Significato predittivo dei markers di funzione vascolare nel paziente iperteso

Introduzione. L’ipertensione arteriosa, un importante fattore di rischio cardiovascolare, risulta associata a processi di rimodellamento vascolare e di irrigidimento delle arterie, fenomeni che però sembrano procedere in maniera diversa a seconda del profilo di rischio del paziente. L’evoluzione temporale dei parametri di rigidità arteriosa in presenza di diversi fattori di rischio è un aspetto ancora poco studiato. Scopo dello studio. Valutare l’evoluzione nel tempo dei parametri di geometria e rigidità arteriosa in pazienti ipertesi e studiare il loro valore predittivo. Metodi. In questo studio prospettico osservazionale sono stati arruolati 153 pazienti ipertesi essenziali, valutati basalmente (V0) e dopo un follow-up di 3.6±1.2 anni (V1). I parametri di rigidità aortica (carotid-femoral pulse wave velocity, PWV) e la pressione di pulsazione (PP) carotidea sono stati ottenuti tramite tonometria ad applanazione. La variazione di diametro e lo spessore medio-intimale carotideo (cIMT) sono stati calcolati tramite analisi automatica di immagini ultrasonografiche delle arterie carotidi comuni, da cui sono stati ottenuti il coefficiente di distensibilità (DC) e la stiffness carotidea (CS). Risultati. Durante il periodo di follow-up si è verificata una riduzione significativa della pressione arteriosa diastolica (PAD da 82.2±8.8 a 79.7±10.9 mmHg, p=0.026), ma non di quella sistolica (PAS da 142.4±15.6 a 141.2±17.2 mmHg, p=ns) a fronte di un incremento del numero di farmaci antiipertensivi usati (da 1.2±1.0 a 1.8±1.0, p<0.0001). Si è registrata inoltre una stabilità negli anni del profilo lipidico (colesterolo LDL da 128.3±36.4 a 125.3±37.9 mg/dl, p=ns), in rapporto ad un incremento dei soggetti in terapia ipocolesterolemizzante (dal 14.4% al 25.5%, p=0.01). Nel gruppo dei pazienti diabetici il controllo glicemico è migliorato (Hb glicata da 8.3±0.7 a 7.7±1.2 mg/dl), grazie a un incremento del numero di farmaci antidiabetici impiegati (da 1.4±0.7 a 2.1±0.9, p<0.0001). Per quanto riguarda i parametri vascolari, non sono state rilevate variazioni significative di PWV, cIMT, DC e CS. Al contrario, si è verificato un aumento del diametro medio della carotide comune (da 7,49±0,85 a 7,80±0,81 mm, p=0,002). I pazienti in cui durante il follow-up si è verificata una riduzione della PWV>0.5 m/s presentavano a V0 valori più elevati di PAS (146.3±14.4 vs 139.8±13.6 e 141.0±17.4 mmHg, p=0.077), di PWV (10.1±2.1 vs 8.7±1.8 e 8.9±1.8 m/s, p0.5m/s). Essi hanno inoltre mostrato una maggiore riduzione della PAS nel tempo (-7.9±17.0 vs -2.0±15.1 e +3.5±18.2 mmHg, p<0.0001) e un minore incremento del diametro carotideo medio (+0.16±0.58 vs +0.40±0.53 e +0.39±0.47 mm, p=0.046). I pazienti in cui durante il follow-up si è verificata una riduzione della CS>0.5 m/s presentavano a V0 valori più elevati di PAS (146.9±15.3 vs 144.6±13.0 e 135.8±16.3 mmHg, p=0,0008) e di PP carotidea (56.2±14.5 vs 51.6±14.3 e 46.1±15.0 mmHg, p=0,004) rispetto a coloro con CS invariata (variazione compresa tra -0.5 e +0.5m/s) o aumentata nel tempo (aumento>0.5m/s). Essi hanno inoltre mostrato una maggiore riduzione della PAS nel tempo (-10.6±18.1 vs -4.5±16.3 e +7.6±12.8 mmHg, p0.5 m/s di CS, il numero di farmaci antiipertensivi è aumentato in percentuale minore (54.7% e 51.1% vs 31.9%, p=0.05). Infine, solo nel 38.8% dei pazienti c’è stata concordanza tra l’andamento temporale di PWV e CS. Conclusioni. In una coorte di pazienti ipertesi seguiti per circa 3 anni e trattati in maniera convenzionale (in relazione ai fattori di rischio classici), rigidità aortica e carotidea rimangono stazionarie, come pure il cIMT. Tuttavia si verifica una progressione del rimodellamento carotideo maladattativo, suggerendo una minore efficacia dell’approccio terapeutico tradizionale su questo tipo di danno vascolare. I pazienti con una riduzione nel tempo di PWV e CS presentano un abbassamento più marcato della PA e un minore aumento del diametro carotideo, ottenuti con un maggiore incremento del numero di farmaci

New strategies for curve and arbitrary-topology surface constructions for design

This dissertation presents some novel constructions for curves and surfaces with arbitrary topology in the context of geometric modeling. In particular, it deals mainly with three intimately connected topics that are of interest in both theoretical and applied research: subdivision surfaces, non-uniform local interpolation (in both univariate and bivariate cases), and spaces of generalized splines. Specifically, we describe a strategy for the integration of subdivision surfaces in computer-aided design systems and provide examples to show the effectiveness of its implementation. Moreover, we present a construction of locally supported, non-uniform, piecewise polynomial univariate interpolants of minimum degree with respect to other prescribed design parameters (such as support width, order of continuity and order of approximation). Still in the setting of non-uniform local interpolation, but in the case of surfaces, we devise a novel parameterization strategy that, together with a suitable patching technique, allows us to define composite surfaces that interpolate given arbitrary-topology meshes or curve networks and satisfy both requirements of regularity and aesthetic shape quality usually needed in the CAD modeling framework. Finally, in the context of generalized splines, we propose an approach for the construction of the optimal normalized totally positive (B-spline) basis, acknowledged as the best basis of representation for design purposes, as well as a numerical procedure for checking the existence of such a basis in a given generalized spline space. All the constructions presented here have been devised keeping in mind also the importance of application and implementation, and of the related requirements that numerical procedures must satisfy, in particular in the CAD context

Phytobalneotherapy: When traditional herbal medicine meets spa therapy

Phytobalneotherapy (or hay baths) is a balneological treatment which combines the effects of thermal baths and the properties of fermenting herbs. Alpine hay, made of many different herbs harvested in mountain fields, is traditionally used for this treatment. Some studies have investigated the effects of hay baths on health, underscoring potential their benefits for rheumatic conditions. In conclusion, phytobalneotherapy seems an interesting way to harness therapeutic properties of medicinal herbs in a way which appears to be tolerable and sustainable. Further investigation is needed

Effects of lavender on anxiety: A systematic review and meta-analysis

Abstract Background Anxiety is one of the uprising psychiatric disorders of the last decades and lavender administration has been traditionally suggested as a possible treatment. The objective of this review is to assess the efficacy of lavender, in any form and way of administration, on anxiety and anxiety-related conditions. Methods The PRISMA guidelines were followed. Retrieved data were qualitatively and quantitatively synthesized. Randomized Controlled Trials (RCTs) and Non-Randomized Studies (NRSs) which investigated the efficacy of lavender, in any form and way of administration, on patients with anxiety, involved in anxiety-inducing settings or undergoing anxiety-inducing activities, compared to any type of control, without language restrictions, were identified through electronic database searches. Medline via PubMed, Scopus, Web of Science, Cochrane Library, EMBASE, and Google Scholar were systematically searched. All databases were screened up to November 2018. Risk of bias was assessed with the Cochrane risk-of-bias tool and the following domains were considered: randomization, allocation sequence concealment, blinding, incomplete outcome data, selective outcome reporting, and other biases. Results 65 RCTs (7993 participants) and 25 NRSs (1200 participants) were included in the qualitative synthesis and 37 RCTs (3964 participants) were included in the quantitative synthesis. Overall, the qualitative synthesis indicated that 54 RCTs and 17 NRSs reported at least a significant result in favor of lavender use for anxiety. The quantitative synthesis showed that lavender inhalation can significantly reduce anxiety levels measured with any validated scale (Hedges' g = −0.73 [95% CI −1.00 to −0.46], p  Discussion The most important limitation of this review is the low average quality of available studies on the topic. The majority of included RCTs were characterized by a high overall risk of bias. Another limitation regards the heterogeneity of study designs, especially with regard to non-oral ways of administration. Overall, oral administration of lavender essential oil proves to be effective in the treatment of anxiety, whereas for inhalation there is only an indication of an effect of reasonable size, due to the heterogeneity of available studies. Lavender essential oil administered through massage appears effective, but available studies are not sufficient to determine whether the benefit is due to a specific effect of lavender. Further high-quality RCTs with more homogeneous study designs are needed to confirm these findings. Available information outlines a safe profile for lavender-based interventions, although more attention should be paid to the collection and reporting of safety data in future studies. Considering these findings, since treatments with lavender essential oil generally seem safe, and, in the case of inhalation, also simple and inexpensive, they are a therapeutic option which may be considered in some clinical contexts. Other The present systematic review was not funded and was registered in PROSPERO under the following number: CRD42019130126

Popular Culture and Totalitarianism: Accounting for Propaganda in Italy under the Fascist Regime (1934-1945)

Throughout history both democratic and totalitarian States have sought to take advantage of the possible political contributions of art and culture. This study presents the first in-depth historical study of the relationship between accounting and culture in a totalitarian State; the Fascist State in Italy between 1934 and 1945. Accounting documents in the form of budgets and reports provided by the Fascist government, along with other accounts prepared by the Fascists, were used to build a narrative that identified the ways in which the Fascist regime sought to win the committed allegiance of the Italian people in unseen ways. Accounting documents and the cultural activities to which they relate show the ways in which the Fascists developed their own conception of popular culture and sought control of cultural organisations and intellectuals in spreading their values and beliefs through cultural artefacts. The study documents the importance of accounting records as a less obvious, often underscored source for social history. It also adds to the growing literature that has explored the place of accounting in totalitarian regimes by focusing on the unexplored context of Fascist popular culture and identifying the contributions of accounting to the management of propaganda activities

Rituximab in the treatment of patients with systemic sclerosis. Our experience and review of the literature

BACKGROUND: The treatment of systemic sclerosis (SSc) represents a great clinical challenge because of the complex disease pathogenesis including vascular, fibrotic, and immune T- and B-lymphocyte-mediated alterations. Therefore, SSc should be treated by combined or sequential therapies according to prevalent clinico-pathogenetic phenotypes. Some preliminary data suggest that rituximab (RTX) may downregulate the B-cell over expression and correlated immunological abnormalities. METHODS: Here, we describe a series of 10 SSc patients (4M and 6F, mean age 46±13.5SD years, mean disease duration 6.3±2.7SD years; 5 pts had limited and 5 diffuse SSc cutaneous subset) treated with one or more cycles of RTX (4 weekly infusions of 375mg/m(2)). The main indications to RTX were interstitial lung fibrosis, cutaneous, and/or articular manifestations unresponsive to previous therapies; ongoing treatments remained unchanged in all cases. The effects of RTX were evaluated after 6months of the first cycle and at the end of long-term follow-up period (37±21SD months, range 18-72months). An updated review of the world literature was also done. RESULTS: RTX significantly improved the extent of skin sclerosis in patients with diffuse SSc at 6months evaluation (modified Rodnan skin score from 25±4.3 to 17.2±4.6; p=.022). A clinical improvement of other cutaneous manifestations, namely hypermelanosis (7/7), pruritus (6/8), and calcinosis (3/6) was observed. Moreover, arthritis revealed particularly responsive to RTX showing a clear-cut reduction of swollen and tender joints in 7/8 patients; while lung fibrosis detected in 8/10 remained stable in 6/8 and worsened in 2/8 at the end of follow-up. Pro-inflammatory cytokines, namely IL6, IL15, IL17, and IL23, evaluated in 3 patients with diffuse cutaneous SSc, showed a more or less pronounced reduction after the first RTX cycle. These observations are in keeping with the majority of previous studies including 6 single case reports and 10 SSc series (from 5 to 43 pts), which frequently reported the beneficial effects of RTX on some SSc manifestations, particularly cutaneous sclerosis, along with the improvement/stabilization of lung fibrosis. Possible discrepancies among different clinical studies can be related to the etiopathogenetic complexity of SSc and not secondarily to the patients' selection and disease duration at the time of the study. CONCLUSION: The present study and previous clinical trials suggest a possible therapeutical role of RTX in SSc, along with its good safety profile. The specific activity of RTX on B-cell-driven autoimmunity might explain its beneficial effects on some particular SSc clinical symptoms, namely the improvement of skin and articular involvement, and possibly the attenuation of lung fibrosis

Thyroid Involvement in Hepatitis C Virus-Infected Patients with/without Mixed Cryoglobulinemia

Thyroid involvement is a common condition that can be recorded during the natural course of different systemic rheumatic diseases, including the mixed cryoglobulinemia (MC) syndrome or cryoglobulinemic vasculitis. MC is triggered by hepatitis C virus (HCV) chronic infection in the majority of cases; it represents the prototype of autoimmune-lymphoproliferative disorders complicating a significant proportion of patients with chronic HCV infection. HCV is both hepato- and lymphotropic virus responsible for a great number of autoimmune/lymphoproliferative and/or neoplastic disorders. The complex of HCV-related hepatic and extrahepatic manifestations, including MC and thyroid involvement, may be termed "HCV syndrome." Here, we describe the prevalence and clinico-serological characteristics of thyroid involvement, mainly autoimmune thyroiditis and papillary thyroid cancer, in patients with HCV syndrome with or without cryoglobulinemic vasculitis

Current treatment of hepatitis C-associated rheumatic diseases.

ABSTRACT: The hepatitis C virus (HCV) is both hepatotropic and lymphotropic, responsible for a great number of hepatic and extrahepatic immune-system disorders that comprise the so-called HCV syndrome. HCV-associated rheumatic diseases are characterized by frequent clinico-serological overlap; therefore, correct classification of individual patients is necessary before therapeutic decisions are made. This is particularly difficult to do, however, because of the coexistence of viral infection and complex autoimmune alterations. In this context, mixed cryoglobulinemia syndrome (MCs) represents the prototype of virus-related autoimmune-lymphoproliferative diseases. MCs can be treated at different levels by means of etiological treatment with antivirals (peg-interferon-alpha plus ribavirin) aimed at HCV eradication and/or pathogenetic/symptomatic treatments directed to both immune-system alterations and the vasculitic process (rituximab, cyclophosphamide, steroids, plasmapheresis, and so on). In clinical practice, the therapeutic strategy should be modulated according to severity/activity of the MCs and possibly tailored to each individual patient's conditions. Cryoglobulinemic skin ulcers may represent a therapeutic challenge, which should be managed by means of both local and systemic treatments. HCV-associated arthritis should be differentiated from the simple comorbidity of HCV infection and classical rheumatoid arthritis. It may be treated with low doses of steroids and/or hydroxychloroquine; the use of biologics (rituximab) may be considered in more severe cases. Primary Sj\uf6gren's syndrome is rarely associated with HCV infection, while sicca syndrome and myalgia are frequently detectable in hepatitis C patients, with or without cryoglobulinemic vasculitis. Other autoimmune rheumatic disorders (poly/dermatomyositis, polyarteritis nodosa, osteosclerosis, fibromyalgia, and so on) have been reported as potentially associated with HCV infection in patient populations from different countries, suggesting the role of genetic and/or environmental co-factors. The therapeutic approach to these disorders should be decided according to each individual patient's evaluation, including hepatic, virological, and immunological findings

Regenerative medicine: potential applications for foot and ankle disorders

Introduction. Regenerative therapies have recently gained popularity in orthopedics and we overview the available scientific evidence on the topic.Methods. A narrative literature review with three relevant case reports.Results. Scientific evidence on regenerative medicine is growing, but some established findings can de underscored. First, a persistent inflammatory response plays a key role in tissue reparation because it inhibits the activity of stem cells: therefore, regenerative therapy is effective if it can reduce local inflammation, thus allowing stem cells to regenerate the damage. Secondly, the regenerative potential of stem cells is regulated by local immunity and, in particular, by macrophages, which are involved in damage response and tissue regeneration. Among others, the concentrate of peripheral blood mononuclear cells (PBMNCs), rich in monocytes, lymphocytes, and CD34+ hematopoietic stem cells, appears an interesting cell-based therapeutic strategy to promote tissue regeneration in several orthopedic disorders.Discussion. Regenerative medicine can offer new valuable therapeutic strategies. In particular, potential applications of PB-MNCs in foot and ankle disorders are discussed with some explanatory cases from clinical practice

New Targeted Molecular Therapies for Dedifferentiated Thyroid Cancer

Dedifferentiated thyroid cancer (DeTC) derived from follicular epithelium is often incurable because it does not respond to radioiodine, radiotherapy, or chemotherapy. In cases, RET/PTC rearrangements are found in 30%–40%, RAS mutations in about 10%, and BRAF mutations in around 40%–50%, with no overlap between these mutations results in papillary thyroid cancer, while a higher prevalence of BRAF mutations (up to 70%) has been observed in DeTC. The identification of these activating mutations in DeTC makes this malignancy an excellent model to examine the effect of tyrosine kinase inhibitors (TKIs). Clinical trials with several TKIs targeting RET, and to a lesser extent BRAF, and other TKRs have shown positive results, with about one-third of DeTC showing a reduction in tumor size up to 50%, with the longest treatment duration of approximately three-four years. Angiogenesis inhibitors have also shown promising activity in DeTC. Progress is being made toward effective targeted DeTC therapy. The possibility of testing the sensitivity of primary DeTC cells from each subject to different TKIs could increase the effectiveness of the treatment