The frequency of clinically important valve regurgitation was significantly increased in patients taking pergolide or cabergoline, but not in patients taking non-ergot-derived dopamine agonists, as compared with control subjects. These findings should be considered in evaluating the risk-benefit ratio of treatment with ergot derivatives.

SUMMARY Aims:In a previous echocardiographic prevalence study we reported a significant increase in the frequency of heart valve regurgitation in patients with Parkinson's disease taking the ergot-derived dopamine agonists pergolide and cabergoline versus controls. We followed-up our original cohort of patients to ascertain whether valvulopathy regressed after discontinuation of treatment and/or its incidence increased over time. Methods: Prospective follow-up of 101 patients treated with ergot-derived dopamine agonists included in the prevalence study: 53 given pergolide and 48 cabergoline (64% male; 66.4 ± 8.7 years of age, 11.5 ± 5.9 years of disease, 21.8 ± 5.9 months of followup); 55 stopped treatment while 46 continued. The main outcomes measures, were: echocardiographic quantification of regurgitant valve disease, abnormal leaflet, or cusp thickening and measurement of mitral valve tenting area. Results: Valve abnormalities regressed in about one third of patients with significant multivalvular and in about half of the patients with monovalvular regurgitation who withdrew; no progression was observed in remaining patients. Patients continuing ergot-derived dopamine agonists showed progression of cardiac valvulopathy: seven new cases with three to four regurgitation grade of any valve occurred during follow-up; this regarded also patients who had been on pergolide for many years. Conclusion: Owing to the persistence of risk of heart valve damage over time and the lack of its mid-term reversibility in many patients, we believe that pergolide and cabergoline should be prescribed only when therapeutic alternatives with a better risk/benefit ratio are unavailable and the patient has access to echocardiography.

Introduction: The professional self is often hindered by a lack of self-care and poor work-life balance, and cannot be considered an unlimited resource. Given this, the reflexive team is an important organizational tool for protecting workers' well-being. The non-profit organization Maestri di Strada (MdS) (“Street Teachers”) conducts action research (AR) in the area of socio-education. The main tool used by the group to protect the well-being of its members is a guided reflexivity group, inspired by the Balint Group and termed the Multi-Vision Group (MG). In March 2020, because of the COVID-19 lockdown, the MdS team had to quickly revamp its working model, and MGs were held online for the first time.Aim: Through qualitative research that takes a longitudinal approach, the aim of this study is to evaluate the efficacy of the MG in supporting the team's reflexivity in this new online format.Methods: This article considers MGs during two different time periods: pre-pandemic (T1) and early pandemic (T2). During T1, the MdS team met 18 times in person, while during T2 the team met 12 times through an online platform (always under the guidance of a psychotherapist). During all sessions in both time periods, a silent observer was present in the meetings, and they subsequently compiled narrative reports. The textual corpora of the reports were submitted for a Thematic Analysis of Elementary Contexts through T-Lab Plus, in order to examine the main content of the groups' discourse.Results: The results (five clusters in T1; and five in T2) show that, during T2, the group devoted considerable time to experiences tied to the pandemic (T21: schools facing the pandemic crisis; T2.2: the pandemic: death, inner worlds, and thought resistance; T2.3: kids' stories involving physical distancing and emotional proximity). The group also came up with innovative educational initiatives that defied the lockdown (T2.4: fieldwork: the delivery of “packages of food for thought”; T2.5: the MdS group: identity and separation). Based on these findings, the MG most likely contributed to the emergence of MdS as a “resilient community,” capable of absorbing the shock of the pandemic and realizing a fast recovery response.

La guerra scatena angosce collettive, suscitando fantasie e prese di posizione rispetto a una fazione o l'altra. Al di là delle ragioni socio-economiche e dei sentimenti di appartenenza, questo articolo esplora e offre una chiave di let- tura psichica del conflitto, evidenziando l'origine nella psiche dell'uomo. Appropriarsi degli affetti che sono alla base dei conflitti significa riconoscere la propria quota di responsabilità. Il conflitto è possibile riconoscerlo oppure no, pensare di esserne immuni attribuendo all'altro la responsabilità di ciò che accade. Com- prendere che ciò che accade fuori richiama anche aspetti personali non semplici da digerire, permette a ciascuno di integrare dentro di sé il buono e il cattivo.

To assess the influence of work load on both LV and RV performance in chronic severe mitral regurgitation N R ) , our model for estimating LV wall stress was extended to include the RV modeled as a hi-axially truncated prolate ellipsoid. Pressure and echocardiographic chamber dimensions were entered into the niodel. Estimated R V circurnjierential(cir), meridional(iner) and radial(racl) stress in AdR were 124+13, 97*13 and 1612, and LV cir, mer and rad stress estimates were 300h31, 123*14 and 68+5 (xl d Dynes/cm?, respectively. The RV-cir and rad and LV-cir, mer and rad stresses were signiJicantly higher than control(p<. 05). These preliminary results indicate that RV wall stress estimation appears feasible and niay provide important pathophysiologic understanding of processes aflecting both R 17 and L Vperforniance.