When Agencies and Families Come Together: Dealing with Conflict in Building Partnerships

In età tardoromana e bizantina l'insediamento di Vaste era articolato in una serie di villaggi sparsi nel territorio, intorno all'odierno abitato, le cui tracce sono venute in luce grazie alle ricognizioni dio superficie condotte dall'équipe dell'Università del Salento. In questo sistema insediativo un ruolo di particolare importanza era ricoperto da un edificio di culto, messo in luce nell'area di Fondo Giuliano, nelle vicinanze della cripta dei SS. Stefani. La chiesa presenta diverse fasi costruttive. La prima, il cui impianto è collocabile alla fine del IV sec. d.C., ha pianta cruciforme, con piccola abside, e muro di recinzione. La copertura doveva essere a capriate lignee che sostenevano un tetto di tegole. Nell’edificio è stato riconosciuto un martyrium, ossia un monumento dedicato al culto delle reliquie. Dopo la sua distruzione, forse collegabile agli eventi della guerra greco-gotica (535-553), nella seconda metà del VI secolo fu innalzata una seconda chiesa, la maggiore per dimensioni e certamente la più importante: presenta un impianto a tre navate separate da file di pilastri, con grande abside centrale, e tetto a doppio spiovente. La struttura si inserisce bene nel quadro dell’architettura cristiana di Terra d’Otranto. In epoca altomedievale (VIII-IX sec. d.C.), infine, la struttura subisce una significativa trasformazione: viene riutilizzata l’abside, ma sono escluse le navate laterali con l’innalzamento di muri perimetrali tra i pilastri, cambia completamente l’articolazione dello spazio interno, con la creazione di quattro piccole campate per ciascun lato. In relazione con la fase di vita della prima chiesa, nell’area circostante si estende una grande necropoli rupestre. Di questa è stato indagato il nucleo principale, situato alle spalle dell’edificio e comprendente circa 130 tombe. Le tombe sono scavate nel banco calcareo, all'interno di una cavità artificiale ricavata nel costone roccioso in maniera da formare una necropoli rupestre, assai simile alle catacombe. Le fosse erano coperte con lastroni piani o a doppio spiovente con "acroteri" ai quattro angoli, spesso provvisti di “coppelle”, che servivano durante lo svolgimento del rito del refrigerium, l’offerta di cibi e bevande ai defunti. Le tombe risultano prevalentemente utilizzate per numerose deposizioni, probabilmente in riferimento a gruppi famigliari; alcune fosse di piccole dimensioni ospitano esclusivamente bambini. I corredi sono costituiti da oggetti di ceramica e vetro come brocche, coppe e lucerne, monili (bracciali, collane, orecchini, fibbie) ed oggetto di uso personale (pettini e spilloni). Al rituale di offerta dell’obolo per Caronte fa ancora riferimento la presenza di monete, talora collocate nella bocca del defunto

Metabolic and structural skeletal muscle health in systemic lupus erythematosus related fatigue : a multi-modal magnetic resonance imaging study

Funding: This work was supported by Lupus UK Acknowledgements. Special thanks to the patient community who participated in this research effort.Peer reviewedPostprin

Protocol for Biospecimen Collection and Analysis within the BACPAC Research Program

The Biospecimen Collection and Processing Working Group of the NIH HEAL Initiative BACPAC Research Program was charged with identifying molecular biomarkers of interest to chronic low back pain (cLBP). Having identified biomarkers of interest, the Working Group worked with the New York University Grossman School of Medicine, Center for Biospecimen Research and Development-funded by the Early Phase Pain Investigation Clinical Network Data Coordinating Center-to harmonize consortium-wide and site-specific efforts for biospecimen collection and analysis. Biospecimen collected are saliva, blood (whole, plasma, serum), urine, stool, and spine tissue (paraspinal muscle, ligamentum flavum, vertebral bone, facet cartilage, disc endplate, annulus fibrosus, or nucleus pulposus). The omics data acquisition and analyses derived from the biospecimen include genomics and epigenetics from DNA, proteomics from protein, transcriptomics from RNA, and microbiomics from 16S rRNA. These analyses contribute to the overarching goal of BACPAC to phenotype cLBP and will guide future efforts for precision medicine treatment

Diurnal Cortisol and Survival in Epithelial Ovarian Cancer

IntroductionHypothalamic-pituitary-adrenal (HPA) deregulation is commonly observed in cancer patients, but its clinical significance is not well understood. We prospectively examined the association between HPA activity, tumor-associated inflammation, and survival in ovarian cancer patients prior to treatment.Materials and methodsParticipants were 113 women with ovarian cancer who provided salivary cortisol for three days prior to treatment for calculation of cortisol slope, variability, and night cortisol. Cox proportional hazard regression analyses were used to examine associations between cortisol and survival in models adjusting for disease stage, tumor grade, cytoreduction and age. On a subsample of 41 patients with advanced disease ascites fluid was assayed for levels of interleukin-6 (IL-6) and correlated with cortisol variables.ResultsEach cortisol measure was associated with decreased survival time, adjusting for covariates (all p<.041). A one standard deviation increase in night cortisol was associated with a 46% greater likelihood of death. Patients in the high night cortisol group survived an estimated average of 3.3 years compared to 7.3 years for those in the low night cortisol group. Elevated ascites IL-6 was associated with each cortisol measure (all r>36, all p<.017).DiscussionAbnormal cortisol rhythms assessed prior to treatment are associated with decreased survival in ovarian cancer and increased inflammation in the vicinity of the tumor. HPA abnormalities may reflect poor endogenous control of inflammation, dysregulation caused by tumor-associated inflammation, broad circadian disruption, or some combination of these factors. Nocturnal cortisol may have utility as a non-invasive measure of HPA function and/or disease severity

Top down or bottom up? An observational investigation of improvement in fibromyalgia symptoms following hip and knee replacement

Objectives: Many patients with osteoarthritis have comorbid symptoms of FM, but it is unknown how these symptoms respond to surgical procedures that address nociceptive input in the periphery, such as total joint replacement. Here we explore differences in clinical characteristics between patients whose FM symptoms do and do not improve following total hip or knee replacement. Methods: Participants were 150 patients undergoing knee or hip replacement who had a minimum FM survey score of 4 or greater prior to surgery. The top tertile of patients experiencing the most improvement in FM symptoms at month 6 were categorized as ‘Improve’ (n = 48) while the bottom two tertiles were categorized as ‘Worsen/Same’ (n = 102). Baseline symptom characteristics were compared between groups, as well as improvement in overall pain severity, surgical pain severity and physical function at 6 months. Results: The Worsen/Same group had higher levels of fatigue, depression and surgical site pain at baseline (all P < 0.05). Additionally, they improved less on overall pain severity and physical functioning 6 months after surgery (both P < 0.05). Conclusion: Most patients derive significant benefit in improvement of comorbid FM symptoms following total joint replacement, but a substantial proportion do not. Understanding the neurobiological basis for these different trajectories may help inform clinical judgment and improve patient care

A multi-modal MRI study of the central response to inflammation in rheumatoid arthritis

Special thanks to the patient community who participated in this research effort. Thanks to Mariella D’Allesandro for efforts towards recruitment.Peer reviewedPublisher PD

Depression in Cancer: the many biobehavioural pathways driving tumor progression

Major Depressive Disorder (MDD) is common among cancer patients, with prevalence rates up to four-times higher than the general population. Depression confers worse outcomes, including non-adherence to treatment and increased mortality in the oncology setting. Advances in the understanding of neurobiological underpinnings of depression have revealed shared biobehavioral mechanisms may contribute to cancer progression. Moreover, psychosocial stressors in cancer promote: (1) inflammation and oxidative/nitrosative stress; (2) a decreased immunosurveillance; and (3) a dysfunctional activation of the autonomic nervous system and of the hypothalamic-pituitary-adrenal axis. Consequently, the prompt recognition of depression among patients with cancer who may benefit of treatment strategies targeting depressive symptoms, cognitive dysfunction, fatigue and sleep disturbances, is a public health priority. Moreover, behavioral strategies aiming at reducing psychological distress and depressive symptoms, including addressing unhealthy diet and life-style choices, as well as physical inactivity and sleep dysfunction, may represent important strategies not only to treat depression, but also to improve wider cancer-related outcomes. Herein, we provide a comprehensive review of the intertwined biobehavioural pathways linking depression to cancer progression. In addition, the clinical implications of these findings are critically reviewed

Cortisol and inflammatory processes in ovarian cancer patients following primary treatment: Relationships with depression, fatigue, and disability

a b s t r a c t Elevations in the pro-inflammatory cytokine interleukin-6 (IL-6) and alterations in the anti-inflammatory hormone cortisol have been reported in a variety of cancers. IL-6 has prognostic significance in ovarian cancer and cortisol has been associated with fatigue, disability, and vegetative depression in ovarian cancer patients prior to surgery. Ovarian cancer patients undergoing primary treatment completed psychological self-report measures and collected salivary cortisol and plasma IL-6 prior to surgery, at 6 months, and at 1 year. Patients included in this study had completed chemotherapy and had no evidence of disease recurrence. At 6 months, patients showed significant reductions in nocturnal cortisol secretion, plasma IL-6, and a more normalized diurnal cortisol rhythm, changes that were maintained at 1 year. The reductions in IL-6 and nocturnal cortisol were associated with declines in self-reported fatigue, vegetative depression, and disability. These findings suggest that primary treatment for ovarian cancer reduces the inflammatory response. Moreover, patients who have not developed recurrent disease by 1 year appear to maintain more normalized levels of cortisol and IL-6. Improvement in fatigue and vegetative depression is associated with the normalization of IL-6 and cortisol, a pattern which may be relevant for improvements in overall quality of life for ovarian cancer patients