Significato predittivo dei markers di funzione vascolare nel paziente iperteso

Introduzione. L’ipertensione arteriosa, un importante fattore di rischio cardiovascolare, risulta associata a processi di rimodellamento vascolare e di irrigidimento delle arterie, fenomeni che però sembrano procedere in maniera diversa a seconda del profilo di rischio del paziente. L’evoluzione temporale dei parametri di rigidità arteriosa in presenza di diversi fattori di rischio è un aspetto ancora poco studiato. Scopo dello studio. Valutare l’evoluzione nel tempo dei parametri di geometria e rigidità arteriosa in pazienti ipertesi e studiare il loro valore predittivo. Metodi. In questo studio prospettico osservazionale sono stati arruolati 153 pazienti ipertesi essenziali, valutati basalmente (V0) e dopo un follow-up di 3.6±1.2 anni (V1). I parametri di rigidità aortica (carotid-femoral pulse wave velocity, PWV) e la pressione di pulsazione (PP) carotidea sono stati ottenuti tramite tonometria ad applanazione. La variazione di diametro e lo spessore medio-intimale carotideo (cIMT) sono stati calcolati tramite analisi automatica di immagini ultrasonografiche delle arterie carotidi comuni, da cui sono stati ottenuti il coefficiente di distensibilità (DC) e la stiffness carotidea (CS). Risultati. Durante il periodo di follow-up si è verificata una riduzione significativa della pressione arteriosa diastolica (PAD da 82.2±8.8 a 79.7±10.9 mmHg, p=0.026), ma non di quella sistolica (PAS da 142.4±15.6 a 141.2±17.2 mmHg, p=ns) a fronte di un incremento del numero di farmaci antiipertensivi usati (da 1.2±1.0 a 1.8±1.0, p<0.0001). Si è registrata inoltre una stabilità negli anni del profilo lipidico (colesterolo LDL da 128.3±36.4 a 125.3±37.9 mg/dl, p=ns), in rapporto ad un incremento dei soggetti in terapia ipocolesterolemizzante (dal 14.4% al 25.5%, p=0.01). Nel gruppo dei pazienti diabetici il controllo glicemico è migliorato (Hb glicata da 8.3±0.7 a 7.7±1.2 mg/dl), grazie a un incremento del numero di farmaci antidiabetici impiegati (da 1.4±0.7 a 2.1±0.9, p<0.0001). Per quanto riguarda i parametri vascolari, non sono state rilevate variazioni significative di PWV, cIMT, DC e CS. Al contrario, si è verificato un aumento del diametro medio della carotide comune (da 7,49±0,85 a 7,80±0,81 mm, p=0,002). I pazienti in cui durante il follow-up si è verificata una riduzione della PWV>0.5 m/s presentavano a V0 valori più elevati di PAS (146.3±14.4 vs 139.8±13.6 e 141.0±17.4 mmHg, p=0.077), di PWV (10.1±2.1 vs 8.7±1.8 e 8.9±1.8 m/s, p0.5m/s). Essi hanno inoltre mostrato una maggiore riduzione della PAS nel tempo (-7.9±17.0 vs -2.0±15.1 e +3.5±18.2 mmHg, p<0.0001) e un minore incremento del diametro carotideo medio (+0.16±0.58 vs +0.40±0.53 e +0.39±0.47 mm, p=0.046). I pazienti in cui durante il follow-up si è verificata una riduzione della CS>0.5 m/s presentavano a V0 valori più elevati di PAS (146.9±15.3 vs 144.6±13.0 e 135.8±16.3 mmHg, p=0,0008) e di PP carotidea (56.2±14.5 vs 51.6±14.3 e 46.1±15.0 mmHg, p=0,004) rispetto a coloro con CS invariata (variazione compresa tra -0.5 e +0.5m/s) o aumentata nel tempo (aumento>0.5m/s). Essi hanno inoltre mostrato una maggiore riduzione della PAS nel tempo (-10.6±18.1 vs -4.5±16.3 e +7.6±12.8 mmHg, p0.5 m/s di CS, il numero di farmaci antiipertensivi è aumentato in percentuale minore (54.7% e 51.1% vs 31.9%, p=0.05). Infine, solo nel 38.8% dei pazienti c’è stata concordanza tra l’andamento temporale di PWV e CS. Conclusioni. In una coorte di pazienti ipertesi seguiti per circa 3 anni e trattati in maniera convenzionale (in relazione ai fattori di rischio classici), rigidità aortica e carotidea rimangono stazionarie, come pure il cIMT. Tuttavia si verifica una progressione del rimodellamento carotideo maladattativo, suggerendo una minore efficacia dell’approccio terapeutico tradizionale su questo tipo di danno vascolare. I pazienti con una riduzione nel tempo di PWV e CS presentano un abbassamento più marcato della PA e un minore aumento del diametro carotideo, ottenuti con un maggiore incremento del numero di farmaci

New strategies for curve and arbitrary-topology surface constructions for design

This dissertation presents some novel constructions for curves and surfaces with arbitrary topology in the context of geometric modeling. In particular, it deals mainly with three intimately connected topics that are of interest in both theoretical and applied research: subdivision surfaces, non-uniform local interpolation (in both univariate and bivariate cases), and spaces of generalized splines. Specifically, we describe a strategy for the integration of subdivision surfaces in computer-aided design systems and provide examples to show the effectiveness of its implementation. Moreover, we present a construction of locally supported, non-uniform, piecewise polynomial univariate interpolants of minimum degree with respect to other prescribed design parameters (such as support width, order of continuity and order of approximation). Still in the setting of non-uniform local interpolation, but in the case of surfaces, we devise a novel parameterization strategy that, together with a suitable patching technique, allows us to define composite surfaces that interpolate given arbitrary-topology meshes or curve networks and satisfy both requirements of regularity and aesthetic shape quality usually needed in the CAD modeling framework. Finally, in the context of generalized splines, we propose an approach for the construction of the optimal normalized totally positive (B-spline) basis, acknowledged as the best basis of representation for design purposes, as well as a numerical procedure for checking the existence of such a basis in a given generalized spline space. All the constructions presented here have been devised keeping in mind also the importance of application and implementation, and of the related requirements that numerical procedures must satisfy, in particular in the CAD context

Evaluating qigong as integrative support for COVID-19 and Long-COVID-19 rehabilitation: a systematic review

IntroductionAmidst the ongoing global impact of COVID-19 on public health, there is an increasing focus on holistic strategies encompassing integrative therapies and rehabilitation techniques, particularly in addressing the challenges posed by Long-COVID-19. This review investigates the potential of Qigong, an ancient Chinese practice characterized by gentle movements, controlled breathing, and meditative elements, within the context of COVID-19.MethodsA systematic search of PubMed, EMBASE, Web of Science, Scopus, and Google Scholar was conducted to identify pertinent clinical studies.ResultsFollowing thorough database scrutiny, nine studies were identified as meeting the eligibility criteria. Across the spectrum of COVID-19 severity, individuals engaging in qigong practice exhibited notable enhancements in both physical and psychological wellbeing, evidenced by ameliorated respiratory symptoms, reduced anxiety levels, enhanced sleep quality, bolstered mental wellbeing, and augmented health-related quality of life. Moreover, qigong training, whether employed independently or in conjunction with other therapies, demonstrated beneficial effects on Long-COVID-19 symptoms, encompassing persistent respiratory issues, dizziness, sleep disturbances, and compromised health-related quality of life.DiscussionThis review underscores the necessity for further investigation to quantify and standardize the contribution of Qigong to COVID-19 recovery and rehabilitation. Such endeavors aim to integrate this accessible and low-impact practice into public health strategies and comprehensive treatment regimens.Systematic review registrationThe review protocol was registered in the Open Science Framework under the following doi: 10.17605/OSF.IO/7K5X6 (URL: https://osf.io/7k5x6)

Phytobalneotherapy: When traditional herbal medicine meets spa therapy

Phytobalneotherapy (or hay baths) is a balneological treatment which combines the effects of thermal baths and the properties of fermenting herbs. Alpine hay, made of many different herbs harvested in mountain fields, is traditionally used for this treatment. Some studies have investigated the effects of hay baths on health, underscoring potential their benefits for rheumatic conditions. In conclusion, phytobalneotherapy seems an interesting way to harness therapeutic properties of medicinal herbs in a way which appears to be tolerable and sustainable. Further investigation is needed

Design Methodology for a Novel Bending Pneumatic Soft Actuator for Kinematically Mirroring the Shape of Objects

In the landscape of Industry 4.0, advanced robotics awaits a growing use of bioinspired adaptive and flexible robots. Collaborative robotics meets this demand. Due to human–robot coexistence and interaction, the safety, the first requirement to be satisfied, also depends on the end effectors. End effectors made of soft actuators satisfy this requirement. A novel pneumatic bending soft actuator with high compliance, low cost, high versatility and easy production is here proposed. Conceived to be used as a finger of a collaborative robot, it is made of a hyper-elastic inner tube wrapped in a gauze. The bending is controlled by cuts in the gauze: the length and the angular extension of them, the pressure value and the dimensions of the inner tube determine the bending amplitude and avoid axial elongation. A design methodology, oriented to kinematically mirror the shape of the object to be grasped, was defined. Firstly, it consists of the development of a non-linear parametric numerical model of a bioinspired finger; then, the construction of a prototype for the experimental validation of the numerical model was performed. Hence, a campaign of simulations led to the definition of a qualitatively predictive formula, the basis for the design methodology. The effectiveness of the latter was evaluated for a real case: an actuator for the grasping of a light bulb was designed and experimentally tested

Effects of lavender on anxiety: A systematic review and meta-analysis

Abstract Background Anxiety is one of the uprising psychiatric disorders of the last decades and lavender administration has been traditionally suggested as a possible treatment. The objective of this review is to assess the efficacy of lavender, in any form and way of administration, on anxiety and anxiety-related conditions. Methods The PRISMA guidelines were followed. Retrieved data were qualitatively and quantitatively synthesized. Randomized Controlled Trials (RCTs) and Non-Randomized Studies (NRSs) which investigated the efficacy of lavender, in any form and way of administration, on patients with anxiety, involved in anxiety-inducing settings or undergoing anxiety-inducing activities, compared to any type of control, without language restrictions, were identified through electronic database searches. Medline via PubMed, Scopus, Web of Science, Cochrane Library, EMBASE, and Google Scholar were systematically searched. All databases were screened up to November 2018. Risk of bias was assessed with the Cochrane risk-of-bias tool and the following domains were considered: randomization, allocation sequence concealment, blinding, incomplete outcome data, selective outcome reporting, and other biases. Results 65 RCTs (7993 participants) and 25 NRSs (1200 participants) were included in the qualitative synthesis and 37 RCTs (3964 participants) were included in the quantitative synthesis. Overall, the qualitative synthesis indicated that 54 RCTs and 17 NRSs reported at least a significant result in favor of lavender use for anxiety. The quantitative synthesis showed that lavender inhalation can significantly reduce anxiety levels measured with any validated scale (Hedges' g = −0.73 [95% CI −1.00 to −0.46], p  Discussion The most important limitation of this review is the low average quality of available studies on the topic. The majority of included RCTs were characterized by a high overall risk of bias. Another limitation regards the heterogeneity of study designs, especially with regard to non-oral ways of administration. Overall, oral administration of lavender essential oil proves to be effective in the treatment of anxiety, whereas for inhalation there is only an indication of an effect of reasonable size, due to the heterogeneity of available studies. Lavender essential oil administered through massage appears effective, but available studies are not sufficient to determine whether the benefit is due to a specific effect of lavender. Further high-quality RCTs with more homogeneous study designs are needed to confirm these findings. Available information outlines a safe profile for lavender-based interventions, although more attention should be paid to the collection and reporting of safety data in future studies. Considering these findings, since treatments with lavender essential oil generally seem safe, and, in the case of inhalation, also simple and inexpensive, they are a therapeutic option which may be considered in some clinical contexts. Other The present systematic review was not funded and was registered in PROSPERO under the following number: CRD42019130126

Popular Culture and Totalitarianism: Accounting for Propaganda in Italy under the Fascist Regime (1934-1945)

Throughout history both democratic and totalitarian States have sought to take advantage of the possible political contributions of art and culture. This study presents the first in-depth historical study of the relationship between accounting and culture in a totalitarian State; the Fascist State in Italy between 1934 and 1945. Accounting documents in the form of budgets and reports provided by the Fascist government, along with other accounts prepared by the Fascists, were used to build a narrative that identified the ways in which the Fascist regime sought to win the committed allegiance of the Italian people in unseen ways. Accounting documents and the cultural activities to which they relate show the ways in which the Fascists developed their own conception of popular culture and sought control of cultural organisations and intellectuals in spreading their values and beliefs through cultural artefacts. The study documents the importance of accounting records as a less obvious, often underscored source for social history. It also adds to the growing literature that has explored the place of accounting in totalitarian regimes by focusing on the unexplored context of Fascist popular culture and identifying the contributions of accounting to the management of propaganda activities

Rituximab in the treatment of patients with systemic sclerosis. Our experience and review of the literature

BACKGROUND: The treatment of systemic sclerosis (SSc) represents a great clinical challenge because of the complex disease pathogenesis including vascular, fibrotic, and immune T- and B-lymphocyte-mediated alterations. Therefore, SSc should be treated by combined or sequential therapies according to prevalent clinico-pathogenetic phenotypes. Some preliminary data suggest that rituximab (RTX) may downregulate the B-cell over expression and correlated immunological abnormalities. METHODS: Here, we describe a series of 10 SSc patients (4M and 6F, mean age 46±13.5SD years, mean disease duration 6.3±2.7SD years; 5 pts had limited and 5 diffuse SSc cutaneous subset) treated with one or more cycles of RTX (4 weekly infusions of 375mg/m(2)). The main indications to RTX were interstitial lung fibrosis, cutaneous, and/or articular manifestations unresponsive to previous therapies; ongoing treatments remained unchanged in all cases. The effects of RTX were evaluated after 6months of the first cycle and at the end of long-term follow-up period (37±21SD months, range 18-72months). An updated review of the world literature was also done. RESULTS: RTX significantly improved the extent of skin sclerosis in patients with diffuse SSc at 6months evaluation (modified Rodnan skin score from 25±4.3 to 17.2±4.6; p=.022). A clinical improvement of other cutaneous manifestations, namely hypermelanosis (7/7), pruritus (6/8), and calcinosis (3/6) was observed. Moreover, arthritis revealed particularly responsive to RTX showing a clear-cut reduction of swollen and tender joints in 7/8 patients; while lung fibrosis detected in 8/10 remained stable in 6/8 and worsened in 2/8 at the end of follow-up. Pro-inflammatory cytokines, namely IL6, IL15, IL17, and IL23, evaluated in 3 patients with diffuse cutaneous SSc, showed a more or less pronounced reduction after the first RTX cycle. These observations are in keeping with the majority of previous studies including 6 single case reports and 10 SSc series (from 5 to 43 pts), which frequently reported the beneficial effects of RTX on some SSc manifestations, particularly cutaneous sclerosis, along with the improvement/stabilization of lung fibrosis. Possible discrepancies among different clinical studies can be related to the etiopathogenetic complexity of SSc and not secondarily to the patients' selection and disease duration at the time of the study. CONCLUSION: The present study and previous clinical trials suggest a possible therapeutical role of RTX in SSc, along with its good safety profile. The specific activity of RTX on B-cell-driven autoimmunity might explain its beneficial effects on some particular SSc clinical symptoms, namely the improvement of skin and articular involvement, and possibly the attenuation of lung fibrosis