La guerra di Segrate. Il primo scontro fra Berlusconi e «la Repubblica»

2012 - 2013The fight between the biggest Italian entrepreneurs of the eighties, Silvio Berlusconi and Carlo De Benedetti, it's an exemplar vicissitude of the transition from the First to the Second Italian Republic. In fact into the War of Segrate, the financial and judiciary clash happened between the 1984 and the 1991 for the control of the publishing house Mondadori, we find a lot of phenomena typical of the First Republic, from the ambiguous connections between the institutions, the mass media and the political power to the difficult relationships between civil society and the leading class. At the same time, the War of Segrate has been one of the founding episodes of the Second Republic, characterized by the sunset of the mass party that emerged during the thirties and forties and from the birth of two anomalous parties: the enterprise-party of Berlusconi and the newspaper- party of «la Repubblica». Analyzing the crisis of the mass party, ethical power with thousands of members and a structure similar to the State’s one, we have recognized the necessity of spreading the spectrum of the Italian political history further the traditional history of the parties to deal with the study of the seventies, eighties and nineties of the twentieth century. We have therefore placed at the center of the narrative the War of Segrate, recounting the years of transition from the point of view of the newspaper founded and led by liberal-socialist Eugenio Scalfari. The journalists' sources, memoirs, television programs, supplemented by parliamentary debate, have let us to paint a picture of the relationships between the powers of different nature in the Italy of the "long" eighties. [edited by author]XII n.s

Infected pancreatic necrosis: outcomes and clinical predictors of mortality. A post hoc analysis of the MANCTRA-1 international study

: The identification of high-risk patients in the early stages of infected pancreatic necrosis (IPN) is critical, because it could help the clinicians to adopt more effective management strategies. We conducted a post hoc analysis of the MANCTRA-1 international study to assess the association between clinical risk factors and mortality among adult patients with IPN. Univariable and multivariable logistic regression models were used to identify prognostic factors of mortality. We identified 247 consecutive patients with IPN hospitalised between January 2019 and December 2020. History of uncontrolled arterial hypertension (p = 0.032; 95% CI 1.135-15.882; aOR 4.245), qSOFA (p = 0.005; 95% CI 1.359-5.879; aOR 2.828), renal failure (p = 0.022; 95% CI 1.138-5.442; aOR 2.489), and haemodynamic failure (p = 0.018; 95% CI 1.184-5.978; aOR 2.661), were identified as independent predictors of mortality in IPN patients. Cholangitis (p = 0.003; 95% CI 1.598-9.930; aOR 3.983), abdominal compartment syndrome (p = 0.032; 95% CI 1.090-6.967; aOR 2.735), and gastrointestinal/intra-abdominal bleeding (p = 0.009; 95% CI 1.286-5.712; aOR 2.710) were independently associated with the risk of mortality. Upfront open surgical necrosectomy was strongly associated with the risk of mortality (p < 0.001; 95% CI 1.912-7.442; aOR 3.772), whereas endoscopic drainage of pancreatic necrosis (p = 0.018; 95% CI 0.138-0.834; aOR 0.339) and enteral nutrition (p = 0.003; 95% CI 0.143-0.716; aOR 0.320) were found as protective factors. Organ failure, acute cholangitis, and upfront open surgical necrosectomy were the most significant predictors of mortality. Our study confirmed that, even in a subgroup of particularly ill patients such as those with IPN, upfront open surgery should be avoided as much as possible. Study protocol registered in ClinicalTrials.Gov (I.D. Number NCT04747990)

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Biological monitoring of Italian soldiers deployed in Iraq. Results of the SIGNUM project

Background: Leukemia/lymphoma cases reported in 2001 among United Nation soldiers or peacekeepers deployed to the Balkans aroused alert on the exposure to depleted uranium. Recent epidemiological studies carried out in different European countries among peacekeepers who served in the Balkans failed to demonstrate a higher than expected risk of all cancers but, mostly due to their limitations in size and follow up time, leave open the debate on health risk of depleted uranium. The aim of SIGNUM (Study of the Genotoxic Impact in Military Units) was to identify potential genotoxic risk associated with the exposure to depleted uranium or other pollutants in the Italian Army military personnel deployed in Iraq. Methods: Blood and urine samples were collected before and after the deployment from 981 Italian soldiers operating in Iraq in 2004-2005. As, Cd, Mo, Ni, Pb, U, V, W, and Zr were determined in urine and serum. DNA-adducts, 8-hydroxy-2'-deoxyguanine and micronuclei frequency were evaluated in blood lymphocytes. Three different genetic polymorphisms, GSTM1, XRCC1, OGG1 were analyzed. Results: Significant T0-. T1 reduction in the total concentration of uranium, increases for Cd, Mo, Ni, Zr, and decreases for As, Pb, W, and V in urine and plasma were observed. Increases in oxidative alterations and in micronuclei frequency, included in the range of values of non-occupationally exposed populations, were observed at the end of the period of employment. Conclusions: Our results did not detect any toxicologically relevant variation of DNA-damage biomarkers related to the deployment in the operational theater

Anaplastic thyroid carcinoma and foscarnet use in a multitarget treatment documented by 18F-FDG PET/CT: a case report

Rationale: The case reported the rapid remission of disease recurrence achieved adding foscarnet, a DNA polymerase inhibitor that interacts with fibroblast growth factor 2, to low molecular weight heparin and sunitinib for the first time in a patient with an anaplastic thyroid cancer (ATC). Patient concerns: A 65-year-old woman with a multinodular goiter referred for a rapid enlargement of a nodule. Histological examination revealed an ATC with a little area of papillary thyroid cancer (PTC). The patient was resistant to selective single-target treatment. DIagnoses: Immunophenotyping and gene analyses found a significant increase in FGF2 and FGFR1 expression in the primary ATC area (FGF2 = 38.2 ± 6.2% in ATC vs 34.6 ± 6.0% in the differentiated area of PTC, P < 0.05; FGFR1: 41.7 ± 6.0% in ATC vs 34.4 ± 4.2% in PTC, P < 0.001) and in metastatic neck lymph nodes (P < 0.001 vs normal control tissues). Unlike conventional imaging, 18F-FDG PET/CT with PERCIST 1.0 criteria promptly and quantitatively detected disease recurrence and remission before and after multitarget therapy, combining anatomic, metabolic, and functional data. Interventions: Foscarnet was administered given the positivity for FGF2, FGFR1 and FGFR4 in ATC. Low molecular wight heparin and Sunitinib were coadministere to limiti metastatic progression and on neck tumor masse, respectively. Outcomes: The rationale for the clinical response to this innovative multitarget association with foscarnet is based on the histological and genetic finding that fibroblast growth factors and their receptor super-family are up-regulated in the primary anaplastic thyroid tumor and in the metastatic lymph node of our patient. Lessons: We propose that fibroblast growth factors and their receptor super-family play a key role as potential therapeutic targets in anaplastic thyroid cancer and the positive relevance of this suggestion for patient care, especially for an individualized management

Misure critiche. N.s. A. 11, n. 1-2 (2012)

N.S. A. 11, n. 1-2 (2012) : Martelli S., Premessa, P. 5 ; Aufiero G., Rileggere il Medioevo nel XXI secolo: filologia, scienza e magia, P. 9 ; Gigliello P., Da una Medea all’altra: da Boccaccio a Christine de Pisan, P. 17 ; D’Arienzo D., “Com’una foglia ad ogni vento volta”. Matteo Maria Boiardo e l’impossibile armonia tra poesia e tempo presente, P. 25 ; Celentano S., Le “Metamorfosi” da Ovidio a Niccolo’ Degli Agostini, P. 44 ; Esposito S., Camillo Pellegrino, “Del concetto poetico” (Ms. 436, Biblioteca del Museo Campano di Capua), P. 71 ; Bellotta C., Il monachesimo basiliano in età moderna. Analisi di tre casi: San Giovanni a Piro, Pattano e Montesano sulla Marcellana, P. 86 ; Nigro P., Il Fondo manoscritto di Giuseppe Maria Galanti. Le carte galantiane sull’Abruzzo, P. 104 ; Terracciano R., L’epistolario di Michele Colombo nella Biblioteca Palatina di Parma, P. 125 ; Pierno L., Il rapporto tra le arti in Pasquale De Luca, P. 138 ; Mascia V., Carlo Michelstaedter e il senso della ‘segreta armonia’, P. 156 ; Ferrauto E., La cultura teatrale a Napoli nel decennio 1910-1920, P. 170 ; Guercio G., “Proprio così”: la rappresentazione dell’inconscio nell’inedito di Luigi Pirandello. Un’importante scoperta, P. 191 ; Faengyong W., La nascita del romanzo sentimentale in Italia: estratto da “Liala, compagna d’ali e d’insolenze”, il romanzo rosa in Italia, P. 201 ; Avagliano G., La Lucania contadina nel documentario etnografico, P. 212 ; Rainone A., Interni moraviani. Immagini dell’abitare in romanzi e racconti di Alberto Moravia, P. 233 ; Martucci R., La forza della scrittura in Giose Rimanelli: dalla produzione italo-canadese allo sperimentalismo de “La macchina paranoica” (inedito), P. 240 ; Ottieri A., La poesia di Toti Scialoja. Dai versetti nonsensici agli ‘esametri’ degli anni Novanta, P. 260 ; Gioia V. A., Un’introduzione alla guerra di Segrate, P. 285 ; Gallotta G., L’opera di Tabucchi: l’impegno, i personaggi, il romanzo italiano contemporaneo, P. 302 ; Pontis A., Esempi di didattica dell’italiano L2 attraverso il testo letterario e il testo fotografico, P. 310

The left atrial appendage: from embryology to prevention of thromboembolism

The left atrial appendage (LAA) is the main source of thromboembolism in patients with non-valvular atrial fibrillation (AF). As such, the LAA can be the target of specific occluding device therapies. Optimal management of patients with AF includes a comprehensive knowledge of the many aspects related to LAA structure and thrombosis. Here we provide baseline notions on the anatomy and function of the LAA, and then focus on current imaging tools for the identification of anatomical varieties. We also describe pathogenetic mechanisms of LAA thrombosis in AF patients, and examine the available evidence on treatment strategies for LAA thrombosis, including the use of non-vitamin K antagonist oral anticoagulants and interventional approaches