Sindrome fibromialgica : un caso clinico

La Sindrome Fibromialgica (SFM) \ue8 una malattia che colpisce i muscoli causando tensione muscolare e che si manifesta principalmente con le seguenti sensazioni: iperalgesia, rigidit\ue0, astenia e affaticamento. La diagnosi clinica non \ue8 sempre agevole poich\ue9 non esistono indagini di laboratorio che permettano l\u2019identificazione certa della malattia. Gli studi di neuro-imaging mostrano che la SFM sia legata ad una disfunzione cerebrale che non permette la corretta elaborazione del dolore, tuttavia non \ue8 chiaro se questa disfunzione ne sia causa o effetto. \uc8 indubbio per\uf2 che i fattori psicologici influiscano in maniera significativa sulla sintomatologia dolorosa. Il caso clinico proposto \ue8 riferito ad una paziente (A.) affetta da SFM inviata presso il Servizio di Psicoterapia del Dipartimento di Salute Mentale, Fondazione IRCSS Ca\u2019 Granda Ospedale Maggiore Policlinico di Milano. La paziente effettua una valutazione clinico-diagnostica al baseline (T0) che prevede la somministrazione della seguente batteria testale: Interviste Cliniche Semi-Strutturate per diagnosi secondo DSM-IV TR (SCID I e II), Hamilton Rating scale for Depression and Anxiety (HAM-D e HAM-A), Tema Relazionale Conflittuale Centrale (CCRT), Toronto Alexithymia Scale (TAS-20), Symptom Checklist (SCL-90-R) ed Inventory of Interpersonal Problems (IIP-127). Tale valutazione ha evidenziato un quadro psicopatologico caratterizzato da incapacit\ue0 di individuare e mentalizzare i propri stati emotivi e tendenza alla somatizzazione. In considerazione di quanto emerso e dei dati anamnestici della paziente, viene proposta una psicoterapia psicodinamica breve (STPP), della durata di 9 mesi, finalizzata al conseguimento di una maggiore consapevolezza di s\ue8 e delle proprie emozioni attraverso un focus centrato sul miglioramento delle relazioni interpersonali. Al termine del percorso psicoterapico la paziente esegue una valutazione follow-up (T1) con la medesima batteria testale utilizzata al T0. Le valutazioni al T1 non mostrano variazioni psicopatologiche clinicamente significative, tuttavia la paziente riferisce un vissuto soggettivo positivo, riportando la percezione di un miglioramento della sintomatologia algica cronica derivante da una maggior individuazione delle proprie sensazioni somatiche. Verranno illustrati brani delle sedute psicoterapeutiche per approfondire le principali tematiche cliniche

Association of kidney disease measures with risk of renal function worsening in patients with type 1 diabetes

Background: Albuminuria has been classically considered a marker of kidney damage progression in diabetic patients and it is routinely assessed to monitor kidney function. However, the role of a mild GFR reduction on the development of stage 653 CKD has been less explored in type 1 diabetes mellitus (T1DM) patients. Aim of the present study was to evaluate the prognostic role of kidney disease measures, namely albuminuria and reduced GFR, on the development of stage 653 CKD in a large cohort of patients affected by T1DM. Methods: A total of 4284 patients affected by T1DM followed-up at 76 diabetes centers participating to the Italian Association of Clinical Diabetologists (Associazione Medici Diabetologi, AMD) initiative constitutes the study population. Urinary albumin excretion (ACR) and estimated GFR (eGFR) were retrieved and analyzed. The incidence of stage 653 CKD (eGFR < 60 mL/min/1.73 m2) or eGFR reduction > 30% from baseline was evaluated. Results: The mean estimated GFR was 98 \ub1 17 mL/min/1.73m2 and the proportion of patients with albuminuria was 15.3% (n = 654) at baseline. About 8% (n = 337) of patients developed one of the two renal endpoints during the 4-year follow-up period. Age, albuminuria (micro or macro) and baseline eGFR < 90 ml/min/m2 were independent risk factors for stage 653 CKD and renal function worsening. When compared to patients with eGFR > 90 ml/min/1.73m2 and normoalbuminuria, those with albuminuria at baseline had a 1.69 greater risk of reaching stage 3 CKD, while patients with mild eGFR reduction (i.e. eGFR between 90 and 60 mL/min/1.73 m2) show a 3.81 greater risk that rose to 8.24 for those patients with albuminuria and mild eGFR reduction at baseline. Conclusions: Albuminuria and eGFR reduction represent independent risk factors for incident stage 653 CKD in T1DM patients. The simultaneous occurrence of reduced eGFR and albuminuria have a synergistic effect on renal function worsening

Trasferrin receptor 2 gene regulation by microRNA 221 in SH-SY5Y cells treated with MPP+ as Parkinson's disease cellular model

Parkinson's disease (PD) is one of the most frequent human neurodegenerations. The neurodegeneration in PD is related to cellular iron increase but the mechanisms involved in iron accumulation remain unclear. Transferrin receptor type 2 (TFR2) is a protein expressed on cell membrane and involved in the cellular iron uptake. We hypothesized that microRNA 221 could regulate the expression of TfR2 in an in vitro model of Parkinson's disease, SH-SY5Y cells treated with MPP⁺. The miRNA 221 was selected by in silico analysis of several miRNAs predicted to target the TFR2 gene in SHSY5Y cells treated with MPP⁺. Taqman miRNA assay was used to evaluate the expression of the selected miRNAs. Using a luciferase assay we demonstrated the inhibition of TFR2 by miRNA 221. We show that in PD cellular model, TFR2 expression is regulated by miRNA 221. TFR2 and miR 221 are inversely correlated in SHSY5Y cells during the treatment with MPP⁺. Moreover, overexpression of miRNA 221 decreases the expression of TFR2, respectively, at the mRNA and protein levels. The inhibition of endogenous miRNA 221 also is able to regulate TFR2. These data suggest that miRNA 221 regulate TFR2 in PD mode

Climatic variability over the last 3000 years in the central - western Mediterranean Sea (Menorca Basin) detected by planktonic foraminifera and stable isotope records

The climate evolution of the last 2700 years in the central - western Mediterranean Sea has been reconstructed from marine sediment records by integrating planktonic foraminifera and geochemical signals. The results provide the characterization of six climatic phases: Balearic Bronze Age (BA), Roman Period (RP), Dark Age (DA), Medieval Climate Anomaly (MCA), Little Ice Age (LIA) and Industrial Period (IP). Paleoclimatic curve inferred from planktonic foraminifera associated with heavy values in δ18O Globigerinoides ruber during the BA document two cold intervals (spanning ca. 200 years) related to the Homeric and Greek solar minima. The dominance of Turborotalita quinqueloba –Globigerinita glutinata gr. and Globigerina bulloides during the RP suggest high fertility surface waters condition probably triggered by the increase in precipitation. During the DA, changes in the foraminiferal paleoclimate curve and oxygen isotope values display a cold –dry phase from 700 CE to the end of the DA (ca. 850 CE). This phase corresponds to the cold Roman IV solar minimum and marks the beginning of a long - term cooling interval that terminates during the LIA. The MCA is characterized by mild climatic conditions, interrupted at ca. 1050 CE by a cold - dry event. The gradually increase in abundance of G. ruber white characterize the IP warm period. The reconstructed climate evolution in the Balearic Basin results almost time - equivalent with the Mediterranean climate variability over the last 2700 years

Live benthic foraminifera from the Volturno River mouth (central Tyrrhenian Sea, Italy)

Living benthic foraminiferal assemblages were investigated at 22 marine stations in front of the Volturno River mouth (Gulf  of Gaeta, central Tyrrhenian Sea), during 3-years survey (2012–2014). The results were compared with the oceanographic  data recorded at the same sites, to highlight the ecology of the main dominant species and the relationship between the community structures and the environmental variables (turbidity, dissolved oxygen content, salinity, temperature, and runol).  The living assemblage, analyzed in the top 1fcm of sea ioor, was characterized by three dominant species (Ammonia tepida,  Bulimina elongata, and Rectuvigerina phlegeri) during all the sampling periods. Correlation analysis identiÂed turbidity,  runol, and oxygen as the main environmental factors iniuencing living foraminiferal assemblages. Ammonia tepida and Rectuvigerina phlegeri showed opportunistic behaviour in response to turbidity, oxygen, and salinity values. No signiÂcant  correlation was recorded between Bulimina elongata and the environmental parameters, testifying the capability of this  species to adapt to dilerent environmental conditions. The occurrence and distribution of these species provided useful  information about coastal dynamics and sediment transport, and our results conÂrmed them as reliable proxies of coastal  water column turbidity and Volturno river basin runol

Living and thanatocoenosis coccolithophore communities in a neritic area of the central Tyrrhenian Sea

The analyses of water and sediment samples, collected at 24 marine stations in a coastal area (Gulf of Gaeta, central Tyrrhenian Sea) during a three year survey (2012–2014), have improved our knowledge of coccolithophore ecology in the Mediterranean neritic domain. A comparison between the results and the oceanographic data has highlighted the ecology of the considered groups, and quantified the relationship between the community structures and the environmental parameters. The coccosphere concentration measured in the Gulf of Gaeta is extremely variable over the sampling periods (min:64 l−1; max:2.4*105 l−1), and comparable with data from other Mediterranean sites. Placolith-bearing taxa are the dominant group of the living communities. The concentration and distribution of Emiliania huxleyi is controlled by the distance from the coast and the Volturno River runoff. The K-strategist taxa are an important component of the summer nannoplankton in the upper 15 m and in the sediment samples. These taxa are also related to summer oligotrophic warm waters and low turbidity as well. The opportunistic behaviour of Helicosphaera carteri is confirmed and is related to moderately elevated nutrient levels and also tolerance to low salinity and terrigenous input. Nevertheless, our findings raise some questions on the reliability of H. carteri as a low salinity proxy. Overall, the sediment assemblages reflect the composition and the temporal distribution of the living communities. The occurrence and distribution of abundant reworked coccoliths, both in water and sediments, provides useful information about coastal dynamics and confirm their use as a reliable runoff prox