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To evaluate the effects of rehabilitation (physical and cognitive) treatments on the diagnosis severity and Disability Rating Scale (DRS) scores, adjusted for a number of potential confounders measured at baseline, in a large cohort of patients with disorders of consciousness across time.An observational, longitudinal (2 evaluations), multicenter project was made in 90 Italian centers.Patients (N=364) with a diagnosis of disorders of consciousness.Primary outcome was the severity of diagnosis, expressed on an ordinal scale (OtherMCSVSdeath). In the Other group were included patients who emerged from an MCS and recovered consciousness. The secondary outcome was the DRS score (range of 0-30 with 30 being the worst value). The DRS is a tool used to define the level of residual disability, commonly used to classify the level of functional impairment in patients with acquired brain injury. Both outcomes were measured for each wave.A total of 364 subjects having a complete set of demographic, clinical, and pharmacologic data were included in the propensity score (PS) analysis. Results showed that the rehabilitation treatments (physical and cognitive) reduced the clinical worsening over time in both severity diagnosis and DRS (around 6.5 points) in patients with disorders of consciousness across different propensity score strategies (ie, PS matching, PS adjustment, and PS-weighted procedures). In addition, cognitive protocols seem to be limited to patients with a median value of DRS=23.Our propensity score analysis suggests that rehabilitation treatment protocols seem effective and should be applied to a broader spectrum of patients with disorders of consciousness.

Contains fulltext : 284067.pdf (Publisher’s version ) (Open Access) Memory perspectives on past events allegedly take one of two shapes. In field memories, we recall episodes from a first-person point of view, while in observer memories, we look at a past scene from a third-person perspective. But this mere visuospatial dichotomy faces several practical and conceptual challenges. First, this binary distinction is not exhaustive. Second, this characterization insufficiently accounts for the phenomenology of observer memories. Third, the focus on the visual aspect of memory perspective neglects emotional, agential, and self-related social aspects. Fourth, the focus on the time of recall neglects the fact that visual, emotional, agential, and social aspects of perspective can also be dissociated in the original experience. In this chapter, we move away from the standard visual dichotomy. Instead, we propose that memory perspective is better understood along four lines: visual, agential, emotional, and social. Drawing on empirical research, we argue that these dimensions predict a disposition to recall a past event based on the present situation of the memorizer. This account supports seeing episodic memory as a natural kind, supported by scenario construction mechanisms and minimal memory traces. By remapping the classic distinction between field and observer perspectives along four dimensions, our proposal provides explanatory advantages and secures practical gains by enabling testable hypotheses.

"Many research works have unveiled how grapevine cultivars respond to environmental conditions; however, the molecular mechanisms underlying the interplay between clones (vegetatively propagated lines of selected mother plants) and environment need to be elucidated. This study was aimed to explore the complexity of the clone x environment interaction by investigating changes controlled by clone, vineyard or developmental stage. The transcriptome of berries collected over ripening in different vineyards from three 'Nebbiolo' clones was analyzed by integrating RNA-seq data with analysis of candidate genes, quantification of secondary metabolites and agronomical parameters. Transcripts associated to sugar transport and anthocyanin biosynthesis were differently modulated among clones, while genes involved in secondary metabolism and defence, such as stilbene synthase genes, were affected by vineyard, consistently with stilbenoid accumulation. This attests that clone-specific responses exert a role in shaping agronomic performances of a grape variety in different environments, thus providing indications for orienting viticultural practices in light of both cultivation area and clone choice."

"During the last years, several research works were addressed to uncover how different grapevine cultivars respond to environmental conditions, nevertheless the molecular mechanisms tuning this phenomenon needs to be further deepened. In particular, little is known on the molecular processes underlying the interplay between clones of the same cultivar and vineyard. In order to investigate this point, we analyzed the transcriptome of berries collected over the ripening period from three 'Nebbiolo' clones (CVT 71, CVT 423, CVT 185, whose respective genome sequences have recently been released) grown in three different vineyards of the Langhe area (Piedmont, North-West Italy), in two years. Transcriptomic data obtained through RNA-sequencing analysis were integrated by: i) real-time RT-qPCR of candidate genes; ii) HPLC quantification of abscisic acid, flavonoid and stilbenoid contents; iii) agronomical parameters; and iv) climate conditions. This multidisciplinary approach was instrumental for exploring the whole complexity of the genotype-environment interaction and identifying the molecular changes controlled by clone, vineyard, phenological phase or a combination of them. The results showed that transcript categories associated to sugar mediated-signalling, anthocyanin biosynthesis and transport can be differently modulated among diverse clones of the same cultivar, thus influencing related yields in terms of berry quality and agronomical features. Conversely, genes involved in the production of secondary metabolites, typically playing a role in stress response such as stilbenoids, were significantly affected by the vineyard location, consistently with the accumulation patterns of different stilbenoids.We thus demonstrated that clone-specific molecular responses exert a key role in determining the agronomic performances of a grapevine variety in different environments. These results provide valuable indications also for directing viticulture practices aimed at enhancing the typicality of grapevine productions in light of both the cultivation area and clone choice."

The advent of cognitive science has been characterized by the need to answer the traditional questions about the nature of the mind by inquiring about the actual elaboration processes that under- lie it. This means that beyond the conceptual analysis traditionally pursued by philosophers, cognitive scientists claim the need to con- strain the theoretical investigation to a key empirical criterion, namely the psychological plausibility of the interpretative models. In the case of human language, the application of this methodology leads to analyze the actual processes of comprehension and produc- tion that are implemented by speakers when they communicate. Taking this into account, recently a transition from classical cognitive science to the so-called post-classical cognitive science has been characterized by the attention to evolutionary issues. In par- ticular, the conceptual core of this transition is to adopt a new methodology that imposes constraints to evaluate the plausibility of a certain model of the mind and language in the light of its com- patibility with the theory of natural evolution. The adoption of the constraint of evolutionary plausibility has been the heartland of the debate in cognitive science in the past years. In this contribution we propose to examine the implications of adopting the evolutionary constraint on discussions on the nature of language.

Calabrese breed takes its origin from ancient iberian and italic swine populations (Giannone, 2002). In the last century, this genotype was reared in many areas of Calabria region and it was distinguished in numerous ‘local types’ (Mascheroni, 1927). It has been always reared according to the free range management. This breed is characterised by an high adaptability and frugality with a good damming ability in sows and marked sexual instinct in boars (Pianelli, 2001 and 2002)...

Healthcare costs for heart failure are increasing. The need for a better care, however, has to be matched with a policy of cost containment. A way to improve the cost-effectiveness of heart failure care is the disease management approach, in which therapy, education and follow-up are tailored for each patient by a multidisciplinary team. Such a complex intervention can be facilitated by the use of telemedicine, which allows the remote control of considerable amounts of clinical data. In Italy, a few studies with telemedicine have been reported. A recent development in this field is represented by the ICAROS project (Integrated Care vs Conventional Intervention in Cardiac Failure Patients: Randomized Open Label Study), whose aim is to improve the clinical and psychological care of heart failure patients employing advanced wireless telecommunication technology. So far, we randomized 60 patients: 30 in usual ambulatory care, 30 in an intensive treatment group. The latter patients were instructed to use a portable computer to get in touch daily with the heart failure clinic and receive feedback instruction for the management of drug therapy and daily problems. At the first year of follow-up, the treatment group showed good compliance to drug prescriptions, and could easily handle the portable computer. The preliminary results of this ongoing study support the feasibility and appropriateness of new technologies for the management of heart failure, even in elderly patients in whom a limited expertise with these appliances could have been anticipated.

Persistence on treatment affects the efficacy of antihypertensive treatment. We prospectively investigated the persistence on therapy and the extent of blood pressure (BP) control in 347 hypertensive patients (age 59.4 +/- 6 years) randomly allocated to a first-line treatment with: angiotensin-converting enzyme (ACE) inhibitors, calcium-channel blockers (CCBs), beta-blockers, angiotensin-II receptor blockers (ARBs), or diuretics and followed-up for 24-months. Persistence on treatment was higher in patients treated with ARBs (68.5%) and ACE inhibitors (64.5%) vs CCBs (51.6%; p < 0.05), beta-blockers (44.8%, p < 0.05), and diuretics (34.4%, p < 0.01). No ARB, ACE inhibitor, beta-blocker, or diuretic was associated with a higher persistence in therapy compared with the other molecules used in each therapeutic class. The rate of persistence was significantly higher in patients treated with lercanidipine vs others CCBs (59.3% vs 46.6%, p < 0.05). Systolic and diastolic BP was decreased more successfully in patients treated with ARBs (-11.2/-5.8 mmHg), ACE inhibitors (-10.5/-5.1 mmHg), and CCBs (-8.5/-4.6 mmHg) compared with beta-blockers (-4.0/-2.3 mmHg p < 0.05) and diuretics (-2.3/-2.1 mmHg, p < 0.05). No ARB, ACE inhibitor, beta-blocker, or diuretic was associated with a higher BP control compared with the other molecules used in each therapeutic class. A trend toward a better BP control was observed in response to lercanidipine vs other CCBs (p = 0.059). The present results confirm the importance of persistence on treatment for the management of hypertension in clinical practice.

Angiotensin-converting enzyme (ACE) inhibitors are widely used for the treatment of cardiovascular disease since they improve blood pressure control in patients with hypertension and prolong survival in patients with acute myocardial infarction, asymptomatic left ventricular dysfunction and congestive heart failure. Most of the information about the therapeutic role of ACE-inhibitors has been achieved during the last 20 years since the publication of some pivotal trials mostly involving the use of ACE-inhibitors like captopril and enalapril. In particular the treatment with enalapril has considerably improved the clinical outcome of patients with either mild-to-moderate (SOLVD studies) or severe (CONSENSUS trial) congestive heart failure. The benefit of ACE-inhibitors in patients with congestive heart failure has also involved a remarkable reduction in the rate of hospitalization, thus contributing to improve the pharmaco-economic approach to the disease. Most of the beneficial effect of ACE-inhibitors in clinical practice is dependent on their capacity of inhibiting the renin-angiotensin system, although some recent trials have supported a primary role for such drugs (in particular enalapril) in the prevention of atrial fibrillation. After more than 25 years from their discovery, ACE-inhibitors must be again considered among the first-line treatment in many patients with cardiovascular disease.

L'automisurazione della pressione arteriosa è una metodica introdotta fin dagli anni trenta ed attualmente praticata da circa 2/3 della popolazione ipertesa. Poichè i dispositivi per la misurazione della pressione arteriosa sono ampiamente disponibili ed economici, l'automonitoraggio è in grande incremento sia negli USA che in Europa. Evidenze sperimentali hanno mostrato come la automisurazione della pressione arteriosa migliori la aderenza alla terapia farmacologica e quindi il controllo dei valori pressori. Allo stesso tempo, i valori pressori misurati a domicilio sembrano avere una capacità prognostica superiore rispetto a quelli ottenuti con l'ABPM. Tutto questo è stato recepito da numerose linee guida internazionali che, infatti, raccomandano l'automisurazione domiciliare come passo verso un maggior coinvolgimento del paziente nella gestione della malattia.

La non aderenza al trattamento rappresenta un comportamento frequentemente osservato nella pratica medica, soprattutto in quelle patologie caratterizzate dall’assenza di sintomi come l’ipertensione. Scopo del presente studio è stato quello di indagare l’aderenza al trattamento farmacologico in un campione di 61 pazienti affetti da ipertensione essenziale, cercando di evidenziare l’eventuale ruolo svolto rispetto a tale collaborazione dal sostegno percepito da parte della famiglia, dalla soddisfazione rispetto al rapporto con il proprio medico e dell’eventuale presenza di sintomi psicopatologici. I risultati del presente studio non hanno mostrato alcuna correlazione significativa tra le variabili esaminate e l’adesione al trattamento nel campione esaminato. Gli autori sottolineano come i presenti risultati siano coerenti con studi precedenti che non hanno finora individuato chiare correlazioni tra l’aderenza al trattamento dell’ipertensione e diversi fattori individuali, affettivi, sociali,e sanitari.

La broncopneumatia cronica ostruttiva (BPCO) è una delle principali cause di mortalità e morbosità e comporta un costo economico e sociale consistente e crescente. La terapia farmacologica è volta a ridurre i sintomi, a ridurre la frequenza e la gravità delle riacutizzazioni, a migliorare lo stato di salute e la tolleranza allo sforzo. Tra i farmaci per via inalatoria più frequentemente prescritti ci sono gli agenti anticolinergici. L'anticolinergico a lunga durata di azione tiopropio ha dimostrato, in somministrazione unica giornaliera, di determinare miglioramenti significativi della funzione respiratoria nei pazienti affetti da BPCO. Il suo favorevole impatto sul decorso clinico della patologia, inoltre, può contrinuire a cambiare il modo in cui i pazienti convivono con essa.

Although many efforts paid to prevention and treatment of the hypertension, mortality and morbidity hypertension-related is still unacceptably high. This is largely due to the difficulty in mantaining the blood pressure values strictly below the goal recommended by guidelines. As confirmed by recent intervention trials, more than half of hypertensive patients treated with a single drug regime not adeguately controls its blood pressure. On this base, current guidelines have recommended the use of combination therapy as first-line treatment in high or very high risk patients or when blood pressure is above the goal of 20/10 mmHg (>160/100 mmHg). In these patients blocking two or more blood pressure regulatory systems provides a more effectve reduction in blood pressure with a parallell reduction of cardiovascular events. Calcium Channel Blockers (CCBs) and Angiotensin Converting Enzyme (ACE) inhibitors (ACE-I) administered in combination can complemement each other in lowering blood pressure. Recently a fixed-dose combinations of lercanidipine (10 mg) plus enalapril (20 mg) has been approved in some E.C. countries: here we review both the rationale and the available clinical data for the use of this combination in hypertensive patients.

La frequenza cardiaca elevata a riposo è correlata ad un maggior rischio di mortalità cardiovascoalre. Questa correlazione appare lineare e continua, indipendente da altri fattori di rischio cardiovascolari, dalla presenza di co-morbidità e dall'età.

Relazione tra dislipidemia ed eventi cerebrovascolari e possibilità di intervento terapeutico.

Esiste ormai una chiara evidenza che supporta l'utilizzo dei beta-bloccanti beta-1 selettivi nello scompenso cardiaco cronioco. Questo articolo fa il punto sulle caratteristiche peculiari di questi farmaci alla luce dei risultati dei trials clinici.