Heterotriplex-forming PNA in the targeting of the Bcl-2 P1 promoter in anticancer treatment

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The role of beta-blocker drugs in critically ill patients: a SIAARTI expert consensus statement

Background: The role of β-blockers in the critically ill has been studied, and data on the protective effects of these drugs on critically ill patients have been repeatedly reported in the literature over the last two decades. However, consensus and guidelines by scientific societies on the use of β-blockers in critically ill patients are still lacking. The purpose of this document is to support the clinical decision-making process regarding the use of β-blockers in critically ill patients. The recipients of this document are physicians, nurses, healthcare personnel, and other professionals involved in the patient's care process. Methods: The Italian Society of Anesthesia, Analgesia, Resuscitation and Intensive Care (SIAARTI) selected a panel of experts and asked them to define key aspects underlying the use of β-blockers in critically ill adult patients. The methodology followed by the experts during this process was in line with principles of modified Delphi and RAND-UCLA methods. The experts developed statements and supportive rationales in the form of informative text. The overall list of statements was subjected to blind votes for consensus. Results: The literature search suggests that adrenergic stress and increased heart rate in critically ill patients are associated with organ dysfunction and increased mortality. Heart rate control thus seems to be critical in the management of the critically ill patient, requiring careful clinical evaluation aimed at both the differential diagnosis to treat secondary tachycardia and the treatment of rhythm disturbance. In addition, the use of β-blockers for the treatment of persistent tachycardia may be considered in patients with septic shock once hypovolemia has been ruled out. Intravenous application should be the preferred route of administration. Conclusion: β-blockers protective effects in critically ill patients have been repeatedly reported in the literature. Their use in the acute treatment of increased heart rate requires understanding of the pathophysiology and careful differential diagnosis, as all causes of tachycardia should be ruled out and addressed first

Impact of primary kidney disease on the effects of empagliflozin in patients with chronic kidney disease: secondary analyses of the EMPA-KIDNEY trial

Background: The EMPA KIDNEY trial showed that empagliflozin reduced the risk of the primary composite outcome of kidney disease progression or cardiovascular death in patients with chronic kidney disease mainly through slowing progression. We aimed to assess how effects of empagliflozin might differ by primary kidney disease across its broad population. Methods: EMPA-KIDNEY, a randomised, controlled, phase 3 trial, was conducted at 241 centres in eight countries (Canada, China, Germany, Italy, Japan, Malaysia, the UK, and the USA). Patients were eligible if their estimated glomerular filtration rate (eGFR) was 20 to less than 45 mL/min per 1·73 m2, or 45 to less than 90 mL/min per 1·73 m2 with a urinary albumin-to-creatinine ratio (uACR) of 200 mg/g or higher at screening. They were randomly assigned (1:1) to 10 mg oral empagliflozin once daily or matching placebo. Effects on kidney disease progression (defined as a sustained ≥40% eGFR decline from randomisation, end-stage kidney disease, a sustained eGFR below 10 mL/min per 1·73 m2, or death from kidney failure) were assessed using prespecified Cox models, and eGFR slope analyses used shared parameter models. Subgroup comparisons were performed by including relevant interaction terms in models. EMPA-KIDNEY is registered with ClinicalTrials.gov, NCT03594110. Findings: Between May 15, 2019, and April 16, 2021, 6609 participants were randomly assigned and followed up for a median of 2·0 years (IQR 1·5–2·4). Prespecified subgroupings by primary kidney disease included 2057 (31·1%) participants with diabetic kidney disease, 1669 (25·3%) with glomerular disease, 1445 (21·9%) with hypertensive or renovascular disease, and 1438 (21·8%) with other or unknown causes. Kidney disease progression occurred in 384 (11·6%) of 3304 patients in the empagliflozin group and 504 (15·2%) of 3305 patients in the placebo group (hazard ratio 0·71 [95% CI 0·62–0·81]), with no evidence that the relative effect size varied significantly by primary kidney disease (pheterogeneity=0·62). The between-group difference in chronic eGFR slopes (ie, from 2 months to final follow-up) was 1·37 mL/min per 1·73 m2 per year (95% CI 1·16–1·59), representing a 50% (42–58) reduction in the rate of chronic eGFR decline. This relative effect of empagliflozin on chronic eGFR slope was similar in analyses by different primary kidney diseases, including in explorations by type of glomerular disease and diabetes (p values for heterogeneity all >0·1). Interpretation: In a broad range of patients with chronic kidney disease at risk of progression, including a wide range of non-diabetic causes of chronic kidney disease, empagliflozin reduced risk of kidney disease progression. Relative effect sizes were broadly similar irrespective of the cause of primary kidney disease, suggesting that SGLT2 inhibitors should be part of a standard of care to minimise risk of kidney failure in chronic kidney disease. Funding: Boehringer Ingelheim, Eli Lilly, and UK Medical Research Council

Intelligenza artificiale e sicurezza: opportunità, rischi e raccomandazioni

L'IA (o intelligenza artificiale) è una disciplina in forte espansione negli ultimi anni e lo sarà sempre più nel prossimo futuro: tuttavia è dal 1956 che l’IA studia l’emulazione dell’intelligenza da parte delle macchine, intese come software e in certi casi hardware. L’IA è nata dall’idea di costruire macchine che - ispirandosi ai processi legati all’intelligenza umana - siano in grado di risolvere problemi complessi, per i quali solitamente si ritiene che sia necessario un qualche tipo di ragionamento intelligente. La principale area di ricerca e applicazione attuale dell’IA è il machine learning (algoritmi che imparano e si adattano in base ai dati che ricevono), che negli ultimi anni ha trovato ampie applicazioni grazie alle reti neurali (modelli matematici composti da neuroni artificiali) che a loro volta hanno consentito la nascita del deep learning (reti neurali di maggiore complessità). Appartengono al mondo dell’IA anche i sistemi esperti, la visione artificiale, il riconoscimento vocale, l’elaborazione del linguaggio naturale, la robotica avanzata e alcune soluzioni di cybersecurity. Quando si parla di IA c'è chi ne è entusiasta pensando alle opportunità, altri sono preoccupati poiché temono tecnologie futuristiche di un mondo in cui i robot sostituiranno l'uomo, gli toglieranno il lavoro e decideranno al suo posto. In realtà l'IA è ampiamente utilizzata già oggi in molti campi, ad esempio nei cellulari, negli oggetti smart (IoT), nelle industry 4.0, per le smart city, nei sistemi di sicurezza informatica, nei sistemi di guida autonoma (drive o parking assistant), nei chat bot di vari siti web; questi sono solo alcuni esempi basati tutti su algoritmi tipici dell’intelligenza artificiale. Grazie all'IA le aziende possono avere svariati vantaggi nel fornire servizi avanzati, personalizzati, prevedere trend, anticipare le scelte degli utenti, ecc. Ma non è tutto oro quel che luccica: ci sono talvolta problemi tecnici, interrogativi etici, rischi di sicurezza, norme e legislazioni non del tutto chiare. Le organizzazioni che già adottano soluzioni basate sull’IA, o quelle che intendono farlo, potrebbero beneficiare di questa pubblicazione per approfondirne le opportunità, i rischi e le relative contromisure. La Community for Security del Clusit si augura che questa pubblicazione possa fornire ai lettori un utile quadro d’insieme di una realtà, come l’intelligenza artificiale, che ci accompagnerà sempre più nella vita personale, sociale e lavorativa.AI (or artificial intelligence) is a booming discipline in recent years and will be increasingly so in the near future.However, it is since 1956 that AI has been studying the emulation of intelligence by machines, understood as software and in some cases hardware. AI arose from the idea of building machines that-inspired by processes related to human intelligence-are able to solve complex problems, for which it is usually believed that some kind of intelligent reasoning is required. The main current area of AI research and application is machine learning (algorithms that learn and adapt based on the data they receive), which has found wide applications in recent years thanks to neural networks (mathematical models composed of artificial neurons), which in turn have enabled the emergence of deep learning (neural networks of greater complexity). Also belonging to the AI world are expert systems, computer vision, speech recognition, natural language processing, advanced robotics and some cybersecurity solutions. When it comes to AI there are those who are enthusiastic about it thinking of the opportunities, others are concerned as they fear futuristic technologies of a world where robots will replace humans, take away their jobs and make decisions for them. In reality, AI is already widely used in many fields, for example, in cell phones, smart objects (IoT), industries 4.0, for smart cities, cybersecurity systems, autonomous driving systems (drive or parking assistant), chat bots on various websites; these are just a few examples all based on typical artificial intelligence algorithms. Thanks to AI, companies can have a variety of advantages in providing advanced, personalized services, predicting trends, anticipating user choices, etc. But not all that glitters is gold: there are sometimes technical problems, ethical questions, security risks, and standards and legislation that are not entirely clear. Organizations already adopting AI-based solutions, or those planning to do so, could benefit from this publication to learn more about the opportunities, risks, and related countermeasures. Clusit's Community for Security hopes that this publication will provide readers with a useful overview of a reality, such as artificial intelligence, that will increasingly accompany us in our personal, social and working lives

The Attitudes of Italian Psychologists Towards Homosexuality and Lesbian and Gay Clients: Theoretical, Clinical, and Social Implications

Aim: Many people are still referred to mental health professionals to change their sexual orientation (American Psychological Association, 2012; Lingiardi & Capozzi, 2004; Spitzer, 2012). We conducted a national survey in order to understand how Italian psychologists address this request. In more general terms, we wanted to explore Italian psychologists’ attitudes towards homosexuality and, more specifically, if they are willing to engage in efforts to change sexual orientation. Method: We developed an internet based questionnaire (ATH, Attitude Towards Homosexuality) that was completed anonymously by 3,135 licensed psychologists. Results: 76% of the sample considered “homosexuality to be a normal variant of sexuality”, but 58% said that “a psychological intervention aimed at modifying the sexual orientation is feasible”. Interestingly, less than 16% of participants considered themselves “adequately trained on clinical and theoretical issues regarding homosexuality”, with 25% reporting having received no training and 59% reporting that they had received partial training. Discussion: Unlike other countries, until recently there were no Italian guidelines for mental health professionals on LGBT issues. As a result of this research-survey, and in collaboration with the Italian Association of Psychologists, we have developed guidelines to fill this gap and meet the increasing request for training and continuing education about GLBT issues (Lingiardi & Nardelli, 2013). Our guidelines aim to equip psychologists with the basic tools to avoid homophobic prejudice in counseling and psychotherapy, and provide appropriate responses to clients

Atteggiamenti degli psicologi verso le omosessualità: dati preliminari di una ricerca nazionale

Anche se i professionisti della salute mentale considerano l’omosessualità in quanto tale una variante normale della sessualità, sono ancora molte le persone omosessuali, bisessuali o incerte rispetto al proprio orientamento che si rivolgono allo psicologo per essere aiutati a “diventare eterosessuali”. Come rispondono gli psicologi a questa domanda? Più in generale, quali sono i loro atteggiamenti verso l’omosessualità? In quanti modi, più o meno espliciti, più o meno consapevoli, può essere fornita una terapia “riparativa”? Per conoscere e studiare l’atteggiamento di psicologi e psicoterapeuti nei confronti di pazienti/clienti omosessuali abbiamo predisposto, in collaborazione con gli Ordini degli Psicologi della Campania, del Lazio e del Piemonte, una ricerca pilota sul campo. Dopo un attento esame della letteratura internazionale e successivamente a un’esperienza di focus group, abbiamo costruito un questionario ad hoc (APO: Atteggiamenti degli Psicologi verso l’Omosessualità) con domande a risposta sia chiusa sia aperta. Al momento, la numerosità dei partecipanti (N = 2114) ci spinge a considerare i dati rilevati da un punto di vista prevalentemente esplorativo e descrittivo, tuttavia la sufficiente eterogeneità del campione ci consente di descrivere un “quadro” che raffigura alcune tendenze. I risultati ottenuti sono molti e meritano uno spazio adeguato di dibattito. Tra gli altri: il 24% dei partecipanti si sente “per nulla preparato sulle tematiche cliniche e teoriche relative all’omosessualità”, solo il 73% ritiene che l’omosessualità sia “una variante normale della sessualità” (WHO, 1990) e il 63% sostiene che “possa essere utile un intervento psicologico rivolto alla modificazione dell'orientamento sessuale”. Analizzando le risposte alle domande aperte abbiamo infine cercato di comprendere più in profondità come gli psicologi si muovono in questo campo. Uno degli scopi di questo lavoro è la conoscenza dello stato delle cose in vista di progetti di formazione e aggiornamento in tema di (omo)sessualità

Reparative attitudes of italian psychologists toward lesbian and gay clients. Theoretical, clinical and social implications

Many mental health professionals still consider homosexuality to be a mental disturbance. These professionals often practice interventions that aim to change or “repair” homosexuality. Even when these “reparative” interventions are required by the client her/himself, the interventions minimize the role of internalized homophobia and promote ineffective and harmful therapeutic practices. This report aims to study this “reparative attitude” (RA) through the use of an Internet-based questionnaire that was administered anonymously to Italian licensed psychologists (n=3,135). The analysis of the frequencies showed that RA affected 58% of the participants. In addition, RA was predicted by variables representing demographic, sociocultural and professional characteristics, as well as by some theoretical assumptions about homosexuality. This study highlighted the need to improve the theoretical preparation of mental health professionals. The study also contributed to the development of the first Italian guidelines for providing counseling and psychotherapy to lesbian, gay, and bisexual clients

Atteggiamenti degli Psicologi dell’Emilia-Romagna nei confronti dell’omosessualità e dei clienti/pazienti omosessuali: report sintetico della ricerca

Questa ricerca nasce dall’esigenza di rilevare e studiare gli atteggiamenti degli Psicologi verso l’omosessualità e le persone omosessuali. Alcuni professionisti ancora oggi si riconoscono in una concezione patologizzante dell’omosessualità e ne propongono una cura, più o meno aderente al modello delle cosiddette “terapie riparative” (per una rassegna sulle terapie riparative vedi Lingiardi, 2007/2012; Lingiardi e Luci, 2006; Rigliano, 2006; Rigliano, Ciliberto e Ferrari, 2012), in evidente contrasto sia con le posizioni assunte dalle principali associazioni della salute mentale (APA, 2000; APA, 2009; PAHO, 2012; WHO, 1990), sia con i risultati della ricerca scientifica (Shidlo e Schroeder, 2002). Prendendo spunto da un precedente lavoro (Lingiardi e Capozzi, 2004; Capozzi, Lingiardi e Luci, 2004; vedi anche Lingiardi, Falanga, D’Augelli, 2005), abbiamo elaborato un questionario denominato Atteggiamento degli Psicologi verso l’Omosessualità (APO). Dopo Lazio, Campania, Piemonte e Puglia (Lingiardi e Nardelli, 2011; Lingiardi, Nardelli e Tripodi, 2013; Brustia, Rollè e Lingiardi, 2013; Lingiardi, Taurino, Tripodi, Laquale e Nardelli, 2013), l’Emilia-Romagna è stata la quinta regione coinvolta in questa indagine. La ricerca è stata promossa dalla cattedra di Valutazione Clinica e Diagnosi del prof. Vittorio Lingiardi (Sapienza Università di Roma), in collaborazione con il dott. Nicola Nardelli e il dott. Emiliano Tripodi e con l’Ordine degli Psicologi dell’Emilia-Romagna. L’obiettivo è quello di studiare, in un campione di Psicologi iscritti all’Ordine dell’Emilia-Romagna, gli atteggiamenti, le credenze, i modelli teorico-clinici e socio-culturali relativi alle omosessualità e alle persone omosessuali

"Assay of HMG-CoA reductase activity in the evaluation of cholesterol synthesis in man".

Assay of HMG-CoA reductase activity is useful in the evaluation of cholesterol synthesis in human