Family Problems. Debates over Coupling, Marriage, and Family within the Italian Lesbian Community, 1990s

In the European context, Italy is currently an anomaly. It has no legislative instrument with which to regulate same sex relationship , despite the fact that in the last twenty-five years the Italian LGBTIQ movement (at least in its mainstream manifestation) has continued to call for a law on the subject (civil partnerships, regulation of de facto cohabitation, PACS, and marriage, are a handful of the solutions that have been proposed). In the political elaboration of certain radical sectors of the movement there has been an attempt to critique, or at least question, the imaginaries produced by the investment in the gay family. There has never been a stage of the Italian LGBTIQ movement in which positions regarding the concept of the family were homogeneous. Instead often it was precisely regarding this issue that the radical or reformist dialectic contrasted

Neuroactive Peptides as Putative Mediators of Antiepileptic Ketogenic Diets

Various ketogenic diet (KD) therapies, including classic KD, medium chain triglyceride administration, low glycemic index treatment, and a modified Atkins diet, have been suggested as useful in patients affected by pharmacoresistant epilepsy. A common goal of these approaches is to achieve an adequate decrease in the plasma glucose level combined with ketogenesis, in order to mimic the metabolic state of fasting. Although several metabolic hypotheses have been advanced to explain the anticonvulsant effect of KDs, including changes in the plasma levels of ketone bodies, polyunsaturated fatty acids, and brain pH, direct modulation of neurotransmitter release, especially purinergic (i.e., adenosine) and γ-aminobutyric acidergic neurotransmission, was also postulated. Neuropeptides and peptide hormones are potent modulators of synaptic activity, and their levels are regulated by metabolic states. This is the case for neuroactive peptides such as neuropeptide Y, galanin, cholecystokinin and peptide hormones such as leptin, adiponectin, and growth hormone-releasing peptides (GHRPs). In particular, the GHRP ghrelin and its related peptide des-acyl ghrelin are well-known controllers of energy homeostasis, food intake, and lipid metabolism. Notably, ghrelin has also been shown to regulate the neuronal excitability and epileptic activation of neuronal networks. Several lines of evidence suggest that GHRPs are upregulated in response to starvation and, particularly, in patients affected by anorexia and cachexia, all conditions in which also ketone bodies are upregulated. Moreover, starvation and anorexia nervosa are accompanied by changes in other peptide hormones such as adiponectin, which has received less attention. Adipocytokines such as adiponectin have also been involved in modulating epileptic activity. Thus, neuroactive peptides whose plasma levels and activity change in the presence of ketogenesis might be potential candidates for elucidating the neurohormonal mechanisms involved in the beneficial effects of KDs. In this review, we summarize the current evidence for altered regulation of the synthesis of neuropeptides and peripheral hormones in response to KDs, and we try to define a possible role for specific neuroactive peptides in mediating the antiepileptic properties of diet-induced ketogenesis

Predictive Echocardiography

In this thesis multiple echocardiographic approaches and techniques to predict clinical and functional outcome were evaluated. The value of high-dose dobutamine stress echocardiography for the prediction of longterm cardiac events was evaluated in various clinical settings in patients with known or suspected coronary artery disease. Low-dose dobutamine stress echocardiography and tissue Doppler imaging were used to evaluate myocardial viability and left ventricular remodelling in patients with ischemic cardiomyopathy who underwent myocardial revascularization or percutaneous transplantation of skeletal myoblasts. The value of myocardial contrast echocardiography was studied to predict functional recovery in patients with acute myocardial infarction who underwent primary coronary intervention. Next, resting 2-D echocardiography was used to predict the onset of dilated-hypokinetic evolution and cardiovascular events in patients with hypertrophic cardiomyopathy. Finally, the role of intracardiac echocardiography was investigated for prediction of the infarct area in patients with obstructive hypertrophic cardiomyopathy who underwent percutaneous septal myocardial ablation

Restrictive cardiomyopathy and hypertrophic cardiomyopathy overlap: the importance of the phenotype

Restrictive cardiomyopathy (RCM) is defined on the basis of the haemodynamic finding of restrictive ventricular physiology. However, restrictive ventricular pathophysiology is also a feature of other subtypes of cardiomyopathy, including hypertrophic cardiomyopathy (HCM). Clinically and aetiologically, there is an overlap between RCM and HCM with restrictive physiology. However, the clinical distinction between these two entities can be an important pointer towards the underlying aetiology. This review highlights the importance of the recognition of the clinical phenotype as the first step in the classification of cardiomyopathies

Antithrombotic Management during Percutaneous Mitral Valve Repair with the Mitraclip System in a Patient with Heparin-Induced Thrombocytopenia

Interventional cardiology procedures require full anticoagulation to prevent thrombus formation on catheters and devices with potential development of embolic complications. Bivalirudin, a short half-life direct thrombin inhibitor, has been largely used during percutaneous coronary interventions and represents the preferred alternative to heparin in patients with heparin-induced thrombocytopenia (HIT). However, few data are available about intraprocedural use of bivalirudin during transcatheter structural heart disease interventions. Activated clotting time (ACT) monitoring during bivalirudin infusion pre- sents some limitations and it is not mandatory. We report a case of bivalirudin use in a patient with type-2 HIT during percutaneous mitral valve repair with the Mitraclip system (Abbott, Abbott Park, Illinois, United States). Despite use of standard bivalirudin dose (0.75 mg/kg bolus and 1.4 mg/kg/min infusion—reduced infusion rate was motivated by a glomerular filtration rate of 37 mL/min), the patient developed a large thrombus on the second clip during its orientation toward the mitral orifice. ACT was measured at that time and was suboptimal (240 seconds). The case was successfully managed with clip and thrombus retrieval, adjunctive 0.3 mg/kg bivalirudin bolus and increased infusion rate, and clip repositioning with ACT monitoring. This report makes the case for mandatory ACT checking and drug titration during high-risk catheter–based structural heart disease interventions, even when thromboprophylaxis is performed with bivalirudin. Additional coagulation tests may be useful to monitor bivalirudin response in similar cases

Prognostic stratification of obese patients by stress ^99mTc- tetrofosmin myocardial perfusion imaging

Obesity is a major heath problem associated with increased cardiovascular mortality. There are currently no data to support a role for stress imaging techniques in the risk stratification of obese patients. The aim of this study was to assess the independent value of stress 99mTc-tetrofosmin SPECT in predicting mortality and hard cardiac events in obese patients. Methods: We studied 265 patients with a body mass index greater than 30 kg/m2 by exercise or dobutamine stress 99mTc-tetrofosmin myocardial perfusion tomography. Endpoints during follow-up were cardiac death and death of any cause. Results: The mean patient age (±SD) was 59 ± 10 y, and 110 of the patients were men (42%). The mean body mass index was 37 ± 7 kg/m2. Scan findings were normal in 113 patients (43%). Myocardial perfusion abnormalities were fixed in 62 patients (23%) and reversible in 90 patients (34%). During a mean follow-up period of 5.5 ± 2 y, 41 patients (15%) died. Death was considered cardiac in 22 patients (8%). Nonfatal myocardial infarction occurred in 20 patients (7.5%). The annual cardiac death rate was 0.6% in patients with normal perfusion and 3.3% in patients with abnormal perfusion. Patients with a multiple-vessel distribution of abnormalities had a higher cardiac death rate than did patients with a single-vessel distribution (4.1%vs. 2.5%, P &lt; 0.05). The annual mortality rate was 1.3% in patients with normal perfusion and 4.2% in patients with abnormal perfusion. In a multivariate analysis, perfusion abnormalities were independently predictive of cardiac mortality (risk ratio, 3.2; 95% confidence interval, 1.5-6.7) and overall mortality (risk ratio, 2.7; 95% confidence interval, 1.4-4.3). Conclusion: Stress 99mTc-tetrofosmin myocardial perfusion imaging is a useful tool for predicting cardiac and overall mortality in obese patients.</p

Prognostic stratification of obese patients by stress ^99mTc- tetrofosmin myocardial perfusion imaging

Obesity is a major heath problem associated with increased cardiovascular mortality. There are currently no data to support a role for stress imaging techniques in the risk stratification of obese patients. The aim of this study was to assess the independent value of stress 99mTc-tetrofosmin SPECT in predicting mortality and hard cardiac events in obese patients. Methods: We studied 265 patients with a body mass index greater than 30 kg/m2 by exercise or dobutamine stress 99mTc-tetrofosmin myocardial perfusion tomography. Endpoints during follow-up were cardiac death and death of any cause. Results: The mean patient age (±SD) was 59 ± 10 y, and 110 of the patients were men (42%). The mean body mass index was 37 ± 7 kg/m2. Scan findings were normal in 113 patients (43%). Myocardial perfusion abnormalities were fixed in 62 patients (23%) and reversible in 90 patients (34%). During a mean follow-up period of 5.5 ± 2 y, 41 patients (15%) died. Death was considered cardiac in 22 patients (8%). Nonfatal myocardial infarction occurred in 20 patients (7.5%). The annual cardiac death rate was 0.6% in patients with normal perfusion and 3.3% in patients with abnormal perfusion. Patients with a multiple-vessel distribution of abnormalities had a higher cardiac death rate than did patients with a single-vessel distribution (4.1%vs. 2.5%, P &lt; 0.05). The annual mortality rate was 1.3% in patients with normal perfusion and 4.2% in patients with abnormal perfusion. In a multivariate analysis, perfusion abnormalities were independently predictive of cardiac mortality (risk ratio, 3.2; 95% confidence interval, 1.5-6.7) and overall mortality (risk ratio, 2.7; 95% confidence interval, 1.4-4.3). Conclusion: Stress 99mTc-tetrofosmin myocardial perfusion imaging is a useful tool for predicting cardiac and overall mortality in obese patients.</p

Association of ischemia on stress ^99mTc-tetrofosmin myocardial perfusion imaging with all-cause mortality in patients with diabetes mellitus

Stress myocardial perfusion imaging is a useful method for evaluation of coronary artery disease (CAD) in patients with diabetes mellitus. However, its role in predicting all-cause mortality is not well defined. The aim of this study was to determine whether myocardial ischemia on stress myocardial perfusion imaging can predict all causes of death in patients with diabetes mellitus. Methods: We studied 297 patients with diabetes mellitus and known or suspected CAD by exercise or dobutamine stress 99mTc-tetrofosmin myocardial perfusion tomographic imaging. Ischemia was defined as reversible perfusion abnormalities. The endpoints were death from any cause and hard cardiac events (cardiac death and nonfatal myocardial infarction). Results: An abnormal scan was detected in 179 (60%) patients. Myocardial perfusion abnormalities were fixed in 76 (26%) patients and were reversible in 103 (35%) patients. During a mean follow-up of 6 ± 2.1 y, 80 (27%) patients died. Nonfatal myocardial infarction occurred in 14 (5%) patients. The annual mortality rate was 2.5% in patients with normal perfusion, 4.5% in patients with fixed defects, and 6% in patients with ischemia. The annual cardiac death rate was 4.2% in patients with ischemia and 2.6% in patients with fixed defects. In patients with normal perfusion, the annual cardiac death rate was 0.9% during the 5 y after the stress test. In a Cox multivariate analysis model, predictors of death were age, history of heart failure, peripheral vascular disease, and reversible perfusion defects. Conclusion: Myocardial ischemia on stress 99mTc-tetrofosmin myocardial perfusion imaging is associated with an increased risk of all-cause mortality during long-term follow-up among patients with diabetes mellitus. Patients with normal perfusion have a lower mortality rate and may require less frequent follow-up stress perfusion imaging.</p