Immune changes induced by periampullary adenocarcinoma are reversed after tumor resection and modulate the postoperative survival

Abstract Background Tumor growth encompasses multiple immunologic processes leading to impaired immunity. Regarding cancer surgery, the perioperative period is characterized by additional immunosuppression, which may contribute to poorer outcomes. In this exploratory study, we assessed plasma parameters characterizing the perioperative immunity with a particular focus on their prognostic value. Patients and methods 31 patients undergoing pancreatoduodenectomy were enrolled (adenocarcinoma of the pancreatic head and its periampullary region: n = 24, benign pancreatic diseases n = 7). Abundance and function of circulating immune cells and the plasma protein expression were analyzed in blood samples taken pre- and postoperatively using flow cytometry, ELISA and Proximity Extension Assay. Results Prior to surgery, an increased population of Tregs, a lower level of intermediate monocytes, a decreased proportion of activated T-cells, and a reduced response of T-cells to stimulation in vitro were associated with cancer. On the first postoperative day, both groups showed similar dynamics. The preoperative alterations did not persist six weeks postoperatively. Moreover, several preoperative parameters correlated with postoperative survival. Conclusion Our data suggests systemic immunologic changes in adenocarcinoma patients, which are reversible six weeks after tumor resection. Additionally, the preoperative immune status affects postoperative survival. In summary, our results implicate prognostic and therapeutic potential, justifying further trials on the perioperative tumor immunity to maximize the benefit of surgical tumor therapy

Understanding the use of Smart Working in Public Administration: the experience of the Presidency of the Council of Ministers

While there is no consensus in terms of what “smart government” includes and how it is related to emergent technologies and innovation in the public sector, in this paper smart working (SW) is regarded as one of the most important initiatives for building smart government. In the Italian public sector—according to the Law n. 81/2017—SW has emerged as a “new” way to define what is considered as an innovative approach to work organisation and human resource management. Analysing the Presidency of the Council of Ministers case study the paper aims to investigate to answer to the following questions: (i) to what extent is the interface between organisational model for working and new technology contextually bound? (ii) what are the combination of the different elements affecting the configuration of SW? (iii) what are the outcomes of SW likely to be for smar-workers, organisations and society