Search

Although discrimination of the model for end stage liver disease (MELD) is generally considered acceptable, its calibration is still unclear. In a validation study, we assessed the discrimination and calibration performance of 3 versions of the model: original MELD-TIPS, used to predict survival after transjugular intra-hepatic portosystemic shunt (TIPS); classic MELD-Mayo; MELD-UNOS, used by United Network for Organ Sharing (UNOS). Recalibration and model updating were also explored.

Background & Aims: Portosystemic encephalopathy (PSE) is a major complication of trans-jugular intrahepatic porto-systemic shunt (TIPS) placement. Most devices are self-expandable polytetrafluoroethylene-covered stent grafts (PTFE-SGs) that are dilated to their nominal diameter (8 or 10 mm). We investigated whether PTFE-SGs dilated to a smaller caliber (under-dilated TIPS) reduce PSE yet maintain clinical and hemodynamic efficacy. We also studied whether under-dilated TIPS self-expand to nominal diameter over time. Methods: We performed a prospective, non-randomized study of 42 unselected patients with cirrhosis who received under-dilated TIPS (7 and 6 mm) and 53 patients who received PTFE-SGs of 8 mm or more (controls) at referral centers in Italy. After completion of this study, dilation to 6 mm became the standard and 47 patients were included in a validation study. All patients were followed for 6 months; Doppler ultrasonography was performed 2 weeks and 3 months after TIPS placement and every 6 months thereafter. Stability of PTFE-SG diameter was evaluated by computed tomography analysis of 226 patients with cirrhosis whose stent grafts increased to 6, 7, 8, 9, or 10 mm. The primary outcomes were incidence of at least 1 episode of PSE grade 2 or higher during follow up, incidence of recurrent variceal hemorrhage or ascites, incidence of shunt dysfunction requiring TIPS recanalization, and reduction in porto-caval pressure gradient. Results: PSE developed in a significantly lower proportion of patients with under-dilated TIPS (27%) than controls (54%) during the first year after the procedure (P =.015), but the proportions of patients with recurrent variceal hemorrhage or ascites did not differ significantly between groups. No TIPS occlusions were observed. These results were confirmed in the validation cohort. In an analysis of self-expansion of stent grafts, during a mean follow-up period of 252 days after placement, none of the PTFE-SGs self-expanded to t

The science of arithmetic has been a constant interest in all of Giovanni Piana's reflection. The aim of this essay is to show how this interest can help to illustrate the main articulations of the thought of the Italian phenomenologist. This path passes through the difference, established by Piana, between a prearithmetic level and an arithmetic level as a reflection of the Husserlian distinc-tion between an ante-predicative level and a predicative level. Furthermore, the pre-arithmetic / arithmetic pair brings the distinction between ante-predicative and predicative beyond the sphere of verbal language in which predication takes place. As will be seen, the result is a generalized differentiation between a prelinguistic level and a linguistic level, in which music is an important example of the potential scope of this theme., La ciencia aritmética ha sido un interés constante en toda la reflexión de Giovanni Piana. El objetivo de este ensayo es mostrar de qué forma este interés pueda ayudar para ilustrar las articulaciones principales del pensamiento del fenomenólogo italiano. Este camino pasa por la diferencia, establecida por Piana, entre un nivel pre-aritmético y un nivel aritmético como re-flejo de la distinción husserliana entre un nivel ante-predicativo y un nivel predicativo. Ade-más, el par prearitmético/aritmético, trae la distinción entre antepredicativo y predicativo más allá de la esfera del lenguaje verbal en el que tiene lugar la predicación. Como se verá, el re-sultado es una diferenciación generalizada entre un nivel pre-lingüístico y un nivel lingüístico, cuyo alcance potencial encuentra en la música un ejemplo de grande valor.

This essay presents the main points of Giovanni Piana’s interpretation of phenomenology as a “doctrine of experience” aimed at conceptual clarification. It shows how genetic-constitutive analyses become crucial in this interpretation and therefore how phenomenology comes to be close to its empiricist ancestors (except for its anti-psychologism) and how far from authors like Heidegger and Merleau-Ponty. Moreover, the essay highlights that such a “doctrine of experience” deliberately assumes only the “analytic” parts of the tasks that Husserl assigned to philosophy, while refusing the ideological (i.e. the ethical-foundational) ones. Finally, some details are given of the applications of such a devoted-to-analysis-phenomenology to musical experience, one of the fields in which Giovanni Piana’s work has been more influential on the Italian philosophical culture.

Il testo, pubblicato in un volume collettaneo sulla fenomenologia in iItalia, presenta l'approccio di Giovanni Piana alla fenomenologia cercando di metterne in evidenza i momenti di forte originalità non solo nel panorama italiano ma anche in quello europeo. Viene in particolare messa in luce l'insistenza da parte dell'autore sul legame fra la fenomenologia ed l'empirismo classico e sulle affinità fra l'approccio husserliano e la filosofia dei "giochi linguistici" del secondo Wittgestein.