"Omne, quod no est ex fide, peccatum est". The relevance of good faith in canonical transactio

Il substrato canonistico della transazione è di particolare evidenza. In essa, infatti, il conflitto ha spesso già raggiunto lo stadio litigioso. Ragion per cui nella sua interpretazione la dottrina tende a separare i due profili economico ed etico. Su quest’ultimo, in particolare, la Chiesa, pur dotata di un sistema di sanzioni giuridiche necessariamente imperfetto, ha svolto, nei secoli, un ruolo di primo piano. É infatti un insegnamento evangelico che alla base di ogni rapporto umano debba regnare la concordia, poiché concordia mater est unitatis: se le parti, ignorando l’etica, stanno per giungere ad una lite, o vi siano giunte, la Chiesa deve esortarle a comporla. Ciò che si intende qui indagare è dunque la rilevanza di due fra i requisiti essenziali dell’istituto transattivo, ovvero la lis e la res dubia, all’interno del sistema delle Decretali (X 1.36. 1-11 de transactionibus). La cornice sarà offerta dal principio cardine che sancisce l’effettività del negozio: Effectus transactionis est, ut ei stetur; questo per valutare come debba essere intesa nell’ordinamento canonico l’incertezza della lite in rapporto al principio di buona fede.It is quite clear that there is a canonical foundation underlying the institute of transactio. Indeed, a compromise is often reached when a dispute has already entered the litigation phase, and as such legal doctrine tends to separate the economic aspect from the ethical aspect in its interpretation. Though the Church has a necessarily imperfect system of legal sanctions at its disposal, over the centuries it has in fact played a fundamental role in the ethical aspect of compromise. Indeed, the Gospel teaches that every human relationship must be based on concordia, as concordia mater est unitatis: if parties have ignored such morals and are about to litigate, or have already started legal proceedings, the Church must exhort them to settle the dispute. This article aims to examine the relevance of two of the essential requirements of transactio – namely lis and res dubia – within the Decretals (X 1.36. 1-11 de transactionibus). The framework of this analysis is provided by the tenet Effectus transactionis est, ut ei stetur, which sanctions the effectiveness of transactio as a juristic act. The goal is to evaluate how the uncertainty of legal proceedings relates to the principle of good faith in canon law.Ciencias ReligiosasDerech

Un ‘vecchio’ noi ed un ‘nuovo’ loro. L’introduzione enciclopedica allo studio del diritto di G.D. Romagnosi

Gian Domenico Romagnosi’s contribution to the restructuring of legal studies in Italy – a reform unfurled through plans and bills, namely the Piano di istruzione legale (Legal Education Plan) and Progetto di Regolamento degli Studi Legali (Project for the Regulation of Legal Studies) and, from a legislative point of view, through the formation of the Regolamento per gli studi Pratici Legali (Regulations for Practical Legal Studies), as well as the creation of three Postgraduate Schools – culminating in the drafting of an unpublished textbook entitled Introduzione enciclopedica allo studio del diritto. his work still strove to collect and explain knowledge: as such, it was a sort of manifestation of the goals he had alluded to ten years earlier in Studio preparatorio alla Facoltà Politico Legale. His Introduzione was meant to be just that: ‘introductory tool’ that could embrace the whole of legal knowledge, so that the elderly Professor could take stock of his educational ambitions and disseminate the epistemological views that he identified with in the new institutional climate. Romagnosi came to this subject matter late in life, having left behind the various forms of individualistic radicalism that had typified the revolutionary era and his encyclopedia seems to be an appropriate way to summarize his life’s work.L’apporto di Gian Domenico Romagnosi al riassetto degli studi giuridici – un percorso piuttosto lungo che lo accompagna per tutto l’arco della sua parabola scientifica e che si snoda attraverso programmi e disegni dal Piano di istruzione legale al Regolamento per gli studi Pratici Legali con la creazione di tre Scuole di Specializzazione post laurea – si conclude con la redazione di un manuale di Introduzione enciclopedica allo studio del diritto cui è dedicato il presente contributo. Lo scritto, rimasto incompiuto ed inedito, non rappresenta solo uno schema provvisorio per le lezioni rimasto incompiuto. Ma proprio per essere stato maturato in un clima assai diverso rispetto ai lavori precedenti – ormai alla fine della vita del Maestro – testimonia un momento significativamente critico dell’insegnamento del diritto in genere e del percorso educativo romagnosiano in specie

Union is strength: the combination of radiomics features and 3D-deep learning in a sole model increases diagnostic accuracy in demented patients: a whole brain 18FDG PET-CT analysis

ObjectiveFDG PET imaging plays a crucial role in the evaluation of demented patients by assessing regional cerebral glucose metabolism. In recent years, both radiomics and deep learning techniques have emerged as powerful tools for extracting valuable information from medical images. This article aims to provide a comparative analysis of radiomics features, 3D-deep learning convolutional neural network (CNN) and the fusion of them, in the evaluation of 18F-FDG PET whole brain images in patients with dementia and normal controls.Methods18F-FDG brain PET and clinical score were collected in 85 patients with dementia and 125 healthy controls (HC). Patients were assigned to various form of dementia on the basis of clinical evaluation, follow-up and voxels comparison with HC using a two-sample Student's t-test, to determine the regions of brain involved. Radiomics analysis was performed on the whole brain after normalization to an optimized template. After selection using the minimum redundancy maximum relevance method and Pearson's correlation coefficients, the features obtained were added to a neural network model to find the accuracy in classifying HC and demented patients. Forty subjects not included in the training were used to test the models. The results of the three models (radiomics, 3D-CNN, combined model) were compared with each other.ResultsFour radiomics features were selected. The sensitivity was 100% for the three models, but the specificity was higher with radiomics and combined one (100% vs. 85%). Moreover, the classification scores were significantly higher using the combined model in both normal and demented subjects.ConclusionThe combination of radiomics features and 3D-CNN in a single model, applied to the whole brain 18FDG PET study, increases the accuracy in demented patients

The use of complementary and alternative medicine (CAM) during pregnancy

Background: Approximately one-third of the global population uses complementary medicine, as yoga and meditation, not endorsed by evidence-based conventional medicine and, with more difficulties in case of pregnancy. Methods: Our study investigates the prevalence of Complementary and Alternative Medicine (CAM) usage in Novara (Italy) and its province through a survey to pregnant women at 36 gestational weeks. Results: The sample consisted of 70 women, average age of 33 years, most Caucasian, highly educated, mostly employed, under private gynecological care, with a prevalence of CAM use of 24.3 % [95 % CI 14.83; 36.01]. Six women (35.3 %) did not inform their healthcare provider of using these medicines, 15 women (88.2 %) express willingness to use complementary medicine in their next pregnancy, while 2 (11.8 %) are uncertain. The study found a significant association between higher education and CAM usage among pregnant women. Other factors, including nationality, occupation, choice of private practice, parity, physical activity, diet, smoking, pregnancy complications, and vaccination status, did not show significant relationships with CAM usage. Conclusions: Our objective is to delineate the characteristics of CAM users, explore the methodologies and motivations of their usage, and ascertain any correlations with the rejection of conventional vaccination practices. The analyzed population consists of 70 women aged 32.9 years in mean, mostly Caucasian, with a high level of education. Most women are under private gynecological care (84.3 %), half of the participants are experiencing their first pregnancy. Physical activity levels vary, with 34.3 % reporting high activity levels. Regarding diet, 77.1 % consider their eating habits moderately healthy, with a notable portion of smokers women (24.3 %); 20.0 % have experienced pregnancy complications. 17 participants utilized non-conventional or alternative medicine, with a prevalence of 24.3 [95 % CI 14.83; 36.01]. Six women (35.3 %) did not inform their healthcare provider about using CAM. Seven women (46.7 %) claim significant beneficial effects in most cases, while 8 (53.3 %) state this occasionally. Based on their experiences, 15 women (88.2 %) express willingness to use complementary alternative medicine in their subsequent pregnancy, while 2 (11.8 %) are uncertain. Only one person (11.1 %) used this type of therapy as a substitute for conventional treatment, but they informed their attending physician. The study seeks to enhance our understanding of CAM utilization in pregnancy, informing more comprehensive and evidence-based healthcare practices for expectant mothers

Use of the anatomical formulae for predicted postoperative (PPO) evaluation overestimates the loss of FEV1 and DLCO after minimally invasive lung resections

Background: Pulmonary function assessment is mandatory before oncological lung resection surgery. To do so, subjects undergo a pulmonary function test (PFT) and the calculation of predicted postoperative (PPO) values to estimate the residual lung function after surgery. The aim of this study is to evaluate the use of anatomical formulae in estimating postoperative pulmonary function in patients undergoing minimally invasive surgery (MIS). Methods: This is a retrospective study. Patients affected by lung cancer who underwent pulmonary lobectomy or segmentectomy with MIS or thoracotomy approach at our center from June 2020 to May 2021 were considered. Exclusion criteria were: subjects who underwent atypical pulmonary resection surgery or pneumonectomy; and patients who underwent adjuvant therapy (chemotherapy or immunotherapy). PFT data measured before and 1 year after surgery were collected. In particular, postoperative PFT data, especially forced expiratory volume in the first second (FEV1) and diffusing capacity for carbon monoxide (DLCO), and PPO values calculated by the anatomical formulae were compared. Secondary endpoints were: analysis of the postoperative pulmonary function in patients who underwent lung resection with the standard approach (thoracotomy) and evaluation of the anatomical formulae accuracy in subjects operated through thoracotomy. Results: The sample consisted of 48 patients operated on MIS (video-assisted thoracoscopic surgery and robotic-assisted thoracoscopic surgery) and 20 subjects who underwent thoracotomy for stage I-IIA and I-IIB lung cancer in both groups. The anatomical formula seemed to underestimate the postoperative FEV1% by 8.65% [interquartile range (IQR), 0.5-17.28%; P<0.001]. Furthermore, when comparing postoperative PPODLCO% and post-operative DLCO%, a significant difference was shown with an underestimation of the actual postoperative value of 2.78% (IQR, -3.63% to 10.47%; P=0.045). Conclusions: Our results confirmed that the anatomical formulae currently used to predict postoperative pulmonary function are reliable in the case of the standard approach (thoracotomy), while they tend to overestimate the loss of FEV1 and DLCO in the postoperative period in patients who were operated on MIS, thus excluding some subjects from the operation

Comparison of frailty indexes as predictors of clinical outcomes after major thoracic surgery

Background: Despite greater appreciation for the importance of frailty in surgical patients, due to improved understanding that frailty is often linked to poor outcomes, the optimal method of assessment remains unknown. In this study, we sought to evaluate the prevalence of frailty in patients considered for elective thoracic surgery and to test the ability of several frailty measurements to predict postoperative outcomes. Methods: Patients included were candidates for major elective thoracic surgery. Preoperative assessment of frailty included the Fried frailty phenotype, the Edmonton Frail Scale (EFS), the modified frailty index (mFI), the Clinical Frailty Scale (CFS), and additional components of frailty. Outcome data include days with chest drain, length of hospital stay, and postoperative adverse events. Results: According to the Fried frailty phenotype, 53% of 94 patients included were prefrail or frail. A significant association between frailty and postoperative complications was found (odds ratio 7.65; P=0.001). No association between CFS, mFI, EFS, and complications was observed. The Frailty Phenotype seemed the most accurate in predicting postoperative complications, with an area under the curve (AUC) of 0.77. Twenty-seven percent of patients meet the criteria for depression according to the Geriatric Depression Scale and they showed a higher risk of postoperative complications (OR 2.47; P=0.03). A lower psoas muscle index was associated with a higher risk of complications (OR 3.40; P=0.04). Conclusions: According to our results, the Fried frailty phenotype seems the most accurate tool to test frailty in patients undergoing thoracic resections. Surgeons should be aware that, although these aspects are not routinely tested, they are potential targets to improve clinical outcomes. Studies on additional interventions specifically targeting frail people in the setting of elective thoracic surgery are require

COVID-19 pandemic experiences, ethical conflict and decision-making process in critical care professionals (Quali-Ethics-COVID-19 Research Part 1): An international qualitative study

Aim and Objectives: The aim of this study was to explore the sources of ethical conflict and the decision-making processes of ICU nurses and physicians during the first and subsequent waves of the COVID-19 pandemic. Background: Depside several studies exploring ethical conflicts during COVID-19 pandemic, few studies have explored in depth the perceptions and experiences of critical care professionals regarding these conflicts, the decision-making process or which have analysed the complexity of actually implementing the recommendations of scientific societies and professional/healthcare institutions in interdisciplinary samples. Design: A descriptive phenomenological study. Methods: Thirty-eight in-depth interviews were conducted with critical care nurses and physicians from five hospitals in Spain and Italy between December 2020 and May 2021. A thematic content analysis of the interview transcripts was conducted by two researchers. Consolidated criteria for reporting qualitative research (COREQ) were employed to ensure the quality and transparency of this study. Results: Two main themes emerged as sources of ethical conflict: the approach to end of life in exceptional circumstances and the lack of humanisation and care resources. The former comprised two subthemes: end-of-life care and withholding and withdrawal of life-sustaining treatment; the latter comprised three subthemes: the impossibility of guaranteeing the same opportunities to all, fear of contagion as a barrier to taking decisions and the need to humanise care. Conclusions: Professionals sought to take their decisions in line with professional ethics and bioethical principles, but, nevertheless, they experienced moral dilemmas and moral distress when not being able to care for, or to treat, their patients as they believed fit. Relevance to Clinical Practice: Further education and training are recommended on the provision of end-of-life and post mortem care, effective communication techniques via video calls, disclosure of bad news and bioethical models for decision-making in highly demanding situations of uncertainty, such as those experienced during the COVID-19 pandemic

Minimally invasive vs. open segmental resection of the splenic flexure for cancer: a nationwide study of the Italian Society of Surgical Oncology-Colorectal Cancer Network (SICO-CNN)

Background: Evidence on the efficacy of minimally invasive (MI) segmental resection of splenic flexure cancer (SFC) is not available, mostly due to the rarity of this tumor. This study aimed to determine the survival outcomes of MI and open treatment, and to investigate whether MI is noninferior to open procedure regarding short-term outcomes. Methods: This nationwide retrospective cohort study included all consecutive SFC segmental resections performed in 30 referral centers between 2006 and 2016. The primary endpoint assessing efficacy was the overall survival (OS). The secondary endpoints included cancer-specific mortality (CSM), recurrence rate (RR), short-term clinical outcomes (a composite of Clavien-Dindo &gt; 2 complications and 30-day mortality), and pathological outcomes (a composite of lymph nodes removed ≧12, and proximal and distal free resection margins length ≧ 5 cm). For these composites, a 6% noninferiority margin was chosen based on clinical relevance estimate. Results: A total of 606 patients underwent either an open (208, 34.3%) or a MI (398, 65.7%) SFC segmental resection. At univariable analysis, OS and CSM were improved in the MI group (log-rank test p = 0.004 and Gray’s tests p = 0.004, respectively), while recurrences were comparable (Gray’s tests p = 0.434). Cox multivariable analysis did not support that OS and CSM were better in the MI group (p = 0.109 and p = 0.163, respectively). Successful pathological outcome, observed in 53.2% of open and 58.3% of MI resections, supported noninferiority (difference 5.1%; 1-sided 95%CI − 4.7% to ∞). Successful short-term clinical outcome was documented in 93.3% of Open and 93.0% of MI procedures, and supported noninferiority as well (difference − 0.3%; 1-sided 95%CI − 5.0% to ∞). Conclusions: Among patients with SFC, the minimally invasive approach met the criterion for noninferiority for postoperative complications and pathological outcomes, and was found to provide results of OS, CSM, and RR comparable to those of open resectio