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La gestione delle cronicità nel paziente affetto da sclerosi sistemica secondo il PDTA promosso dalla Rete Toscana Malattie Rare: analisi della qualità di vita
No full textL'obiettivo del progetto di tesi è descrivere la gestione del paziente affetto da sclerosi sistemica con riferimento al PDTA regionale, promosso dalla Rete Toscana Malattie Rare, e l'impatto delle problematiche croniche sulla qualità di vita. Il lavoro prevede l'analisi delle manifestazioni cliniche, tra cui i segni e sintomi a livello orofacciale, e delle complicanze che vi possono sopraggiungere, con particolare riferimento alla disfagia
Glitches from Gamma-ray Pulsars: Analysis and Multi-Messenger prospects
No full textPulsars are among the most extreme astrophysical objects in the Galaxy. They are highly magnetized spinning neutron stars, characterized by pulsed periodic electromagnetic emission, which takes place at the expense of the rotational energy. Therefore, pulsars slow down in time, in a process generally referred to as pulsar braking. However, sudden deviations from this expected behavior have been observed and labeled with the name "glitches". Glitches are unpredictable events, supposedly caused by an abrupt redistribution of angular momentum within the crust of the neutron star, because of a non-uniform internal composition. Among the known pulsars, those emitting gamma-rays are of particular interest, because they are very young and energetic, and the study of their glitches can be very interesting. Moreover, since a glitch leads to a rearrangement of the pulsar interior, a dislocation of matter is most likely to occur too, causing a variation in the mass quadrupole moment of the star, with consequent emission of a gravitational wave signal (GW). However, this emission has not yet been detected by current GW detectors. In this work, we present a systematic analysis of gamma-ray glitches for a selection of radio-quiet pulsars, reported in the Fermi Third Pulsar Catalog (3PC), which is the result of more than 15 years of observation performed by the Fermi Large Area Telescope (Fermi-LAT). Furthermore, we select those glitches that occurred within LIGO-Virgo-KAGRA (LVK) observing runs, computing the corresponding expected GW strain amplitude. We decided to analyze the radio-quiet pulsars because they can reveal important information about the pulsar emission mechanisms and they permit a complementary insight on pulsar physics with respect to radio observations alone, also considering that Fermi-LAT permits continuous monitoring in the gamma-ray frequency band. After selecting 17 radio-quiet gamma-ray pulsars form the 3PC, we analyzed the Fermi-LAT data of each source, over a period spanning between August 4, 2008 and May 5, 2025. For each pulsar, we performed a periodicity search aimed at tracking the pulsar spin-down evolution, detecting glitches, and measuring their parameters. By plotting the spin frequency as a function of time, we confirmed the glitches already reported in the 3PC and we also discovered new uncataloged glitches. We selected all the glitches that occurred during one of the LVK observing runs and we computed their expected GW strain amplitude. These estimates are important to understand the potential of glitch detection by present and future GW detectors, and to provide useful input in order to develop new detection pipeline, selecting the best glitches to look for, in order to maximize the scientific output of the next multi-messenger investigations of pulsars
Sant'Uffizio a Pisa nel Settecento: giurisdizione e prassi decisionale nell'età della Reggenza.
No full textAbstract
L’elaborato mira a indagare l’azione del Sant’Uffizio nell’Arcidiocesi di Pisa nel Settecento, concentrandosi sull’età della Reggenza lorenese (1737-1765). A partire da una ricostruzione della più recente storiografia sul periodo, e attraverso l’analisi di casi di studio, si è indagato il funzionamento dell’Inquisizione pisana nel più ampio sistema dei rapporti fra Stato e Chiesa, non riducibili alla mera contrapposizione. La ricerca, condotta principalmente presso l’Archivio Storico Diocesano di Pisa, esamina documenti inediti che dimostrano come, in età lorenese, le relazioni fra potere civile ed ecclesiastico abbiano assunto talora le forme del compromesso, e come la spinta giurisdizionalista dei ministri di Francesco Stefano abbia progressivamente eroso lo spazio d’azione della Congregazione. In particolare, la presenza nel territorio diocesano del porto di Livorno, città che per ragioni economiche accolse e protesse mercanti ebrei e acattolici, costrinse l’Inquisizione ad adattarsi a un regime di tolleranza imposto dallo Stato. La tesi si concentra inoltre sul ristabilimento del tribunale del Sant’Uffizio (1754) in seguito alla sospensione della sua attività dopo la legge sulla stampa del 1743, a partire dal rinvenimento del regolamento frutto dell’accordo fra Roma e Firenze, che ben mette in luce il nuovo indirizzo della politica giurisdizionalista lorenese.
Abstract
This study investigates the activity of the Roman Inquisition in the Archdiocese of Pisa during the XVIII century, paying particular attention to the period of the Regency (1737-1765). The cases taken into consideration are analyzed within the broader framework of the relations between State and Catholic Church, which were never only and always in opposition. Based especially on original documents preserved in the Diocesan Historical Archive of Pisa, this study reveals how, under the Lorraine administration, interactions between ecclesiastical and civil authorities often assumed the form of compromise, while the jurisdictionalist orientation of Grand Duke Francis Stephen gradually constrained the authority of the Holy Office. This autonomy was also curtailed by the presence of the port of Livorno within the diocesan territory; for economic reasons, this city welcomed and protected Jewish and non-Catholic merchants, so the Inquisition had to operate within a framework of religious tolerance imposed by the civil authorities. The thesis finally examines the re-establishment of the Holy Office tribunal in 1754, following its suspension: central to this section is the discovery of the tribunal’s internal regulations, the result of an agreement between Rome and Florence, which sheds light on the evolving nature of the jurisdictionalist policy of the Regency
Terapia radiorecettoriale nei tumori neuroendocrini: analisi retrospettiva monocentrica.
No full textLa medicina nucleare sta ricoprendo un ruolo importante nella terapia dei tumori neuroendocrini mediante la terapia radiorecettoriale.
La PRRT agisce legando un radionuclide a un analogo della somatostatina (SSA), che può colpire i rettori della somatostatina (SSTR) sulle cellule NET. Dopo il legame dell'SSA radiomarcato all'SSTR, questo complesso viene internalizzato nella cellula, dove l'emissione di radiazioni beta causa localmente danni al DNA per irradiazione.
In questi tesi è stata condotta una analisi retrospettiva di 57 pazienti che sono stati trattati presso il nostro centro con 177Lu-Oxodotreotide. Per ogni paziente sono state analizzate le PET con 68GA-DOTATOC eseguite prima e dopo il trattamento usando i criteri PERCIST-like
Termoablazione dei noduli tiroidei benigni : indicazioni, tecniche e risultati clinici
No full textI noduli tiroidei sono estremamente comuni nella popolazione generale, con una prevalenza stimata tra il 50 ed il 67%, unendo le stime dei dati autoptici ed ecografici[1]. Questi noduli possono avere una natura benigna o maligna, che viene determinata attraverso lo screening ecografico e l’analisi cito-istologica su campioni di agoaspirati e biopsie.
I noduli benigni non necessitano di trattamento, a meno che non determinino effetto massa e compressione delle strutture circostanti, difetti estetici o che presentino una citologia indeterminata con rischio di trasformazione maligna.
In questi casi i trattamenti classici, quali procedure chirurgiche, radio-iodio ed ablazioni con iniezione percutanea di etanolo possono comportare rischi e complicanze per il paziente. Molti pazienti rifiutano quindi di sottoporsi alle procedure di trattamento tradizionali perché temono i rischi delle operazioni rispetto ai benefici che potrebbero trarne. In molti scelgono dunque la sorveglianza attiva tramite periodici follow-up, opzione che spesso lascia il paziente in uno stato di inquietudine o che lo induce a dover convivere con i sintomi compressivi e i difetti estetici legati al nodulo.
Qui entrano in gioco le tecniche mini-invasive della radiologia interventistica ossia la termoablazione dei noduli. In questo studio sono riportati dati inerenti a un pool di pazienti operati al Nuovo Ospedale Apuano di Massa e i risultati ottenuti
Ottimizzazione del Timing della Tracheostomia in Pazienti Neurolesi: uno studio osservazionale stratificato per comorbidità respiratorie
No full textLo studio analizza l’impatto delle comorbidità respiratorie sugli outcome clinici di pazienti neurolesi sottoposti a tracheostomia, confrontando due gruppi: con e senza patologie respiratorie.
Non sono emerse differenze statisticamente significative in termini di ventilazione invasiva, degenza, mortalità e complicanze, ma si osservano tendenze cliniche favorevoli nei pazienti con comorbidità respiratorie, probabilmente legate a una tracheostomia precoce e a una gestione multidisciplinare.
Il lavoro contribuisce a colmare una lacuna nella letteratura, offrendo nuove prospettive sulla gestione ottimale dei pazienti neurolesi critici
Globalization’s Hidden Cost: Uneven Development in the Chinese Miracle
No full textGlobalization, through the progressive opening of markets and the increasing flows of goods, capital, information, and people, has profoundly reshaped the world economy. It has promoted growth and innovation, but it has also produced structural imbalances and exposed persistent inequalities in the distribution of wealth. These contrasting effects have driven an ongoing debate in economics: does globalization promote inclusive development, or does it primarily benefit a narrow segment of society? This thesis focuses on China, a country whose rapid economic transformation provides a particularly relevant context for examining the distributional effects of globalization. For centuries, China’s development was constrained by demographic pressures and agricultural limits, consistent with the Malthusian Trap. This situation changed in 1978, when market oriented reforms under Deng Xiaoping initiated rapid industrialization, urbanization, and
integration into global trade. By 2009, China had surpassed Germany to become the world’s largest exporter, highlighting the extraordinary speed with which it shifted from a rural, agrarian system to a central actor in the global economy. The research has two main objectives. First, it presents an empirical analysis of economic inequality in China, using indicators such as the Gini coefficient and the income shares of the richest 1% and the poorest 50%. This analysis evaluates whether the gains from globalization have reached marginalized populations or remained concentrated among those with pre-existing access to capital and resources. Second, the study introduces and applies the Boltzmann Wealth Model to this context, providing a theoretical and computational framework to analyze wealth dynamics and the potential impact of policy interventions. The findings suggest that while globalization has driven remarkable economic growth, its benefits have been distributed unevenly. Rural and low-income populations remain largely marginalized. Simulations using the Boltzmann Wealth Model highlight the importance of
redistributive policies and suggest the possibility of a more balanced and inclusive devel
opment trajectory. The thesis is structured as follows. Chapter 1 reviews globalization from historical, theoretical, and empirical perspectives. Chapter 2 examines China’s economic rise, focusing on both its role in global trade and the internal distribution of its gains. Chapter 3 presents the empirical analysis of inequality. Chapter 4 develops the theoretical foundations of the Boltzmann Wealth Model, detailing its assumptions and mechanisms. Chapter 5 applies
the model to the Chinese case and explores the effects of taxation and redistribution poli
cies. The conclusion reflects on whether globalization inevitably generates inequality or
whether policy choices can foster a more balanced and sustainable development path
Antidepressant treatment of depressive and anxiety symptoms in patients with Parkinson's disease: a retrospective comparison of TCAs, SNRIs and SSRIs
No full textBackground: Depression and anxiety are highly prevalent non-motor symptoms in patients with Parkinson’s disease (PD), significantly affecting quality of life and disease outcomes. Despite their clinical relevance, evidence comparing the efficacy and tolerability of different antidepressant classes in PD remains limited and inconsistent.
Objective: This study aimed to retrospectively compare the effectiveness and tolerability of three classes of antidepressants, tricyclic antidepressants (TCAs), selective serotonin reuptake inhibitors (SSRIs), and serotonin–norepinephrine reuptake inhibitors (SNRIs), in the treatment of depressive and anxiety symptoms in patients with PD.
Methods: We conducted a naturalistic, observational follow-up study of 29 PD patients with clinically significant depressive and/or anxiety symptoms treated with TCAs (n = 12), SSRIs (n = 9), or SNRIs (n = 8) at the University Hospital of Pisa between February 2020 and February 2025. Clinical assessments were performed at baseline, 3 months, and 12 months using the Clinical Global Impression (CGI) and the Brief Psychiatric Rating Scale (BPRS, depressive/anxiety subscale). Linear mixed-effects models were used to assess changes over time and between treatment groups.
Results: Baseline characteristics were broadly comparable across groups, although patients prescribed SNRIs exhibited later onset of psychiatric symptoms, fewer lifetime depressive episodes and milder symptoms. At 3 months, patients treated with TCAs showed greater symptom improvement than those receiving SSRIs or SNRIs, both on the CGI (trend-level significance, p = 0.08) and BPRS subscale (p < 0.05). By 12 months, depressive/anxiety symptoms improved significantly in all groups, and between-group differences were no longer significant, suggesting convergence of outcomes over time. Adverse effects were reported in 38% of patients overall, with xerostomia and constipation more common with TCAs, somnolence with SSRIs, and tremor with SNRIs; discontinuation rates were low and comparable across groups.
Conclusions: TCAs were more often prescribed to patients with earlier and more severe psychiatric histories and were associated with greater short-term improvement, while SSRIs showed slower response but good tolerability. SNRIs were used mainly in later-onset, milder cases, with intermediate outcomes. Over one year, all antidepressant classes were associated with significant clinical improvement, supporting individualized treatment strategies that balance efficacy, tolerability, and patient characteristics
Violenza nei luoghi di lavoro: metodo sperimentale per la valutazione del rischio
No full textObiettivo: Elaborare un metodo per la valutazione del rischio aggressione nei luoghi di lavoro. Sulla base di quanto indicato dall’Art. 8 della Raccomandazione ILO n. 206 e dall’Art. 9 della Convenzione ILO n. 190, la valutazione dei rischi sui luoghi di lavoro deve tenere conto dei fattori che aumentano la probabilità di violenza e molestie, soprattutto quelli che siano conseguenza delle condizioni, delle modalità e dell’organizzazione del lavoro, che riguardino soggetti terzi e che siano dovuti alla discriminazione anche di genere e dell’abuso di potere.
Materiali e Metodi: Prendendo spunto dalla Convenzione ILO n.190, dalla Raccomandazione n. 206 e dal percorso di valutazione del rischio stress lavoro-correlato dell’INAIL, sono state elaborate la fase preliminare e approfondita della valutazione del rischio aggressione nei luoghi di lavoro. La fase preliminare è data da una check-list di 24 item da sottoporre a lavoratori esperti. La fase approfondita, cui si accede se alla preliminare si raggiunge il punteggio ≥10, prevede la pianificazione e adozione di interventi correttivi (strutturali, organizzativi, formativi, comunicativi, procedurali) con particolare attenzione al genere. Se però alla valutazione preliminare non si raggiunge il punteggio ≥10, ma dai colloqui emergono comunque delle criticità, queste andranno corrette, il risultato riportato nel DVR (Documento Valutazione dei Rischi) con previsto piano di monitoraggio. Se invece emerge un punteggio ≥10, nella fascia di rischio gialla qui si aprono due scenari: possono essersi verificati casi di aggressione sul luogo di lavoro o meno. In caso che non si siano verificati eventi si esegue una valutazione approfondita restituisce un punteggio che corrisponde a fasce di rischio correlate alla tempistica di intervento, se invece si fossero verificati eventi si procede con una valutazione approfondita mediante check-list mirate a trovare le irregolarità che hanno permesso che accadesse. Gli interventi correttivi, se validi ed efficaci, dovranno essere riportati nel DVR e dovrà essere previsto un piano di monitoraggio. La sperimentazione è iniziata dall’U.O. Laboratorio Analisi Chimico-Cliniche dell’AOUPisana, formato da due centri prelievi nella città di Pisa (presidi di S. Chiara e di Cisanello) e da un laboratorio analisi (presidio di Cisanello) per poi proseguire con i lavoratori del servizio accoglienza dello stesso ospedale e con i lavoratori del call-center del servizio prenotazione e del servizio prenotazione-accettazione di secondo livello.
Risultati: Le criticità maggiori sono emerse dai centri prelievi, dal servizio accoglienza dell’ospedale e dal call-center, dove il punteggio è in fascia di rischio gialla e rossa per il servizio accoglienza. Seguendo la flow-chart per la valutazione del rischio aggressione che abbiamo elaborato, è previsto il passaggio alla valutazione approfondita, con effettuazione di sopralluoghi e compilazione di check-list (variante “con casi”). Da questi sono emerse criticità riguardanti le vie di fuga, l’accesso dell’utenza, la presenza di oggetti contundenti, la sicurezza dei parcheggi e del tragitto parcheggio-luogo di lavoro.
Conclusioni: Si rende sempre più impellente la valutazione del rischio aggressione nei luoghi di lavoro. Gli infortuni per aggressione nella sanità sono in aumento ed è spesso colpito il sesso femminile. Dal nostro studio emerge un grave criticità soprattutto nei punti dell’ospedale con accesso libero dell’utenza, non mediato da liste di prenotazione. Questo accade allo stesso modo per il call center, dove episodi di violenza verbale e molestie sono quotidiani. È di grande importanza la formazione e la diffusione di procedure di segnalazione veloci ed efficaci.
Objective: To develop a method for assessing the risk of aggression in the workplace. Based on the provisions of Article 8 of ILO Recommendation No. 206 and Article 9 of ILO Convention No. 190, workplace risk assessments must take into account factors that increase the likelihood of violence and harassment, especially those resulting from the conditions, methods, and organization of work, involving third parties, and resulting from discrimination, including gender discrimination, and abuse of power.
Materials and Methods: Drawing on ILO Convention No. 190, Recommendation No. 206, and the INAIL work-related stress risk assessment process, the preliminary and in-depth phases of the workplace aggression risk assessment were developed. The preliminary phase consists of a 24-item checklist to be submitted to experienced workers. The in-depth phase, accessed if the preliminary assessment scores ≥10, involves planning and implementing corrective measures (structural, organizational, training, communication, procedural) with particular attention to gender. However, if the preliminary assessment does not score ≥10, but the interviews still reveal critical issues, these will need to be addressed. The results are reported in the Risk Assessment Document (DVR) with a planned monitoring plan. If, however, a score ≥10 is achieved, the yellow risk band presents two scenarios: workplace aggression may or may not have occurred.If no events have occurred, a thorough assessment is performed, resulting in a score corresponding to risk bands related to the timing of the intervention. If events have occurred, a thorough assessment is performed using checklists aimed at identifying the irregularities that allowed them to occur. Corrective actions, if valid and effective, must be reported in the DVR, and a monitoring plan must be established. The trial began with the Clinical-Chemical Analysis Laboratory Unit of the AOUPisana Hospital, consisting of two blood collection centers in the city of Pisa (S. Chiara and Cisanello facilities) and a laboratory analysis center (Cisanello facility). It then continued with the hospital's reception staff, the call center staff, and the second-level booking-admission staff.
Results: The greatest critical issues emerged in the blood collection centers, the hospital reception service, and the call center, where the score is in the yellow risk band, while the reception service is in the red risk band. Following the flowchart for assessing assault risk that we developed, a transition to an in-depth assessment is planned, with on-site inspections and the completion of checklists (the "with cases" variant). These revealed critical issues regarding escape routes, user access, the presence of blunt objects, parking safety, and the route from the parking lot to the workplace.
Conclusions: Assessing the risk of assault in the workplace is increasingly urgent. Accidents involving assault in healthcare are on the rise, and women are often affected. Our study highlights a serious problem, especially in hospital areas with free, unrestricted access. This is also true for call centers, where incidents of verbal abuse and harassment are commonplace. Training and dissemination of rapid and effective reporting procedures are of paramount importance
Mapping spatiotemporal evolution of dystonia in atypical parkinsonisms: a retrospective longitudinal cohort study
No full textAtypical parkinsonian disorders (APDs) represent a group of neurodegenerative disorders,
including progressive supranuclear palsy (PSP), multiple system atrophy (MSA), and corticobasal
syndrome (CBS), characterized by signs and symptoms of parkinsonism with other motor and non-
motor features. Dystonia is a frequent yet inconsistently described characteristic within the clinical
spectrum of APDs, and its different distribution and evolution across syndromes remain
substantially unexplored.
This study provides the first systematic, longitudinal comparison of dystonia across PSP, MSA, and
CBS, with the aim to explore the spatial and temporal evolution of this feature. Clinical data were
retrospectively collected from a large single-center cohort (182 patients) and analysed to determine
the topography, timing, and clinical correlates of dystonia. A subset of patients (n = 119) with at least five years of homogeneous follow-up from disease onset was examined to ensure comparability
across diagnoses and to extract both prevalence estimates and spatiotemporal trajectory of
dystonia. Complementary time-to-event analyses were used to model the evolution of dystonia
across the entire disease course. Finally, we investigated potential association between dystonia
and major clinical milestones, like dysphagia and loss of ambulation.
Dystonia was found to be highly frequent in our cohort as per prevalence estimates after 5 years
from disease onset. Distinct spatiotemporal patterns of dystonia emerged among PSP, MSA and
CBS, suggesting that each condition follows a characteristic trajectory in terms of both body
distribution and timing of onset. When comparing dystonia prevalence across body regions,
significant differences were found for cranial dystonia (p < 0.001) and upper limb dystonia (p <
0.001). Specifically, cranial dystonia was most frequent in PSP (55.6%), while upper limb dystonia
predominated in CBS (82.6%). No significant differences were observed for cervical (p = 0.075) or
truncal (p = 0.293) dystonia. Regarding the timing of onset, upper limb dystonia occurred earlier in
CBS compared to PSP (p = 0.025), whereas no significant temporal differences were found in
other regions. Dystonia-related pain was more common in CBS than in MSA and PSP (p < 0.001). Among PSP
subtypes, dystonia prevalence did not differ significantly; however, patients with MSA-P exhibited a
significantly higher prevalence of dystonia compared to those with MSA-C (p = 0.002). Dysphagia
and loss of ambulation were not significantly influenced by dystonia, although they appeared more
frequently in association with specific forms of dystonic patterns.
This work offers new insights into the natural history of dystonia in APDs and proposes a
structured approach for its longitudinal assessment. Prospective and larger studies will further
clarify the existing findings and potentially improve both diagnostic and therapeutic approaches