L'espressione proteica del gene CYB5A correla con la ratio linfonodale e la volumetria della massa tumorale nei pazienti affetti da carcinoma duttile pancreatico

L’Adenocarcinoma duttale del pancreas (PDAC), è una patologia letale. Nonostante la bassa incidenza, risulta essere una delle prime cause di morte per cancro nei paesi industrializzati. Questa sua aggressività è attribuita ad una crescita praticamente silente, tantoché la maggior parte dei pazienti oncologici si presenta all’osservazione con una malattia in stadio avanzato. Questo tumore per la sua sede di origine, è in grado di metastatizzare rapidamente, pertanto, i soggetti lungo sopravviventi sono molto rari (<5%) ed nei casi in cui la chirurgia pancreatica migliora la prognosi del paziente operabile, la radicalita’ oncologica diventa un fattore discriminante per incrementare la sopravvivenza e il periodo libero da malattia per questi pazienti. Nel caso del pancreas questo non risulta sempre possibile proprio per le caratteristiche biologiche della neoplasia che influenzano l’infiltrazione perineurale, linfonodale (anche extra regionale) nonché la presenza di metastasi a distanza. Benche’ si parli di “PDACs” resecabili o “borderline resectable” e’ stato riportato che la detection di microinfiltarzioni neoplastiche nei margini di resezione e nei linfonodi sono pari al 75% e 80°% rispettivamente. In questo lavoro e’ stata valutata la relazione tra la dimensione della neoplasia, lo status linfonodale e l’aggressivita’ biologica del tumore in 158 pazienti che tra il 2003 e il 2008 son stati sottoposti ad intervento chirurgico resettivo per PDAC. Il rapporto volumetrico del tumore (TVR) la ratio delle metastasi linfonodali sono stati analizzati in rapporto alla sopravvivenza globale , periodo libero da malattia. In alcuni casi e stata valutata l’espressione della proteina CYB5A. Questo marcatore e’ stato recentemente associato con la progressione tumorale, la presenza di metastasi linfonodali ed a distanza in un modello ortotopico di PDAC. Nella nostra coorte di pazienti abbiamo trovato un’associazione statisticamente significativa tra lo stato linfonodale e il TVR nei pazienti resecati stadiati come pT3 (p=0,0070). Inoltre l’espressione del gene CYB5A e’ stata correlata in maniera significativa con il tempo di sopravvivenza ed il periodo libero da malattia nei pazienti affetti da PDAC resecabile e metastatico (p<0,05). Indipendentemente dalla possibilita’ resettiva chirurgica con intento curativo, le caratteristiche patologico-molecolari del singolo individuo giocano un ruolo fondamentale nella progressione della malattia, influenzando la sopravvivenza e comparsa di recidiva nei pazienti affetti PDAC

The role of immune suppression in COVID-19 hospitalization: clinical and epidemiological trends over three years of SARS-CoV-2 epidemic

Specific immune suppression types have been associated with a greater risk of severe COVID-19 disease and death. We analyzed data from patients &gt;17 years that were hospitalized for COVID-19 at the “Fondazione IRCCS Ca′ Granda Ospedale Maggiore Policlinico” in Milan (Lombardy, Northern Italy). The study included 1727 SARS-CoV-2-positive patients (1,131 males, median age of 65 years) hospitalized between February 2020 and November 2022. Of these, 321 (18.6%, CI: 16.8–20.4%) had at least one condition defining immune suppression. Immune suppressed subjects were more likely to have other co-morbidities (80.4% vs. 69.8%, p &lt; 0.001) and be vaccinated (37% vs. 12.7%, p &lt; 0.001). We evaluated the contribution of immune suppression to hospitalization during the various stages of the epidemic and investigated whether immune suppression contributed to severe outcomes and death, also considering the vaccination status of the patients. The proportion of immune suppressed patients among all hospitalizations (initially stable at &lt;20%) started to increase around December 2021, and remained high (30–50%). This change coincided with an increase in the proportions of older patients and patients with co-morbidities and with a decrease in the proportion of patients with severe outcomes. Vaccinated patients showed a lower proportion of severe outcomes; among non-vaccinated patients, severe outcomes were more common in immune suppressed individuals. Immune suppression was a significant predictor of severe outcomes, after adjusting for age, sex, co-morbidities, period of hospitalization, and vaccination status (OR: 1.64; 95% CI: 1.23–2.19), while vaccination was a protective factor (OR: 0.31; 95% IC: 0.20–0.47). However, after November 2021, differences in disease outcomes between vaccinated and non-vaccinated groups (for both immune suppressed and immune competent subjects) disappeared. Since December 2021, the spread of the less virulent Omicron variant and an overall higher level of induced and/or natural immunity likely contributed to the observed shift in hospitalized patient characteristics. Nonetheless, vaccination against SARS-CoV-2, likely in combination with naturally acquired immunity, effectively reduced severe outcomes in both immune competent (73.9% vs. 48.2%, p &lt; 0.001) and immune suppressed (66.4% vs. 35.2%, p &lt; 0.001) patients, confirming previous observations about the value of the vaccine in preventing serious disease

Autism's Institutionalization from Clinical Files of Venice Asylum of San Servolo

When we started working on autism, the first thing we asked ourselves was, what was autism before 1943, that is, the date of birth of the disease? Since human difference replicates statistically in a regular way, people in the same condition always existed, object (or not) of social, cultural and medical attention. Since we are interested into history of psychiatry, we started a research project on thousands of clinical files on the archive of the ex-psychiatric asylum in the island of San Servolo, in Venice, from 1874 to 1939, to see how autism, in its whole spectrum, was treated. So in our talk we will contextualize the pre-history of autism as institutionalization, a theme that is at the core of Gil Eyal’s The Autism Matrix, focusing on the findings of our research on San Servolo’s clinical files

Arguing at the Margins: Louis Wolfson, Le Schizo et les Langues

Our presentation will be centered on the intriguing schizophrenic writer Louis Wolfson. His books are something to be set apart from every other kind of literary production; and his life is absolutely incredible

Autism: an Historical Ontology

The authors are developing a broad spectrum research on autism’s history and its prehistory. Retracing its genesis allows us to contextualize, in a proper way, the interesting phenomenum of the amazing cultural exposure of this psychiatric category, raised in a few decades from the status of a rare condition to its current public overexposure. The diagnostic proliferation of autism has turned relational disability into a hype, around which etiologies have been developed, along with methodologies of intervention, different and at times opposite theoretical approaches, but also, in a broader sense, a proliferation in cultural productions. The starting point of the present research are Foucault’s genealogy and the history of psychiatric knowledge/power, and place itself in the trail of the researches on autism developed by Ian Hacking, who dedicated in 2004 a course at the Collège de France to autism, and many other works in the following years. One activity carried out in the elaboration process of an historical ontology of autism consisted in a research about the institutionalization of relational disabilities in the ex psychiatric hospital of Venice, in San Servolo’s island, around the turn of the 19th century. What was the autistic human kind prior to its psychiatric naming? On which explicit and implicit assumptions are structured the medical, educational and reparative interventions? Which expectations in the involved subjectivities (parents, professionals, autistics) do they meet? Beside the clinical aspects, our investigation addressed the cultural traces of relational disabilities in literature, cinema and in a broader sense in cultural productions at many levels. Autism is highlighted as an absolutely complex cultural object and subject to a swirling evolution. Our goal is to consider the object “autism” in its complexity, not aiming to frame it in an organic and definitive meaning, but to represent its redundancy and its dispersion, according to Foucault’s theories. In the paper we will propose our itineraries of mapping, analysis and contextualization of autism, Asperger’s Syndrome and relational disabilities

Autism and institutionalization. A report from a research on the archive of Venice’s ex asylum in the island of St. Servolo

In a recent book, by Gil Eyal and colleagues, The Autism Matrix, the deinstitutionalization of mental retardation in the sixties is seen as the auroral moment of its emergence. While we were working on autism, we posed ourselves the same questions. Where does the discourse about “autism” come from? What was autism before being “autism”, that is, before its naming by Kanner and Asperger? We also had the perception that the absence of “autism” in the public discourse during the previous decades, had something to do with the institutionalization as a psychiatric problem of what now stays under the name of autism. Therefore, we started a research on the clinical files of the archive of the ex-asylum of Venice, on the island of St. Servolo, to verify that assumption. This research was published in 2013 with the title A sé e agli altri: Storia della manicomializzazione dell’autismo e delle altre disabilità relazionali nelle cartelle cliniche di S. Servolo, To him/her/itself and to others: History of the institutionalization of Autism and other relational disabilities from the clinical files of St. Servolo. Looking in front of you at St. Marco’s square, from Palazzo Ducale, you can see a small island surrounded by a high wall of bricks: that is St. Servolo’s island, and from the end of 18th century until 1980 it was Venice asylum. After Basaglia’s law in Italy, a museum of the asylum and an archive has been created there

Ethnoclinic: languages, migrations, identities

Ci proponiamo di descrivere le pratiche ed esperienze etnocliniche, intese come luogo di ascolto e conversazione terapeutica. Nel nostro lavoro con megranti, rifugiati e richiedenti asilo viene utilizzato un modello che include diverse professioni, ognuna delle quali possiede specifiche competenze: psicoterapeuti, psicologi clinici, psichiatri, antropologi, educatori e pedagogisti. Ci riferiamo ad un’epistemologia che trae origine dall’etnopischiatra e dalla psicologia culturale prendendone altresì le distanze rispetto ad alcune peculiari visioni.Our purpose is to describe the ethnoclinic experiences and practices, meant as a place of listening and therapeutic conversation. In our work, with migrants, refugees and asylum seekers, we use a model that involves several practitioners, each with multiples skills: psychotherapists, clinical psychologists, psychiatrists, anthropologists, educators and pedagogues. We are referring to the epistemology origined by ethnopsychiatry and by cultural psychology. Nevertheless, we move away from these disciplines, as soon as the meeting between practitioners and migrants does not fall into the presumption of replacing the traditional health care practices, as happened due to the ethonopsychiatric ingenuities

Esophageal liposarcoma: Well-differentiated rhabdomyomatous type

Rhabdomyomatous well-differentiated esophageal liposarcomas are extremely rare. As of August 2016, only one other such case has been reported in the English-language medical literature. Liposarcomas in general are one of the most common soft tissue neoplasms in adults, but the incidence of primary esophageal liposarcomas is exceptionally low. There have been only 42 reported cases of primary liposarcoma of the esophagus worldwide thus far. These malignancies are harbored within giant fibrovascular polyps, which slowly grow within the esophageal lumen causing obstructing symptoms. We hereby present the case of a 68-year-old male patient who came in with a 2-mo history of worsening intermittent dysphagia, persistent cough, and postprandial retrosternal pain. After an esophagogastroduodenoscopy, a computed tomographic scan, and a diagnostic endoscopy, complete endoscopic resection was performed of the 13 cm x 6 cm x 2.6 cm fibrovascular polyp. A literature review was done and results are presented herein