174 research outputs found
Il Liceo Dantesco di Leonardo Antonio Forleo
No full textEnThe present essay is concerned with highlighting the figure and the interpretation of Dante's poetry in the Commedia of Leonardo Antonio Forleo, an italian author from Salento (a fervent liberal in the years of the Neapolitan Constitution, and therefore, following the Bourbon repression, a defender of Catholic-reactionary ideals), in his book Liceo Dantesco ovvero Guida allo studio di Dante (1844), highlighting above all the moralistic intentions of the author, who reads the Dante's Commedia almost always favoring a criticism characterized by the presence of meticulous observations aimed at always discerning ethics in poetry.ItIl presente studio si occupa di mettere in evidenza la figura e l'interpretazione dantesca del salentino Leonardo Antonio Forleo (fervente liberale negli anni della Costituzione napoletana, trasformatosi in difensore degli ideali cattolico-reazionari dopo la repressione borbonica) nel suo saggio Liceo Dantesco ovvero Guida allo studio di Dante (1844), sottolineando soprattutto gli intenti moralistici dell'autore, che legge la Commedia dantesca quasi sempre privilegiando una critica caratterizzata dalla presenz a di minuziose osservazioni tese a scorgere l'etica nella poesia
Shortened head-up tilting test guided by systolic pressure reductions in neurocardiogenic syncope
No full textBACKGROUND: Asymptomatic reductions in arterial pressure have been reported to occur before the onset of tilt-induced syncope. We investigated the predictive value of these reductions for a positive tilt result.
METHODS AND RESULTS: In a first study, 238 consecutive healthy subjects with unexplained syncope underwent a passive tilt table test. Finger systolic arterial pressure (SAP) recordings made it possible to calculate how many of the beat-to-beat SAP values during the first 15 minutes of tilt were lower than the lowest value recorded at baseline. Neurocardiogenic syncope was diagnosed in 73 subjects; 28 fainted after 15 minutes of tilt and experienced more pressure reductions than did the subjects with a negative test (328+/-400 versus 119+/-284; P<0.01). More than 14 SAP reductions during the first 15 minutes of tilt allowed us to predict a positive test with 93% sensitivity, 58% specificity, and positive and negative predictive values of 28% and 98%, respectively. In a second prospective study (80 consecutive subjects), the online analysis of this criterion by visually inspecting a Finapres monitor showed 80% sensitivity, 85% specificity, and positive and negative predictive values of 57% and 94%.
CONCLUSIONS: In healthy subjects with unexplained syncope, the evaluation of SAP reductions during the first 15 minutes of tilt is a marker of systolic pressure instability preceding syncope and constitutes a simple and good predictor of tilt outcome that could be used to guide test duration
Prevalence, timing, and haemodynamic correlates of prodromes in patients with vasovagal syncope induced by head-up tilt test
No full textAimsTo evaluate the prevalence, timing, and haemodynamic characteristics of prodromal symptoms in patients experiencing vasovagal syncope (VVS) during a head-up tilt test (HUT) potentiated with nitroglycerin, and their relationships with those reported before spontaneous episodes.Methods and resultsSymptoms preceding HUT-induced syncope were recorded, together with heart rate (HR) and arterial blood pressure (BP) values, in 149 otherwise healthy and drug-free subjects with recurrent unexplained syncope. Head-up tilt test significantly increase the number of patients capable of recognizing the premonitory symptoms of VVS than before spontaneous episodes (96 vs. 79; P < 0.001). The nine most frequent symptoms were stratified into three groups on the basis of their characteristics: headache, hot flashes, and palpitations occurred more than 3 min before syncope, with a very slight reduction in BP; nausea, asthenia, diaphoresis, vertigo, and epigastric discomfort preceded syncope by 1-3 min and were associated with a slight reduction in BP; and blurred vision appeared the last minute before syncope and was characterized by the lowest BP and HR values.ConclusionIn comparison with spontaneous syncopal episodes, HUT allows the more frequent recognition of prodromes also providing useful information in terms of timing and haemodynamic characteristics of symptoms that may allow more tailored patient counselling
Head-up tilt testing for diagnosing vasovagal syncope: a meta-analysis.
No full textBACKGROUND: A systematic evaluation focused on sensitivity and specificity of head-up tilt testing (HUT) for diagnosing vasovagal syncope has not been previously performed. We conducted a meta-analysis of studies comparing HUT outcome between patients with syncope of unknown origin and control subjects without previous syncope.
METHODS: We searched Pubmed and Embase databases for all English-only articles concerning case-control studies estimating the diagnostic yield of HUT, and selected 55 articles, published before March 2012, including 4361 patients and 1791 controls. The influence of age, test duration, tilt angle, and nitroglycerine or isoproterenol stimulation on tilt testing outcome was analyzed.
RESULTS: Head-up tilt testing demonstrated to have a good overall ability to discriminate between symptomatic patients and asymptomatic controls with an area under the summary receiver-operating characteristics curve of 0.84 and an adjusted diagnostic odds ratio of 12.15 (p<0.001). A significant inverse relationship between sensitivity and specificity of tilt testing for each study was observed (p<0.001). At multivariate analysis, advancing age and a 60° tilt angle showed a significant effect in reducing sensitivity and increasing specificity of the test. Nitroglycerine significantly raised tilt testing sensitivity by maintaining a similar specificity in comparison to isoproterenol.
CONCLUSIONS: The results from this meta-analysis show the high overall performance of HUT for diagnosing vasovagal syncope. Our findings provide useful information for evaluating clinical and instrumental parameters together with pharmacological stressors influencing HUT accuracy. This could allow the drawing of tilt testing protocols tailored on the diagnostic needs of each patient with unexplained syncope
Leonardo Antonio Forleo e la ‘Divina Commedia’: il «libro verseggiato di morale»
No full textThe essay proposes the analysis of Guida allo studio di Dante, published in 1844 by Leonardo Antonio Forleo, an Apulian scholar whose crit-ics have recognized the merit of having contrib-uted to the cult and reading of Dante in Salento.Through precise and constant references to the text, the intention of the author is highlighted to detect the poetic, scientific and ethical beau-ties of Dante's Comedy, but also its allegorical contents, in order to instruct the 'valiant Italian youth' to which, motivated with a solid classi-cistic background, Forleo recommends reading and studving the poem as a source of good stud-ies and as the mother of poetry and of the Ital-ian language
Multifocal Ectopic Purkinje-Related Premature Contractions Syndrome in R222Q-SCN5A Gene Mutation Carriers Treated With Flecainide
No full textA 21-year-old male patient with syncopal episodes and his 56-year-old father, with a family history of sudden cardiac death and dilated cardiomyopathy, were referred to our center.
Physical examination and laboratory investigations were normal. The father’s ambulatory electrocardiographic (ECG) abnormalities (Figures 1A and 1B) were poorly responsive to beta-blockers. The father’s cardiac imaging showed mild left ventricular dilation and systolic dysfunction with no myocardial fibrosis.
Catheter ablation of the right ventricle outflow tract (RVOT) was attempted, because of the prevalence of premature ventricle contractions at this level, and a regression of systolic dysfunction and dilation was observed (Figure 2), but no beneficial effect on the arrhythmic burden was obtained. Genetic testing was performed, revealing the R222Q-SCN5A gene mutation in both father and son, accountable for the rare multifocal ectopic Purkinje-related premature contractions (MEPPC) syndrome.1,2 Therefore, flecainide via oral route was started with complete
normalization of ECG (Figure 1C)
Role of nuclear Lamin A/C in cardiomyocyte functions
No full textLamin A/C is a structural protein of the nuclear envelope (NE) and cardiac involvement in Lamin A/C mutations was one of the first phenotypes to be reported in humans, suggesting a crucial role of this protein in the cardiomyocytes function. Mutations in LMNA gene cause a class of pathologies generically named 'Lamanopathies' mainly involving heart and skeletal muscles. Moreover, the well-known disease called Hutchinson-Gilford Progeria Syndrome due to extensive mutations in LMNA gene, in addition to the systemic phenotype of premature aging, is characterised by the death of patients at around 13 typically for a heart attack or stroke, suggesting again the heart as the main site sensitive to Lamin A/C disfunction. Indeed, the identification of the roles of the Lamin A/C in cardiomyocytes function is a key area of exploration. One of the primary biological roles recently conferred to Lamin A/C is to affect contractile cells lineage determination and senescence. Then, in differentiated adult cardiomyocytes both the 'structural' and 'gene expression hypothesis' could explain the role of Lamin A in the function of cardiomyocytes. In fact, recent advances in the field propose that the structural weakness/stiffness of the NE, regulated by Lamin A/C amount in NE, can 'consequently' alter gene expression. © 2014 Société Française des Microscopies and Société de Biologie Cellulaire de France
Functional characterization of a newly identified LMNA mutant in HL-1 cardiomyocytes
No full textA novel mutation in the Lamin A/C gene (LMNA c.418_438dup) was detected in the index patient and in additional family members with diagnosis of arrhythmogenic right ventricular cardiomyopathy (ARVC) and history of sudden cardiac death. The functional characterization of this LMNA mutant was performed in cultured HL-1 cardiomyocytes expressing EGFP-tagged wild-type and mutated LMNA constructs and subjected to confocal microscopy analysis and hypoxic stress conditions in 100% N2 for 8h. Mutated LMNA was clearly expressed in aggregates of different sizes and not uniformly distributed along the nuclear envelope as WT LMNA. Moreover, the mutated LMNA variant causes perturbation in nuclear shape and Nuclear Pore Complexes organization. Of note, we observed that under hypoxic conditions nuclear envelopes expressing mutated LMNA become leaky, leading a nuclear fluorescent marker to escape into the cytoplasm. This indicates that, under cell stressing conditions, the nucleo-cytoplasmic compartmentalization is affected in cardiomyocytes expressing this LMNA mutation, inducing, as final fatal consequence, cell apoptosis. In conclusion, we not only open new avenues to gain more insights in the pathogenesis of ARVC and to conceive novel therapeutic strategies but we also shed lights on the role of nuclear Lamin A in the physio-pathology of cardiomyocytes
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