Un testo ben scritto è caratterizzato da una vera e propria architettura, la quale è in sintonia con i suoi obiettivi comunicativi, con la tipologia a cui appartiene, con altri testi con cui dialoga, ...con il contesto in cui si manifesta, con le conoscenze e le aspettative del lettore. Una delle caratteristiche di fondo di questa architettura è la sua profonda costituzione gerarchica, la quale si applica alle sue unità secondo diversi principi. Così per esempio, c’è una gerarchia che distingue il piano principale del testo da quello degli incisi; c’è una gerarchia che interessa gli enunciati che formano il piano principale del testo, la quale è definita dalla sua progressione tematica e logico-argomentativa; c’è una gerarchia che caratterizza, a un livello più microscopico, il contenuto interno dei singoli enunciati, che viene ad articolarsi in informazioni in primo piano e informazioni sullo sfondo comunicativo. Le diverse gerarchie si disegnano a partire da indicazioni date dalla lingua – lessicali, sintattiche, interpuntive – e da operazioni inferenziali che chiamano in causa vari tipi di conoscenze extralinguistiche. L’obiettivo di questo intervento consiste nel tratteggiare l’intreccio di gerarchie che caratterizza i testi coerenti e coesi, e ciò sulla base di una serie di esemplificazioni tratte da testi autentici. Imparare, e poi insegnare, a riconoscerlo è fondamentale sia nell’ottica di una didattica della lettura sia in quella di una didattica della scrittura. E questo per quanto riguarda tutti i tipi di testi. Si pensi paradigmaticamente al riassunto, che – essendo un testo che elabora un altro testo – combina lettura e scrittura. Nella sua elaborazione, una grossa parte del lavoro consiste infatti proprio nel riconoscere ai diversi livelli le informazioni principali e quelle secondarie: nello sfrondare cum grano salis le seconde e nel riunire, combinare, generalizzare le prime.
The text as a intertwine of hierarchies
A well written text is characterized by a real architecture, which is in tune with its communicative objectives, its typology, with other texts it dialogues with, with the context where it manifests, with the reader’s knowledge and expectations. One of the basic characteristics of this architecture is its deep hierarchical constitution, which is applied to its units according to different principles. Thus, for example, there is a hierarchy that distinguishes the main level of the text from the asides; there is a hierarchy that affects the utterances that form the main level of the text, defined by its thematic and logical-argumentative progression; at a more microscopic level, there is a hierarchy that characterizes the internal content of the individual utterances, which is articulated into information in the foreground and information in the communicative background. The different hierarchies are drawn from indications given by the language - lexical, syntactic, interpunctual - and from inferential operations that involve various types of extralinguistic knowledge. The aim of this paper is to outline the interweaving of hierarchies that characterizes coherent and cohesive texts on the basis of a series of examples taken from authentic texts. Learning, and then teaching, how to recognize it is fundamental both for the teaching of reading and for the teaching of writing. This applies to all types of texts. Think paradigmatically of the summary, which - being a text that elaborates another text - combines reading and writing. In its elaboration, a large part of the work consists, in fact, in recognizing the main and secondary information at different levels: in pruning the latter cum grano salis and in reuniting, combining and generalizing the former.
This study provides the dietary intakes of six trace elements (cadmium, chromium, copper, manganese, selenium and zinc), generally characterized by both nutritional and toxicological features ...depending on their exposure. Being diet the most relevant source of exposure to trace elements in non-professionally exposed subjects, we measured content of these trace elements in foods composing the typical Italian diet using inductively coupled plasma-mass spectrometry, and assessing dietary habits using a validated semi-quantitative food frequency questionnaire we eventually estimated dietary daily intake of trace elements in a Northern Italian community.
In the 890 analyzed food samples, the main contributors to cadmium intake are cereals, vegetables and sweets, while cereals, beverages and vegetable are to primary source of manganese. The primary contributors for copper are cereals, fresh fruits and vegetables, while for chromium are beverages, cereals and meat. The main source of selenium intake are cereals and meat, followed by fish, seafood and milk and dairy products, while of zinc intake are meat, cereals, milk and dairy products. In our Italian population sample, the estimated median (interquartile range) dietary daily intakes are 5.00 (3.17–7.65), 56.70 (36.08–86.70) and 66.53 (40.04–101.32) μg/day for cadmium, chromium and selenium, and corresponding figures are 0.98 (0.61–1.49), 2.34 (1.46–3.52) and 8.50 (5.21–12.48) mg/day for copper, manganese and zinc.
The estimated intakes are generally within the average intake reported in other European populations, and in such cases well above the daily dietary intakes recommended by national international agencies, avoiding the risk of excess or deficiency. The present estimated intake data can be used to examine a specific trace element of interest and would afford enhanced health protection from those trace elements characterized by both nutritional and toxicological effects.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK, ZRSKP
L’articolo propone un bilancio provvisorio di un progetto di ricerca in corso dal 2020 all’Università di Basilea, il cui oggetto di analisi è l’italiano istituzionale svizzero. Il progetto vuole ...descrivere, spiegare e valutare le peculiarità di questa varietà linguistica e le caratteristiche specifiche dei generi testuali in cui essa si realizza. L’obiettivo del bilancio qui proposto è duplice: valutare con occhio critico le scelte fatte nell’ambito del progetto e fare il punto sui risultati raggiunti, con attenzione ai prodotti concreti della ricerca (volumi, articoli, convegni ecc.). Quanto al primo aspetto, si mostra quali sono state le linee di ricerca contenutistiche e metodologiche via via perseguite: si sottolineano da una parte le scelte che si sono rivelate virtuose – come ad esempio la stretta collaborazione con chi opera concretamente nelle Cancellerie svizzere – e dall’altra gli arricchimenti e gli aggiustamenti che il confronto con la realtà della ricerca ha reso necessari – per esempio, per quanto riguarda l’analisi, il passaggio da una concezione statica a una concezione dinamica del corpus o, per quanto riguarda la valutazione, la tematizzazione dell’italiano svizzero quale lingua pluricentrica –. Quanto al secondo aspetto, si mostra come le linee di ricerca del progetto disegnino nel complesso un quadro articolato dell’italiano istituzionale svizzero, che tocca numerosi contesti d’uso (Costituzione svizzera, web e social media, lingua facile, comunicazione legata al Covid) e confronti significativi (con l’italiano istituzionale d’Italia, con le altre lingue ufficiali svizzere, con l’italiano di Svizzera come centro autonomo di elaborazione linguistica). A national project on Swiss institutional Italian. A review of research paths, scientific results and applications The paper implements a provisional report of a research project in progress since 2020 at the University of Basel, whose object of analysis is Swiss institutional Italian. The project aims to describe, explain and evaluate the peculiarities of this language variety and the specific characteristics of the text genres realizing it. The aim of the report is twofold: to critically evaluate the choices made within the project and to take stock of the results achieved, with attention to concrete research outputs (volumes, articles, conferences, etc.). As for the first aspect, the paper describes the content and methodological lines of research that were pursued: on the one hand, the choices that turned out to be virtuous – such as, e.g., the close collaboration with people working in the Swiss Chancelleries – and, on the other hand, the enrichments and adjustments that the confrontation with the reality of research made necessary – e.g., as far as the analysis is concerned, the transition from a static to a dynamic conception of the corpus or, as far as evaluation is concerned, the thematization of Swiss Italian as a pluricentric language – are emphasized. As for the second aspect, the paper shows how the research avenues of the project draw an articulated picture of Swiss institutional Italian, touching on several contexts of use (Swiss Constitution, web and social media, easy-to-read language, Covid-related communication) and significant comparisons (with the institutional Italian of Italy, with the other Swiss official languages, with Swiss Italian as an autonomous center of linguistic elaboration).
Standard treatment for patients with primary CNS lymphoma remains to be defined. Active therapies are often associated with increased risk of haematological or neurological toxicity. In this trial, ...we addressed the tolerability and efficacy of adding rituximab with or without thiotepa to methotrexate-cytarabine combination therapy (the MATRix regimen), followed by a second randomisation comparing consolidation with whole-brain radiotherapy or autologous stem cell transplantation in patients with primary CNS lymphoma. We report the results of the first randomisation in this Article.
For the international randomised phase 2 International Extranodal Lymphoma Study Group-32 (IELSG32) trial, HIV-negative patients (aged 18-70 years) with newly diagnosed primary CNS lymphoma and measurable disease were enrolled from 53 cancer centres in five European countries (Denmark, Germany, Italy, Switzerland, and the UK) and randomly assigned (1:1:1) to receive four courses of methotrexate 3·5 g/m(2) on day 1 plus cytarabine 2 g/m(2) twice daily on days 2 and 3 (group A); or the same combination plus two doses of rituximab 375 mg/m(2) on days -5 and 0 (group B); or the same methotrexate-cytarabine-rituximab combination plus thiotepa 30 mg/m(2) on day 4 (group C), with the three groups repeating treatment every 3 weeks. Patients with responsive or stable disease after the first stage were then randomly allocated between whole-brain radiotherapy and autologous stem cell transplantation. A permuted blocks randomised design (block size four) was used for both randomisations, and a computer-generated randomisation list was used within each stratum to preserve allocation concealment. Randomisation was stratified by IELSG risk score (low vs intermediate vs high). No masking after assignment to intervention was used. The primary endpoint of the first randomisation was the complete remission rate, analysed by modified intention to treat. This study is registered with ClinicalTrials.gov, number NCT01011920.
Between Feb 19, 2010, and Aug 27, 2014, 227 eligible patients were recruited. 219 of these 227 enrolled patients were assessable. At median follow-up of 30 months (IQR 22-38), patients treated with rituximab and thiotepa had a complete remission rate of 49% (95% CI 38-60), compared with 23% (14-31) of those treated with methotrexate-cytarabine alone (hazard ratio 0·46, 95% CI 0·28-0·74) and 30% (21-42) of those treated with methotrexate-cytarabine plus rituximab (0·61, 0·40-0·94). Grade 4 haematological toxicity was more frequent in patients treated with methotrexate-cytarabine plus rituximab and thiotepa, but infective complications were similar in the three groups. The most common grade 3-4 adverse events in all three groups were neutropenia, thrombocytopenia, anaemia, and febrile neutropenia or infections. 13 (6%) patients died of toxicity.
With the limitations of a randomised phase 2 study design, the IELSG32 trial provides a high level of evidence supporting the use of MATRix combination as the new standard chemoimmunotherapy for patients aged up to 70 years with newly diagnosed primary CNS lymphoma and as the control group for future randomised trials.
Associazione Italiana del Farmaco, Cancer Research UK, Oncosuisse, and Swiss National Foundation.
Background
International guidelines suggest hepatitis C virus (HCV) eradication by direct‐acting antivirals (DAAs) after first‐line immunochemotherapy (I‐CT) in patients with HCV‐positive diffuse ...large B‐cell lymphoma (DLBCL), although limited experiences substantiate this recommendation. Moreover, only a few data concerning concurrent administration of DAAs with I‐CT have been reported.
Subjects, Materials, and Methods
We analyzed hematological and virological outcome and survival of 47 consecutive patients with HCV‐positive DLBCL treated at 23 Italian and French centers with DAAs either concurrently (concurrent cohort ConC: n = 9) or subsequently (sequential cohort SeqC: n = 38) to first‐line I‐CT (mainly rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone R‐CHOP‐like).
Results
Median age was 61 years, 89% of patients had stage III/IV, and 25% presented evidence of cirrhosis. Genotype was 1 in 56% and 2 in 34% of cases. Overall, 46 of 47 patients obtained complete response to I‐CT. All patients received appropriate DAAs according to genotype, mainly sofosbuvir‐based regimens (n = 45). Overall, 45 patients (96%) achieved sustained virological response, 8 of 9 in ConC and 37 of 38 in SeqC. DAAs were well tolerated, with only 11 patients experiencing grade 1–2 adverse events. Twenty‐three patients experienced hepatic toxicity (grade 3–4 in seven) following I‐CT in SeqC, compared to only one patient in ConC. At a median follow‐up of 2.8 years, two patients died (2‐year overall survival, 97.4%) and three progressed (2‐year progression‐free survival, 93.1%).
Conclusion
Excellent outcome of this cohort of HCV‐positive DLBCL suggests benefit of HCV eradication by DAAs either after or during I‐CT. Moreover, concurrent DAAs and R‐CHOP administration appeared feasible, effective, and ideally preferable to deferred administration of DAAs for the prevention of hepatic toxicity.
Implications for Practice
Hepatitis C virus (HCV)‐associated diffuse large B‐cell lymphomas (DLBCLs) represent a great therapeutic challenge, especially in terms of hepatic toxicity during immune‐chemotherapy (I‐CT) and long‐term hepatic complications. The advent of highly effective and toxicity‐free direct‐acting antivirals (DAAs) created an exciting opportunity to easily eradicate HCV shortly after or in concomitance with first‐line immunochemotherapy (usually R‐CHOP). This retrospective international study reports the real‐life use of the combination of these two therapeutic modalities either in the concurrent or sequential approach (DAAs after I‐CT) in 47 patients. The favorable reported results on long‐term outcome seem to support the eradication of HCV with DAAs in all patients with HCV‐positive DLBCL. Moreover, the results from the concurrent approach were effective and safe and displayed an advantage in preventing hepatic toxicity during I‐CT.
Epidemiological studies have established that hepatitis C virus (HCV) is associated with diffuse large B‐cell lymphoma (DLBCL). This article reports on patients with HCV‐positive DLBCL treated with direct‐acting antivirals either concurrently or subsequently to a curative‐intent first‐line immunochemotherapy.
Summary
Optimal treatment for transformed follicular lymphoma (tFL) is not fully defined. Clinical characteristics and treatments that impact on post‐transformation outcome of 176 biopsy‐proven tFL ...were analysed. Transformation occurred at initial diagnosis in 52% (Group 1) and after a FL diagnosis in 48% (Group 2). Five‐year overall survival was 84% for Group 1 and 51% for Group 2 (P < 0·001). In Group 1, 5‐year progression‐free survival was superior after rituximab maintenance compared to observation only (94% vs. 53%, P = 0·024). In Group 2, an inverse trend was found between survival and both a higher number of pre‐transformation treatment lines and a short time‐to‐transformation.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK
Phthalates are non-persistent chemicals largely used as plasticizers and considered ubiquitous pollutants with endocrine disrupting activity. The exposure during sensible temporal windows as ...pregnancy and early childhood, may influence physiological neurodevelopment.
The aim of this study is to analyze the relationship between the urinary levels of phthalate metabolites in newborn and infants and the global development measured by the Griffiths Scales of Children Development (GSCD) at six months.
Longitudinal cohort study in healthy Italian term newborn and their mothers from birth to the first 6 months of life. Urine samples were collected at respectively 0 (T0), 3 (T3), 6 (T6) months, and around the delivery for mothers. Urine samples were analyzed for a total of 7 major phthalate metabolites of 5 of the most commonly used phthalates. At six months of age a global child development assessment using the third edition of the Griffith Scales of Child Development (GSCD III) was performed in 104 participants.
In a total of 387 urine samples, the seven metabolites analyzed appeared widespread and were detected in most of the urine samples collected at any time of sampling (66-100%). At six months most of the Developmental Quotients (DQs) falls in average range, except for the subscale B, which presents a DQ median score of 87 (85-95). Adjusted linear regressions between DQs and urinary phthalate metabolite concentrations in mothers at T0 and in infants at T0, T3 and T6 identified several negative associations both for infants' and mothers especially for DEHP and MBzP. Moreover, once stratified by children's sex, negative associations were found in boys while positive in girls.
Phthalates exposure is widespread, especially for not regulated compounds. Urinary phthalate metabolites were found to be associated to GSCD III scores, showing inverse association with higher phthalate levels related to lower development scores. Our data suggested differences related to the child's sex.
Background: Immunocompromised persons infected with Mycobacterium tuberculosis (MTB) have increased risk of tuberculosis (TB) reactivation, but their management is hampered by the occurrence of ...false-negative
results of the tuberculin skin test (TST). The T-cell interferon (IFN)-γ release blood assays T-SPOT. TB (TS.TB) Oxford Immunotec; Abingdon, UK and QuantiFERON-TB Gold In-Tube (QFT-IT) Cellestis Ltd; Carnegie, VIC, Australia
might improve diagnostic accuracy for latent TB infection (LTBI) in high-risk persons, although their performance in different
groups of immunocompromised patients is largely unknown.
Methods and results: Over a 1-year period, we prospectively enrolled patients in three different immunosuppressed groups, as follows: 120 liver
transplantation candidates (LTCs); 116 chronically HIV-infected persons; and 95 patients with hematologic malignancies (HMs).
TST, TS.TB, and QFT-IT were simultaneously performed, their results were compared, and intertest agreement was evaluated.
Overall, TST provided fewer positive results (10.9%) than TS.TB (18.4%; p < 0.001) and QFT-IT (15.1%; p = 0.033). Significantly
fewer HIV-infected individuals had at least one positive test (9.5%) compared with LTCs (35.8%; p < 0.001) and patients with
HMs (29.5%; p < 0.001). Diagnostic agreement between tests was moderate (κ = 0.40 to 0.65) and decreased in the HIV-infected
group when the results of the TS.TB were compared with either TST (κ = 0.16) or QFT-IT (κ = 0.19). Indeterminate blood test
results due to low positive control values were significantly more frequent with QFT-IT (7.2%) than with TS.TB (0.6%; p <
0.001).
Conclusions: Blood tests identified significantly more patients as being infected with MTB than TST, although diagnostic agreement varied
across groups. Based on these results, we recommend tailoring application of the new blood IFN-γ assays for LTBI in different
high-risk groups and advise caution in their current use in immunosuppressed patients.
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