hospitalized elderly patients, the coexistence of COPD and HF significantly worsened prognosis at one year. This finding may help to better define the care needs of this population

Sex-Differences in the Pattern of Comorbidities, Functional Independence, and Mortality in Elderly Inpatients: Evidence from the RePoSI Register

Background: The RePoSi study has provided data on comorbidities, polypharmacy, and sex dimorphism in hospitalised elderly patients. Methods: We retrospectively analysed data collected from the 2010, 2012, 2014, and 2016 data sets of the RePoSi register. The aim of this study was to explore the sex-differences and to validate the multivariate model in the entire dataset with an expanded follow-up at 1 year. Results: Among 4714 patients, 51% were women and 49% were men. The disease distribution showed that diabetes, coronary artery disease, chronic obstructive pulmonary disease, chronic kidney disease, and malignancy were more frequent in men but that hypertension, anaemia, osteoarthritis, depression, and diverticulitis disease were more common in women. Severity and comorbidity indexes according to the Cumulative Illness Rating Scale (CIRS-s and CIRS-c) were higher in men, while cognitive impairment, mood disorders, and disability in daily life measured by the Barthel Index (BI) were worse in women. In the multivariate analysis, BI, CIRS, and malignancy significantly increased the risk of death in men at the 1-year follow-up, while age was independently associated with mortality in women. Conclusions: Our study highlighted the relevance and the validity of our previous predictive model in the identification of sex dimorphism in hospitalised elderly patients underscoring the need of sex-personalised health-care

Need for deprescribing in hospital elderly patients discharged with a limited life expectancy: The REPOSI study

Objective: Older people approaching the end of life are at a high risk for adverse drug reactions. Approaching the end of life should change the therapeutic aims, triggering a reduction in the number of drugs. The main aim of this study is to describe the preventive and symptomatic drug treatments prescribed to patients discharged with a limited life expectancy from internal medicine and geriatric wards. The secondary aim was to describe the potentially severe drug-drug interactions (DDI). Materials and Methods: We analyzed Registry of Polytherapies Societa Italiana di Medicina Interna (REPOSI), a network of internal medicine and geriatric wards, to describe the drug therapy of patients discharged with a limited life expectancy. Results: The study sample comprised 55 patients discharged with a limited life expectancy. Patients with at least 1 preventive medication that could be considered for deprescription at the end of life were significantly fewer from admission to discharge (n = 30; 54.5% vs. n = 21; 38.2%; p = 0.02). Angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, calcium channel blockers, lipid-lowering drugs, and clonidine were the most frequent potentially avoidable medications prescribed at discharge, followed by xanthine oxidase inhibitors and drugs to prevent fractures. Thirty-seven (67.3%) patients were also exposed to at least 1 potentially severe DDI at discharge. Conclusion: Hospital discharge is associated with a small reduction in the use of commonly prescribed preventive medications in patients discharged with a limited life expectancy. Cardiovascular drugs are the most frequent potentially avoidable preventive medications. A consensus framework or shared criteria for potentially inappropriate medication in elderly patients with limited life expectancy could be useful to further improve drug prescription

Mortality rate and risk factors for gastrointestinal bleeding in elderly patients

Background: Gastrointestinal bleeding (GIB) is burdened by high mortality rate that increases with aging. Elderly patients may be exposed to multiple risk factors for GIB. We aimed at defining the impact of GIB in elderly patients. Methods: Since 2008, samples of elderly patients (age 65 65 years) with multimorbidity admitted to 101 internal medicine wards across Italy have been prospectively enrolled and followed-up (REPOSI registry). Diagnoses of GIB, length of stay (LOS), mortality rate, and possible risk factors, including drugs, index of comorbidity (Cumulative Illness Rating Scale [CIRS]), polypharmacy, and chronic diseases were assessed. Adjusted multivariate logistic regression models were computed. Results: 3872 patients were included (mean age 79 \ub1 7.5 years, F:M ratio 1.1:1). GIB was reported in 120 patients (mean age 79.6 \ub1 7.3 years, F:M 0.9:1), with a crude prevalence of 3.1%. Upper GIB occurred in 72 patients (mean age 79.3 \ub1 7.6 years, F:M 0.8:1), lower GIB in 51 patients (mean age 79.4 \ub1 7.1 years, F:M 0.9:1), and both upper/lower GIB in 3 patients. Hemorrhagic gastritis/duodenitis and colonic diverticular disease were the most common causes. The LOS of patients with GIB was 11.7 \ub1 8.1 days, with a 3.3% in-hospital and a 9.4% 3-month mortality rates. Liver cirrhosis (OR 5.64; CI 2.51\u201312.65), non-ASA antiplatelet agents (OR 2.70; CI 1.23\u20135.90), and CIRS index of comorbidity >3 (OR 2.41; CI 1.16\u20134.98) were associated with GIB (p < 0.05). Conclusions: A high index of comorbidity is associated with high odds of GIB in elderly patients. The use of non-ASA antiplatelet agents should be discussed in patients with multimorbidity

Pattern of comorbidities and 1-year mortality in elderly patients with COPD hospitalized in internal medicine wards: data from the RePoSI Registry

Currently, chronic obstructive pulmonary disease (COPD) represents the fourth cause of death worldwide with significant economic burden. Comorbidities increase in number and severity with age and are identified as important determinants that influence the prognosis. In this observational study, we retrospectively analyzed data collected from the RePoSI register. We aimed to investigate comorbidities and outcomes in a cohort of hospitalized elderly patients with the clinical diagnosis of COPD. Socio-demographic, clinical characteristics and laboratory findings were considered. The association between variables and in-hospital, 3-month and 1-year follow-up were analyzed. Among 4696 in-patients, 932 (19.8%) had a diagnosis of COPD. Patients with COPD had more hospitalization, a significant overt cognitive impairment, a clinically significant disability and more depression in comparison with non-COPD subjects. COPD patients took more drugs, both at admission, in-hospital stay, discharge and 3-month and 1-year follow-up. 14 comorbidities were more frequent in COPD patients. Cerebrovascular disease was an independent predictor of in-hospital mortality. At 3-month follow-up, male sex and hepatic cirrhosis were independently associated with mortality. ICS-LABA therapy was predictor of mortality at in-hospital, 3-month and 1-year follow-up. This analysis showed the severity of impact of COPD and its comorbidities in the real life of internal medicine and geriatric wards

Prevalence of use and appropriateness of antidepressants prescription in acutely hospitalized elderly patients

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Hyperglycemia at admission, comorbidities, and in-hospital mortality in elderly patients hospitalized in internal medicine wards: data from the RePoSI Registry

377nononeAims: The association between hyperglycemia at hospital admission and relevant short- and long-term outcomes in elderly population is known. We assessed the effects on mortality of hyperglycemia, disability, and multimorbidity at admission in internal medicine ward in patients aged ≥ 65&nbsp;years. Methods: Data were collected from an active register of 102 internal medicine and geriatric wards in Italy (RePoSi project). Patients were recruited during four index weeks of a year. Socio-demographic data, reason for hospitalization, diagnoses, treatment, severity and comorbidity indexes (Cumulative Illness rating Scale CIRS-SI and CIRS-CI), renal function, functional (Barthel Index), and cognitive status (Short Blessed Test) and mood disorders (Geriatric Depression Scale) were recorded. Mortality rates were assessed in hospital 3 and 12&nbsp;months after discharge. Results: Of the 4714 elderly patients hospitalized, 361 had a glycemia level ≥ 250&nbsp;mg/dL at admission. Compared to subjects with lower glycemia level, patients with glycemia ≥ 250&nbsp;mg/dL showed higher rates of male sex, smoke and class III obesity. These patients had a significantly lower Barthel Index (p = 0.0249), higher CIRS-SI and CIRS-CI scores (p = 0.0025 and p = 0.0013, respectively), and took more drugs. In-hospital mortality rate was 9.2% and 5.1% in subjects with glycemia ≥ 250 and &lt; 250&nbsp;mg/dL, respectively (p = 0.0010). Regression analysis showed a strong association between in-hospital death and glycemia ≥ 250&nbsp;mg/dL (OR 2.07; [95% CI 1.34–3.19]), Barthel Index ≤ 40 (3.28[2.44–4.42]), CIRS-SI (1.87[1.27–2.77]), and male sex (1.54[1.16–2.03]). Conclusions: The stronger predictors of in-hospital mortality for older patients admitted in general wards were glycemia level ≥ 250&nbsp;mg/dL, Barthel Index ≤ 40, CIRS-SI, and male sex.noneCorrao S.; Nobili A.; Natoli G.; Mannucci P.M.; Perticone F.; Pietrangelo A.; Argano C.; Licata G.; Violi F.; Corazza G.R.; Corrao S.; Marengoni A.; Salerno F.; Cesari M.; Tettamanti M.; Pasina L.; Franchi C.; Franchi C.; Cortesi L.; Tettamanti M.; Miglio G.; Tettamanti M.; Cortesi L.; Ardoino I.; Novella A.; Prisco D.; Silvestri E.; Emmi G.; Bettiol A.; Caterina C.; Biolo G.; Zanetti M.; Guadagni M.; Zaccari M.; Chiuch M.; Zaccari M.; Vanoli M.; Grignani G.; Pulixi E.A.; Bernardi M.; Bassi S.L.; Santi L.; Zaccherini G.; Lupattelli G.; Mannarino E.; Bianconi V.; Paciullo F.; Alcidi R.; Nuti R.; Valenti R.; Ruvio M.; Cappelli S.; Palazzuoli A.; Girelli D.; Busti F.; Marchi G.; Barbagallo M.; Dominguez L.; Cocita F.; Beneduce V.; Plances L.; Mularo S.; Raspanti M.; Zoli M.; Lazzari I.; Brunori M.; Fabbri E.; Magalotti D.; Arno R.; Pasini F.L.; Capecchi P.L.; Palasciano G.; Modeo M.E.; Di Gennaro C.; Cappellini M.D.; Maira D.; Di Stefano V.; Fabio G.; Seghezzi S.; Mancarella M.; De Amicis M.M.; De Luca G.; Scaramellini N.; Cesari M.; Rossi P.D.; Damanti S.; Clerici M.; Conti F.; Bonini G.; Ottolini B.B.; Di Sabatino A.; Miceli E.; Lenti M.V.; Pisati M.; Dominioni C.C.; Murialdo G.; Marra A.; Cattaneo F.; Pontremoli R.; Beccati V.; Nobili G.; Secchi M.B.; Ghelfi D.; Anastasio L.; Sofia L.; Carbone M.; Cipollone F.; Guagnano M.T.; Valeriani E.; Rossi I.; Mancuso G.; Calipari D.; Bartone M.; Delitala G.; Berria M.; Pes C.; Delitala A.; Muscaritoli M.; Molfino A.; Petrillo E.; Zuccala G.; D'Aurizio G.; Romanelli G.; Marengoni A.; Zucchelli A.; Manzoni F.; Volpini A.; Picardi A.; Gentilucci U.V.; Gallo P.; Dell'Unto C.; Annoni G.; Corsi M.; Bellelli G.; Zazzetta S.; Mazzola P.; Szabo H.; Bonfanti A.; Arturi F.; Succurro E.; Rubino M.; Tassone B.; Sesti G.; Serra M.G.; Bleve M.A.; Gasbarrone L.; Sajeva M.R.; Brucato A.; Ghidoni S.; Fabris F.; Bertozzi I.; Bogoni G.; Rabuini M.V.; Cosi E.; Scarinzi P.; Amabile A.; Omenetto E.; Prandini T.; Manfredini R.; Fabbian F.; Boari B.; De Giorgi A.; Tiseo R.; De Giorgio R.; Paolisso G.; Rizzo M.R.; Borghi C.; Strocchi E.; Ianniello E.; Soldati M.; Sabba C.; Vella F.S.; Suppressa P.; Schilardi A.; Loparco F.; De Vincenzo G.M.; Comitangelo A.; Amoruso E.; Fenoglio L.; Falcetta A.; Bracco C.; Fargion A.L.F.S.; Tiraboschi S.; Cespiati A.; Oberti G.; Sigon G.; Peyvandi F.; Rossio R.; Ferrari B.; Colombo G.; Agosti P.; Monzani V.; Savojardo V.; Folli C.; Ceriani G.; Salerno F.; Pallini G.; Dallegri F.; Ottonello L.; Liberale L.; Caserza L.; Salam K.; Liberato N.L.; Tognin T.; Bianchi G.B.; Giaquinto S.; Purrello F.; Di Pino A.; Piro S.; Rozzini R.; Falanga L.; Spazzini E.; Ferrandina C.; Montrucchio G.; Petitti P.; Peasso P.; Favale E.; Poletto C.; Salmi R.; Gaudenzi P.; Violi F.; Perri L.; Landolfi R.; Montalto M.; Mirijello A.; Guasti L.; Castiglioni L.; Maresca A.; Squizzato A.; Campiotti L.; Grossi A.; Bertolotti M.; Mussi C.; Lancellotti G.; Libbra M.V.; Dondi G.; Pellegrini E.; Carulli L.; Galassi M.; Grassi Y.; Perticone M.; Battaglia R.; FIlice M.; Maio R.; Stanghellini V.; Ruggeri E.; del Vecchio S.; Salvi A.; Leonardi R.; Damiani G.; Capeci W.; Gabrielli A.; Mattioli M.; Martino G.P.; Biondi L.; Pettinari P.; Ghio R.; Col A.D.; Minisola S.; Colangelo L.; Cilli M.; Labbadia G.; Afeltra A.; Marigliano B.; Pipita M.E.; Castellino P.; Zanoli L.; Pignataro S.; Gennaro A.; Blanco J.; Saracco V.; Fogliati M.; Bussolino C.; Mete F.; Gino M.; Cittadini A.; Vigorito C.; Arcopinto M.; Salzano A.; Bobbio E.; Marra A.M.; Sirico D.; Moreo G.; Gasparini F.; Prolo S.; Pina G.; Ballestrero A.; Ferrando F.; Berra S.; Dassi S.; Nava M.C.; Graziella B.; Baldassarre S.; Fragapani S.; Gruden G.; Galanti G.; Mascherini G.; Petri C.; Stefani L.; Girino M.; Piccinelli V.; Nasso F.; Gioffre V.; Pasquale M.; Scattolin G.; Martinelli S.; Turrin M.; Sechi L.; Catena C.; Colussi G.; Passariello N.; Rinaldi L.; Berti F.; Famularo G.; Tarsitani P.; Castello R.; Pasino M.; Ceda G.P.; Maggio M.G.; Morganti S.; Artoni A.; Del Giacco S.; Firinu D.; Losa F.; Paoletti G.; Costanzo G.; Montalto G.; Licata A.; Malerba V.; Montalto F.A.; Lasco A.; Basile G.; Catalano A.; Malatino L.; Stancanelli B.; Terranova V.; Di Marca S.; Di Quattro R.; La Malfa L.; Caruso R.; Mecocci P.; Ruggiero C.; Boccardi V.; Meschi T.; Lauretani F.; Ticinesi A.; Nouvenne A.; Minuz P.; Fondrieschi L.; Pirisi M.; Fra G.P.; Sola D.; Porta M.; Riva P.; Quadri R.; Larovere E.; Novelli M.; Scanzi G.; Mengoli C.; Provini S.; Ricevuti L.; Simeone E.; Scurti R.; Tolloso F.; Tarquini R.; Valoriani A.; Dolenti S.; Vannini G.; Tedeschi A.; Trotta L.; Volpi R.; Bocchi P.; Vignali A.; Harari S.; Lonati C.; Cattaneo M.; Napoli F.Corrao, S.; Nobili, A.; Natoli, G.; Mannucci, P. M.; Perticone, F.; Pietrangelo, A.; Argano, C.; Licata, G.; Violi, F.; Corazza, G. R.; Corrao, S.; Marengoni, A.; Salerno, F.; Cesari, M.; Tettamanti, M.; Pasina, L.; Franchi, C.; Franchi, C.; Cortesi, L.; Tettamanti, M.; Miglio, G.; Tettamanti, M.; Cortesi, L.; Ardoino, I.; Novella, A.; Prisco, D.; Silvestri, E.; Emmi, G.; Bettiol, A.; Caterina, C.; Biolo, G.; Zanetti, M.; Guadagni, M.; Zaccari, M.; Chiuch, M.; Zaccari, M.; Vanoli, M.; Grignani, G.; Pulixi, E. A.; Bernardi, M.; Bassi, S. L.; Santi, L.; Zaccherini, G.; Lupattelli, G.; Mannarino, E.; Bianconi, V.; Paciullo, F.; Alcidi, R.; Nuti, R.; Valenti, R.; Ruvio, M.; Cappelli, S.; Palazzuoli, A.; Girelli, D.; Busti, F.; Marchi, G.; Barbagallo, M.; Dominguez, L.; Cocita, F.; Beneduce, V.; Plances, L.; Mularo, S.; Raspanti, M.; Zoli, M.; Lazzari, I.; Brunori, M.; Fabbri, E.; Magalotti, D.; Arno, R.; Pasini, F. L.; Capecchi, P. L.; Palasciano, G.; Modeo, M. E.; Di Gennaro, C.; Cappellini, M. D.; Maira, D.; Di Stefano, V.; Fabio, G.; Seghezzi, S.; Mancarella, M.; De Amicis, M. M.; De Luca, G.; Scaramellini, N.; Cesari, M.; Rossi, P. D.; Damanti, S.; Clerici, M.; Conti, F.; Bonini, G.; Ottolini, B. B.; Di Sabatino, A.; Miceli, E.; Lenti, M. V.; Pisati, M.; Dominioni, C. C.; Murialdo, G.; Marra, A.; Cattaneo, F.; Pontremoli, R.; Beccati, V.; Nobili, G.; Secchi, M. B.; Ghelfi, D.; Anastasio, L.; Sofia, L.; Carbone, M.; Cipollone, F.; Guagnano, M. T.; Valeriani, E.; Rossi, I.; Mancuso, G.; Calipari, D.; Bartone, M.; Delitala, G.; Berria, M.; Pes, C.; Delitala, A.; Muscaritoli, M.; Molfino, A.; Petrillo, E.; Zuccala, G.; D'Aurizio, G.; Romanelli, G.; Marengoni, A.; Zucchelli, A.; Manzoni, F.; Volpini, A.; Picardi, A.; Gentilucci, U. V.; Gallo, P.; Dell'Unto, C.; Annoni, G.; Corsi, M.; Bellelli, G.; Zazzetta, S.; Mazzola, P.; Szabo, H.; Bonfanti, A.; Arturi, F.; Succurro, E.; Rubino, M.; Tassone, B.; Sesti, G.; Serra, M. G.; Bleve, M. A.; Gasbarrone, L.; Sajeva, M. R.; Brucato, A.; Ghidoni, S.; Fabris, F.; Bertozzi, I.; Bogoni, G.; Rabuini, M. V.; Cosi, E.; Scarinzi, P.; Amabile, A.; Omenetto, E.; Prandini, T.; Manfredini, R.; Fabbian, F.; Boari, B.; De Giorgi, A.; Tiseo, R.; De Giorgio, R.; Paolisso, G.; Rizzo, M. R.; Borghi, C.; Strocchi, E.; Ianniello, E.; Soldati, M.; Sabba, C.; Vella, F. S.; Suppressa, P.; Schilardi, A.; Loparco, F.; De Vincenzo, G. M.; Comitangelo, A.; Amoruso, E.; Fenoglio, L.; Falcetta, A.; Bracco, C.; Fargion, A. L. F. S.; Tiraboschi, S.; Cespiati, A.; Oberti, G.; Sigon, G.; Peyvandi, F.; Rossio, R.; Ferrari, B.; Colombo, G.; Agosti, P.; Monzani, V.; Savojardo, V.; Folli, C.; Ceriani, G.; Salerno, F.; Pallini, G.; Dallegri, F.; Ottonello, L.; Liberale, L.; Caserza, L.; Salam, K.; Liberato, N. L.; Tognin, T.; Bianchi, G. B.; Giaquinto, S.; Purrello, F.; Di Pino, A.; Piro, S.; Rozzini, R.; Falanga, L.; Spazzini, E.; Ferrandina, C.; Montrucchio, G.; Petitti, P.; Peasso, P.; Favale, E.; Poletto, C.; Salmi, R.; Gaudenzi, P.; Violi, F.; Perri, L.; Landolfi, R.; Montalto, M.; Mirijello, A.; Guasti, L.; Castiglioni, L.; Maresca, A.; Squizzato, A.; Campiotti, L.; Grossi, A.; Bertolotti, M.; Mussi, C.; Lancellotti, G.; Libbra, M. V.; Dondi, G.; Pellegrini, E.; Carulli, L.; Galassi, M.; Grassi, Y.; Perticone, M.; Battaglia, R.; Filice, M.; Maio, R.; Stanghellini, V.; Ruggeri, E.; del Vecchio, S.; Salvi, A.; Leonardi, R.; Damiani, G.; Capeci, W.; Gabrielli, A.; Mattioli, M.; Martino, G. P.; Biondi, L.; Pettinari, P.; Ghio, R.; Col, A. D.; Minisola, S.; Colangelo, L.; Cilli, M.; Labbadia, G.; Afeltra, A.; Marigliano, B.; Pipita, M. E.; Castellino, P.; Zanoli, L.; Pignataro, S.; Gennaro, A.; Blanco, J.; Saracco, V.; Fogliati, M.; Bussolino, C.; Mete, F.; Gino, M.; Cittadini, A.; Vigorito, C.; Arcopinto, M.; Salzano, A.; Bobbio, E.; Marra, A. M.; Sirico, D.; Moreo, G.; Gasparini, F.; Prolo, S.; Pina, G.; Ballestrero, A.; Ferrando, F.; Berra, S.; Dassi, S.; Nava, M. C.; Graziella, B.; Baldassarre, S.; Fragapani, S.; Gruden, G.; Galanti, G.; Mascherini, G.; Petri, C.; Stefani, L.; Girino, M.; Piccinelli, V.; Nasso, F.; Gioffre, V.; Pasquale, M.; Scattolin, G.; Martinelli, S.; Turrin, M.; Sechi, L.; Catena, C.; Colussi, G.; Passariello, N.; Rinaldi, L.; Berti, F.; Famularo, G.; Tarsitani, P.; Castello, R.; Pasino, M.; Ceda, G. P.; Maggio, M. G.; Morganti, S.; Artoni, A.; Del Giacco, S.; Firinu, D.; Losa, F.; Paoletti, G.; Costanzo, G.; Montalto, G.; Licata, A.; Malerba, V.; Montalto, F. A.; Lasco, A.; Basile, G.; Catalano, A.; Malatino, L.; Stancanelli, B.; Terranova, V.; Di Marca, S.; Di Quattro, R.; La Malfa, L.; Caruso, R.; Mecocci, P.; Ruggiero, C.; Boccardi, V.; Meschi, T.; Lauretani, F.; Ticinesi, A.; Nouvenne, A.; Minuz, P.; Fondrieschi, L.; Pirisi, M.; Fra, G. P.; Sola, D.; Porta, M.; Riva, P.; Quadri, R.; Larovere, E.; Novelli, M.; Scanzi, G.; Mengoli, C.; Provini, S.; Ricevuti, L.; Simeone, E.; Scurti, R.; Tolloso, F.; Tarquini, R.; Valoriani, A.; Dolenti, S.; Vannini, G.; Tedeschi, A.; Trotta, L.; Volpi, R.; Bocchi, P.; Vignali, A.; Harari, S.; Lonati, C.; Cattaneo, M.; Napoli, F