La inclusión diferencial de los solicitantes de asilo en Italia.

This article aims to critically analyze the reception system for asylum seekers in Italy as a device for “differential inclusion” of migrants on the southern edge of Europe. To defend this argument, first, we will analyze the evolution and the main characteristics of this system, as well as its most recent transformations from 2011. Secondly, we will observe that the three main segments of the reception system can be found on a scale that goes from the greatest exclusion to the greatest inclusion. In third and last place, we will observe that the reception “best practices” also present an ambivalent character, producing a continuous tension between the two poles of reception and integration.Este trabajo pretende analizar críticamente el sistema de acogida de los solicitantes de asilo en Italia como dispositivo de “inclusión diferencial” de los migrantes en los confines meridionales de Europa. Para defender este argumento, en primer lugar, analizaremos la evolución y las principales características de ese sistema, además de sus transformaciones más recientes a partir del 2011. En segundo lugar, observaremos que los tres segmentos principales del sistema de acogida pueden hallarse en una escala que va desde la mayor exclusión a la mayor inclusión. En tercer y último lugar, observaremos que también las “mejores prácticas” de acogida presentan un carácter ambivalente que produce una continua tensión entre los dos polos de la acogida y de la integración

Visualization of coronary arteries and coronary stents by low dose 320-slice multi-detector computed tomography in a patient with atrial fibrillation

Abstract Cardiac multi-detector computed tomography (MDCT) is widely used in the diagnosis of coronary disease. However, the predictive value of this technique is limited in the presence of atrial fibrillation and coronary stents. Here we present a case showing the ability of the new 320-slice MDCT to assess coronary anatomy in a patient with atrial fibrillation and coronary stents

Transcatheter aortic valve implantation results are not superimposable to surgery in patients with aortic stenosis at low surgical risk

Background: The aim of this meta-analysis was to compare the impact of transcatheter aortic valve implantation (TAVI) vs. surgical aortic valve replacement (SAVR) in patients with severe aortic valve stenosis at low surgical risk. Methods: All randomized controlled trials (RCTs) and observational studies (Obs) published from January 2014 until March 31st, 2020 were retrieved through the PubMed computerized database and at the site https://www.clinicaltrials.com. The relative risk (RR) with the 95% confidence interval (CI) was used to evaluate the effect of the intervention under comparison. The primary endpoints were all-cause 30-day mortality and 1-year mortality. The 30-day safety endpoints were: stroke, acute kidney injury stage 2 or 3, major bleeding, moderate/severe paravalvular leak, need for new permanent pacemaker (PM) implantation. Results: After detailed review 9 studies, related to 4 RCTs and 5 Obs, were selected. The overall analysis of RCTs plus Obs showed a significantly lower 30-day mortality for TAVI (RR = 0.55; 95% CI 0.45–0.68, p < 0.00001; I2 = 0%). However, an increased risk of new PM implantation (RR = 2.87; 95% CI 2.01–3.67, p < 0.00001, I2 = 0%) and of paravalvular leak (RR = 7.28; 95% CI 3.83–13.81, p < 0.00001, I2 = 0%) was observed in TAVI compared to SAVR. On the contrary, a lower incidence of major bleeding (RR = 0.38; 95% CI 0.27–0.54, p < 0.00001, I2 = 0%) and of acute kidney injury was observed (RR = 0.33; 95% CI 0.19–0.56, p < 0.0001, I2 = 0%) in TAVI. Conclusions: TAVI and SVAR in the treatment of AS in the patients at low surgical risk are not superimposable. In particular, if 30-day and 1-year mortality, major bleeding and acute kidney injury were significantly lower for TAVI, the need of new PM implantation and paravalvular leak were significantly lower in SAVR. Consequently, we suggest the need of more trials to evaluate the effectiveness of TAVI as routine therapeutic procedure in the treatment of patients with low surgical risk AS

Optimal drug treatment of systolic hypertension in the elderly.

Approximately two-thirds of the elderly population has hypertension, mainly of the isolated systolic hypertension (ISH) type. However, while large-scale, randomized controlled intervention trials have demonstrated that treatment of ISH reduces rates of total mortality, cardiovascular mortality and stroke in older hypertensives, control of ISH in the elderly remains poor. The aim of this review of drug treatment of ISH in the elderly is to provide a succinct, practical and clinically orientated guide that summarizes international recommendations and practices with special emphasis on newer approaches. Knowledge of pathophysiological changes in older subjects (decreased elastic artery compliance, reduced plasma renin activity, increased salt sensitivity) and evidence from epidemiological surveys and randomized controlled trials give clear clues that thiazide(-like) diuretics and long-acting dihydropyridine calcium channel antagonists are the drugs of choice in the treatment of ISH. Thus, based on this evidence, American, European and international guidelines for hypertension management still offer the best available recommendations for optimal treatment of ISH in the elderly. Newer combination treatments, especially the fixed combination of a dihydropyridine calcium channel antagonist and an ACE inhibitor, have valuable benefits in terms of efficacy and tolerability. Use of nitrates added to other antihypertensive medications can provide the practising physician with a further unconventional therapeutic strategy

Semeiotica Fisica Cardiovascolare

La semeiotica cardiovascolare viene presentata, con prospettiva moderna, al laureando in medicina tradizionalmente orientato secondo le tappe dell’anamnesi orientata ai sintomi e dell’esame obiettivo suddiviso in ispezione, palpazione, percussione, auscultazione

Semeiotica Fisica Cardiovascolare in Patologia integrata medico-chirurgica 1. Vol. 1: Malattie dell'apparato cardiovascolare

criteri e metodi di semeiotica fisica cardiovascolar

Bayesian Gene Regulatory Network Inference Optimization by means of Genetic Algorithms

Inferring gene regulatory networks from data requires the development of algorithms devoted to structure extraction. When time-course data is available, gene interactions may be modeled by a Bayesian Network (BN). Given a structure, that models the conditional independence between genes, we can tune the parameters in a way that maximize the likelihood of the observed data. The structure that best fit the observed data reflects the real gene network's connections. Well known learning algorithms (greedy search and simulated annealing) devoted to BN structure learning have been used in literature. We enhanced the fundamental step of structure learning by means of a classical evolutionary algorithm, named GA (Genetic algorithm), to evolve a set of candidate BN structures and found the model that best fits data, without prior knowledge of such structure. In the context of genetic algorithms, we proposed various initialization and evolutionary strategies suitable for the task. We tested our choices using simulated data drawn from a gene simulator, which has been used in the literature for benchmarking [Yu et al. (2002)]. We assessed the inferred models against this reference, calculating the performance indicators used for network reconstruction. The performances of the different evolutionary algorithms have been compared against the traditional search algorithms used so far (greedy search and simulated annealing). Finally we individuated as best candidate an evolutionary approach enhanced by Crossover-Two Point and Selection Roulette Wheel for the learning of gene regulatory networks with BN. We show that this approach outperforms classical structure learning methods in elucidating the original model of the simulated dataset. Finally we tested the GA approach on a real dataset where it reach 62% of recovered connections (sensitivity) and 64% of direct connections (precision), outperforming the other algorithms