L’orrore sublime. Il Vesuvio tra attrazione turistica e locus horridus

Southern Italy, particularly Campania, has long been associated with stereotypical descriptions such as “Earthly Paradise”, “Arcadia” and “Eden”, but it also has a dark and disturbing, not to say perturbing, side, with places which fall into the category of locus horridus, and are associated with the experience of “sublime horror”. A long excursus is devoted to the genesis, in the British context, of the modern interpretation of notions such as “horror” and “the sublime”, which come together in the oxymoronic concept of “sublime horror”. In order to illustrate the itinerary, we will consider a number of paintings, travelogues and poems by Russian travellers who, following in the footsteps of those who preceded them, especially Goethe and Gregorovius, are confronted with a series of “horrible places”: grandiose spectacles of untamed Nature. The essay focuses in particular on descriptions of Vesuvius, a volcano capable of evoking the emotion of “sublime horror”, and perhaps the most emblematic locus horridus

Isadora Duncan e la sua danza del futuro tra Germania e Russia

The figure of Isadora Duncan, as a woman and dancer, is an authentic cultural phenomenon. She has produced a strong artistic and cultural impact and has deeply influenced lifestyles with her proclamations about the liberation of dance and the emancipation of women. In Russia, writers, thinkers, musicians, choreographers, dancers and critics were divided between those who regarded the dancer as the embodiment of the progressive ideas of the new era and those who accused her of desecrating music and dance. Isadora Duncan has not only deeply influenced the development of dance and the whole theatre, but has revolutionized many aspects of life, from fashion, through the enhancement of physicality and body, to women’s self-awareness

Energiearbeit im Schamanismus und im New Age

Das Phänomen des Schamanismus zeichnet sich besonders durch seine ausgeprägte Ritualkultur aus. Im Ritual findet ein Schamane Zutritt zu scheinbar verborgenen Lebenswelten mit teils phantastischen Lebensweisen bzw. Energieformen. Dies geschieht in einem außergewöhnlichen Bewusstseinszustand (ABZ) von Seiten des Schamanen, oft auch einiger bis aller Mitwirkenden am jeweiligen Ritual. Hier setzt praktische Energiearbeit im Schamanismus an. Nach Meinung vieler Forscher findet sich schamanisches Wissen bis heute in den meisten, wenn nicht in allen Kulturen in der einen oder anderen Form wieder, so auch in den asiatischen Systemen zur Energiebearbeitung und im Rahmen der Magie. Dabei wird überall dem Aspekt der Lebenskraft eine große Bedeutung eingeräumt. Daher soll in dieser Arbeit der Frage nachgegangen werden, wie weit energetische Bewusstseinsarbeit im Leben jedes Menschen sinnvoll ist, und ob dies in weiterer Folge zum wissenschaftlichen Erkenntnisprozess beitragen kann. Als forschungsleitende Fragestellungen ergeben sich daher: Inwiefern ist es sinnvoll, sich mit Energiearbeit zu beschäftigen? Was kann Energiearbeit im Leben des Einzelnen verbessern? Wie verhält sich Energiearbeit zu Wissenschaft? Als Methode der Darstellung wurde die vergleichende Literaturarbeit gewählt. In ihrem Aufbau gliedert sich die Arbeit in drei Teile: In Teil A erfolgt zunächst eine Vorstellung des Phänomens des Schamanismus. Dabei wird kurz auf Entstehung und Verbreitung eingegangen, wie auch die schamanische Reise im Zustand der Trance und der dazugehörige Kontakt mit den Geistern behandelt werden. In der Folge wird auf das äußerst prägende Initiationserlebnis eingegangen, aus welchem der Schamane seine heilenden Kräfte schöpft. Energiearbeit präsentiert sich im Schamanismus daher als sehr eng mit dieser Initiation verbunden. Der erste Teil der Arbeit wird schließlich mit einer Untersuchung über die verschiedenen Formen schamanischer Energiearbeit abgeschlossen. Teil B befasst sich mit dem New Age, einem spirituellen Phänomen, welches sich ab den 1950er-Jahren besonders in den industriellen Nationen auszubreiten begann. Es werden drei Systeme angewandter Energiearbeit vorgestellt. Bei den untersuchten Systemen handelt es sich um den indischen Yoga, das aus China stammende Qigong sowie um eine Betrachtung über den Zusammenhang von Mystik und Magie, wobei für diese Arbeit die so genannte hohe Magie von besonderem Interesse ist. In Teil C wird zuerst auf die Geschichte der Beziehungen zwischen unserer Kultur und dem Schamanismus eingegangen. Diese führte letztlich zum Aufkommen des Phänomens des Neo-Schamanismus und einer teilweise damit verbundenen modernen anthropologischen Schamanismusforschung, welche sich durch eine erhöhte Bereitschaft zur teilnehmenden Beobachtung auszeichnet. Des Weiteren wird auch die jüngere Geschichte der im zweiten Teil der Arbeit behandelten Energiearbeitssysteme beleuchtet, um schließlich auf den Nutzen von Energiearbeit im Allgemeinen einzugehen. In den Schlussbemerkungen wird eine kurze Bilanz dieser Arbeit gezogen

Alloimmune Risk Stratification for Kidney Transplant Rejection

Alloimmune risk; High-risk transplantation; Individualized immunosuppressionRiesgo aloinmune; Trasplante de alto riesgo; Inmunosupresión individualizadaRisc aloimmune; Trasplantament d'alt risc; Immunosupressió individualitzadaDifferent types of kidney transplantations are performed worldwide, including biologically diverse donor/recipient combinations, which entail distinct patient/graft outcomes. Thus, proper immunological and non-immunological risk stratification should be considered, especially for patients included in interventional randomized clinical trials. This paper was prepared by a working group within the European Society for Organ Transplantation, which submitted a Broad Scientific Advice request to the European Medicines Agency (EMA) relating to clinical trial endpoints in kidney transplantation. After collaborative interactions, the EMA sent its final response in December 2020, highlighting the following: 1) transplantations performed between human leukocyte antigen (HLA)-identical donors and recipients carry significantly lower immunological risk than those from HLA-mismatched donors; 2) for the same allogeneic molecular HLA mismatch load, kidney grafts from living donors carry significantly lower immunological risk because they are better preserved and therefore less immunogenic than grafts from deceased donors; 3) single-antigen bead testing is the gold standard to establish the repertoire of serological sensitization and is used to define the presence of a recipient’s circulating donor-specific antibodies (HLA-DSA); 4) molecular HLA mismatch analysis should help to further improve organ allocation compatibility and stratify immunological risk for primary alloimmune activation, but without consensus regarding which algorithm and cut-off to use it is difficult to integrate information into clinical practice/study design; 5) further clinical validation of other immune assays, such as those measuring anti-donor cellular memory (T/B cell ELISpot assays) and non–HLA-DSA, is needed; 6) routine clinical tests that reliably measure innate immune alloreactivity are lacking.This initiative was supported by the European Society for Organ Transplantation

Proposed Definitions of T Cell-Mediated Rejection and Tubulointerstitial Inflammation as Clinical Trial Endpoints in Kidney Transplantation

T cell-mediated rejection; Kidney transplantation; OutcomesRebuig mediat per cèl·lules T; Trasplantament renal; ResultatsRechazo mediado por células T; Trasplante renal; ResultadosThe diagnosis of acute T cell-mediated rejection (aTCMR) after kidney transplantation has considerable relevance for research purposes. Its definition is primarily based on tubulointerstitial inflammation and has changed little over time; aTCMR is therefore a suitable parameter for longitudinal data comparisons. In addition, because aTCMR is managed with antirejection therapies that carry additional risks, anxieties, and costs, it is a clinically meaningful endpoint for studies. This paper reviews the history and classifications of TCMR and characterizes its potential role in clinical trials: a role that largely depends on the nature of the biopsy taken (indication vs protocol), the level of inflammation observed (e.g., borderline changes vs full TCMR), concomitant chronic lesions (chronic active TCMR), and the therapeutic intervention planned. There is ongoing variability—and ambiguity—in clinical monitoring and management of TCMR. More research, to investigate the clinical relevance of borderline changes (especially in protocol biopsies) and effective therapeutic strategies that improve graft survival rates with minimal patient morbidity, is urgently required. The present paper was developed from documentation produced by the European Society for Organ Transplantation (ESOT) as part of a Broad Scientific Advice request that ESOT submitted to the European Medicines Agency for discussion in 2020. This paper proposes to move toward refined definitions of aTCMR and borderline changes to be included as primary endpoints in clinical trials of kidney transplantation.This initiative was supported by the European Society for Organ Transplantation

Proposed Definitions of Antibody-Mediated Rejection for Use as a Clinical Trial Endpoint in Kidney Transplantation

Antibody-mediated rejection; Biopsy; Kidney transplantationRechazo mediado por anticuerpos; Biopsia; Trasplante renalRebuig mediat per anticossos; Biòpsia; Trasplantament renalAntibody-mediated rejection (AMR) is caused by antibodies that recognize donor human leukocyte antigen (HLA) or other targets. As knowledge of AMR pathophysiology has increased, a combination of factors is necessary to confirm the diagnosis and phenotype. However, frequent modifications to the AMR definition have made it difficult to compare data and evaluate associations between AMR and graft outcome. The present paper was developed following a Broad Scientific Advice request from the European Society for Organ Transplantation (ESOT) to the European Medicines Agency (EMA), which explored whether updating guidelines on clinical trial endpoints would encourage innovations in kidney transplantation research. ESOT considers that an AMR diagnosis must be based on a combination of histopathological factors and presence of donor-specific HLA antibodies in the recipient. Evidence for associations between individual features of AMR and impaired graft outcome is noted for microvascular inflammation scores ≥2 and glomerular basement membrane splitting of >10% of the entire tuft in the most severely affected glomerulus. Together, these should form the basis for AMR-related endpoints in clinical trials of kidney transplantation, although modifications and restrictions to the Banff diagnostic definition of AMR are proposed for this purpose. The EMA provided recommendations based on this Broad Scientific Advice request in December 2020; further discussion, and consensus on the restricted definition of the AMR endpoint, is required.This initiative was supported by the European Society for Organ Transplantation

The Effect of Cortex/Medulla Proportions on Molecular Diagnoses in Kidney Transplant Biopsies: Rejection and Injury Can Be Assessed in Medulla

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/137720/1/ajt14233_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/137720/2/ajt14233.pd

A Prospective Multicenter Trial to Evaluate Urinary Metabolomics for Non-invasive Detection of Renal Allograft Rejection (PARASOL): Study Protocol and Patient Recruitment

Kidney transplant rejection; Non-invasive test; Urinary metabolitesRechazo del trasplante renal; Prueba no invasiva; Metabolitos urinariosRebuig del trasplantament renal; Prova no invasiva; Metabòlits urinarisBackground: In an earlier monocentric study, we have developed a novel non-invasive test system for the prediction of renal allograft rejection, based on the detection of a specific urine metabolite constellation. To further validate our results in a large real-world patient cohort, we designed a multicentric observational prospective study (PARASOL) including six independent European transplant centers. This article describes the study protocol and characteristics of recruited better patients as subjects. Methods: Within the PARASOL study, urine samples were taken from renal transplant recipients when kidney biopsies were performed. According to the Banff classification, urine samples were assigned to a case group (renal allograft rejection), a control group (normal renal histology), or an additional group (kidney damage other than rejection). Results: Between June 2017 and March 2020, 972 transplant recipients were included in the trial (1,230 urine samples and matched biopsies, respectively). Overall, 237 samples (19.3%) were assigned to the case group, 541 (44.0%) to the control group, and 452 (36.7%) samples to the additional group. About 65.9% were obtained from male patients, the mean age of transplant recipients participating in the study was 53.7 ± 13.8 years. The most frequently used immunosuppressive drugs were tacrolimus (92.8%), mycophenolate mofetil (88.0%), and steroids (79.3%). Antihypertensives and antidiabetics were used in 88.0 and 27.4% of the patients, respectively. Approximately 20.9% of patients showed the presence of circulating donor-specific anti-HLA IgG antibodies at time of biopsy. Most of the samples (51.1%) were collected within the first 6 months after transplantation, 48.0% were protocol biopsies, followed by event-driven (43.6%), and follow-up biopsies (8.5%). Over time the proportion of biopsies classified into the categories Banff 4 (T-cell-mediated rejection [TCMR]) and Banff 1 (normal tissue) decreased whereas Banff 2 (antibody-mediated rejection [ABMR]) and Banff 5I (mild interstitial fibrosis and tubular atrophy) increased to 84.2 and 74.5%, respectively, after 4 years post transplantation. Patients with rejection showed worse kidney function than patients without rejection. Conclusion: The clinical characteristics of subjects recruited indicate a patient cohort typical for routine renal transplantation all over Europe. A typical shift from T-cellular early rejections episodes to later antibody mediated allograft damage over time after renal transplantation further strengthens the usefulness of our cohort for the evaluation of novel biomarkers for allograft damage.This study was sponsored by numares AG