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After a short account about the state of the research on Pseudo-Hegemonius Adversus Haereses, the author focuses on the present condition of the text and makes his considerations on the genesis of the booklet as the result of a translation, here and there quite literal, from probably one Greek source, perhaps from a heresiological synthesis in Greek that was not preserved. From that point of view, some decisions taken by former editors are perhaps worth to be reconsidered, such as a conjecture that seems to become superfluous.

Summary Background Patients with chronic obstructive pulmonary disease (COPD) have few options for treatment. The efficacy and safety of the phosphodiesterase-4 inhibitor roflumilast have been investigated in studies of patients with moderate-to-severe COPD, but not in those concomitantly treated with longacting inhaled bronchodilators. The effect of roflumilast on lung function in patients with COPD that is moderate to severe who are already being treated with salmeterol or tiotropium was investigated. Methods In two double-blind, multicentre studies done in an outpatient setting, after a 4-week run-in, patients older than 40 years with moderate-to-severe COPD were randomly assigned to oral roflumilast 500 μg or placebo once a day for 24 weeks, in addition to salmeterol (M2-127 study) or tiotropium (M2-128 study). The primary endpoint was change in prebronchodilator forced expiratory volume in 1 s (FEV 1 ). Analysis was by intention to treat. The studies are registered with ClinicalTrials.gov, number NCT00313209 for M2-127, and NCT00424268 for M2-128. Findings In the salmeterol plus roflumilast trial, 466 patients were assigned to and treated with roflumilast and 467 with placebo; in the tiotropium plus roflumilast trial, 371 patients were assigned to and treated with roflumilast and 372 with placebo. Compared with placebo, roflumilast consistently improved mean prebronchodilator FEV 1 by 49 mL (p 1 was noted in both groups. Furthermore, roflumilast had beneficial effects on other lung function measurements and on selected patient-reported outcomes in both groups. Nausea, diarrhoea, weight loss, and, to a lesser extent, headache were more frequent in patients in the roflumilast groups. These adverse events were associated with increased patient withdrawal. Interpretation Roflumilast improves lung function in patients with COPD treated with salmeterol or tiotropium, and could become an important treatment for these patients. Funding Nycomed.

Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality. Theoretically, an appropriate management of the disease should be aimed to prevent and reduce symptoms, to reduce the number and the severity of exacerbations, to improve exercise tolerance and lung function and to decrease the rate of mortality. However, the rapid progress in understanding the pathophysiologic aspects of COPD has been followed by very few advances in its management and currently there is no pharmacological treatment which is able to reduce the decline in lung function that occurs in these patients or to affect mortality. Effective symptomatic relief and improvement in exercise capacity can be obtained with inhaled bronchodilators and a new long-acting (24 h) inhaled anticholinergic, tiotropium bromide, is now available. New pharmacological approaches for COPD include the development of drugs which should be able to control the neutrophilic, steroid-insensitive inflammation, to reassess the protease/antiprotease balance and to reduce oxidative stress in the airways. While most of these drugs are still in preclinical evaluation, some recent phase II-III clinical trials have shown the beneficial effects of a new class of anti-inflammatory compounds, the phosphodiesterase-4 (PDE-4) inhibitors, in patients with COPD. Given the relevance of mucus hypersecretion in the pathophysiology of this disease, efforts have been made also to draw definitive conclusions on the effectiveness of the available mucoactive drugs and in the development of new mucoactive molecules. Further studies are required to understand the impact of each potential therapeutic strategy in the effective control of COPD.

In some asthmatics deep inspiration causes a sustained bronchoconstration, which is dependent on Ca2+ uptake. Inhaled diuretics protect against bronchoconstriction induced by a variety of indirect stimuli, by inhibiting the ionic fluxes involving Ca2+ uptake across the cell membrane of airway epithelium. The aim of this study was therefore to investigate the protective effect of inhaled furosemide on the bronchoconstriction induced by deep inspiration in asthma and to compare it with the effect of acetazolamide, an inhibitor of carbonic anhydrase devoid of effect on ion cotransport but possessing inhibitory effects on chloride ion influx and Na+/K+ exchange. The study was carried out on three different study days according to a randomized, double-blind, placebo-controlled, crossover design. Nine non smoking asthmatic subjects first performed a series of 9 controlled deep inspirations to TLC followed by forced expirations to RV within 20 min, which caused a decrease of FEV120% from baseline. Two hours later, the subjects inhaled either furosemide (40 mg), or acetazolamide (500 mg), or saline (placebo) in random order, and then two more deep-inspiration challenges were performed after 30 and 140 mins. The progressive percent decrement of FEV1 caused by deep-inspiration challenge was taken as an index of bronchoconstriction. Bronchoconstriction was significantly blunted at 30 mins, but not 140 mins, after inhaling furosemide (p0.01) or acetazolamide (p0.05) compared to control. We interpret these results as due to a modulation of ionic fluxes across the smooth muscle cell membrane afforded by inhaled furosemide and acetazolamide.

COPD is a chronic pathological condition of the respiratory system characterized by persistent and partially reversible airflow obstruction, to which variably contribute remodeling of bronchi (chronic bronchitis), bronchioles (small airway disease) and lung parenchyma (pulmonary emphysema). COPD can cause important systemic effects and be associated with complications and comorbidities. The diagnosis of COPD is based on the presence of respiratory symptoms and/or a history of exposure to risk factors, and the demonstration of airflow obstruction by spirometry. GARD of WHO has defined COPD "a preventable and treatable disease". The integration among general practitioner, chest physician as well as other specialists, whenever required, assures the best management of the COPD person, when specific targets to be achieved are well defined in a diagnostic and therapeutic route, previously designed and shared with appropriateness. The first-line pharmacologic treatment of COPD is represented by inhaled long-acting bronchodilators. In symptomatic patients, with pre-bronchodilator FEV160%predicted and ≥ 2 exacerbations/year, ICS may be added to LABA. The use of fixed-dose, single-inhaler combination may improve the adherence to treatment. Long term oxygen therapy (LTOT) is indicated in stable patients, at rest while receiving the best possible treatment, and exhibiting a PaO2 ≤ 55 mmHg (SO288%) or PaO2 values between 56 and 59 mmHg (SO289%) associated with pulmonary arterial hypertension, cor pulmonale, or edema of the lower limbs or hematocrit55%. Respiratory rehabilitation is addressed to patients with chronic respiratory disease in all stages of severity who report symptoms and limitation of their daily activity. It must be integrated in an individual patient tailored treatment as it improves dyspnea, exercise performance, and quality of life. Acute exacerbation of COPD is a sudden worsening of usual symptoms in a person with COPD, over and beyond normal daily variability that requires treatment modification. The pharmacologic therapy can be applied at home and includes the administration of drugs used during the stable phase by increasing the dose or modifying the route, and adding, whenever required, drugs as antibiotics or systemic corticosteroids. In case of patients who because of COPD severity and/or of exacerbations do not respond promptly to treatment at home hospital admission should be considered. Patients with "severe or "very severe COPD who experience exacerbations should be carried out in respiratory unit, based on the severity of acute respiratory failure. An integrated system is required in the community in order to ensure adequate treatments also outside acute care hospital settings and rehabilitation centers. This article is being simultaneusly published in Multidisciplinary Respiratory Medicine 2014; 9:25.

To examine the effect of inhaled platelet-activating factor (PAF) on airway sensitivity and on maximal airway narrowing, we measured airway response to doubling concentrations of methacholine (MCh) 48 h before and 48 h after inhalation of 10, 50 and 100 micrograms of PAF in six nonatopic, nonasthmatic subjects. The forced expiratory volume in one second (FEV1) and airflow at 30 percent of vital capacity (V30) from partial forced expiration were used to assess changes in airway calibre. Inhalation of PAF caused only minor changes in FEV1. In contrast, inhalation of 100 micrograms of PAF caused a significant fall in V30 from 2.64 +/- 0.35 to 1.35 +/- 0.43 l.min-1 (p0.05). Two days after PAF inhalation a leftward shift of the concentration-response curve to MCh was observed. The MCh concentration causing a 20% fall in FEV1 (PC20FEV1) was 11.25 +/- 1.78 and 2.38 +/- 1.29 mg.ml-1 (geometric mean +/- GSEM; p0.05) before and after PAF inhalation, respectively. PAF did not affect the maximal airway response to MCh. The maximum percentage fall in FEV1 was 36.2 +/- 1.9% at baseline and 37.6 +/- 1.8% after PAF inhalation. Likewise, maximum percentage change in V30 was 72.8 +/- 3.7% at baseline and 73.6 +/- 3.4% after PAF inhalation. The results of this study show that PAF inhalation increases airway sensitivity without altering the maximal bronchoconstrictive response to MCh in normal subjects.

Background. Alzheimer’s cognitive-behavioral syndrome is the result of impaired connectivity between nerve cells, due to misfolded proteins, which accumulate and disrupt specific brain networks. Electroencephalography, because of its excellent temporal resolution, is an optimal approach for assessing the communication between functionally related brain regions. O bjective. To detect and compare EEG resting-state networks (RSNs) in patients with amnesic mild cognitive impairment (aMCI), and healthy elderly (HE). Methods. We recruited 125 aMCI patients and 70 healthy elderly subjects. One hundred and twenty seconds of artifact-free EEG data were selected and compared between patients with aMCI and HE. We applied standard low-resolution brain electromagnetic tomography (sLORETA)-independent component analysis (ICA) to assess resting-state networks. Each network consisted of a set of images, one for each frequency (delta, theta, alpha1/2, beta1/2). Results. The functional ICA analysis revealed 17 networks common to groups. The statistical procedure demonstrated that aMCI used some networks differently than HE. The most relevant findings were as follows. Amnesic-MCI had: i) increased delta/beta activity in the superior frontal gyrus and decreased alpha1 activity in the paracentral lobule (ie, default mode network); ii) greater delta/theta/alpha/beta in the superior frontal gyrus (i.e, attention network); iii) lower alpha in the left superior parietal lobe, as well as a lower delta/theta and beta, respectively in post-central, and in superior frontal gyrus(ie, attention network). Conclusions. Our study confirms sLORETA-ICA method is effective in detecting functional resting-state networks, as well as between-groups connectivity differences. The findings provide support to the Alzheimer’s network disconnection hypothesis.

Encouraging active and sustainable transport modes in order to limit the excessive use of cars, as well as reducing pollutant emissions and creating livable urban environments, has become one of the priorities for policymakers in recent years. The introduction of innovative systems increasingly being introduced in modern cities, such as bike sharing, can certainly contribute to the spread of cycling and thus allow a radical change in the mobility habits of their citizens. This can be especially true for high-school students who are often otherwise accompanied by their parents with private cars. This article aims to assess the influence that a bike sharing program for students has on modal share and on city mobility. As a case study, the city of Palermo was chosen, where the use of the car for home-school trips is prevalent. The “Go2School” project, which involves the creation of a bike sharing program for four schools, with the construction of cycle docks and cycle paths in the nearby areas, will soon become a reality. Thanks to appropriate surveys and questionnaires, a multinomial logit model was calibrated to estimate the modal share towards bike sharing for the students and evaluate the demand for this transport mode.

Diacritical marks introduced by Pietro Bembo with the help of his editor, Aldus Manutius, in the first edition of his dialogue De Aetna form a complex and well-structured system. Although devised for practical purposes, so as to ensure a correct reading and phrasing of the Latin text, this system is clearly based on solid theoretical premises. The decisive factor for its introduction was the experience of editing Greek texts, which became the impulse as well as the basis for the system of diacritical signs. The influence of Latin grammarians (in particular, Servius and Priscianus), who had applied Greek accent theory to Latin language, also played an important part. Within a system essentially devoid of ambiguity, the three accents conveyed a variety of indications bearing on the correct pronunciation of the text, from basic principles to expressive nuances. Several editorial decisions involving phrase accents suggest that Bembo considered not only private reading, whether oral or mental (endophasic), but also public declamation.

ABSTRACT Lung metastasectomy is considered a safe and potentially curative procedure despite there is not a strong evidence that metastasectomy prolongs long-term survival in patients with lung metastases. Moreover, the debate is open regarding the best approach for lung metastasectomy, video-assisted thoracic surgery versus open approach. A systematic review of literature to clarify what is the best approach to prolong survival in patients with lung metastases was performed. Our study confirms that overall survival is equivalent for video-assisted thoracic surgery and thoracotomy, therefore the ‘gold standard’ surgical treatment for lung metastases remains a point of debate. The choice of the surgical approach still depends more on the single center or surgeon practice than on strong scientific evidence. A prospective randomized trial could clarify the question.

Background: The role of disability and its association with patient-reported outcomes in the nonsevere forms of chronic obstructive pulmonary disease (COPD) has never been explored. Objectives: The aim of this study was to assess, in a cross-sectional real-life study, the prevalence and degree of disability in moderate COPD patients and to assess its association with health status, illness perception, risk of death and well-being. Methods: Moderate COPD outpatients attending scheduled visits were involved in a quantitative research program using a questionnaire-based data collection method. Results: Out of 694 patients, 17.4% were classified as disabled and 47.6% reported the loss of at least one relevant function of daily living. Disabled patients did not differ from nondisabled patients in terms of working status (p = 0.06), smoking habits (p = 0.134) and ongoing treatment (p = 0.823); however, the former showed a significantly higher disease burden as measured by illness perception, health status and well-being. The stepwise regression analysis showed that the modified Medical Research Council (mMRC) score was the most relevant factor related to COPD disability (F = 38.248; p = 0.001). Patient stratification was possible according to the forced expiratory volume in 1 s (FEV1) value and an mMRC score ≥2, which identified disabled patients, whereas the mMRC values were differently associated with the risk of disability. Conclusion: A significant proportion of individuals with moderate COPD reported a limitation of daily life functions, with dyspnea being the most relevant factor inducing disability. Adding the evaluation of patient-reported outcomes to lung function assessment could facilitate the identification of disabled patients.

In riguardo alla genesi delle costituzioni Tanta e dedoken di Giustiniano (a. 533), prefatorie ai Digesta, l’autore si sofferma sulla retorica della traduzione indagandone le modalità e gli intendimenti, basandosi soprattutto sul 21 prescelto come campione significativo. Oltre alla conferma che dedoken costituisca il testo-fonte e Tanta il testo-versione, si avvalora il convincimento che Triboniano sia l’autore della versione/revisione, mentre dedoken dovrebbe rappresentare soprattutto un prodotto degli adiutores che stavano a disposizione del magister sacri palatii.

Si ripropone al lettore del secolo XXI in traduzione italiana, corredandolo di ampie note di aggiornamento e di discussione, il volumetto miscellaneo (1877) con cui il Moesinger rendeva accessibile agli uomini di cultura la narrazione della predicazione e del martirio di San Bartolomeo apostolo contenuta nel Martirologio armeno. Si trattò di una lettura innovativa condotta con il rigore del filologo, che diede impulso agli studi di agiografia comparativa che si conducevano soprattutto sugli apocrifi Atti degli Apostoli. La collazione dei testi qui rappresentati, provenienti da ambiti storiografici diversi, ci fornisce un’informazione attendibile sui primi tentativi di evangelizzazione di quei territori del Medio oriente, quando l’Armenia Maggiore, oggetto di mire espansionistiche dei regni vicini, costituiva un privilegiato terreno di confronto fra culture e sistemi politici diversi. Inoltre il testo latino dello stesso Moesinger qui è riveduto con la discussione di alterazioni, sviste ed errori della stampa primigenia, e si aggiunge altresì una nota critica sul testo dello pseudo-Abdia da lui costituito.

Si ripubblica con aggiornamenti, revisione ed ampliamento degli indici e con qualche correzione l'edizione critica edita presso l'Università di Palermo nel 1996 (Annali della Facoltà di Lettere e Filosofia dell'Università di Palermo. Studi e ricerche; 27). La presente edizione documenta come il trattato (mutilo) De universo e gli opuscoli De Arati vita, De phaenomenorum interpretatione, tramandati sotto il nome di Achille, siano opera di un unico studioso, un grammatico appassionato di astronomia e di filosofia. Vengono inoltre studiati per la prima volta estesamente i rapporti genealogici fra tutti i manoscritti acquisibili (risultano dispersi alcuni manoscritti posteriori all'invenzione della stampa) e si mostra come ricadano tutti all'interno di due famiglie, con tre codici indipendenti (i Vaticani Graeci 191, 381 e il Mediceus plut. XXVIII 44) e gli altri descripti. La rivendicazione del ruolo autonomo del Vaticanus Graecus 381, valida per un piccolo corpus di testi che si estende oltre Achille, costituisce un'acquisizione innovativa che il Di Maria mette a frutto in due articoli scientifici collegati. Seguono il testo critico propriamente detto, aggiornato allo stato dell'arte anche per i testi di tradizione indiretta, e gli indici (Index verborum notabilium, index nominum, index astrorum, index locorum laudatorum).

L'articolo fa il punto su risultati innovativi della ricerca archeologica relativamente alle isole Lipari inserendoli nel contesto filologico-letterario.

Codicem Vaticanum Graecum 381, qui minime neglegendus est, cum ex eodem fonte manaverit atque 191, non solum in opere astronomico Achillis, verum etiam in opusculis aliorum auctorum quae eadem Achillea in Vaticanis sequuntur, ad alterius codicis menda corrigenda adhibere oportet.