Gentile da Fabriano. Espaces ouverts à l’interprétation

Une monographie classique sur Gentile da Fabriano c’est-à-dire fondée sur un excursus de l’activité du peintre, un catalogue raisonné de ses œuvres et une documentation annexe « ne serait pas nécessaire aujourd’hui ». C’est ainsi que débute le dernier ouvrage monographique important écrit sur le maître en 1992 et cette même affirmation pourrait à nouveau être prononcée aujourd’hui et s’étendre à d’autres personnalités de l’art italien du Quattrocento. Non parce que les monographies existantes..

Spinal dural and epidural arteriovenous fistula: Recurrence rate after surgical and endovascular treatment

IntroductionSpinal dural arteriovenous fistula consist of an heterogenous group of vascular malformation often causing severe neurological deficit due to progressive myelopathy. This type of malformation could be associated with subarachnoid or subdural hemorrhage inside the spinal canal. In the English literature surgical treatment is regarded as the best option if compared to endovascular procedure, being the latter associated with an increased risk of relapse despite its less invasiveness.MethodsIn this study a retrospective analysis of 30 patients with spinal dural and epidural fistula associated with perimedullary venous congestion was undertaken. The radiological and clinical presentation of each patient is analyzed, and the grade of myelopathy is classified through the mJOA score.ResultsA total number of 31 out of 41 collected procedures (22 surgery vs. 19 endovascular) were dural fistulas while the remaining 10 were classified as epidural. A 46% recurrence rate for endovascular treatment against 0% for surgical (p-value 0.004) was described for dural fistulas, while in the epidural fistula group the rate of recurrence was 80% and 20% respectively for endovascular and surgery treatment (p-value 0.6).DiscussionAccording to the results, surgical treatment could be considered as first-line treatment for spinal dural arteriovenous fistulas. Endovascular embolization can be proposed in selected cases, as a less invasive technique, for elderly patients or with important comorbidities. In spinal epidural arteriovenous fistulas, in view of the greater invasiveness of the surgical treatment and the non-significant difference in terms of recurrence risk between the two techniques, endovascular treatment could be proposed as a first choice treatment; in the event of a recurrence, a surgical intervention will instead be proposed in a short time

Cancer screening uptake: association with individual characteristics, geographic distribution, and time trends in Italy

In Italy, organized screening programmes invite the vast majority of the population for cervical and breast cancer, and about one half of the population for colorectal cancer. Programme activity and quality are closely monitored. Nevertheless, there is a vast spontaneous activity, both public and private, for which information on service and coverage is missing. To estimate actual population coverage for the three types of screening the extent of spontaneous screening needs to be known

Impact of social determinants on antiretroviral therapy access and outcomes entering the era of universal treatment for people living with HIV in Italy

Background: Social determinants are known to be a driving force of health inequalities, even in high income countries. Aim of our study was to determine if these factors can limit antiretroviral therapy (ART) access, outcome and retention in care of people living with HIV (PLHIV) in Italy. Methods: All ART naïve HIV+ patients (pts) of Italian nationality enrolled in the ICONA Cohort from 2002 to 2016 were included. The association of socio-demographic characteristics (age, sex, risk factor for HIV infection, educational level, occupational status and residency area) with time to: ART initiation (from the first positive anti-HIV test), ART regimen discontinuation, and first HIV-RNA < 50 cp/mL, were evaluated by Cox regression analysis, Kaplan Meier method and log-rank test. Results: A total of 8023 HIV+ pts (82% males, median age at first pos anti-HIV test 36 years, IQR: 29-44) were included: 6214 (77.5%) started ART during the study period. Women, people who inject drugs (PWID) and residents in Southern Italy presented the lowest levels of education and the highest rate of unemployment compared to other groups. Females, pts aged > 50 yrs., unemployed vs employed, and people with lower educational levels presented the lowest CD4 count at ART initiation compared to other groups. The overall median time to ART initiation was 0.6 years (yrs) (IQR 0.1-3.7), with a significant decrease over time [2002-2006 = 3.3 yrs. (0.2-9.4); 2007-2011 = 1.0 yrs. (0.1-3.9); 2012-2016 = 0.2 yrs. (0.1-2.1), p < 0.001]. By multivariate analysis, females (p < 0.01) and PWID (p < 0.001), presented a longer time to ART initiation, while older people (p < 0.001), people with higher educational levels (p < 0.001), unemployed (p = 0.02) and students (p < 0.001) were more likely to initiate ART. Moreover, PWID, unemployed vs stable employed, and pts. with lower educational levels showed a lower 1-year probability of achieving HIV-RNA suppression, while females, older patients, men who have sex with men (MSM), unemployed had higher 1-year risk of first-line ART discontinuation. Conclusions: Despite median time to ART start decreased from 2002 to 2016, socio-demographic factors still contribute to disparities in ART initiation, outcome and durability

MANUAL WORKERS ARE MORE LIKELY TO ADOPT UNHEALTHY HABITS

Background. In Italy, organized screening programmes invite the vast majority of the population for cervical and breast cancer, and about one half of the population for colorectal cancer. Programme activity and quality are closely monitored. Nevertheless, there is a vast spontaneous activity, both public and private, for which information on service and coverage is missing. To estimate actual population coverage for the three types of screening the extent of spontaneous screening needs to be known. Methods. PASSI is a national telephone-interview surveillance system that continuously collects information about behavioural health risk factors and the diffusion of preventive health interventions. From 2010 to 2013, more than 151,000 18- to 69-year-olds were interviewed. During 2013, 136 out of 147 Italian local health authorities participated in the survey. Information about screening includes: test uptake (Pap smear, HPV, mammography, faecal occult blood test, colonoscopy), date of the last test, provider of the last test (whether paid or for free, proxy of the organized screening programme), reason for not participating in screening, and screening promotion/recommendation received. Individual information on socio-economic characteristics is available. Results. Seventy-seven percent of the 25-64 year-old women interviewed said they had undergone a Pap smear or HPV test in the three years before the interview, 40% within the screening programme, 37% spontaneously and paying. Seventy percent of the 50-69 year-old women interviewed reported having had a mammography in the two years before the interview, 51% within the screening programme, 19% spontaneously and paying. Thirty-eight percent of the 50-69 year olds interviewed reported having undergone colorectal screening in the two years before the interview, 31% within the screening programme, 7% spontaneously and paying. All three screening programmes showed a decreasing North-South trend in coverage. From 2010 to 2013, coverage increased for all types of screening; the trend was stronger in the South; the increase was mostly due to the tests performed within the organized programmes. People with low education, economic problems, and immigrants from high migration pressure countries had lower coverage levels. In regions with well-implemented organized screening programmes, test coverage was higher and differences for socio-economic factors were smaller than in regions with incomplete programme activation

Self-reported influenza vaccination uptake in people with chronic diseases: data from Progressi delle Aziende Sanitarie per la Salute in Italia (PASSI)

Background Influenza is an important public health problem, with potential severe consequences among people with chronic diseases. The aim of this study was to obtain reliable measures of seasonal influenza vaccine uptake in this population, otherwise not available in Italy. Methods Progressi delle Aziende Sanitarie per la Salute in Italia (PASSI) is a nationwide surveillance system of health-related behaviours and acceptance of preventive interventions (including influenza immunisation) offered by the Italian National Health Service. Data are collected with telephone interviews at local health unit level for supporting local activities. The survey sample is randomly selected from local health unit lists of adult residents. The trend of annual vaccine coverage since 2008 was estimated for people aged 18–64 years who reported having at least one chronic disease. To obtain a sufficient sample size in subgroups, we analysed the characteristics of vaccinated people in the 2010–13 cumulative dataset. Univariate, multivariate, and logistic regression analyses were undertaken. Findings In 2008–13, 13 659 individuals with at least one chronic disease were interviewed. Vaccination coverage fell significantly from 29·7% (95% CI 27·2–32·4) in 2007–08 to 19·9% (18·0–22·1) in 2012–13. During 2010–13, the overall proportion of vaccinated people with a chronic disease was 25·6% (24·5–26·7). Vaccine coverage of people with diabetes (34·3%, 31·7–36·9) or cardiovascular diseases (31·8%, 29·6–34·2) was greater than that of people affected by renal failure, respiratory diseases, tumours, or chronic liver diseases (26·5% [22·5–30·7], 24·9% [23·2–26·7], 22·2% [20·0–24·6], and 20·6% [17·5–24·6], respectively). Vaccination coverage increased with age (from 13·1% [11·0–15·5] in the 18–34 year age group to 33·4% [31·9–35·1] in people aged 50–64 years); it was higher among people with a low educational level than among those with a high educational level, higher in those having economic difficulties than in those with no economic difficulties, and higher among Italian citizens than among non-citizens. Interpretation In the past few years, prevalence of influenza vaccination in Italian adults with at least one chronic disease was well below the Ministry of Health's goal (75% minimum) and showed a downward trend. A major reason of this evolution is probably the changing public perception of the benefits and risks of vaccines. PASSI is a source of useful data not otherwise available for public health intervention. Funding Italian Ministry of Health

Self-reported influenza vaccination uptake in people with chronic diseases: data from Progressi delle Aziende Sanitarie per la Salute in Italia (PASSI)

Background Influenza is an important public health problem, with potential severe consequences among people with chronic diseases. The aim of this study was to obtain reliable measures of seasonal influenza vaccine uptake in this population, otherwise not available in Italy. Methods Progressi delle Aziende Sanitarie per la Salute in Italia (PASSI) is a nationwide surveillance system of health-related behaviours and acceptance of preventive interventions (including influenza immunisation) offered by the Italian National Health Service. Data are collected with telephone interviews at local health unit level for supporting local activities. The survey sample is randomly selected from local health unit lists of adult residents. The trend of annual vaccine coverage since 2008 was estimated for people aged 18\u201364 years who reported having at least one chronic disease. To obtain a sufficient sample size in subgroups, we analysed the characteristics of vaccinated people in the 2010\u201313 cumulative dataset. Univariate, multivariate, and logistic regression analyses were undertaken. Findings In 2008\u201313, 13\u2008659 individuals with at least one chronic disease were interviewed. Vaccination coverage fell significantly from 29\ub77% (95% CI 27\ub72\u201332\ub74) in 2007\u201308 to 19\ub79% (18\ub70\u201322\ub71) in 2012\u201313. During 2010\u201313, the overall proportion of vaccinated people with a chronic disease was 25\ub76% (24\ub75\u201326\ub77). Vaccine coverage of people with diabetes (34\ub73%, 31\ub77\u201336\ub79) or cardiovascular diseases (31\ub78%, 29\ub76\u201334\ub72) was greater than that of people affected by renal failure, respiratory diseases, tumours, or chronic liver diseases (26\ub75% [22\ub75\u201330\ub77], 24\ub79% [23\ub72\u201326\ub77], 22\ub72% [20\ub70\u201324\ub76], and 20\ub76% [17\ub75\u201324\ub76], respectively). Vaccination coverage increased with age (from 13\ub71% [11\ub70\u201315\ub75] in the 18\u201334 year age group to 33\ub74% [31\ub79\u201335\ub71] in people aged 50\u201364 years); it was higher among people with a low educational level than among those with a high educational level, higher in those having economic difficulties than in those with no economic difficulties, and higher among Italian citizens than among non-citizens. Interpretation In the past few years, prevalence of influenza vaccination in Italian adults with at least one chronic disease was well below the Ministry of Health's goal (75% minimum) and showed a downward trend. A major reason of this evolution is probably the changing public perception of the benefits and risks of vaccines. PASSI is a source of useful data not otherwise available for public health intervention. Funding Italian Ministry of Health

Documento II-XV: La corrispondenza inedita tra Austen Henry Layard (1817-1894), William Richard Drake (1817-1890) e Robert Jenkins Nevin (1839-1906)

Al fine di integrare il quadro delle vicende relative l’esecuzione dei mosaici di Edward Burne-Jones per la chiesa di San Paolo Dentro le Mura, si è scelto di pubblicare la corrispondenza fra il reverendo Robert Jenkins Nevin (1839-1906) e Sir Austen Henry Layard (1817-1894), socio fondatore, insieme a Sir William Richard Drake (1817-1890), della Compagnia Venezia e Murano (CVM). Lo scambio epistolare con Nevin, oltre a sondare i retroscena della commessa, testimonia altresì un rapporto d’amicizia e di stima. Ne è una prova più che evidente la lettera del 7 maggio 1894. Di particolare rilievo, inoltre, è quella datata 25 maggio 1890, grazie alla quale è ora possibile individuare, con maggiore sicurezza, alcune delle opere acquistate da Nevin presso la collezione del conte Augusto Caccialupi. Le Layard Papers documentano, poi, una relazione amichevole con lo stesso Burne-Jones. Ben più rilevanti, per l’oggetto qui trattato, alcune battute del carteggio fra Layard e Drake, inserite in ordine cronologico fra le lettere Nevin. I documenti, raccolti e pubblicati per la prima volta in questa sede, provengono interamente dall’epistolario di Sir Austen Henry Layard, custodito presso il Dipartimento Manoscritti della British Library di Londra

Composite microsphere-functionalized scaffold for the controlled release of small molecules in tissue engineering

Current tissue engineering strategies focus on restoring damaged tissue architectures using biologically active scaffolds. The ideal scaffold would mimic the extracellular matrix of any tissue of interest, promoting cell proliferation and de novo extracellular matrix deposition. A plethora of techniques have been evaluated to engineer scaffolds for the controlled and targeted release of bioactive molecules to provide a functional structure for tissue growth and remodeling, as well as enhance recruitment and proliferation of autologous cells within the implant. Recently, novel approaches using small molecules, instead of growth factors, have been exploited to regulate tissue regeneration. The use of small synthetic molecules could be very advantageous because of their stability, tunability, and low cost. Herein, we propose a chitosan–gelatin scaffold functionalized with composite microspheres consisting of mesoporous silicon microparticles and poly( dl -lactic-co-glycolic acid) for the controlled release of sphingosine-1-phospate, a small molecule of interest. We characterized the platform with scanning electron microscopy, Fourier transform infrared spectroscopy, and confocal microscopy. Finally, the biocompatibility of this multiscale system was analyzed by culturing human mesenchymal stem cells onto the scaffold. The presented strategy establishes the basis of a versatile scaffold for the controlled release of small molecules and for culturing mesenchymal stem cells for regenerative medicine applications