The search of a new logic of public administration reforms: the case of metropolitan areas in Italy

The aim of this paper is to formulate some recommendations for the currently undergoing reform of Italian metropolitan areas. This case is particularly relevant since it clearly represents how, even if expected by law, reforms might not happen on the implementation side. We draw the recommendations from some basic assumptions of the collaborative governance model. Recommendations deal with the development of a systemic, collaborative and leadership oriented view of reforms. Indeed, reforms should be intended not only as a legislative process, but also as a complex change management process characterized by the decisive role of the human factor

Endoscopic Bronchopleural Fistula Repair Using Autologous Fat Graft.

Bronchopleural fistula (BPF) represents a not rare catastrophic complication of pulmonary resection with high mortality rates. While surgical treatments of BPF are often technically difficult and can only be tolerated by a limited number of patients, less invasive endoscopic approaches showed variable success rates, mainly related to the size of the fistula. With this report, we describe for the first time the successful treatment of large BPF by means of endoscopic autologous fat implantation and we discuss the surgical technical details of the procedure

Prevalence and development of chronic critical illness in acute patients admitted to a respiratory intensive care setting

Introduction- Chronic Critical Illness (chronic CI) is a condition associated to patients surviving an episode of acute respiratory failure (ARF). The prevalence and the factors associated with the development of chronic CI in the population admitted to a Respiratory Intensive Care Unit (RICU) have not been yet elucidated. Methods- An observational prospective cohort study was undertaken at the RICU of the University Hospital of Modena (Italy). Patients mechanically ventilated with ARF in RICU were enrolled. Demographics, severity scores (APACHEII, SOFA, SAPSII), and clinical condition (septic shock, pneumonia, ARDS) were recorded on admission. Respiratory mechanics and inflammatory-metabolic blood parameters were measured both on admission and over the first week of stay. All variables were tested as predictors of chronic CI through univariate and multivariate analysis. Results- chronic CI occurred in 33 out of 100 patients observed. Higher APACHEII, the presence of septic shock, diaphragmatic dysfunction (DD) at sonography, multidrug-resistant (MDR) bacterial infection, the occurrence of a second infection during stay, and a C-reactive protein (CRP) serum level inceasing 7 days over admission were associated with chronic CI. Septic shock was the strongest predictor of chronic CI (AUC=0.92 p<0.0001). Conclusions- Chronic CI is frequent in patients admitted to RICU and mechanically ventilated due to ARF. Infection-related factors seem to play a major role as predictors of this syndrome

Endocarditis of Native Valve due to Proteus mirabilis: Case Report and Literature Review

AbstractEndocarditis due to Proteus mirabilis is very uncommon and the optimal surgical and/or antibiotic treatment is not well defined. Guidelines from the AHA and ESC recommend prolonged courses of combined antibiotic therapy but information regarding the clinical presentation, the choice of treatment, the surgical management, and the duration of therapy can only be taken from clinical cases reported in literature. We describe a case of native valve endocarditis due to Proteus mirabilis, successfully treated with antibiotic therapy alone with a review of the relevant literature on this topic

Infestazione intestinale da Schistosoma mansoni: un caso emblematico di importazione

Viene descritto, sia dal punto di vista clinico che parassitologico, un caso di importazione di schistosomiasi intestinale da S. mansoni contratta durante un soggiorno in Tanzania. Dopo circa 50 giorni da un contatto casuale ma ripetuto con le acque del Lago Vittoria, al soggetto, giovane adulto in missione umanitaria, compare febbre elevata, accompagnata da astenia (presente da più giorni) cui segue un episodio di diarrea acuta. La comparsa anche di una ipereosinofilia, dapprima assente, spinge il curante ad eseguire immediatamente un esame coproparassitologico standard (in precedenza sempre negativo) che risulta positivo per uova di S. mansoni. La terapia condotta con praziquantel risolve il caso e porta a guarigione il soggetto, cui inizialmente era stata esclusa la malaria, allorché dopo circa 1 mese dal rientro aveva presentato rialzo termico con disturbi respiratori

Case report: Endoscopic closure with double stenting and autologous fascia lata graft of large tracheo-esophageal fistula

IntroductionRadiotherapy and esophageal stenting are usually employed to manage esophageal localization of distant cancer. However, they are also related to the occurrence of an increased risk of tracheoesophageal fistula. Tracheoesophageal fistula management in these patients involves dealing with poor general conditions and short-term prognosis. This paper presents the first case in literature of bronchoscopic fistula closure through an autologous fascia lata graft placement between two stents.Case report and aimA 67-years-old male patient was diagnosed with pulmonary squamous cell carcinoma in the inferior lobe of the left lung with mediastinal lymph node metastasis. After a multidisciplinary discussion, bronchoscopic repair of tracheoesophageal fistula with autologous fascia lata was decided without the removal of the esophageal stent due to the high risk on the esophagus possibly related to such a procedure. Oral feeding was progressively introduced without the development of aspiration symptoms. Videofluoroscopy and esophagogastroduodenoscopy were performed at 7 months showing no signs of tracheoesophageal fistula patency.ConclusionThis technique might represent a low risks viable option for patients unsuitable for open surgical approaches

The Asiago-ESO/RASS QSO Survey. III. Clustering analysis and its theoretical interpretation

This is the third paper of a series describing the Asiago-ESO/RASS QSO survey (AERQS), a project aimed at the construction of an all-sky statistically well-defined sample of relatively bright QSOs (B<15) at z<0.3. We present here the clustering analysis of the full spectroscopically identified database (392 AGN). The clustering signal at 0.02<z<0.22 is detected at a 3-4 sigma level and its amplitude is measured to be r_0=8.6\pm 2.0 h^{-1} Mpc (in a LambdaCDM model). The comparison with other classes of objects shows that low-redshift QSOs are clustered in a similar way to Radio Galaxies, EROs and early-type galaxies in general, although with a marginally smaller amplitude. The comparison with recent results from the 2QZ shows that the correlation function of QSOs is constant in redshift or marginally increasing toward low redshift. We discuss this behavior with physically motivated models, deriving interesting constraints on the typical mass of the dark matter halos hosting QSOs, M_DMH= 10^{12.7} h^{-1} M_sun (10^{12.0}-10^{13.5}h^{-1} M_sun at 1 sigma confidence level). Finally, we use the clustering data to infer the physical properties of local AGN, obtaining M_BH=2 10^8 h^{-1} M_sun (10^7-3 10^9 h^{-1} M_sun) for the mass of the active black holes, tau_{AGN}= 8 10^6 yr (2 10^{6}-5 10^{7} yr) for their life-time and eta = 0.14 for their efficiency (always for a LambdaCDM model).Comment: 37 pages, Astronomical Journal in press. Changes to match the referee comment

Molecular mechanisms and physiological changes behind benign tracheal and subglottic stenosis in adults.

Laryngotracheal stenosis (LTS) is a complex and heterogeneous disease whose pathogenesis remains unclear. LTS is considered to be the result of aberrant wound-healing process that leads to fibrotic scarring, originating from different etiology. Although iatrogenic etiology is the main cause of subglottic or tracheal stenosis, also autoimmune and infectious diseases may be involved in causing LTS. Furthermore, fibrotic obstruction in the anatomic region under the glottis can also be diagnosed without apparent etiology after a comprehensive workup; in this case, the pathological process is called idiopathic subglottic stenosis (iSGS). So far, the laryngotracheal scar resulting from airway injury due to different diseases was considered as inert tissue requiring surgical removal to restore airway patency. However, this assumption has recently been revised by regarding the tracheal scarring process as a fibroinflammatory event due to immunological alteration, similar to other fibrotic diseases. Recent acquisitions suggest that different factors, such as growth factors, cytokines, altered fibroblast function and genetic susceptibility, can all interact in a complex way leading to aberrant and fibrotic wound healing after an insult that acts as a trigger. However, also physiological derangement due to LTS could play a role in promoting dysregulated response to laryngo-tracheal mucosal injury, through biomechanical stress and mechanotransduction activation. The aim of this narrative review is to present the state-of-the-art knowledge regarding molecular mechanisms, as well as mechanical and physio-pathological features behind LTS

Treatment Outcome of metastatic lesions from renal cell carcinoma underGoing Extra-cranial stereotactic body radioTHERapy: The together retrospective study

Abstract Objectives stereotactic body radiation therapy (SBRT) use has increased overtime for the management of metastatic renal cell carcinoma (mRCC) patients, with a likely good control of irradiated lesions. We planned a retrospective multicenter Italian study, with the aim of investigating the outcome of treatment with SBRT for non-brain secondary lesions in mRCC patients. Methods all consecutive metastatic non-brain lesions from mRCC that underwent SBRT at nine Italian institutions from January 2015 to June 2017 were considered. The primary endpoint of the study was the lesion-PFS, calculated from SBRT initiation to the local progression of the irradiated lesion. Results 57 extracranial metastatic lesions from 48 patients with primary mRCC were treated with SBRT. At the median follow-up of 26.4 months, the median lesion-PFS was not reached (43 censored); 72.4% of lesions were progression-free at 40 months, with significantly better lesion-PFS for small metastatic lesions ( Conclusions consistently with the previous literature, our findings support the use of SBRT in selected mRCC patients