Immunohistochemical profile of VEGF, TGF-ß and PGE2 in human pterygium and normal conjunctiva: experimental study and review of the literature.

Human pterygium is made up of chronic proliferative fibro-vascular tissue growing on the ocular surface. This disease exhibits both degenerative and hyperplastic properties. Some fibroangiogenic factors have recently been shown to play a potential role in fibrovascular diseases via the angiogenesis process. The aim of this study is to evaluate VEGF, TGF-ß and PGE2 expression in the epithelial, endothelial and stromal cells of human pterygium and normal conjunctiva in order to determine whether these factors participate in the development of pterygium. Ten specimens from patients with pterygium and two normal conjunctivas (cadavers) were analyzed by immunohistochemistry using specific antibodies against these growth factors. The technique used was ABC/HRP (Avidin complexed with biotinylated peroxidase). Immunoreactivity of VEGF was significantly increased in the epithelium, vascular endothelium and stromal cells in primary pterygium as compared with normal conjunctiva. A moderate expression of TGF-ß in the pterygium was observed in the epithelial and stromal layers. On the contrary, immunolabeling of this growth factor in the human normal conjunctiva was weak. PGE2 was strongly expressed in the epithelium of patients with pterygium, as in control conjunctival tissues, and the immunolabeling was moderate in the stroma from the same patients. Our results suggest that these growth factors may contribute to the progression of primary pterygium by increasing angiogenesis, thus leading to the formation of new blood vessels from the pre-existing vasculature. We conclude that VEGF, TGF-ß and PGE2 may be potential therapeutic targets in the treatment of this disease although proof of this evidence requires further studies.

Health tourism: an opportunity for sustainable development.

In February 2017, the "Programma Mattone Internazionale Salute" (ProMis), that is the Italian Program for Internationalization of Regional Health Systems of the Ministry of Health (MoH), presented the first version of its Position Paper on Health Tourism, which embeds a first shared approach to the recommendations expressed by the European Committee of Regions (CoR) on "Age-Friendly" tourism. The CoR stresses the importance of local and regional authorities in the coordination of multi-sectoral policies such as healthcare, social assistance, transport, urban planning and rural development in relation to the promotion of mobility, security, accessibility of services, including health care and social services. "Age-friendly" tourism is an example of an innovative tourist offer that strives to meet the health needs of the entire "traveling" population, with an integrated and cross-sector approach that involves various organizations operating in sectors such as healthcare, accessibility and transport. The aim of the workshop was to explore the interest of the stakeholders to participate in a systemic action in the field of "health" tourism, and to identify priority implementation areas that offer opportunities to take advantage of validated, innovative experiences that strengthen the accessibility to health and social services in regional, national and international contexts. This effort provides the opportunity to take advantage of aligning the European Structural and Investment Funds (ESIF) to the development of tourism, coherently with the needs and resources of local and regional health authorities.

Intraocular lens implantation in Marfan's syndrome.

PURPOSE: To describe the results of the removal of ectopic lenses from patients with Marfan's syndrome using the scleral fixation method. METHODS: Intraocular lenses (IOLs) were implanted in six eyes affected by lens dislocation (ectopia lentis) using either the scleral fixation method (five eyes) or a silicone IOL in the capsular bag (one eye). Mean patient age ranged from 8-11 years and follow-up ranged from 7-20 months. RESULTS: Functional success was obtained in all eyes. Postoperative visual acuity was 20/20 to 20/40. One patient showed a dislocation of the IOL in the anterior chamber. In three eyes, an opacification of the posterior capsule was treated using an Nd:YAG laser. CONCLUSION: Intraocular lens implantation using the scleral fixation technique is the first choice in patients with Marfan's syndrome because it reduces the complications of IOL decentration.

The meaning of dreams in the psychotic state. Theoretical considerations and clinical applications.

The authors consider that the Freudian theory of dreams is not directly applicable to psychotic and borderline patients with their constantly varying states of mental integration. Because these patients' dreams lack associations, the usual psychoanalytic approach cannot be used to ascertain their meaning. After reviewing the literature on the specific quality of dreams in the psychotic state, the authors point out that such dreams have nothing to do with the metaphorical language of the dream work but instead express the concreteness of the hallucinatory construction. For this reason, a dream's meaning may fail to be understood by the patient even if it seems clear to an observer. Yet the analyst's reception of a 'psychotic dream' is a unique and essential source of valuable information on the manner of construction of the delusional system, allowing analytic work on the psychotic nucleus. In the authors' view, such dreams may help the analyst and the patient--while still lucid--to acquire insight, thus affording a stable foundation for emergence from psychosis. The paper includes some case histories, in one of which a psychotic female patient is enabled by work on dreams to reconstruct a psychotic episode and thereby to ward off an imminent fresh lapse into psychosis.