Appropriateness and efficacy of Spa therapy for musculoskeletal disorders. A Delphi method consensus initiative among experts in Italy.

OBJECTIVE: The aim of the study was to identify the main aspects concerning appropriateness and efficacy of Spa therapy for musculoskeletal pathologies. METHODS: A committee of 8 experts from Italian universities, public hospitals, territorial services, research institutes and patient associations was set up. Clinicians from Italian medical centers specialized in rheumatology, rehabilitation and thermal medicine took part in a Delphi process aimed at obtaining consensus statements among the participants. RESULTS: Large consensus was obtained for statements grouped under the following main themes: treatment indications; choice of treatment modality and treatment efficacy. CONCLUSIONS: The experts developed a number of consensus statements which may be used as a practical reference to guide the choice of physicians to treat musculoskeletal diseases with Spa therapy

Solar selective absorbers based on Al2O3:W cermets and AlSiN/AlSiON layers

Solar selective coatings based on double Al2O3:W cermet layers and AlSiN/AlSiON bilayer structures were prepared by magnetron sputtering. Both were deposited on stainless steel substrates using a metallic tungsten (W) layer as back reflector. The coating stacks were completed by an antireflection (AR) layer composed of Al2O3, SiO2, or AlSiOx. Spectrophotometer measurements, X-Ray diffraction, Scanning electron microscopy, Energy Dispersive X-Ray Spectroscopy and Rutherford Backscattering Spectrometry were used to characterize the optical properties, crystalline structure, morphology and composition of these coatings. The spectral optical constants of the single layers were calculated from the reflectance and transmittance measurements and used to design the optical stack. The coatings exhibit a solar absorptance of 93%-95% and an emissivity of 7%-10% (at 400 ºC). The coatings also exhibit excellent thermal stability, with small changes in the optical properties of the coating during heat-treatments at 400 ºC in air for 2500 h and at 580 ºC in vacuum for 850 h. The coating based on the AlSiN/AlSiON bilayer structure was obtained with an Al:Si ratio of 2.5:1. These coatings revealed similar performance as the one obtained with coatings based on Al2O3:W cermet layers.The authors acknowledge the funding from the Finnish Funding Agency for Technology and Innovation, Tekes, and from FEDER funds through the “Programa Operacional Factores de Competitividade – COMPETE” and from national funds by FCT- “Fundação para a Ciência e a Tecnologia”, under project no. PEst-C/FIS/UI0607/2011.info:eu-repo/semantics/publishedVersio

Nonlocal, noncommutative picture in quantum mechanics and distinguished canonical maps

Classical nonlinear canonical (Poisson) maps have a distinguished role in quantum mechanics. They act unitarily on the quantum phase space and generate $\hbar$-independent quantum canonical maps. It is shown that such maps act in the noncommutative phase space as dictated by the classical covariance. A crucial observation made is that under the classical covariance the local quantum mechanical picture can become nonlocal in the Hilbert space. This nonlocal picture is made equivalent by the Weyl map to a noncommutative picture in the phase space formulation of the theory. The connection between the entanglement and nonlocality of the representation is explored and specific examples of the generation of entanglement are provided by using such concepts as the generalized Bell states. That the results have direct application in generating vacuum soliton configurations in the recently popular scalar field theories of noncommutative coordinates is also demonstrated.Comment: 14 pages, one figur

Longitudinal Analysis of Quality of Life, Clinical, Radiographic, Echocardiographic, and Laboratory Variables in Dogs with Preclinical Myxomatous Mitral Valve Disease Receiving Pimobendan or Placebo: The EPIC Study

Background: Changes in clinical variables associated with the administration of pimobendan to dogs with preclinical myxomatous mitral valve disease (MMVD) and cardiomegaly have not been described. Objectives: To investigate the effect of pimobendan on clinical variables and the relationship between a change in heart size and the time to congestive heart failure (CHF) or cardiac-related death (CRD) in dogs with MMVD and cardiomegaly. To determine whether pimobendan-treated dogs differ from dogs receiving placebo at onset of CHF. Animals: Three hundred and fifty-four dogs with MMVD and cardiomegaly. Materials and Methods: Prospective, blinded study with dogs randomized (ratio 1:1) to pimobendan (0.4-0.6 mg/kg/d) or placebo. Clinical, laboratory, and heart-size variables in both groups were measured and compared at different time points (day 35 and onset of CHF) and over the study duration. Relationships between short-term changes in echocardiographic variables and time to CHF or CRD were explored. Results: At day 35, heart size had reduced in the pimobendan group:median change in (Delta) LVIDDN -0.06 (IQR:-0.15 to + 0.02), P < 0.0001, and LA:Ao -0.08 (IQR:-0.23 to + 0.03), P < 0.0001. Reduction in heart size was associated with increased time to CHF or CRD. Hazard ratio for a 0.1 increase in Delta LVIDDN was 1.26, P = 0.0003. Hazard ratio for a 0.1 increase in Delta LA:Ao was 1.14, P = 0.0002. At onset of CHF, groups were similar. Conclusions and Clinical Importance: Pimobendan treatment reduces heart size. Reduced heart size is associated with improved outcome. At the onset of CHF, dogs treated with pimobendan were indistinguishable from those receiving placebo

Two Mathematically Equivalent Versions of Maxwell's Equations

This paper is a review of the canonical proper-time approach to relativistic mechanics and classical electrodynamics. The purpose is to provide a physically complete classical background for a new approach to relativistic quantum theory. Here, we first show that there are two versions of Maxwell's equations. The new version fixes the clock of the field source for all inertial observers. However now, the (natural definition of the effective) speed of light is no longer an invariant for all observers, but depends on the motion of the source. This approach allows us to account for radiation reaction without the Lorentz-Dirac equation, self-energy (divergence), advanced potentials or any assumptions about the structure of the source. The theory provides a new invariance group which, in general, is a nonlinear and nonlocal representation of the Lorentz group. This approach also provides a natural (and unique) definition of simultaneity for all observers. The corresponding particle theory is independent of particle number, noninvariant under time reversal (arrow of time), compatible with quantum mechanics and has a corresponding positive definite canonical Hamiltonian associated with the clock of the source. We also provide a brief review of our work on the foundational aspects of the corresponding relativistic quantum theory. Here, we show that the standard square-root and the Dirac equations are actually two distinct spin-$\tfrac{1}{2}$ particle equations.Comment: Appeared: Foundations of Physic

The Inverse Variational Problem for Autoparallels

We study the problem of the existence of a local quantum scalar field theory in a general affine metric space that in the semiclassical approximation would lead to the autoparallel motion of wave packets, thus providing a deviation of the spinless particle trajectory from the geodesics in the presence of torsion. The problem is shown to be equivalent to the inverse problem of the calculus of variations for the autoparallel motion with additional conditions that the action (if it exists) has to be invariant under time reparametrizations and general coordinate transformations, while depending analytically on the torsion tensor. The problem is proved to have no solution for a generic torsion in four-dimensional spacetime. A solution exists only if the contracted torsion tensor is a gradient of a scalar field. The corresponding field theory describes coupling of matter to the dilaton field.Comment: 13 pages, plain Latex, no figure

Raising awareness of non-hodgkin lymphoma in HIV-infected adolescents: Report of 2 cases in the HAART era

Human immunodeficiency virus (HIV) chronically infected patients are at increased risk of developing non-Hodgkin lymphoma compared with the general population. Highly active antiretroviral therapy has had a dramatic effect on the natural history of HIV infection, reducing the incidence of acquired immunodeficiency syndrome-related non-Hodgkin lymphoma and improving overall survival. However, problems related to adherence to treatment, frequently experienced during adolescence, may increase the risk of acquired immunodeficiency syndrome-related cancers. Optimizing highly active antiretroviral therapy and monitoring noncompliant patients with persisting HIV replication should be considered by physicians who take care of these patients. We herein report 2 cases of relapsed/progressive Burkitt lymphoma in HIV vertically infected adolescents

Gait analysis advancements: rehabilitation value and new perspectives from forensic application

The clinical and rehabilitation value of gait analysis is remarkable and indisputable and poised to grow as technological advancements unfold. This article aims to shed light on the advances in how gait is assessed, enabling those who have suffered an injury impairing their motor skills to be diagnosed more accurately and efficiently as well as to compare the hallmarks of rehabilitative and forensic gait analysis. The authors have conducted an analysis of relevant papers (published between 1967 and 2020) from a medicolegal perspective, cited in PubMed, MEDLINE, Cochrane Library, EMBASE, and available recommendations for the legal application of such techniques. Moreover, considering the use of gait analysis as a forensic tool, this study broadens the scope of research by including search engines, legal databases, and court filings (DeJure, Lexis Nexis, Justia) between 2000 and 2022. The instrumental assessment of movement (Gait Analysis) has come to constitute an essential analytical tool for the biomedical sector to objectively and accurately assess human movement and posture. The article is also aimed at elaborating differences and similarities between clinical and forensic gait analysis. When it comes to the forensic applicability of gait analysis and its evidentiary value, however, there is a pressing need for a review of its scientific basis. Therefore, it is necessary to conduct a thorough evaluation of its use in legal practice, as stressed in scientific literature and surveys. It is of utmost importance to highlight the procedural and assessment standards currently applied to forensic gait analysis, to evaluate its strengths and weaknesses, and to achieve standardized guidelines based on broad scientific consensus

Immunotherapy with an HIV-DNA Vaccine in Children and Adults

Therapeutic HIV immunization is intended to induce new HIV-specific cellular immune responses and to reduce viral load, possibly permitting extended periods without antiretroviral drugs. A multigene, multi-subtype A, B, C HIV-DNA vaccine (HIVIS) has been used in clinical trials in both children and adults with the aim of improving and broadening the infected individuals’ immune responses. Despite the different country locations, different regimens and the necessary variations in assays performed, this is, to our knowledge, the first attempt to compare children’s and adults’ responses to a particular HIV vaccine. Ten vertically HIV-infected children aged 4–16 years were immunized during antiretroviral therapy (ART). Another ten children were blindly recruited as controls. Both groups continued their antiretroviral treatment during and after vaccinations. Twelve chronically HIV-infected adults were vaccinated, followed by repeated structured therapy interruptions (STI) of their antiretroviral treatment. The adult group included four controls, receiving placebo vaccinations. The HIV-DNA vaccine was generally well tolerated, and no serious adverse events were registered in any group. In the HIV-infected children, an increased specific immune response to Gag and RT proteins was detected by antigen-specific lymphoproliferation. Moreover, the frequency of HIV-specific CD8+ T-cell lymphocytes releasing perforin was significantly higher in the vaccinees than the controls. In the HIV-infected adults, increased CD8+ T-cell responses to Gag, RT and viral protease peptides were detected. No augmentation of HIV-specific lymphoproliferative responses were detected in adults after vaccination. In conclusion, the HIV-DNA vaccine can elicit new HIV-specific cellular immune responses, particularly to Gag antigens, in both HIV-infected children and adults. Vaccinated children mounted transient new HIV-specific immune responses, including both CD4+ T-cell lymphoproliferation and late CD8+ T-cell responses. In the adult cohort, primarily CD8+ T-cell responses related to MHC class I alleles were noted. However, no clinical benefits with respect to viral load reduction were ascribable to the vaccinations alone. No severe adverse effects related to the vaccine were found in either cohort, and no virological failures or drug resistances were detected

Rehabilitación deportiva post-hernioplastía TAPP: resultados en deportistas de alto rendimiento y recreacionales y en no deportistas : Experiencia tras 731 hernioplastías TAPP

Históricamente se ha recomendado el reposo después de hernioplastía inguinal con el objeto de evitar el dolor asociado a la movilización y proteger las suturas durante la primera fase de la inflamación. El desarrollo de procedimientos mínimamente invasivos y la evolución de las drogas analgésicas permitió reducir las restricciones y acelerar el proceso de reinserción social y laboral; no obstante aún no existen evidencias que permitan establecer el tiempo óptimo de reposo postoperatorio, las actividades proscriptas durante el mismo y la secuencia del reinicio hasta alcanzar el pleno desempeño. Un criterio consagrado por la práctica es permitir al paciente todas aquellas actividades que no desencadenen dolor hasta lograr la ejecución de movimientos que, por su amplitud o carga, se consideran análogos a los que enfrentará en su actividad laboral, pero esta conducta hace que la recuperación dependa en gran parte de su personalidad. Contrariamente, la rehabilitación temprana y controlada por fisioterapeutas ha resultado ventajosa durante el período postoperatorio o de recuperación de lesiones en grupos de deportistas, pero no se han publicado experiencias sobre su aplicación en el postoperatorio de hernioplastía inguinal en pacientes no deportistas. Los atletas profesionales o de alto rendimiento aceptan los ejercicios de rehabilitación como una fase del tratamiento que los acerca al retorno a la competencia y los deportistas recreacionales ven en ellos la posibilidad de reiniciar rápidamente la actividad física y retomar sus contactos sociales; ambos grupos cuentan con estas motivaciones que, en general, no están presentes en los no deportistas.Facultad de Ciencias Médica