ANATOMY OF A DISCOVERY THAT NEVER TOOK PLACE. FROM WAX TO ROBOTICS. Anatomisti Bolognesi A 1944 movie, The Monster Maker, by S. Newfield, will be shown in the Main Hall of the Istituti Anatomici of the University of Bologna. It recounts the poignant story of a ruthless scientists who injects a human being with a draught that can cause acromegaly. The movie will provide a great opportunity to analyze the mistakes that, throughout history, made it possible to identify the correct clinical nature of the hypophysial disease. Walking through the halls of the L. Cattaneo Anatomical Museum, the observation of the anatomical wax model by Cesare Taruffi representing a man affected by acromegaly will thus allow to describe “a discovery that never took place”. More in-depth historical and scientific details will be gathered in the Dissection Room of the Istituti Anatomici where human-corpse heads will be used to demonstrate, via a high resolution 3D endoscope, the modern transnasal access approaches to the pituitary gland, whose “malfunctioning” causes acromegaly.
Visitors, stepping back to a nineteenth-century atmosphere, will be the leading figures of a clinical investigation from wax to robotics. The project was jointly promoted by the Anatomists of the University of Bologna and the Neurosurgeons of the Istituto di Scienze Neurologiche di Bologna.
GIVING THE FLOOR TO THE JURY
Theater event and workshop
A medical case typified by a strong bioethical problematic aspect will be submitted to the students by way of a basic script. The ending of the story will be left “open” on purpose, in order to serve as the starting step for a workshop on the complex scientific, philosophical, and moral issues connected to the case. The students will work in groups, with the support of some expert coordinators, and will thus become the key players of a debate on bioethics. Just like a real jury, they will be summoned to choose the ending that they deem to be the “fairest” one, and will explain their decision to their schoolmates.
For high-school students. By reservation only (please reserve by email: email@example.com)
ABOUT NATURE AND WHAT IS ARTIFICAL: BETWEEN BIONICS AND FUTURE ROBOTICS Antonio Autiero Andrea Stella Giovanni Torsello Today, the gradual replacement of vital parts of our body with artificial organs takes place within an ideal journey from the skin to the heart via the aorta, the main artery. A minimally invasive percutaneous endovascular technique was progressively developed which, through the femoral artery, allows to re-build heart valves, thoracic and abdominal aortas and the visceral arteries, i.e. hepatic, splenic, or renal. An unavoidable transformation that raises ethical questions about our condition as human beings , between bionics and future robotics.
VISIT TO THE WARD. DEPARTMENT OF DERMATOLOGY simulated hospital rounds with: Massimino Negosanti and Annalisa Patrizi As it is by now customary, the Sala degli Atti of Palazzo Re Enzo will host the “visit to the ward”. A travel through time, from tradition to innovation, a tour guided by some leading figures of the Bologna Medical School, along the developments of the science of healing. An exclusive appointment by Bologna Medicina.
ENEMY WITHIN – THE NASAL RESERVOIR FOR INVASIVE STAPHYLOCOCCUS AUREUS INFECTIONS Andreas Peschel Introduced and coordinated by:Lucio Ildebrando Maria Cocco Staphylococcus aureus is a constituent of the nasal microbiota in 20-30% of the human population and also represents the most frequent cause of life-threatening invasive infections in the northern hemisphere. The individual predisposition to S. aureus colonization and the transition from commensal to pathogenic life-styles represent exciting examples of microbe-host coevolution and adaptation processes. Recent discoveries on the molecular mechanisms governing S. aureus interaction with nasal cells, interference with microbiota, and evasion of host defense shed new light on the life style of a major human pathogen and open new avenues for innovative preventive and therapeutic approaches.
Enzo Bonora promoted by: Società Italiana di Diabetologia and Fondazione Diabete Ricerca Onlus The spreading of Type2 diabetes seems to be “viral”. Human societies appear to be infected by a “virus” that is easily transmitted in situations of industrialization, mechanization, urbanization, pollution, psycho-physical stress, the need for food rewards, high-calorie food, incessant advertising on food. The vaccine against this pandemic is called “knowledge”.
THE PHYSICIAN-PATIENT RELATIONSHIP: A NEUROSCIENTIFIC POINT OF VIEW Fabrizio Benedetti The relationship between physician and patient is one of the oldest traditional founding elements of medicine. Modern neurosciences allow to describe what happens in the patients’ brain when they interact with their doctor. It is now coming out that this unique, very special interaction, within which patients believe and hope, activates the same mechanisms that are activated by drugs.
NOT JUST DRUGS: CLINICAL TRIALS AND EFFICACY ASSESMENT Pietro Grossi Patrizia Popoli promoted by: Alphasigma The last three decades saw a huge progress in scientific studies aimed at proving the important role of nutraceutical products (medical food, dietary supplements) in preventing or reducing risks in chronic diseases. Consumers/patients often apply to doctors to be reassured about the potential benefits of these products, which are supported by dedicated studies and advertised by the media. Doctors are therefore asked to carefully assess the related scientific and clinical evidence in order to add such products to diets and medical treatments. We will analyze, together with industry regulators and industrial pharmaceutical researchers, the importance of studies on the innovative use of special-purpose foods (medical food) for the prevention and treatment of illnesses.
ON VACCINES AND ANTIBIOTIC RESISTANCE. OLD AND NEW EMERGENCY IN GLOBAL HEALT Roberto Burioni Nicoletta Luppi Angela Santoni Introduced and coordinated by: Gilberto Corbellini
Sometimes they come back! The great plagues of the past that during the twentieth century were gradually defeated thanks to vaccines, and the unavoidable deaths caused by bacterial infections that antibiotics prevented thanks to their increasing efficacy, are again coming to the fore in the medical world. The infamous campaigns against vaccines are reducing the so-called herd immunity for several infections, while the misuse of antibiotics, the population shifts, and the normal developmental mechanisms are spreading bacterial resistance to antibiotics. It is thus compelling to develop new strategies to enhance the effectiveness of vaccination campaigns and to plan new, improved antibiotics.
AUTOPSY, GENETIC FOOT-PRINT AND CRIME: FROM FICTION TO REALITY Gianfranco Bangone Andrea Del Ferraro Susi Pelotti Claudio Rapezzi How can death reveal the nature of a crime? By means of examples taken from fictions featuring an ideal situation in order to reach a frequently quite complex reality, and going back to the past, more specifically to the very first forensic autopsy, which was performed in Bologna in 1302, it will be shown how the body can “speak” after death. And how it can be listened to via a traditional autopsy, but also via a virtual, molecular, or psychological autopsy. A working process based on methods that somehow assimilate doctors to detectives.
SEEING THE ULTRASOUND Peter Burns Introduced and coordinated by: Luigi Bolondi It is well known that creatures such as bats and dolphins ‘see’ by detecting echoes from pulses of sound they emit. Pulse-echo ultrasound imaging in medicine has become an invaluable tool to see into the human body. But animals teach us more: dolphins detect the speed of their prey by the Doppler effect, which we use to image blood flow; owls form an aural scene by unscrambling reflections from ambient structures, which we use to make ultrafast images. Most surprisingly, shrimp stun their prey by means of sound and tiny bubbles, which we now use to break the seal protecting the human brain in order to deliver drugs to treat cancer.
THE IMPACT OF ICT, BIG DATA AND AI ON MEDICINE Enrico Bucci Andreas Hoeft According to Moore’s law complexity and speed of processors as well as storage will double every 12 to 24 month. Indeed, this law from 1965 has hold true until today. Simultaneously, IP traffic in the internet grows at a rate of 20-25% per year. However, the most disruptive technology in ICT will be cognitive computing and artificial intelligence (AI). AI has been hyped for more than four decades, but it went through several cycles of enthusiasm as well as so called “AI winters”. The coincidence of availability of big data and new tools for big data analysis, new technologies for semantic analysis of unstructured data, cloud computing and machine learning facilitate a leap in AI, which will also impact medicine. Cloud based systems will soon easily pass the Turing test, i.e. for users it will be indiscernible whether they communicate with a human being or a machine, including emulation of empathy and emotions. Personal health consultation by machines might endanger many disciplines in medicine, offering definitely chances to areas in the world, which are medically underserved, but also threads to physicians in developed countries. On the other hand, AI and cloud computing will add significantly to quality of patient care and patient safety in hospitals, by interfacing super-intelligent decision support systems with hospital information systems. The crucial question remains to be, how long it will take: 5, 15 or 50 years? “Prediction is very difficult, especially about the future” (Niels Bohr)
THE RETURN OF LOMBROSO? GENETICS AND NEUROSCIENCE OF THE ANTISOCIAL BEHAVIOUR Pietro Pietrini To what extent is human behavior determined by genetic factors or influenced by the environment? Which relationship is there between the brain and free will, that is the ability to understand the meaning of one’s own actions and therefore acting in one way or another? Thanks to the acquisition of new notions in neuroscience, the never-ending “nature vs nurture” debate, that is whether the role of (neuro)biological factors prevails over the role of cultural factors or viceversa, appears now outdated. Today we know that several genetic constellations shape the extent to which individuals are affected by environmental features, thus making them more or less vulnerable to the presence of negative factors, such as abuse and violence in childhood. Starting with plasticity genes, the recent progresses in neuroscience yield more general implications, e.g. in the forensic, ethical and rehabilitation fields.
PARASOMNIAS AND THE RELEASE OF PRIMITIVE INSTINCTS DURING SLEEP: ARE DREAMS ALWAYS WISHES? Carlos H. Schenck
Introduced and coordinated by: Giuseppe Plazzi Parasomnias are defined as the behavioral, emotional and autonomic nervous system disorders that accompany sleep, and can emerge during any stage of sleep, including Rapid Eye Movement (REM) sleep and Non-REM sleep, and during wake-sleep or sleep-wake transitional states. Thus, all of sleep carries a vulnerability for parasomnias. Instinctual behaviors and experiences can emerge pathologically with the parasomnias, such as aggression (as found in REM sleep behavior disorder [RBD], with violent dream-enacting behaviors), eating (as found in Sleep Related Eating Disorder [SRED]), sex (as found in Sexsomnia), locomotion (as found in Somnambulism, and less commonly in RBD), and terror states (as found in Sleep Terrors). Sleep itself is an instinctual behavior, and so with the parasomnias two or more instinctual behaviors can become pathologically intertwined in a self-perpetuating manner, as parasomnias are often chronic conditions. Parasomnias reflect abnormal brain-mind states during sleep, and can include disturbed dreaming. Central pattern generators in the brainstem are presumed to become abnormally activated with the parasomnias. Gender often plays a role with the manifestation of parasomnias, with RBD and Sexsomnia being male-predominant, and SRED being female-predominant. A notable psychiatric parasomnia involves Sleep Related Dissociative Disorder, which is female-predominant. Fortunately, most parasomnias can be effectively managed with behavioral and/or pharmacologic interventions. A series of video examples of the range of parasomnias will be shown and discussed, along with the presentation of illustrative clinical vignettes. Finally, the important scientific discovery and current research on RBD with dream-enactment and its strong link with parkinsonian disorders and dementia will be discussed.
SHOW AND TELL AT THE ANATOMICAL THEATRE, FOR FAMILIES Two events dedicated to families. Children and their parents are invited to take part to an “anatomical lesson” in the suggestive Anatomical Theatre of the Archiginnasio. A show where professional entertainers will tell the wonders of the human body in a funny and engaging way. Ticket € 3,00, free for kids. By reservation only (please reserve by email: firstname.lastname@example.org)
COUGH PLEASE! IS TELEMEDICINE THE FUTURE? Giuseppe Boriani Federico Lombardi Manlio Nicoletti Marco Pozzi Claudio Rapezzi Studio Pacinotti-Telbios and Gruppo ABMedica
promoted by: Intesa Sanpaolo The future of Medicine is already here: medical-surgical remote consultation between different medical centers thanks to telemedicine; virtual teaching; remote monitoring of patients with implanted electrical devices; medical use of smartphone apps to measure the heart rate, heartbeat and to gather information on prognosis, cardiac risk stratification, drug monitoring, monitoring of cognitive functions, dietary norms, fitness, etc. Medicine still has a great future.
HOW TO START THE STARTUP. EXPERIENCES AND PROPOSALS Fabrizio Landi promoted by: Intesa Sanpaolo
The future of Research Pharmaceutical, Biotech and Med-Tech is increasingly based on the capacity of the New Start Up Companies to develop innovative and disruptive solutions, differently from the conventional development of pharmaceutical and biomedical new products. The biggest company are quite aware of this new approach, knowing that almost two third of the new pharmaceutical products come from the independent research of small innovative start up. This and a unique opportunity for our Country, but helping the development of these initiatives requires efforts, investments, a lot of work, method and discipline.
DRIVING OUT CANCER Patrizia Paterlini-Bréchot Introduced and coordinated by:Pino Donghi The molecular oncologist Patrizia Paterlini-Bréchot, professor at the University of Paris Descartes, in 2000 developed, and then comercialized, a technique to isolate and characterize fetal and tumor cells circulating in the blood (Test ISET). The device, invented to detect and identify the tumoral cells, consists of a blood test and it’s based on the cells dimension, allowing to diagnose cancer even in early states. In the book Patrizia Paterlini-Bréchot tells firsthand her path and the steps they took to build a promising invention. A history of science and humanity.
Made in Germany LARGE SCALE FACILITIES: PRESENT AND FUTURE OF SCIENTIFIC RESEARCH. A COMPARISON BETWEEN ITALY AND GERMANY Thomas Hirth Massimo Inguscio Jorge Vienken chairman: Horst Klinkmann co-chairman: Claudio Franceschi Since the advent of Big Science, that is after WW2, scientific research and innovation models faced the need for increasingly larger-scale equipments and organizational structures. Thus, the so-called Large Scale Facilities came into being, as infrastructures making it possible for groups to access services that they would be unable to use individually, and also allowing the development of local, national, or international cooperation, which is indispensable in order to carry out research and to provide innovative components in the frontier sections of science and technology. While Italy, with a great delay, wonders how to fill the gap that developed in past decades as compared to other European countries, the comparison with similar experiences in a country at the forefront such as Germany, with her world-famous institutes, such as Max Planck and Frauenhofer, provides quite interesting issues for debate.
EXPORTING ITALIAN NATIONAL EALTH MODELS: IS THAT POSSIBLE? Bruno Biagi promoted by: Gruppo Villa Maria
The social surveys carried out in recent years reveal a situation that contradicts some commonplaces. In Italy the national health system works better than in England, and comes out quite well also when compared with the German system. Obviously, an overall look at the Italian situation cannot conceal some differences – sometimes quite remarkable ones – between the various areas of the country. In the private sector, too, a number of excellencies are being appraised by foreign countries that feature similar socio-demographic general conditions. As absurd as it may seem to many, the balance of Italian exports can rely on the health and wellbeing industry.
IN CONSCIENCE. WHAT IS CONSCIENCE AND WHY WE RISK TO LOOSE IT Marcello Massimini Usually we assess the level of conscience of other individuals on the basis of their ability to interact with the surrounding environment. However, we perfectly know that conscience can be generated as a whole inside the brain, even when all communication with the external world is lacking. It happens almost every night, when we dream. Due to such an incongruity, the presence of conscience could be unrecognized in people with brain injuries who come out of a coma but do not communicate. The development of an objective and reliable measurement of conscience skills is a great challenge for medical sciences.
A SILENT PANDEMIC: THE DIABETES MELLITUS Enzo Bonora promoted by: Società Italiana di Diabetologia and Fondazione Ricerca Diabete Onlus Diabetes mellitus is rampant. In Italy, known cases were approximately 1.5 million in 1985 and now are close to 4 million. In addition to known cases, it must be mentioned that there are almost one million people who are unaware of their disease. As a matter of fact, diabetes is often asymptomatic, sometimes for many years, and problems arise exactly because physical ailments are lacking, and no clinical flaws are detectable. Until something serious comes to the fore …
THE UNIQUE ROLE OF NITRIC OXIDE AS A WIDESPREAD SIGNALING MOLECULE Louis Ignarro Introduced and coordinated: Claudio Borghi promoted by: Fondazione Internazionale Menarini The field of nitric oxide (NO) research has developed in explosive proportions since the discovery of endogenous NO in 1986. The first biologically important actions of NO were that nitroglycerin and related nitrovasodilators elicit vascular smooth muscle relaxation by liberating NO in the smooth muscle. NO relaxes smooth muscle by activating cytosolic guanylate cyclase and elevating smooth muscle levels of cyclic GMP. Soon thereafter, NO was found to inhibit platelet aggregation by mechanisms also involving cyclic GMP. NO acts as a neurotransmitter in the central and peripheral nervous systems, where NO modulates memory, learning, recall and erectile function. NO may function in a similar manner in the GI tract, airways and bladder. Based on these properties of NO, new drugs can be developed to treat hypertension, atherosclerosis, stroke, angina pectoris, heart failure, vascular complications of diabetes, GI ulcers, impotency and other vascular disorders…and there is much more to explore!