Riorganizzazione del MEF. Una riforma silenziosa

L’articolo analizza il progetto di riorganizzazione del MEF approvato, in via definitiva, dal Consiglio dei Ministri in data 26.07.2023, che prevede la scissione in due del Dipartimento del Tesoro, con la creazione di un secondo Dipartimento, il Dipartimento dell’Economia. Il nuovo Dipartimento avrà competenza in materia di interventi finanziari in economia, partecipazioni societarie dello Stato e valorizzazione del patrimonio pubblico. Il provvedimento andrà a modificare il Decreto del Presidente del Consiglio dei Ministri del 26 giugno 2019 n. 103, concernente il regolamento di organizzazione del Ministero dell’Economia e delle Finanze. La tesi che si vuole sostenere è che la bi-partizione non sia una pura e semplice riorganizzazione burocratica delle articolazioni interne del MEF, ma una riforma strutturale che ne modificherà e potenzierà le funzioni, in particolare col ritorno alla gestione politica unitaria delle partecipazioni statali; esigenza questa che, ciclicamente, viene riproposta dal decisore politico. In quest’ottica si è cercato di inquadrare il provvedimento nel percorso storico-giuridico degli assetti organizzativi dei dicasteri economici, con particolare attenzione alle strutture preposte alla gestione delle partecipazioni statali

Robotic gastric resection of large gastrointestinal stromal tumors

Abstract Background The stomach is the most common site for gastrointestinal stromal tumors (GIST) development. Surgical treatment consists of excision of the entire neoplastic mass, with sufficient surgical margins within healthy tissue. This can be achieved with different techniques ranging from wedge resections, typical gastric resections, right up to total gastrectomy. There aren't clear guidelines for the use of minimally invasive approach. Materials and methods From January 2011 to April 2012, 5 patients with presumed preoperative diagnosis of GIST were treated by robotic surgery at the Unit of Surgery and Advanced Oncologic Therapies, Forli Hospital, Forli, Italy. We report operative techniques, perioperative outcomes and follow-up. Results Lesions were localized at anterior wall of gastric antrum ( N = 2) and near pyloric area ( N = 3). Mean tumor size was 5 cm (range 4–7 cm). Surgical procedures were 5 distal gastrectomy. None intervention was converted to open surgery and there weren't major intraoperative complications. Median operative time was 240 min (range 210–300 min) and mean intraoperative blood loss was 96 ml (80–120 ml). All lesions had microscopically negative resection margins. Median follow-up was 13.5 months (range 12–15 months) with a disease-free survival rate of 100%. Conclusions Surgical robotic approach for large GISTs is feasibility and new evidences are needed to clarify the effective role of different surgical strategies

M. CROCE, A. SALVATORE (a cura di), Carl Schmitt Costituzione e Istituzione, Macerata, Quodlibet Ius, 2022, pp. 173*

La recensione ha per oggetto la pubblicazione, per la prima volta in lingua italiana, di due saggi del giurista e politologo Carl Schmitt (Diritti di Libertà e Garanzie istituzionali della Costituzione del Reich del 1931 e Diritti fondamentali e doveri fondamentali del 1932) corredati dagli scritti di Mariano Croce e Andrea Salvatore. Si tratta di due saggi che intervengono, cronologicamente, poco prima dell'adesione dello studioso tedesco al nazional-socialismo e rappresentano un passaggio storico fondamentale nell'evoluzione del pensiero e della storia di Schmitt

Upper eyelid platinum chain placement for treating paralytic lagophthalmos

For the definitive treatment of lagophthalmos and satisfactory rehabilitation of the affected eye, different surgical strategies have been proposed, including static or dynamic procedures. Although some of these can have good results, lid loading is now the most common technique for treating paralytic long-term lagophthalmos. Among the different types of loading, the use of a platinum chain is preferred to the use of a standard gold weight because platinum has a higher density than gold and is also more biocompatible. In this paper authors retrospectively analyzed 43 patients with regards to functional and cosmetic results. Questionnaires were also employed to assess changes and improvements in the patients' quality of life. Analysis of the excellent results achieved confirmed that platinum chain lid loading should be considered as a first-line treatment for paralytic lagophthalmos rehabilitation. It is a simple, reliable, and effective technique that significantly improves the health-related quality of life of patients

Massive mandibular destruction and alveolar nerve infiltration without lower lip paresthesia in primary intraosseous carcinoma: Report of two cases and critical appraisal of diagnostic criteria

Objective: To report two cases of solid type primary intraosseous carcinoma (PIOC) with a critical appraisal of one of the WHO diagnostic criteria. Summary: Both patients had radiographic and histopathologic findings showing massive mandibular destruction as well as the involvement of the inferior alveolar nerve, without lip or chin paresthesia. Patients were treated through hemimandibulectomy followed by reconstruction through fibula free flap and forearm flap. Conclusion: Lip and/ or chin paresthesia are rather frequent in metastatic and salivary gland tumors but not in primary tumors of the jaws. Reasons for such a discrepancy are mostly unknown. A few hypotheses are put forward here. It is the opinion of the authors that most of the diagnostic criteria for solid type PIOC are acceptable. However, the criterion "absence of ulcer formation on the overlying mucosa" mainly depends on the dimension of the tumor at diagnosis

Pre-surgical assessment of mandibular bone invasion from oral cancer: comparison between different imaging techniques and relevance of radiologist expertise

PURPOSE: To compare diagnostic performance between computed tomography (CT) and magnetic resonance imaging (MRI) for the detection of bone infiltration from oral cancer, and to test interobserver agreement between radiologists with different expertises. MATERIALS AND METHODS: Pre-surgical CT and MRI were reviewed independently by two radiologists with different expertises in head and neck oncology. A third radiologist reviewed CT and MRI simultaneously. Interobserver agreement was calculated by Cohen test. Association between radiological evidence of bone infiltration and histological reference was tested by Fisher's exact test or Chi-squared test, as appropriate. Receiving operator curve was calculated and area under the curve (AUC) was compared between CT, MRI, and both methods together. RESULTS: Interobserver agreement was moderate: the trainee under-reported periosteal reaction on CT and inferior alveolar canal involvement on MRI. Imaging findings associated with histologic evidence of bone infiltration were: periosteal reaction and cortical erosion on CT; bone marrow involvement, contrast enhancement within bone; and inferior alveolar canal involvement on MRI. Sensitivity of MRI alone (74 %) was higher than CT (52 %). Simultaneous review of CT and MRI showed the highest specificity (91 %), with the increase of diagnostic performance in the subgroup of subjects with positive MRI (AUC = 0.689; p = 0.044). CONCLUSION: Higher expertise allows pre-surgical detection of clinically relevant signs of bone infiltration sensitivity of MRI alone is higher than CT for the detection of bone infiltration from oral cancer. In MRI positive cases, diagnostic integration with combined review of CT and MRI is suggested for optimal diagnostic performance

Enteric glial cells counteract Clostridium difficile Toxin B through a NADPH oxidase/ROS/JNK/caspase-3 axis, without involving mitochondrial pathways

Enteric glial cells (EGCs) are components of the intestinal epithelial barrier essential for regulating the enteric nervous system. Clostridium difficile is the most common cause of antibiotic-associated colitis, toxin B (TcdB) being the major virulence factor, due to its ability to breach the intestinal epithelial barrier and to act on other cell types. Here we investigated TcdB effects on EGCs and the activated molecular mechanisms. Already at 2 hours, TcdB triggered ROS formation originating from NADPH-oxidase, as demonstrated by their reduction in the presence of the NADPH-oxidase inhibitor ML171. Although EGCs mitochondria support almost completely the cellular ATP need, TcdB exerted weak effects on EGCs in terms of ATP and mitochondrial functionality, mitochondrial ROS production occurring as a late event. ROS activated the JNK signalling and overexpression of the proapoptotic Bim not followed by cytochrome c or AIF release to activate the downstream apoptotic cascade. EGCs underwent DNA fragmentation through activation of the ROS/JNK/caspase-3 axis, evidenced by the ability of ML171, N-acetylcysteine, and the JNK inhibitor SP600125 to inhibit caspase-3 or to contrast apoptosis. Therefore, TcdB aggressiveness towards EGCs is mainly restricted to the cytosolic compartment, which represents a peculiar feature, since TcdB primarily influences mitochondria in other cellular types