Guidelines on the diagnosis, treatment and management of visceral and renal arteries aneurysms: a joint assessment by the Italian Societies of Vascular and Endovascular Surgery (SICVE) and Medical and Interventional Radiology (SIRM)

: The objective of these Guidelines is to provide recommendations for the classification, indication, treatment and management of patients suffering from aneurysmal pathology of the visceral and renal arteries. The methodology applied was the GRADE-SIGN version, and followed the instructions of the AGREE quality of reporting checklist. Clinical questions, structured according to the PICO (Population, Intervention, Comparator, Outcome) model, were formulated, and systematic literature reviews were carried out according to them. Selected articles were evaluated through specific methodological checklists. Considered Judgments were compiled for each clinical question in which the characteristics of the body of available evidence were evaluated in order to establish recommendations. Overall, 79 clinical practice recommendations were proposed. Indications for treatment and therapeutic options were discussed for each arterial district, as well as follow-up and medical management, in both candidate patients for conservative therapy and patients who underwent treatment. The recommendations provided by these guidelines simplify and improve decision-making processes and diagnostic-therapeutic pathways of patients with visceral and renal arteries aneurysms. Their widespread use is recommended

Pratella, Roccavecchia, Fontana Sant’Arcangelo, loc.

Nella località Fontana Sant’Arcangelo, presso la frazione di Mastrati di Pratella (fig. 3), si segnala la presenza di materiale votivo che documenta la probabile esistenza di un luogo di culto sorto presso una sorgente d’acqua. Fig. 3 Il territorio del municipium di Allifae. © DR È da segnalare peraltro che sulle colline sovrastanti il sito, nella località Palombiscio, furono messe in luce nel 1993 due fornaci, utilizzate tra il IV e il II sec. a.C., pertinenti ad uno degli insediamenti sann..

Piedimonte Matese, Epitaffio, loc.

Nel sito ubicato ai piedi del Monte Cila (fig. 3) e allo sbocco di una delle fonti sorgive del Maretto, confluenti nel Torano, che alimentavano anche gli acquedotti romani, il rinvenimento di una statuina votiva e di terrecotte architettoniche potrebbe documentare la presenza di un luogo di culto; lo confermerebbe il recente ritrovamento di un bronzetto di Herakles, recuperato tra i resti della chiesa medioevale normanna, ma con varie fasi edilizie precedenti, scoperta tra il 1994 e il 1998 a..

Piedimonte Matese, Pigna, loc., via Pioppitelli

Nella località Pigna, situata a ridosso del Monte Cila, in via Pioppitelli, si sono in passato rinvenute terrecotte architettoniche e vasi che indurrebbero ad ipotizzare la presenza di un luogo di culto (fig. 3). Fig. 3 Il territorio del municipium di Allifae. © DR Fonti archeologiche Decorazione architettonica Terrecotte architettoniche, di cui una a protome leonina e un’altra con testa femminile nimbata potrebbero essere pertinenti ad edifici con destinazione sacrale. Reperti Dalla localit..

Sant’Angelo d’Alife, Grotte, loc.

Nel territorio di Sant’Angelo d’Alife, in località Grotte, è stato rinvenuto un piede fittile votivo, reperto che potrebbe confermare le incerte testimonianze orali tramandate dagli anziani del luogo relative alla fortuita scoperta, nel corso della seconda guerra mondiale, di numerose statuine fittili, andate poi perdute. È da rilevare, a tale proposito, che alcune frammentarie statuine fittili votive, di cui una di guerriero con armi sannitiche (figg. 3 e 28-30), con generica provenienza «da..

Pratella, Roccavecchia, Grotte, loc.

Ancora a Pratella, ma nella località Grotte, presso il Mulino Castallo (fig. 3), furono rinvenuti nel 1912 alcuni oggetti votivi, forse connessi ad un culto salutifero locale (cfr. anche scheda Pratella, frazione Roccavecchia, Fontana Sant’Arcangelo, loc.). Fig. 3 Il territorio del municipium di Allifae. © DR Fonti archeologiche Reperti Sono segnalati un piede, ed un frammento di braccio fittili oltre a un vaso di ceramica grezza

Disease Reactivation in Secondary Progressive Multiple Sclerosis Patients Switching from Fingolimod to Siponimod: A Case Series

Siponimod, a selective modulator of sphingosine 1-phosphate receptors 1 (S1P1) and 5 (S1P5), has recently been marketed for patients with Secondary Progressive Multiple Sclerosis (SPMS). Herein, we report three SPMS patients presenting disease reactivation in the first three months after switching from fingolimod to siponimod. Fingolimod binds to S1P1, S1P3, S1P4 and S1P5 receptors. S1P3 holds a central role in eliciting central proinflammatory responses, thus it has been hypothesized that upregulation of S1P3 may be the mechanism behind relapses after switching from fingolimod to siponimod. Further studies are needed to investigate the safety and efficacy of this treatment sequencing

Validation of the swallowing disturbance questionnaire in people with multiple sclerosis

Background: The DYSPHAGIA IN MULTIPLE SCLEROSIS (DYMUS) questionnaire is the only specific tool developed to screen for dysphagia in people with Multiple Sclerosis (pwMS). However, some limitations of DYMUS could potentially be addressed by the SWALLOWING DISTURBANCE QUESTIONNAIRE (SDQ), which has not yet been validated in pwMS. The objective of this study was to translate and validate the SDQ into the Italian language for use in pwMS to detect swallowing disturbances.Methods: We translated the SDQ into Italian and adapted it for use in Italian pwMS. PwMS aged > 18 years, assessed for disability using the Expanded Disability Status Scale (EDSS), completed the SDQ and DYMUS questionnaires and performed the 3-OUNCE WATER SWALLOW TEST (WST). Clinical and demographic data were collected for each patient. The Italian version of the SDQ was retested after 30 days.Results: A total of 84 pwMS were recruited for the study, consisting of 73.8 % women and 48.8 % with a relapsing-remitting form of MS. The mean age of participants was 44.5 years (SD: +/- 12.46), with a mean disease duration of 17 years (SD: +/- 10.27), and a median EDSS of 4 (range 1.5-7.5). The Cronbach's alpha for SDQ (to assess internal consistency) was 0.902, which increased to 0.908 after the elimination of item 15, resulting in the SDQ composed of 14 items. ROC analysis demonstrated good accuracy of the 14-item SDQ in pwMS (AUC: 0.811). By dividing the 14-item SDQ score into quartiles, three risk levels for dysphagia were identified: low (score 1-3), intermediate (score 4-8), and high (score >= 9). 14-item SDQ scores significantly correlated with DYMUS (r = 0.820; p<0.0001) and with EDSS (r = 0.541; p<0.0001). PwMS who reported dysphagia had a significantly higher mean 14-item SDQ score (8.27 +/- SD 8.15) compared to those without swallowing problems (2.77 +/- SD 4.25; p = 0.003). Additionally, pwMS with a positive WST had a significantly higher mean 14-item SDQ score (10.17 +/- SD 8.96) than those with a negative WST (2.96 +/- SD 3.93; p = 0.02). The Intraclass Correlation Coefficient for the retest, calculated on 48 pwMS in a stable phase of the disease, was 0.91 (95 % CI 0.84-0.95).Conclusion: The 14-item SDQ has demonstrated high internal consistency, good accuracy, and reliability in pwMS, making it a readily applicable tool for investigating dysphagia in MS

Residues 762-801 of PLD1 mediate the interaction with PED/PEA15

The interaction of Phospholipase D1 (PLD1) by its C-terminal domain D4 with PED/PEA15 has been indicated as a target for type 2 diabetes. PED/PEA15 is overexpressed in several tissues of individuals affected by type 2 diabetes and its overexpression in intact cells and in transgenic animal models impairs insulin regulation of glucose transport by a mechanism mediated by the interaction with D4 and the consequent increase of protein kinase C-alpha activity. Expression of D4 or administration of a peptide mimicking the PED/PEA15 region involved in this interaction to cells stably overexpressing PED/PEA15 reduces its interaction with PLD1, thereby lowering PKC-alpha activation and restoring normal glucose transport mediated by PKC-zeta. By using D4 deletion mutants, we have restricted the PLD1 region involved in PED/PEA15 interaction to an N-terminal fragment named D4alpha (residues 712-818). This region binds PED/PEA15 with the same efficacy as D4 (K(D) approximately 0.7 microM) and, when transfected in different PED/PEA15-overexpressing cells, it is able to reduce PKC-alpha activity and to restore the sensitivity of PKC-zeta to insulin stimulation, independently of the PI3K/Akt signalling. We also show that the effective disruption of the PED/PEA15-PLD1 interaction can restore the normal ERK1/2 signalling. Finally, using a set of overlapping peptides that cover the D4alpha region, we have further restricted the shortest PED/PEA15-binding site to a segment encompassing residues 762-801, suggesting that a quite limited binding interface mostly contributes to the interaction and can thus be a selective target for the design of effective antagonists

Health related quality of life in the domain of physical activity predicts confirmed disability progression in people with relapsing remitting multiple sclerosis

Introduction: The diagnosis of the progression phase of Multiple Sclerosis (MS) is still retrospective and based on the objectivation of clinical disability accumulation. Objectives: To assess whether the Patient Reported Outcomes Measures (PROMs) scores predict the occurrence of disease progression within three years of follow-up. Methods: Observational prospective multicenter study. Stable Relapsing-Remitting MS (RRMS) patients were enrolled. At enrollment, patients completed the following PROMs: Beck Depression Inventory- II, The Treatment Satisfaction Questionnaire for Medications, Medical Outcomes Study Short Form 36- Item (SF36), Fatigue Severity Scale. EDSS was assessed at enrollment and three years later. The outcome measure was defined as the occurrence of confirmed disability progression (CDP) within three years of follow-up. Univariable and multivariable logistic regression models were performed to study the association between the final score of each test and the outcome. Results: SF36-Physical Functioning (SF36-PF) was the only independent variable associated with the outcome. The ROC curve analysis determined a score of 77.5 at SF36-PF as the cut-off point identifying patients experiencing CDP within three years of follow-up [AUC: 0.66 (95% CI: 0.56-0.75)]. Conclusions: RRMS patients scoring higher (>77.5) at SF36-PF subscale have a higher likelihood to experience CDP within the next three years