147 research outputs found
La Northern Avenue a Yerevan e il piano urbanistico di Tamanian
A differenza di molte altre capitali dei paesi dell'area, come la vicina Tbilisi, che in anni recenti ha ceduto alla fascinazione e alle suggestioni di architetture spettacolari, perlopiĂč estranee al contesto, alla geografia ed al tessuto urbano, o di Baku, dove il restauro della cittĂ vecchia ha aperto le porte alla realizzazione di un gran numero di cattedrali dellâarchitettura globalizzata, Yerevan sta perseguendo, autonomamente e in controtendenza rispetto ai vicini, un proprio modello di sviluppo urbano, non incentrato sullâalteritĂ e il conflitto con lâesistente, ma basato in gran parte sugli indirizzi contenuti nel piano di Alexander Tamanian del 1924.In contrast with its neighbour Tbilisi, which in recent years has yielded to the fascination and charm of spectacular architecture, mostly out of context, geography and urban fabric, or from Baku, where the restoration of the Old Town has opened up the doors to the realization of a large number of archistar-made buildings, Yerevan is pursuing an own model of urban development, not focused on the conflict with the existing fabric, but largely based on the addresses contained in the 1924 plan by Alexander Tamanian
Post covid Rome: âBeing in the worldâ and urban metabolism. Post covid Roma: âSer-en el mundoâ y metabolismo urbano
This paper aims to propose a reflection on how the city of Rome is reacting to the social and urban consequences caused by the pandemic situation. Starting from the analysis of urban densification and hyper-densification âand their correlations with globalismâ the paper also intends to underline a broader phenomenon linked to the progressive âabandonmentâ of large cities. In fact, the pandemic phenomenon risks catalyzing two trends currently at an embryonic stage in Italy, generating a scenario with uncertain consequences: on the one hand, the loss of urban attractiveness could suggest a progressive âabandonmentâ of large cities; on the other hand, cities may have to deal with the need to stop sprawl phenomena and promote greater densification of the urban perimeter.
Furthermore, the pandemic is showing how, at the base of the emergency, there is a problem of spaces and that beyond the social distancing, which will end as the contagion began, it will be the architectâs task to help the community to overcome the memory of the trauma experienced, leading to a greater awareness of taking care of spaces and urban metabolism.Este trabajo pretende proponer una reflexioÌn sobre coÌmo estaÌ reaccionando la ciudad de Roma ante las consecuencias sociales y urbanas provocadas por la situacioÌn de pandemia. Partiendo del anaÌlisis de la densificacioÌn y la hiperdensificacioÌn urbanas -y de sus correlaciones con el globalismo-, el documento pretende tambieÌn subrayar un fenoÌmeno maÌs amplio vinculado al progresivo âabandonoâ de las grandes ciudades. De hecho, el fenoÌmeno de la pandemia corre el riesgo de catalizar dos tendencias actualmente en fase embrionaria en Italia, generando un escenario de consecuencias inciertas: por un lado, la peÌrdida de atractivo urbano podriÌa sugerir un progresivo âabandonoâ de las grandes ciudades; por otro, las ciudades podriÌan tener que enfrentarse a la necesidad de frenar los fenoÌmenos de dispersioÌn y promover una mayor densificacioÌn del periÌmetro urbano.
AdemaÌs, la pandemia estaÌ mostrando coÌmo, en la base de la emergencia, hay un problema de espacios y que maÌs allaÌ del distanciamiento social, que acabaraÌ como empezoÌ el contagio, seraÌ tarea del arquitecto ayudar a la comunidad a superar la memoria del trauma vivido, lo que llevaraÌ a una mayor conciencia de cuidado de los espacios y del metabolismo urbano
Ipsilateral and contralateral carotid stenosis contribute to the outcome of reperfusion treatment for ischemic stroke
IntroductionIpsilateral and contralateral carotid stenosis (ICS, CCS) influence acute ischemic stroke (AIS) severity and prognosis. Few data are available about their impact on reperfusion therapies efficacy. Aim of this study was to evaluate the impact of ICS and CCS on the effect of intravenous thrombolysis (IT), mechanical thrombectomy (MT) or both and of antiplatelet therapy (AT).MethodsWe enrolled all the consecutive patients admitted for AIS to our stroke unit and submitted to IT, MT, IT+MT, or AT. We established the presence of a significant ICS or CCS (â„70%) by ultrasound examination or brain angio-CT, or MRI. Clinical and instrumental information were collected; delta National Institutes of Health Stroke Scale (NIHSS) from pre-treatment to patients' discharge was employed as the main outcome measure.ResultsIn total, 460 subjects were enrolled, 86 with ICS and 38 with CCS. We observed a significant linear trend of delta (NIHSS) between carotid stenosis categories for patients undergoing IT (p = 0.011), MT (p = 0.046), and MT+IT (p = 0.040), but no significant trend among subjects receiving no reperfusion treatments was observed (p = 0.174).DiscussionAccording to our findings, ICS and CCS negatively influence AIS patients' outcome treated by interventional therapies. ICS might exert an unfavorable effect both by cerebral hypoperfusion and by continuous microembolization toward ischemic area, while CCS is probable involved in reducing the collateral circles effectiveness. The importance of early carotid stenosis detection and treatment should then be reevaluated not only to manage the prevention approaches but also to obtain insights about post-stroke treatment strategies efficacy
Doppler and Spectral Ultrasound of Sacroiliac Joints in Pediatric Patients with Suspected Juvenile Spondyloarthritis
Background: Power Doppler ultrasound (PDUS) with spectral wave analysis (SWA) has been compared with magnetic resonance imaging (MRI) in documenting active sacroiliitis in early spondyloarthritis (SpA) but, to date, PDUS/SWA has not been yet applied to the study of sacroiliac joints (SIJs) in children. Methods: A group of 20 children (13 F/7 M, mean age 14.2 y) with suspected juvenile SpA (jSpA) underwent PDUS/SWA and, subsequently, MRI of the SIJs. SIJs PDUS scoring and resistance index (RI) of the SIJs flows were recorded. The accuracy of PDUS/SWA for the diagnosis of active sacroiliitis was evaluated, with MRI as the gold standard. Results: PDUS signals were detected in 19 patients and 30 SIJs. Bone marrow edema (BME) lesions on MRI were detected in 12 patients (diagnosed as jSpA) and 22 SIJs. PDUS scoring on SIJs were higher in patients with a final diagnosis of jSpA (p = 0.003). On SWA, the mean RIs in patients with or without final diagnosis of active sacroiliitis were, respectively, 0.604 and 0.767 (p = 0.005) at joint level. A RI < 0.55 and PDUS > 1 showed the higher specificity for sacroiliitis (AUROC curve 0.854 for PDUS and 0.920 for RI). SIJs PDUS/SWA showed an overall concordance of 82.35%, with substantial agreement (k = 0.627) with MRI on the diagnosis of sacroiliitis. Conclusions: In children with sacroiliitis, PDUS demonstrates a rich vascularization into SIJs and low RIs (<0.55) have high specificity for this condition. SIJs PDUS/SWA could be useful as a screening method in children with suspected jSpA
Rituximab-induced hypogammaglobulinaemia in patients affected by idiopathic inflammatory myopathies: a multicentre study
Objective Rituximab (RTX) is an anti-CD20 chimeric monoclonal antibody recommended as off-label treatment in patients with idiopathic inflammatory myopathies (IIM). The present study aimed to evaluate changes in immunoglobulin (Ig) levels during RTX-treatment and their potential association with infections in a cohort of IIM patients.Methods Patients evaluated in the Myositis clinic belonging to the Rheumatology Units of Siena, Bari and Palermo University Hospitals, and treated for the first time with RTX were enrolled. Demographic, clinical, laboratory and treatment variables, including previous and concomitant immunosuppressive drugs and glucocorticoid (GC) dosage were analysed before (T0) and after 6 (T1) and 12 (T2) months of RTX treatment.Results Thirty patients (median age, IQR 56 (42-66); 22 female) were selected. During the observational period, low levels of IgG (<700 mg/dl) and IgM (<40 mg/dl) occurred in 10% and 17% of patients, respectively. However, no one showed severe (IgG<400 mg/dl) hypogammaglobulinaemia. IgA concentrations were lower at T1 than T0 (p=0.0218), while IgG concentrations were lower at T2 compared to those at baseline (p=0.0335). IgM concentrations were lower at T1 and T2 than T0 (p<0.0001), as well at T2 than T1 (p=0.0215). Three patients suffered major infections, two others had paucisymptomatic COVID-19, one suffered from mild zoster. GC dosages at T0 were inversely correlated with IgA T0 concentrations (p=0.004, r=-0.514). No correlation was found between demographic, clinical and treatment variables and Ig serum levels.Conclusion Hypogammaglobulinaemia following RTX is uncommon in IIM and is not related to any clinical variables, including GC dosage and previous treatments. IgG and IgM monitoring after RTX treatment does not seem useful in stratifying patients who require closer safety monitoring and prevention of infection, due to the lack of association between hypogammaglobulinaemia and the onset of severe infections
Risk prediction of clinical adverse outcomes with machine learning in a cohort of critically ill patients with atrial fibrillation
Critically ill patients affected by atrial fibrillation are at high risk of adverse events: however, the actual risk stratification models for haemorrhagic and thrombotic events are not validated in a critical care setting. With this paper we aimed to identify, adopting topological data analysis, the risk factors for therapeutic failure (in-hospital death or intensive care unit transfer), the in-hospital occurrence of stroke/TIA and major bleeding in a cohort of critically ill patients with pre-existing atrial fibrillation admitted to a stepdown unit; to engineer newer prediction models based on machine learning in the same cohort. We selected all medical patients admitted for critical illness and a history of pre-existing atrial fibrillation in the timeframe 01/01/2002-03/08/2007. All data regarding patients' medical history, comorbidities, drugs adopted, vital parameters and outcomes (therapeutic failure, stroke/TIA and major bleeding) were acquired from electronic medical records. Risk factors for each outcome were analyzed adopting topological data analysis. Machine learning was used to generate three different predictive models. We were able to identify specific risk factors and to engineer dedicated clinical prediction models for therapeutic failure (AUC: 0.974, 95%CI: 0.934-0.975), stroke/TIA (AUC: 0.931, 95%CI: 0.896-0.940; Brier score: 0.13) and major bleeding (AUC: 0.930:0.911-0.939; Brier score: 0.09) in critically-ill patients, which were able to predict accurately their respective clinical outcomes. Topological data analysis and machine learning techniques represent a concrete viewpoint for the physician to predict the risk at the patients' level, aiding the selection of the best therapeutic strategy in critically ill patients affected by pre-existing atrial fibrillation
Baricitinib retention rate: âreal-lifeâ data from a mono-centric cohort of patients affected by rheumatoid arthritis
ObjectivesThe aim of this retrospective study was to evaluate baricitinib retention rate in patients affected by rheumatoid arthritis. Secondary aims were to compare the impact on treatment persistence of monotherapy and other variables such as systemic corticosteroid use, line of treatment, disease duration, sex, biomarkers positivity, and Herpes Zoster virus infection.Materials and methodsPatients with Rheumatoid Arthritis undergoing baricitinib were consecutively enrolled. Rheumatoid Arthritis diagnosis was performed with 2010 ACR/EULAR classification criteria. The cohortâs demographic, clinical and therapeutical data were retrospectively collected. The whole follow-up duration was 104âweeks.ResultsNinety-five patients affected by rheumatoid arthritis and treated with baricitinib were consecutively enrolled. At the end of follow-up, the overall retention rate was 69.3%. No statistically significant difference in retention rate was observed between patients treated with baricitinib in monotherapy or in combination with methotrexate (pâ=â0.638) while patients undergoing a steroidal treatment showed a significantly reduced treatment retention (pâ=â0.028). Contrarily, patients treated with baricitinib as a first-line b/tsDMARD showed higher drug retention (pâ=â0.002) compared to further treatment lines. Steroid employment, steroid dosage and previous treatment with bDMARDs correlated with risk of treatment discontinuation and at univariate analysis (pâ=â0.028, pâ<â0.001, and pâ=â0.002 respectively). Multivariate analysis confirmed significance for higher steroid dosage and previous treatment with bDMARDs (pâ=â0.002 and pâ=â0.046). No adverse events such as deep venous thrombosis, pulmonary embolism or tubercular infection/reactivation were reported during the study observation.ConclusionOur data show a good baricitinib retention rate after 12 and 24âmonths of observation (75.1 and 69.3%, respectively). In our cohort, concomitant treatment with methotrexate did not influence treatment persistence while retention was reduced in patients undergoing a steroidal treatment and/or in multi-failure subjects
Interspinous bursitis is common in polymyalgia rheumatica, but is not associated with spinal pain
The association between insight and depressive symptoms in schizophrenia: Undirected and Bayesian network analyses
Background. Greater levels of insight may be linked with depressive symptoms among patients with schizophrenia, however, it would be useful to characterize this association at symptom-level, in order to inform research on interventions. Methods. Data on depressive symptoms (Calgary Depression Scale for Schizophrenia) and insight (G12 item from the Positive and Negative Syndrome Scale) were obtained from 921 community-dwelling, clinically-stable individuals with a DSM-IV diagnosis of schizophrenia, recruited in a nationwide multicenter study. Network analysis was used to explore the most relevant connections between insight and depressive symptoms, including potential confounders in the model (neurocognitive and social-cognitive functioning, positive, negative and disorganization symptoms, extrapyramidal symptoms, hostility, internalized stigma, and perceived discrimination). Bayesian network analysis was used to estimate a directed acyclic graph (DAG) while investigating the most likely direction of the putative causal association between insight and depression. Results. After adjusting for confounders, better levels of insight were associated with greater self-depreciation, pathological guilt, morning depression and suicidal ideation. No difference in global network structure was detected for socioeconomic status, service engagement or illness severity. The DAG confirmed the presence of an association between greater insight and self-depreciation, suggesting the more probable causal direction was from insight to depressive symptoms. Conclusions. In schizophrenia, better levels of insight may cause self-depreciation and, possibly, other depressive symptoms. Person-centered and narrative psychotherapeutic approaches may be particularly fit to improve patient insight without dampening self-esteem
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