Reliable Peer-to-Peer Access for Italian Citizens to Digital Government Services on the Internet

In the delivery of e-government services to citizens it should be clear that the viewpoint cannot simply be the standard one of client-supplier commonly used to provide services on the Internet. In a modern society it has rather to be the peer-to-peer approach which is typical of democracies, where institutions are equal to citizens in front of the law. But this is not yet a widely accepted standpoint in digital government efforts going on in many advanced countries in the world. Italian government, in its ever increasing effort to provide citizens with easier access to online government services, has instead adopted and is pursuing this symmetric approach, which is going to represent a fundamental tool in the ongoing march towards e-democracy. In this paper we describe the organizations involved in the process and the Information Technology (IT) infrastructure enabling the effective management of the whole process while ensuring the mandatory security functions in a democratic manner. Organizational complexity lies in the distribution of responsibilities for the management of people’s personal data among the more than 8000 Italian Municipalities and the need of keeping a centralized control on all processes dealing with identity of people. Technical complexity stems from the need of efficiently supporting this distribution of responsibilities while ensuring, at the same time, interoperability of IT-based systems independent of technical choices of the organizations involved, and fulfillment of privacy constraints. The IT architecture defined for this purpose features a clear separation between security services, provided at an infrastructure level, and application services, exposed on the Internet as Web Services

Study and modelling of the passenger safety devices of an electric vehicle by finite elements

Abstract Electric mobility gets mainly involved quadricycles and cars. Between these two vehicle types there are differences in terms of stability, performance, cost, autonomy and safety. The authors studied the implementation of passenger safety devices on a prototype for an electric vehicle derived from a heavy quadricycle. A finite element analysis starting from experimental results was carried out in order to determine the effectiveness in case of frontal and side crashes

CD28 individual signaling up-regulates IL-22 expression and IL-22-mediated effector functions in human T lymphocytes

IL‐22 is a member of the IL‐10 cytokine family involved in host protection against extracellular pathogens, by promoting epithelial cell regeneration and barrier functions. Dysregulation of IL‐22 production has also frequently been observed in acute respiratory distress syndrome (ARDS) and several chronic inflammatory and autoimmune diseases. We have previously described that human CD28, a crucial co‐stimulatory receptor necessary for full T cell activation, is also able to act as a TCR independent signalling receptor and to induce the expression of IL‐17A and inflammatory cytokines related to Th17 cells, which together with Th22 cells represent the main cellular source of IL‐22. Here we characterized the role of CD28 autonomous signalling in regulating IL‐22 expression in human CD4+ T cells. We show that CD28 stimulation in the absence of TCR strongly up‐regulates IL‐22 gene expression and secretion. As recently observed for IL‐17A, we also found that CD28‐mediated regulation of IL‐22 transcription requires the cooperative activities of both IL‐6‐activated STAT3 and RelA/NF‐κ transcription factors. CD28‐mediated IL‐22 production also promotes the barrier functions of epithelial cells by inducing mucin and metalloproteases expression. Finally, by using specific inhibitory drugs, we also identified CD28‐associated class 1A phosphatidylinositol 3‐kinase (PI3K) as a pivotal mediator of CD28‐mediated IL‐22 expression and IL‐ 22‐dependent epithelial cell barrier functions

CD28 autonomous signaling orchestrates IL-22 expression and IL-22-regulated epithelial barrier functions in human T lymphocytes

IL-22 is a member of the IL-10 cytokine family involved in host protection against extracellular pathogens, by promoting epithelial cell regeneration and barrier functions. Dysregulation of IL-22 production has also frequently been observed in acute respiratory distress syndrome (ARDS) and several chronic inflammatory and autoimmune diseases. We have previously described that human CD28, a crucial co-stimulatory receptor necessary for full T cell activation, is also able to act as a TCR independent signaling receptor and to induce the expression of IL-17A and inflammatory cytokines related to Th17 cells, which together with Th22 cells represent the main cellular source of IL-22. Here we characterized the role of CD28 autonomous signaling in regulating IL-22 expression in human CD4+ T cells. We show that CD28 stimulation in the absence of TCR strongly up-regulates IL-22 gene expression and secretion. As recently observed for IL-17A, we also found that CD28-mediated regulation of IL-22 transcription requires the cooperative activities of both IL-6-activated STAT3 and RelA/NF-κB transcription factors. CD28-mediated IL-22 production also promotes the barrier functions of epithelial cells by inducing mucin and metalloproteases expression. Finally, by using specific inhibitory drugs, we also identified CD28-associated class 1A phosphatidylinositol 3-kinase (PI3K) as a pivotal mediator of CD28-mediated IL-22 expression and IL-22–dependent epithelial cell barrier functions

Mesonephric-Like Adenocarcinomas a Rare Tumor: The Importance of Diagnosis

Mesonephric-like adenocarcinomas (MLA) are rare neoplasms that arise in the uterine body and ovary and have been added to the World Health Organisation’s recent 2020 classification of female genital cancers. The pathogenesis of MLA is unknown and it remains debated whether they represent mesonephric carcinomas (Wolffian) arising in the endometrium/ovary or endometrioid carcinomas (Müllerian) closely mimicking mesonephric carcinomas. Here we report the case of a 57-year-old woman with an initial misdiagnosis of endometrioid adenocarcinoma on diagnostic biopsy. The patient came to our clinical evaluation for the appearance of menometrorrhagia complicated by anemia for several months. Therefore, she underwent pelvic echo-flowmetry, with indication for diagnostic hysteroscopy with endometrial biopsy, which yielded a positive result for endometrioid endometrial adenocarcinoma. Following staging CT scan and targeted examinations on pulmonary findings, the patient underwent surgery with surprise of definitive diagnosis deponent for endometrial MLA. Our intention is to establish a brief review of the scientific evidence in the literature and the tools available for a correct histological diagnosis, in the light of the scant anatomopathological evidence. Our question gives rise to the motive for the publication: is immunohistochemistry the right way to resolve the diagnostic error at histology, which is usually the only source of diagnostic certainty? This case is intended to alert of diagnostic error that risked having the patient treated as a neoplasm with a favorable prognosis and low degree of aggressiveness instead of for a very aggressive and poor prognosis tumor such as MLA

CUP-syndrome: Inguinal high grade serous ovarian carcinoma lymph node metastases with unknown primary origin – a case report and literature review

Objective: High-grade serous ovarian carcinoma (HGSC) often presents lymph node involvement. According to the paths of lymphatic drainage, the most common site of nodal metastasis is in the aortic area. However, pelvic lymph nodes are also involved and inguinal metastases are less frequent. Methods: Our report concerns the case of a 78-year-old woman with an inguinal lymph node relapse of HGSC, with the prior positivity of a right inguinal lymph node, after the primary surgery. Ovaries and tubes were negative on histological examination. A comprehensive search of the literature published from January 2000 to October 2021 was conducted on PubMed and Scopus. The papers were selected following the PRISMA guidelines. Nine retrospective studies were evaluated. Results: Overall, 67 studies were included in the initial search. Applying the screening criteria, 36 articles were considered eligible for full-text reading of which, after applying the exclusion criteria, 9 studies were selected for the final analysis and included in the systematic review. No studies were included for a quantitative analysis. We divided the results according to the relapse location: loco-regional, abdominal, and extra-abdominal recurrence. Conclusions: Inguinal node metastasis is a rare but not unusual occurrence in HGSC. A reasonable level of suspicion should be maintained in patients with inguinal adenopathy and high CA125 values, especially in women with a history of gynecologic surgery, even in the absence of negative imaging for an ovarian origin

Quadro severo di mieloma multiplo e insufficienza renale trattato con successo con bortezomib e desametasone

Il trattamento delle malattie mieloproliferative richiede sempre più frequentemente il coinvolgimento della figura del nefrologo nella gestione terapeutica. Il nefrologo è chiamato a mettere in atto una serie di provvedimenti terapeutici che mirino a correggere fattori precipitanti la funzionalità renale. Mostreremo un caso emblematico di gestione ematologica e nefrologica di un caso di mieloma multiplo di tipo micromolecolare con severa compromissione renale trattato con successo con associazione di Velcade e desametasone in 8 cicli in un periodo di 6 mesi. In questo periodo il paziente è stato supportato con terapia medica e infusionale per mantenere un'adeguata idratazione, una costante alcalinizzazione delle urine, buoni livelli di albuminemia, calcemia e uricemia senza ricorrere a trattamento dialitico sostitutivo. Non viene mai sospeso il trattamento chemioterapico e gli effetti tossici più importanti vengono monitorati e trattati con terapia specifica senza mai ridurre il dosaggio del chemioterapico. Si ottiene un progressivo recupero della funzione renale oltre a una remissione della malattia di base

Role of minimally invasive surgery versus open approach in patients with early-stage uterine carcinosarcomas: a retrospective multicentric study

Objective: The aim of this retrospective study was to compare surgical and survival outcome in only patients with early-stage UCSs managed by laparotomic surgery (LPT) versus minimally invasive surgery (MIS). Methods: Data were retrospectively collected in four Italian different institutions. Inclusion criteria were UCS diagnosis confirmed by the definitive histological examination, and stage I or II according to the FIGO staging system. Results: Between August 2000 and March 2019, the data relative to 170 patients bearing UCSs were collected: of these, 95 were defined as early-stage disease (stage I-II) based on the histological report at the primary surgery, and thus were included in this study. Forty-four patients were managed by LPT, and 51 patients were managed by MIS. The operative time was lower in the MIS group versus the LPT group (p value 0.021); the median estimated blood loss was less in the MIS group compared to the median of LPT group (p value < 0.0001). The length of hospital stay days was shorter in the MIS patients (p value < 0.0001). Overall, there were eight (8.4%) post-operative complications; of these, seven were recorded in the LPT group versus one in the MIS group (p value 0.023). There was no difference in the disease-free survival (DFS) and overall survival (OS) between the two groups. Conclusion: There was no difference of oncologic outcome between the two approaches, in face of a more favourable peri-operative and post-operative profile in the MIS group