Minerva Medica

Tramadol is a synthetic opioid agonist used extensively in human and, to a lesser extent, veterinary medicine throughout the world. The clinical efficacy and pharmacokinetic profile of intravenous (i.v.) and extradural (e.d.) tramadol (2 mg/kg) and its o-desmethyl metabolite were studied in dogs undergoing tibial plateau levelling osteotomy (TPLO). Intra-operative cardiorespiratory variables were monitored and post-operative pain was assessed using the short form of the Glasgow Composite Pain Scale. A rapid (<5 min) and effective production of o-desmethyl tramadol was recorded. The pharmacokinetic profile was similar for tramadol and its metabolite irrespective of the route of administration. E.d. tramadol provided sufficient intra- and post-operative analgesia without significant clinical side-effects, but the post-operative analgesia was comparable to that following i.v. administration and the e.d. route could therefore not be considered a practical alternative to the i.v. route.

Discussion paper Hygieia at:  ‘Historicisation’ A summer course for PhD students arranged by the Nordic network for medical history (NordForsk) about "framing health".. The University of Bergen, 24-26 August, 2011.

Updated and corrected version: 28 juni 2021

"The article explores how, when andwhy Pirro Ligorio (c. 1513–83) chose to link a sanctuary dedicated to MinervaMedica, listed in the fourth-century AD Regionary Catalogues of the monuments of Rome as being on the Esquiline, with the late antique decagonal pavilion, near Termini, which had the second largest dome in Rome after the Pantheon. It establishes that the catalyst was the unearthing of several statues, including one of Minerva, in 1552. The fate of these finds is examined, as well as Ligorio’s attempt to locate the mysterious Schola Medicorum on the same site.

Con l’articolo si indaga come, quando e perché Pirro Ligorio (ca. 1513–83) scelse di legare un santuario dedicato a Minerva Medica, citato nei Cataloghi Regionari del IV secolo d.C., che
elencavano i monumenti di Roma come situati sull’Esquilino, con il padiglione tardo-antico decagonale situato vicino la stazione Termini, che aveva la seconda più grande cupola a Roma dopo il Pantheon. Il saggio stabilisce che il catalizzatore fu la scoperta di molte statue, inclusa quella di Minerva, nel 1552. Viene esaminato il destino di questi ritrovamenti e ugualmente il tentativo di Ligorio di individuare la misteriosa Schola Medicorum sullo stesso sito."

Extracted from: The Eastern Part of the Mons Oppius in Rome. By Chrystina Häuber

The research on The Eastern Part of the Mons Oppius in Rome presented here has been conducted since March 1981 in close cooperation with the Musei Capitolini, the Sovraintendenza ai Beni Culturali of the Comune di Roma, now Roma Capitale, and other partners. It deals with the part of the Esquiline which in antiquity was occupied by a number of sanctuaries and the adjacent Horti of Maecenas. Since her first publication 30 years ago, the author has studied the archaeological finds from this area in depth, but in order to understand their historical contexts it became necessary to consider the topography of a much wider area. The results therefore include contributions to the `Esquiline Venus, to the bust of Commodus as Hercules Romanus (both Roma, Musei Capitolini), and the dating of the `Esquiline Group (Copenhagen, Ny Carlsberg Glyptotek), as well as a reconstruction of the Servian city wall between the `Auditorium of Maecenas and the Porta Capena. The accompanying maps, drawn by the author, are based on the photogrammetric data of Roma Capitale which were generously provided by the Sovraintendente ai Beni Culturali of Roma Capitale.

After a chapter on the methodological approach, the text is divided into two parts: Topography and excavations, with a topographical survey of the research area, and Discussion of selected archaeological finds.


Chrystina Haeuber studied drawing (Werkkunstschule Krefeld), art, theology and geography (Universitaet Duisburg), and classical archaeology, art history and ancient history (Universitaet zu Koeln). She has published widely on ancient sculpture, the topography of ancient Rome and Archaeological Information Systems (AIS). Among her research projects are FORTVNA and The AIS ROMA. Since December 2010 she has been a researcher and project director at the Ludwig-Maximilians-Universitaet (LMU) Muenchen, Department of Geography.

Atrial fibrillation is the most common arrhythmia in the United States, whose incidence is greatest in the elderly population. This rhythm disorder can be paroxysmal or chronic and is associated with a range of clinical conditions from palpitations and dyspnea to stroke and death. In ...

The use of hepatitis B immunoglobulin (HBIg) combined with nucleos(t)ide analogues (NUCs) has improved outcomes in post-hepatitis B (PHB) liver transplant (LT), reducing the 1-year recurrence rate below 10%. The aim of this study was to evaluate efficacy and pharmacokinetics of prophylaxis with NUC(s) and intravenous (iv-) or intramuscular (im-) HBIg in 33 PHBLTs, transplanted for more than 1 year. During the first six months of the study, 18 subjects received 5000 IU of iv-HBIg every four weeks and 15 patients 2160 IU/12 mL of im-HBIg every two weeks. In the following six months, 31 subjects were switched to two different concentrations of im-HBIg, 2160/12 mL (16 patients) or 2000 IU/6 mL every two weeks (15 patients). All patients remained HBsAg-negative and 30/31 maintained anti-HBs >100 IU/L. Overall mean anti-HBs titer during treatment was 363 IU/mL. Mean HBIg half-life was 21.4, 27.3 and 26 days with intravenous, diluted or concentrated im-preparations, respectively. These ...

α-Lipoic acid is an important micronutrient with several pharmacological as well as antioxidant properties. The present study was aimed to examine the human bioavailability, pharmacokinetics (PK) and tolerability of an innovative oral formulation (ALA600) containing racemic α-lipoic acid 600 mg. After a single 600-mg oral administration in healthy volunteers, blood samples were collected up to 8 hours post dosing, and plasma α-lipoic acid concentrations were determined by Liquid Chromatography-Mass Spectrometry (LC-MS) detection. The PK data revealed a short time to reach plasma peak oncentrations (50.8± 4.2 min) with a C(max) of 6.86±1.29 µg/mL. The C(max) implying that the new pharmaceutical form positively influences absorption and absorption time. The AUC value of 5.65±0.79 µg/mL*h is the more reliable measure of new formulation bioavailability. The half-life and MRT values further show that new formulation is absorbed consistently and rapidly and is eliminated efficiently. Thes...

Iron is an important metal in the complex biochemistry in human beings. However there are primary or secondary diseases that lead to an accumulation of iron in parenchymal organs and induce progressive and serious systemic harm. This review aims to define the fundamental steps of cell biology and physiology of iron and the pathophysiological mechanisms responsible for its accumulation in the parenchyma. In addition, we analyze the main primitive (hemochromatosis) and secondary (inflammation, liver diseases and hematological) diseases, responsible for the damage caused by iron, and we analyze the clinical consequences of iron overload. Furthermore, we pass under review a particular classification of general mechanisms and kinetics of iron overload responsible for its clinical phenotypes, dividing them into systemic, cellular and subcellular overload mechanisms. Finally we describe the main pathologic stages resulting from iron overload, with particular reference to liver damage and p...

Nowadays, rigid and flexible ureteroscopy is a precise, minimal invasive surgery that can assess the entire collecting system in order to treat a stone with intracorporeal lithotripsy. The implication of laser technology has revolutionized the intracorporeal lithotripsy. Currently, laser lithotripsy is advancing in two different directions: improvements of the existing Ho:YAG laser platform and the development of novel laser systems. Herein, we review the current literature upon intracorporeal lithotripsy.

BACKGROUND Acute liver failure (ALF) is a rare but often lethal syndrome. In Italy, recent data on its incidence and causes are lacking. We report here the epidemiological analysis of ALF cases observed in Campania, a Southern Italian region, over the last 25 years. METHODS Medical records of ALF cases hospitalized from 1992 to 2018 were retrospectively analyzed. RESULTS Two hundred ten ALF cases occurred during 1992-2018: 103 (49%) hepatitis B virus (HBV)-related (including 5 cases also infected with Delta virus), 39 (19%) from undetermined cause, 36 (17%) drug-induced, 11 (5%) Wilson's disease-associated, 8 (4%) hepatitis A virus (HAV)-related and 12 (6%) from other causes. Separate time-periods analysis of data showed a significant progressive decrease in ALF incidence mainly attributable to a decline of HBV and other viruses aetiology. Already before 2010, HAV or Delta virus-related cases have no longer been observed. No hepatitis C or E virus-related ALF was detected through the study period. A progressive decrease in frequency of ALF due to undetermined causes or drug was also evident. CONCLUSIONS A decrease in ALF incidence and a changing in its aetiology were observed in Campania during 1992-2018. Both results were likely mainly due to 1991 introduction of HBV universal vaccination and may be considered generalizable nationwide.

Storia, Restauro e Struttura non individuano, nelle intenzioni di chi ha pensato questo libro, tre settori disciplinari in cui collocare gli scritti dei diversi autori a seconda del proprio ambito disciplinare e selezionati in modo più o meno casuale. Storia, Restauro e Struttura rappresentano compiutamente il ricco ambiente, il contesto culturale in cui si è potuto formare Carlo Baggio, la sua storia personale e l'essenza della sua sapienza disciplinare. E non vi è discontinuità logica in quelle che potrebbero essere definite tre discipline separate perché, come nella definizione più propria di contesto culturale, nel grande tema della conservazione del patrimonio architettonico, storico, artistico, monumentale e più in generale della memoria, i confini sono labili, gli ambiti sovrapposti e forti le connessioni. E per chi si occupa di questo grande tema, non vi è altra strada che quella di essere collocati in un ambito aperto e pluridisciplinare e in quanto tale in un ambiente umanistico. Il carattere comune agli autori di questo volumetto è appunto la possibilità di individuarne per ognuno di essi un tratto di identità, per quanto generico e sfuggevole come concetto, ascrivibile ad un medesimo contesto culturale. Enrico Da Gai, Introduzione; Margherita Fratarcangeli, Mura in gelatine d'argento scialbate con «ossi di seppia»; Giovanna Curcio, Domenico Castelli e il cortile del Palazzo Nuovo Vaticano; Paola Zampa, L'ala est del palazzo di Montecavallo «quasi tutta rifatta [...] d'ordine di papa Urbano VIII»; Marina Cogotti, Bernini a Villa d'Este: la fontana del Bicchierone; Enrico Da Gai, Architetti e capomastri: una sinergia indispensabile; Marina Magnani Cianetti, Riflessioni sulla manutenzione dei monumenti. Alcune applicazioni; Elisabetta Pallottino, Sicurezza e conservazione del patrimonio architettonico e urbano. Carlo Baggio: una testimonianza laica; Silvia Santini, Le indagini in situ e il monitoraggio strutturale: strumenti per la valorizzazione del patrimonio architettonico; Luigi Ficacci, AUT IN HOC. Piranesi versus Mariette; indice dei nomi.

Asthma is a complex inflammatory disorder of the airways characterized by airway hyper-responsiveness and variable, reversible, airflow obstruction. Bronchial thermoplasty (BT) is a new modality for treating asthma. It targets airway smooth muscles (ASM) by delivering a controlled specific amount of thermal energy (radiofrequency ablation) to the airway wall through a dedicated catheter. The use of bronchial thermoplasty has been widely discussed for its potential in the treatment of asthma, since it seems to be able to reduce the symptoms of asthma. The definitive study for BT (AIR2 trial) employed a randomized, double-blind, sham-controlled design and enrolled 288 subjects with severe persistent asthma from 30 US and international centers. The results of the AIR2 trial demonstrated clinically significant benefits of BT compared with the sham group at one year post-treatment, including an improvement in asthma-related quality of life, 32% reduction in severe exacerbations, 84% redu...

Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia encountered in clinical cardiology, particularly in patients with heart failure. Its prevalence increases with the degree of left ventricular dysfunction and severity of heart failure symptoms. The development of AF in the setting of heart failure has been shown to result in increased mortality. Studies thus far indicate that rhythm control with antiarrhythmic drug therapy or catheter ablation offers both symptomatic and probably survival advantage in patients with heart failure and AF. In patients with permanent AF, the effects of restoring a regular ventricular response with atrioventricular junction ablation followed by biventricular pacing remain to be shown. In the current manuscript, we will review the proposed mechanisms of increased morbidity and mortality associated with AF and the current treatment options including the roles of radiofrequency ablation and pacing.

Minimal encephalopathy was originally associated with chronic liver disease but is increasingly associated with most other chronic diseases and particularly with diabetes and also chronic disorders in other organs: kidneys, lungs, thyroid and with obesity. It is increasingly with dramatically increased and more or less permanent increase in systemic inflammation, most likely a result of Western lifestyle. Frequent physical exercise and intake of foods rich in vitamins, antioxidants, fibres, lactic acid bacteria etc in combination with reduction in intake of refined and processed foods is known to reduce systemic inflammation and prevent chronic diseases. Some lactic acid bacteria, especially Lb paracasei, lb plantarum and pediococcus pentosaceus have proven effective to reduce inflammation and eliminate encephalopathy. Significant reduction in blood ammonia levels and endotoxin levels were reported in parallel to improvement of liver disease. Subsequent studies with other lactic acid bacteria seem to demonstrate suppression of inflammation and in one study also evidence of clinical improvement.

Breathlessness is a key symptom in chronic obstructive pulmonary disease (COPD) with prognostic implications on health status and survival. Since most conditions underlying chronic refractory breathlessness in COPD are not modifiable, the use of opioids and benzodiazepines has been proposed to relieve it. However, respiratory depression is a known adverse event of these drugs, and concerns have been raised on their use in patients with chronic respiratory failure. Despite safety-related concerns, benzodiazepines are frequently prescribed for a variety of reasons, including treatment of insomnia, depression and anxiety, as well as to relieve refractory dyspnea in patients with COPD. The key role of opioids in the end-of-life and in the management of dyspnea that is unresponsive to best-possible disease management is recognized. Moreover, the use of low dose opioids to treat dyspnea, discomfort or refusal for patient undergoing non-invasive ventilation is still debated. In the current...

Understanding whether the ABCD GOLD classification method is informative with respect to the spirometric classification of severity in predicting mortality of patients with chronic obstructive pulmonary disease (COPD) is subject of debate. The results of a study performed on a sample of the Norwegian population (HUNT2) were recently published. Such data showed the inferiority of ABCD classification in predicting mortality compared to the spirometric classification, which was considered the gold standard up to the 2011 version of GOLD guidelines. This result is not in line with the results of other studies that have shown the equivalence of the two classifications. The new GOLD classification seemed to be a step forward for what concerns understanding patient's needs, but it seems clear that the insertion of a single clinical variable to the spirometric data may not be exhaustive in describing all the phenomena related to a heterogeneous disease such as COPD. The publication of t...

Basketball involves high-intensity bouts interspersed with brief/incomplete recovery periods. As a result repeated-sprint ability and change of direction training assume logical validity in basketball. Ball-drill games (BD) were suggested as a viable training to provide a range of specific physiological adaptation in basketball. Therefore, the aim of this study was to compare the effects of BD with Sprint Training (ST), and Generic Training (GT) on sprint ability and agility in basketball players. Thirty male regional-level players (17.3 \ub1 0.8 years, 74.2 \ub1 9.8 kg, 181.7 \ub1 7.3 cm) were matched according to VO2max and Anthropometrics and randomly assigned to 3 training groups: BDG (n=12, 4x4min 3 vs 3 at 95% of HRmax with 3-min passive recovery), STG (n=9, 3x6x20m shuttle running with 20-sec and 4-min recovery between bouts and series respectively) and GTG (n=9, control group, generic basketball technical/tactical exercises). Players were tested before and after 8 training weeks (2 sessions/week, 2hrs/session), for force platform Squat Jump and Countermovement Jump; Yo-Yo Intermittent Recovery Test level 1 (YYIRTL1); Agility T-test (forward, lateral, and backward running); Line sprinting over 5/10/20 m and Line drill (LD). No time x group differences were found in jumping and sprinting performance. Significant improvements were reported for YYIRTL1 in BDG (+21%, p<0.05) and STG (+30%, p<0.05). Agility T-test performance showed significant improvements in BDG (-3.4%, p<0.05) and STG (-4.7%, p<0.05). LD test performance was enhanced in the BDG (-1.3 %, p<0.05) and STG (-2.2%, p<0.05). No significant changes in performance occurred in the GTG. These results showed that BD and ST may enhance aerobic and anaerobic fitness if added to usual training. BD, promoting skill development, should be considered as a valuable training tool when pursuing a holistic performance development in basketball players. Researches addressing the concurrent use of BD and ST are warranted

Diagnosis of indeterminate mediastinal masses and staging of lung cancer poses a significant challenge. Options for tissue diagnoses include computed tomography (CT)-guided percutaneous biopsy, transbronchial fine-needle aspiration, mediastinoscopy/mediastinotomy or thoracoscopy, but these investigations have limitations in terms of tissue yield, safety profile and cost. Trans-esophageal endoscopic ultrasound scanning (EUS) is a new minimal invasive method that provides high resolution imaging of the mediastinum using high frequency ultrasound probes attached to the tip of a flexible endoscope and offers in addition the facility of fine needle aspiration (EUS-FNA) or tru-cut biopsy (TCB) under real-time ultrasound guidance. EUS-FNA allows access to the posterior mediastinum and tissue acquisition under real-time ultrasound guidance through the oesophageal wall. Indications of EUS-FNA in the mediastinum is to obtain a diagnosis from an unknown primary lesion or to sample tissue from ...

Two months after monolateral adrenalectomy, a 47-year-old woman stopped taking corticosteroid replacement therapy in the first 15 days of therapy. She was admitted to the Department of Internal Medicine because of hypertension, severe hypercalcemia, uncompensated metabolic alkalosis and clinical symptoms of acute adrenal insufficiency. The presence of hypokalemia and hypernatremia precluded a diagnosis of hypocortisolism, therefore no corticosteroids were given during the time required to investigate the cause of hypercalcemia, which resulted negative. Administration of intravenous saline infusion produced no improvement in her clinical condition. Despite electrolyte alterations, hydrocortison (100 mg i.v.) and zoledronate (4 mg i.v.) were also administered, leading to a rapid and marked improvement in her clinical picture within a few hours, with normalization of the calcemia and the other electrolytic disturbances. After her neurological condition had fully normalized, the patient...

Alcoholic hepatitis is an acute and severe form of alcoholic liver disease associated with high morbidity and mortality of 30-50% worldwide, severity ranging from asymptomatic derangement of liver biochemistries to fulminant liver failure or death. Rapidly progressing jaundice and coagulopathy in prolonged excessive alcohol abusers with or without fever, malnutrition, and tender liver are the clinical hallmarks. The prognostic models (MELD, MDF, ABIC, GAHS, Lille's score) not only predict the short term mortality, but also guide the clinicians to choose appropriate specific therapy (corticosteroid or pentoxifylline) and as a stopping rule if there is no significant benefits of it. MDF score is commonly followed in clinical practice, score of >32 would predict short term mortality of around 20-30% at 1 month and 30-40% within 6 months after presentation. The GAHS on day 1 can predict 28 day overall survival outcome accuracy of 81%, which is comparatively higher than MDF score....

Aim of this study was to evaluate the effects of phytocomplexes of Uncaria, Shiitake and Ribes in terms of viability and inflammatory response on immune cell-derived cultures. Standardized extracts of Uncaria, Shitake and Ribes and their commercial formulation were tested on cell lines PBMC, U937 and macrophage. The activity was evaluated in terms of cell viability (MTT test), variations of oxidative marker release (ROS and PGE2) and modulatory effects on immune response (gene expression of IL-6, IL-8 and TNFα, RT-PCR). Cell viability was not affected by extracts, except subtle variations observed only at higher doses (>250 µg/mL). The extract mixture was well tolerated, with no effects on cell viability up to doses of 500 µg/mL. Pre-treatment of macrophages with subtoxic doses of the extracts reduced the basal release of oxidative markers and enhanced the cell response to exogenous oxidant stimulation, as revealed by ROS and PGE2 release reduction. The same treatment on macrophage resulted in a selective modulation of the immune response, as shown by an increase of IL-6 mRNA and, partially, IL-8 mRNA, while a reduction was observed for TNFα mRNA. Data confirm that extracts and their formulations can act as regulator of the immune system with mechanisms involving the oxidative stress and the release of selected proinflammatory cytokines.