Valutazione del rapporto urinario proteine totali/creatinina e albumina/creatinina in cani affetti da iperadrenocorticismo e da diabete mellito

INTRODUCTION – In human medicine, diabetes mellitus (DM), hypertension, proteinuria and nephropathy are often associated although it is still not clear whether hypertension is the consequence or the cause of nephropathy and albuminuria. Microalbuminuria, in humans, is an early and sensitive marker which permits timely and effective therapy in the early phase of renal damage. Conversely, in dogs, these relationships were not fully investigated, even though hypertension has been associated with many diseases (Bodey and Michell, 1996). In a previous study, 20% of diabetic dogs were found proteinuric based on a U:P/C > 1 and 46% were hypertensive; this latter finding is similar to the prevalence of hypertension in diabetic people (40-80%) (Struble et al., 1998). In the same canine study, hypertension was also positively correlated with the duration of the disease, as is the case in human beings. Hypertension was also found to be a common complication of hypercortisolism (HC) in dogs, with a prevalence which varies from 50 (Goy-Thollot et al., 2002) to 80% (Danese and Aron, 1994).The aim of our study was to evaluate the urinary albumin to creatinine ratio (U:A/C) in dogs affected by Diabetes Mellitus and HC in order to ascertain if, as in human beings, it could represent an early and more sensitive marker of renal damage than U:P/C. Furthermore, the relationship between proteinuria and hypertension in DM and HC was also investigated. MATERIALS AND METHODS – Twenty dogs with DM, 14 with HC and 21 healthy dogs (control group) were included in the prospective case-control study. Inclusion criteria were hyperglycaemia, glicosuria and serum fructosamine above the reference range for DM dogs and a positive ACTH stimulation test and/or low-dose dexamethasone test and consistent findings of HC on abdominal ultrasonography in HC dogs. Dogs were excluded if affected by urinary tract infections and if the serum creatinine or urea values were above the reference range. At the moment of inclusion, an appropriate therapy had already been instituted less than 1 month earlier in 12 diabetic dogs. The control dogs were considered healthy based on clinical exam and clinicopathological findings. All dogs underwent urine sample collection by cystocentesis and systemic blood pressure measurement by means of either an oscillometric device (BP-88 Next, Colin Corporation, Japan) or by Doppler ultrasonic traducer (Minidop ES-100VX, Hadeco, Japan). The choice of method depended on the dog’s body weight: Doppler ultrasonography was employed in dogs < 20 kg of body weight and the oscillometric method in the other subjects. Dogs were considered hypertensive whenever systemic blood pressure was found ≥ 160 mmHg. The urine was assayed for U:P/C and U:A/C (Gentilini et al., 2005). The data between groups were compared using the Mann-Whitney U test. The reference ranges for U:P/C and U:A/C had already been established by our laboratory as 0.6 and 0.05, respectively. U:P/C and U:A/C findings were correlated to systemic blood pressure and Spearman R correlation coefficients were calculated. In all cases, p < 0.05 was considered statistically significant. RESULTS – The mean ± sd urinary albumin concentration in the three groups was 1.79 mg/dl ± 2.18; 20.02 mg/dl ± 43.25; 52.02 mg/dl ± 98.27, in healthy, diabetic and hypercortisolemic dogs, respectively. The urine albumin concentration differed significantly between healthy and diabetic dogs (p = 0.008) and between healthy and HC dogs (p = 0.011). U:A/C values ranged from 0.00 to 0.34 (mean ± sd 0.02 ± 0.07), 0.00 to 6.72 (mean ± sd 0.62 ± 1.52) and 0.00 to 5.52 (mean ± sd 1.27 ± 1.70) in the control, DM and HC groups, respectively; U:P/C values ranged from 0.1 to 0.6 (mean ± sd 0.17 ± 0.15) 0.1 to 6.6 (mean ± sd 0.93 ± 1.15) and 0.2 to 7.1 (mean ± sd 1.90 ± 2.11) in the control, DM and HC groups, respectively. In diabetic dogs, U:A/C was above the reference range in 11 out of 20 dogs (55%). Among these, 5/20 (25%) showed an increase only in the U:A/C ratio while, in 6/20 (30%), both the U:P/C and the U:A/C were abnormal. Among the latter, 4 dogs had already undergone therapy. In subjects affected with HC, U:P/C and U:A/C were both increased in 10/14 (71%) while in 2/14 (14%) only U:A/C was above the reference range. Overall, by comparing U:P/C and U:A/C in the various groups, a significant increase in protein excretion in disease-affected animals compared to healthy dogs was found. Blood pressure (BP) in diabetic subjects ranged from 88 to 203 mmHg (mean ± sd 143 ± 33 mmHg) and 7/20 (35%) dogs were found to be hypertensive. In HC dogs, BP ranged from 116 to 200 mmHg (mean ± sd 167 ± 26 mmHg) and 9/14 (64%) dogs were hypertensive. Blood pressure and proteinuria were not significantly correlated. Furthermore, in the DM group, U:P/C and U:A/C were both increased in 3 hypertensive dogs and 2 normotensive dogs while the only increase of U:A/C was observed in 2 hypertensive and 3 normotensive dogs. In the HC group, the U:P/C and the U:A/C were both increased in 6 hypertensive and 2 normotensive dogs; the U:A/C was the sole increased parameter in 1 hypertensive dog and in 1 dog with normal pressure. DISCUSSION AND CONCLUSION- The findings of this study suggest that, in dogs affected by DM and HC, an increase in U:P/C, U:A/C and systemic hypertension is frequently present. Remarkably, some dogs affected by both DM and HC showed an U:A/C but not U:P/C above the reference range. In diabetic dogs, albuminuria was observed in 25% of the subjects, suggesting the possibility that this parameter could be employed for detecting renal damage at an early phase when common semiquantiative tests and even U:P/C fall inside the reference range. In HC dogs, a higher number of subjects with overt proteinuria was found while only 14% presented an increase only in the U:A/C. This fact, associated with a greater number of hypertensive dogs having HC rather than DM, could suggest a greater influence on renal function by the mechanisms involved in hypertension secondary to hypercortisolemia. Furthermore, it is possible that, in HC dogs, the diagnosis was more delayed than in DM dogs. However, the lack of a statistically significant correlation between hypertension and increased protein excretion as well as the apparently random distribution of proteinuric subjects in normotensive and hypertensive cases, imply that other factors besides hypertension are involved in causing proteinuria. Longitudinal studies are needed to further investigate the relationship between hypertension and proteinuria.

Teorie e immagini del governo "misto" nel Cinquecento: i casi di Gasparo Contarini, Donato Giannotti, Paolo Paruta e Traiano Boccalini

This doctoral dissertation faces the debated topic of the traditions of Republicanism in the Modern Age assuming, as a point of view, the problem of the "mixed" government. The research therefore dwells upon the use of this model in Sixteenth-Century Italy, also in connection with the historical events of two standard Republics such as Florence and Venice. The work focuses on Donato Giannotti (1492-1573), Gasparo Contarini (1483-1542) and Paolo Paruta (1540-1598), as the main figures in order to reconstruct the debate on "mixed" constitution: in them, decisive in the attention paid to the peculiar structure of the Venetian Republic, the only of a certain dimension and power to survive after 1530. The research takes into account also the writings of Traiano Boccalini (1556-1613): he himself, though being involved in the same topics of debate, sets for some aspects his considerations in the framework of a new theme, that of Reason of State.

L' "opera mondo" di Paolo Volponi fra satira e morale

Nella mia tesi di dottorato mi propongo di indagare la metamorfosi del romanzo nella letteratura italiana contemporanea attraverso il lavoro di Paolo Volponi, che può essere descritto come un’«opera mondo», in accordo con la formula critica coniata da Franco Moretti. Volponi intende superare il divario fra l’io e il mondo e ricomporre il corpo come una mediazione umanistica di ragione e sensi. La sua opera può essere definita ‘epica’ perché recupera la tradizione del romanzo cavalleresco e la parodia esercitata su questa tradizione letteraria da Cervantes nel Don Chisciotte. Ma, come l’Ulysses di Joyce, è un’epica «moderna» perché fondata su una totalità disgiunta e sul conflitto dialogico, in una linea che accomuna la moltiplicazione dei punti di vista, propria del romanzo polifonico secondo Bachtin, alla pluralità di prospettive del discorso scientifico. Dopo un primo capitolo teorico, nel secondo e nel terzo capitolo della tesi i romanzi di Volponi vengono studiati in rapporto al filone dell’«epica moderna» e al genere satirico, che ha un suo modello fondativo nell’opera di Giacomo Leopardi. Il quarto capitolo si focalizza sulle ultime raccolte poetiche, che mostrano la tendenza a recuperare il linguaggio formulare e la matrice orale della poesia delle origini, servendosene per rappresentare in funzione contrappuntistica l’universo globale dell’età contemporanea.

Ruolo del test da sforzo cardiopolmonare nei pazienti affetti da cardiomiopatia ipertrofica in età pediatrica

Background Decreased exercise capacity, and reduction in peak oxygen uptake are present in most patients affected by hypertrophic cardiomyopathy (HCM) . In addition an abnormal blood pressure response during a maximal exercise test was seen to be associated with high risk for sudden cardiac death in adult patients affected by HCM. Therefore exercise test (CPET) has become an important part of the evaluation of the HCM patients, but data on its role in patients with HCM in the pediatric age are quite limited. Methods and results Between 2004 and 2010, using CPET and echocardiography, we studied 68 children (mean age 13.9 ± 2 years) with HCM. The exercise test was completed by all the patients without adverse complications. The mean value of achieved VO2 max was 31.4 ± 8.3 mL/Kg/min which corresponded to 77.5 ± 16.9 % of predicted range. 51 patients (75%) reached a subnormal value of VO2max. On univariate analysis the achieved VO2 as percentage of predicted and the peak exercise systolic blood pressure (BP) Z score were inversely associated with max left ventricle (LV) wall thickness, with E/Ea ratio, and directly related with Ea and Sa wave velocities No association was found with the LV outflow tract gradient. During a mean follow up of 2.16 ± 1.7 years 9 patients reached the defined clinical end point of death, transplantation, implanted cardioverter defibrillator (ICD) shock, ICD implantation for secondary prevention or myectomy. Patients with peak VO2 < 52% or with peak systolic BP Z score < -5.8 had lower event free survival at follow up. Conclusions Exercise capacity is decreased in patients with HCM in pediatric age and global ventricular function seems being the most important determinant of exercise capacity in these patients. CPET seems to play an important role in prognostic stratification of children affected by HCM.

Il viaggio celeste di Paolo (2Cor 12,1-10). Particolarità e funzionalità di una forma di contatto con il soprannaturale

L’obiettivo principale di questa ricerca è quello di affrontare le questioni critiche poste all’esegesi da uno dei passi paolini più discussi. Grazie all’impiego delle categorie connesse all’esperienza religiosa, si vuole argomentare la possibilità di leggere il viaggio celeste in termini di modello culturale attraverso il quale interpretare un’esperienza di contatto con il soprannaturale. L’approccio individuato può consentire di rivalutare la funzione di tale narrazione non solo nel contesto di 2 Corinzi, bensì anche in relazione ai paralleli letterari di matrice tanto giudaica e protocristiana quanto greco-romana. Conseguenza di simile analisi ad ampio raggio è il riconoscimento dell’importanza attribuita da Paolo ad esperienze di questo tipo, come testimoniato da alcuni brani centrali delle sue lettere.

I tre libri di salmi vespertini a otto voci (opp. I, VII e XI) di Giovanni Paolo Colonna

Le tre raccolte di salmi da vespro a otto voci nello stile pieno di Giovanni Paolo Colonna (Bologna 1637-1695), pubblicate rispettivamente nel 1681, nel 1686 e nel 1694 (opp.I, VII e XI), costituiscono un oggetto di studio privilegiato nell’ambito della ricca produzione a stampa dell’autore: in primo luogo, esse ebbero ampia e favorevole recezione, come testimoniano la diffusione degli esemplari, le ristampe, le copie manoscritte ricavate dalle edizioni; in secondo luogo, la fortuna postuma del compositore fu legata in buona parte alla sua musica sacra a doppio coro e, in particolare, al favore riscosso dai suoi libri di salmi; infine, l’analisi delle tre raccolte consente di confrontare le risorse tecniche e stilistiche messe in opera da Colonna in composizioni afferenti a uno stesso genere ma risalenti a periodi diversi. La dissertazione è articolata in tre parti: nella prima sono presi in esame gli ordinamenti liturgici secenteschi relativi alla celebrazione dei vespri, onde illustrare la cornice rituale alla quale i salmi di Colonna erano destinati, e si passano in rassegna alcune definizioni di stile pieno e di contrappunto a otto voci desunte dalla trattatistica coeva. La seconda parte è dedicata alla lettura storico-critica delle opp. I, VII e XI nel contesto generale della produzione dell’autore. La terza parte contiene l’edizione integrale dell’opera VII e XI, nonché una scelta di brani tratti dall’op. I.