Percorsi dell'emigrazione italiana in Svizzera tra fonti orali e scritture di gente comune (1946-1974)

Sintesi II presente lavoro di ricerca, maturato nel quadro di un dottorato in storia contemporanea, propone una ricostruzione dei percorsi materiali e dei percorsi culturali degli emigrati italiani in Svizzera tra la tìne della Seconda guerra mondiale e i primi anni Settanta. Le principali fonti di prima mano adoperate nella ricerca consistono in tre diversi generi di narrazioni autobiogratìche: le fonti orali (cento interviste complessive raccolte e analizzate); le scritture epistolari (tre fondi per un totale di circa duecento lettere); le scritture scolastiche di adolescenti e giovani emigrati italiani, iscritti, tra la fine degli anni Sessanta e i primi anni Settanta, ad una scuola privata del Canton Zurigo (circa seicento temi validi come prova di lingua italiana per il conseguimento della licenza media tra il 1973 e il 1974). Le fonti soggettive raccolte hanno permesso di tracciare i profili di numerosi di percorsi migratori vissuti da queste persone, lavorando, in primo luogo, sulla loro dimensione materiale, ovvero sulle tappe íìsiche, dal viaggio, alla ricerca del posto di lavoro e dell'alloggio, alla formazione di una famiglia, agli strumenti utilizzati per mantenersi in contatto con il proprio paese d'origine. Si sono poi inquadrate alcune delle possibili evoluzioni ideologiche e culturali, nei termini consentiti dallo studio della memoria e delle rappresentazioni di sé, offerte dagli emigrati stessi. In sintesi, quindi, il lavoro propone una ricostruzione di un frammento di storia dell'emigrazione italiana, con tutte le specitìcità legate a un paese di accoglienza, la Svizzera, e a un periodo storico, il Secondo dopoguerra. Alcuni dei caratteri principali dei percorsi materiali sono senz'altro legati alle peculiarità della legislazione svizzera, con la detìnizione di "straniero" che dava, le condizioni di vita che rendeva praticabili e possibili, i passaggi di tempo che imponeva per avere una permesso a tempo indeterminato, per raggiungere una certa stabilità, per ricomporre il proprio nucleo familiare. Anche alcuni fenomeni culturali erano legati a queste dimensioni specitïche, per cui non hanno riscontro, negli stessi termini, in altri contesti e in altri periodi. Accanto alle peculiarità e alle differenze che questa storia ha rispetto ad altre storie di emigrazione legate ad altri paesi e ad altri contesti, dal lavoro emergono processi e fenomeni di interesse più generale, qualora ci si interessi di fenomeni migratori, di conflitti, di inclusione e di esclusione di gruppi umani differenti. Alcune delle problematiche che si sono poste nella storia in analisi -per esempio quelle relative alla scolarizzazione dei minori, al rapporto tra diritto di residenza e obbligo di impiego, alla presenza di clandestini e al loro rapporto con associazioni o gruppi di assistenza legali o illegali -sono senza dubbio utili riferimenti per chi oggi voglia ragionare su problematiche analoghe poste in diversi contesti.

Solving Leontief Input-Output Model with Trapezoidal Fuzzy Numbers and Gauss-Seidel Algorithm

In this work a fuzzy linear system is used to solve Leontief input-output model with fuzzy entries. For solving this model, we assume that the consumption matrix from di erent sectors of the economy and demand are known. These assumptions heavily depend on the information obtained from the industries. Hence uncertainties are involved in this information. The aim of this work is to model these uncertainties and to address them by fuzzy entries such as fuzzy numbers and LR-type fuzzy numbers (triangular and trapezoidal). Fuzzy linear system has been developed using fuzzy data and it is solved using Gauss-Seidel algorithm. Numerical examples show the e ciency of this algorithm. The famous example from Prof. Leontief, where he solved the production levels for U.S. economy in 1958, is also further analyzed.

Production and partial characterization of lipase from Penicillium verrucosum obtained by submerged fermentation of conventional and industrial media

The growing interest in lipase production is related to the potential biotechnological applications that these enzymes present. Current studies on lipase production by submerged fermentation involve the use of agro-industrial residues aiming at increasing economic attractiveness. Based on these aspects, the objective of this work was to investigate lipase production by Penicillium verrucosum in submerged fermentation using a conventional medium based on peptone, yeast extract, NaCl and olive oil, and an industrial medium based on corn steep liquor, Prodex Lac (yeast hydrolysate), NaCl and olive oil, as well as to characterize the crude enzymatic extracts obtained. Kinetics of lipase production was evaluated and the highest enzymatic activities, of 3.15 and 2.22 U.mL-1, were observed when conventional and industrial media were used, respectively. The enzymatic extract showed optimal activity in the range from 30 to 40 °C and at pH 7.0. Although the industrial medium presents economical advantages over the conventional medium, the presence of agro-industrial residues rich in nitrogen and other important nutrients seemed to contribute to a reduction in lipase activity.

Timing of di-ammonium phosphate addition to fermenting chardonnay must : effect on nitrogen utilization, ethyl-carbamate formation, and CAR1 expression by yeast /

The maximum amount of ethyl carbamate (EC), a known animal carcinogen produced by the reaction of urea and ethanol, allowed in alcoholic beverages is regulated by legislation in many countries. Wine yeast produce urea by the metabolism of arginine, the predominant assimilable amino acid in must. This action is due to arginase (encoded by CARl). Regulation of CARl, and other genes in this pathway, is often attributed to a well-documented phenomenon known as nitrogen catabolite repression. The effect of the timing of di-ammonium phosphate (DAP) additions on the nitrogen utilization, regulation of CARl, and EC production was investigated. A correlation was found between the timing of DAP addition and the utilization of nitrogen. When DAP was added earlier in the fermentations, less amino nitrogen and more ammonia nitrogen was sequestered from the media by the cells. It was also seen that early DAP addition led to more total nitrogen being used, with a maximal difference of ~25% between fermentations where no DAP was added versus addition at the start of the fermentation. The effect of the timing ofDAP addition on the expression of CARJ during fermentation was analyzed via northern transfer and the relative levels of CARl expression were determined. The trends in expression can be correlated to the nitrogen data and be used to partially explain differences in EC formation between the treatments. EC was quantified at the end of fermentation by GC/MS. In Montrachet yeast, a significant positive correlation was found between the timing of DAP addition, from early to late, and the final EC concentration m the wine (r = 0.9226). In one of the fermentations, EC levels of 30.5 ppb was foimd when DAP was added at the onset of fermentation. A twofold increase (69.5 ppb) was observed when DAP was added after 75% of the sugars were metabolized. When no DAP was added, the ethyl carbamate levels are comparable at a value of 38 ppb. In contrast, the timing of DAP additions do not affect the level EC produced by the yeast ECU 18 in this manner. The study of additional yeast strains shows that the effect of DAP addition to fermentations is strain dependent. Our results reveal the potential importance of the timing of DAP addition to grape must with respect to EC production, and the regulatory effect of DAP additions on the expression of genes in the pathway for arginine metabolism in certain wine yeast strains.

Formules de quadrature pour les fonctions entières de type exponentiel

Ce mémoire contient quelques résultats sur l'intégration numérique. Ils sont liés à la célèbre formule de quadrature de K. F. Gauss. Une généralisation très intéressante de la formule de Gauss a été obtenue par P. Turán. Elle est contenue dans son article publié en 1948, seulement quelques années après la seconde guerre mondiale. Étant données les circonstances défavorables dans lesquelles il se trouvait à l'époque, l'auteur (Turán) a laissé beaucoup de détails à remplir par le lecteur. Par ailleurs, l'article de Turán a inspiré une multitude de recherches; sa formule a été étendue de di érentes manières et plusieurs articles ont été publiés sur ce sujet. Toutefois, il n'existe aucun livre ni article qui contiennent un compte-rendu détaillé des résultats de base, relatifs à la formule de Turán. Je voudrais donc que mon mémoire comporte su samment de détails qui puissent éclairer le lecteur tout en présentant un exposé de ce qui a été fait sur ce sujet. Voici comment nous avons organisé le contenu de ce mémoire. 1-a. La formule de Gauss originale pour les polynômes - L'énoncé ainsi qu'une preuve. 1-b. Le point de vue de Turán - Compte-rendu détaillé des résultats de son article. 2-a. Une formule pour les polynômes trigonométriques analogue à celle de Gauss. 2-b. Une formule pour les polynômes trigonométriques analogue à celle de Turán. 3-a. Deux formules pour les fonctions entières de type exponentiel, analogues à celle de Gauss pour les polynômes. 3-b. Une formule pour les fonctions entières de type exponentiel, analogue à celle de Turán. 4-a. Annexe A - Notions de base sur les polynômes de Legendre. 4-b. Annexe B - Interpolation polynomiale. 4-c. Annexe C - Notions de base sur les fonctions entières de type exponentiel. 4-d. Annexe D - L'article de P. Turán.

La ventilazione non-invasiva a pressione positiva nell’insufficienza respiratoria acuta ipercapnica: 10 anni di esperienza clinica di una Unità di Terapia Semi-Intensiva Respiratoria

PremessaSebbene numerosi studi prospettici, controllati e randomizzati abbiano dimostrato il successo della ventilazione non-invasiva a pressione positiva (NIV) in casi selezionati di insufficienza respiratoria acuta ipercapnica (IRA) in setting con intensità di cura differenti, i dati di pratica clinica relativi all’uso della NIV nel “mondo reale” sono limitati. Scopo Riportare i risultati della nostra esperienza clinica sulla NIV nell’IRA applicata nell’Unità di Terapia Semi-Intensiva Respiratoria (UTSIR) allocata all’interno dell’Unità Operativa di Pneumologia di Arezzo negli anni 1996-2006 in termini di: tollerabilità, effetti sui gas ematici, tasso di successo e fattori predittivi del fallimento.MetodiTrecentocinquanta dei 1484 pazienti (23.6%) consecutivamente ammessi per IRA nella nostra Unità Operativa di Pneumologia durante il periodo di studio hanno ricevuto la NIV in aggiunta alla terapia standard, in seguito al raggiungimento di criteri predefiniti impiegati di routine.RisultatiOtto pazienti (2.3%) non hanno tollerato la NIV per discomfort alla maschera, mentre i rimanenti 342 (M: 240, F: 102; età: mediana (interquartili) 74.0 (68.0-79.3) anni; BPCO: 69.3%) sono stati ventilati per >1 ora. I gas ematici sono significativamente migliorati dopo 2 ore di NIV (media (deviazione standard) pH: 7.33 (0.07) versus 7.28 (7.25-7.31), p<0.0001; PaCO2: 71.4 (15.3) mmHg versus 80.8 (16.6) mmHg, p<0.0001; PaO2/FiO2: 205 (61) versus 183 (150-222), p<0.0001). La NIV ha evitato l’intubazione in 285/342 pazienti (83.3%) con una mortalità ospedaliera del 14.0%. Il fallimento della NIV è risultato essere predetto in modo indipendente dall’Apache III (Acute Physiology and Chronic Health Evaluation III) score, dall’indice di massa corporea e dal fallimento tardivo della NIV (> 48 ore di ventilazione) dopo iniziale risposta positiva.ConclusioniSecondo la nostra esperienza clinica di dieci anni realizzata in una UTSIR, la NIV si conferma essere ben tollerata, efficace nel migliorare i gas ematici e utile nell’evitare l’intubazione in molti episodi di IRA non-responsivi alla terapia standard.

Correlación entre el test de la figura humana de F.L. Goodenough y Harris y las notas escolares de media general del curso anterior : Área de Ciencias Naturales y Dibujo y comprensión del hombre y de la mujer en dos muestras de 610 y 500 alumnos de Sevilla y Córdoba y Las Palmas de Gran Canaria, y dos pequeñas muestras de deficientes mentales escolarizados controlando las variables edad y sexo.

1) Realizar un trabajo experimental con sujetos normales y deficientes de Sevilla, Córdoba y Las Palmas de Gran Canaria 2) Averiguar la correlación existente entre el test de la figura humana de F.L. Goodenough y D.B Harris y las calificaciones escolares de media general de la muestra escogida 3) Ofrecer a dichas zonas una estandarización del test de la figura humana de Goodenough y Harris, y de este modo hacer extensible a la población española un nuevo elemento más en la diagnosis de la inteligencia. 610 sujetos de escuelas normales en edades comprendidas entre los 6 y 10 años y 162 deficientes mentales de 5 a 21 años escolarizados en centros específicos, todos ellos de Sevilla y Córdoba, 500 niños de escuelas normales de Las Palmas de Gran Canaria de edades comprendidas entre 6 y 10 años y 50 sujetos de centros específicos de 9 años de edad. Analiza las bases teóricas del test de Goodenough y Harris, relaciona los estudios españoles en torno al test de Goodenough y plantea algunas hipótesis para comprobarlas con una investigación que se realiza en dos muestras con niños normales y niños deficientes mentales en las provincias españolas de Sevilla, Córdoba y Las Palmas de Gran Canaria. Test del dibujo de la figura humana de Goodenough-Harris. El test de Goodneough y Harris ha sido aplicado según las normas indicadas en el manual del Test della figura umana (ed. Organizzazioni Speciali, Firenze) en cuanto a motivar a los niños en la realización del dibujo del hombre y de la mujer y siguiendo las pautas descriptivas. Terminado el dibujo del hombre se les presentaba otra hoja para que dibujasen una mujer y concluido éste, se les presentaba un cuestionario para que lo respondiesen teniendo delante la figura del hombre y de la mujer. La aplicación del test se realizó en las primeras horas de clase, bien de la mañana o de la tarde, para evitar momentos en que los alumnos se encontrasen cansados y dicho cansancio pudiese influir en los resultados del test. Se procuró durante la aplicación del test un ambiente de relax y simpatía entre testista y alumnos y se invalidaron todos aquellos protocolos que no cumplían las normas exigidas por el test, los cuales fueron 10 en total. 1) La obtención de una correlación positiva y significativa entre el dibujo del hombre y de la mujer en ambas muestras de sujetos normales, demuestran la fidelidad del test. 2) La correlación del test tanto en el dibujo del hombre como en el de la mujer, con las notas escolares de media del curso anterior, en las áreas de ciencias naturales y dibujo, son todas ellas positivas y en su mayoría significativas, lo que significa una efectiva correlación entre el test y el rendimiento escolar. 3) el resultado de las diversas correlaciones positivas y significativas entre las notas de media del curso anterior y de estas con el test, pueden ofrecer información del tipo de inteligencia que mide el test, pudiendo predecir el éxito escolar en las áreas tratadas más que en otras materias. Sin olvidar que la predicción debe ser estudiada y profundizada. 4) No existen diferencias significativas en los resultados del test entre una edad y la inmediatamente superior, pero en general, existe diferencia significativa cuando se trata de dos años de diferencia. 5) Las diferencias entre la muestra Sevilla y Córdoba con Las Palmas de Gran Canaria son significativas, a favor de los niños andaluces. 6) En la muestra de sujetos deficientes mentales existe entre el dibujo del hombre y de la mujer una correlación positiva y significativa en todos los casos, salvo en las niñas de la muestra de Las Palmas, que aunque positiva no es significativa. Por lo cual sólo se puede hablar de una moderada correlación entre los dos dibujos. 7) Nada certero se puede afirmar respecto a las diferencias significativas de medias tanto al comparar los resultados obtenidos por los deficientes mentales niños y niñas de la muestra Sevilla y Córdoba, como al compararlos con la muestra de Las Palmas. El pequeño número de sujetos, el grado diferente de deficiencia dentro de las diversas edades no controladas harían equívocas e infundadas cualquier afirmación. 1) Entre las técnicas y los tests que se emplean con niños, el test de la figura humana es significativo, interesante y agradable, ya que a la mayoría de los sujetos les encanta dibujar y pintar. Además, tanto los sujetos normales como los deficientes dibujan, en numerosas ocasiones, figuras humanas. La representación del dibujo de la persona humana en sus diversas etapas es un reflejo del desarrollo intelectual del niño, puesto que el niño no pinta lo que ve sino lo que sabe. Por consiguiente, los resultado con el uso del test utilizado han sido satisfactorios tanto en normales como en deficientes.

Complexes of palladium using di-2-pyridyl ketone as ligand: synthesis, structure and, spectral and catalytic properties

During the reaction of di-2-pyridyl ketone (dpk) with Na(2)[PdCl(4)] in alcoholic media, the C=O fragment of dpk undergoes facile solvolysis and the transformed di-2-pyridyl ketone (dpk(ROH), R = Me or H) binds to palladium as NN-donor. When the reaction is carried out in refluxing methanol, a mono-complex of type [Pd(dpk(MeOH))Cl(2)] is obtained. A similar reaction in ethanol affords a bis-complex of type [Pd(dpk(ROH))(2)]Cl(2). Structure of both the complexes have been determined by X-ray crystallography. In acetonitrile solution the [pd(dpk(MeOH))Cl(2)] and [pd(dpk(ROH))(2)]Cl(2) complexes show intense absorptions in the visible and ultraviolet region, origin of which has been probed through uvr calculations. These two palladium complexes are found to be efficient catalysts for Suzuki cross-coupling reactions.

Salt and ionic cocrystalline forms of amides: protonation of carbamazepine in aqueous media

The products of reactions of the pharmaceutical amide carbamazepine (CBZ) with strong acids under aqueous conditions were investigated by both powder and single crystal X-ray diffraction. Despite previous claims to the contrary, it was found that salt forms with CBZ protonated at the amide O atom could be isolated from reactions with both HCl and HBr. These forms include the newly identified hydrate phase [CBZ(H)][Cl]·H O. Reactions with other mineral acids (HI and HBF ) gave ionic cocrystalline (ICC) forms (CBZ· [acridinium][I ]·2.5I and CBZ·[H O ] [BF ] ·H O) as well as the salt form CBZ·[CBZ(H)][BF ]·0.5H O. Reaction 2 4 3 2 5 2 0.25 4 0.25 2 4 2 of CBZ with a series of sulfonic acids also gave salt forms, namely, [CBZ(H)][O SC H ], [CBZ(H)][O SC H (OH)]· 3 6 5 3 6 4 0.5H O, [CBZ(H)] [O SCH CH SO ], and [CBZ(H)][O SC H (OH) (COOH)]·H O. CBZ and protonated CBZ(H) 2 2 3 2 2 3 3 6 3 2 moieties can be differentiated in the solid state both by changes to molecular geometry and by differing packing preferences

BEM modeling of saturated porous media susceptible to damage

This paper deals with the numerical analysis of saturated porous media, taking into account the damage phenomena on the solid skeleton. The porous media is taken into poro-elastic framework, in full-saturated condition, based on Biot's Theory. A scalar damage model is assumed for this analysis. An implicit boundary element method (BEM) formulation, based on time-independent fundamental solutions, is developed and implemented to couple the fluid flow and two-dimensional elastostatic problems. The integration over boundary elements is evaluated using a numerical Gauss procedure. A semi-analytical scheme for the case of triangular domain cells is followed to carry out the relevant domain integrals. The non-linear problem is solved by a Newton-Raphson procedure. Numerical examples are presented, in order to validate the implemented formulation and to illustrate its efficacy. (C) 2011 Elsevier Ltd. All rights reserved.

Organismi acquatici e ambiente: meccanismi biochimici di interazione, risposta e adattamento

The research is focused on the relationship between some Mg2+-dependent ATPase activities of plasma- and mitochondrial membranes from tissues of cultured marine bivalve molluscs and potentially stressful environmental conditions, such as the exposure to contaminants both of natural origin (ammonia nitrogen, the main contaminant of aquaculture plants) and of anthropic source (alkyltins). The two filter-feeding bivalve species selected colonize different habitats: the common mussel Mytilus galloprovincialis binds to hard substrates and the Philippine clam Tapes philippinarum burrows into sea bottom sandy beds. The choice of typical species of coastal waters, extremely suitable for environmental studies due to their features of poor motility, resistance to transport and great filtering efficiency, may constitute a model to evaluate responses to contaminants of membrane-bound enzyme activities involved in key biochemical mechanisms, namely cell ionic regulation and mitochondrial energy production. In vitro and in vitro approaches have been pursued. In vitro assays were carried out by adding the contaminants (NH4Cl and alkyltins) directly to the ATPase reaction media. In vivo experiments were carried out by exposing mussels to various tributyl tin (TBT) concentrations under controlled conditions in aquaria. ATPase activities were determined spectrophotometrically according to the principles of the method of Fiske and Subbarow (1925). The main results obtained are detailed below. In Tapes philippinarum the interaction of NH4 +, the main form of ammonia nitrogen at physiological and seawater pHs, with the Na,K-ATPase and the ouabaininsensitive Na-ATPase was investigated in vitro on gill and mantle microsomal membranes. The proven replacement by NH4 +of K+ in the activation of the Na,KATPase and of Na+ in the activation of the ouabain-insensitive ATPase displayed similar enzyme affinity for the substituted cation. on the one hand this finding may represent one of the possible mechanisms of ammonia toxicity and, on the other, it supports the hypothesis that NH4 + can be transported across the plasma membrane through the two ATPases. In this case both microsomal ATPases may be involved and co-operate, at least under peculiar circumstances, to nitrogen excretion and ammonia detoxification mechanisms in bivalve molluscs. The two ATPase activities stimulated by NH4 + maintained their typical response to the glycoside ouabain, specific inhibitor of the Na,K-ATPase, being the Na++ NH4 +-activated ATPase even more susceptive to the inhibitor and the ouabain-insensitive ATPase activity activated indifferently by Na+ or NH4 + unaffected by up to 10-2 M ouabain. In vitro assays were carried out to evaluate the response of the two Na-dependent ATPases to organotins in clams and mussels and to investigate the interaction of TBT with mussel mitochondrial oligomycin-sensitive Mg-ATPase. Since no literature data were available, the optimal assay conditions and oligomycin sensitivity of mussel mitochondrial MgATPase were determined. In T. philippinarum the ouabain-insensitive Na-ATPase was found to be refractory to TBT both in the gills and in the mantle, whereas the Na,K-ATPase was progressively inhibited by increasing TBT doses; the enzyme inhibition was more pronounced in the gills than in the mantle. In both tissues of M. galloprovincialis the Na,K-ATPase inhibition by alkyltins decreased in the order TBT>DBT(dibutyltin)>>MBT(monobutyltin)=TeET(tetraethyltin) (no effect). Mussel Na-ATPase confirmed its refractorimess to TBT and derivatives both in the gills and in the mantle. These results indicate that the Na,K-ATPase inhibition decreases as the number of alkyl chains bound to tin decreases; however a certain polarity of the organotin molecule is required to yield Na,K-ATPase inhibition, since no enzyme inhibition occurred in the presence of tetraalkyl-substituted derivatives such as TeET . Assays carried out in the presence of the dithioerythritol (DTE) pointed out that the sulphhydrylic agent is capable to prevent the Na,K-ATPase inhibition by TBT, thus suggesting that the inhibitor may link to -SH groups of the enzyme complex.. Finally, the different effect of alkyltins on the two Na-dependent ATPases may constitute a further tool to differentiate between the two enzyme activities. These results add to the wealth of literature data describing different responses of the two enzyme activities to endogenous and exogenous modulators . Mussel mitochondrial Mg-ATPase was also found to be in vitro inhibited by TBT both in the gills and in the mantle: the enzyme inhibition followed non competitive kinetics. The failed effect of DTE pointed out that in this case the interaction of TBT with the enzyme complex is probably different from that with the Na,K-ATPase. The results are consistent with literature data showing that alkyltin may interact with enzyme structures with different mechanisms. Mussel exposure to different TBT sublethal doses in aquaria was carried out for 120 hours. Two samplings (after 24 and 120 hrs) were performed in order to evaluate a short-term response of gill and mantle Na,K-ATPase, ouabain-insensitive Na-ATPase and Mg-ATPase activities. The in vivo response to the contaminants of the enzyme activities under study was shown to be partially different from that pointed out in the in vitro assays. Mitochondrial Mg-ATPase activity appeared to be activated in TBTexposed mussels with respect to control ones, thus confirming the complexity of evaluating in vivo responses of the enzyme activities to contaminants, due to possible interactions of toxicants with molluscan metabolism. Concluding, the whole of data point out that microsomal and mitochondrial ATPase activities of bivalve molluscs are generally responsive to environmental contaminants and suggest that in some cases membrane-bound enzyme activities may represent the molecular target of their toxicity. Since the Na,K-ATPase, the Na-ATPase and the Mg-ATPase activities are poorly studied in marine bivalves, this research may contribute to enlarge knowledge in this quite unexplored field.

Gli effetti della terapia di resincronizzazione cardiaca in pazienti con fibrillazione atriale permanente sulla sopravvivenza a lungo-termine: l'importanza dell'ablazione del nodo atrio-ventricolare

La terapia di resincronizzazione cardiaca (TRC) è un presidio non farmacologico che riduce la mortalità e la morbosità nei pazienti con scompenso refrattario alla terapia medica. La maggior parte dei dati riguardanti gli effetti della TRC coinvolgono i pazienti con le indicazioni consolidate seguenti: classe NYHA III-IV, ritardo della conduzione ventricolare (QRS>opp= 20 msec), disfunzione sistolica ventricolare sinistra (frazione di eiezione ventricolare sinistra >opp= 35%) e ritmo sinusale (RS). Mentre è noto che la fibrillazione atriale permanente (FA) sia presente in una porzione consistente dei pazienti con scompenso cardiaco, vi sono pochi dati riguardanti la sopravvivenza e gli effetti a lungo-termine della TRC in pazienti con scompenso cardiaco e fibrillazione atriale (FA); la maggior parte degli studi sono osservazionali ed hanno dimostrato che la TRC potrebbe conferire dei benefici a corto e medio termine anche in pazienti con FA permanente. Solo recentemente un ampio studio osservazionale ha descritto che, a lungo-termine, la TRC migliora significativamente la capacità funzionale, la frazione di eiezione e induce il rimodellamento inverso del ventricolo sinistro solamente in quei pazienti con FA dove la TRC viene combinata con l’ablazione del nodo atrio-ventricolare (NAV). La strategia ablativa del NAV infatti conferendo una stimolazione completa e costante, permette di eliminare gli effetti del ritmo spontaneo di FA (ritmo irregolare e tendenzialmente tachicardico) cheinterferisce in maniera importante con la stimolazione biventricolare in particolare durante gli sforzi fisici. Sulla base di queste premesse il presente studio si propone di valutare gli effetti a lungo-termine della TRC su pazienti con scompenso cardiaco e FA permanente focalizzando su due aspetti principali: 1) confrontando la sopravvivenza di pazienti con FA permanente rispetto ai pazienti in RS; 2) confrontando la sopravvivenza di pazienti in FA suddivisi secondo la modalità di controllo della frequenza con somministrazione di farmaci antiaritmici (gruppo FA-farm) oppure mediante controllo ablazione del NAV (gruppo FA-abl). Metodi e risultati: Sono presentati i dati di 1303 pazienti sottoposti consecutivamente ad impianto di dispositivo per la TRC e seguiti per un periodo mediano di 24 mesi. Diciotto pazienti sono stati persi durante il follow-up per cui la popolazione dello studio è rappresentata da una popolazione totale di 1295 pazienti di cui 1042 in RS e 243 (19%) in FA permanente. Nei pazienti con FA il controllo della frequenza cardiaca è stato effettuato mediante la somministrazione di farmaci anti-aritmici (gruppo FA-farm: 125 pazienti) oppure mediante ablazione del NAV (FA-abl: 118 pazienti). Rispetto ai pazienti in RS, i pazienti in FA permanente erano significativamente più vecchi, più spesso presentavano eziologia nonischemica, avevano una frazione di eiezione più elevata al preimpianto, una durata del QRS minore e erano più raramente trattati con un defibrillatore. Lungo un follow-up mediano di 24 mesi, 170/1042 pazienti in RS e 39/243 in FA sono deceduti (l’incidenza di mortalità a 1 anno era di 8,4% e 8,9%, rispettivamente). I rapporti di rischio derivanti dall’analisi multivariata con il 95% dell’intervallo di confidenza (HR, 95% CI) erano simili sia per la morte per tutte le cause che per la morte cardiaca (0.9 [0.57-1.42], p=0.64 e 1.00 [0.60-1.66] p=0.99, rispettivamente). Fra i pazienti con FA, il gruppo FA-abl presentava una durata media del QRS minore ed era meno frequentemente trattato con il defibrillatore impiantabile rispetto al gruppo FA-farm. Soli 11/118 pazienti del FA-abl sono deceduti rispetto a 28/125 nel gruppo FA-farm (mortalità cumulativa a 1 anno di 9,3% e 15,2% rispettivamente, p<0.001), con HR, 95% CI per FA-abl vs FA-farm di 0.15 [0.05-0.43],,p<0.001 per la mortalità per tutte le cause, di 0.18 [0.06-0.57], p=0.004 per la mortalità cardiaca, e di 0.09 [0.02-0.42], p<0.002 per la mortalità da scompenso cardiaco. Conclusioni: I pazienti con scompenso cardiaco e FA permanente trattati con la TRC presentano una simile sopravvivenza a lungo-termine di pazienti in RS. Nei pazienti in FA l’ablazione del NAV in aggiunta alla TRC migliora significativamente la sopravvivenza rispetto alla sola TRC; questo effetto è ottenuto primariamente attraverso una riduzione della morte per scompenso cardiaco.

Effetti dell'acido urico sulle cellule glomerulari mesangiali: meccanismi intracellulari di trasduzione del segnale e possibili implicazioni nella progressione del danno renale e nella sindrome infiammatoria in corso di nefropatie croniche

Uric acid is a major inducer of inflammation in renal interstitium and may play a role in the progression of renal damage in hyperuricemic subjects with primary nephropathies, renal vascular disease, and essential hypertension. At the same time, UA also acts as a water-soluble scavenger of reactive oxygen species. We evaluated the cellular effects of UA on cultured HMC as a potential interstitial target for abnormally elevated levels in acute and chronic renal disease. Intracellular free Ca2+ ([Ca2+]i) was monitored by microfluorometry of fura 2-loaded cells, while oxidation of intracellularly trapped non-fluorescent 2’,7’-dichlorofluorescein diacetate (DCFHDA, 20 uM) was employed to assess the generation of reactive oxygen species during 12-hr incubations with various concentrations of UA or monosodium urate. Fluorescent metabolites of DCFH-DA in the culture media of HMC were detected at 485/530 nm excitation/emission wavelengths, respectively. UA dose-dependently lowered resting [Ca2+]i (from 102±9 nM to 95±3, 57±2, 48±6 nM at 1-100 uM UA, respectively, p <0.05), leaving responses to vasoconstrictors such as angiotensin II unaffected. The effect was not due to Ca2+/H+ exchange upon acidification of the bathing media, as acetate, glutamate, lactate and other organic acids rather increased [Ca2+]i (to max. levels of 497±42 nM with 0.1 mM acetate). The decrease of [Ca2+]i was abolished by raising extracellular Ca2+ and not due to effects on Ca2+ channels or activation of Ca2+-ATPases, since unaffected by thapsigargin. The process rather appeared sensitive to removal of extracellular Na+ in combination with blockers of Na+/Ca2+ exchange, such as 2’,4’-dichlorobenzamil, pointing to a countertransport mechanism. UA dose-dependently prompted the extracellular release of oxidised DCFH (control 37±2 relative fluorescence units (RFU)/ml, 0.1uM 47±2, 1 uM 48±2, 10 uM 51±4, 0.1 mM 53±4; positive control, 10 uM sodium nitroprusside 92±5 RFU/ml, p<0.01). In summary, UA interferes with Ca2+ transport in cultured HMC, triggering oxidative stress which may initiate a sequence of events leading to interstitial injury and possibly amplifying renal vascular damage and/or the progression of chronic disease.