Tiranni, eroi e burocrati

Since the 19th century, the literary representations of school have been founded on two different perspective: school has been portrayed either as a tyrannical, oppressive institution, or as a means of personal and social redemption and growth. The same alternative applies also to the representation of the teacher, and of her/his relationship with the students: either a merciless war, or a splendid opportunity of mutual enrichment. This dialectic is outlined through a series of exemplary literary works, from Edmondo De Amicis’s Romanzo di un maestro to Sandro Onofri’s Registro di classe.La rappresentazione della scuola fin dall’Ottocento è avvenuta all’insegna di due prospettive divergenti: la scuola è vista da una parte come istituzione totalitaria e repressiva, dall’altra come strumento di liberazione e di crescita individuale e sociale. Parallelamente, cambia la raffigurazione dei professori e del rapporto tra alunni e professori: spietata guerra senza quartiere o straordinaria possibilità di reciproco arricchimento. Tale dialettica è seguita su alcuni testi campione, dal Romanzo di un maestro di Edmondo De Amicis a Registro di classe di Sandro Onofri

Survival benefit della resezione epatica nel colangiocarcinoma intraepatico avanzato: un'analisi dei dati del SEER (Surveillance, Epidemiology, and End Results)

Background: Liver resection (LR) is the cornerstone in the treatment of Intrahepatic Cholangiocarcinoma (I-CCA). However, it is a controversial solution for advanced lesions not only due to surgical technical aspects but also its survival benefit remains questionable. Aim of the work: The aim of this study is to verify the survival benefits of LR in advanced stages of I-CCA based on the 7th and 8th editions of American Joint Committee on Cancer (AJCC) Staging System, and to identify prognostic factors that directly influence patients’ survival after LR. Methods: A retrospective cohort study was performed using the Surveillance, Epidemiology, and End Results (SEER) database to identify stage III and IV a of I-CCA patients based on the 7thedition of AJCC (American Joint Committee on Cancer) staging system. 315 patients were enrolled in this study, during the period 2010-2013 and classified into 2 groups; group A includes 154 patients who underwent LR and group B includes 161 patients who did not have LR but received chemotherapy. The selected population has been classified according to the AJCC 8th edition as well. 233 patients out of 315 were enrolled and classified into group A with LR and Group B with CTH. To account for missing data, two sets of analyses were performed for both 7th and 8th editions module; the 1st includes complete cases (CC) data-set and the 2nd is multiple imputation (MI). The patients in group A and B were matched and propensity score (PS) analysis performed for both 7th and 8th editions in both CC and MI data-set. A Cox proportional hazards model were developed using relevant clinic-pathologic variables to determine the prognostic factors. Results: In CC/ AJCC 7th edition data set with PS analysis the median survival was 35 months (12.5–57.4) 95% CI, and 1, 2, and 3 years survival rates were 64.3%, 51.1%, and 40.8%. In matched group B, the median survival was 14 months, (9.1–18.8) 95% CI and the 1, 2, and 3years survival rates were 51.6%, 16.4%, and 5.5% for matched group B patients (p=0.007). In CC/AJCC 8th edition with PS analysis the median survival for group A was 17 months (8.1–25.8) 95% CI and 1, 2, and 3 years survival rates were 57.8%, 43.4% and 32.6%. In group B, The median survival was 12 months (8.7–15.2) 95% CI and the 1, 2, and 3 years survival rates were 46.6%, 7.4%, and 3.7% for matched group B patients (p=0.013). In CC/AJCC 7th edition data-set, poor prognosis has been shown in patients above 65 years old (HR 1.804, 95% CI 1.139 – 2.858, P .012), in multifocal lesion (HR 1.588, 95% CI 0.950- 2.654, P = 0.077) and positive lymph node (HR 1.885, 95% CI 1.012 – 3.513, P = 0.046). After PS analysis in CC/AJCC 7th edition data set poor prognosis has been noticed in patients above 65 years old (HR 2.618, 95% CI 1.501 – 4.569, P = 0.001), Multifocal lesion (HR 1.890, 95% CI 1.083 – 3.298, P = 0.025) and positive lymph node (HR 1.188, 95% CI 0. 0.680 – 2.075, P = 0.546). A survival benefit of liver resection over chemotherapy was confirmed in both data-set (data-set CC AJCC 7^ ed. before PS: HR 0.505 CI 95% 0.313 – 0.814; P = 0.005; after PS: HR 0.567 CI 95% 0.347 – 0.926 P = 0.023). Conclusion: LR has showed a significant survival benefit over chemotherapy for I-CCA stage III and IV a of the AJCC 7th edition and some survival benefit also in stage III b of 8th edition. Poor outcome has been observed in patients >65 years and with multifocal lesions and lymph node metastasis before the performing of PS analysis. A prospective RCT is needed for better understanding predictors of survival and to establish evidence based algorithmic approach in IC management

Kublai Kan, i mondi possibili e le menzogne del racconto

In Invisible Cities, Italo Calvino questions the status of literary fiction, between truth, falsehood and possible worlds. Having faced the impasse of a mimetic vision of literature, and of a manichean distinction between ‘true’ and ‘false’ fictions, Marco Polo avoids the risk of annihilation by creating a Heterocosm, in which the oppositions real/unreal and true/false can be completely disarmed. The dialogue between Marco and Kublai Kan keeps coming back to the same questions: what is the relationship between cities existing on maps, cities created through a narrative, and narrated cities which pretend to reproduce real cities? And what is the whole point in describing cities, be them visible or invisible? Considering literary universes as fictional objects (grounded in alternative realities which are self-sufficient and yet variously connected to real places and objects, historical people and events) does not imply denying their truth value and their cognitive function in relation to our world, the one in which we live and act, or which is our immediate past or possible future. As people keep inventing and telling fiction, we must ackowledge their value for our lives in the real world

«E quell’infame sorrise». A proposito di somari scolastici e della loro rappresentazione

The article questions the representation of lazy students at school in literature, with a special focus on Edmondo De Amicis Cuore (1886), Paola Mastrocola's Togliamo il disturbo (2011), Pennac's Chagrin d’école (2007) and Eraldo Affinati's Elogio del ripetente (2013).Il somaro per eccellenza – cioè quella fascia più o meno estesa di alunni refrattari al dialogo educativo – diventa la cartina di tornasole da cui partire per interrogarsi sul valore e la legittimità dell’insegnamento e della scuola oggi. All’interno dell’enorme mole di produzione saggistica e narrativa centrata sulla scuola, in cui spesso è molto difficile identificare un genere di appartenenza e stabilire il confine tra autobiografia, fiction e riflessione critica, si indaga il corto circuito tra il Franti di Cuore, il nonstudiante Di Paola Mastrocola (Togliamo il disturbo, 2011), il somaro di (Chagrin d’école, 2007) Daniel Pennac e il ripetente di Eraldo Affinati (Elogio del ripetente, 2013)

Claudio Gigante - Dirk Vanden Berghe (eds.), Il romanzo del Risorgimento

Review of the book Il romanzo del Risorgimento, edited by Claudio Gigante and Dirk Vanden Berghe.A  lungo il dibattito storiografico sul Risorgimento è stato dominato dalla contrapposizione tra la retorica patriottica (la celebrazione della nascita della patria, il culto dei martiri e degli eroi risorgimentali) e la denuncia dei limiti e delle inadempienze del processo di unificazione (la critica del Risorgimento come rivoluzione mancata, il riconoscimento della sostanziale immobilità delle strutture di potere, la questione meridionale). Parallelamente, in campo specificamente letterario il filone d’indagine più praticato è stato quello relativo alla narrativa ‘antirisorgimentale’ – sulla scia della celebre definizione di ‘romanzo antistorico’ coniata da Spinazzola a proposito di tre testi fondamentali nella rappresentazione del periodo storico in questione (e cioè I Vicerè, I vecchi e i giovani e Il gattopardo)

Pharmacodynamic effects of atorvastatin vs. rosuvastatin in coronary artery disease patients with normal platelet reactivity while on dual antiplatelet therapy — The PEARL randomized cross-over study

n/

SerpinB3 as hepatic marker of post-resective shear stress

Post-resective liver failure is a frequent complication of liver surgery and it is due to portal hyperperfusion of the remnant liver and to arterial vasoconstriction, as buffer response of the hepatic artery. In this context, splenectomy allows a reduction of portal flow and increases the survival chance in preclinical models. SerpinB3 is over-expressed in the liver in oxidative stress conditions, as a mechanism of cell defense to provide survival by apoptosis inhibition and cell proliferation. In this study, the expression of SerpinB3 was assessed as predictor of liver damage in in vivo models of major hepatic resection with or without splenectomy. Wistar male rats were divided into 4 groups: group A received 30% hepatic resection, group B > 60% resection, group C > 60% resection with splenectomy and group D sham-operated. Before and after surgery liver function tests, echo Doppler ultrasound and gene expression were assessed. Transaminase values and ammonium were significantly higher in groups that underwent major hepatic resection. Echo Doppler ultrasound showed the highest portal flow and resistance of the hepatic artery in the group with > 60% hepatectomy without splenectomy, while the association of splenectomy determined no increase in portal flow and hepatic artery resistance. Only the group of rats without splenectomy showed higher shear-stress conditions, reflected by higher levels of HO-1, Nox1 and of Serpinb3, the latter associated with an increase of IL-6. In conclusion, splenectomy controls inflammation and oxidative damage, preventing the expression of Serpinb3. Therefore, SerpinB3 can be considered as a marker of post-resective shear stress

Local delivery of thrombolytics before thrombectomy in patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention — The DISSOLUTION randomized trial

Background: Ranolazine decreases the frequency of arrhythmias during the acute phases of ischemic heart disease (IHD), but it remains unknown if it has similar effects in the chronic phase of the disease. We performed a prospective, randomized, cross-over pilot trial to test the hypothesis that chronic treatment with ranolazine can reduce the incidence of documented arrhythmias and the related symptoms of palpitation in stable patients with IHD. Methods: We randomized 105 patients with stable IHD and symptoms of angina and palpitations already on therapy with betablockers and/or calcium antagonists to ranolazine (750 mg bid, N = 53) or placebo (N = 52) for 30 days (until T-1). After a washout period to avoid any carryover effect, cross-over was performed,and patients were switched to the other drug which was continued for 30 days (until T-2). All patients underwent symptomlimited exercise stress testing and 48-hour ECG Holter monitoring at T1 and T2. During the study period, patients were told to use a OmronN® portable ECG monitor HCG-801 device in case of symptoms of palpitations. Results: Ranolazine reduced the number of anginal episodes more commonly than placebo (5 ± 8 episodes/30 days vs. 21 ± 24 episodes/30 day, p = 0.001) and increased exercise durations at 1 mm ST-segment depression (514 ± 211 s vs. 402 ± 287 s, p = 0.025) and at onset of angina (614 ± 199 s vs. 519 ± 151 s, p = 0.007) at stress testing. These effects were coupled by significant decreases with ranolazine as compared with placebo treatment periods in the occurrence of frequent (N1000 beats) supraventricular arrhythmias (33% vs 52%, p = 0.01) and complex ventricular arrhythmias (17% vs 30%, p = 0.045). Complete resolution of symptoms of palpitations was significantly more common with ranolazine than placebo (31/53 vs 16/52 patients, p = 0.008). Also, portable ECG recordings showed that arrhythmias were less common during ranolazine vs. placebo, with significant decreases in number (7 ± 10 episodes/30 days vs. 23 ± 29 episodes/30 day, p = 0.001) and duration (10 ± 18 min/ 30 days vs. 19 ± 21 min/30 day, p = 0.021) of symptomatic arrhythmic episodes. No severe side effects were recorded during the trial period. Conclusion: The antianginal and antiischemic properties of ranolazine are paralleled by significant decreases in the occurrence of both arrhythmias and the related symptoms of palpitations in stable patients with IHD. (ClinicalTrials.gov identifier: NCT01495520)

Solid Organ Transplantation During COVID-19 Pandemic: An International Web-based Survey on Resources’ Allocation

Background. Solid organ transplants (SOTs) are life-saving interventions, recently challenged by coronavirus disease 2019 (COVID-19). SOTs require a multistep process, which can be affected by COVID-19 at several phases. Methods. SOT-specialists, COVID-19-specialists, and medical ethicists designed an international survey according to CHERRIES guidelines. Personal opinions about continuing SOTs, safe managing of donors and recipients, as well as equity of resources' allocation were investigated. The survey was sent by e-mail. Multiple approaches were used (corresponding authors from Scopus, websites of scientific societies, COVID-19 webinars). After the descriptive analysis, univariate and multivariate ordinal regression analysis was performed. Results. There were 1819 complete answers from 71 countries. The response rate was 49%. Data were stratified according to region, macrospecialty, and organ of interest. Answers were analyzed using univariate- multivariate ordinal regression analysis and thematic analysis. Overall, 20% of the responders thought SOTs should not stop (continue transplant without restriction); over 70% suggested SOTs should selectively stop, and almost 10% indicated they should completely stop. Furthermore, 82% agreed to shift resources from transplant to COVID-19 temporarily. Briefly, main reason for not stopping was that if the transplant will not proceed, the organ will be wasted. Focusing on SOT from living donors, 61% stated that activity should be restricted only to "urgent"cases. At the multivariate analysis, factors identified in favor of continuing transplant were Italy, ethicist, partially disagreeing on the equity question, a high number of COVID-19- related deaths on the day of the answer, a high IHDI country. Factors predicting to stop SOTs were Europe except-Italy, public university hospital, and strongly agreeing on the equity question. Conclusions. In conclusion, the majority of responders suggested that transplant activity should be continued through the implementation of isolation measures and the adoption of the COVID-19-free pathways. Differences between professional categories are less strong than supposed

Survival benefit della resezione epatica nel colangiocarcinoma intraepatico avanzato: un'analisi dei dati del SEER (Surveillance, Epidemiology, and End Results)

Background: Liver resection (LR) is the cornerstone in the treatment of Intrahepatic Cholangiocarcinoma (I-CCA). However, it is a controversial solution for advanced lesions not only due to surgical technical aspects but also its survival benefit remains questionable. Aim of the work: The aim of this study is to verify the survival benefits of LR in advanced stages of I-CCA based on the 7th and 8th editions of American Joint Committee on Cancer (AJCC) Staging System, and to identify prognostic factors that directly influence patients’ survival after LR. Methods: A retrospective cohort study was performed using the Surveillance, Epidemiology, and End Results (SEER) database to identify stage III and IV a of I-CCA patients based on the 7thedition of AJCC (American Joint Committee on Cancer) staging system. 315 patients were enrolled in this study, during the period 2010-2013 and classified into 2 groups; group A includes 154 patients who underwent LR and group B includes 161 patients who did not have LR but received chemotherapy. The selected population has been classified according to the AJCC 8th edition as well. 233 patients out of 315 were enrolled and classified into group A with LR and Group B with CTH. To account for missing data, two sets of analyses were performed for both 7th and 8th editions module; the 1st includes complete cases (CC) data-set and the 2nd is multiple imputation (MI). The patients in group A and B were matched and propensity score (PS) analysis performed for both 7th and 8th editions in both CC and MI data-set. A Cox proportional hazards model were developed using relevant clinic-pathologic variables to determine the prognostic factors. Results: In CC/ AJCC 7th edition data set with PS analysis the median survival was 35 months (12.5–57.4) 95% CI, and 1, 2, and 3 years survival rates were 64.3%, 51.1%, and 40.8%. In matched group B, the median survival was 14 months, (9.1–18.8) 95% CI and the 1, 2, and 3years survival rates were 51.6%, 16.4%, and 5.5% for matched group B patients (p=0.007). In CC/AJCC 8th edition with PS analysis the median survival for group A was 17 months (8.1–25.8) 95% CI and 1, 2, and 3 years survival rates were 57.8%, 43.4% and 32.6%. In group B, The median survival was 12 months (8.7–15.2) 95% CI and the 1, 2, and 3 years survival rates were 46.6%, 7.4%, and 3.7% for matched group B patients (p=0.013). In CC/AJCC 7th edition data-set, poor prognosis has been shown in patients above 65 years old (HR 1.804, 95% CI 1.139 – 2.858, P .012), in multifocal lesion (HR 1.588, 95% CI 0.950- 2.654, P = 0.077) and positive lymph node (HR 1.885, 95% CI 1.012 – 3.513, P = 0.046). After PS analysis in CC/AJCC 7th edition data set poor prognosis has been noticed in patients above 65 years old (HR 2.618, 95% CI 1.501 – 4.569, P = 0.001), Multifocal lesion (HR 1.890, 95% CI 1.083 – 3.298, P = 0.025) and positive lymph node (HR 1.188, 95% CI 0. 0.680 – 2.075, P = 0.546). A survival benefit of liver resection over chemotherapy was confirmed in both data-set (data-set CC AJCC 7^ ed. before PS: HR 0.505 CI 95% 0.313 – 0.814; P = 0.005; after PS: HR 0.567 CI 95% 0.347 – 0.926 P = 0.023). Conclusion: LR has showed a significant survival benefit over chemotherapy for I-CCA stage III and IV a of the AJCC 7th edition and some survival benefit also in stage III b of 8th edition. Poor outcome has been observed in patients >65 years and with multifocal lesions and lymph node metastasis before the performing of PS analysis. A prospective RCT is needed for better understanding predictors of survival and to establish evidence based algorithmic approach in IC management.Premesse: La resezione epatica rappresenta il trattamento di prima scelta nel trattamento del colangiocarcinoma intraepatico in stadio I e II. Il ricorso alla terapia chirurgica negli stadi più avanzati è controverso, non solo a causa di aspetti tecnici legati all’intervento resettivo, ma anche per quanto riguarda l’eventuale beneficio in termini di sopravvivenza. Scopo del lavoro: Lo scopo di questo studio è stato quello di verificare il potenziale beneficio in termini di sopravvivenza della resezione epatica nel colangiocarcinoma intraepatico avanzato classificato in base alla 7^ ed 8^ edizione dell’AJCC (American Joint Committee on Cancer) e di individuare i fattori prognostici in grado di influenzare direttamente la sopravvivenza dei pazienti dopo resezione epatica. Metodologia: E’ stato condotto uno studio retrospettivo di coorte con i dati presenti del data-base del SEER (Surveillance, Epidemiology, And End Results - SEER) per identificare i pazienti di affetti da colangiocarcinoma intraepatico in stadio III e IV secondo la classificazione della 7^ edizione del sistema di stadiazione AJCC. 315 pazienti sono stati arruolati in questo studio nel periodo compreso tra il 2010 ed il 2013 e sub-classificati in 2 gruppi; il gruppo A comprendeva 154 pazienti sottoposti a resezione epatica ed il gruppo B comprendeva 161 pazienti che non avevano subito una resezione epatica ma avevano ricevuto la sola chemioterapia. La popolazione selezionata è stata classificata anche in base alla 8^ edizione dell'AJCC (pubblicata in corso dello svolgimento dello studio); Dei 315 pazienti arruolati ne sono stati selezionati 233 a loro volta suddivisi in gruppo A (resezione epatica, n = 100) e nel gruppo B (chemioterapia, n= 133). A causa della presenza di dati mancanti le analisi sono state condotte su due diversi data-set: il primo comprende i set di dati completi (CC) e il secondo comprende i dati a imputazione multipla (MI) per entrambe le edizioni dell’AJCC. I pazienti nel gruppo A e B sono quindi stati abbinati tramite il Propensity Score Matching (PS) sia per la 7^ che per l’8^ edizione dell’AJCC per entrambi i data-set (CC ed MI). L’analisi dei fattori prognostici è stata condotta mediante il modello di regressione di Cox a rischi proporzionali.   Risultati: Nel data-set CC della 7^ edizione dell’ AJCC per colangiocarcinoma intraepatico, dopo l’analisi PS, la sopravvivenza media per il gruppo A è risultata essere di 35 mesi (12,5-57,4) 95% CI ed a 1, 2 e 3 anni i tassi di sopravvivenza sono risultati pari a 64,3%, 51,1% e 40,8% rispettivamente. Nel gruppo B corrispondente, la sopravvivenza media è risultata essere di 14 mesi (9,1-18,8) 95% CI ed i tassi di sopravvivenza a 1, 2 e 3 anni pari a 51,6%, 16,4% e 5,5% (P = 0,007). Nel data-set CC dell’AJCC 8^ edizione dopo l’analisi PS la sopravvivenza mediana per il gruppo A è stata di 17 mesi (8,1-25,8) 95% CI e per 1, 2 e 3 anni i tassi di sopravvivenza sono stati del 57,8%, 43,4% e 32,6% rispettivamente. Nel gruppo B, la sopravvivenza media è risultata di 12 mesi (8,7-15,2) 95% CI ed i tassi di sopravvivenza a 1, 2 e 3 anni rispettivamente del 46,6%, 7,4% e 3,7% (P = 0,013). Nel data-set CC della 7^ edizione dell’ AJCC è stata dimostrata una prognosi peggiore nei pazienti di età superiore ai 65 anni (HR 1.804, 95% CI 1.139 - 2.858, P = 0.012), nelle lesioni multifocali (HR 1.588, 95% CI 0.950-2.654 , P = 0,077) e con positività linfonodale (HR 1,885, 95% CI 1,011 - 3,513, P = 0,046). Dopo l'analisi PS del data-set CC (AJCC 7^ edizione) si confermavano prognosticamente negativi l’età superiore a 65 (HR 2.618, 95% CI 1.501 - 4.569, P = 0.001) e la presenza di lesioni multifocali (HR 1.890, 95% CI 1.083 - 3.298 , P = 0,025); non si confermava invece il valore prognostico della positività linfonodale (HR 1.188, 95% CI 0. 0.680 - 2.075, P = 0.546). Per ogni analisi si è confermato il ruolo protettivo in termini di beneficio di sopravvivenza della resezione epatica rispetto al trattamento chemioterapico (data-set CC AJCC 7^ edizione pre-PS HR 0.505 CI 95% 0.313 – 0.814; P = 0.005; post-PS HR 0.567 CI 95% 0.347 – 0.926 P = 0.023). Conclusione: Nei pazienti sottoposti a resezione epatica si è dimostrato un benefico in termini di sopravvivenza rispetto ai pazienti chemiotrattati per gli stadi III e IV a della 7^ edizione dell’AJCC; un minor beneficio, sebbene presente, si è riscontrato invece nei pazienti in stadio III b dell'8^ edizione del sistema di stadiazione AJCC. Prognosticamente sfavorevoli sono risultati essere l’età superiore a 65 anni, la presenza di malattia multifocale e la presenza di metastasi linfonodali nell’analisi pre-PS. Alla luce di tali risultati sarà necessario eseguire un trial prospettico randomizzato controllato per generare un algoritmo prognostico-terapeutico basato sulle evidenze scientifiche per il trattamento del colangiocarcinoma intraepatico e per una più adeguata definizione dei fattori prognostici di malattia.