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Agrigento, Italy

Perciaccante A.,San Giovanni Di Dio Hospital | Coralli A.,San Giovanni Decollato Andosilla Hospital
Sleep Medicine | Year: 2015

Marcel Proust is considered one the greatest novelists of all times. His life was characterised by a long list of diseases. We analyse an important illness suffered by Proust: insomnia. It began in childhood and continued throughout his life, worsening progressively, and leading to a complete reversal of the sleep-wake cycle in the last years of the novelist's life. Several factors may be involved in the pathogenesis of Proust's insomnia. The beginning of insomnia since childhood, its characteristics, and the lack of precipitating factors suggest a form of idiopathic insomnia. Psychological traits of his personality (severe anxiety and depression) may have played a central role in the onset of insomnia. Further factors such as asthma and intake of stimulating substances may have had an important role in the maintenance and worsening of his insomnia. This sleep disorder affected both the lifestyle and literary genius of Marcel Proust. Insomnia is the prominent figure in the first novel ("Swann's way") of Proust's masterpieces entitled "In search of lost time," in which the novelist begins his journey through involuntary memory starting from his insomnia. © 2015 Elsevier B.V. Source


Siniscalchi A.,Annunziata Hospital | Gallelli L.,University of Catanzaro | Malferrari G.,Santa Maria Nuova Hospital | Pirritano D.,San Giovanni Di Dio Hospital | And 3 more authors.
Journal of Basic and Clinical Physiology and Pharmacology | Year: 2014

Stroke represents the most frequent cause of permanent disability in adults worldwide. Cerebral ischemia triggers the pathological pathways of the ischemic cascade and causes irreversible neuronal injury in the ischemic core within minutes of the onset. Elements of the immune system are involved in all stages of ischemic cascade from acute intravascular events triggered by the interruption of blood supply, to the parenchymal processes leading to brain damage and to the ensuing tissue repair. In this review, we will provide a brief overview of current understanding of the role of cytokines and brain inflammation during acute ischemic stroke. © 2014 by Walter de Gruyter Berlin/Boston. Source


Tarantino L.,San Giovanni Di Dio Hospital | Sordelli I.,The Second University of Naples | Calise F.,Cardarelli Hospial | Ripa C.,San Giovanni di Dio Hospital Frattamaggiore | And 2 more authors.
Updates in Surgery | Year: 2011

The treatment of cirrhotic patients with spontaneous rupture of hepatocellular carcinoma (HCC) is controversial and largely dependent on general conditions of the patients and compensation of the underlying cirrhosis. We retrospectively reviewed clinical, imaging and surgical records of 24 consecutive cirrhotic patients (17 males, 7 females; age range 52-88 years) with hemoperitoneum from spontaneous rupture of HCC observed from June 2004 to January 2010 at our Institution. When indicated, patients were referred to surgery or trans-arterial embolization (TAE). Advanced decompensated patients were conservatively treated and clinically followed up. Spontaneous rupture of HCC was assessed by aspiration of bloody ascites at paracentesis in all cases. The presence of large blood-clots over HCC and liver surface at US and/or CT was considered a specific sign of rupturedHCCin 14 cases. In two out of four patients who underwent TAE active bleeding from tumor surface could be demonstrated. In 2 cases, the active hemorrhage from the HCC surface could be assessed by contrast-enhanced ultrasonography. Four out of 24 patients underwent surgery. Three out of four of these patients died within 2 weeks, 8 months, and 20 months after operation, respectively. The remaining patient is still alive at 52 months follow-up. Four patients underwent TAE and died at 1, 2, 6 and 10 months after treatment, because of recurrent peritoneal bleeding and/or liver failure. Sixteen patients with ruptured HCC in the advanced Child C cirrhosis were treated conservatively with blood derivative transfusion and with procoagulant drugs. All patients, but one died within 2-18 days. One patient survived the acute hemorrhage from ruptured HCC and died of liver failure after 3 months. We concluded that spontaneous rupture of HCC is usually a fatal event in patients with poor liver function, even after successful TAE. In compensated patients, timely surgical treatment can result in long term and even tumor-free survival of the patient. © 2011 Springer-Verlag. Source


Tamburino C.,University of Catania | Latib A.,EMO GVM Centro Cuore | Van Geuns R.-J.,Erasmus Medical Center | Sabate M.,University of Barcelona | And 22 more authors.
EuroIntervention | Year: 2015

Aims: Next to patient characteristics, the lack of a standardised approach for bioresorbable vascular scaffold (BVS) implantation is perceived as a potential explanation for the heterogeneous results reported so far. To provide some guidance, we sought to find a consensus on the best practices for BVS implantation and management across a broad array of patient and lesion scenarios. Methods and results: Fourteen European centres with a high volume of BVS procedures combined their efforts in an informal collaboration. To get the most objective snapshot of different practices among the participating centres, a survey with 45 multiple choice questions was prepared and conducted. The results of the survey represented a basis for the technical advice provided in the document, whereas areas of controversy are highlighted. Conclusions: Consensus criteria for patient and lesion selection, BVS implantation and optimisation, use of intravascular imaging guidance, approach to multiple patient and lesion scenarios, and management of complications, were identified. © Europa Digital & Publishing 2015. All rights reserved. Source


Santini D.,Biomedical University of Rome | Schiavon G.,Biomedical University of Rome | Schiavon G.,Erasmus Medical Center | Vincenzi B.,Biomedical University of Rome | And 16 more authors.
PLoS ONE | Year: 2011

Background: Receptor activator of NFkB (RANK), its ligand (RANKL) and the decoy receptor of RANKL (osteoprotegerin, OPG) play a pivotal role in bone remodeling by regulating osteoclasts formation and activity. RANKL stimulates migration of RANK-expressing tumor cells in vitro, conversely inhibited by OPG. Materials and Methods: We examined mRNA expression levels of RANKL/RANK/OPG in a publicly available microarray dataset of 295 primary breast cancer patients. We next analyzed RANK expression by immunohistochemistry in an independent series of 93 primary breast cancer specimens and investigated a possible association with clinicopathological parameters, bone recurrence and survival. Results: Microarray analysis showed that lower RANK and high OPG mRNA levels correlate with longer overall survival (P = 0.0078 and 0.0335, respectively) and disease-free survival (P = 0.059 and 0.0402, respectively). Immunohistochemical analysis of RANK showed a positive correlation with the development of bone metastases (P = 0.023) and a shorter skeletal disease-free survival (SDFS, P = 0.037). Specifically, univariate analysis of survival showed that "RANK-negative" and "RANK-positive" patients had a SDFS of 105.7 months (95% CI: 73.9-124.4) and 58.9 months (95% CI: 34.7-68.5), respectively. RANK protein expression was also associated with accelerated bone metastasis formation in a multivariate analysis (P = 0.029). Conclusions: This is the first demonstration of the role of RANK expression in primary tumors as a predictive marker of bone metastasis occurrence and SDFS in a large population of breast cancer patients. © 2011 Santini et al. Source

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