Semeiotica dell'articolazione temporo-mandibolare

Ha senso, nel 3° millennio ormai inoltrato, proporre un manuale di semeiotica clinica reumatologica? Negli ultimi due decenni la medicina si è avvalsa sempre più della tecnologia e i vantaggi che le sue applicazioni offrono a pazienti, clinici e ricercatori sono tutti ben evidenti. La Reumatologia non è rimasta impermeabile a questo nuovo corso, vedendo crescere in modo esponenziale il ruolo assunto dalla diagnostica per immagini. Chi ha vissuto la Reumatologia ai suoi albori si è adoperato per conferire alla disciplina autonomia accademica e nosografica dotandola, tra le altre cose, di un solido impianto clinico-semeiologico a supportare la convinzione che la Reumatologia sia una disciplina eminentemente clinica. Di questo lascito siamo debitori nei confronti di chi ci ha preceduto. Le nuove metodiche di imaging come l'ecografia e la risonanza magnetica (per citare le più diffuse) hanno aperto nuovi orizzonti su scenari prima sconosciuti o solo parzialmente esplorati e costretto le nuove generazioni di clinici ad una seria e critica revisione del loro patrimonio culturale in ambito clinico-semeiologico. In questo nuovo scenario alcune nozioni e pratiche semeiologiche storicamente sedimentate nel corso degli anni sono, oggi, da ritenersi troppo imprecise, se non addirittura superflue o desuete

Are pleiotropic effects of statins real?

The clinical benefits of statins are strongly related to their low density lipoprotein-cholesterol (LDL-C) lowering properties. However, because mevalonic acid (MVA), the product of 3-hydroxy-3-methyl-3-glutaryl coenzyme A (HMG-CoA) reductase reaction, is the precursor not only of cholesterol but also of nonsteroidal isoprenoid compounds, the inhibition of HMG-CoA reductase may result in pleiotropic effects, independent of their hypocholesterolemic properties. The discrimination between the pleiotropic from LDL-C lowering effects may potentially be more evident during the early phase of treatment since plasma MVA levels drop up to 70% within 1–2 hours while a reduction of LDL-C, detectable after 24 hours, became significant after 6–7 days. Therefore, the deprivation of circulating MVA-derived isoprenoids in the early phase of treatment could be the main mechanism responsible for the atheroprotective effect of statins. This early window of protection in the absence of LDL-C lowering suggests that the anti-inflammatory and the pleiotropic properties of statins may have clinical importance. Therefore, acute coronary syndromes could represent a clinical condition for addressing the early benefits of statins therapy, ie, within 24 h of the event, independent of LDL-C lowering

L'imprenditoria immigrata nella Provincia di Pisa.

Nella presente tesi viene trattato il tema dell’imprenditoria immigrata nella Provincia di Pisa. Anche qui, come in altre realtà italiane, il fenomeno ha assunto una visibilità e una consistenza tali, da meritare un approfondimento specifico che sia in grado di metterne in luce le caratteristiche e di interpretarne gli sviluppi. Il presente lavoro si propone come un contributo in questa direzione; l’obiettivo principale era quello di ottenere una descrizione accurata dell’imprenditoria immigrata della provincia, che permettesse tanto di evidenziarne le peculiarità, quanto di inquadrare il fenomeno attraverso gli spunti interpretativi forniti dalla vasta letteratura scientifica sul tema. Analizzando i dati ottenuti dalla Camera di Commercio, relativi a imprese ed imprenditori extra-UE, è stato possibile delineare un quadro piuttosto dettagliato dell’imprenditoria immigrata nella Provincia di Pisa. Essa, evidenzia delle caratteristiche analoghe a quelle riscontrate a livello nazionale, essendo “concentrata” in termini di paesi di provenienza degli imprenditori, distribuzione territoriale, settori di attività e forma giuridica adottata. Si verificano poi, anche su scala provinciale, fenomeni di “specializzazione etnica”, che vedono talune comunità nazionali, operare quasi esclusivamente in un determinato settore. Dai risultati di questa ricerca, si può concludere che l’imprenditoria immigrata della provincia sembra avvalersi delle opportunità economiche presenti sul territorio, sfruttando gli spazi di mercato che presentano meno barriere di accesso in termini di risorse e di vincoli amministrativi. Emerge un quadro sfaccettato del fenomeno nel quale, accanto ad imprese più strutturate, attive prevalentemente nel commercio e nella ristorazione, si trova un gran numero di iniziative che sembrano rispondere soprattutto ad esigenze legate alla mera sussistenza economica o alla regolarizzazione del soggiorno. L’approfondimento di una tale ipotesi esula dal presente lavoro, ma può costituire l’oggetto di ulteriori ricerche

Haematological Malignancies in Systemic Sclerosis Patients: Case Reports and Review of the World Literature

Background.The association of systemic sclerosis (SSc) and haematological cancers was reported in a large number of case reports and cohort studies, describing SSc patients with highly heterogeneous clinical pictures. Objective. We reviewed the literature to better describe SSc patients with haematological malignancies. Methods. SSc cases complicated by haematological malignancies described in the world literature were collected; other 2 cases referred to our centre were reported. Results. One hundred-thirty SSc subjects were collected from 1954 up to date. The mean age of patients at cancer diagnosis was 56.1 ± 16.7 years; 72% of patients were females. In 60% of cases, the diagnosis of haematological malignancy was described within 5 years of SSc diagnosis. In 7.8% of cases, coexistence of Sj¨ogren’s syndrome or other autoimmune disorders was cited. Sixty-six cases with lymphoma (in the majority of cases B-cell neoplasms), 28 with leukaemia (chronic lymphocytic form in 9), 14 with multiple myeloma plus one solitary IgM plasmocytoma, and 16 with myeloproliferative disorders were found. No specific SSc subsets seem to be related to haematological malignancies. Conclusions. We remarked the importance of clinical work-up in SSc, in order to early diagnose and treat eventual occult haematological malignancies, especially during the first years of the disease

Impegno cardiaco nella sclerosi sistemica

L'impegno cardiaco in corso di sclerosi sistemia consta di uno spettro variabile di manifestazioni cliniche conseguenti ad alterazioni di natura microangiopatica, elettrica e/o emodinamica. In danno ischemico e/o flogistico autoimmune del miocardio producono, in ultima analisi, il quadro istopatologico caratteristico della 'necrosi a bande' con deposizione di tessuto fibroso, responsabile della riduzione di elasticità e della capacità contrattile muscolare. ...

Epstein-Barr Virus Reactivation after Infliximab in Rheumatoid Arthritis: A Case Report

TNF-alpha blockers represent one of the most important therapeutic strategies for rheumatoid arthritis, but their use has raised the question about their safety profile, particularly in respect to viral infections/reactivations. We describe the case of a patient who developed a symptomatic EBV reactivation 11 days after the first infusion of infliximab

Investigation of electrochemically-induced repassivation of Al 7075-T6 and Al 2024-T3 as a function of applied stress and galvanic corrosion

The repassivation behavior of Al alloys 7075-T6 and 2024-T3 was investigated by means of pitting scan (PS) technique (Fig. 1) (Trueba, Trasatti, 2015). The effect of mechanical load and galvanic coupling was estimated by considering principally the electrochemical characteristics of the reverse curve, namely the pit transition potential (Eptp), the associated current density (iptp) and the steepness. The load levels explored were mostly below the elastic limit, using four point bent-beam (4PBB) stress-corrosion test specimens (ASTM G39-99). CRES 304 or Ti6Al4V alloy were physically joined with Al sheet for simulating stress-induced galvanic corrosion. Different experimental variables (e.g. irev, [Cl-], pH, scan rate, etc.) were also considered. The study was complemented with corrosion morphology analysis. Please click Additional Files below to see the full abstract

Methods of Control of the Leishmania infantum Dog Reservoir: State of the Art

Leishmania infantum is a protozoan parasite causing severe vector-borne visceral diseases both in humans and dogs. The latter are the most important natural reservoir and therefore should be the main target of control measures. The real efficacy of seropositive dogs culling as a direct control method is still debated, and the new sensitivity of large part of population considers ethically unacceptable this kind of approach. Treatment of infectious dogs with one of the available therapeutic protocols is recommendable as it allows to reduce parasite burdens and therefore the possibility of transmission of Leishmania infantum to vectors. Vaccination has been proven to be a very effective control tool, but the absence of a commonly recognized diagnostic method able to distinguish vaccinate from seropositive individuals is still an important limit. Concerning indirect control methods, a number of studies have demonstrated the efficacy of topical insecticides treatment (collars, spot-on, and sprays) in reducing incidence and prevalence of L. infantum. Also, the reduction of the odds of seroconversion in humans in endemic areas has been reported after the application of indirect control measures on dogs. The contemporary use of direct and indirect methods is even more effective in reducing seroprevalence in dogs

From Localized Scleroderma to Systemic Sclerosis: Coexistence or Possible Evolution

Background. Systemic sclerosis (SSc) and localized scleroderma (LoS) are two different diseases that may share some features. We evaluated the relationship between SSc and LoS in our case series of SSc patients. Methods. We analysed the clinical records of 330 SSc patients, in order to find the eventual occurrence of both the two diseases. Results. Eight (2.4%) female patients presented both the two diagnoses in their clinical histories. Six developed LoS prior to SSc; in 4/6 cases, the presence of autoantibodies was observed before SSc diagnosis. Overall, the median time interval between LoS and SSc diagnosis was 18 (range 0–156) months. Conclusions. LoS and SSc are two distinct clinical entities that may coexist. Moreover, as anecdotally reported in pediatric populations, we suggested the possible development of SSc in adult patients with LoS, particularly in presence of Raynaud’s phenomenon or antinuclear antibodies before the SSc onset