Leaving or staying - an analysis of Italian graduates' migratory patterns

The migration of graduates is one of the main characteristics of the current phase of Italian emigration. This thesis investigates why Italian graduates are migrating both within and outside Italy. The main research questions this thesis gravitates around are: why do Italian graduates migrate? What is the difference, if any, in terms of motivations, between graduates who decide to migrate internally within Italy as compared to the ones who decide to migrate to the UK? Why do some graduates stay in their home town despite regional and national differentials in terms of employment and lifestyle opportunities? Namely, this thesis examines and compares the motivations that drove three samples of Italian graduates to migrate. Firstly, those who migrated to the UK; secondly, those who from the southern Italy moved internally to the Italian cities of Rome (centre) and Milan (north); and thirdly, those who decided to stay in the Italian cities of Palermo (south), Rome (centre), and Milan (north). The analysis proposed is qualitative and exploratory in nature and is based on 87 in-depth interviews conducted with Italian graduates in 2008-2009. The study provides an integrated view of different migratory patterns. In particular, the comparison between internal and international flows indicates that Italian graduates are generally oriented towards the UK and particularly towards London because of the many professional, educational and cultural opportunities that London as a global city has to offer. Meanwhile, internal migration within Italy (south to north) is generally experienced as constrained by deep regional differences in terms of employment opportunities between southern and northern Italy. Finally, staying in one’s home town emerged as a decision based, among other factors, on the lack of interest in experiencing mobility vs. the importance a person attributes to social, emotional and cultural ties to his or her own family, friends, partners and the local area

Effect of Etanercept on anti-carbamylated protein antibodies in patients with rheumatoid arthritis

Rheumatoid Arthritis (RA) is a systemic, chronic inflammatory disease characterized by inflammation of synovial joints and production of autoantibodies such as Rheumatoid Factor and antibodies directed against modified proteins - i.e. anti-citrullinated peptides antibody (ACPA). Carbamylation, as a post translational modification, has been recently associated to RA since anti-carbamylated protein antibodies (anti-CarP) have been detected in the sera of RA patients. The effect of treatment on anti-CarP level has been never addressed before. Through this study we aimed to investigate the short term effect of anti-TNF treatment with Etanercept on anti-CarP. We enrolled consecutive RA patients before starting treatment with Etanercept. Clinical data and serum samples were gathered from each patient at baseline and after 3 months of treatment. Disease activity was assessed at baseline and after 3 months by using the C-reactive protein - Disease Activity Score (DAS) 28. Sixty-three age and sex matched healthy donors served as controls. Anti-Car-P antibodies were investigated by immune-enzymatic assay. We enrolled 17 RA patients (F:M 15:2, mean age 44.1 ± 10.7 years, mean disease duration 7.9 ± 5.8 years). Six patients (35.3%) were positive for anti-CarP antibodies at baseline while three months after only 4 patients (23.5%) remained positive. Mean serum level of anti-CarP antibodies at baseline and after 3 months were: 253.0 ± 139.8AU/ml and 271.0 ± 132.4AU/ml respectively. Considering the persistently anti-CarP positive patients, the mean antibody titre increases from 386.2 ± 49.3AU/ml at baseline to 421.8 ± 144.0AU/ml at follow up. The effect of anti-TNF treatment on autoantibody status is still controversial; in particular, data on ACPA variation during treatment are discordant. In our cohort of long standing RA patients, a short term course of Etanercept did not affect the anti-CarP status. In conclusion, this pilot study demonstrated a slight reduction in the percentage of anti-CarP positive patients but an overall increase of antibody titres unrelated to the clinical response to TNF blockade was observed

Association between antibodies to carbamylated proteins and subclinical atherosclerosis in rheumatoid arthritis patients

BACKGROUND: Rheumatoid arthritis (RA) patients carry a high risk of cardiovascular morbidity and mortality. The excess of cardiovascular disease cannot be entirely explained by traditional risk factors and the immune system contributes to the development of atherosclerosis. Moreover, post-translational modifications such as citrullination and carbamylation have been linked to inflammation and atherosclerosis. Anti-carbamylated proteins antibodies (anti-CarP) are a new subset of autoantibodies identified in RA patients. This study aimed to investigate a possible association between anti-CarP and subclinical atherosclerosis in RA patients. METHODS: We enrolled RA patients and normal healthy controls (NHS) without known cardiovascular risk factors or heart disease. Cardiovascular risk was assessed using the Modified Systemic Coronary Risk Evaluation (mSCORE). Anti-CarP were investigated by a solid phase "home-made" ELISA. Anti-citrullinated protein antibodies (ACPA) and Rheumatoid Factor (RF) were investigated by ELISA assays. Subclinical atherosclerosis was evaluated by brachial artery Flow-Mediated Dilatation (FMD) and Carotid Intima-Media Thickness (c-IMT) while arterial stiffness by Ankle-Brachial Index (ABI) and Cardio-Ankle Vascular Index (CAVI). RESULTS: We enrolled 50 RA patients (34 F and 16 M, mean age 58.4 ± 13.1 years, mean disease duration 127 ± 96.7 months) and 30 age and sex matched NHS. According to the mSCORE, 58% of patients had a low risk, 32% a moderate and 8% a high risk for cardiovascular disease. FMD was significantly lower in RA patients than in NHS (5.6 ± 3.2 vs 10.7 ± 8.1%; p < 0.004) and CAVIs significantly higher in a RA patients compared to NHS (left CAVI 8.9 ± 1.7 vs 8.1 ± 1.5; p < 0.04 for and right CAVI 8.8 ± 1.6 vs 8.0 ± 1.4; p < 0.04 for the). ABI and c-IMT did not differ between the two populations. The multivariate regression analysis showed a significant association of anti-CarP antibodies with FMD, left and right CAVI and both c-IMT (r = 1.6 and p = 0.05; r = 1.7 and p = 0.04; r = 2.9 and p = 0.05; r = 1.5 and p = 0.03; r = 1.1 and p = 0.03 respectively). CONCLUSIONS: This study confirms that RA patients, without evidence of cardiovascular disease or traditional risk factors, have an impaired endothelial function. Moreover, we found an association with anti-CarP antibodies suggesting a possible contribution of these autoantibodies to endothelial dysfunction, the earliest stage of atherosclerosis. Besides ultrasound assessment, anti-CarP should be assessed in RA patients and considered an additional cardiovascular risk factor

Systemic Lupus Erythematosus with and without Anti-dsDNA Antibodies: Analysis from a Large Monocentric Cohort

Objectives. The anti-dsDNA antibodies are a marker for Systemic Lupus Erythematosus (SLE) and 70–98% of patients test positive. We evaluated the demographic, clinical, laboratory, and therapeutical features of a monocentric SLE cohort according to the antidsDNA status. Methods. We identified three groups: anti-dsDNA + (persistent positivity); anti-dsDNA ± (initial positivity and subsequent negativity during disease course); anti-dsDNA − (persistent negativity). Disease activity was assessed by the European Consensus Lupus Activity Measurement (ECLAM). Results. We evaluated 393 patients (anti-dsDNA +: 62.3%; anti-dsDNA ±: 13.3%; anti-dsDNA −: 24.4%). The renal involvement was signifiantly more frequent in anti-dsDNA + (30.2%), compared with antidsDNA ± and anti-dsDNA − (21.1% and 18.7%, resp.; = 0.001). Serositis resulted signifiantly more frequent in anti-dsDNA − (82.3%) compared to anti-dsDNA + and anti-dsDNA ± (20.8% and 13.4%, resp.; < 0.0001). Th reduction of C4 serum levels was identified significantly more frequently in anti-dsDNA + and anti-dsDNA ± (40.0% and 44.2%, resp.) compared with antidsDNA − (21.8%, = 0.005). We did not identify significant differences in the mean ECLAM values before and after modifiation of anti-dsDNA status ( = 0.7). Conclusion. Anti-dsDNA status influences the clinical and immunological features of SLE patients. Nonetheless, it does not appear to affect disease activity

Mucosa-Environment Interactions in the Pathogenesis of Rheumatoid Arthritis

Mucosal surfaces play a central role in the pathogenesis of rheumatoid arthritis (RA). Several risk factors, such as cigarette smoking, environmental pollution, and periodontitis interact with the host at the mucosal level, triggering immune system activation. Moreover, the alteration of microbiota homeostasis is gaining increased attention for its involvement in the disease pathogenesis, modulating the immune cell response at a local and subsequently at a systemic level. Currently, the onset of the clinical manifest arthritis is thought to be the last step of a series of pathogenic events lasting years. The positivity for anti-citrullinated protein antibodies (ACPAs) and rheumatoid factor (RF), in absence of symptoms, characterizes a preclinical phase of RA namely systemic autoimmune phase- which is at high risk for disease progression. Several immune abnormalities, such as local ACPA production, increased T cell polarization towards a pro-inflammatory phenotype, and innate immune cell activation can be documented in at-risk subjects. Many of these abnormalities are direct consequences of the interaction between the environment and the host, which takes place at the mucosal level. The purpose of this review is to describe the humoral and cellular immune abnormalities detected in subjects at risk of RA, highlighting their origin from the mucosa environment interaction

Allestimento di un saggio per la valutazione della risposta immunitaria cellulo-mediata nell'ambito di un protocollo di vaccinazione contro il virus dell'immunodeficienza felina

RIASSUNTO La vaccinazione si basa sulla stimolazione dei naturali meccanismi di difesa del sistema immunitario per generare resistenza nei confronti di vari agenti patogeni. La maggior parte dei vaccini attualmente in uso è in grado di evocare una risposta immunitaria soprattutto di tipo umorale. Tuttavia, nel caso di infezioni croniche endocellulari, come quelle causate da retrovirus, l’immunità cellulo-mediata è fondamentale al controllo dell’infezione ed al conferimento di una robusta immunità protettiva. I vaccini vivi attenuati si sono rivelati più efficaci nell’indurre l’attivazione delle cellule T citotossiche, ma una valida alternativa, emersa recentemente, è rappresentata dai vaccini a DNA, soprattutto se somministrati tramite un protocollo prime-boost, che combina un priming a DNA con un boost che utilizza un vettore ricombinante. Nel nostro laboratorio è in corso di sperimentazione un protocollo di vaccinazione di questo tipo contro il virus dell’immunodeficienza felina (FIV). Il prime consiste nella somministrazione di un plasmide a DNA esprimente env di FIV in combinazione con la citochina granulocyte macrophage colony stimulating factor felina (fGM-CSF), potente adiuvante naturale. Il boost, effettuato con lo scopo di potenziare proprio la risposta cellulo-mediata, consiste nella somministrazione di cellule dendritiche autologhe trasdotte in vitro con un vettore veicolante env e l’interleuchina 15 felina, la quale viene utilizzata per stimolare il differenziamento e la proliferazione delle cellule effettrici della risposta immunitaria. Lo scopo di questa tesi è l’allestimento di un saggio che ci permetta di valutare l’entità della risposta immunitaria cellulo-mediata indotta dal vaccino. Il saggio si basa sull’utilizzo di fibroblasti autologhi, che vengono trasformati in maniera da generare una linea stabile e vitale in coltura per lunghi periodi di tempo (anche dopo scongelamento). Le linee cellulari così prodotte vengono trasdotte stabilmente per esprimere l’antigene di interesse ed una proteina reporter, la green fluorescent protein (GFP), e vengono incubate con i peripheral blood mononuclear cells (PBMC) prelevati dall’animale vaccinato. Se i PBMC sono stati sensibilizzati efficacemente dalla vaccinazione, sono in grado di riconoscere l’antigene espresso dai fibroblasti e procedono alla loro lisi. Questa viene rilevata, dopo diversi tempi di incubazione, tramite analisi al citofluorimetro, il quale registra una diminuzione nel numero di fibroblasti fluorescenti. La percentuale di lisi ottenuta ci permette di valutare l’entità della risposta immunitaria cellulo-mediata sviluppata dall’animale vaccinato. Rispetto alle precedenti tecniche, questo saggio presenta numerosi vantaggi, tra i quali la facilità di applicazione, il basso costo e la bassa pericolosità, dal momento che non vengono impiegati reagenti radioattivi o tossici. Opportunamente modificato, il metodo è facilmente applicabile ad altri protocolli di vaccinazione e trasferibile all’uomo o ad altri modelli sperimentali

HiJAKing SARS-CoV-2? The potential role of JAK inhibitors in the management of COVID-19.

JAK kinase inhibitors are being investigated as a way of managing cytokine storm in patients with severe COVID-19

Oral mucosal lesions in electronic cigarettes consumers versus former smokers

Electronic cigarettes (ECs) have become very popular in recent years. However, many uncertainties remain about their side effects. This study aims to evaluate the prevalence and characteristics of oral mucosal lesions (OMLs) in former smokers compared to ECs consumers

Oral mucosal lesions in teenagers: a cross-sectional study

Aim The aim of this study was to evaluate the distribution of oral mucosal lesions (OMLs) in a wide sample of adolescents. Methods A retrospective cross-sectional study was carried out examining all medical records of adolescents (aged 13-18 years) treated at the Dental Clinic of the University of Brescia (Italy) in the period from 2008 to 2014. Cases with OMLs were selected. Data regarding age, gender, type of OML, bad habits, systemic chronic diseases were collected. Results A total of 6.374 medical records (mean age 15.2+-1.7 years) were examined. We found 1544 cases (31.7%) of oral mucosal lesions; 36 different types of mucosal alterations were detected and the most frequent were: aphthous ulcers (18%), traumatic ulcerations (14.3%), herpes simplex virus (11%), geographic tongue (9.6%), candidiasis (5.5%), and morsicatio buccarum (4.7%). Papilloma virus lesions (1.7%), piercing-related lesions (4%), multiform erythema (0.13%), oral lichen planus (0.13%) and granular cell tumour (0.06%) were also diagnosed. Conclusions The prevalence of OMLs in adolescents are different from those in children and, in some conditions, it could increase with age

Efficacy of the photobiomodulation therapy in the treatment of the burning mouth syndrome

This study aims to evaluate the efficacy of the photobiomodulation therapy (PBMT) - in terms of pain and of quality of life- in patients affected by burning mouth syndrome (BMS). This study was designed as a randomised double-blinded prospective study. Patients diagnosed with BMS in the period from June 2015 to June 2018 were recruited. The patients were randomised into two groups and each received treatment once a week for ten weeks: group A received laser therapy (K Laser Cube 3®) while group B was given sham therapy (placebo). Pain was evaluated through the Visual Analogue Scale (VAS) and quality of life was assessed with the short form of the Oral Health Impact Profile (OHIP-14). Assessment was done at baseline and after every therapy session. The researchers were blind to the randomised allocations. A total of 85 patients were analysed. Group A (laser treatment) was composed of 43 patients while group B (sham therapy) of 42 patients. Patients treated with PBMT showed a significant decrease in symptoms (p=0.0008) and improved quality of life related to oral health (p=0.0002). PBMT has demonstrated to have a positive effect in relieving BMS symptoms and in improving a patient?s overall quality of life