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Riassunto: Il percorso di stadiazione e l’indicazione al trattamento dell’epatocarcinoma devono essere scelti poiché ritenuti i più omogenei ed efficaci rispetto alle condizioni generali del paziente. Numerose linee guida sono applicate dai maggiori centri di riferimento Europei, Asiatici e Nordamericani e, nel nostro paese, di recente sono state emanate le raccomandazioni dell’AISF (Associazione Italiana per lo Studio del Fegato) per la gestione integrata del paziente con Epatocarcinoma. La presente revisione riassume la posizione assunta dalla comunità di esperti Nazionali riunitasi in occasione del Congresso Gargano 2012 in merito alla stadiazione ed al trattamento dell’HCC nei diversi stadi, alla luce delle linee guida e delle raccomandazioni vigenti.

An in-depth assessment of work-related stress was conducted in a major national telecommunications company undergoing major changes. The assessment was made on three homogeneous groups of workers and covered a large representative sample of the corresponding populations.To identify the main sources of stress for the three populations of workers, stimulate a discussion on the possible corrective actions, and assess the impact of the on-going organizational changes on workers' health.The assessment started with an analysis of the objective stress indicators listed in the INAIL (National Insurance Institute for Occupational Diseases and Accidents) Checklist. This was followed by a combination of qualitative and quantitative investigations on work context and tasks and on the subjective perceptions of workers, which were carried out by using: semi-structured interviews with management, field observations of work tasks, focus groups and questionnaires (GHQ-12, HSE Indicator Tool, ad-hoc questionnaire).The assessment allowed identification of the critical areas to be addressed with specific interventions: relationship with the company, work performance, work organization, and equipment.the investigation allowed to identification of specific practical actions (improvement of technological tools; professional development through training courses) as well as strategic actions ( re-establish relationship of trust with the company) so as to mitigate the workers' level of stress. Analysis of the results also showed that the three targeted populations differed in the degree of acceptance and understanding of the organizational changes.

Negli ultimi anni numerose pubblicazioni hanno descritto un aumento nella frequenza delle malformazioni ed un declino nelle popolazioni di anfibi. Tra le possibili cause, viene riportata l’esposizione a prodotti fitosanitari usati in agricoltura. E’ noto infatti che gli organofosfati, tra cui chlorpyrifos (CPF), provochino effetti tossici negli organismi non bersaglio come per esempio l’inibizione dell’attività enzimatica dell’acetilcolinesterasi (AChE) che causa una continua stimolazione dei recettori colinergici con conseguente alterazione della contrazione muscolare. La valutazione del bioaccumulo e della capacità detossificante, in termini di clearance, negli stadi larvali di Xenopus laevis esposti a CPF, è uno degli scopi del progetto di ricerca attualmente in corso. I risultati ottenuti dai saggi ecotossicologici effettuati hanno permesso di evidenziare tre fasi distinte nella cinetica di uptake e clearance, ciascuna delle quali caratterizzata da una peculiare cinetica di reazione. Queste risultano essere tutte correlate alle proprietà chimico-fisiche della molecola in studio e alle proprietà biologiche dell’organismo saggiato. Le differenze delle reazioni individuate nei vari stadi di sviluppo hanno una grande rilevanza ecologica nell’ambito di una stima del rischio ecotossicologico per anfibi in seguito ad esposizione a xenobiotici

Levamisole is an anthelmintic drug with immunostimulant properties when administered at repeated doses of 2.5 mg/kg prior to a vaccine being administered. In order to assess the effect of levamisole administration on bluetongue (BT) vaccination in sheep, four groups of unvaccinated pregnant sheep (8 sheep per group) were used. Group A received vaccine only; Group B received levamisole+vaccine; Group C received Levamisole only; Group D was a non-treated control. Levamisole (Citarin L-10%) was administered three times weekly at an initial dose of 5.0 mg/kg of body weight and subsequently at 2.5 mg/kg of body weight. There was a significant decrease in faecal egg count of gastrointestinal strongyles in Groups B and C. At the beginning of the trial, all animals were serologically negative for BT antibodies; after vaccination, there was a difference in antibody response in animals in the treated groups. Significantly, more animals in Group B developed BT antibodies following vaccination than those in Group A. In conclusion, levamisole appeared to have an immunostimulating effect on the response of sheep to BT vaccination.

Since 2000, the emergence of several large disease-specific global health initiatives (GHIs) has changed the way in which international donors provide assistance for public health. Some critics have claimed that these initiatives burden health systems that are already fragile in countries with few resources, whereas others have asserted that weak health systems prevent progress in meeting disease-specific targets. So far, most of the evidence for this debate has been provided by speculation and anecdotes. We use a review and analysis of existing data, and 15 new studies that were submitted to WHO for the purpose of writing this Report to describe the complex nature of the interplay between country health systems and GHIs. We suggest that this Report provides the most detailed compilation of published and emerging evidence so far, and provides a basis for identification of the ways in which GHIs and health systems can interact to mutually reinforce their effects. On the basis of the findings, we make some general recommendations and identify a series of action points for international partners, governments, and other stakeholders that will help ensure that investments in GHIs and country health systems can fulfil their potential to produce comprehensive and lasting results in disease-specific work, and advance the general public health agenda. The target date for achievement of the health-related Millennium Development Goals is drawing close, and the economic downturn threatens to undermine the improvements in health outcomes that have been achieved in the past few years. If adjustments to the interactions between GHIs and country health systems will improve efficiency, equity value for money, and outcomes in global public health, then these opportunities should not be missed.

Background/aims: Hepatic resection in metastatic disease from colorectal cancer offers the best chance in selected cases for long-term survival. Neoadjuvant chemotherapy (NACT) has been advocated in some cases initially deemed irresectable, with few reports of the efficacy of such a strategy and the influence of the response to chemotherapy on the outcome of radical hepatic resection. Methodology: Between December 1995 and May 2005, 27 patients with colorectal liver metastases (seven males, 20 females, mean age: 58 ± 8 years; range: 40–75) were treated with neoadjuvant chemotherapy. A seven-year survival analysis was performed. Chemotherapy included mainly 5-fluorouracil, leucovorin and either oxaliplatin or irinotecan for a median of eight courses. Results: A total of 16 patients (59%) had synchronous and 11 (41%) metachronous metastases. During pre-operative chemotherapy, tumour regression occurred in ten cases (37%), stable disease in a further ten patients (37%) and progressive disease developed in seven cases (26%). The five-year overall survival for NACT responders was 64% and only 15% for non-responders (p=0.044). Conclusions: The response to chemotherapy is likely to be a significant prognostic factor affecting survival after liver resection for cure.