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Introduction: Bartolomeo Vivarini (Venezia 1432c.-Venezia 1499c.) was an Italian painter during the Renaissance. The artist was widely influenced by Andrea Mantegna, whose opera was characterized by personages with anatomical details meticulously described., Materials and Methods: Some of the most valued paintings of Bartolomeo Vivarini were analyzed. Purpose of the present article is to describe these artworks focusing on female personages represented with thyroid swelling., Results: A recurring female model in Vivarini's artworks is portrayed with a goitrous neck. This might display a real prevalence of thyroid diseases among young women in the Renaissance age (e.g. postpartum thyroiditis)., Conclusions: Representation of goiter in the artworks of Vivarini and Mantegna reflects the increased anatomic accuracy and knowledge developed in art since Renaissance and Baroque.

During the second half of the twentieth century, coastal lagoons in densely populated regions experienced eutrophication due to excessive nutrient inputs. Detrimental effects, including hypoxia/anoxia and harmful algae blooms, have occurred in many Mediterranean lagoons, but their trophic evolution is poorly documented. The lack of adequate monitoring data can partly be offset by examining sedimentary records. In the Mar Piccolo, a lagoon comprising two basins near Taranto (Italy), eutrophication has followed population growth and pollution resulting from naval activities and massive industrialisation. Based on 210 Pb-dated sediment cores, continuous in situ density profiles obtained with computed tomography, organic carbon (OC) and total nitrogen (TN) content and OC and TN isotopic signatures, this paper reconstructs the history of eutrophication, discusses the sources of organic matter and provides an estimate of the OC burial rate before and during the eutrophic period. OC burial increased in the period 1928-1935 and peaked in the decade 1960-1970. OC and TN content were still high in the surface sediments collected in 2013, despite partial diversion of sewage outfalls in the period 2000-2005. The divergent δ 13 C and δ 15 N signatures of the two basins during the eutrophic period suggest they were affected by different nutrient sources. The OC burial rate during the eutrophic phase (≈ 46 g m -2 y -1 ) was close to the world median value for lagoon sediments, and was about twice the burial rate recorded in the preceding oligotrophic phase., (© 2023. The Author(s).)

The church of San Bernardino in Ivrea (Piedmont) houses a cycle of frescoes of "The Life of Christ" by the Italian painter Giovanni Martino Spanzotti. In the painting, a damned soul of the Hell with a large bi-lobar goiter is represented, confirming the interest of Renaissance artists towards thyroid diseases., (© 2021. Italian Society of Endocrinology (SIE).)

Part 2 presents detailed genealogic information on Josephine Imperato's paternal and maternal lineages extending from four to seven generations into the nineteenth and eighteenth centuries. Among these lineages are some where early adult death over successive generations is perhaps indicative of type 2 diabetes mellitus (type 2 DM). These lineages, all in the town of San Prisco in Italy, include both paternal and maternal ones with the following surnames: Casaccia, Casertano, Cipriano, de Angelis, de Paulis, Peccerillo, Foniciello, di Monaco, Vaccarella, Valenziano, Ventriglia, and Zibella. Genealogic studies of eighteenth and nineteenth century vital records in this area of Italy cannot definitively establish type 2 diabetes mellitus as either an immediate or contributory cause of death. This is because causes of death were not recorded and because disease diagnostic capabilities were largely absent. Genealogic studies of those who lived in Italy in the eighteenth and nineteenth centuries can at best provide data on approximate age at time of death. Early adult death in this era was not uncommon. However, its presence over several successive generations in a lineage raises the possibility of inherited diseases prominent among which is type 2 DM.

Establishing the role of heredity in type 2 diabetes mellitus (type 2 DM) is challenging. While type 2 DM frequently displays a pattern of familial aggregation, many other risk factors are responsible for the clinical expression of the disease. This paper reviews a number of the early twentieth-century studies of inheritance patterns for type 2 DM and presents in detail the history of Josephine Foniciello Imperato (Maria Giuseppa Foniciello) who died from the disease in New York City at the age of 52 years on 14 November 1921, ten months before commercial insulin became available.

Consulti are one of the most interesting sources for reconstructing a true outline of the state of the medical art in the Early Modern period. They were epistulae--in Latin as well as in vernacular--sent to famous physicians to receive a more correct diagnosis, and better therapeutical prescriptions. They collect and illustrate case studies, therapeutical uses, as well as the patient's attitude towards disease. This article concerns five urological consulti by Marcello Malpighi.

Purpose: The Primavera is considered amongst the greatest and controversial artistic masterpieces worldwide painted by renaissance artist Sandro Botticelli. The aim was to identify any underlying medical foundations for the painting., Methods: Observational study., Results: The painting reveals, a 'butterfly' malar rash, bilateral ptosis and a clear neck swelling consistent with a goitre in the figure of Flora. This could be explained by concomitant Graves' disease and systemic lupus erythematosus, or other presentations of multiple autoimmune syndrome., Conclusion: These findings highlight the likely presentation of the earliest pictorial depictions of thyroid disease with systemic lupus erythematosus and emphasize the exactitude of depiction demonstrated by Botticelli in renaissance era., (© 2021. The Author(s).)

Alessandro Bonvicino (c. 1498-1554), commonly known as Il Moretto da Brescia, was an Italian Renaissance painter. In his "The Adoration of Shepherds" (1539-1540), a shepherd shows a bi-lobar goiter. The painter was active in a geographical area, where inhabitants often suffered from endemic goiter due to dietary iodine deficiency and could have influenced Moretto.

Purpose: There are many of the representations in iconography of individuals with goiters reported in the literature., Methods: The article describe a unique representation of goiter, as observed by the authors in a sculpture in Italy., Results: In a Nativity, in the upper part of the altar of the Church of the Annunciata, Boccioleto (Val Sermenza, Piedmont, Italy), a horn player with a huge goiter, gladdens the Holy Family. Wooden work by Francesco Antonio d'Alberto, 1694., Conclusion: This is an appropriate example of the iconography of "real goiter," since in this case the sculptor had the aim of showing person with goiter.

This paper re-investigates the time-varying impacts of economic growth on carbon emissions in the G-7 countries over a long history. In doing so, the historical data spanning the period from the 1800s to 2010 (as constructed) for each country is examined using the time-varying cointegration and bootstrap-rolling window estimation approach. Unlike the previous environmental Kuznets curve (EKC) studies, using this methodology gives us avenue to detect more than one, two, or more turning points for the economic growth-carbon emissions nexus. The empirical findings show that the nexus between economic growth and carbon emission seems over a long history to be M-shaped for Canada and the UK; N-shaped for France; inverted N-shaped for Germany; and inverted M-shaped (W-shaped) for Italy, Japan, and the USA. In addition, the possible validity of EKC hypothesis is examined for both the pre-1973 and post-1973 sub-periods. Based on this investigation, we found that an inverted U-shaped is confirmed only for the pre-1973 period in France, Italy, and the USA. These empirical evidences provide new insights to policy makers to improve environmental quality using economic growth as an economic tool for the long run by observing changes in the environmental impact of this growth from year to year.

Aims: This joint document of the Italian Diabetes Society and the Italian Society of Nephrology reviews the natural history of diabetic kidney disease (DKD) in the light of the recent epidemiological literature and provides updated recommendations on anti-hyperglycemic treatment with non-insulin agents., Data Synthesis: Recent epidemiological studies have disclosed a wide heterogeneity of DKD. In addition to the classical albuminuric phenotype, two new albuminuria-independent phenotypes have emerged, i.e., "nonalbuminuric renal impairment" and "progressive renal decline", suggesting that DKD progression toward end-stage kidney disease (ESKD) may occur through two distinct pathways, albuminuric and nonalbuminuric. Several biomarkers have been associated with decline of estimated glomerular filtration rate (eGFR) independent of albuminuria and other clinical variables, thus possibly improving ESKD prediction. However, the pathogenesis and anatomical correlates of these phenotypes are still unclear. Also the management of hyperglycemia in patients with type 2 diabetes and impaired renal function has profoundly changed during the last two decades. New anti-hyperglycemic drugs, which do not cause hypoglycemia and weight gain and, in some cases, seem to provide cardiorenal protection, have become available for treatment of these individuals. In addition, the lowest eGFR safety thresholds for some of the old agents, particularly metformin and insulin secretagogues, have been reconsidered., Conclusions: The heterogeneity in the clinical presentation and course of DKD has important implications for the diagnosis, prognosis, and possibly treatment of this complication. The therapeutic options for patients with type 2 diabetes and impaired renal function have substantially increased, thus allowing a better management of these individuals.

Vincenzo Malacarne, professor of medicine, surgery, and obstetrics in Turin, Pavia, and Padua, Italy, represented a perfect example of an eighteenth century "letterato", combining interests in humanities, sciences, and politics, embodying the ideal of an encyclopedic and universal culture. He made important contributions in anatomy and surgery, teratology, obstetrics, neurology, and history of medicine, adopting a interdisciplinary approach based on the correlation between anatomy, surgery, and clinics. He deserves a special place in the history of neurology because of the first complete description of the human cerebellum. He quantified the units of the cerebellar internal structures, the lamellae being numbered for a systematic description of the human cerebellum. He thought the mental faculties depended on their number, considering a relation between the number of cerebellar lamellae and the expression of intellectual faculties. In this way, he made first statistics on human faculties. He advanced the concept that the number of cerebellar folia was influenced by the environment, thus providing the first nature-nurture hypothesis made on the basis of observations, and the concept of neuroplasticity in the scientific literature. Finally, he also contributed to the emergence of a new science, namely electrophysiology, because he laid down experimental foundations of a project on the recording of brain electricity, comparing the structure of the human brain with Volta's galvanic pillar.

CKD is utilized as a paradigm, a chronic disease which allows decades of life conquered with great effort through a machine, a life with many losses and many dependencies. We must understand the patient's needs, which are not related to availability of drugs and machines and hospitals. We cannot provide good medical care with the limited amount of national product devoted to health care. Society is much older than ever before. We need a new cadre of economists working on health care with vision and ability, keeping in mind that there are no resources and there are no expenses which can be cut in medical care nowadays. We have to switch from curative medicine towards prevention, by implementing clinical research, bearing in mind that in the Western world, democracy was granted through the correct allocation of resources. The search for happiness and good quality of life are old concepts born in the Mediterranean area over the centuries, starting with Hesiod and Homer, and sleep and dreams were being investigated centuries before Freud was born.

Clinal variation in body size and related life history traits is common and has stimulated the postulation of several eco-geographical rules. Whereas some clinal patterns are clearly adaptive, the causes of others remain obscure. We investigated intra-specific body size, development time and female fecundity (egg size and number) clines across 13 European populations of the dung fly Sepsis fulgens spanning 20° latitude from southern Italy to Estonia in a genetic common garden approach. Despite very short generation times (ca. 2 weeks at 24 °C), we found a converse Bergmann cline (smaller size at higher latitudes). As development time did not change with latitude (flat cline), integral growth rate thus likely declines towards the pole. At the same time, early fecundity, but not egg size, increased with latitude. Rather than being mediated by seasonal time constraints, the body size reduction in the northernmost flies from Estonia could suggest that these are marginal, edge populations, as when omitting them the body size cline became flat as well. Most of the other sepsid species investigated to date also show flat body size clines, a pattern that strikingly differs from Drosophila. We conclude that S. fulgens life history traits appear to be shaped by similar environmental pressures and selective mechanisms across Europe, be they adaptive or not. This reiterates the suggestion that body size clines can result as a secondary consequence of selection pressures shaping an entire life history syndrome, rendering them inconsistent and unpredictable in general.

Purpose: Risk factors for sporadic GEP-NENs are still not well defined. To identify the main clinical risk factors represents the aim of this study performed by three Italian referral centers for NENs., Methods: We performed a retrospective case-control study including 148 consecutive sporadic GEP-NENs and 210 age- and sex-matched controls. We collected data on clinical features, cancer family history and other potential risk factors., Results: Mean age was 58.3 ± 15.8 years; 50% males, primary site was pancreas (50.7%), followed by ileum (22.3%). The 62.8% and 29.1% of cases were G1 and G2, respectively; the 40% had locally advanced or metastatic disease at diagnosis. Independent risk factors for GEP-NENs were: family history of non-neuroendocrine GEP cancer (OR 2.16, 95% CI 1.31-3.55, p = 0.003), type 2 diabetes mellitus (T2DM) (OR 2.5, 95% CI 1.39-4.51, p = 0.002) and obesity (OR 1.88, 95% CI 1.18-2.99, p = 0.007). In the T2DM subjects, metformin use was a protective factor (OR 0.28, 95% CI 0.08-0.93, p = 0.049). T2DM was also associated with a more advanced (OR 2.39, 95% CI 1.05-5.46, p = 0.035) and progressive disease (OR 2.47, 95% CI 1.08-5.34, p = 0.03). Stratifying cases by primary site, independent risk factors for pancreatic NENs were T2DM (OR 2.57, 95% CI 1.28-5.15, p = 0.008) and obesity (OR 1.98, 95% CI 1.11-3.52, p = 0.020), while for intestinal NENs family history of non-neuroendocrine GEP cancer (OR 2.46, 95% CI 1.38-4.38, p = 0.003) and obesity (OR 1.90, 95% CI 1.08-3.33, p = 0.026)., Conclusion: This study reinforces a role for family history of non-neuroendocrine GEP cancer, T2DM and obesity as independent risk factors for GEP-NENs and suggests a role of metformin as a protective factor in T2DM subjects. If confirmed, these findings could have a significant impact on prevention strategies for GEP-NENs., (© 2021. Italian Society of Endocrinology (SIE).)

For many centuries, unwed mothers in southern Italy were forced to surrender their infants because of a number of social, religious, economic, and political pressures. This study focuses on the policies and practices that were in place in southern Italy regarding illegitimate infants in the late nineteenth century. A detailed analysis of the policies and practices present in the town of Forio d'Ischia during the 20-year period 1880-1899 is also presented. During these two decades, there were 37 illegitimate live births representing 0.70% of the 5249 live births recorded in this town. Although small in number, these illegitimate births, referred to as spuri in Italian, from the Latin spurius, meaning bastard, were managed by standard predetermined procedures. These included anonymity for the parents, the transfer of such infants to an official town receiver of foundlings, and their transport to Naples' orphanage, the Real Casa Santa dell'Annunziata. This orphanage maintained fairly detailed records about the children who were delivered to it. After a few days at the orphanage, infants were often entrusted to the care of external wet nurses, preferably outside of Naples. This was done in the belief that infant survival was better assured in more rural environments. The case of an illegitimate infant, Antonino Spinalbese, is presented in detail. Born on 14 February 1882 in the town of Forio d'Ischia, he was brought to the orphanage 4 days later. Following a two-day stay at the orphanage, he was entrusted to an external wet nurse, Michele Mondella, and her husband, Ciro Fiscale di Felice, a mariner in the town of Torre del Greco. The available evidence indicates that Antonino Spinalbese became a mariner like his stepfather. As a crew member of the passenger ship, Vulcano, he made three trips from Naples to New York City in 1922 and 1923.

Ferruccio Ritossa wrote these lines only a few months before he died, as a preface to a book he wanted to write and that, unfortunately, we will never be able to read. It was to be the story of his life, an amazing story indeed. With this article, we want to take a picture of Ferruccio's life, a mosaic of events, facts, ideas, hopes, and memories linked in a way that they will not go away, even after "a stroll in our brain."

The second world cholera pandemic in Europe (1829-1849) was significant because of its geographic extent and the enormous numbers of people who fell ill or died. It was also singularly important because it demonstrated the profound levels of ignorance in both Europe and North America concerning the cause, modes of transmission, and treatment of cholera. This paper discusses the pandemic in the Kingdom of the Two Sicilies in great detail. Even though medical and public health authorities in this kingdom had several years to prepare for cholera's eventual arrival in 1836-1837, their elaborate preventive and therapeutic measures proved no more successful than elsewhere. Despite their efforts, it was estimated that there were 32,145 cases of cholera in the city of Naples by July 1837. Some 19,470 people were estimated to have died among the city's then 357,283 population. This amounted to a cholera-specific mortality rate of 54.5/1000 population. Sicily was also severely affected by the epidemic. It was estimated that 69,000 people died of cholera in Sicily, 24,000 of them in the city of Palermo. Two rural towns in the kingdom, San Prisco and Forio d'Ischia, were selected for in-depth epidemiologic study. The former had a population of 3700 in 1836-1837, while the latter had a population of 5500. The economic basis of both towns was agriculture. However, because Forio is located on an island, fishing and sea transport were then also important industries. Cholera appeared in San Prisco in July 1837 and quickly swept through the population. By August, the epidemic was essentially over. It is estimated that some 109 people died from cholera in San Prisco for a disease-specific mortality rate of 29.5/1000 population. The age range of those who died from cholera was 1 to 90 years. The majority of deaths (60.6 %) were among women. The first cases of cholera appeared in Forio d'Ischia in June 1837. The epidemic then peaked in July. It is estimated that approximately 316 people died from cholera in Forio out of a population of 5500. This resulted in a cholera-specific mortality rate of 57.5/1000 population. Among the first 42 fatal cases in whom the disease was documented on their death certificates, ages ranged from 15 to 88 years. The mean age was 52.4 years. The majority of deaths (57.1 %) were among women. We reached beyond the statistics of this epidemic by presenting an in-depth study of the first person to die from cholera in Forio d'Ischia, Nicola Antonio Insante. By focusing on him, we were able to develop a broad account of the social and economic consequences of his death on his family. At the same time, our research demonstrated the resiliency of his immediate and distant descendants. Similarly, we discuss the D'Ambra and Scola families of Forio d'Ischia, and the Caruso and Valenziano families of San Prisco, among whom a number died from cholera in 1837.

The teaching of nephrology and of practical medicine in general (that is, clinical medicine) in Naples University (Studium) in the 17th and 18th centuries can be reconstructed through a plurality of textual testimonies: prominent among them the manuscript of students' notes. Notes taken by students attending the lessons of the prominent physician and scientist Nicola Cirillo (1671-1735) are here compared with the published textbook by his teacher Luca Tozzi (1638-1727), as well as with data gathered from a collection of consultations by Cirillo, in order to reconstruct the actual contents of the teaching and clinical practice of nephrology in Naples in that period.