Duration of Internal Displacement at the Intersection of Law and Politics

Even though the question of when internal displacement ends was the subject of the UN-led standards-seting eff orts and addressed in the resulting international sotilaw norms, in practice, the determination of when an internally displaced person (IDP) is no longer in need of assistance and protection is still performed arbitrarily and on ad hoc basis. There are diff erent explanations of why the rights-based criteria on the duration of displacement have not served their aim. In this paper, the authors identify another one by arguing that their ineff ectiveness is caused in the fi rst place by the essentially political nature of the matier they are supposed to regulate. The paper’s aim is to serve as a preliminary investigation and set the ground for a more systematic and in-depth analysis of the relationship between the law and the politics in the process of deciding when the internal displacement is over. To this aim, the paper provides an overview of the two main international sotilaw instruments regulating the status of IDPs and a short analysis of the principal humanitarian, human rights and refugee law norms from which these soti -law instruments were derived or which have otherwise directed the identifi cation of therein contained standards. The investigation shows not only that the two main international soti -law instruments tend to be inadequate as means to regulate the process of determining when a person should no longer be considered in need of assistance and protection as an IDP, but that the international law norms restated in these instruments as such cannot off er clear guidance on the matter. The inquiry also shows, in the context of protracted displacement, that where the impasse in the negotiation and/or implementation of a peace agreement reduces the traditional triad of durable solutions to only two of them – integration in the place of displacement and resettlement to the third place - the entire edifi ce of the rights-based criteria collapses. Such situations, the authors argue, demonstrate that the rights-based criteria on the duration of displacement can only serve as a framework for the essentially political deliberations on the matter

DNA methylation profiling reveals common signatures of tumorigenesis and defines epigenetic prognostic subtypes of canine Diffuse Large B-cell Lymphoma

Epigenetic deregulation is a hallmark of cancer characterized by frequent acquisition of new DNA methylation in CpG islands. To gain insight into the methylation changes of canine DLBCL, we investigated the DNA methylome in primary DLBCLs in comparison with control lymph nodes by genome-wide CpG microarray. We identified 1,194 target loci showing different methylation levels in tumors compared with controls. The hypermethylated CpG loci included promoter, 5'-UTRs, upstream and exonic regions. Interestingly, targets of polycomb repressive complex in stem cells were mostly affected suggesting that DLBCL shares a stem cell-like epigenetic pattern. Functional analysis highlighted biological processes strongly related to embryonic development, tissue morphogenesis and cellular differentiation, including HOX, BMP and WNT. In addition, the analysis of epigenetic patterns and genome-wide methylation variability identified cDLBCL subgroups. Some of these epigenetic subtypes showed a concordance with the clinical outcome supporting the hypothesis that the accumulation of aberrant epigenetic changes results in a more aggressive behavior of the tumor. Collectively, our results suggest an important role of DNA methylation in DLBCL where aberrancies in transcription factors were frequently observed, suggesting an involvement during tumorigenesis. These findings warrant further investigation to improve cDLBCL prognostic classification and provide new insights on tumor aggressiveness

Relationship between low Ankle-Brachial Index and rapid renal function decline in patients with atrial fibrillation: A prospective multicentre cohort study

OBJECTIVE: To investigate the relationship between Ankle-Brachial Index (ABI) and renal function progression in patients with atrial fibrillation (AF). DESIGN: Observational prospective multicentre cohort study. SETTING:Atherothrombosis Center of I Clinica Medica of 'Sapienza' University of Rome; Department of Medical and Surgical Sciences of University Magna Græcia of Catanzaro; Atrial Fibrillation Registry for Ankle-Brachial Index Prevalence Assessment-Collaborative Italian Study. PARTICIPANTS: 897 AF patients on treatment with vitamin K antagonists. MAIN OUTCOME MEASURES: The relationship between basal ABI and renal function progression, assessed by the estimated Glomerular Filtration Rate (eGFR) calculated with the CKD-EPI formula at baseline and after 2 years of follow-up. The rapid decline in eGFR, defined as a decline in eGFR >5 mL/min/1.73 m(2)/year, and incident eGFR<60 mL/min/1.73 m(2) were primary and secondary end points, respectively. RESULTS: Mean age was 71.8±9.0 years and 41.8% were women. Low ABI (ie, ≤0.90) was present in 194 (21.6%) patients. Baseline median eGFR was 72.7 mL/min/1.73 m(2), and 28.7% patients had an eGFR60 mL/min/1.73 m(2), 153 (23.9%) had a reduction of the eGFR <60 mL/min/1.73 m(2). ABI ≤0.90 was also an independent predictor for incident eGFR<60 mL/min/1.73 m(2) (HR 1.851, 95% CI 1.205 to 2.845, p=0.005). CONCLUSIONS: In patients with AF, an ABI ≤0.90 is independently associated with a rapid decline in renal function and incident eGFR<60 mL/min/1.73 m(2). ABI measurement may help identify patients with AF at risk of renal function deterioration

Frequency of left ventricular hypertrophy in non-valvular atrial fibrillation

Left ventricular hypertrophy (LVH) is significantly related to adverse clinical outcomes in patients at high risk of cardiovascular events. In patients with atrial fibrillation (AF), data on LVH, that is, prevalence and determinants, are inconsistent mainly because of different definitions and heterogeneity of study populations. We determined echocardiographic-based LVH prevalence and clinical factors independently associated with its development in a prospective cohort of patients with non-valvular (NV) AF. From the "Atrial Fibrillation Registry for Ankle-brachial Index Prevalence Assessment: Collaborative Italian Study" (ARAPACIS) population, 1,184 patients with NVAF (mean age 72 \ub1 11 years; 56% men) with complete data to define LVH were selected. ARAPACIS is a multicenter, observational, prospective, longitudinal on-going study designed to estimate prevalence of peripheral artery disease in patients with NVAF. We found a high prevalence of LVH (52%) in patients with NVAF. Compared to those without LVH, patients with AF with LVH were older and had a higher prevalence of hypertension, diabetes, and previous myocardial infarction (MI). A higher prevalence of ankle-brachial index 640.90 was seen in patients with LVH (22 vs 17%, p = 0.0392). Patients with LVH were at significantly higher thromboembolic risk, with CHA2DS2-VASc 652 seen in 93% of LVH and in 73% of patients without LVH (p &lt;0.05). Women with LVH had a higher prevalence of concentric hypertrophy than men (46% vs 29%, p = 0.0003). Logistic regression analysis demonstrated that female gender (odds ratio [OR] 2.80, p &lt;0.0001), age (OR 1.03 per year, p &lt;0.001), hypertension (OR 2.30, p &lt;0.001), diabetes (OR 1.62, p = 0.004), and previous MI (OR 1.96, p = 0.001) were independently associated with LVH. In conclusion, patients with NVAF have a high prevalence of LVH, which is related to female gender, older age, hypertension, and previous MI. These patients are at high thromboembolic risk and deserve a holistic approach to cardiovascular prevention

Full penetrance of Morgagni-Stewart-Morel syndrome in a 75-year-old woman: case report and review of the literature

Morgagni-Stewart-Morel syndrome is defined as the presence of hyperostosis frontalis interna, variably associated with metabolic, endocrine, and neuropsychiatric disorders. The possible cause-effect relationship of these associations remains uncertain. A 75-year-old woman presented with severe frontal headache and a history of psychotic disorders. On instrumental examination she was found to have extensive frontal hyperostosis and cortical atrophy. These findings, associated to the metabolic and neuropsychiatric pattern of the patient, are consistent with a high penetrance of Morgagni-Stewart-Morel syndrome. In this clinical case seminar, we summarize the current understanding of the association between hyperostosis frontalis interna and Morgagni-Stewart-Morel, based on a MEDLINE search (case reports, original articles, and reviews published between 1928 and 2011) on this topic. Possible pathophysiological mechanisms underlying both the headache and the hyperostosis frontalis interna are discussed. A case of full penetrance of Morgagni-Stewart-Morel syndrome is reported, presenting many of the clinical features described in the literature. Metabolic and endocrine dysfunctions should be interpreted not only as isolated components of the syndrome, but also as the reason behind its pathogenesis. Endocrine or nutritional disorders may have led to an altered bone metabolism with frontal bone apposition. On the other hand, the severity of our patient's neurological and psychiatric symptoms correlates well with the severity of her hyperostosis frontalis interna and the cortical atroph

HYPOTHYROIDISM IN THE ELDERLY:DIAGNOSTIC PITFALLS ILLUSTRATED BY A CASE REPORT

A diagnosis of hypothyroidism in the elderly can easily be overlooked if we rely exclusively on its clinical presentation because this may be highly non-specific, since the signs and symptoms of the disease are common to other diseases typical of old age, and even to the normal aging process. Imaging diagnostics (ultrasound or CT), when considered alone, are also of little use for the purpose of clarifying thyroid gland function. We report here on a case of primary hypothyroidism that was diagnosed late because the correlated signs and symptoms (asthenia, bradycardia, pleural effusions, hyponatremia, worsening renal and respiratory insufficiency, hoarseness) had previously been attributed to the normal aging process and to the patient's other health conditions (Parkinson's disease, PD; chronic obstructive pulmonary disease, COPD). After a couple of weeks of treatment with levothyroxine and liothyronine, there were clinical and laboratory evidences of an improvement in the patient's condition. She became more reactive, with a shriller voice. The pleural effusion disappeared, and so did the bradycardia. Laboratory tests showed normal sodium levels, and the renal insufficiency had improved. The lack of specificity of the clinical presentation of hypothyroidism in the elderly might justify the routine measurement of thyroid-stimulating hormone in these patients

A case of naturally evolving gout in an elderly man

Gout is a common disorder in adults that can lead to severe organ decline, disability and impaired quality of life due to the formation of periarticular tophi. We report a case of massive tophaceous gout in a 78-year-old man with a 16-year-long history of untreated disease. The patient gradually became disabled, his renal function deteriorated, and he finally died of sepsis. Our case demonstrates that chronic gout not only affects the joints, but is also associated with organ function decline and can, even nowadays, lead to death

Toxicity of individual and binary mixtures of perfluoroalkyl compounds in freshwater algae Raphidocelis subcapitata

Introduction: Per- and polyfluoroalkyl substances (PFAS) are environmental pollutants of increasing scientific interest. Widely used for several commercial and industrial applications, they are potentially harmful to the environment and biota. Following the ban of legacy PFAS such as perfluorooctanoic sulfonic acid (PFOS), several next-generation substitutes have been developed and introduced in the industry (1). Our study investigated the effects of one PFAS monitored by EFSA and two next-generation substitute compounds, either individually or in binary mixtures, in the unicellular algae model of ecotoxicology Raphidocelis subcapitata. Materials and Methods: Algal toxicity tests for perfluorononanoic acid (PFNA), PFOS, perfluorobutanesulfonic acid (PFBS) and perfluorobutanoic acid (PFBA) were executed using the US-EPA 96h Acute Toxicity Test (2), with minor modifications. Each compound was dissolved in Bold’s Basal Medium (1.0 g/L) and serial dilutions were made using a dilution factor of 2.0. Binary mixtures were set up according to the individually obtained concentration inhibiting the algal growth by 50% (EC 50 ), with the highest concentration represented by the sum of each EC 50 and using a dilution factor of 2.0. Results: Data obtained (four replicates) allowed us to determine the EC 50 for each tested PFAS and the type of interaction (additive effect, synergism or antagonism) in PFAS binary mixtures. PFBA was the most toxic PFAS (EC50 30.3 mg/L), followed by PFOS (47.3 mg/L), PFNA (90.5 mg/L) and PFBS (105.8 mg/L). The EC 50 of binary mixtures were 57.0 mg/L (PFOS-PFBS), 44.5 mg/L (PFOS-PFBA), 116.6 mg/L (PFNA-PFBA), 221.5 mg/L (PFNA-PFBS) and 121.4 mg/L (PFBA-PFBS). Discussion: Overall, PFAS toxicity (e.g., trend to bioaccumulation) is directly proportional to the carboxyl chain length; moreover, it increases with the presence of the sulfonate functional group at the end of the carboxyl chain (3). Our study highlights the highest toxicity of PFBA (a short-chain perfluoroalkyl substitute) on the freshwater algae R. subcapitata. Among the binary mixtures, PFOS-PFBS and PFOS-PFBA combinations were proved additive. However, antagonism was observed in the PFNA-PFBA, the PFNA-PFBS, and the PFBA-BFBS mixtures. We hypothesize this might be due to competition for the same molecular targets. Further studies are needed to shed a light on molecular mechanisms involved in PFAS uptake and toxicity in this ecotoxicology model species