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This article interrogates the humanitarian discourse and the emergence of the new Treaty on the Prohibition of Nuclear Weapons (TPNW). Often acknowledged as decisive for adopting the TPNW, the humanitarian discourse is considered vital to stigmatizing nuclear weapons and their purported deterrence value. However, the literature has not thoroughly examined the mechanisms through which speaking in humanitarian terms enabled proponents of the TPNW to exercise agency, failing to appreciate the complex discursive practices sustaining power relations in nuclear politics. This article introduces a theoretical framework that can help us make sense of these complexities, while illuminating additional ways through which the humanitarian discourse contributed to the TPNW. Using a feminist post-structuralist lens, I argue that the humanitarian discourse enabled small and middle-power states to challenge war traditions that sustain dominant configurations of power in nuclear politics. Upon speaking in humanitarian terms, these states destabilized the ongoing reiteration of the protector/protected dichotomy that has placed non-nuclear states in a position of subordination. The article draws attention to how dominant assumptions of the masculine and feminine shape global politics, while advancing theoretical tools to help us grasp and seize possibilities for policy innovation and change.

Giuseppe Ventriglia,1 Fabrizio Gervasoni,2 Massimiliano Franco,1 Alberto Magni,1 Giorgio Panico,2 Giovanni Iolascon3 1SIMG (Italian College of General Practitioners and Primary Care), Florence, Italy; 2Rehabilitation Unit, Luigi Sacco University Hospital, ASST Fatebenefratelli-Sacco, Milan, Italy; 3Department of Medical and Surgical Specialties and Dentistry, University of Campania “Luigi Vanvitelli”, Naples, ItalyCorrespondence: Fabrizio Gervasoni, Rehabilitation Unit, Ospedale L. Sacco, ASST Fatebenefratelli-Sacco, Via G.B. Grassi 74, Milan, 20157, Italy, Tel +39 02 39041, Email fabrizio.gervasoni@asst-fbf-sacco.itPurpose: In Italy, musculoskeletal (MSK) disorders are pervasive with one-third of adults seeking medical consultation for a MSK issue in the past year. MSK pain is often treated with local heat applications (LHAs) which can be integrated into MSK care by different specialists and in different settings. Compared to analgesia and physical exercise, LHAs have been less evaluated, and the quality of randomized clinical trials is generally low. The aim of the survey is to assess the knowledge, attitude, perception/practices of general practitioners (GPs), physiatrists and sports medicine doctors towards thermotherapy as delivered by superficial heat pads or wraps.Patients and Methods: The survey was conducted between June and September 2022 in Italy. An online questionnaire with 22 multiple-choice questions was administered to explore the demographics and prescribing habits of the participants; the clinical profile of MSK patients; and physicians’ attitude and beliefs about the use of thermotherapy/superficial heat applications in MSK pain management.Results: GPs are at the forefront of the MSK patient journey and preferentially select NSAIDs as first-line option in arthrosis, muscle stiffness, and strain while prescribing heat wraps as preferred choice in presence of muscle spasm/contracture. Similar pattern of prescribing habits was found among specialists who, in contrast to GPs, adopted more frequently ice/cold therapy to relieve pain due to muscle strain and limited paracetamol use. Generally, survey participants agreed on the benefits of thermotherapy in MSK care management, namely increased blood flow and local tissue metabolism as well as connective tissue elasticity and pain relief which all may be of help in attaining pain control and improvement of function.Conclusion: Our findings provided the basis for further investigations aimed at optimizing the MSK patient journey while building up additional evidence supporting the benefit of using superficial heat applications to effectively manage patients with MSK disorders.Keywords: musculoskeletal disorder, superficial heat therapy, general practitioner, heat pads, heat wraps

Aims: Metformin is the most widely used drug for the first-line treatment of type 2 diabetes mellitus (T2DM), but its use and schedule have been poorly investigated in elderly patients. Methods: We conducted an observational, cross-sectional, multicentric study on metformin in T2DM outpatients older than 65 years who were taking the drug for at least 6 months and referred to Italian Endocrinology and Diabetology Services. The primary endpoint was daily metformin dose, and secondary endpoints were the correlations between metformin dose and age, comorbidities, and concomitant use of other drugs. The study was open to all members of AME (Associazione Medici Endocrinologi). Results: Fifteen Italian centers recruited 751 consecutive participants (42.9% older than 75 years, 48.6% females). T2DM duration was 12.9 ± 9.7 years (longer than 10 years in 53.8%). Metformin had been used for 10.3 ± 6.8 years (longer than 10 years in 52.4%). Metformin dose was 1.6 ± 0.9 g/day (>1.5 g/day in 63.4%). As compared to the youngest, participants older than 75 years did not differ for metformin daily dose or number of administrations. Metformin dose was significantly directly correlated to eGFR, diabetes duration, and metformin treatment duration. Conclusion: In this real-world study, the minimum daily effective dose of metformin was prescribed in more than half of older T2DM outpatients.

Aims/hypothesis: Islet autoimmunity may progress to adult-onset diabetes. We investigated whether circulating odd-chain fatty acids (OCFA) 15:0 and 17:0, which are inversely associated with type 2 diabetes, interact with autoantibodies against GAD65 (GAD65Ab) on the incidence of adult-onset diabetes. Methods: We used the European EPIC-InterAct case–cohort study including 11,124 incident adult-onset diabetes cases and a subcohort of 14,866 randomly selected individuals. Adjusted Prentice-weighted Cox regression estimated HRs and 95% CIs of diabetes in relation to 1 SD lower plasma phospholipid 15:0 and/or 17:0 concentrations or their main contributor, dairy intake, among GAD65Ab-negative and -positive individuals. Interactions between tertiles of OCFA and GAD65Ab status were estimated by proportion attributable to interaction (AP). Results: Low concentrations of OCFA, particularly 17:0, were associated with a higher incidence of adult-onset diabetes in both GAD65Ab-negative (HR 1.55 [95% CI 1.48, 1.64]) and GAD65Ab-positive (HR 1.69 [95% CI 1.34, 2.13]) individuals. The combination of low 17:0 and high GAD65Ab positivity vs high 17:0 and GAD65Ab negativity conferred an HR of 7.51 (95% CI 4.83, 11.69), with evidence of additive interaction (AP 0.25 [95% CI 0.05, 0.45]). Low dairy intake was not associated with diabetes incidence in either GAD65Ab-negative (HR 0.98 [95% CI 0.94, 1.02]) or GAD65Ab-positive individuals (HR 0.97 [95% CI 0.79, 1.18]). Conclusions/interpretation: Low plasma phospholipid 17:0 concentrations may promote the progression from GAD65Ab positivity to adult-onset diabetes. Graphical Abstract: [Figure not available: see fulltext.]

El trabajo muestra que los procesos de liberalización y la expansión del sector financiero han cambiado profundamente la vida económica, social y política de la economía mundial. Han surgido fenómenos nuevos, por ejemplo, la supremacía de las autoridades monetarias sobre las fiscales y la transformación de los gobiernos nacionales en acreedores de los bancos centrales. Estos cambios han generado consecuencias negativas, como la inestabilidad financiera, el aumento del número de crisis, el bajo crecimiento y la desigualdad distributiva. El artículo aclara la necesidad de modificar aspectos relevantes de la política económica. Se argumenta que atribuir a las autoridades monetarias el papel de líderes en la coordinación de las políticas económicas perjudica el crecimiento y la equidad distributiva. Se alega que debe devolverse discrecionalidad a la política fiscal y que la intervención pública tiene que guiar la evolución de la estructura productiva. A fin de cumplir lo primero, deben mejorarse la calidad de las políticas públicas y los niveles de confianza entre las diferentes instituciones de la política económica nacional y entre los operadores de los mercados financieros y las autoridades de gobierno.

Turbulent phenomena are among the most striking effects that both classical and quantum fluids can exhibit. While classical turbulence is ubiquitous in nature, the observation of quantum turbulence requires the precise manipulation of quantum fluids such as superfluid helium or atomic Bose-Einstein condensates. In this work we demonstrate the turbulent dynamics of a 2D quantum fluid of exciton-polaritons, hybrid light-matter quasiparticles, both by measuring the kinetic energy spectrum and showing the onset of vortex clustering. We demonstrate that the formation of clusters of quantum vortices is triggered by the increase of the incompressible kinetic energy per vortex, showing the tendency of the vortex-gas towards highly excited configurations despite the dissipative nature of our system. These results lay the basis for the investigations of quantum turbulence in two-dimensional fluids of light.

Background: Minimally invasive sacral colpopexy is considered the gold standard for surgical treatment of Pelvic Organ Prolapse (POP), combining high success rates with low recurrence risk in comparison to other techniques. This is the first case of robotic sacral colpopexy (RSCP) performed with the innovative Hugo™ RAS robotic system. Objectives: The aim of this article is to show the surgical steps of a nerve sparing RSCP performed with the new Hugo™ RAS robotic system (Medtronic), by also evaluating the feasibility of this technique using this novel Robotic System. Materials and methods: A 50-year-old Caucasian woman with symptomatic pelvic organ prolapse (POP-Q): Aa: +2, Ba: +3, C: +4, D: +4, Bp: -2, Ap: -2 , TVL:10 GH: 3,5 BP:3 underwent RSCP as well as a subtotal hysterectomy with bilateral salpingo-oophorectomy, using the new surgical robot Hugo™ RAS in the Division of Urogynaecology and Pelvic Reconstructive Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy. Main outcome measures: Intraoperative data, docking specifics, objective and subjective outcomes at three months follow up. Results: Surgical procedure was carried out without intra-operative complications, operative time (OT) was 150 minutes, docking time was 9 minutes. No system errors or faults in the robotic arms were registered. Urogynaecological examination at three months follow up showed a complete resolution of the prolapse. Conclusion: RSCP using the Hugo™ RAS system seems to be a feasible and effective approach according to results in terms of operative time, cosmetic results, postoperative pain and length of hospitalisation. Large number of case reports as well as longer follow up are mandatory to better define its benefits, advantages, and costs.

Background: Non-homogeneous results about the frequency of HPV in leukoplakia are presented in current literature, possibly linked to different factors. Among them, a diverse HPV geographical distribution was suggested. This study aimed to describe the frequency of HPV in patients diagnosed with leukoplakia. Patients & Methods: A cross-sectional study was carried out at the Facultad de Odontología, Universidad Nacional de Córdoba. HPV status was studied by polymerase-chain reaction (HPV-PCR) and p16 by immunohistochemistry. HPV status was analyzed concerning the clinical-demographic features using the Fisher test and the McNemar test. Results: There were included 33 patients diagnosed with different subtypes of oral leukoplakia. HPV genome was detected by PCR in 48.5% (n=16). The most common viral genotype was HPV16. p16 was positive in 27% (n=9) of the cases. The concordance between HPV detection techniques showed poor or weak agreement (Mc Nemar 0.1185). Except for chronic mechanical irritation with HPV-PCR + (p=0.0049), and tongue location with HPV-PCR + (p=0.0366), no significant statistical association between the other included variables was found. Conclusions: The low frequency of HPV in this study agrees with previous studies of our region. Chronic mechanical irritation could play a role in the development of HPV-associated leukoplakias, mainly located on the ventrolateral tongue.

Como Fox e Alldred (2020) consideram, o dualismo Cultura / Natureza forneceu aos filósofos, cientistas e cientistas sociais pós-iluministas uma maneira elegante de estabelecer limites para as respectivas preocupações das ciências sociais e naturais (ver também Barad, 2007; Braidotti, 2013; Fullagar et al., 2019). Este dualismo tem permitido a criação de distinções entre corpos e modos de estar no mundo “modernos” (leia-se “civilizados”) e “tradicionais” (leia-se “primitivos”). No entanto, quando questões pertencentes à incorporação do social são exploradas criticamente, a influência sobre o bem-estar do entorno construído, as transições climáticas e a pandemia de Covid-19 em curso começam a problematizar tais formas, como é argumentado nas últimas três décadas por autores com perspectivas feministas, pós-humanas, novo-materialistas e político-ecológicas, entre outras. Dando continuidade a um diálogo permanente iniciado em 2018 entre acadêmicos e ativistas da América Latina e Europa, organizamos o seminário online “Re-ligando o nexo natureza-cultura-corpo: práticas e epistemologias”. O evento virtual desenvolvido em duas partes explorou como os territórios inter-relacionados de saúde, atividade física e educação podem ser repensados a partir de perspectivas que desestabilizam as fronteiras ontológicas estabelecidas entre natureza, cultura e corpo, e suas possíveis articulações. Este artigo é a transcrição da segunda sessão, denominada “Cartografias do corpo em tempos de pandemia”, e apresenta os diálogos entre Alice del Gabbo, Carla Panico, Gianluca De Fazio, Alexandre Fernandez Vaz e Eduardo Galak, pesquisadores da Itália, Portugal, Brasil e Argentina. Palavras-chave: Corpo; COVID-19; Educação; Atividade física; Cultura.

BACKGROUND: The sacroiliac joint (SIJ) transfers the load of the upper body to the lower extremities while allowing a variable physiological movement among individuals. The axis of rotation (AoR) and center of rotation (CoR) of the SIJ can be evaluated to analyze the stability of the SIJ, including when the sacrum is fixed. The purpose of this study was to determine how load intensity affects the SIJ for the intact model and to characterize how sacropelvic fixation performed with different techniques affects this joint. METHODS: Five T10-pelvis models were used: (1) intact model; (2) pedicle screws and rods in T10-S1; (3)pedicle screws and rods in T10-S1, and bilateral S2 alar-iliac screws (S2AI); (4) pedicle screws and rods in T10-S1, bilateral S2AI screws, and triangular implants inserted bilaterally in a sacral alar-iliac trajectory ; and (5) pedicle screws and rods in T10-S1, bilateral S2AI screws, and 2 bilateral triangular implants inserted in a lateral trajectory. Outputs of these models under flexion-extension were compared: AoR and CoR of the SIJ at incremental steps from 0 to 7.5 Nm for the intact model and AoR and CoR of the SIJ for the instrumented models at 7.5 Nm. RESULTS: The intact model was validated against an in vivo study by comparing range of motion and displacement of the sacrum. Increasing the load intensity for the intact model led to an increase of the rotation of the sacrum but did not change the CoR. Comparison among the instrumented models showed that sacropelvic fixation techniques reduced the rotation of the sacrum and stabilized the SIJ, in particular with triangular implants. CONCLUSION: The study outcomes suggest that increasing load intensity increases the rotation of the sacrum but does not influence the CoR, and use of sacropelvic fixation increases the stability of the SIJ, especially when triangular implants are employed. CLINICAL RELEVANCE: The choice of the instrumentation strategy for sacropelvic fixation affects the stability of the construct in terms of both range of motion and axes of rotation, with direct consequences on the risk of failure and mobilization. Clinical studies should be performed to confirm these biomechanical findings.

Introducción: La Osteonecrosis Maxilar asociada a Medicamentos (ONMAM) constituye uno de los efectos adversos más relevantes en el tratamiento con drogas antirresortivas como bifosfonatos y denosumab. Patologías oncológicas como mieloma múltiple, cáncer de mama, próstata, y alteraciones óseas-metabólicas como la osteoporosis lideran las indicaciones para estas terapias antirresortivas. El tratamiento es complejo debido a que muchas veces, la enfermedad es refractaria a la terapéutica aplicada. Se describen tratamientos farmacológicos, conservadores y quirúrgicos. Objetivo: El objetivo de este trabajo es reportar dos casos clínicos de ONMAM tratados con dos protocolos terapéuticos diferentes y el análisis de la literatura disponible en la actualidad sobre estos aspectos en base a la clasificación clínica definida por la American Association of Oral and Maxillofacial Surgeons (AAOMS). Conclusión: Los pacientes que desarrollan cuadros clínicos bucales de gran morbilidad como lo es ONMAM, pueden ver condicionada su calidad de vida y sufrir un agravamiento de su patología de base. El tratamiento de ONMAM está condicionado al estadio de la enfermedad, el éxito del mismo depende del manejo interdisciplinario y de un estricto seguimiento clínico médico y odontológico, así como también un riguroso monitoreo para evitar o detectar precozmente futuras recurrencias.

An 18-year-old male was referred to our institution with a labial swelling of 45 days of evolution located on the upper lip. The patient was healthy, without systemic diseases or mental disabilities. No relevant family medical history was recorded during anamnesis. The patient mentioned that the lesion began as a painful small inflammation of the lip that increased in size. The patient consulted a general physician, who ordered laboratory tests to rule out syphilis diagnosis. Subsequently, the patient was treated with amoxicillin for 1 month with no improvement of the lesion. Labial discomfort became more intense, presenting episodes of pus discharge and suppuration of a whitish fluid. Clinical examination revealed a mobile, nonfluctuant, slightly firm mass, which measured 1.5 cm in greatest diameter, covered by a surface with normal mucosa (Figure 1). Extraoral examination revealed no facial swelling, asymmetry, or regional lymphadenopathy. Laboratory tests were requested and revealed normal values. Surgical intervention under local anesthesia was performed to arrive at the final diagnosis., Fil: Panico, René Luis. Universidad Nacional de Córdoba. Facultad de Odontología. Oral Medicine Department; Argentina, Fil: Panico, Ignacio. Universidad Católica de Córdoba. Facultad de Ciencias de la Salud. Dentistry School; Argentina, Fil: Leonardi, Nicolás. Universidad Católica de Córdoba. Facultad de Ciencias de la Salud. Oral Medicine Department, Dentistry School; Argentina, Fil: Garola, Federico. Universidad Nacional de Córdoba. Facultad de Odontología. Oral Medicine Department; Argentina, Fil: Gilligan, Gerardo. Universidad Nacional de Córdoba. Facultad de Odontología. Oral Medicine Department; Argentina

Laparoscopic uterosacral ligament suspension (LUSLS) of the vaginal apex for the treatment of pelvic organ prolapse (POP) has gained popularity. The aim of this systematic review is to investigate perioperative outcomes and complications, subjective and objective success rates and recurrence rates in women undergoing this surgical procedure.A systematic literature search was performed in December 2021. The critical appraisal skills program (CASP) was used to assess the methodological quality of the selected studies. The Clavien-Dindo (CD) scale and the Satava scale were used to classify periprocedural complications. Continuous variables were described as means and standard deviations while categorical were expressed as percentages of the whole group. Statistical significance was set at p 0.05.26 articles were selected and analysed, with a total population of 1401 patients. Anatomical and subjective success rates after LUSLS ranged from 79% and 100% and from 76.2% to 100% respectively. The re-operation rate varied from 2% to 4.5% in the largest cohorts. The overall complication rate was 13.6%, however grade III CD complications occurred only in 1% of patients. Ureteral complications were described in only 2 cases.LUSLS represent a safe and effective technique for vaginal apex resuspension in women with POP. Further larger prospective randomized studies are required to confirm these data.

Loa loa is a filarial nematode responsible for loiasis, endemic to West–Central Africa south of the Sahara and transmitted by flies. This study reports a case of L. loa in the vitreous cavity of the eye of a young patient, along with an in-depth literature review. A 22-year-old woman from Cameroon who migrated from Cameroon to Italy was referred to the Emergency Ophthalmology Department at Policlinico di Bari in July 2021 with the presence of a moving parasite in the subconjunctiva of the left eye. A recent onset of a papular lesion on the dorsal surface of the right wrist and a nodular lesion in the scapular region were detected. L. loa filariasis was diagnosed based on anamnestic data, clinical and paraclinical signs, and a parasitological test confirming the presence of microfilariae in two blood samples collected in the morning of two different days. Because of the unavailability of diethylcarbamazine (DEC), albendazole (ALB) 200 mg twice daily was administered for 21 days. A mild exacerbation of pruritus occurred during treatment, but resolved with the use of an antihistamine. A single dose of 12 mg ivermectin was prescribed at the end of the treatment with albendazole. Unlike other endemic parasite infections, L. loa is not included in the Global Program to Eliminate Lymphatic Filariasis, because it is not mentioned in the WHO and CDC list of neglected tropical diseases. This can result in an overall risk of lack of attention and studies on loiasis, with lack of data on global burden of the disease.

Biomechanical finite-element study.To directly compare the biomechanical effects of two different techniques for sagittal plane correction of adult spine deformity based on the anterior longitudinal ligament (ALL) resection and use of hyperlordotic cages, namely, the anterior column realignment (ACR) in L3-4, and ALIF in L5-S1 in terms of primary stability and rod stresses using finite-element models.A finite-element model of the thoracolumbar spine was used to perform the analysis. Starting from this "intact" model, three further models were constructed through the insertion of spinal instrumentation, i.e., pedicle screws, rods and cages: 1) posterior instrumentation between T9 and S1 (referred to as "T9-S1"); 2) posterior instrumentation T9-S1 + Hyperlordotic (26°) ALIF cage in L5-S1 ("ALIF"); 3) posterior instrumentation T9-S1 + Hyperlordotic (30°) ACR cage in L3-4 ("ACR"). These models were studied by simulations applying, alternately, a pure moment of 7.5 Nm between the three planes of motion (flexion, extension, lateral bending, and bilateral axial rotation), uniformly distributed over the upper surface of the T9 thoracic vertebra. A total of 24 simulations were performed (6 per models).All models presented a significant reduced ROM when compared to the intact model; the ROM reduction was higher both at L3-4 in the ACR model and at L5-S1 in the ALIF model. At L3-4, the ACR model had, in all cases, the lowest maximum values of Von Mises stresses on the rods, especially in flexion-extension. At L4-5, the ALIF model had the lowest stresses during flexion-extension and axial rotation, while the ACR model had the lowest stresses during lateral bending. At L5-S1, the ALIF model had, in all cases, the lowest stresses on the rods.This finite-element study showed how both ACR at L3-4 and ALIF-ACR at L5-S1 are effective in restoring lumbar lordosis (LL), stabilizing the spine and reducing stress on posterior rods at the index level when compared to a simple fixation model. Interestingly, ALIF-ACR reduces rod stress even at L4-5 in flexion-extension and axial rotation, possibly due to a better distribution of LL, especially on the lower arch, while ACR reduces the stress at L4-5 in lateral bending, possibly thanks to the larger footprint of the cage that increases the area of contact with the lateral side of the endplates.

Contexto da Pesquisa: A Hipertensão Arterial Sistêmica (HAS) é caracterizada por níveis elevados da pressão arterial sistêmica (acima de 120/80 mmHg) e é considerada um revés da atenção primária, pois associa-se às alterações metabólicas e funcionais em órgãos-alvo. Grande parcela da população hipertensa não realiza o tratamento medicamentoso e não medicamentoso de forma correta. Pergunta problema: Quais os motivos pelo qual os portadores de hipertensão não realizarem o tratamento de maneira correta, tanto no âmbito farmacológico quanto não farmacológico? Objetivo Geral: Identificar, através de um questionário, as possíveis causas de falha na adesão do tratamento medicamentoso e não medicamentoso em indivíduos classificados como idosos (a partir de 60 anos), acometidos pela HAS, adscritas no território da Unidade de Saúde da Família Aeroporto II (USF) em Mogi das Cruzes. Metodologia: Os participantes foram selecionados por meio da análise de fichas da USF e os que se enquadraram responderam um questionário elaborado pelas pesquisadoras. Este foi composto por questões acerca de dados e hábitos pessoais, questões relacionadas com a HAS e a USF e hábitos alimentares. As respostas foram analisadas por meio de gráficos comparando os pacientes. Principais resultados: Foi observada maior prevalência da HAS em mulheres, idosos entre 61 e 70 anos, brancos e que não terminaram a escola. O sedentarismo e a má alimentação foram prevalentes na maioria dos idosos, enquanto o tabagismo e o alcoolismo foram minoria entre os participantes. A maioria dos idosos que interromperam o tratamento da HAS, o fizeram por esquecerem-se da medicação. A diabetes foi a doença mais associada com a HAS. Conclusão: Aqueles idosos que possuíam um estilo de vida mais saudável, apresentaram maior adesão e efetividade no tratamento da HAS. A falha no tratamento foi associada aos hábitos e a falta de compreensão sobre a doença.

Solar greenhouses are currently the most energy-intensive agricultural sector. In literature, there is no worldwide mapping of solar greenhouse performance under different climate scenarios. This study analyzes the performance of a Venlo solar greenhouse for 48 localities around the world. Solar greenhouses are mainly made of a transparent envelope and the effect of the direct and diffuse component of solar radiation impacts the internal plant well-being. This study aims to identify the best solution of a transparent envelope on locations with different latitudes and evenly distributed around the globe. The simulations are carried out using TRNsys, considering different thermal phenomena three-dimensional shortwave and longwave radiative exchange, airflow exchanges, presence of lamps with their exact 3D position, ground, plant evapotranspiration, and convective heat transfer coefficients. A total of 336 simulations are performed in the free-floating regime. A new index for the identification of the best glass solutions based on annual average deviation is defined. For all climates, the best glass solutions work better in winter than in summer. The optimal choice of the glass must be combined with effective scheduling of openings for natural ventilation to avoid internal overheating phenomena.

This article explores the narratives of the Covid-19 crisis in Italy, in the ways that they intersect with cultural memory processes. Moving from the hypothesis that the Covid-19 crisis, in Italy, has undergone two distinct narrative phases, we focus on the comparison between the forms taken, during the first lockdown, by an important (but also somehow divisive) memory ritual: the celebration of 25 April (the day that Italy was liberated from Nazi-Fascism) and the newly established commemorations of Covid-19 casualties. The aim is to observe the osmoses between two discursive domains (memory discourse vs emergency discourse). To do so, we propose the concept of “pre-emptive memory,” which can be defined as an act of—unwitting—anticipation, pre-figuration, and re-combination of the future cultural memory of an ongoing event in the present.

Background. To assess the incremental value of 18F-fluorodeoxyglucose (FDG) cardiac positron emission tomography (PET) over dobutamine stress echocardiography (DSE) in predicting myocardial ischemia in patients with suspected coronary artery disease (CAD). Methods. Forty-one patients with suspected CAD underwent within 7 days apart rest-stress cardiac PET with 82Rb and DSE followed by cardiac 18F-FDG PET imaging. 18F-FDG images were scored on a 0 (no discernible uptake) to 2 (intense uptake) scale. Logistic regression analysis was performed to identify predictors of stress-induced ischemia. The incremental value of 18F-FDG PET over DSE in detecting ischemia at 82Rb PET cardiac imaging was assessed by the likelihood ratio chi-square and net reclassification index. Results. On 82Rb-PET imaging, myocardial ischemia (ischemic total perfusion defect > 5%) was detected in 20 (49%) patients. Inducible ischemia was found in 22 (54%) patients on DSE (biphasic or worsening response pattern in > 1 segment) and in 21 (51%) patients on 18FFDG PET (uptake score of 2 in ‡ 1 segment). 18F-FDG PET resulted as statistically significant predictor of ischemia on 82Rb-PET. The addition of 18F-FDG PET to DSE increased the likelihood of ischemia on 82Rb-PET (P < .05). 18F-FDG PET was able to reclassify the probability of stress-induced myocardial ischemia on both patient and vessel analyses. Conclusion. 18F-FDG PET performed after dobutamine stress test may provide incremental value to DSE in the evaluation of myocardial ischemia. These results suggest that stress induced myocardial ischemia can be imaged directly using 18F-FDG PET after dobutamine stress test.

Background Cardiovascular risk models are based on traditional risk factors and investigations such as imaging tests. External validation is important to determine reproducibility and generalizability of a prediction model. We performed an external validation of t the Japanese Assessment of Cardiac Events and Survival Study by Quantitative Gated SPECT (J-ACCESS) model, developed from a cohort of patients undergoing stress myocardial perfusion imaging. Methods We included 3623 patients with suspected or known coronary artery disease undergoing stress single-photon emission computer tomography (SPECT) myocardial perfusion imaging at our academic center between January 2001 and December 2019. Results In our study population, the J-ACCESS model underestimated the risk of major adverse cardiac events (cardiac death, nonfatal myocardial infarction, and severe heart failure requiring hospitalization) within three-year follow-up. The recalibrations and updated of the model slightly improved the initial performance: C-statistics increased from 0.664 to 0.666 and Brier score decreased from 0.075 to 0.073. Hosmer–Lemeshow test indicated a logistic regression fit only for the calibration slope (P = .45) and updated model (P = .22). In the update model, the intercept, diabetes, and severity of myocardial perfusion defects categorized coefficients were comparable with J-ACCESS. Conclusion The external validation of the J-ACCESS model as well as recalibration models have a limited value for predicting of three-year major adverse cardiac events in our patients. The performance in predicting risk of the updated model resulted superimposable to the calibration slope model.

Através do estudo estrutural da íris permite-se a avaliação de registros associados à saúde física e psicossomática. Complexa em sua vasta capacidade de codificação, são as notórias respostas da íris durante momentos alegres, tristes, estado de alerta e fadiga nos seres humanos. É uma das estruturas mais nobres do corpo humano, extremamente pigmentada e vascularizada, única como a digital, haja vista sua conexão com todos os órgãos e sua demonstração sensorial visíveis tanto macro quanto microscopicamente. Objetiva-se descrever através de revisão bibliográfica, a importância da iridologia para a optometria na área dos cuidados primários, corroborando para identificar além de alterações oculares, problemas ocultos ou vindouros, contribuindo em hipótese diagnóstica com visão holística e no direcionamento para setores multidisciplinares, evitando filas no sistema único de saúde (SUS) que já adota programas de práticas integrativas e complementares (PICS), como solução para o cuidado humano de maneira integrativa.

The dynamics of the true-vacuum bubbles nucleated during a first-order phase transition is affected by the distribution functions of the particle species in the plasma, driven out-of-equilibrium by the travelling domain wall. An accurate modelling of this phenomenon is relevant for a quantitative description of phase transitions in the early universe and for the determination of the corresponding cosmic relics, such as, among the others, the stochastic background of gravitational waves. We address this problem by developing a new spectral method devised for a fast and reliable computation of the collision integral in the Boltzmann equations. In a scalar singlet extension of the Standard Model chosen as a benchmark scenario, we test our algorithm, determining the bubble speed and profile, and we asses the impact of the out-of-equilibrium dynamics., Comment: 18 pages, 3 figures

BackgroundAim of this study was to define the prognostic value of stress myocardial perfusion imaging by cadmium zinc telluride (CZT) single-photon emission computed tomography (SPECT) for prediction of adverse cardiovascular events in patients with known or suspected coronary artery disease (CAD).Methods and ResultsStudies published until November 2022 were identified by database search. We included studies using stress myocardial perfusion imaging by CZT-SPECT to evaluate subjects with known or suspected CAD and providing primary data of adverse cardiovascular events. Total of 12 studies were finally included recruiting 36,415 patients. Pooled hazard ratio (HR) for the occurrence of adverse events was 2.17 (95% confidence interval, CI, 1.78-2.65) and heterogeneity was 66.1% (P=0.001). Five studies reported data on adjusted HR for the occurrence of adverse events. Pooled HR was 1.69 (95% CI, 1.44-1.98) and heterogeneity was 44.9% (P=0.123). Seven studies reported data on unadjusted HR for the occurrence of adverse events. Pooled HR was 2.72 (95% CI, 2.00-3.70). Nine studies reported data useful to calculate separately the incidence rate of adverse events in patients with abnormal and normal myocardial perfusion. Pooled incidence rate ratio was 2.38 (95% CI, 1.39-4.06) and heterogeneity was 84.6% (PP=0.517). At meta-regression analysis, we found an association between HR for adverse events and presence of angina symptoms and family history of CAD.ConclusionsStress myocardial perfusion imaging by CZT-SPECT is a valuable noninvasive prognostic indicator for adverse cardiovascular events in patients with known or suspected CAD.

According to both definitions of US Centers for Disease Control and Prevention and World Health Organization, Neglected Tropical Diseases (NTDs) are a group of preventable and treatable parasitic, viral, and bacterial diseases that affect more than one billion people globally. They generally afflict the more indigent patients of the world and historically have not received as much attention as other diseases. NTDs tend to thrive in low-income regions, where water quality, sanitation and access to health care are substandard. They are common in several countries of Africa, Asia, and Latin America. In this literature review, we want to focus on Human African Trypanosomiasis (HAT), also known as “sleeping sickness”, one of the most common neglected diseases in Africa. It is caused by infection with the subspecies of the parasitic protozoan Trypanosoma brucei, and it is transmitted by the bite of the tsetse fly. It puts 70 million people at risk throughout sub-Saharan Africa and it is usually fatal if untreated or inadequately treated. This review covers several aspects of the disease. We focused our interests on most recent epidemiological data, novel diagnostic methods with their advantages and limitations, new improved treatment and orphan drugs and eradication programs, including vector control, according to a “One Health” approach, to achieve the new goals recently set by WHO.

This article seeks to investigate the role that a symbol—connected to a legal event and a collective trauma—has in the construction of a past imaginary. It begins with a theoretical reflection on the role of the symbol as proposed by Juri Lotman and the function of repetition in the consolidation of collective memory. It subsequently focuses on the semiotic resonance of one specific object: the bulletproof cabin of the Nazi criminal Adolf Eichmann, used during his trial in Jerusalem, in 1961. I consider the ‘afterlives’ of this object, examining the different ‘remakes’ of Eichmann’s cabin in several mediatic and artistic contexts, focusing on the modalities that have anchored it to the post-1961 imaginary of the perpetrator and the legal consequences of his actions. To do so, the article proposes a typology of uses of the cabin, identifying the different nuances of its representation and how they encapsulate the thorny issues surrounding that infamous legal event.

Peer reviewed: True, Funder: Fondazione Policlinico Agostino Gemelli—IRCCS, Breast cancer (BC) is the most common cancer among women worldwide. Neoadjuvant chemotherapy (NACT) indications have expanded from inoperable locally advanced to early-stage breast cancer. Achieving a pathological complete response (pCR) has been proven to be an excellent prognostic marker leading to better disease-free survival (DFS) and overall survival (OS). Although diagnostic accuracy of MRI has been shown repeatedly to be superior to conventional methods in assessing the extent of breast disease there are still controversies regarding the indication of MRI in this setting. We intended to review the complex literature concerning the tumor size in staging, response and surgical planning in patients with early breast cancer receiving NACT, in order to clarify the role of MRI. Morphological and functional MRI techniques are making headway in the assessment of the tumor size in the staging, residual tumor assessment and prediction of response. Radiomics and radiogenomics MRI applications in the setting of the prediction of response to NACT in breast cancer are continuously increasing. Tailored therapy strategies allow considerations of treatment de-escalation in excellent responders and avoiding or at least postponing breast surgery in selected patients.

Background. The purpose of this study was to assess the prognostic value of cardiac 82Rb positron emission tomography (PET)/computed tomography (CT) imaging in patients with myocardial ischemia of nonobstructive coronary arteries (INOCA). Methods. We retrospectively evaluated 311 INOCA patients who underwent rest stress 82Rb PET/CT. Cardiac end points were cardiac death, myocardial infarction, or late coronary revascularization. A parametric survival model was also used to identify how the variables influenced time to event. Results. During a median follow-up of 37 months (range 6–108), 23 (7%) cardiac events occurred. In patients with events total perfusion defect (TPD) was higher and myocardial flow reserve (MFR) lower compared to those without events (both P < .001). At multivariable Cox analysis, increased TPD (i.e., ‡ 5%) and reduced MFR (i.e., < 2) were predictors of events (both P < .001). At Weibull survival analysis, the highest probability of cardiac events and risk acceleration were observed in patients with both increased TPD and reduced MFR. Annualized event rate was higher in patients with reduced MFR compared to those with preserved MFR (P < .001). Conclusion. In patients with INOCA, the combined evaluation of myocardial perfusion and coronary vascular function by 82Rb PET/CT is able to identify those at higher risk of cardiac events.

Oral squamous cell carcinoma (OSCC) is a multifactorial disease. The individual effect of each risk factor for OSCC may be conditioned by the frequency of other factors. The objective of this study was to identify the association between chronic mechanical irritation (CMI) and OSCC and to analyse the influence of CMI on other important risk factors for OSCC.A prospective and age/sex-matched case-control study was performed in two institutions from Argentina between 2009 and 2019, with consecutive and newly diagnosed OSCC. The frequencies of tobacco, alcohol, and CMI were analysed using conditional logistic regression. Cumulative tobacco consumption and the presence of CMI were analysed using the Mann-Whitney test.CMI and OSCC were associated with an OR of 7.02 (95% CI 3.57-13.78, p0.001). The combination of CMI and alcohol demonstrated the highest risk of OSCC (OR 53.83, CI 95% 8.04-360, p0.0001), followed by the combination of CMI, tobacco, and alcohol (OR 48.06, CI 95% 8.47-272, p0.0001). The combination of CMI and tobacco was also significant (OR 5.61, CI 95% 1.07-29.54, p = 0.042). Patients with CMI developed OSCC with less cumulative tobacco use compared with those without CMI.CMI is an independent risk factor for OSCC, and it could act as a risk modifier among tobacco and alcohol users having an enhancing effect.Elimination of CMI could decrease the risk of OSCC.

The Grammont-style reverse shoulder arthroplasty (RSA) relies on medialization and distalization of the shoulder center of rotation. Lateralized designs have recently gained popularity. The amount of lateralization, however, remains a controversial topic. The purpose of this study was to correlate the change in humeral offset (HO) with outcomes and complications following RSA. We hypothesized that a lateralized HO following RSA would be associated with improved range of motion (ROM), better patient-reported outcomes (PROs), and fewer complications.A consecutive series of 104 patients (109 shoulders) was retrospectively evaluated. All patients underwent primary RSA by 2 shoulder and elbow fellowship-trained orthopedic surgeons at 2 different centers. Inclusion criteria was a primary RSA with at least 1-year follow-up. All patients had the HO measured on a preoperative and a postoperative Grashey radiograph, and the change in HO was calculated (ΔHO = The mean age was 72 years with a mean follow-up of 22.3 months. The average FE (92° vs. 148°), ER (34° vs. 44°), SSV (35% vs. 87%), and ASES score (37.2 vs. 81.2) increased significantly (all P .01) compared with preoperative values. The HO was medialized postoperatively in 63 shoulders and lateralized in 46 shoulders. No statistically significant differences in the mean values for postoperative FE (147° vs. 146°, P = .892), ER (43° vs. 45°, P = .582), IR (L3 vs. L3, P = .852), SSV (88% vs. 85%, P = .476), and ASES score (81.3 vs. 81.1, P = .961) were found between the groups. However, there was significantly more improvement in ER in the lateralized HO cohort than the medialized cohort (16° vs. 7°, P = .033). Six shoulders, 5 medialized and 1 lateralized HO, demonstrated scapular notching and remained asymptomatic. Five shoulders, 4 medialized and 1 lateralized HO, experienced at least 1 instability incident, and 2 shoulders with medialized HO had an acromion/scapular spine fracture. Overall, 2 shoulders with medialized HO underwent revision surgery because of instability.Although RSA provides significant improvement in ROM and PROs regardless of postoperative HO, restoring baseline HO or lateralization beyond baseline may be favorable for improving ER and decreasing complications following RSA.

This study was carried out to evaluate the forage quantity and quality of several halophyte species grown in arid-saline environments. After identifying 44 halophytic species in the region and considering the potential of quantitative and qualitative forage production, 13 species from four families, i.e. Amaranthaceae, Asteraceae, Leguminosae and Convolvulaceae, and eight genera were selected for further evaluation. These species differed significantly in terms of both forage quantity, measured in terms of fresh (FW) and dry weight (DW), and forage quality assessed in terms of tissue water content (TWC), ash, nitrogen content (N), crude protein (CP), acid detergent fiber (ADF), neutral detergent fiber (NDF), dry matter digestibility and metabolizable energy (ME). The highest fresh and dry weights were obtained from Suaeda ferticosa (1006.3 g and 306.3 g, respectively) and Noaea mucronata (909.3 g and 309 g, respectively). However, based on forage quality characteristics, Alhagi maurorum, Bassia scoparia, Noaea mucronata, Halostachys belangriana and Cressa cretica showed the best forage potential. Values of ash, CP, ADF, NDF and ME measured in the halophytes species ranged between 7.9% and 33.2%, 6.2% and 15.8%, 30.0% and 50.3%, 33.2% and 56.4%, 5.6 and 8.7 MJ kg−1, respectively. The forage quality of the evaluated halophytic plants was influenced by unfavorable environmental conditions such as high soil salinity and low rainfall, however, these species can be considered as new sources of forage. Nevertheless, further studies are needed to improve the quality of such halophytic species by reducing the ash content and increasing the ME.

BACKGROUND: To examine the associations of animal and plant protein intake with all-cause, cardiovascular and cancer mortality risk in middle-aged Italian men and women with substantially lower animal protein intake than North Americans. METHODS AND RESULTS: Food consumption was assessed by validated Epic semiquantitative FFQs. Multivariable Cox models stratified by center, age, and sex, and adjusted for confounders, estimated associations of animal and plant protein consumption with mortality for all causes, cardiovascular disease, and cancer. After a median follow-up of 15.2 years, 2,449 deaths were identified in 45,009 participants. No significant association between intake of total, animal or plant protein and mortality was found in the fully adjusted models. Substitution of plant protein for animal protein was inversely associated with cardiovascular mortality (HR, 0.47; 95% CI, 0.24–0.92) only in people with at least 1 unhealthy lifestyle risk factor and poor adherence to a Mediterranean diet. Participants in the highest quintile group of animal protein intake had higher glucose, total and LDL cholesterol levels than those in the lowest quintile. In contrast, higher plant protein intake was negatively associated with fasting insulin and cholesterol, despite higher BMI, physical inactivity and starch consumption. CONCLUSIONS: Replacing plant protein for animal protein was associated with lower cardiovascular mortality among individuals with unhealthy lifestyle risk factors. High animal but not plant protein intake is associated with impaired fasting glucose and hypercholesterolemia, despite lower calorie and carbohydrate intake, suggesting that protein source plays crucial roles in modulating cardiometabolic health independently of body weight.

Aims This study aimed to evaluate the association between physical activity and the incidence of coronary heart disease (CHD) in individuals with and without CHD risk factors. Methods and results EPIC-CVD is a case-cohort study of 29 333 participants that included 13 582 incident CHD cases and a randomly selected sub-cohort nested within the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort. Self-reported physical activity was summarized using the Cambridge physical activity index (inactive, moderately inactive, moderately active, and active). Participants were categorized into sub-groups based on the presence or the absence of the following risk factors: obesity (body mass index ≥30 kg/m2), hypercholesterolaemia (total cholesterol ≥6.2 mmol/L), history of diabetes, hypertension (self-reported or ≥140/90 mmHg), and current smoking. Prentice-weighted Cox regression was used to assess the association between physical activity and incident CHD events (non-fatal and fatal). Compared to inactive participants without the respective CHD risk factor (referent), excess CHD risk was highest in physically inactive and lowest in moderately active participants with CHD risk factors. Corresponding excess CHD risk estimates amongst those with obesity were 47% [95% confidence interval (CI) 32–64%] and 21% (95%CI 2–44%), with hypercholesterolaemia were 80% (95%CI 55–108%) and 48% (95%CI 22–81%), with hypertension were 80% (95%CI 65–96%) and 49% (95%CI 28–74%), with diabetes were 142% (95%CI 63–260%), and 100% (95%CI 32–204%), and amongst smokers were 152% (95%CI 122–186%) and 109% (95%CI 74–150%). Conclusions In people with CHD risk factors, moderate physical activity, equivalent to 40 mins of walking per day, attenuates but does not completely offset CHD risk.

Este artigo de campo, resultado de pesquisa de natureza empírica, trata de uma experiência de formação - parte de um programa em realização - de Técnicos da Secretaria de Educação de diversas localidades para atuarem como agentes de mobilização social. Tal formação está baseada no estudo e em experiências práticas que favorecem a reflexão sobre as concepções de mobilização social e de formação de Redes Sociais como uma alternativa para que diferentes atores da sociedade possam atuar em prol de questões complexas e policausais como a Educação. A prática se dá por meio de encontros formativos e pela experiência da participação desses técnicos como integrantes e facilitadores de Redes Sociais, atuando em conjunto com diversos atores da sociedade civil. Nas Redes Sociais são desenvolvidas ações que contribuem para a educação pública de qualidade, com a mediação de formadores. O artigo apresenta a experiência de trabalho da Comunidade Educativa CEDAC no contexto de parceria técnica no programa Parceria pela Valorização da Educação (PVE) promovido pelo Instituto Votorantim em parceria com Secretarias Municipais de Educação. Busca sistematizar algumas estratégias formativas e analisar os efeitos desse trabalho na participação social na educação e também na abertura das Gestões Educacionais para atuar em parcerias dentro da proposta de uma gestão democrática. Destaca o princípio de ação-reflexão-ação e a atuação conjunta entre técnico mobilizador e formador como aspectos chave da formação.

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