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Inflammatory cardiomyopathy: Position paper of the Italian Society of Cardiology Working Group on cardiomyopathies and pericardial diseases in collaboration with the Italian Society of Cardiology Working Group on cardiac magnetic resonance
No full textInflammatory cardiomyopathy (iCMP) usually represents the chronic, hypokinetic phenotype within the myocarditis spectrum, characterized by persistent myocardial inflammation, systolic ventricular dysfunction, and adverse remodelling. It frequently evolves from prior acute or subacute myocarditis and is associated with significantly worse outcomes, including progression to dilated cardiomyopathy, heart failure, and arrhythmias. The condition arises from heterogeneous causes-infectious, autoimmune, or idiopathic-and may be influenced by genetic susceptibility, supporting a two-hit model in which environmental triggers interact with pathogenic variants. Diagnosis requires a multimodal approach. While clinical presentation is variable and often non-specific, cardiac magnetic resonance (CMR) provides essential tissue characterization, enabling detection of inflammation and fibrosis. Endomyocardial biopsy (EMB) remains critical for defining histologic subtype, identifying viral genomes, and guiding targeted therapy, especially in intermediate-or high-risk cases. Genetic testing assists in differentiating inherited CMPs and recognizing forms with distinctive inflammatory behavior, such as desmoplakin CMP. Management focuses on guideline-directed medical therapy for heart failure and treatment of underlying aetiologies. In biopsy-proven, virus-negative iCMP, immunosuppressive therapy may improve ventricular function and limit adverse remodelling, while antiviral strategies remain reserved for selected virus-positive cases. Arrhythmia management, including ICD implantation, is essential in patients with substantial fibrotic burden or arrhythmias. Prognosis depends on ventricular function, extent of fibrosis, viral persistence, arrhythmic burden, and recurrence of inflammatory "hot phases." Lifelong follow-up is warranted. This position paper provides a comprehensive framework for the diagnosis, risk stratification, and management of iCMP, highlighting current evidence, guideline alignment, and remaining gaps
Giulia Battistoni, Il privilegio della follia. Hegel tra diritto, morale e antropologia, il Mulino, Bologna 2024, pp. 280
No full textTime-dependent reproductive and genotoxic effects of cypermethrin and dichlorvos insecticides in female Clarias gariepinus
No full textGenetica e Genomica di Candida albicans nel concetto One Health
No full textInvasive fungal infections represent a growing threat to global public health, affecting approximately 6.5 million people annually and causing up to 3.8 million deaths. Among fungal pathogens, Candida albicans is one of the most frequently isolated species in clinical settings, responsible for cutaneous and systemic candidiasis, especially in immunocompromised patients. Due to its clinical relevance, C. albicans was included by the World Health Organization in the “WHO Fungal Priority Pathogens List” (2022) as a critically prioritized pathogen.
Although traditionally considered a commensal of the human mucosa, C. albicans has also been isolated from numerous animal species, both domestic and wild. However, knowledge of the genetic diversity of isolates from wildlife remains limited, despite increasing interest in their potential zoonotic role. In this context, it is essential to explore the intra-specific and inter-host genetic variability of C. albicans, especially within the One Health concept, which highlights the interconnection between human, animal, and environmental health in the management of infectious diseases and antimicrobial resistance.
To date, animal-derived isolates are severely underrepresented in the international PubMLST database dedicated to C. albicans, comprising only 4.9% of animal strains out of a total of 5,786. This gap limits the understanding of the genetic structure and potential epidemiological and zoonotic implications of the species.
In this study, 41 C. albicans isolates from Italian wildlife (European hedgehogs, wolves, badgers, foxes, a porcupine, and a roe deer) were analyzed. Isolates were identified using phenotypic tests, MALDI-ToF spectrometry, and partial amplification of the hwp1 gene. Subsequently, isolates were characterized by ABC Typing and Multi-Locus Sequence Typing (MLST).
ABC Typing revealed a predominance of genotype B (27 isolates), followed by genotypes A (10) and C (4), the latter rarely detected among C. albicans isolates. MLST analysis showed high genetic variability, with the identification of 116 total alleles, including 20 novel ones, and 36 Diploid Sequence Types (DSTs), 28 of which had never been previously described, substantially expanding the representation of animal isolates in the global database.
Phylogenetic analyses placed the isolates within several well-known clades of the global C. albicans phylogeny (mainly clades 11, 1, 14, and 15), with no clear correlation between genotype, host species, or geographical area. No lineages exclusive to wildlife were identified, but some genotypes overlapped with those of human clinical strains, suggesting interspecific genetic flows and a possible transient role of wildlife as a reservoir of potentially pathogenic variants.
Overall, the results support a dynamic model of genetic exchange between different environments and species, in accordance with the One Health concept, reinforcing the need to adopt interdisciplinary strategies for molecular surveillance and containment of C. albicans, with the aim of preventing emerging fungal infections and limiting the spread of resistant strains
Adverse Respiratory Reactions to Tyrosine Kinase Inhibitors: A Disproportionality Analysis of Spontaneous Reports from European Countries
No full textBackground: The tyrosine kinase inhibitors (TKIs) asciminib, bosutinib, dasatinib, imatinib, nilotinib, and ponatinib have been approved for chronic myelogenous leukemia (CML) therapy. However, pharmacovigilance reports associated with these drugs are neither consistent nor homogenous, with reports of pulmonary toxicity, which could limit their utilization. To better clarify TKIs’ pulmonary risk, we used the European database EudraVigilance to conduct a study on adverse events suspected to be caused by the TKIs asciminib, bosutinib, dasatinib, imatinib, nilotinib, and ponatinib when used for CML therapy. Methods: Suspected adverse reactions to TKIs in the EudraVigilance database (2020–2024) coming from European countries and the United Kingdom were analyzed and compared through a disproportionality analysis. Results: The most frequent alerts concerned the respiratory disorders “pleural effusion” (PE) and “pulmonary arterial hypertension” (PAH) in relation to dasatinib and bosutinib use. Among the TKIs, the prescription of dasatinib is associated with a higher occurrence of PE and PAH, while the prescription of bosutinib induces PE at a minor frequency that nonetheless carries a significant risk for PAH, occurring more often in women. Conclusions: The results indicate that respiratory disorders induced by the TKIs dasatinib and bosutinib need to be diagnosed in a timely manner, and suggest that caution should be taken when prescribing these TKIs to patients affected by CML and pulmonary comorbidities
Neuromodulation techniques for the treatment of nicotine addiction
No full textNicotine addiction remains one of the most prevalent substance use disorders worldwide and continues to represent a major public health challenge. Despite the availability of pharmacological and behavioral interventions, long-term smoking cessation rates remain low, highlighting the need for innovative therapeutic strategies. In this context, non-invasive brain stimulation (NIBS) techniques have emerged as promising tools capable of modulating neural circuits involved in craving, reward processing, and cognitive control.
The present study investigated the efficacy and feasibility of a novel combined neuromodulation protocol integrating transcranial direct current stimulation (tDCS) and repetitive transcranial magnetic stimulation (rTMS) for the treatment of nicotine addiction. The protocol was designed to exploit the priming effects of anodal tDCS on cortical excitability to enhance the subsequent neuromodulatory impact of rTMS on the dorsolateral prefrontal cortex (DLPFC), a key region involved in executive control and addiction-related behaviors.
Seventy-two adult smokers from the general population were enrolled and randomly assigned to either a conventional rTMS protocol (21 daily sessions) or a short, intensive combined protocol consisting of sequential tDCS and rTMS delivered twice daily for five consecutive days. Clinical outcomes included cigarette consumption (cigarettes per day), nicotine dependence severity measured with the Fagerström Test for Nicotine Dependence, smoking expectancy, and abstinence rates. Neurophysiological changes were assessed through resting motor threshold measurements as an index of cortical excitability.
Results showed that the combined neuromodulation protocol produced significantly greater reductions in cigarette consumption and nicotine dependence compared with conventional rTMS. Participants receiving the combined intervention were also more likely to achieve clinically meaningful reductions in smoking (≥50% reduction in cigarettes per day) and showed higher rates of complete abstinence in the short term. The combined protocol demonstrated superior feasibility and adherence, with markedly lower dropout rates than the conventional treatment. Both interventions induced significant reductions in motor threshold, indicating increased cortical excitability and supporting the presence of neuromodulation-induced plasticity.
These findings suggest that sequential tDCS–rTMS stimulation represents a promising and time-efficient strategy for modulating the neural circuitry underlying nicotine dependence. By enhancing neuroplasticity within prefrontal networks implicated in craving regulation and inhibitory control, the combined approach may offer clinically meaningful benefits beyond those achieved with conventional single-technique protocols.
Beyond its clinical implications, this work contributes to the growing field of precision neuromodulation in addiction medicine. Future research integrating advanced neurophysiological methods, such as TMS-EEG, may allow the identification of biomarkers of treatment response and the development of personalized neuromodulation protocols tailored to individual cortical profiles. In this perspective, the present study provides both empirical evidence and a conceptual framework supporting the role of combined neuromodulatory interventions as a next-generation therapeutic strategy in the management of nicotine addiction
Primary and Revisional One Anastomosis Gastric Bypass: A Systematic Review and GRADE-Based IFSO Position Statement
No full textObesity is a chronic, systemic disease that alters the function of tissues, organs, and overall health, requiring prompt recognition and treatment by qualified professionals. IFSO recognizes the need to provide a new methodology for developing IFSO position statements. All new official position statements should be developed using a GRADE-based methodology, systematically reviewing all available evidence relevant to Metabolic and Bariatric Surgery (MBS). The present Position Statement was developed using results coming from a systematic review and meta-analysis, reported herein, following the criteria of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Fourteen Randomized controlled trials (RCTs) were included in this meta-analysis, 13 and 1 of them assessing outcomes of OAGB in primary and revisional setting respectively, with a total of 1288 patients. In the short term, OAGB exhibited a significantly higher excess weight loss percentage (EWL%) compared to RYGB. Regarding weight loss and metabolic outcomes, OAGB was not reported to be inferior in terms of weight loss and T2DM resolution when compared to RYGB. Further RCTs comparing OAGB to other MBS procedures are needed to reach a definitive recommendation regarding OAGB in revisional surgery setting. Regarding safety profile, no statistically significant differences between OAGB and other MBS were reported. This position statement was issued by the IFSO OAGB task force and approved by IFSO Scientific Committee aims to provide evidence on the effectiveness of One Anastomosis Gastric Bypass in both primary and revisional settings
Cytotoxic Effects of a Triorganotin Derivative on HTLV-1-Infected Cells at Different Immortalization/Transformation Stages In Vitro
No full textAmong the metal-derived complexes, recently, tin derivatives have been investigated as promising anti-cancer drug candidates. Our previous study showed that the tin-based compound Bu3SnOCOCF3 (TBT) exerts cytotoxic activity on solid tumor cell lines. In the present study, the effects of TBT were evaluated in vitro on HTLV-1-infected human lymphocytic cell lines at different stages of viral transformation, consisting of IL-2-dependent (PB2/IL-2) and IL-2-independent (PB2/NO-IL-2) cells, generated in our laboratory by HTLV-1 in vitro infection of lymphocytes from the same donor, and the C91/PL cell line established by co-cultivation with T cells from a patient with HTLV-1-positive leukemia. TBT induced a reliable and reproducible dose-dependent inhibition of metabolic activity and viability in the HTLV-1-infected cells. The effect was cell-type-dependent, with C91/PL cells being quite resistant. An investigation into the cytotoxic effects induced by TBT in HTLV-1-infected cells and data on caspase inhibitors/caspase activation indicated that apoptotic cell death was involved, but also that the possible involvement of other forms of cell death could not be excluded. Taken together, the results show for the first time that the tin-based compound, although not devoid of a certain cytotoxicity toward uninfected cells, can induce typical and potent effects on HTLV-1-infected cells
Libertà di coscienza e salute nelle scelte di fine-vita tra diritti individuali e doveri di solidarietà
No full textNel presente contributo si analizza la recente giurisprudenza costituzionale sul fine-vita nella quale la Consulta tenta di raggiungere un punto di equilibrio tra autodeterminazione individuale del malato terminale e tutela solidale del bene vita. Sia pure nel suo ondivago peregrinare, la Corte invita costantemente il legislatore a emanare una disciplina che attui un bilanciamento tra questi due poli del dibattito, seguendo le linee-guida tracciate nelle sue pronunce. Nel paper si analizza pertanto anche il disegno di legge governativo sul suicidio assistito, che peraltro non segue pedissequamente la giurisprudenza della Corte. L’autore sostiene che, se si arriverà ad una legge, questa dovrà rispettare «i limiti imposti dal rispetto della persona umana», previsti dall’art. 32 Cost. La normativa, pertanto, realizzando un laico bilanciamento tra l’autonomia individuale nelle scelte che riguardano la propria salute e l’interesse della collettività alla tutela della vita, dovrà disporre tutte le garanzie necessarie affinché il malato terminale non sia condizionato dal suo stato di fragilità ad optare per la morte a causa del convincimento di essere un peso per la società e per i familiari. Il paziente, insomma, se sceglierà il suicido assistito lo farà perché, nonostante la comunità sociosanitaria e le persone care hanno un solidale ed empatico interesse a farlo vivere, e a tal fine gli mettono a disposizione un’efficiente e articolata organizzazione umana e materiale, lui è fermamente convinto che il suo attuale modus vivendi non sia più in linea con la propria coscienza. In questi termini, quindi, l’estrema decisione non sarebbe frutto di una istintiva, semplice e astratta autodeterminazione, condizionata negativamente dal contesto sociale e sanitario in cui si trova il malato, bensì l’esito di una libera e ponderata manifestazione di volontà assiologicamente qualificata (autonomica) in ordine alle proprie scelte di vita (weltanschauung)
The Cultural Influence of the Iviron Monastery on Mount Athos During the 17th-19th Centuries on the Bulgarian Lands
No full textThe article refers to the cultural influence of the Athonite Monastery of Iviron during the 17th–19th centuries on the
territory of current-day Bulgaria through the spiritual and artistic activities of Iviron’s monks. The observations, mostly based
on unknown data of Greek epigraphical materials, preserved in treasures of Christian art, show the presence of nine monks
from the Iviron Monastery, most of whom held superior ecclesiastical positions. All of them, in their own way, contributed to its
cultural flourishing with their donations, high held positions, or engaged in artistic activities