Giroldo da Lugano a Massa Marittima Interpretazione di un fonte

Indagine delle vicende biografiche e artistiche dello scultore con particolare attenzione per l'episodio del fonte battesimale realizzato per il duomo di S. Cerbone a Massa Martittima. Contestualizzazione, descrizione e analisi tipologica, iconografica, allegorica e stilistica del fonte con un tentativo finale di confronto relativo ad altri episodi artistici di maestranze comacine coeve

Gli impatti e gli ambiti di applicazione delle Intranet nel settore sanitario italiano: scelte tecnologiche e di management: i risultati di una ricerca empirica

Il presente lavoro è stato realizzato nell’ambito del progetto di indagine annuale dell’ Osservatorio Intranet condotto dal MIP e dal Politecnico di Milano. L'Osservatorio Permanente Intranet Files nasce nel 2002 per iniziativa del MIP Politecnico di Milano e di Webegg, business unit di Value Team, con l'obiettivo di creare e diffondere la conoscenza sulle Intranet in Italia. Lavorando a stretto contatto con un campione significativo delle maggiori imprese operanti in Italia, l'Osservatorio sta analizzando le applicazioni Intranet dal punto di vista strategico, organizzativo e tecnologico, andando a monitorare nel tempo l'evoluzione e confrontandole con i principali benchmark a livello internazionale. L'attività di ricerca viene affiancata da iniziative di analisi e divulgazione dei risultati tese a sviluppare una comunità di manager aziendali maggiormente coinvolti nei progetti Intranet delle loro imprese, finalizzata ad accrescere le proprie rispettive competenze e conoscenze in questo ambito, grazie al confronto continuativo e pragmatico con i colleghi operanti nelle altre imprese. La ricerca 2006 è andata ad analizzare le Intranet di 100 fra le più rilevanti organizzazioni operanti in Italia, con un approfondimento su alcune tematiche chiave (strumenti di community e collaboration, mobile Intranet, integrazione fra la Intranet e i Sistemi Informativi aziendali) e anadndo ad analizzare peculiarità di settore. L’elaborato è il risultato di un indagine condotta su tre direttrici portanti: una prima parte ha riguardato l’analisi della letteratura in termini di Intranet, delle loro funzionalità ed impatti sul businnes e soprattutto un’analisi dei trend. La seconda direttrice di analisi ha passato in rassegna il settore sanitario, tracciandone un quadro generale in termini di evoluzioni, responsabilità, processi. A termine della seconda sezione si pone l’analisi degli impatti dell’ICT in sanità, valutandone strategie, risorse e scenari. La terza ed ultima sezione è il risultato di una indagine condotta nell’arco dei mesi di lavoro, nella quale si è condotta un’analisi su 20 casi di aziende operanti nel settore sanitario, per ognuna delle quali è stata sviluppata una accurata scheda informativa, risultato di un processo di indagine strutturato. Obiettivo è quello di mostrare le interrelazioni tra sistema organizzativo ed approccio all'informatica nel settore sanitatio, nonchè evidenziare le potenzialità di miglioramento ottenibili da una integrazione dei dati e degli applicativi in sanità

6MWT predicts survival better than CPET in Patients with Stable Cardiomyopathy

Aims: The prognostic value of different clinical, echocardiographic and functional parameters was evaluated in clinically stable outpatients with heart failure due to idiopathic dilated cardiomyopathy (DCM). Study Design: Observational prospective study. Methodology: 56 patients suffering from idiopathic dilated cardiomyopathy in waiting list for heart transplantation (33 men and 23 women, mean age 56.4 years) and in clinical stable conditions for a minimum of 3 months underwent baseline clinical evaluation, echocardiogram, 6 minute walk test (6 MWT) and cardiopulmonary exercise test (CPET). They were followed for an average period of 26.5 months to assess eventfree survival (death, heart transplantation). Results: During follow-up period 23 patients died, 21 for cardiovascular causes. 4 patients underwent heart transplantation. Age and sex were not related to survival. We found a significant predictive value for 6MWTD (at 1 year event-free survival was 53% for a distance <300 m), but not for VO2 peak or respectively anaerobic threshold (AT). At multivariate analysis using Cox-stepwise regression model NYHA class, 6MWTD, left ventricular ejection fraction and left ventricular end diastolic diameter were independent prognostic markers of survival. Conclusion: An advanced NYHA class, a higher LVEDD and a distance of < 300m at 6MWT are useful prognostic markers of event free survival in outpatients with stable DCM while CPET was not

semi quantitative ultrasound assessment of nonalcoholic fatty liver disease highlightens early subclinical atherosclerotic vascular damage from risk factors to vascular damage

Introduction Nonalcoholic fatty liver disease (NAFLD) is an independent risk factor for coronary artery disease; moreover, it increases systemic atherosclerotic burden by inducing the overexpression of inflammatory mediators, promoting endothelial damage, and impairing blood pressure regulation. Aim Aim of this work was to evaluate whether a standardized evaluation of NAFLD improves cardiovascular risk assessment recognizing subclinical atherosclerosis in lower cardiovascular risk. Material and methods We investigated NAFLD occurrence and severity, carotid and femoral intima-media-thickness (IMT) and vascular stiffness by ultrasound technique, endothelial function by peripheral-arterial-tonometry, lipid profile and inflammatory markers in 220 subjects (100 men, 120 women; 45.42 ± 13.22 years old), without history of cardiovascular event, diabetes, liver infection, alcohol consumption, systemic diseases, and the use of drugs causing liver damage. NAFLD was evaluated, graded according to an eight-point scoring semi-quantitative severity score. Results and discussion At univariate logistic analysis, NAFLD ≥ 3 score was significantly associated with pathological IMT, augmentation index, pulsewave-velocity at carotids and femoral arteries, and endothelial dysfunction, and this association was confirmed after adjustment for European Society of Cardiology Systematic Coronary Risk Evaluation (ESC SCORE) at multivariate analyses. Moreover, high sensitivity C-reactive protein levels were significantly higher in patients with at least 3 point steatosis, in comparison to the others. Receiver operating characteristic (ROC) curve analysis for NAFLD showed a significant higher area under curve for the detection of both early atherosclerotic burden and vascular stiffness, in comparison to ROC curve of ESC SCORE. Conclusions According to our findings a NAFLD ≥ 3 score was able to screen a subgroup with widespread morphological vascular damage and endothelial dysfunction in a primary prevention population

Persistent and selective upregulation of renin-angiotensin system in circulating T lymphocytes in unstable angina.

Introduction: Unstable angina is associated with an acute systemic inflammatory reaction and circulating T lymphocytes are activated. We investigated whether in unstable angina with marked immune system activation a selective upregulation of the circulating T-cell renin–angiotensin system, modulated by angiotensin II, could occur. Methods: We studied 13 unstable angina patients, 10 patients with stable angina and 10 healthy subjects. After T-lymphocyte isolation, mRNAs for angiotensin-converting enzyme (ACE) and angiotensin type 1 receptor (AT1-R) were quantified at baseline and after angiotensin II stimulation. ACE activity in cell pellet and supernatant and angiotensin II cell content were measured. Results: Plasma renin activity was similar in controls, stable and unstable angina patients. At baseline ACE and AT1-R mRNA levels were higher (P<0.05) in T cells from unstable angina patients than in T cells from stable angina patients and controls, and further increased after angiotensin II addition to cultured T cells. ACE activity of unstable angina T cells was significantly higher than that of T cells from controls and stable angina patients. Only in T cells from unstable angina patients did angiotensin II stimulation cause the almost complete release of ACE activity in the supernatant. Conclusions: The circulating T-cell-based renin–angiotensin system from unstable angina patients was selectively upregulated. In vivo unstable angina T cells could locally increase angiotensin II concentration in tissues where they migrate independently of the circulating renin–angiotensin system

Ectopic Fat Depots and Cardiometabolic Burden: A Possible Dangerous Liaison in Women Planning Assisted Reproduction

Objective: We evaluated cardiometabolic burden in women planning assisted reproduction in order to identify subgroups at higher risk of pregnancy complications and cardiovascular disease. Materials and methods: In this cross-sectional study we investigated 60 infertile women with BMI≥25 kg/m(2) referred to the Center for Assisted Reproduction. All women underwent metabolic, anthropometric parameters and ultrasound evaluation of ectopic fat depots. Results: All women had waist ≥80 cm. We found that 93.3% of women had pathological subcutaneous, 58.3% visceral and 80% para-perirenal fat; all women had fatty liver. Visceral fat and severity of steatosis were significantly related to the presence of metabolic syndrome (OR =5.7; p=0.03).A significant negative correlation between low HDL-c and para-perirenal fat (p<0.0001), a significant positive correlation with fasting plasma glucose and para-perirenal fat (p=0.001) were found. We observed a significant positive correlation between visceral fat and hs-CRP (p=0.002), HOMA-IR (p=0.04) and triglycerides (p=0.002), a significant negative correlation with HDL-c (p=0.05). Conclusion: This study by highlighting a clinically “dangerous liaison” between ectopic fat depots and metabolic/inflammatory markers, might permit to identify women with a worse metabolic phenotype and encourage lifestyle changes for improving their general and reproductive health together

Present and future association between obesity and hypogonadism in Italian male

Objective: Obesity prevalence is increasing worldwide and it is nowadays considered a real public health problem. Obesity is associated with co-morbidities like cardiovascular diseases (CVD) and type 2 diabetes mellitus (T2DM), furthermore visceral obesity can be related to low testosterone (T) plasma levels. The link between obesity and hypogonadism (HG) is complex and not completely clarified. Current guidelines suggest that screening for HG should be done in subjects with obesity and T2DM. The aim of this evaluation is to assess the estimated actual and future prevalence of obesity and related co-morbidities, in particular HG, in the Italian general population. Materials and Methods: The Strategyst Consulting Inc. recently completed an epidemiology forecast model for several countries, looking at HG and CV/Metabolic Disease, based on National Health and Nutrition Examination Survey (NHANES) data collected between 1999-2010. Data from NHANES survey were used to evaluate the Italian estimated prevalence of obesity and HG. Results: Results show that obesity estimated prevalence will increase in 2030 also in Italy. In addition, also the prevalence of obese CVD and T2DM subjects will increase too. Even Italian HG prevalence is estimated to increase in the next two decades, irrespective of T threshold considered (&lt; 8, 10 and 12 nmol/L). In obese CVD subjects the relative risk (RR) of developing HG (T &lt; 8 nmol/L) is four times greater than in not-CVD obese subjects (RR = 4.1, 3.1 and 1.9 accordingly to the aforementioned T thresholds for defining HG). Accordingly, the estimated percentage of hypogonadal obese CVD and T2DM subjects will rise in 2030. Conclusions: The Strategyst epidemiology forecast model has allowed to assess the current and future prevalence of obesity and its relative co-morbidities like HG in Italy. Data emerged from this evaluation suggest that obesity and HG prevalence will increase in Italian population and confirm the complex link between adipose tissue and male T levels