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As for hypertension, chronic pain, epilepsy and other disorders with particular symptoms, a commonly accepted and unambiguous definition provides a common ground for researchers and clinicians to study and treat the problem. The WHO's ICD11 definition only mentions tinnitus as a nonspecific symptom of a hearing disorder, but not as a clinical entity in its own right, and the American Psychiatric Association's DSM-V doesn't mention tinnitus at all. Here we propose that the tinnitus without and with associated suffering should be differentiated by distinct terms: “Tinnitus” for the former and “Tinnitus Disorder” for the latter. The proposed definition then becomes “Tinnitus is the conscious awareness of a tonal or composite noise for which there is no identifiable corresponding external acoustic source, which becomes Tinnitus Disorder “when associated with emotional distress, cognitive dysfunction, and/or autonomic arousal, leading to behavioural changes and functional disability.”. In other words “Tinnitus” describes the auditory or sensory component, whereas “Tinnitus Disorder” reflects the auditory component and the associated suffering. Whereas acute tinnitus may be a symptom secondary to a trauma or disease, chronic tinnitus may be considered a primary disorder in its own right. If adopted, this will advance the recognition of tinnitus disorder as a primary health condition in its own right. The capacity to measure the incidence, prevalence, and impact will help in identification of human, financial, and educational needs required to address acute tinnitus as a symptom but chronic tinnitus as a disorder. © 2021 Elsevier B.V.

Elderly patients represent the majority of lung cancer cases, but they are often under-represented in clinical cancer treatment trials or excluded from studies because of comorbidities. Due to lack of data, treatment options for this population must be carefully evaluated and preliminary assessment should aim to stratify patients into different risk subgroups. In early NSCLC stages, surgery remains the best therapeutic option in low-moderate risk patients. Conversely, in patients unfit for surgery or in advanced stages, chemotherapy and radiotherapy should be considered as they may offer benefits in terms of clinical outcomes. Recent developments in targeting driver genes mutations as well as immune checkpoints have opened novel horizon in lung cancer management and systematic investigation in elderly population is required. In this review, we examined the more recent results of the literature about the therapeutic scenario in limited and advanced lung cancer stages in elderly and very elderly population.

Summary. Background: A prolonged treatment with oral anticoagulants has been claimed to reduce the incidence of newly diagnosed cancer in the long-term follow-up of patients with venous thromboembolism. Objectives: In a multicenter prospective study we assessed the incidence of newly diagnosed clinically overt cancer in patients with a first episode of idiopathic venous thromboembolism (VTE) treated with oral anticoagulants for 3 months or 1 year. Patients and methods: Consecutive patients with an idiopathic venous thromboembolism who had completed 3 months of oral anticoagulant therapy without having a recurrence, bleeding or newly diagnosed cancer were randomized to discontinue oral anticoagulant therapy or to continue it for nine additional months. Idiopathic venous thromboembolism was defined as thrombosis occurring in the absence of known cancer, known thrombophilia, or temporary risk factors for venous thromboembolism. All patients were followed up for at least 1 year after randomization. Results: A total of 429 patients, 265 patients with DVT and 164 with PE, were followed up for an average of 43.7 months after randomization. A newly diagnosed cancer occurred in 32 patients (7.5%), 13 (6.2%) of the 210 patients treated for 3 months and 19 (8.7%) of the 219 patients treated for 1 year (RR = 0.71, 95% confidence interval 0.36–1.41). Conclusions: The incidence of newly diagnosed clinically overt cancer is not reduced in patients with idiopathic venous thromboembolism treated with 1-year anticoagulant treatment compared with patients treated for 3 months.

Calcium activated proteases, or calpains, play an important role in neurodegeneration. In some cases, neural degeneration can be significantly reduced by leupeptin, a potent calpain inhibitor. To determine if leupeptin could protect against noise-induced hearing loss and hair cell loss, we infused leupeptin into scala tympani of one cochlea before, during and after a 14-day exposure to a 100 dB SPL, octave band noise centered at 4.0 kHz. Hearing loss, assessed with the auditory evoked response, was less in the leupeptin-treated ear than in the control ear during the early stage of recovery from acoustic trauma. In addition, hair cell loss in the leupeptin-treated ear was significantly less than in the control ear. These preliminary results suggest that leupeptin may protect against noise-induced hearing loss.

The nature of bile duct-like (oval) cells proliferating during chemical hepatocarcinogenesis has been controversial. To investigate this issue further, the authors compared the hepatic distribution of albumin (ALB) and alpha-fetoprotein (AFP) mRNAs in rats in which oval cell proliferation was induced by feeding a choline-devoid diet containing 0.1% ethionine (CDE, a hepatocarcinogenic diet) with that in normal rats and in rats in which biliary epithelial cell hyperplasia was induced by either bile duct ligation or feeding alpha-naphthylisothiocyanate (ANIT). Northern blot analysis in parenchymal and nonparenchymal liver cells isolated from these animals demonstrated that ALB mRNA was present in the hepatocytes of both control and experimental animals, whereas this transcript was detected in nonparenchymal epithelial cells only in CDE-fed rats. Alpha-fetoprotein mRNA was not seen in either parenchymal or nonparenchymal cells isolated from normal or hyperplastic livers induced by bile duct ligation or ANIT feeding. In CDE-fed rats, however, both parenchymal and nonparenchymal cell populations displayed AFP message. In situ hybridization directly demonstrated nonparenchymal cell expression of both ALB and AFP transcripts in CDE-fed rats. Most surprisingly, ALB and AFP mRNAs were also detected by in situ hybridization in occasional nonparenchymal cells located in portal tracts near the limiting plate in normal liver, as well as under conditions associated with bile duct hyperplasia. Immunohistochemical studies of intermediate filament proteins, cytokeratin 19 (a marker of glandular epithelia), vimentin (a marker of mesenchymal lineage), and desmin (a marker of muscle cell differentiation) demonstrated that oval cells, as well as normal and hyperplastic bile duct cells, were positive for cytokeratin 19 and negative for both vimentin and desmin. Cytokeratin-positive oval cells formed duct profiles and were connected to preexisting ductules and ducts. These results are construed to suggest that oval cells proliferating during CDE hepatocarcinogenesis are derived from epithelial cells within the biliary tree. The presence of cells with similar morphologic appearance, periportal location, and AFP and ALB expression in normal liver suggests that these cells may be the progenitors of oval cells induced by some carcinogenic regimens.

Over the last few years the frequency and severity of mishaps in medical practice and legal encounters triggered by malpractice suits have been heavily reported in the headlines and the media in general, indicating the tensions which arise when ethical trust between doctors (and other healthcare professionals) and patients breaks down and the legal mechanisms for responding to patient safety episodes in healthcare. By utilizing the tools the Internet provides, lawyers leave no stone unturned in the settlement of clinical mishaps and drive results based on meaningful case stories or case studies about successfully defended claims that speak to the concerns of their prospective patient clients hiring legal help. This way of creating valuable content on the Web via case studies/stories enable lawyers to develop a digital presence for their law firms whilst engaging customers and building social traction. Against this backdrop, the present paper addresses the way medical malpractice stories as a Web genre are constructed in professional discourse where a doctor or medical professional's negligent act or omission causes harm to a patient client, and the way they emphasize the lawyer's acting in the client's interest. Informed by a theoretical framework for genre analysis (Bhatia 2004) and problem-solution pattern (Hoey 2001) in a corpus of randomized, real-life clinical negligence case studies (30) published on British lawyer firm platforms in November 2015, the paper examines first the organizational (move) structure and then the most salient lexico-grammatical features that relate the communicative practices to the communicative purposes of the genre. Looking at the Web-mediated case study genre as the outcome of social action and as an interdiscursive site where law and medicine are intertwined, the paper discusses the linguistic and discoursal choices authors make and the effect they produce in building trust among informed patient clients and promoting lawyer talent and marketing while delivering an unparalleled level of legal service. This is where the value of the Web-mediated case study genre as shaped by primarily informational as well as promotional goals attempts to fill the gap in research on the interface between law and medicine and thus contribute to the field of genre studies.

Lung cancer (LC) and chronic obstructive pulmonary disease (COPD) represent leading causes of morbidity and mortality worldwide. Common risk factors lead to an increased inflammatory response, enhances oxidative stress, and changes in lung microenvironment contributing to fine-tuned interaction between these respiratory disorders. Despite evidence that COPD represents a main risk factor for LC, assessment of LC risk features among COPD patients is not routinely considered in the clinical practice. In LC patients concurrent COPD may impact on clinical scenario influencing the response to treatment. Better understanding LC and COPD coexistence may impact on clinical scenario influencing therapeutic approach. In this review, we describe the basis of this network and how the complex interplay between these respiratory disorders affects the clinical decision-making process.

Trans-bronchial needle aspiration allows lymph node sampling in several thoracic conditions; the ability of Rapid On-Site Evaluation (ROSE) to predict the final diagnosis in this setting has not been well characterized. We performed a retrospective study to establish the utility of ROSE in the diagnosis of thoracic diseases with mediastinal lymph node involvement. We retrospectively reviewed 297 patients with hilar-mediastinal lymph node enlargement detected at CT scan from January 2013 to April 2016. 201 patients underwent conventional TBNA; in 96 patients, TBNA procedure was performed by on-site presence of a team of pathologists and research morphologists. Lung neoplasms, sarcoidosis, infections and lymphoma were the most common diseases diagnosed with TBNA samples. TBNA simultaneously performed in combination with ROSE produced an increase in percentage of appropriate samples compared to single cTBNA (adequate samples cTBNA vs ROSE-TBNA: 73% vs 81%; p

Objective: To investigate the effectiveness of a home-based preoperative rehabilitation program for improving preoperative lung function and surgical outcome of patients with chronic obstructive pulmonary disease (COPD) undergoing lobectomy for cancer. Methods: This was a prospective, observational, single-center study including 59 patients with mild COPD who underwent lobectomy for lung cancer. All patients attended a home-based preoperative rehabilitation program including a minimum of 3 sessions each week for 4 weeks. Each session included aerobic and anaerobic exercises. Participants recorded the frequency and the duration of exercise performed in a diary. The primary end point was to evaluate changes in lung function including predicted postoperative (PPO) forced expiratory volume in 1 second (FEV1), 6-minute walking distance test (6MWD), PPO diffusing capacity for carbon monoxide (DLCO) %, and blood gas analysis values before and after the rehabilitation program. Postoperative pulmonary complications were recorded and multivariable analysis was used to identify independent prognostic factors (secondary end point). Results: All patients completed the 4-week rehabilitation program. Thirteen of 59 (22%) patients (Group A) performed 1% and 6MWD before and after rehabilitation showed a significant improvement only in Group B. No significant changes in PPO DLCO% or in blood gas analysis values were seen. Nine patients presented postoperative pulmonary complications, including atelectasis ( n = 6), pneumonia ( n = 1), respiratory failure ( n = 1), and pulmonary embolism ( n = 1). Group A presented higher number of postoperative pulmonary complications than Group B (6 vs 3; p = 0.0005). Multivariate analysis showed that the number of weekly rehabilitation sessions was the only independent predictive factor ( p = 0.001). Conclusions: Our simple and low-cost rehabilitation program could improve preoperative clinical function in patients with mild to moderate COPD undergoing lobectomy and reduce postoperative pulmonary complications. All patients should be motivated to complete at least 3 rehabilitation sessions per week in order to obtain significant clinical benefits. Our preliminary results should be confirmed by larger prospective studies.

Research on teacher motivation has recently given evidence of being closely related to several variables such as pre-service and in-service teacher training, educational reform, teaching practice, student motivation, work environment, psychological fulfilment and general health conditions. Taking into consideration the most recent studies on EFL teacher motivation across different disciplines and cultures, this paper aims at sharing the author’s personal experience with colleagues who have taught in CLIL trainee courses for High School content teachers. The results of the project, carried out in university run-courses from 2013 to 2017, have shown that teaching certain linguistic aspects (such as WE and ELF features, or word-forming processes) makes teachers linguistically aware of the plurality of English in communication and education, stimulates them strategically, increases their intrinsic motivation and influences their teaching effectiveness.

Objective: Preoperative functional evaluation is central to optimizing the identification of patients with non-small cell lung cancer (NSCLC) who are candidates for surgery. The minute ventilation/carbon dioxide output (VE/VCO2) slope has proven to be a predictor of surgical complications and mortality. Pulmonary rehabilitation programs (PRPs) could influence short-term outcomes in patients with COPD undergoing lung resection. Our objective was to evaluate the effects of a PRP on the VE/VCO2 slope in a cohort of patients with COPD undergoing lung resection for NSCLC. Methods: We retrospectively evaluated 25 consecutive patients with COPD participating in a three-week high-intensity PRP prior to undergoing lung surgery for NSCLC, between December of 2015 and January of 2017. Patients underwent complete functional assessment, including spirometry, DLCO measurement, and cardiopulmonary exercise testing. Results: There were no significant differences between the mean pre- and post-PRP values (% of predicted) for FEV1 (61.5 ± 22.0% vs. 62.0 ± 21.1%) and DLCO (67.2 ± 18.1% vs. 67.5 ± 13.2%). Conversely, there were significant improvements in the mean peak oxygen uptake (from 14.7 ± 2.5 to 18.2 ± 2.7 mL/kg per min; p < 0.001) and VE/VCO2 slope (from 32.0 ± 2.8 to 30.1 ± 4.0; p < 0.01). Conclusions: Our results indicate that a high-intensity PRP can improve ventilatory efficiency in patients with COPD undergoing lung resection for NSCLC. Further comprehensive prospective studies are required to corroborate these preliminary results. RESUMO Objetivos: A avaliação funcional pré-operatória é fundamental para otimizar a seleção dos pacientes para cirurgia torácica para tratamento do CPCNP. Uma alta inclinação VE/VCO2 se mostrou um preditor de complicações cirúrgicas e de aumento da mortalidade. Programas de reabilitação pulmonar (PRP) demonstraram aumentar os parâmetros funcionais e os desfechos de curto prazo em pacientes com DPOC submetidos à ressecção pulmonar. O impacto dos PRP na inclinação VE/VCO2 não foi totalmente investigado. Métodos: Avaliamos retrospectivamente 25 pacientes com DPOC consecutivos submetidos aos efeitos de um programa de reabilitação pulmonar de alta intensidade (PRP) na inclinação VE/VCO2. Resultados: Não foram observadas variações significativas nos principais parâmetros espirométricos após o programa de reabilitação de três semanas (pré-reabilitação VEF1 versus pós-reabilitação VEF1 %prev: 61,5 ± 22,0% para 62,0 ± 21,1%, ns; pré-reabilitação DLCO para pós-reabilitação DLCO %prev: 67,2 ± 18,1% para 67,5 ± 13,2%, ns). Por outro lado, o pico de VO2 e a inclinação VE/VCO2 melhoraram significativamente após PRP (pico de VO2 pré-reabilitação para pico de VO2 pós-reabilitação: 14,7 ± 2,5 para 18,2 ± 2,7 mL/kg/min, p < 0,0000001; inclinação pré-reabilitação VE/VCO2 para pós-reabilitação inclinação VE/VCO2: 32,0 ± 2,8 para 30,1 ± 4,0, p

Over the last decades, proposals to modernise legislative drafting have been choral and among the specific causes generally mentioned there are sentences of undue length, overuse of archaic expressions, repeated definitions and expressions, partiality of nominalisations, lack of gender neutrality. The aim of this analysis is to explore the legislative techniques adopted by drafters of English-speaking countries over the last decades, who are asked to write legal sentences aiming at gender fair and symmetric representation of men and women. The issue examined from a lexico-grammatical perspective culminates in the proposed questions whether certain techniques used to implement gender-neutral drafting can result in a product that is better than the one had before.

In recent years, English has become the lingua franca of medicine and the language teaching profession has seen the emergence of im- plementing English for Medical Purposes (EMP) courses. The needs of EMP learners are very specific and EMP teachers who are language experts and not medical ones need to develop materials that are in line with EMP learners’ specific needs. In response to recognizing EMP students’ needs, extensive corpus-based research has led to specialized medical wordlists (Chen and Ge 2007; Wang, Liang, Ge 2008; Mungra and Canziani 2013; Hsu 2013; Lei and Liu 2016). Such wordlists have given instructors the opportunity to focus on specific vocabulary facil- itating domain specific learning. Among these medical wordlists, the Medical Academic Wordlist for clinical cases (MAWLcc) seems to fur- nish a good base for medical students, since it identifies the specific lexis of patient care. The aim of this paper is to propose an EMP teaching model for lexi- cal verbs extracted from the MAWLcc. These verbs are used in differ- ent communicative contexts for the development of medical students’ academic linguistic competence in their professional context.

Il contributo esamina la portata che il principio di proporzionalità ed il criterio ermeneutico-argomentativo di ragionevolezza assumono nella Proposta di Regolamento del diritto comune europeo della vendita. L’analisi assume preminente interesse, poiché il provvedimento, pur non essendo stato approvato, rappresenta un modello innovativo di regolamentazione uniforme, ispirato al principio di “giustizia contrattuale”.

The main aim of the study is to investigate the concept of evaluation applied to a corpus of legislative instruments in favour of migrants’ rights. In particular, attention has been paid to some evaluative lexical choices found in association with two key-words – integration and protection. More specifically, evaluation has been investigated taking into account the phrases and the grammar patterns most frequently found with these words in the corpus. The corpus includes some EU Directives in the time span 2001- 2013 aimed at integrating migrants (see Appendix A). The Directives include rights such as family reunification, equal opportunities to men and women, international protection, the conditions of entry and residence of third-country nationals for the purposes of highly qualified employment, granting and withdrawing international protection. In short, all the Directives are aimed at integrating migrants, granting them some rights and promoting common procedures among the Member States in order to better protect them.

OBJECTIVES: Vacuum-assisted closure (VAC) of chronic empyemas can potentially set challenging patients free of prolonged hospitalization by warranting outpatient care. We wanted to test this concept in post-pneumonectomy empyema patients. METHODS: Three patients with post-pneumonectomy bronchopleural fistula were subjected to open window thoracostomy (OWT) and subsequently to VAC. The BPFs were closed by endobronchial stents in 2 of the patients. The VAC system was applied at a median time of 35 days (range, 23–113) after pneumonectomy. The patients were scheduled for outpatient visits every three days with complete change of the VAC sponges. RESULTS: Hypotension and acute thoracic pain despite minimal suction applied to the VAC sponges were observed during treatment and eventually caused VAC discontinuation. In one patient, the sponges of the VAC system could not be directly removed through the OWT and careful dissection through VATS under deep sedation was needed. CONCLUSIONS: VAC can be of help to obliterate the post-pneumonectomy empyema cavity but its use can trigger clinically significant complications. Cautious monitoring of the VAC system must be exercised in the early period prior to discharging patients to the outpatient clinic.

Short-term tinnitus develops shortly after the administration of a high dose of salicylate. Since salicylate selectively potentiates N-methyl- D-aspartate (NMDA) currents in spiral ganglion neurons, it may play a vital role in tinnitus by amplifying NMDA-mediated neurotransmission. The aim of this study was to determine whether systemic treatment with a NMDA channel blocker, memantine, could prevent salicylate-induced tinnitus in animals. Additional experiments were performed to evaluate the effect of memantine on the auditory brainstem response (ABR) and distortion product otoacoustic emissions (DPOAE) to test for changes in hearing function. Thirty-six rats were divided into 3 groups and treated daily for four consecutive days. One group (n = 12) was injected with salicylate (300 mg/kg/d, IP), the second (n = 12) was treated with memantine (5 mg/kg/d, IP) and the third group (n = 12) was injected with salicylate and memantine. All rats were tested for tinnitus and hearing loss at 2, 24, 48 and 72 h after the first drug administration and 24 h post treatment; tinnituslike behaviour was assessed with gap prepulse inhibition of acoustic startle (GPIAS), and hearing function was measured with DPOAE, ABR and noise burst prepulse inhibition of acoustic startle (NBPIAS). Rats in the salicylate group showed impaired GPIAS indicative of transient tinnitus-like behaviour near 16 kHz that recovered 24 h after the last salicylate treatment. Memantine did not cause a significant change in GPIAS. Combined injection of salicylate and memantine significantly attenuated GPIAS tinnitus-like behaviour at 48 hours after the first injection. None of the treatments induced permanent threshold shifts in the ABR and DPOAE, which recovered completely within one day post treatment. Animals treated with salicylate plus memantine showed results comparable to animals treated with salicylate alone, confirming that there is no effect of memantine on DPOAE which reflects OHC function. The present study confirms the role of cochlear NMDA receptors in the induction of salicylate-induced tinnitus.Il sodio salicilato, principio attivo dell'aspirina, è una molecola in grado di indurre un acufene transitorio mediante l'attivazione dei recettori N-metil-D-aspartato (NMDA) a livello periferico e centrale. L'obiettivo primario di questo studio è di valutare la potenzialità della memantina, inibitore selettivo dei recettori NMDA, nel contrastare l'insorgenza e la persistenza dell'acufene indotto da salicilato in un modello animale. Obiettivo secondario è lo studio degli effetti della memantina sulla funzione uditiva e sulle cellule ciliate esterne. Nel nostro studio sono stati utilizzati 36 ratti divisi in tre gruppi: nel primo gruppo (n = 12) gli animali sono stati trattati con salicilato (300 mg/kg/d, IP), nel secondo (n = 12) con memantina (5 mg/kg/d, IP), nel terzo (n = 12) con entrambi. In tutti gli animali è stato studiato l'acufene con la tecnica GPIAS ad intervalli di 2, 24, 48, 72 e 96 ore dalla prima somministrazione e la funzione uditiva mediante i prodotti di distorsione (DPOAE) ed i potenziali evocati uditivi (ABR). Negli animali trattati con salicilato la nostra metodica ha evidenziato la presenza di un acufene con frequenza vicina ai 16 kHz insorto dopo la prima somministrazione e risoltosi spontaneamente 24 ore dopo l'ultima. Negli animali trattati con salicilato e memantina l'acufene, seppur presente, è risultato significativamente attenuato, prevalentemente durante il secondo giorno di trattamento. Né il salicilato né la memantina hanno causato alterazioni permanenti della funzione uditiva; le variazioni registrate mediante i prodotti di distorsione sono regredite al termine del trattamento. Il nostro studio conferma il ruolo dei recettori NMDA nell'acufene da salicilato e le potenzialità della memantina nel contrastarne l'insorgenza e la persistenza. Data la facile reperibilità del farmaco, già utilizzato nel trattamento della malattia di Alzheimer e del morbo di Parkinson, ed i risultati incoraggianti ottenuti nel modello animale, sono auspicabili ulteriori approfondimenti nell'uomo.

In the last few years, in the picturesque Umbrian city of Perugia, Meredit Kercher’s slaughter has spawned one of Italy’s most sensational and closely watched trials. In November 2007 Meredith’s roommate, Amanda Knox of Seattle (U.S.), was charged along with her Italian ex-boyfriend, Raffaele Sollecito, with murdering Kercher in a drug-fuelled sexual assault, and in December 2009, they were sentenced to 26 and 25 years respectively. Their convictions were overturned on appeal in October 2011 by a panel of six lay jurors and two judges. However, Amanda Knox was also given a three-year sentence for slander after falsely accusing Patrick Lumumba, the owner of a Perugia bar where she worked, of involvement in the killing. In this study we foregrounded a phase of this slander trial, and in particular one segment of relevant linguistic interest. The bilingual setting of such a trial, the defendant’s (Amanda Knox) occasional language switching (from Italian into English and vice versa), and the legal professionals’, interpreter’s and defendant’s accommodative strategies were analysed in socio-psychological perspective. In a broad Critical Discourse Analysis (CDA) approach, such strategies have been identified and described under the Communication Accommodation Theory (CAT) purview. One of the most prominent frameworks in the social psychology of language, CAT is applicable to a wide array of contexts, forensic exchanges among them. Essentially, CAT assumes that interactants use strategic behaviours (convergent, divergent, or maintenance), mainly based on language and communication, to negotiate social distance between themselves and others and/or to maintain perceived separation or nearness with interlocutors. Convergent accommodation strategies can be enacted either to convey empathy, develop a closer relationship, signal common social identities, or to elicit the other’s approval, trust and, also, to enhance cooperation or defuse a potentially volatile situation. Divergent strategies, in contrast, seek to emphasize identity differences and detachment. Our study aimed at analyzing samples from a phase of Amanda Knox trial. A major focus was on evaluating the cohesion between the coerciveness of the prosecutor’s questions and the pertinence of Amanda’s answers.

La trasformazione della società, tuttora in atto, verso una dimensione multilinguistica e multiculturale ha determinato in Italia e, in generale, in Europa una pressante richiesta di strategie e competenze atte a far fronte alle esigenze di una comunicazione multilinguistica, facendo con questo riferimento sia i.) all’uso di lingue diverse per lo sviluppo di pratiche sociali ed il conseguimento di fini comuni, sia ii).alla crescente presenza di cittadini multilingui che usano più lingue per la realizzazione dei loro fini. In questa prospettiva, rinnovata attenzione si è concentrata sul rapporto tra lingua e cultura e sull’apporto che una gamma sempre più ampia di tecnologie può fornire ad un uso rafforzato di tutte le lingue. In considerazione dell’alto potenziale che le tecnologia presenta per “assicurare uno spazio sociolinguistico a tutte le lingue europee” l’articolo prende in esame il contributo che può essere fornito dalle tecnologie digitali ai fini di una comunicazione e di un’informazione multilingustica e interculturale. Nell’esplorazione di corpora, la lettura interpretativa di alcune concordanze si rivela indicativa di scelte non solo linguistiche, ma anche significativamente radicate, a livello culturale, nei vari contesti storico-geografici.

Aims: To evaluate the incidence of cardiovascular events in the tong-term clinical course of patients with a first episode of symptomatic, objectively confirmed pulmonary embolism. Methods and results: Three hundred and sixty patients with a first episode of pulmonary embolism were included in a prospective study: 209 with idiopathic pulmonary embolism and 151 with pulmonary embolism associated with transient risk factors. The study outcomes were cardiovascular events (recurrent venous thrombo-embolism, acute myocardial infarction, stroke, sudden otherwise unexplained death), cardiovascular death, and death due to any cause. The median follow-up was 38 months. Sixty-four patients had at least one cardiovascular event (5.5% patient-year). Recurrent venous thromboembolism occurred in 45 patients (3.9% patient-year), acute myocardial infarction in 12 patients (1.0% patient-year), stroke in six patients (0.5% patient-year), and sudden otherwise unexplained death in four patients (0.3% patient-year). A cardiovascular event occurred in 47 patients with idiopathic pulmonary embolism (7.5% patient-year) and in 17 patients with pulmonary embolism associated with transient risk factors (3.1% patient-year) (RR 2.0; 95% CI 1.20-3.34; P = 0.006). Twenty patients with idiopathic pulmonary embolism (3.2% patient-year) and two patients with pulmonary embolism associated with transient risk factors (0.4% patient-year) presented an arterial cardiovascular event (RR 7.2; 95% CI 1.71-30.45; P = 0.001). Thirty-three patients died (9.2%). Cardiovascular mortality and cancer mortality accounted for 42.4 and 21.2% of overall mortality, respectively. Idiopathic pulmonary embolism was an independent predictor of cardiovascular events after adjusting for age. Conclusions: Cardiovascular events are more common in patients with idiopathic pulmonary embolism than in patients with pulmonary embolism associated with transient risk factors. Cardiovascular events are the major cause of death in patients with idiopathic pulmonary embolism.

The aim of this study was to determine whether paroxysmal atrial fibrillation (PAF) and/or restoration to sinus rhythm with electric or pharmacologic cardioversion induce modifications to the coagulation system. Thirty-five patients with PAF undergoing either electric (n = 11) or pharmacologic (n = 24) cardioversion were studied. Fibrinopeptide A and D-dimer blood samples were taken immediately before and after cardioversion at different intervals. When compared with the control group (n = 70), the precardioversion fibrinopeptide A plasma values were significantly elevated (11.8 vs 2.5 ng/mL). Fibrinopeptide A plasma values were significantly reduced 5 minutes after cardioversion (11.8 vs 5.3 ng/mL) and remained stable throughout the follow-up sequential measurements. D-dimer plasma values were significantly increased (measured at 12 hours and at day 7) in patients who underwent electrical cardioversions only. A positive correlation (R(2) = 0.76) was found between the energy delivered for cardioversion to sinus rhythm and D-dimer plasma values on day 7. In patients with PAF, levels of fibrinopeptide A, an indicator of coagulation activation, are elevated and soon reduced by the restoration of sinus rhythm. Electric, but not pharmacologic, cardioversion induces an early activation of the fibrinolytic system.