1,832 research outputs found
The Acute Porphyric Attack: A Difficult Diagnosis for a Potential Lethal Event in Emergency Medicine
No full textThe porphyrias are a heterogeneous group of metabolic
disorders due to an inherited (but in some forms the disturbance may
also be acquired) enzymatic deficiency in the metabolic pathway
of heme biosynthesis. The variable degree of block in the heme
biosynthetic pathway due to the enzyme deficiency results in
accumulation of different metabolic intermediates, whose toxicity is
responsible for the peculiar (cutaneous and/or neurovisceral) clinical
pictures observed in each of these diseases. According to the clinical
features, the porphyrias are classified as “acute” (or neuropsychic)
[characterized by acute neurovisceral crises (the acute porphyric
attack) involving the autonomic and/or central nervous system, but
also the liver and the kidney] and “on acute” (or dermatological)
(mostly presenting with cutaneous lesions, due to photosensitivity).
The acute porphyrias are often misdiagnosed diseases: the acute
porphyric attack may in fact mimic many other more common medical
and neuropsychiatric conditions; its delayed diagnosis and treatment
(or its inappropriate treatment) may result in a fatal outcome. For
these reasons, many different specialists, such as surgeons,
psychiatrists, gastroenterologists, neurologists, emergency
physicians and dermatologists may be variably involved in the
diagnostic process, especially in those cases presenting with
acute and life-threatening clinical features. An early and definitive
diagnosis is mandatory to improve outcomes and to assure that
potentially harmful drugs are avoided. To date, the availability of an
adequate treatment has significantly improved the outcome of the
acute porphyric attacks, so the knowledge about the management of
these events may be relevant for the physicians working in internal
and emergency medicine units
Art in Science: The Artist and The Disease: The Exemplary Cases of Renoir and Toulouse-Lautrec
No full textFrom the Column Editors,
Our colleagues in Bologna and Milan, Italy have skillfully illustrated how physical illness shaped the artistry of two French 19thcentury icons, Pierre-Auguste Renoir and Henri de Toulouse-Lautrec. In the case of Renoir, he accommodated for his debilitating deformity and pain from arthritis through the use of technical contrivances that allowed him to manage canvases, access palettes, and grip brushes. These contraptions helped Renoir continue his prolific and creative career well beyond usual endurance. Renoir persisted in defining through color and brush stroke the inner light of Impressionism. For Toulose-Lautrec, his physical deformities drove him to seek asylum and anonymity at the margins of a Bohemian lifestyle found in Parisian night clubs. There, he found and painted the vulnerable characters this environment attracted and the theater they represented. For these insights, and for two of many examples of illness influencing art, we are indebted to Dr. Di Matteo and his colleagues
TUTELA DEL LAVORO E LIBERTA' D'IMPRESA NEI PROCESSI DI ESTERNALIZZAZIONE
No full textL’elaborato analizza le conseguenze lavoristiche della successione fra imprenditori, muovendo da una ricognizione delle varie tipologie di esternalizzazione con le relative esigenze e principali criticità.
L’indagine si concentra in primo luogo sul trasferimento d’azienda, esaminando la normativa e la giurisprudenza europee per passare poi alla disciplina di diritto interno, alle procedure sindacali e a uno specifico focus sul trasferimento delle aziende in crisi.
Successivamente l’autore si sofferma sull’appalto, prendendone in particolare considerazione gli indici di genuinità, i criteri di distinzione dalla somministrazione illecita di manodopera e la tutela delle maestranze in caso di avvicendamento fra imprese.
Da ultimo, la ricerca approfondisce le c.d. “clausole sociali”, sia di prima che di seconda generazione, valutandone la compatibilità con il diritto eurounitario e con la costituzione nonché riflettendo sui possibili rimedi in caso di loro violazione.The author analyzes the labour consequences of the succession between entrepreneurs, starting from a recognition of the various types of outsourcing with the related needs and main critical issues.
The survey focuses primarily on the transfer of businesses, examining European legislation and case-law and then moving on to internal legislation, trade union procedures and a specific focus on the transfer of companies in crisis.
The author then dwells on the contract, taking into account in particular the indications of authenticity, the criteria of distinction from the illicit administration of labour and the protection of workers in the event of turnover between companies.
Finally, the research deepens the "social clauses", both first and second generation, assessing their compatibility with European law and with the constitution and reflecting on possible remedies in case of their violation
Platelet-rich plasma: evidence for the treatment of patellar and Achilles tendinopathy-a systematic review
No full textPlatelet-rich plasma (PRP) has been introduced in the clinical practice to treat a growing number of different musculoskeletal pathologies. It is currently applied in the treatment of Achilles and patellar tendinopathies, which are common sport-related injuries very challenging to manage. Aim of the present paper was to review systematically the available clinical evidence concerning the application of PRP in the treatment of patellar and Achilles tendinopathy. A systematic review of the literature was performed according to the following inclusion criteria for relevant articles: (1) clinical reports of any level of evidence, (2) written in the English language, (3) with no time limitation and (4) on the use of PRP to treat conservatively Achilles and patellar tendinopathy. Twenty-two studies were included and analyzed. Two studies on patellar tendinopathy were randomized controlled trials (RCTs), whereas just one RCT was published on Achilles tendon. All the papers concerning patellar tendon reported positive outcome for PRP, which proved to be superior to other traditional approaches such as shock-wave therapy and dry needling. In the case of Achilles tendon, despite the encouraging findings reported by case series, the only RCT available showed no significant clinical difference between PRP and saline solution. The main finding of this study was the paucity of high-level literature regarding the application of PRP in the management of patellar and Achilles tendinopathy. However, the clinical data currently available, although not univocal, suggest considering PRP as a therapeutic option for recalcitrant patellar and Achilles tendinopathies
Mechanisms of Neuronal Damage in Acute Hepatic Porphyrias
No full textPorphyrias are a group of congenital and acquired diseases caused by an enzymatic
impairment in the biosynthesis of heme. Depending on the specific enzyme involved, different types
of porphyrias (i.e., chronic vs. acute, cutaneous vs. neurovisceral, hepatic vs. erythropoietic) are
described, with different clinical presentations. Acute hepatic porphyrias (AHPs) are characterized
by life-threatening acute neuro-visceral crises (acute porphyric attacks, APAs), featuring a wide
range of neuropathic (central, peripheral, autonomic) manifestations. APAs are usually unleashed by
external “porphyrinogenic” triggers, which are thought to cause an increased metabolic demand for
heme. During APAs, the heme precursors -aminolevulinic acid (ALA) and porphobilinogen (PBG)
accumulate in the bloodstream and urine. Even though several hypotheses have been developed to
explain the protean clinical picture of APAs, the exact mechanism of neuronal damage in AHPs is
still a matter of debate. In recent decades, a role has been proposed for oxidative damage caused by
ALA, mitochondrial and synaptic ALA toxicity, dysfunction induced by relative heme deficiency on
cytochromes and other hemeproteins (i.e., nitric oxide synthases), pyridoxal phosphate functional
deficiency, derangements in the metabolic pathways of tryptophan, and other factors. Since the
pathway leading to the biosynthesis of heme is inscribed into a complex network of interactions,
which also includes some fundamental processes of basal metabolism, a disruption in any of the steps
of this pathway is likely to have multiple pathogenic effects. Here, we aim to provide a comprehensive
review of the current evidence regarding the mechanisms of neuronal damage in AHPs
PRP for the treatment of cartilage pathology.
No full textIn recent years biological strategies are being more widely used to treat cartilage lesions. One of the most exploited novel treatments is Platelet-rich Plasma (PRP), whose high content of growth factors is supposed to determine a regenerative stimulus to cartilaginous tissue. Despite many promising in vitro and in vivo studies, when discussing clinical application a clear indication for the use of PRP cannot be assessed. There are initial encouraging clinical data, but only a few randomized controlled trials have been published, so it is not possible to fully endorse this kind of approach for the treatment of cartilage pathology. Furthermore, study comparison is very difficult due to the great variability in PRP preparation methods, cell content and concentration, storage modalities, activation methods and even application protocols. These factors partially explain the lack of high quality controlled trials up to now. This paper discusses the main aspects concerning the basic biology of PRP, the principal sources of variability, and summarizes the available literature on PRP use, both in surgical and conservative treatments. Based on current evidence, PRP treatment should only be indicated for low-grade cartilage degeneration and in case of failure of more traditional conservative approaches
Rediscovering the history of orthopedics.
No full textHistory is difficult to digest, particularly for physicians like
us who are constantly pressed to deliver results, always
committed to the everyday medical practice, and required
to keep up to date with the most recent research. It is not
surprising, then, that in recent years there has been a
shortage of historical insight into indexed journals: where
can we find the time to read papers not dealing with the
progress of research or the latest updates in surgical procedures?
Therefore, why care about finding space to publish
manuscripts with different prerogatives
Ultra Low Carbon Vehicles: New Parameters for Automotive Design
No full textAs the influence of vehicle emissions on our environment has become better understood, the UK government has recently placed urgent emphasis on the implementation of low carbon
technologies in the automotive industry through: the UK Low Carbon Industrial Strategy. The overall objective is to offer big incentives to consumers and support for the development of infrastructure and engineering solutions. This scheme however does not consider how the development of functional and experiential user value might drive consumer demand, contributing to the adoption of low carbon vehicles (LCVs) in the mass market.
With the emergence of the North East of England as the UK’s first specialised region for the development of ultra-low carbon vehicles (ULCVs), ONE North East, as a development agency for the region's economic and business development, and Northumbria University Ideas-lab have supported a project to facilitate innovation through the collaboration of technology, research and development (R&D) and business. The High Value Low Carbon (HVLC) project aims to envisage
new user value made possible by the integration of low carbon vehicle platforms with new process and network technologies. The HVLC consortium represents vehicle manufacturers and their suppliers as well as technology based companies and through an ongoing process of design concept generation the project offers a hub for innovation led enterprise.
Whilst new technological developments in areas such as power generation, nano materials, hydrogen fuel cells, printed electronics and networked communications will all impact on future automotive design, the mass adoption of low carbon technologies represents a paradigm shift for the motorist. This paper aims to describe how the mapping of new parameters will lead to new transport scenarios that will create the space for new collaborative research on user experiences supported by innovative technologies and related services
PRP injections versus viscosupplementation for early knee osteoarthritis: a randomized double-blind study
No full textObjectives: The influence of growth factors (GFs) on cartilage repair is not yet widely studied and its application in clinics is still experimental.
Platelet Rich Plasma (PRP), a blood product rich in GF, is a promising support for treating cartilage defects. Aim of this study is to evaluate and compare the efficacy of PRP and Viscosupplementation (Hyaluronic Acid—HA) injections for the treatment of chondropathy or early osteoarthritis (OA) of the knee.
Methods: 150 patients were enrolled: 72 were evaluated at 6 months follow-up. The study involved patients affected by chondropathy or early OA. All patients underwent an autologous blood harvesting, then 36 patients were randomized in the PRP group and 36 in the HA group. A cycle of 3 weekly injections was administered blindly. All patients were clinically evaluated at the enrolment, 2 months after the treatment and at 6 months follow up. IKDC, EQVAS, TEGNER and KOOS scores were used to clinically evaluate the patients. Adverse events and patient satisfaction were also recorded.
Results: No complications like infection, marked muscle atrophy, deep vein thrombosis, fever, haematoma, tissue hypertrophy, adhesion formation or other major adverse events occurred among study subjects. Only minor adverse events were detected in some patients, as mild pain reaction and effusion after the injections, in particular in the PRP group, but they lasted for no more than a few days. At the follow-up evaluations, both groups showed a significant improvement in terms of function and quality of life. The preliminary comparison between the outcomes of the two groups showed a not statistically significant difference, but with a trend slightly favourable for the PRP group at 6 months.
Conclusions: PRP is a simple, low cost and minimally invasive approach to treat chondropathy and early OA. The clinical results of our study are encouraging and suggest this method may be used to treat the degenerative articular pathology of the knee, leading to results at least comparable with those of HA. Long-term results will confirm the reliability and evaluate the durability of this promising procedure
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Matteo Maria Boiardo (1441-1494)
No full textMatteo Maria Boiardo – contemporary of Sir Thomas Malory and forerunner of Shakespeare, Spenser, Milton, Cervantes, Tolkien, and C.S. Lewis – is best known as the author of the Orlando Innamorato [Orlando in Love], a poem in ottava rima organically merging Carolingian epic and Arthurian romance. He was also a lyric and pastoral poet, playwright, and translator of classical texts into the Italian vernacular. Matteo was active in Italy during the years of 1463 throughout 1494, the year of his death
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