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L’elaborato, prendendo avvio dall’evoluzione della partecipazione dei privati ai processi decisionali degli enti locali, opera un approfondimento sul rapporto tra istanze partecipative ed esigenze di efficienza delle politiche pubbliche dall’angolo prospettico del settore dei servizi pubblici locali, recentemente novellato per opera del d.lgs. n. 201/2022. Sebbene la norma in parola annoveri la centralità dell’utenza tra i principi guida della disciplina e affermi il più ampio coinvolgimento nell’istituzione e organizzazione dei servizi, in concreto tale coinvolgimento pare incontrare ancora diverse resistenze.

La produzione e la circolazione di testi, in particolare di carattere agiografico, la traslazione di reliquie, le alleanze matrimoniali ed i trasferimenti temporanei o definitivi di esponenti dell’aristocrazia sono alcune delle chiavi di lettura che possono contribuire a tracciare la storia dei rapporti Nord-Sud nell’altomedioevo. La Toscana da questo punto di vista offre dati interessanti ; ne è un esempio il bavaro Nibelungo, esponente degli Huosi, la cui presenza in Tuscia va inserita in un quadro più ampio che vide l’intensificarsi delle relazioni tra Italia centro-settentrionale e Baviera nella seconda metà dell’VIII secolo. Spesso però la nostra prospettiva è in grado di cogliere solo la superficie degli eventi, mentre è difficile apprezzare la ricaduta dei rapporti internazionali a livello locale. Nel contesto toscano, ed in quello lucchese in particolare, è possibile riscontrarne gli effetti anche all’interno dell’aristocrazia locale, grazie ad una più allargata base partecipativa degli scambi tra Baviera e Toscana tra VIII e IX secolo di quella fino ad ora evidenziata. Questa particolare forma di sincretismo culturale permette meglio di spiegare il radicamento a Lucca della famiglia comitale di Bonifacio, di origine bavara, destinata a reggere le sorti della marca di Tuscia per circa un secolo. meglio di spiegare il radicamento a Lucca della famiglia comitale di Bonifacio, di origine bavara, destinata a reggere le sorti della marca di Tuscia per circa un secolo.

The toxicity and efficacy of intrathecal liposomal cytarabine (LC) were evaluated in children with central nervous system (CNS) relapsed/refractory acute leukemia/lymphoma. Thirty patients (male:female ratio 21:9; median age 9.4 years) with CNS relapsed/resistant disease were treated with intrathecal LC at dosages adjusted for age. Twenty-seven (90%) patients simultaneously received systemic chemotherapy, including concurrent high-dose cytarabine or methotrexate in 21 (70%) cases. Of 28 patients evaluable for response, 25 patients (89%) achieved CNS complete remission and three (11%) partial remission. The median number of intrathecal LC administrations per patient was 4. The cerebrospinal fluid was cleared after a median of 3 intrathecal LC administrations. Neurological toxicity ≥ grade 3 occurred in four (13%) patients. No permanent sequelae were observed. The median overall survival was 20.9 months and the 5-year probability of survival was 46%. These encouraging data suggest that intrathecal LC is well tolerated and effective in children with relapsed/refractory CNS leukemia/lymphoma.

To differentiate gonadotropin deficiency from delayed puberty in teenage boys, 0.1 mg/m2 of triptorelin, a gonadotropin-releasing hormone agonist, was administered subcutaneously at 4 AM. Serum gonadotropins and testosterone levels were determined at baseline and 4 hours after the injection. The increase in blood gonadotropin and testosterone levels was significantly greater in patients with delayed puberty than in those with gonadotropin deficiency.

Among patients with non-small-cell lung cancer (NSCLC), those with pathological stage I have the best expectation of survival; however, survival is reduced to less than 50% in the long term. At present, it is unclear when patients can be reasonably defined as cured, and if they experience a higher incidence of malignant/nonmalignant diseases and a lower expectation of survival than the general population. A total of 134 stage I NSCLC patients, who had undergone resection at the Thoracic Surgery Unit of the General Hospital of Verona (north-eastern Italy) from October 1987 to December 1993, were still disease-free at 5 years. These subjects were further followed up, and morbidity and mortality rates were compared with those recorded in the general population of the same geographical area. The standardised incidence ratios (SIRs) for all malignancies and for lung cancer were higher than expected (2.39, 95% CI=1.6-3.5, P<0.001; 10.1, 95% CI=6.2-15.6, P<0.0001, respectively). The standardised mortality ratio (SMR) was also significantly increased (1.73, 95% CI=1.1-2.6, P=0.013). The excess mortality could be entirely explained by an increase in mortality from lung cancer (5.7, 95% CI=2.8-10.1, P<0.0001). This study shows that patients, resected for pathological stage I NSCLC and tumour-free after 5 years, have a higher incidence of new lung cancer compared with the general population, which in turn determines an excess in all-cause mortality in the following years.

In 2015, Lithuania entered a new stage of the vocational education and training (VET) curriculum reform with the introduction of the national competence-based qualifications standards and the modul...

Abstract Ovarian cancer remains the most lethal gynecologic malignancy in the United States. Although many patients with advanced-stage disease initially respond to standard combinations of surgical and cytotoxic therapy, nearly 90% develop recurrence and inevitably die from the development of chemotherapy-resistant disease. The discovery of novel and effective therapy against chemotherapy-resistant/recurrent ovarian cancer remains a high priority. Using expression profiling, we and others have recently found claudin-3 and claudin-4 genes to be highly expressed in ovarian cancer. Because these tight junction proteins have been described as the low- and high-affinity receptors, respectively, for the cytotoxic Clostridium perfringens enterotoxin (CPE), in this study we investigated the level of expression of claudin-3 and/or claudin-4 in chemotherapy-naïve and chemotherapy-resistant primary human ovarian cancers as well as their sensitivity to CPE treatment in vitro. We report that 100% (17 of 17) of the primary ovarian tumors tested overexpress one or both CPE receptors by quantitative reverse transcription-PCR. All ovarian tumors showed a dose-dependent cytotoxic effect to CPE in vitro. Importantly, chemotherapy-resistant/recurrent ovarian tumors were found to express claudin-3 and claudin-4 genes at significantly higher levels when compared with chemotherapy-naïve ovarian cancers. All primary ovarian tumors tested, regardless of their resistance to chemotherapeutic agents, died within 24 hours to the exposure to 3.3 μg/mL CPE in vitro. In addition, we have studied the in vivo efficacy of i.p. CPE therapy in SCID mouse xenografts in a highly relevant clinical model of chemotherapy-resistant freshly explanted human ovarian cancer (i.e., OVA-1). Multiple i.p. administration of sublethal doses of CPE every 3 days significantly inhibited tumor growth in 100% of mice harboring 1 week established OVA-1. Repeated i.p. doses of CPE also had a significant inhibitory effect on tumor progression with extended survival of animals harboring large ovarian tumor burdens (i.e., 4-week established OVA-1). Our findings suggest that CPE may have potential as a novel treatment for chemotherapy-resistant/recurrent ovarian cancer.