Persistence of poor sleep predicts the severity of the clinical condition after 6months of standard treatment in patients with eating disorders

Clinical evidence suggests that eating disorder (ED) patients experience poor sleep even if they rarely complain of it. However, direct empirical evidence supporting this relationship is still sparse. In order to provide direct evidence, poor sleep, severity of the ED symptoms and depression were obtained in 562 ED patients at treatment admission (T0). For 271 patients out of them, data were also available after 6 months of standard treatment (T1). Results evidence that at T0 poor sleep predicts severity of ED symptoms through the mediation of depression. Persistence of poor sleep at T1 directly predicts the severity of the ED symptoms both directly and through the mediation of depression. These findings suggest that the treatment of ED may benefit from addressing poor sleep since its presence and persistence increase comorbidity and attrition to the standard treatment

Le garanzie e il processo del credito: aspetti operativi e di vigilanza.

La presente tesi di laurea specialistica, dal titolo “Le garanzie e il processo del credito: aspetti operativi e di vigilanza”, si pone l'obbiettivo di indagare su uno degli elementi che da sempre rivestono un ruolo importante nelle analisi di affidamento bancario, ossia le garanzie: in particolare il lavoro si incentrerà su quelle che vengono definite “attive”, ossia quelle per le quali la banca risulta essere il beneficiario della relativa copertura. L’interesse verso tale argomento nasce dal duplice ruolo che nel tempo è stato assunto da questo strumento nell'ambito della concessione del credito, considerando il contributo che le stesse possono apportare sia da un punto di vista gestionale (in termini di utilità rivestita nell’ambito del processo di risk management), sia da un punto di vista regolamentare (grazie al loro inserimento tra i presidi del credit risk mitigation), il tutto calato in un contesto turbolento come quello attuale caratterizzato da evidenti difficoltà nel reperimento di risorse finanziarie e/o dal peggioramento delle condizioni alle quali queste ultime vengono concesse. Sulla base della suddetta finalità, il presente elaborato si articola in quattro capitoli, oltre alle conclusioni finali. Nell'ambito del primo capitolo viene delineato il contesto economico che si è venuto a creare negli ultimi anni partendo dalla recente e disastrosa crisi finanziaria, con uno sguardo sia alle sue origini statunitensi sia alle sue evoluzioni in campo internazionale, con particolare riferimento all'economia italiana; nello stesso capitolo vengono inoltre tratteggiate quelle che sono le più importanti misure poste in essere in Italia per far fronte alla situazione di difficoltà in cui si trovano le imprese nell'ambito dell'accesso al credito, onde evitare situazioni di stallo del nostro sistema economico. Nel secondo capitolo si intende presentare il quadro teorico riferito alle garanzie, andando ad evidenziare caratteristiche, tipologie e possibili soggetti garanti, nonché definendo il ruolo attribuito a questi strumenti nell'ambito della letteratura dell'intermediazione creditizia; nell'ultimo paragrafo di questo capitolo viene infine fatto cenno alla gestione del portafoglio garanzie, quale argomento utile per comprenderne il ruolo di strumento gestionale. All'interno del terzo capitolo viene fornito il quadro di riferimento dal punto di vista normativo all'interno del quale si calano le garanzie, che come sappiamo alla luce del secondo Accordo di Basilea hanno assunto un ruolo maggiormente importante, in quanto ne viene pienamente riconosciuta la funzione mitigante rispetto al rischio di credito dei prestiti, andando tra l’altro a definirne in dettaglio l’impatto nel processo di determinazione dei requisiti di capitale. Per quanto riguarda il quarto ed ultimo capitolo, esso è dedicato all'analisi delle evidenze empiriche relative al mondo delle garanzie nel mercato italiano ed al loro utilizzo da parte degli istituti bancari all'interno del processo di concessione del credito: nello specifico viene inizialmente fatto un riferimento generico all’andamento del mercato del credito in Italia negli ultimi mesi, con i dati relativi alle difficoltà incontrate nell’accesso al credito; successivamente si tratteggia una panoramica inerente all’utilizzo delle garanzie nella prassi operativa e all’importanza relativa ai diversi canali di recupero dei crediti utilizzabili dalle banche in caso di default del debitore; infine si fa un cenno alla relazione che sussiste tra presenza delle garanzie ed impatto sul prezzo del prestito, sottolineandone ulteriormente l’importanza

Cancer and orofacial pain

Cancer pain is a devastating condition. Pain in the orofacial region, may be present as the single symptom of cancer or as a symptom of cancer in its later stages. This manuscript revises in a comprehensive manner the content of the conference entitled ?Orofacial Pain and Cancer? (Dolor Orofacial y Cancer) given at the VI Simposio International ?Advances in Oral Cancer? on the 22 July, 2016 in Donostia. We have reviewed (pubmed-medline) from the most relevant literature including reviews, systematic reviews and clinical cases, the significant and evidence-based mechanisms and mediators of cancer-associated facial pain, the diverse types of cancers that can be present in the craniofacial region locally or from distant sites that can refer to the orofacial region, cancer therapy that may induce pain in the orofacial region as well as discussed some of the new advancements in cancer pain therapy. There is still a lack of understanding of cancer pain pathophysiology since depends of the intrinsic heterogeneity, type and anatomic location that the cancer may present, making more challenging the creation of better therapeutic options. Orofacial pain can arise from regional or distant tumor effects or as a consequence of cancer therapy. The clinician needs to be aware that the pain may present the characteristics of any other orofacial pain disorder so a careful differential diagnosis needs to be given. Cancer pain diagnosis is made by exclusion and only can be reached after a thorough medical history, and all the common etiologies have been carefully investigated and ruled out. The current management tools are not optimal but there is hope for new, safer and effective therapies coming in the next years

Evidence of a causal relationship between high serum adiponectin levels and increased cardiovascular mortality rate in patients with type 2 diabetes

Background: Despite its beneficial role on insulin resistance and atherosclerosis, adiponectin has been repeatedly reported as an independent positive predictor of cardiovascular mortality. Methods: A Mendelian randomization approach was used, in order to evaluate whether such counterintuitive association recognizes a cause-effect relationship. To this purpose, single nucleotide polymorphism rs822354 in the ADIPOQ locus which has been previously associated with serum adiponectin at genome-wide level, was used as an instrument variable. Our investigation was carried out in the Gargano Heart Study-prospective design, comprising 356 patients with type 2 diabetes, in whom both total and high molecular weight (HMW) adiponectin were measured and cardiovascular mortality was recorded (mean follow-up = 5.4 ± 2.5 years; 58 events/1922 person-year). Results: The A allele of rs822354 was associated with both total and HMW adiponectin [β (SE) = 0.10 (0.042), p = 0.014 and 0.17 (0.06), p = 0.003; respectively]. In a Poisson model comprising age, sex, smoking habits, BMI, HbA1c, total cholesterol, HDL-cholesterol, triglycerides, insulin therapy and hypertension, both rs822354 (IRR = 1.94, 95 % CI 1.23-3.07; p = 0.005), as well as the genetic equivalent of total adiponectin change (IRR = 1.07, 95 % CI 1.02-1.12; p = 0.003) were significantly associated with cardiovascular mortality. The observed genetic effect was significantly greater than that exerted by the genetic equivalent change of serum adiponectin (p for IRR heterogeneity = 0.012). In the above-mentioned adjusted model, very similar results were obtained when HMW, rather than total, adiponectin was used as the exposure variable of interest. Conclusions: Our data suggest that the paradoxical association between high serum adiponectin levels and increased cardiovascular mortality rate is based on a cause-effect relationship, thus pointing to an unexpected deleterious role of adiponectin action/metabolism on atherosclerotic processes

Fixation of genetic variation and optimization of gene expression: The speed of evolution in isolated lizard populations undergoing Reverse Island Syndrome

The ecological theory of island biogeography suggests that mainland populations should be more genetically divergent from those on large and distant islands rather than from those on small and close islets. Some island populations do not evolve in a linear way, but the process of divergence occurs more rapidly because they undergo a series of phenotypic changes, jointly known as the Island Syndrome. A special case is Reversed Island Syndrome (RIS), in which populations show drastic phenotypic changes both in body shape, skin colouration, age of sexual maturity, aggressiveness, and food intake rates. The populations showing the RIS were observed on islets nearby mainland and recently raised, and for this they are useful models to study the occurrence of rapid evolutionary change. We investigated the timing and mode of evolution of lizard populations adapted through selection on small islets. For our analyses, we used an ad hoc model system of three populations: wild-type lizards from the mainland and insular lizards from a big island (Capri, Italy), both Podarcis siculus siculus not affected by the syndrome, and a lizard population from islet (Scopolo) undergoing the RIS (called P. s. coerulea because of their melanism). The split time of the big (Capri) and small (Scopolo) islands was determined using geological events, like sea-level rises. To infer molecular evolution, we compared five complete mitochondrial genomes for each population to reconstruct the phylogeography and estimate the divergence time between island and mainland lizards. We found a lower mitochondrial mutation rate in Scopolo lizards despite the phenotypic changes achieved in approximately 8,000 years. Furthermore, transcriptome analyses showed significant differential gene expression between islet and mainland lizard populations, suggesting the key role of plasticity in these unpredictable environments

The protective effect of M40401, a superoxide dismutase mimetic, on post-ischemic brain damage in Mongolian gerbils

BACKGROUND: Overproduction of free radical species has been shown to occur in brain tissues after ischemia-reperfusion injury. However, most of free radical scavengers known to antagonize oxidative damage (e.g. superoxide dismutase, catalase), are unable to protect against ischemia-reperfusion brain injury when given in vivo, an effect mainly due to their difficulty to gain access to brain tissues. Here we studied the effect of a low molecular weight superoxide dismutase mimetic (M40401) in brain damage subsequent to ischemia-reperfusion injury in Mongolian gerbils. RESULTS: In animals undergoing ischemia-reperfusion injury, neuropathological and ultrastructural changes were monitored for 1–7 days either in the presence or in the absence of M40401 after bilateral common carotid artery occlusion (BCCO). Administration of M40401 (1–40 mg/kg, given i.p. 1 h after BCCO) protected against post-ischemic, ultrastructural and neuropathological changes occurring within the hippocampal CA1 area. The protective effect of M40401 was associated with a significant reduction of the levels of malondialdehyde (MDA; a marker of lipid peroxidation) in ischemic brain tissues after ischemia-reperfusion. CONCLUSION: Taken together, these results demonstrate that M40401 provides protective effects when given early after the induction of ischemia-reperfusion of brain tissues and suggest the possible use of such compounds in the treatment of neurological dysfunction subsequent to cerebral flow disturbances

Suggestive evidence of a multi-cytokine resistin pathway in humans and its role on cardiovascular events in high-risk individuals

In cells and tissues resistin affects IL-1β, IL-6, IL-8, IL-12 and TNF-α expression, thus suggesting the existence of a multi-cytokine "resistin pathway". We investigated whether such pathway does exist in humans and, if so, if it is associated with cardiovascular risk factors and with major adverse cardiovascular events (MACE). Serum cytokines were measured in 280 healthy subjects from the Gargano Study 2 (GS2) whose BMI, waist circumference, HOMA IR, triglycerides, HDL-cholesterol, systolic and diastolic blood pressure data were available and in 353 patients with type 2 diabetes and coronary artery disease from the Gargano Heart Study (GHS)-prospective design (follow-up 5.4 ± 2.5 years; 71 MACE). In GS2, cytokines mRNA levels in white blood cells were also measured. In GS2, resistin mRNA was correlated with all cytokines expression (all p < 0.001), but IL-12B. Consistently, serum resistin was correlated with all serum cytokines (all p < 0.001), but IL-12. Expression (eRPS) and serum (sRPS) resistin pathway scores (excluding IL-12) were each other correlated (p < 0.001) and both associated with cardiovascular risk factors (all p < 0.01). In GHS, sRPS was independently associated with MACE (HR = 1.44, 95% CI = 1.10-1.90). Our data indicate the existence of a resistin pathway, which is associated with cardiovascular risk factors and which strongly and independently predicts MACE