National and Private Ambitions in the Patronage of French Cardinals at the Papal Court (Fifteenth to Sixteenth centuries)

Few French cardinals left important traces in the form of architectural patronage in Rome during the fifteenth and sixteenth centuries, a period characterised by the alternation of times of strong tension between the French kings and the Papacy, and phases of political harmony. French cardinals’ relations with Rome reflected such a changeable contingent political situation: their position was extremely delicate because they owed obedience to the pope, as princes of the church, and to their king, as French nobles and bishops. Generally, their engagement was projected more towards France, typically in the areas of family influence, than towards Rome. Nevertheless, some French cardinals, such as Guillaume d’Estouteville, Jean Jouffroy, Jean de Bilhères, and Jean Du Bellay, were well-established in Rome, participating in cultural life and artistic production. Analysing their architectural patronage helps to evaluate if they were agents of the King of France aiming to promote, in part by supporting art and architecture, royal policy at the papal court, or if they were driven by personal ambitions. Comparing these men with the patronage of Thomas Leroy—not a cardinal, but a Breton-prelate established in Rome where he undertook a brilliant career in the Curia—permits us to place the conduct of cardinals in a more general context, and to verify if it was different from that of other French resident prelates

Tapentadol extended release for the management of chronic neck pain

BACKGROUND: The role of opioids in the management of chronic neck pain is still poorly investigated. No data are available on tapentadol extended release (ER). In this article, we present 54 patients with moderate-to-severe chronic neck pain treated with tapentadol ER. PATIENTS AND METHODS: Patients received tapentadol ER 100 mg/day; dosage was then adjusted according to clinical needs. The following parameters were recorded: pain; Douleur Neuropathique 4 score; Neck Disability Index score; range of motion; pain-associated sleep interference; quality of life (Short Form [36] Health Survey); Patient Global Impression of Change (PGIC); Clinician GIC; opioid-related adverse effects; and need for other analgesics. RESULTS: A total of 44 of 54 patients completed the 12-week observation. Tapentadol ER daily doses increased from 100 mg/day to a mean (standard deviation) dosage of 204.5 (102.8) mg/day at the final evaluation. Mean pain intensity at movement significantly decreased from baseline (8.1 [1.1]) to all time points (P<0.01). At baseline, 70% of patients presented a positive neuropathic component. This percentage dropped to 23% after 12 weeks. Tapentadol improved Neck Disability Index scores from 55.6 (18.6) at baseline to 19.7 (20.9) at the final evaluation (P<0.01). Tapentadol significantly improved neck range of motion in all three planes of motion, particularly in lateral flexion. Quality of life significantly improved in all Short Form (36) Health Survey subscales (P<0.01) and in both physical and mental status (P<0.01). Based on PGIC results, approximately 90% of patients rated their overall condition as much/very much improved. Tapentadol was well tolerated: no patients discontinued due to side effects. The use of other analgesics was reduced during the observed period. CONCLUSION: Our results suggest that tapentadol ER, started at 100 mg/day, is effective and well tolerated in patients with moderate-to-severe chronic neck pain, including opioid-naïve subjects. Patients can expect a decrease in pain, an improvement in neck function, and a decrease in neuropathic symptoms

Learning a bayesian network from ordinal data

Bayesian networks are graphical models that represent the joint distributionof a set of variables using directed acyclic graphs. When the dependence structure is unknown (or partially known) the network can be learnt from data. In this paper, we propose a constraint-based method to perform Bayesian networks structural learning in presence of ordinal variables. The new procedure, called OPC, represents a variation of the PC algorithm. A nonparametric test, appropriate for ordinal variables, has been used. It will be shown that, in some situation, the OPC algorithm is a solution more efficient than the PC algorithm.Structural Learning, Monotone Association, Nonparametric Methods

A look inside the association codeine-paracetamol: clinical pharmacology supports analgesic efficacy

Acute and chronic pain often requires a multimodal approach. Combination therapy reduces the number of individual daily administrations and improves patient's compliance with the prescribed analgesic treatment. Despite the association codeine/paracetamol is one of the most widely used central analgesic, the exact mechanism of action, particularly of paracetamol, is still object of pharmacological research. Recent findings showed that paracetamol may act through cerebral cyclo-oxygenase, descending opioidergic inhibitory pathways, serotonin pathway, and the endocannabinoid system; while codeine activity seems to related not only to its conversion to morphine, as previously known, but also by itself and through its metabolites, such as norcodeine (NORC) and codeine-6-glucuronide (C-6-G). The addition of codeine to paracetamol significantly improves the analgesic action and reduces the number needed to treat (NNT) from 5 to 2.3-3.1. Recent warnings about the risk of its metabolism related to CYP450 and its genetic variability in general population should be mainly considered when the association is used in paediatric patients undergoing tonsillectomy and/or adenoidectomy procedures for obstructive sleep apnoea syndrome (OSAS). In adults, the association codeine/paracetamol has been shown to be effective and safe in different settings: acute pain, trauma patients, and chronic nociceptive pain

A numerical model for the simulation of a solitary wave in a coastal region

In this paper we propose a numerical model for the simulation of the tsunami wave propagation on coastal region. The model can simulate the wave transformation due to refraction, shoaling, diffraction and breaking phenomena that take place in the surf zone and can simulate the wet front progress on the mainland. The above mentioned model is based on the numerical integration of the Fully Non-linear Boussinesq Equations in the deep water region and of the Non-linear Shallow Water Equations in the surf zone. These equations are expressed in an integral contravariant formulation and are integrated on generalized curvilinear boundary conforming grid that can reproduce the complex morphology of the coast line. The numerical integration of the model equations is implemented by a high order Upwind WENO numerical scheme that involves an exact Riemann Solver. For the simulation of the wet front progress on the dry bed, the exact solution of the Riemann problem for the wet-dry front is used. The capacity of the proposed model to simulate the wet front progress velocity is tested by numerical reproducing the dam-break problem on a dry bed. The capacity of the proposed model to correctly simulate the tsunami wave evolution and propagation on the coastal region is tested by numerical reproducing a benchmark test case about the tsunami wave propagation on a conic island

Sublingual sufentanil, a new opportunity for the improvement of postoperative pain management in Italy

Despite the availability of national and international guidelines, adequate postoperative pain (POP) management is still a challenge in Italy. One of the potential reasons for the high incidence of surgical patients complaining moderate to severe pain is the difficult application of the currently recommended analgesic techniques in clinical practice. In particular, morphine, the most commonly used systemic opioid in the POP treatment, has some unfavorable pharmacodynamic and pharmacokinetic characteristics for POP management, suggesting a potential relevant improvement by using different opioids. Many of sufentanil properties make it particularly suitable for POP control: a high affinity for the µ opioid receptor, the highest therapeutic index compared to any other opioid used in clinical practice and the absence of clinically relevant active metabolites. The elevated potency, together with the high lipophilicity of sufentanil, allow the preparation of a nanotablet, 3 mm of diameter and 0.75 mm of thickness, containing 15 µg of active drug. The sublingual route allows a longer time of drug plasmatic permanence in comparison to IV route, overcoming the need for continuous dosing. The patient-controlled system, considered in the present review, is preprogrammed to deliver one sublingual tablet of sufentanil with a 20-minute lockout period with a radiofrequency identification thumb tag allowing only the patient to activate the on demand button. Phase II and III studies have assessed the efficacy of this system in POP management, showing that it was considered more satisfactory than the IV PCA morphine system by both patients and nurses. The introduction of this simple and innovative system of patient-controlled analgesic administration could represent an opportunity for Italy to update the current practice in POP management

Severe chest allodynia as an unusual first presentation of hydatid disease. A case report

Background: Cystic echinococcosis (CE) is a worldwide zoonosis and the liver is the most commonly affected organ. Clinical manifestations range from completely asymptomatic cysts to a potential lethal cyst rupture and anaphylaxis. Case presentation: Severe chest allodynia was an unusual clinical presentation of hepatic cyst rupture in the retroperitoneal space, without any other specific symptoms. CE diagnosis was confirmed by computed tomography scan and magnetic resonance. The patient underwent hepatectomy with complete resolution of the neuropathic pain. Conclusions: Retroperitoneal hydatid cyst rupture is a rare event and its clinical manifestation may mimic other chest neuropathies

Switching quantum reference frames in the N-body problem and the absence of global relational perspectives

Given the importance of quantum reference systems to both quantum and gravitational physics, it is pertinent to develop a systematic method for switching between the descriptions of physics relative to different choices of quantum reference systems, which is valid in both fields. Here, we continue with such a unifying approach, begun in arxiv:1809.00556, whose key ingredients is a gravity-inspired symmetry principle, which enforces physics to be relational and leads, thanks to gauge related redundancies, to a perspective-neutral structure which contains all frame choices at once and via which frame perspectives can be consistently switched. Formulated in the language of constrained systems, the perspective-neutral structure turns out to be the constraint surface classically and the gauge invariant Hilbert space in the Dirac quantized theory. By contrast, a perspective relative to a specific frame corresponds to a gauge choice and the associated reduced phase and Hilbert space. Quantum reference frame switches thereby amount to a symmetry transformation. In the quantum theory, they require a transformation that takes one from the Dirac to a reduced quantum theory and we show that it amounts to a trivialization of the constraints and a subsequent projection onto the classical gauge fixing conditions. We illustrate this method in the relational $N$-body problem with rotational and translational symmetry. This model is particularly interesting because it features the Gribov problem so that globally valid gauge fixing conditions are impossible which, in turn, implies also that globally valid relational frame perspectives are absent in both the classical and quantum theory. These challenges notwithstanding, we exhibit how one can systematically construct the quantum reference frame transformations for the three-body problem.Comment: 22 pages, plus appendice