La caratterizzazione dei personaggi epici nei Commentarii Servio

Nella presente tesi viene esaminata la ricezione di alcuni personaggi fondamentali dell'epica virgiliana in un commentatore tardoantico: attraverso l'esame dei commenti relativi a tale argomento, si valutano le modalità di lettura e gli aspetti messi in risalto nella realtà sociale, morale e scolastica dell'ultimo impero

Lamivudine treatment for severe acute HBV hepatitis

Treatment for acute hepatitis B is recommended in order to reduce the risk of progression to fulminant hepatitis and the need of OLT. We report our experience on treatment with high dose lamivudine, in patients with severe acute HBV infection. The diagnosis was based on clinical and virological findings and exclusion of other known causes of liver damage. The decision to treat was based on the prolongation of INR together with increasing values of bilirubin and ALT. Four patients received Lamivudine 200 mg/daily until clearance of serum HBV-DNA and then 100 mg/daily until clearance of HBsAg and appearance of anti-HBs antibodies. One patient received 100 mg/daily because of chronic renal impairment. The median period of hospitalization was 13 days, and none of the patients had complications, related either to underlying disease or to therapy. The complete normalization of serum transaminases and bilirubin occurred on average after 5.5 weeks and 3 weeks respectively. All patients cleared serum HBV-DNA within three months, lost HBeAg and HBsAg and seroconverted to anti-HBe; four patients developed anti-HBs at a protective titre. Early antiviral treatment attenuates the clinical and biochemical impairment leading to fast healing and promoting complete recovery

Distribution of different HBV DNA forms in plasma and peripheral blood mononuclear cells (PBMCs) of chronically infected patients with low or undetectable HBV plasma viremia

Few studies have documented hepatitis B virus (HBV) DNA in peripheral blood mononuclear cells (PBMCs). We developed real-time PCR methods for differential amplification of covalently closed circular (cccDNA) and total HBV DNA (tDNA). The different distribution of cccDNA and tDNA in plasma and PBMCs was evaluated in 37 patients with low or undetectable viremia. Plasma tDNA measured by the Abbott reference system and the in-house assay correlated well (Spearman rho = 0.804; P<0.0001). tDNA was detected in four PBMC samples, all from patients with detectable plasma viremia (range 633-6,406 IU/ml), cccDNA was not detected in any sample. The reasons for apparently discrepant results need further investigation but possibly include the high diversification of HBV status and plasma viremia levels

Ecophysiological Responses to Rainfall Variability in Grassland and Forests Along a Latitudinal Gradient in Italy

In the Mediterranean region, ecosystems are severely affected by climate variability. The Italian Peninsula is a hot spot for biodiversity thanks to its heterogeneous landscape and the Mediterranean, Continental, and Alpine climates hosting a broad range of plant functional types along a limited latitudinal range from 40′ to 46′ N. In this study we applied a comparative approach integrating descriptive statistics, time series analysis, and multivariate techniques to answer the following questions: (i) do the climatic variables affect Gross Primary Productivity (GPP), Reco, Water Use Efficiency (WUE), and ET to a similar extent among different sites? (ii) Does a common response pattern exist among ecosystems along a latitudinal gradient in Italy? And, finally (iii) do these ecosystems respond synchronically to meteorological conditions or does a delayed response exist? Six sites along a latitudinal, altitudinal, and vegetational gradient from semi-arid (southern Italy), to a mountainous Mediterranean site (central Italy), and sub-humid wet Alpine sites (northern Italy) were considered. For each site, carbon and water fluxes, and meteorological data collected during two hydrologically-contrasting years (i.e., a dry and a wet year) were analyzed. Principal Component Analysis (PCA) was adopted to identify temporal and spatial variations in GPP, Ecosystem Respiration (Reco), WUE, and Evapotranspiration (ET). The model outlined differences among Mediterranean semi-arid, Mediterranean mountainous, and Alpine sites in response to contrasting precipitation regimes. GPP, Reco, WUE, and ET increased up to 16, 19, 25, and 28%, respectively in semi-arid Mediterranean sites and up to 15, 32, 15, and 11%, respectively in Alpine sites in the wet year compared to the dry year. Air temperature was revealed to be one of the most important variables affecting GPP, Reco, WUE, and ET in all the study sites. While relative air humidity was more important in southern Mediterranean sites, global radiation was more significant in northern Italy. Our work suggests that a realistic prediction of the main responses of Italian forests under climate change should also take in account delayed responses due to acclimation to abiotic stress or changing environmental conditions

Profile of lenvatinib in the treatment of hepatocellular carcinoma: design, development, potential place in therapy and network meta-analysis of hepatitis B and hepatitis C in all Phase III trials

Purpose: Sorafenib is the only approved drug in first-line treatment for hepatocellular carcinoma. Recently, the Phase III REFLECT trial proved lenvatinib not inferior to sorafenib, potentially establishing a new standard of care in this setting. The study showed that both have similar overall survivals, yet with longer time to progression for lenvatinib. Currently, the selection of one or other is not based on clinical or biological parameters for this reason we performed a network meta-analysis and we also analyzed the REFLECT trial and its implications in the current and future clinical practice. Materials and methods: We performed the meta-analysis according to the Prisma statement recommendations. HR was the measure of association for time to progression and overall survival. The pooled analysis of HR was performed using a random effect model, fixing a 5% error as index of statistical significance. Results: For HBV-positive patients, there was a clear trend in favor of lenvatinib over sorafenib (HR 0.82 95% credible interval [CrI] 0.60\u20131.15). For HCV-positive no differences between lenvatinib and sorafenib were observed (HR 0.91 95% CrI 0.41\u20132.01). The data showed that lenvatinib could be the best drug for HBV-positive patients in 59% of cases compared to only 1% of patients treated with sorafenib. Conclusion: The identification of clinical or biological markers that could predict response or resistance to treatments is needed to guide treatment decision. This network meta-analysis demonstrates that the etiology is a good candidate and this result should be validated in a specific trial.Purpose: Sorafenib is the only approved drug in first-line treatment for hepatocellular carcinoma. Recently, the Phase III REFLECT trial proved lenvatinib not inferior to sorafenib, potentially establishing a new standard of care in this setting. The study showed that both have similar overall survivals, yet with longer time to progression for lenvatinib. Currently, the selection of one or other is not based on clinical or biological parameters for this reason we performed a network meta-analysis and we also analyzed the REFLECT trial and its implications in the current and future clinical practice.Materials and methods: We performed the meta-analysis according to the Prisma statement recommendations. HR was the measure of association for time to progression and overall survival. The pooled analysis of HR was performed using a random effect model, fixing a 5% error as index of statistical significance.Results: For HBV-positive patients, there was a clear trend in favor of lenvatinib over sorafenib (HR 0.82 95% credible interval [CrI] 0.60-1.15). For HCV-positive no differences between lenvatinib and sorafenib were observed (HR 0.91 95% CrI 0.41-2.01). The data showed that lenvatinib could be the best drug for HBV-positive patients in 59% of cases compared to only 1% of patients treated with sorafenib.Conclusion: The identification of clinical or biological markers that could predict response or resistance to treatments is needed to guide treatment decision. This network meta-analysis demonstrates that the etiology is a good candidate and this result should be validated in a specific trial

Anemia and iron in internal medicine: an Italian survey and a review on iron intravenous therapy in medical patients

In Italy, Internal Medicine Units hospitalize approximately 1,300,000 patients, often elderly and comorbid. The prevalent diagnoses are respiratory diseases, heart failure, or pneumonia. As a matter of fact, anemia is probably underestimated in the compilation of the official discharge forms (SDO) according to ICD-9 diagnostic codes. We promoted a survey among the Members the Italian Scientific Society of Internal Medicine (FADOI) with the aim to investigate the prevalence of anemia and iron deficiency, over than certain aspects related to the therapeutic management of patients with anemia. Furthermore, we performed a review summarizing current evidence for iron intravenous therapy in these patients. According to the survey, anemia is present in around half of the patients hospitalized in Internal Medicine, and about a quarter of them shows iron metabolism alterations. In the evaluation of iron metabolism, the dosage of ferritin is the most requested exam, whereas transferrin saturation is less considered. By focusing on some categories of patients, the awareness of the usefulness of intravenous iron therapy in patients with heart failure seems to be sufficiently common (76% of physicians), while it seems lower (60%) in the management of patients with chronic kidney disease (CKD) and anemia. Finally, more than 75% of the physicians answered that, in their hospital, there are few outpatients' offices or diagnostic pathways dedicated to patients with anemia. Anemia due to absolute or functional iron deficiency is particularly prevalent in Internal Medicine inpatients. For this reason, an accurate evaluation of iron profile and an adequate iron therapy is mandatory in these patients. Recent studies show that, in patients with heart failure, intravenous iron therapy is an effective way of improving patients' health, regardless of the presence of anemia. Similarly, iron therapy results fundamental to optimize erythropoiesis-stimulating agent efficacy in patients with chronic renal failure. In the next future, other therapeutic aspects of intravenous iron therapy will be probably clarified by several interesting ongoing studies focused on these patients

Primary Tumor Resection for Metastatic Colorectal, Gastric and Pancreatic Cancer Patients: In Search of Scientific Evidence to Inform Clinical Practice

The management of the primary tumor in metastatic colorectal, gastric and pancreatic cancer patients may be challenging. Indeed, primary tumor progression could be associated with severe symptoms, compromising the quality of life and the feasibility of effective systemic therapy, and might result in life-threatening complications. While retrospective series have suggested that surgery on the primary tumor may confer a survival advantage even in asymptomatic patients, randomized trials seem not to definitively support this hypothesis. We discuss the evidence for and against primary tumor resection for patients with metastatic gastrointestinal (colorectal, gastric and pancreatic) cancers treated with systemic therapies and put in context the pros and cons of the onco-surgical approach in the time of precision oncology. We also evaluate current ongoing trials on this topic, anticipating how these will influence both research and everyday practice

Popliteal Artery Entrapment Syndrome (PAES) and Ankle-Brachial Index (ABI), any association?

Popliteal Artery Entrapment Syndrome (PAES) is an uncommon pathology. Often, it affects young athletic males, with symptoms like calf claudication, weakness, numbness, pain, coldness of the foot, cramps, foot drop and paresthesia. The etiology of this syndrome is related to anatomical variations determining an altered relationship between popliteal artery and the surrounding structures. Based on described anatomical variations, PAES has been classified in several types (type I to V). In other cases, the compression of the popliteal artery may be caused by the hypertrophic gastrocnemius muscle, without anatomical variations, defining a “functional popliteal entrapment” (type VI). [1]. The Ankle-Brachial Index (ABI) is the ratio of the systolic blood pressure measured at the ankle to that measured at the brachial artery. It’s a non-invasive measure of peripheral artery disease and can serve as a prognostic marker for cardiovascular events and functional impairment [2]. The ABI score is often pathological in patients affected by PAES. Nevertheless, to define diagnosis and type of PAES are often needed imaging studies and invasive procedures. The aim of the present study is to systematically review the available literature to define if ABI score could be useful to predict a specific type of PAES. Electronic databases have been searched using specific Keywords. Articles have been screened and full-texts of relevant papers have been retrieved. Case reports and case series with indications of symptoms, type of PAES, ABI score have been included. Results about ABI score (dependent variable) have been pooled and compared among types of PAES (independent variable). No statistical significance has been noted (ANOVA: F=1.9, p=0.09). The use of ABI is insufficient to predict the type of PAES and its prognosis. Nevertheless, this non-invasive method could be useful to suspect PAES and as a tool in follow up in these patients

Ecophysiological Responses to Rainfall Variability in Grassland and Forests Along a Latitudinal Gradient in Italy

In the Mediterranean region, ecosystems are severely affected by climate variability. The Italian Peninsula is a hot spot for biodiversity thanks to its heterogeneous landscape and the Mediterranean, Continental, and Alpine climates hosting a broad range of plant functional types along a limited latitudinal range from 40\u2032 to 46\u2032 N. In this study we applied a comparative approach integrating descriptive statistics, time series analysis, and multivariate techniques to answer the following questions: (i) do the climatic variables affect Gross Primary Productivity (GPP), Reco, Water Use Efficiency (WUE), and ET to a similar extent among different sites? (ii) Does a common response pattern exist among ecosystems along a latitudinal gradient in Italy? And, finally (iii) do these ecosystems respond synchronically to meteorological conditions or does a delayed response exist? Six sites along a latitudinal, altitudinal, and vegetational gradient from semi-arid (southern Italy), to a mountainous Mediterranean site (central Italy), and sub-humid wet Alpine sites (northern Italy) were considered. For each site, carbon and water fluxes, and meteorological data collected during two hydrologically-contrasting years (i.e., a dry and a wet year) were analyzed. Principal Component Analysis (PCA) was adopted to identify temporal and spatial variations in GPP, Ecosystem Respiration (Reco), WUE, and Evapotranspiration (ET). The model outlined differences among Mediterranean semi-arid, Mediterranean mountainous, and Alpine sites in response to contrasting precipitation regimes. GPP, Reco, WUE, and ET increased up to 16, 19, 25, and 28%, respectively in semi-arid Mediterranean sites and up to 15, 32, 15, and 11%, respectively in Alpine sites in the wet year compared to the dry year. Air temperature was revealed to be one of the most important variables affecting GPP, Reco, WUE, and ET in all the study sites. While relative air humidity was more important in southern Mediterranean sites, global radiation was more significant in northern Italy. Our work suggests that a realistic prediction of the main responses of Italian forests under climate change should also take in account delayed responses due to acclimation to abiotic stress or changing environmental conditions

Surgical management of pleomorphic adenoma of parotid gland in elderly patients: Role of morphological features.

The neoplasms of the salivary glands account for 2% of head and neck tumors and the most common form is the Pleomorphic Adenoma (PA). Parotid gland is affected from 80% to 90% of cases. In elderly this tumors occurs mostly in females. These benign tumors are composed of epithelial and myoepithelial cells that are arranged with various morphological patterns and subtypes. The classification of these tumors is also based on the amount and nature of the stroma. In literature there is a almost complete consensus that, in the major salivary glands, PAs are enclosed by a layer of fibrous tissue often called "capsule" but there is disagreement about the form, extention and thickness of this layer. The treatment is surgical and there are two main different surgical approaches: an enucleation (local dissection) or so-called subtotal superficial parotidectomy and lateral or superficial total parotidectomy. Histopathological characteristics of PAs especially of capsular alterations such as thin capsule areas, capsule-free regions, capsule penetration, satellite nodules and pseudopodia in the different subtypes are important for the choice of surgical treatment and the first explanation for tumor recurrence. In our study we describe a morphological features of 84 cases of pleomorphic adenoma of parotid gland from elderly patients treated by a surgical "enucleation like" method called nucleoresection