Il Dio invisibile dell’Europa

«Per comprendere la crisi sistemica e di identità che concerne l’Europa, entità tanto celebrata quanto incompiuta (eufemisticamente parlando), occorre concentrare l’analisi e la ricerca delle cause su un fenomeno originario e fondamentale al tempo stesso. Questo fenomeno può essere individuato attraverso l’espressione di “metamorfosi del potere”. O meglio, per essere più precisi e aderire alla terminologia politologica, dobbiamo parlare di una metamorfosi della sovranità, tenendo ben presente che quando utilizziamo questo termine stiamo concentrando la nostra attenzione su un fenomeno centrale del consesso umano. Almeno a partire dalla nascita dello Stato inteso in senso moderno, con sovranità intendiamo “il potere supremo della dominazione dello Stato sulle persone che entrano nella sfera della sua giurisdizione” (Beaud 1994: 53). In buona sostanza si tratta di quella forma di potere che, legittima o meno (stando ai parametri delle odierne democrazie occidentali), è comunque visibile e riconoscibile da parte degli individui che si sono associati all’interno di un territorio delimitato e, in virtù di ciò, si trovano sotto la sua giurisdizione (cittadini, popolo). »... (segue)

Os meios de comunicação, Gramsci e a construção de homem-dirigido

Este artigo trata do pensamento de Antonio Gramsci problematizando a seguinte hipótese de trabalho: se for verdade que o campo de estudo e ação mais importante da filosofia marxista consistiu na análise das formas de domínio do mais forte sobre o mais fraco, a grande intuição de Antonio Gramsci parece ter oferecido um dos legados mais frutíferos, que reside, sobretudo no reconhecimento de como, em pleno século XX, surgiam novas formas de dominação para além do contexto estrutural, afetando diretamente a superestrutura ideológica

Simultaneous Bilateral Laparoscopic Adrenalectomy Is Safe for Synchronous Large Adrenal Tumors

Laparoscopy is now considered the gold standard for treating benign monolateral adrenal lesions. We present the case of a patient affected by Cushing's syndrome due to large bilateral adrenal adenomas (7.5cm) who underwent simultaneous laparoscopic bilateral adrenalectomy. An anterior, lateral transperitoneal approach was used. Operative time was 200 minutes, and blood loss was 200mL. No intraoperative complications were encountered. The postoperative course was uneventful, and the patient was discharged after 3 days. Laparoscopic bilateral adrenalectomy is a safe, effective procedure when performed by experienced hands and may be an alternative treatment for large adrenal lesions

Giant hepatic adenoma with bone marrow metaplasia not associated with oral contraceptive intake

BACKGROUND: Hepatocellular adenomas are the most common benign liver tumors. They are usually related to oral contraceptive intake. CASE PRESENTATION: This case describes a 58-year-old woman admitted to our institution for a hepatic mass incidentally discovered during a routine examination. The patient, who was never on oral contraceptives, was asymptomatic upon admission. She underwent a thorough diagnostic evaluation and then a hepatic right trisegmentectomy. The histologic evaluation of the mass showed that it was a hepatocellular adenoma with areas of bone marrow metaplasia. CONCLUSION: Bone marrow metaplasia has rarely been found associated to liver tumors. The presence of marrow-derived hepatic progenitor cells might be the source of both adenoma hepatocytes and bone marrow differentiated cells. To our knowledge, this is only the second case in the English literature in which areas of bone marrow metaplasia were found in a hepatocellular adenoma

Primary Sensory and Motor Cortex Activities During Voluntary and Passive Ankle Mobilization by the SHADE Orthosis

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Current status of the self-expandable metal stent as a bridge to surgery versus emergency surgery in colorectal cancer. Results from an updated systematic review and meta-analysis of the literature

Background: The current use of endoscopic stenting as a bridge to surgery is not always accepted in standard clinical practice to treat neoplastic colonic obstructions. Objectives: The role of colonic self-expandable metal stent (SEMS) positioning as a bridge to resective surgery versus emergency surgery (ES) for malignant obstruction, using all new data and available variables, was studied and we focused on short- and long-term results. Materials and Methods: A systematic review with meta-analysis was performed. PubMed, SCOPUS and Web of Science databases were included. The search comprised only randomized controlled trials (RCTs) investigating the interventions that included SEMS positioning versus ES. The primary outcomes were the rates of overall postoperative mortality, clinical and technical success. The secondary outcomes were the short- and long-term results. Results: A total of 12 studies were eligible for further analyses. A laparoscopic colectomy was the most common operation performed in the SEMS group, whereas the traditional open approach was commonly used in the ES group. Intraoperative colonic lavage was seldomly performed during ES. There were no differences in mortality rates between the two groups (RR 1.06, 95% CI 0.55 to 2.04; I2 = 0%). In the SEMS group, the rate of successful primary anastomosis was significantly higher in of SEMS (69.75%) than in the ES (55.07%) (RR 1.26, 95% 245 CI 1.01 to 1.57; I2 = 86%). Conversely, the upfront Hartmann procedure was performed more frequently in the ES (39.1%) as compared to the SEMS group (23.4%) (RR 0.61, 95% CI 0.45 to 0.85; I2 = 23%). The overall postoperative complications rate was significantly lower in the SEMS group (32.74%) than in the ES group (48.25%) (RR 0.61, 95% CI 0.41 to 0.91; I2 = 65%). Conclusions: In the presence of malignant colorectal obstruction, SEMS is safe and associated with the same mortality and significantly lower morbidity than the ES group. The rate of successful primary anastomosis was significantly higher than the ES group. Nevertheless, recurrence and survival outcomes are not significantly different between the two groups. The analysis of short- and long-term results can suggest the use of SEMS as a bridge to resective surgery when it is performed by an endoscopist with adequate expertise in both colonoscopy and fluoroscopic techniques and who performed commonly colonic stenting

The 2015 version of the Italian Parametric Earthquake Catalogue (CPTI15)

The Italian Parametric Earthquake Catalogue (CPTI) represents the most extensive and reliable source of parameters for earthquakes in Italy and surrounding areas. Since its first introduction in 1999, CPTI benefits from the results of the 30-years-long Italian tradition in historical earthquake research that, still today, keeps on providing a wealth of studies and macroseismic data. Such data have been collected, homogenized and made available through several releases of the related macroseismic database (DBMI). In 2016, the fourth release of CPTI and DBMI, has been finalized. They provide the most advanced and updated sets of macroseismic and instrumental data and parameters, and cover the time-span 1000-2014 with earthquakes with maximum intensity I ≥ 5 or magnitude Mw ≥ 4.0. The catalogue lists 4574 events, 70% of which accompa- nied by intensity data points (about 125’000 as a whole). Macroseismic data derive from 185 studies, 54 of them are new with respect to the previous version CPTI11. Parameters related to historical earthquakes are completely re-assessed, and magnitudes from macroseismic data are derived with new intensity-to-Mw relationships. Such relationships are based on the same dataset that contributes updated instrumental magnitudes to the catalogue. Either Mw from moment tensor solutions or proxies calculated with new published conversion relationship are considered. If available, both macroseismic and instrumental parameters are provided, together with a set of “preferred ones”, which consist of a selection between the macroseismic and the instrumental epicentres, and the weighted average of the macroseismic and instrumental magnitudes.PublishedTrieste, Italy3T. Storia Sismica4T. Sismologia, geofisica e geologia per l'ingegneria sismica4IT. Banche dat

Prognostic Factors for Tumor Recurrence after a 12-Year, Single-Center Experience of Liver Transplantations in Patients with Hepatocellular Carcinoma

Background. Factors affecting outcomes after orthotopic liver transplantation (OLT) for hepatocellular carcinoma (HCC) have been extensively studied, but some of them have only recently been discovered or reassessed. Methods. We analyzed classical and more recently emerging variables with a hypothetical impact on recurrence-free survival (RFS) in a single-center series of 283 patients transplanted for HCC between 1997 and 2009. Results. Five-year patient survival and RFS were 75% and 86%, respectively. Thirty-four (12%) patients had HCC recurrence. Elevated preoperative alpha-fetoprotein (AFP) levels, preoperative treatments of HCC, unfulfilled Milan and up-to-seven criteria at final histology, poor tumor differentiation, and tumor microvascular invasion negatively affected RFS by univariate analysis. Milan and up-to-seven criteria applied preoperatively, and the use of m-TOR inhibitors did not reach statistical significance. Cox's proportional hazard model showed that only elevated AFP levels (Odds Ratio = 2.88; 95% C.I. = 1.43–5.80; P = .003), preoperative tumor treatments (Odds Ratio = 4.84; 95% C.I. = 1.42–16.42; P = .01), and microvascular invasion (Odds Ratio = 4.82; 95% C.I. = 1.87–12.41; P = .001) were predictors of lower RFS. Conclusions. Biological aggressiveness and preoperative tumor treatment, rather than traditional and expanded dimensional criteria, conditioned the outcomes in patients transplanted for HCC

Development and Multicenter Validation of a Novel Immune-Inflammation-Based Nomogram to Predict Survival in Western Resectable Gastric and Gastroesophageal Junction Adenocarcinoma (GEA): The NOMOGAST

Background. More than 50% of operable GEA relapse after curative-intent resection. We aimed at externally validating a nomogram to enable a more accurate estimate of individualized risk in resected GEA. Methods. Medical records of a training cohort (TC) and a validation cohort (VC) of patients undergoing radical surgery for c/uT2-T4 and/or node-positive GEA were retrieved, and potentially interesting variables were collected. Cox proportional hazards in univariate and multivariate regressions were used to assess the effects of the prognostic factors on OS. A graphical nomogram was constructed using R software’s package Regression Modeling Strategies (ver. 5.0-1). The performance of the prognostic model was evaluated and validated. Results. The TC and VC consisted of 185 and 151 patients. ECOG:PS > 0 (p < 0.001), angioinvasion (p < 0.001), log (Neutrophil/Lymphocyte ratio) (p < 0.001), and nodal status (p = 0.016) were independent prognostic values in the TC. They were used for the construction of a nomogram estimating 3- and 5-year OS. The discriminatory ability of the model was evaluated with the c-Harrell index. A 3-tier scoring system was developed through a linear predictor grouped by 25 and 75 percentiles, strengthening the model’s good discrimination (p < 0.001). A calibration plot demonstrated a concordance between the predicted and actual survival in the TC and VC. A decision curve analysis was plotted that depicted the nomogram’s clinical utility. Conclusions. We externally validated a prognostic nomogram to predict OS in a joint independent cohort of resectable GEA; the NOMOGAST could represent a valuable tool in assisting decision-making. This tool incorporates readily available and inexpensive patient and disease characteristics as well as immune-inflammatory determinants. It is accurate, generalizable, and clinically effectivex

Gastrointestinal stromal tumor of the anal canal: an unusual presentation

BACKGROUND: Gastrointestinal stromal tumors (GIST) of the stomach are the most frequent followed by those of the intestinal tract, while colon and rectum represent rare sites. GIST of the anal canal are extremely rare. They have been studied along with GIST of the rectum, as a single entity, and along with them they represent 5% of GIST. GIST arising from the anal canal account for only 2%–8% of the anorectal GIST. Thus anal GIST must be considered an exceptional case. CASE PRESENTATION: A 78-year-old man was referred to our Institution for an anal mass, in absence of any symptom. The patient was treated by local excision. An histological diagnosis of a low grade GIST was made. No further treatment was necessary. No local recurrence of distant metastases were found at follow-up. CONCLUSION: At the moment, only ten cases of c-kit positive anal GIST are reported in the literature. These few data are not sufficient to establish a widely accepted approach for this neoplasia. We recommend to perform an initial local excision, to define the risk of aggressive behavior and the resection margins and proceed to a more aggressive treatment, if the GIST belongs to high or very high risk group. The role of adjuvant therapy is still uncertain. Although inhibitors of tyrosine-kinase receptor needs further studies before their routine use, their role in case of distant or local recurrence has been accepted. Patients' close follow up is mandatory to disclose as soon as possible local recurrences or metastases