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Background: Amyotrophic lateral sclerosis (ALS) is a devastating and untreatable motor neuron disease, with a 3–5-year survival from diagnosis. Possible prognostic serum biomarkers include albumin, C-reactive protein, ferritin, creatinine, uric acid, hemoglobin, potassium, sodium, calcium, glucose, and the neutrophil-to-lymphocyte ratio (NLR), a marker of subclinical inflammation. Objective: To ascertain the influence of NLR on ALS progression rate and survival. Methods: Cross-sectional multicenter study including 146 consecutive incident and prevalent patients (88 males), aged >18 years, diagnosed according to the El Escorial criteria. The exclusion criteria were: (1) patients with tracheostomy or receiving mechanical ventilation; (2) patients with percutaneous endoscopic gastrostomy; and (3) patients who did not sign the informed consent. The rate of disease progression (ΔFS score) represents the monthly decline of the ALSFRS-R score, and was computed as (48 − total ALSFRS-R at recruitment)/symptom duration in months. Patients were followed up to tracheotomy, death, or the end of the follow-up, whichever occurred first. To validate our findings, we used data retrieved from the Pooled Resource Open-Access ALS Clinical Trials (PRO-ACT) Database. Results: The median disease duration was 15 (range = 2–30) months. The mean ALSFRS-R score at recruitment was 35.8 ± 8.0 (range: 10–48), and the median ΔFS was 0.66 (range: 0–5.33). Age at onset, at diagnosis, and at recruitment were significantly lower in the lowest NLR tertile. NLR values positively correlated with ΔFS values (r = 0.28): the regression slope of NLR (log-values) was 0.60 (p < 0.001) before and 0.49 (p = 0.006) after adjustment for age at recruitment. The ΔFS score progressively increased from the lowest to the highest NLR tertile: 0.35 (IQR: 0.18–0.93), 0.62 (IQR: 0.25–1.09), and 0.86 (IQR: 0.53–1.92). Patients were followed for a median of 2 years. The mortality rate passed from 15.9 events per 100 person-years in patients belonging to the lowest NLR tertile to 52.8 in those in the highest tertile. The optimal cut-off value which best classified patients with the lowest and the highest mortality rate was set at the NLR value of 2.315. Indeed, the mortality rate of patients with an NLR value above such cut-off was twice the mortality rate of patients with a value below the cut-off (age adjusted hazard ratio (HR): 2.16, 95% confidence interval (CI): 1.32–3.53). In the PRO-ACT validation sample, patients with an NLR value above the cut-off consistently had a higher mortality rate than those with a value below the cut-off (age adjusted HR: 1.17, 95%CI: 1.01–1.35). Conclusions: NLR could be a candidate easy, fast, and low-cost marker of disease progression and survival in ALS. It may be associated with low-grade inflammation either as a direct mirror of the pathological process of disease progression, or as a consequence of neuronal death (reverse causation). However, prospective studies are needed to understand whether NLR changes during the course of the disease, before using it to monitor disease progression in ALS.

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Girnavaz Höyük is a key site for better understanding the cultural and economic relationship between northern Mesopotamia and the Upper Tigris region between the third and the first millennia BC. The site is located in the liminal zone of the northern Jazirah at the start of the Tur ‘Abdin mountains, in a spot that most likely allowed it to play an important role in financial, cultural, and social exchange during the end of the third and the beginning of the second millennium BC when Assyrian merchants began engaging in long-distance trade with Anatolian settlements. During this period, the Khabur Ware (within the Upper Khabur river valley) and other types of Band Painted Wares (from other neighbouring regions) became clear archaeological correlates of this temporal phase. In this paper, I will focus on a preliminary analysis of the Khabur Ware from Girnavaz Höyük in order to define the similarities and differences between contemporary pottery assemblages discovered in the region as well as in other neighbouring areas. The aim will be to provide an initial definition of a relative inner chronology for this specific ceramic assemblage at the site that has never been previously published.Girnavaz Höyük is a key site for better understanding the cultural and economic relationship between northern Mesopotamia and the Upper Tigris region between the third and the first millennia BC. The site is located in the liminal zone of the northern Jazirah at the start of the Tur ‘Abdin mountains, in a spot that most likely allowed it to play an important role in financial, cultural, and social exchange during the end of the third and the beginning of the second millennium BC when Assyrian merchants began engaging in long-distance trade with Anatolian settlements. During this period, the Khabur Ware (within the Upper Khabur river valley) and other types of Band Painted Wares (from other neighbouring regions) became clear archaeological correlates of this temporal phase. In this paper, I will focus on a preliminary analysis of the Khabur Ware from Girnavaz Höyük in order to define the similarities and differences between contemporary pottery assemblages discovered in the region as well as in other neighbouring areas. The aim will be to provide an initial definition of a relative inner chronology for this specific ceramic assemblage at the site that has never been previously published.

The notion of the presence of stem and progenitor cells in the adult human heart imposes that all currently used treatments, as well as those in the experimental phase of the study, should be revisited with regards to effects on these cardiac cell population. In fact, novel therapies offer the possibility of inhibition or even reversal of heart failure progression by the mobilization and activation of cardiac stem and progenitor cells, as can be the case with extracorporeal cardiac shock wave (SW) therapy, suggested for patients with myocardial ischemia. The scope of the present study was to evaluate the effects of low and high energy SW treatment on cardiac primitive cells in vitro. CD117(+) cells have been isolated from age-matched adult human normal (n=4, males, mean age 51±5.6 years) and pathological hearts with end-stage ischemic cardiomyopathy (n=4, males, mean age 55±3.2 years). Cells have been treated with 800 shots of SW at the energy flux density of 0.05mJ/mm2 and 0.1mJ/mm2. After one week of culture, cardiac cell lineages were characterized by immunofluorescence and immunoblotting, and their total mRNA was examined by stem cell-specific PCRbased microarray. Above all, the effects of high energy treatment differed profoundly from those observed at low energy, with none the same gene up- or downregulated in any of the groups studied. Moreover, cells isolated from pathological hearts were positively influenced in the more evident manner. In fact, low energy treatment of pathological cells induced the activation of a pool of transient amplifying progenitors of cardiomyocytes (expressing α-sarcomeric actin), endothelial (von Willebrand factor) and smooth muscle cells (smooth muscle actin). In these cell population, we observed the upregulation of mRNA of 14 genes involved in the cytoskeleton biogenesis/organization, mitotic spindle formation and cell motility. In contrast, high energy SW application resulted in upregulation of 5 genes, mostly involved in the extracellular matrix- and cell-cell adhesion, and downregulation of 15 genes regulating protein kinase activity, signal transduction and cell-cell signalling. As regards cells from normal heart, remarkably only high energy treatment induced activation of endothelial cell precursors. On the basis of the above data it is possible to predict that timing (between onset and end-stage of disease) and energy of the SW treatment can have profound influence on the therapy outcome in ischemic heart disease. Further pre-clinical studies of these variables are warranted before broad introduction of the method into clinical practice.

Resilience has recently become an insightful conceptual framework that helps scholars explore how communities respond to external shocks, such as environmental changes. In prehistoric archaeology, this notion has primarily been investigated using the Resilience Theory (RT) and the Adaptive Cycle model (AC), developed by Gunderson and Holling, which are applied to adaptive systems in order to understand the source and role of change. However, such systems-theoretical approaches, which derive from ecology and psychology, bear the danger of leading to a top-down application of deductive models when appropriated to the fragmented archaeological sources. In other words, the risk is to assume the RT and AC model first and then to fit archaeological data within those assumptions. In this paper, we propose an alternative, inductive bottom-up approach in which we define resilience as a set of adaptive capacities grounded in social practices that enabled communities to cope with and respond to challenges. We use the Neolithic wetland sites from the Three-Lakes Region in the northern Alpine foreland of western Switzerland as a case study. These sites provide an abundance of archaeological and palaeoecological information, which can be used to examine the resilience of settlement communities to climate fluctuations. We will evaluate whether a causal relationship might have existed between climate changes in the period between 3600 and 3200 BCE and an observable decline of settlement activities on the shores of the large lakes. In addition to year-accurate reconstructions of settlement histories, we will apply statistical significance tests on archaeological and palaeoclimatic time series to question the correlation and causality between settlement activities and climate fluctuations. Besides the settlement frequency curve, we will use the radioactive beryllium-10 isotope (Be10) content in the GISP2 ice core from the Greenland Ice Sheet and the δ18O values of well-dated speleothems as proxies for temperature and precipitation, respectively. The inferred hypothesis, i.e. that periodically rising lake levels led to the flooding of former inhabitable spaces on the lakes’ shore zones and forced communities to relocate their settlements to the hinterland, will further be tested. Therefore, we apply multivariate statistics to pollen data to evaluate human influence on vegetation (land clearing) taken as settlement activity beyond the shores of large lakes. In addition, we examine the relevance of transformations in pottery styles as further indicators for spatial mobility.

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Greater trochanteric pain syndrome (GTPS) is a condition of lateral hip pain. Its physiopathology remains unknown, and there is no consensus on optimal management. The aim of this study was to assess the effectiveness of electromagnetic-focused extracorporeal shockwave treatment (F-ESWT) in patients with GTPS.This multicenter clinical trial included 103 patients with chronic GTPS randomly assigned to the treatment group, consisting of electromagnetic F-ESWT and a specific exercise protocol, or the control group, receiving sham F-ESWT and the same exercise protocol. Both groups were treated with 3 weekly sessions; the F-ESWT group received an energy flux density of 0.20 mJ/mm, whereas the control group received 0.01 mJ/mm. Patients were assessed at baseline and 1, 2, 3, and 6 months after treatment. A visual analogue scale (VAS) score for pain at 2 months was the primary outcome. The Harris hip score (HHS), Lower Extremity Functional Scale (LEFS), EuroQoL-5 Dimensions Questionnaire (EQ-5D), and Roles and Maudsley score were used as secondary outcomes. Complications were recorded.The mean VAS score decreased from 6.3 at baseline in both groups to 2.0 in the F-ESWT group versus 4.7 in the control group at 2 months; the 2-month score differed significantly between groups (p0.001). All secondary outcomes at all follow-up intervals were significantly better in the F-ESWT group, except for the LEFS score at 1 month after treatment (p = 0.25). No complications were observed.F-ESWT in association with a specific exercise program is safe and effective for GTPS, with a success rate of 86.8% at 2 months after treatment, which was maintained until the end of follow-up.Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

Introduction Osteonecrosis of femoral head (ONFH) leads to hip osteoarthritis (HOA); among joint preserving treatments (JPT), the role of core decompression (CD) is still debated. We assessed the efficacy of CD compared with all other JPT in delaying the natural osteonecrosis evolution to HOA. Sources of data Following the PRISMA checklist, the Medline and Scopus databases were searched. Fifteen- to 70-year-old subjects with ONFH with a minimum follow-up of 24 months were considered. The outcomes evaluated were patient clinical status, radiographic progression and total hip arthroplasty (THA) or further surgery (FS) need. Risk ratio (RR) was calculated for every outcome reported. RCT, CCT and prospective studies were included. Areas of agreement A total of 12 studies (776 patients) met the inclusion criteria. Clinical outcome (RR = 1.14; 95% CI 0.58-2.32; P = 0.05), radiographic progression (RR = 1.64; 95% CI 1.14-2.35; P = 0.05) and the need for THA/FS (RR = 1.52; 95% CI 0.95-2.45; P = 0.05) suggested a slight superiority of other JPT compared with CD. Areas of controversy High heterogeneity of the primary investigations was the main limitation of our study. Growing points The efficacy and effectiveness of core decompression for ONFH are, at best, no better than other joint preserving strategies. The more recent scientific evidence seems to suggest that such procedure is less successful than other joint preserving strategies. Areas timely for developing research Further studies are needed to identify the best therapeutic approach to the ONFH.

Trapeziometacarpal (TM) osteoarthritis is the most common type of arthritis of the hand. To date, among surgical alternatives proposed, no one type has been proven superior to others. In this prospective study we evaluated the efficacy of treating arthroplasty with a latest-generation pyrocarbon implant (Pyrocardan).Thirty-six patients with TM arthritis were treated using Pyrocardan implant arthroplasty. Results were evaluated through thumb radial and palmar abduction assessment, key pinch strength evaluation, thumb opposition assessment according to Kapandji classification, the visual analogue scale, the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire and the Patient's Satisfaction Index.There was substantial pain reduction and a satisfying increase in range of motion and strength (p 0.01) and improvement in DASH score (p 0.01). Average Patient's Satisfaction Index was 8 out of 10.TM arthroplasty with Pyrocardan implantation is a suitable option in treating Eaton-Littler grade II or III TM osteoarthritis.

Osteoporosis is a metabolic skeletal disease characterized by an imbalance between osteoclast-mediated bone resorption and osteoblast-mediated bone formation. We examined the beneficial effect of shock waves (SW) alone or in combination with raloxifene (RAL) on bone loss in ovariectomized rats (OVX). Sixteen weeks after surgery, OVX were treated for five weeks with SW at the antero-lateral side of the right hind leg, one session weekly, at 3 Hz (EFD of 0.33 mJ/mm2), or with RAL (5 mg/kg/die, per os) or with SW+RAL. Sera, femurs, tibiae and vertebrae were sampled for following biochemical and histological analysis. SW, alone or combined with RAL, prevented femur weight reduction and the deterioration of trabecular microarchitecture both in femur and vertebrae. All treatments increased Speed of Sound (SoS) values, improving bone mineral density, altered by OVX. Serum parameters involved in bone remodeling (alkaline phosphatase, receptor activator of nuclear factor kappa-B ligand, osteoprotegerin) and osteoblast proliferation (PTH), altered by ovariectomy, were restored by SW and RAL alone or in combination. In tibiae, SW+RAL significantly reduced cathepsin k and TNF-α levels, indicating the inhibition of osteoclast activity, while all treatments significantly increased runt-related transcription factor 2 and bone morphogenetic-2 expression, suggesting an increase in osteoblastogenic activity. Finally, in bone marrow from tibiae, SW or RAL reduced PPARγ and adiponectin transcription, indicating a shift of mesenchymal cells toward osteoblastogenesis, without showing a synergistic effect. Our data indicate SW therapy, alone and in combination with raloxifene, as an innovative strategy to limit the hypoestrogenic bone loss, restoring the balance between bone formation and resorption.

Postischemic cardiomyopathy remains one of the disorders in urgent need of effective noninvasive therapy. It is currently accepted that the isolation, expansion and application of resident cardiac stem cells may hold therapeutic promise for the future. Recently, it has been demonstrated that shock waves (SW) could enhance the expression of vascular endothelial growth factor (VEGF) and its receptor, Flt-1. As the development of angiogenic noninvasive therapy is very important for future therapeutic strategies in cardiovascular diseases, we examined in vitro, the effects of SW treatment on adult resident cardiac primitive cells isolated from bioptic fragments of normal human hearts and from explanted pathologic hearts with postischemic cardiomyopathy. This study demonstrates that SW have positive influence on both the proliferation and the differentiation of cardiomyocytes, smooth muscle and endothelial cells precursors, with a more obvious effect being evident in the cells from normal heart than in those taken from pathologic hearts. Our results suggest that SW treatment could inhibit or retard the pathologic remodeling and functional degradation of the heart if applied during the early stages of heart failure.

Currently, in the international architectural context, complex shapes represent a support capable to allow interesting experiments aimed at the realization of sustainable shells. The purpose of this contribution is to identify a useful method to control the design of parametric surfaces through computation of technological solutions that improve the feasibility, maintainability and durability of results. Currently, this process is strongly favored by the development of computational tools based on user friendly visual scripting approach. These instruments facilitate the self-construction of the building product and allow to control the process from conception and design to manufacturing and assembly. Therefore, we think that the use of computational tools allows to enlarge the participatory dimension for the project of complex shapes. However, this approach requires a cultural refinement, generating organizational and technological knowledge. From research to practice, this approach is possible through the conscious collaboration of all the various figures involved within an integrated process for generating efficient and optimized systems from the constructive, economic and aesthetic point of view. The control of the shape and development of technologies are important to enable searching of integrated and innovative solutions, technologically sustainable and optimized. The contribution aims to highlight how the feasibility of complex shapes is related to the combination of strategies for the discretization of continuous with control of the entire system to encourage the creation of sustainable solutions. In particular, some representative cases allow to highlight the advancements developed in the current research area of the Architectural Geometry, and more precisely about paneling architectural free from surfaces topic. The research examines the issue of single curvature surfaces (developable surfaces), and shows how these surfaces are extremely convenient for the manufacture of complex surface. Hence, the purpose of this research is to obtain complex surfaces with zero or negative Gaussian curvature to break them down into elements developable: Digital Form Finding approach is useful to obtain interesting results. These surfaces allow to reduce production costs and facilitate the control of the manufacture and assembly phases. The collaboration between architects, engineers, mathematicians, computer scientists, educators and users can radically redefine the relationship between design and production: therefore, through a pedagogical activity, the aim is to generate a possible hierarchical system aimed to self-construction of the building product. Therefore, the purpose is to demonstrate how the geometry can be used as an analytical and planning tool, useful to integrate new forms and new materials in search of sustainable solutions and integrated approaches.

The territory of contemporary Intercultural city finds its consistency in the rising role of the plural and multi-ethnic parameters of urban, social and economic change (Bianchini, Bloomfield 2004). At the very beginning of civilization, ritual events contained the meaning of life of first communities; now they are considered as important factors of mediation in order to promote social cohesion and inclusion, in the attempt to overcome exclusive models and sectorial territory managements, centered on the enhancement of divisions (Schuster 2001). The emphasis on the culture of the city, as a parameter of the distinctive quality of the environment, does not relate only to scientific or artistic products or activities of communities, but more generally to their way of living together as a set of actions, practices, uses, etc.

The city is in constant evolution, catalyst of creativity and innovation, but it is also the place of social identity and historical memory. Our cities are soaked in culturally significant realities, which continually need of restoration and maintenance. Therefore, the city is cyclically affected by the presence of construction sites that hinder the usual physical and perceptive fruition. If it is true that the Code of Cultural Heritage and Landscape clarifies that the concept of cultural heritage development mainly concerns the promotion of public knowledge and fruition, "the existent historicity preservation must not deny the continuity of the transformation process" (Torsello, 2005). Then, using the places of transformation such as places of experimentation and spread of knowledge, we produce a new contemporary image of the city, territory and monument, in order to allow transmission in the future of the meaning and value of the existing physical space. The research work focuses on these issues and here we present some critical insights. Traditionally conceived as transitory and temporary element and as an evident perceptive degradation, the construction site can be interpreted as an opportunity to test useful intervention strategies in the management of public space. Above all, consideration has been given to the meaning of public space in terms of "occasion-sharing" to be used with the aim of a joint growth in the sense of citizenship, through which virtuous creative pushes can be trigged. To achieve these objectives, it is necessary to operate at different levels and for different types of users (workers, tourists, occasional users), ensuring the continuity of the works and the direct or indirect fruition of the heritage. The construction site out of necessity prevents the monument fruition, but the fence, protective element that usually "hides", can become "a knowledge instrument". Assuming that the limitations of the construction site, are the translation in terms of physical constraints of the direct fruition of the heritage, the question that is the backdrop to research is “in which way is it possible to make these devices elements of the urban landscape and elements capable of giving an additional value to the hidden good”. The answers are translated as part of valorization plans, in feasibility solutions and design guidelines, which aim to promote a transformation process, which can really be defined "sustainable" by exploiting communication strategies, contributing to transform a traditional construction site in a "construction site of knowledge".

“The word "inhabiting" means something more than having a roof overhead and a number of square meters available. First of all, it means meeting other human beings to exchange goods, ideas and feelings, that is to experience life as a multitude of possibilities. Second, it means to agree with some of them, that is to accept a number of common values. And finally, it means being yourself, that is to choose a small personal world.”(Norberg-Schulz 1984) The project of architecture for the city finds itself at a crossroad: being the sensible demonstration of a personal attitude towards the profession, or disappearing into the processes and hide itself, in the best scenario, behind temporary shapes. It is evident that architecture is called to not look only at the single object, but at wider and more complex contexts, in which the emerges the necessity for the creation of new balance and for the start of processes of identity and spatial appropriation. But still too few are the examples capable of authentically being themselves while at the same time being able to re-interpret the identity of the places re-configuring new scenarios in continuity with the natural atmospheric reality of places. Only in built spaces strongly tied to a context, it is possible for the life to go on authentically, creating a “significant relation between a human being and a given environment”, so that “the condition of living” occurs. (Norberg-Schulz 1984) Starting from the assumption that inhabiting does not mean to simply reside, but to live the spaces of the city, we faced a reflection through the reading of three cases (Quinta da Malagueira housing complex in Evora of Alvaro Siza, Reconfiguration of a Shanty Town in Seoul of Florian Beigel and Philip Christou, Elemental project directed by Alejandro Aravena) trying to comprehend how it could be possible today to inhabit private and public spaces, and what are the values that can be expressed in them and in which the people can recognise themselves, to inhabit them and to look after them. Said cases have been chosen as examples of contemporary architectures capable of rediscovering and amplifying the identity of specific places through the systematisation of physical and abstract elements.

Osteonecrosis (avascular necrosis) of the femoral head is a clinical disease due to a severe bone vascular alteration associated with intense pain and loss of joint function, with an incidence of 0.1% and unknown aetiology. Many classifications exist to describe it and in the final stages the patient will need a total hip arthroplasty. In the early stages, ESWT has given excellent responses. The Neapolitan school studied more than 600 patients who had very good results in I and II stages of Ficat and Arlet Classification, with an improve of outcomes in VAS and HSS scores. Moreover it has shown a complete restoration of the signal intensity of the femoral head in MRI.

/ La crisi globale del nostro modello di sviluppo coinvolge direttamente l'architettura, se è vero che per Gadamer il suo ruolo “reggente e fondante” riguarda la capacità di rappresentare nelle istituzioni un orizzonte di coscienza comune, in cui una comunità possa auto-rappresentarsi e riconoscersi. Per Bauman (2000) si tratta di un salto epistemico epocale nel quale vengono liquefatti tutti i presupposti sociali sui quali l'individuo fondava la sua natura di uomo pubblico (Sennet, 1982), la sua capacità e volontà di partecipare e di comunicare, in altre parole la sua identità. Sulla base di tali presupposti, il mio lavoro intende indagare una delle strade che l'architettura suggerisce per rigenerare l'individuo e ripensare i propri presupposti monumentali (da memento, ricordare) e rappresentativi nell'epoca della modernità liquida. Per fare ciò, prende in esame l'opera dell'architetto John Hejduk e specialmente l'architettura delle “maschere”, la quale affronta profeticamente nella società americana dei primi anni '80 i temi della nostra attualità globale ed universale: la solitudine dell'individuo, il rapporto tra individuo e collettività e quindi la questione urbana e politica (polis), la “perdita del centro” e la conseguente crisi del linguaggio architettonico (e la conseguente condizione babelica e simulacrale in cui versa l'architettura contemporanea). La risposta di Hejduk mira direttamente al cuore dell'architettura, riguarda cioè la ricerca di una ragione in comune tra architettura e utente, che passi attraverso la dimensione simbolica e archetipica. Se le convenzioni sulle quali si era costruita la città borghese non vengono oramai più riconosciute, l'architettura mette in campo tutto il suo potenziale espressivo operando su due fronti: la rieducazione e la cura dell'individuo attraverso la formulazione di nuovi programmi funzionali “ad hoc”; una ri-monumentalizzazione dell'architettura attraverso un'espressione formale che, facendo leva sulla potenza evocativa del simbolo, sia in grado di “incontrare” il cittadino-utente nel profondo della sua natura inconscia ed archetipica. The global crisis in our development model affects architecture directly, if it is true that for Gadamer its “ruling and founding” role concerns its capacity to represent a horizon of common consciousness within institutions, in which a community can self-represent and recognize itself. For Bauman (2000) this is an epochal epistemic leap, in which all the social presuppositions that the individual used to found his nature as uomo pubblico on are liquefied (Sennet, 1982), along with his capacity and desire to participate and communicate, in other words, his identity. On the basis of these presuppositions, my work intends to investigate one of the roads that architecture suggests to regenerate the individual while reconsidering its own monumental (from memento, remember) and representative presuppositions in the era of liquid modernity. To do so, it looks at the work of the architect John Hejduk, and especially the architecture of “masques”, which, in the American society of the early '80s, prophetically tackled the themes of our global and universal contemporary situation: the solitude of the individual, the relationship between individual and community and hence the urban and political question (polis), the “loss of the centre” with the consequent crisis in architectural language (and the ensuing chaotic and simulacral condition contemporary architecture finds itself in). Hejduk's answer points directly at the heart of architecture, i.e. it concerns the search for a reason in common between architecture and user, passing via the symbolic and archetypal dimension. If the conventions on which the bourgeois city was built are no longer recognized, architecture brings into play all its expressive potential by operating on two fronts: re-education and care of the individual through the formulation of new "ad hoc" functional programmes; a re-monumentalization of architecture through formal expression that, by leveraging the evocative power of the symbol, is able to “meet” the citizen-user in the depths of his unconscious archetypal nature.

Although low-energy extracorporeal cardiac shock wave (ECSW) therapy represents an attractive non-invasive treatment option for ischaemic heart disease, the precise mechanisms of its action and influence on the cardiac tissue remain obscure. The goal of this study was to evaluate the effects of SW application on cardiac function and structure. Four-month-old Fisher 344 rats were subjected to ECSW therapy. Echocardiographic measurements of cardiac function were performed at baseline and at 1 and 3 months after treatment. Signs of inflammation, apoptosis and fibrosis were evaluated by immunohistochemistry in the control and treated hearts. ECSW application did not provoke arrhythmia or increase the troponin-I level. At all time points, the left ventricular ejection fraction and fractional shortening remained stable. Histological analysis revealed neither differences in the extracellular matrix collagen content nor the presence of fibrosis; similarly, there were no signs of inflammation. Moreover, a population of cardiac cells that responded eagerly to ECSW application in the adult heart was identified; c-kit–positive, Ki67-positive, orthochromatic cells, corresponding to cardiac primitive cells, were 2.65-fold more numerous in the treated myocardium. In conclusion, non-invasive ECSW therapy is a safe and effective way of activating cardiac stem cells and myocardial regeneration. Because many factors influence cellular turnover in the ischaemic myocardium during the course of ischaemic heart disease, cardiac remodelling, and heart failure progression, studies to identify the optimal treatment time are warranted.