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Implementazione della Direttiva Quadro sulle acque (2000/60/CE) attraverso l'utilizzo dei macroinvertebrati bentonici.
No full textLo studio si concentra sullo studio della fauna a macroinvertebrati, per definire, attraverso l’utilizzo del macrobentos, lo stato/potenziale ecologico di alcuni corpi lacustri, come richiesto dalla Direttiva 2000/60/CE. Campioni biologici, di granulometria e chimica delle acque e dei sedimenti sono stati prelevati in 10 laghi appartenenti a due regioni italiane (Piemonte e Sardegna) seguendo il protocollo di campionamento nazionale.
Ai dati biologici sono stati applicati indici di diversità, di equitabilità e di ricchezza: questi mostrano che i laghi naturali presentano una comunità più eterogenea rispetto agli invasi. Le analisi statistiche (generalized linear mixed effect model e multivariata) applicate ai dati biologici e abiotici mostrano che l’ossigeno è il fattore che maggiormente influenza la comunità, ma è comunque l’insieme di più fattori a determinare la densità e la diversità di comunità, infatti anche la tipologia di sedimento influenza la ricchezza in specie di questi ambienti. L’applicazione dell’Indice di Qualità Bentonico ha inoltre permesso di evidenziare una buona separazione tra laghi profondi con scarso e buon contenuto di ossigeno a livello del fondo, e di fissare i valori di riferimento delle diverse classi di qualità ecologica secondo le richieste della Direttiva Acque. Questo ha quindi permesso ai macroinvertebrati di essere inseriti nel Decreto Classificazione (D. M. 260/2010). Le prime applicazioni del metodo Lake Habitat Survey, utile ai fini di una classificazione idro-morfologica degli ambienti lacustri, mostrano l’esistenza di correlazioni tra questo metodo e la composizione della comunità a macroinvertebrati
Molecular aspects of small bowel adenocarcinoma for new therapeutic approaches.
No full textSmall Bowel Adenocarcinoma (SBA) is a rare and aggressive neoplastic disease.
Several aspects of SBA carcinogenesis still need to be elucidated, but risk factors and histomorphological similarities seem to indicate that SBA can follow a carcinogenetic development similar to that proposed for colorectal cancer. At molecular level, at odds with adenocarcinoma arising in the large intestine, very few, and fragmented, information is available for SBA. In general, it has been suggested that the two models of colorectal carcinogenesis can be valid also for SBA. For that reason, chemotherapies set up for the cancers of the large intestine have been applied also for SBA. Therefore, since recent studies led to the introduction of EGFR-targeted therapies in colorectal cancer, the treatment with anti-EGFR drugs can be proposed also for SBA patients. In particular, in colorectal cancer patients it has been demonstrated that KRAS mutations are correlated with the absence of efficacy of EGFR-targeted therapies, and it has been proposed by few studies to investigate additional markers of the EGFR pathway (EGFR gene copy number, BRAF and PIK3CA mutations, as well as PTEN protein expression), in order to increase the predictive power of the efficacy of anti-EGFR drugs. Information regarding these markers in SBA is quite completely missing.
Primary aim of the present work was the evaluation, in the same cohort, of all the alterations involved in colorectal carcinogenesis, in order to shed light more deeply about the molecular similarity between SBA and colorectal cancer. Second aim of the present work was to investigate in the same cohort of SBA the aforementioned markers involved in the EGFR pathway, in order to verify if the pattern of these alterations could justify the possible introduction of these therapies also in patients affected by SBA.
To do this, for the first aim we investigated -catenin protein expression by immunohistochemistry (IHC), and KRAS and TP53 mutations by direct sequencing, as well as microsatellite instability (MSI) and allelic imbalance of Chromosome 18q MSI by fragment analysis on genomic DNA extracted from formalin-fixed paraffinembedded tissue sections. For the second aim we investigated EGFR gene status by Fluorescent in situ hybridization (FISH), BRAF and PIK3CA mutational status by direct sequencing, as well as PTEN protein expression by IHC, in the same cohort of SBA.
We recruited 40 SBA cases from the Institute of Pathology of Locarno (Canton Tessin, Southern Switzerland) and from three institutions of Northern Italy.
First aim. -catenin overexpression was observed in 23.6% at nuclear level and in additional 47.3% of cases only at cytoplasmic level, MSI was found in 23.6% of cases, KRAS mutations in 43.6% of cases, TP53 mutations in 29% of cases and allelic imbalance of Chromosome 18q in 75% of cases. All the percentages of alterations and the types of mutations are in line with those identified in the analysis of colorectal cancer patients. Therefore, by the analysis of all these markers in a same cohort, we can confirm that SBA shares the carcinogenetic development with colorectal cancer also at molecular level.
Second aim. We identified a copy number gain of EGFR gene in 57.5% of cases, BRAF and PIK3CA mutations in 2.5% and 10.5% of cases respectively, and PTEN loss of expression in 25.6% of cases. Also for the EGFR pathway analysis, percentages of alterations and types of mutations found in SBA are in line with colorectal cancer, even if we did not detect the classical V600E change in the BRAF gene (where, on the contrary, we found a rare mutation, the G596R change). Taking into account the molecular algorithm proposed for the administration of EGFR-targeted therapies in colorectal cancer patients, if we look only at KRAS mutations, we can propose the administration of EGFR-targeted therapies to about 60% of patients (i.e.: KRAS wildtype cases), and to 23% of cases if we base our evaluation on the whole EGFR pathway (i.e.: cases showing, at the same time, EGFR copy number gain, KRAS, BRAF and PIK3CA wild-type sequences, and PTEN normal expression). The treatment with anti-EGFR therapies of a SBA patient of our cohort who developed a metastatic lesion confirmed the relevance of the molecular characterization of the tumor to predict the response to these therapies.
In conclusion, our analyses of SBA confirm the feeling that the mechanisms of carcinogenesis of such disease are superimposable with those proposed for colorectal cancer. Therefore, the hypothesis that therapeutic protocols valid for the large intestine can be applied also to SBA patients is supported. As a consequence, the targeted therapies recently introduced in colorectal cancer can be proposed for SBA patients, pending tumor molecular characterization as demonstrated by our case report
La contraffazione dei farmaci e il commercio dei medicinali su Internet: questioni emergenti, aspetti regolatori, percezione e atteggiamento di operatori e utenti.
No full textThe first part of this research focuses on drug counterfeiting and trade on the Internet in Europe and in Italy in several respects: definition, scale of the problem, examples and alerts, Interpol and Impact; counterfeiting of medicines and Italian legislation, economic implications, criminal activities; European legislation; shortage of drugs and possible purchase online; Impact Italy; tracking of the drug; contrasting efforts. In the second part, the results of a series of surveys concerning online purchase of drugs and knowledge and opinions about the internet as a source of medical information and medicine supply. In a survey via computer, several web sites offering anabolic androgenic steroids and available products were identified and analysed for their content. In a questionnaire survey among a large sample of pharmacy customers we evaluated the attitudes towards the use of Internet to retrieve health-related information and for drugs and/or dietary supplements purchase. Finally, the views of pharmacists on the sale of drugs and parapharmaceutical products on the Internet were suveyed by means of an online questionnaire and their attitudes towards online pharmacies were investigated. In conclusion, it is suggested that the web should be considered not only a source of danger but also of opportunities for the retrieval of health-related information as well as for the availability of medicines, however several measures need to be taken to ensure its safety and reliability
Synthesis and funcionalization of indole skeleton compunds via nitrosoarene-alkyne cycloadditions.
No full textIndoles are one of the most important and abundant classes of N-heterocycles, being present in the form of innumerable natural products and bioactive compounds. A class of indole derivatives which have received considerable attention in recent years are N-hydroxyindoles. The biological role of N-hydroxyindoles is still an area of active investigation since they have been shown to possess biological activity in certain cases. 3-Aroylindoles are another class of indole derivatives, known as bioactive compounds with interesting properties. Not many indolization procedures are known to afford directly 3-acylindoles starting from commercially available reactants.
Our general interest in this topic lead us to disclose a novel and regioselective indole synthesis by annulation reaction between nitro- and nitrosoarenes with alkynes. Indoles, N-hydroxy- and N-alkoxyindoles were afforded in moderate to excellent yields and good regioselectivity. Using conjugated alkynones as starting materials the reaction proceeded with the regioselective formation of 3-acylindoles and/or N-hydroxy-3-acylindoles. Highly functionalizable indole derivatives were synthesized and different derivatization reactions were developed
Estimating the galaxy power spectrum of the VIPERS galaxy distribution.
No full textThe power spectrum is a statistic that describes the clustering of matter in Fourier space. The shape and amplitude of the power are directly predicted by theory and direct measurements of the power can constrain cosmological parameters.
The large size of recent surveys has opened new windows in the observation of secondary features of the galaxy power spectrum such as the Baryonic Acoustic Oscillations (BAO), which used as standard ruler can infer dark energy properties, and Redshift-Space Distortions (RSD), which thanks to the anisotropic observed clustering in redshift space can discriminate between different theories of gravity.
In this thesis, we apply the power spectrum statistic to the VIMOS Public Extragalactic Redshift Survey (VIPERS) distribution of galaxies in order to study the underlying clustering of matter.
VIPERS is an ongoing spectroscopic survey, composed of two fields, W1 and W4, with the aim of mapping the spatial distribution of galaxies within a large volume of the z ∼ 1 Universe. The main properties of VIPERS are the high redshift range surveyed 0.4 < z < 1.2 and the high sampling rate at those redshifts.
Its main goal is the measurement of the anisotropy of the galaxy clustering in redshift space in order to constrain the growth rate of structure at a mean redshift hzi ∼ 0.8, never reached by other surveys.
Even the measure of the galaxy power spectrum at these redshifts is something new. Our goal is to estimate the clustering of matter in Fourier space constraining the cosmological quantities that mainly affect the power spectrum shape such as the matter density and the baryonic fraction. The approach used to estimate the galaxy power spectrum is quite classical and has been used in past surveys such as the Two Degree Field Galaxy Redshift Survey (2dFGRS).
We describe the power spectrum estimator using a novel simulation approach called “Γ”-simulation, including the main properties of a real survey such as the cone-like geometry and the density gradient function of the redshift.
The main factor that alters our power spectrum measurement is the window function, due to the limited size of the sample, which is not negligible even for a box geometry.
We show a method to correctly take into account the window function effects including it with a three dimensional convolution with the input model of the simulation.
To analyse the potential of the VIPERS sample for extracting cosmological information, we use a set of VIPERS mock catalogues drawn from the MultiDark simulation. We analyse all the selection function effects of the survey, such as the sampling strategy and the decreasing mean density, in our estimation and study their effect on the recovered power spectrum.
The VIPERS window function is problematic due to the small angular coverage, strongly suppressing the clustering in Fourier space at large scales and completely damping the BAO signal. We measure the window function of VIPERS which will be used to perform a three dimensional convolution with the theoretical model generated from the tested cosmology.
RSD also determine the observed clustering and, in the simplest case, their impact could be divided in two regimes. Small scale effects due to the high non-linear velocity of galaxies inside virialised structures are corrected with a simple velocity dispersion model, an empirical prediction of the behaviour of the clustering in redshift space. Large scale effects due to the linear in-fall of galaxies in high density peaks, which increase the observed clustering of matter, are included with the Kaiser term dependent on the linear growth rate of matter. We include these two terms before applying the 3D convolution of the model with the window function.
Some tests are performed on VIPERS mock catalogues to recover the known cosmological information of the simulation with a chi-square technique and, in all cases, we were able to extract the input cosmology with lower systematics errors than statistical ones.
Finally we apply this approach to the data dividing the full survey into four subsamples, two redshift bins, 0.6 < z1 < 0.9 and 0.9 < z2 < 1.1, for each field. Despite the different window functions in each subsample due to small differences in volume and in geometry, the four measurements are consistent with each other. This is due to the fact that, at large scales, statistical fluctuations related to cosmic variance are much bigger with respect to small differences in the window. Even the overall amplitude is similar between the two redshift bins because the lower amplitude expected for the higher redshift power spectrum (because structures were less compact in the past) is compensated by the higher bias factor.
We compare the measured power spectrum from data with some theoretical models in order to extract the baryonic fraction and the amount of matter density in the Universe. The probability contours display evidence of a well-known degeneracy previously observed in other surveys (such as 2dFGRS) between the two recovered parameters in the determination of the overall shape of the matter power spectrum. Increasing the matter density of the Universe in fact shifts the power spectrum toward higher modes enhancing the clustering at the scales sampled by VIPERS. In this case to compensate the increase of power, the good fit is given by models with high baryonic fraction necessary to suppress the power at those scales. Vice-versa a low-M Universe does not need a high baryonic fraction. This degeneracy is broken combining the two redshift bins with a joint likelihood.
Finally, we provide an estimation of the matter density fixing all the other cosmological parameters to the best known values. We evaluate the matter density to be M = 0.272+0.027 −0.031 in perfect agreement with Planck (once we rescale the Hubble factor from the Hubble Space Telescope used for the estimation of M to be consistent with the Planck one) and with the matter density estimated from the VIPERS Public Data Release-1 measurements of the clustering ratio
Biodiversity for the protein sources utilized in feeds for intensive fish culture.
No full textThe reduction of dependence on fishmeal (FM) in is compulsory for a sustainable growth of aquaculture. Concerning the protein component, feed companies turned towards the use of alternative protein sources, as vegetable meal (VM), that today vary in the range 48-68% in commercial aquafeeds.
Nevertheless, elevate VM in the diet may not always be tolerated by fish, resulting in gut inflammations and histological damages, with reduced digestive functionalities and integrity. Microbiota composition is influenced by the diet. The digestive apparatus adjusts to changing of diet composition, with the mucosal defence system providing the gastro intestinal tract (GIT) with mucopolysaccarides that protect the intestine walls from injurious agents; moreover, a damaged fish gut may become an important infection route for microbial pathogens in fish.
The GIT contributes to body health in many ways: of particular interest in this context is the emerging concept of "gut health". It covers multiple positive aspects of the gastrointestinal tract, such as the absence of gastrointestinal illness, normal and stable intestinal microbiota, and effective immune status, that are also able to determine a state of well-being. Among protective nutraceuticals that are produced with anaerobic bacteria fermentation and may be add to feed as well, the short chain fatty acids play a relevant role. Among them, butyrate could have a pivotal role in the context of "nutritional welfare”: in particular, acting as an anti-inflammatory agent, providing an enterocytes trophic action, acting as promoter of oligopeptides transport, promoting production of antinflammatory cytokines, thus positively acting on fish growth.
Also the molecular biomarkers, that may early describe the progression of any intestine damages, could be useful tools to tune an appropriate nutritional strategy.
In feeding challenges, a scoring system has been set up to assess the diet-related histological changes in different gut tracts; such system showed that histological changes occur early, within the first 10 days after the new diet administration. The intestine conditions shown a sort of adaptation trend after 40-50 days trial, after which the score trends tend to recover toward the initial level. We speculate that, as long as such changes are reversible, healthy fish is able to respond quickly at diet variation returning toward the initial condition within 1-2 months. However, we have to take in account several parameters (growth performances, histological changes, molecular biomarker levels, gut microflora biodiversity, rearing condition etc.) to compose a comprehensive picture on the animal nutritional welfare.
The present work has enabled to evaluate the zootechnical performances of four diets at different level fishmeal substitution with protein vegetable sources. The result showed that seabass may be fed with aquafeed containing around 20% of fishmeal without relevant difference in growth performance from feed richer in FM.
The great importance of biodiversity concept, in fishing resources for feed as well as in maintaining the fish gut microbiota in good condition, is evident with this study
In vitro modulation of the microgual phenotype by physioological and pathological stimuli: perspectives for neuroinflammatory and neurodegenerative diseases.
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Tra potere e coscienza. La letteratura come luogo dell'azione "pratica".
No full textLe riflessioni contenute nel presente lavoro sono atte a mostrare qualitativamente sia la relazione esistente tra la poesia (ed in via più generale la letteratura) e le materie più prettamente “pratiche” (ossia la politica, l’etica e il diritto) sia a comprendere le modalità attraverso le quali la letteratura, espressione artistica dell’immaginazione simbolica umana con la sua forma “autonoma” di pensiero “primario” ed “originario”, caratterizzato dal linguaggio metaforico, possa topicamente arricchire tali ambiti di azione permettendo contemporaneamente una visione più ampia e completa di essi e rendendo maggiormente consapevoli, i suoi osservatori, delle possibilità messe in campo.
Aristotele, nella sua Poetica, evidenzia come un fattore fondamentale, insito nell’opera letteraria e in particolar modo nella tragedia, sarebbe dato dal cosiddetto “mito interno unificatore”, una qualità universale, archetipo rappresentativo costante nello spazio e nel tempo, di situazioni umane “ideal-tipiche” a cui ogni attore o spettatore possano sempre guardare, dapprima mediante l’imitazione “catartica” di passioni archetipiche (come la paura o la com-passione) e poi facendo tesoro dall’insegnamento che da dette passioni possa trarsi nelle specifiche esperienze di vita. In altri termini il mito fornirebbe al soggetto delle situazioni mitopoietiche “simboliche” ed “universali”, “verosimiglianti” e allo stesso tempo “fondative”e per questa via l’essere umano, animal symbolicum per natura e dunque non solo imitatore ma medesimamente creatore e “significatore” dei propri vissuti, sarebbe in condizione di ri-produrre poieticamente alcune situazioni nel suo specifico ambito “pratico”: un atto riproduttivo, allora, che muoverebbe sì dalla creazione artistica ma che sarebbe tuttavia sempre espressione mimetica della vita reale. In questo senso, la grandezza della poesia ed in via più generale della letteratura, sarebbe dunque quella di arricchire ed approfondire, con le loro peculiari caratteristiche, i pensieri filosofico-pratici umani e così gli stessi loro vissuti. Inoltre, la relazione tra la letteratura e la filosofia pratica creerebbe di fatto la ri-conciliazione tra il poeta e il filosofo andata perduta nel tempo. Il punto di rappacificazione e di sintesi delle due differenti visioni e letture del mondo sarebbe il ritrovamento e l’individuazione di quella condizione mentale o “coscienza liminare” umana dell’ “immaginale”, intesa come soglia di mediazione tra il razionale e l’irrazionale, il sentire intellettuale e il sentire emotivo, il conscio e l’inconscio.
La tragedia e la letteratura, attraverso la narrazione di fatti verosimili, svelerebbero allora situazioni ideali che, sebbene vissute dai singoli personaggi descritti dallo scrittore, anelano all’universalità. Questi ultimi si presentano infatti come dei “tipi” umani che vivono drammaticamente una data situazione narrata nell’opera, suscitando appunto catarticamente, nel vissuto di chi li ascolta o li guarda a teatro, le passioni contraddittorie (come ad esempio quella della pietà e quella del terrore), dalle quali essi, vivendole direttamente con l’ascolto o con la visione, riescono a loro volta personalmente a liberarsi.
Un incontro, quello della letteratura, che quindi “libera” anche colui che legge o ascolta e che lo rende, in prospettiva, attore: questo perché l’ars poetica contiene ed esprime sempre in sé un mito archetipico e, pur con specifiche tematiche e particolari situazioni rappresentate nelle singole opere, esprime le idee in esso contenute e, allo stesso tempo, mediante queste ultime, una morale, ossia un insegnamento “pratico”, che aspira ad essere universalmente valido.
Il presente lavoro, che parte da queste premesse cognitive e da questi presupposti contestuali, si propone allora di individuare, attraverso cinque famosi esempi letterari del mondo antico, moderno e contemporaneo, ossia l’Antigone di Sofocle, L’Orestea di Eschilo, Il Mercante di Venezia di William Shakespeare, Il Grande Inquisitore di Fedor Dostoevskij e L’Avventura di un povero cristiano di Ignazio Silone, i nessi e gli aspetti filosofico-pratici della relazione tra “potere” e “coscienza”; un conflitto tragico che si pone emblematicamente, oltre che tra i soggetti della relazione del dramma, nel foro interiore di ciascun individuo, sia egli “attore” o semplicemente “spettatore” o “lettore” diretto o indiretto, del particolare “caso” preso in esame. Tali esempi saranno evidenziati all’interno di situazioni ideal-tipiche della condizione “tragica” umana “non negoziabili” e in relazione specifica al problema della giustizia, comunemente presente, pur se in diverso modo, sia nell’Antigone sia nell’Orestea, a quello dell’identità, presente nel Mercante di Venezia, a quello del male, presente nel Grande Inquisitore e a quello della libertà, presente ne L’avventura d’un povero cristiano.
Il lavoro si suddivide in due capitoli. Nel primo i testi proposti saranno appunto analizzati comparativamente sotto le diverse suindicate problematiche entro il connubio tra potere e coscienza; nel secondo, essi saranno discussi nuovamente, per essere completati nella presentazione interpretativa, ricorrendo al concetto aristotelico di phrónesis, inteso quale sinonimo di saggezza, ragionevolezza, prudenza, ponderazione, giusta scelta e “giusto mezzo tra” e pensato quale possibile risoluzione “pratica”, soggettiva o relazionale, dei problemi etici singolarmente sollevati e discussi dai personaggi e “catarticamente” vissuti poi, in modo indiretto, dai lettori o dagli spettatori del singolo dramma. Uno studio dunque anche neo-riabilitativo sulla phrónesis che, per le sue caratteristiche costitutive, si porrà nelle vesti di una personale “traccia di proposta” risolutiva della conflittualità tra potere e coscienza e tra i principi fondativi contrastanti dei relazionanti e che, quale elaborazione simbolica universale, oggetto centrale dell’azione e del pensiero fattibile o solo possibile dei e tra i relazionanti (personaggi primari o secondari del dramma), verrà da noi suggerita come possibile condizione di “pensabilità mentale”, atta appunto a risolvere l’innegoziabilità delle posizioni ed il connubio “tragico” ed emblematico della possibile valutazione e del comportamento “pratico”, esteriore ed interiore all’individuo
La rivisitazione della casistica e il suo ruolo nell'etica clinica.
No full textThe object of our research is based on a fundamental question: whether it is
possible to offer, in current bioethical debate, a further Foundation of clinical ethics starting
from the retrieval, through serious and in-depth study, of the characteristics and
the method proposed by the casuistry by Albert R. Jonsen.
The interest in the study of casuistry emerged during the drafting of the text “Fino a
quando? La sospensione dei trattamenti sanitari” ("Until when? The suspension of medical
treatment"), co-written with Mario Picozzi and Vanna Consolandi and published by San
Paolo Publishing House in 2012.
During the work, it became necessary to structure the text by following
a methodology that deals with the presentation of the case through a "many voices"
clinical reading, since offering a clinical, ethical and, where appropriate, also a “dialoguing”
(i.e. involving the main protagonists of the therapeutic scene, like doctor, patient, family
members) analysis. This in order to make it possible all the problems concerning the
considered individual case, the assets/moral values at stake, the socio-cultural context of
reference, the network of relationships woven by the involved characters and with which
the latter should be confronted within the context of clinical practice to emerge.
The result of this methodological approach, which cannot leave aside a careful
examination of the real clinical-existential situation of the single case, has stimulated
research and critical reflection about the basis, i.e. the philosophical-theological-historicalsociocultural
roots establishing the theoretical assumptions of casuistic theory
development (understood as a model of ethical reasoning methodology for the analysis of
moral issues in the context of medical ethics), in order to analyze objectively its
peculiar structure and its role, with specific reference to its application in clinical ethics.
It was therefore chosen to articulate the research work by examining in depth the
theoretical path of the main Author and proponent of casuistry, Albert R. Jonsen, retracing,
through his works, the key moments of the origin and development of casuistic model he
proposed as a method of analysis of cases applicable in clinical medical ethics.
To trace the lines of this analysis, we preferred to propose an interpretation of the
reconstruction of the structure of casuistic model that does not simply draw a chronological
and historical frame; on the contrary, a search for "topics" was preferred, focusing on
factors that led Jonsen, in his own studies and work, to rediscover the need to define and
"codify" the structure and how to use that approach to ethical reasoning, as he himself
gives evidence through his main publications: The Birth of Bioethics, The Abuse of
Casuistry, A History of Moral Reasoning and Clinical Ethics. The analysis of his books –
that starting from the survey of historical-cultural-philosophical context led Jonsen to the
discovery of the casuistic method - leads us to examine the role of case studies within the
traditional ethics and its direct application to the resolution of cases of clinical ethics.
Then we focused on the analysis of the main criticisms and reworkings of Jonsen
casuistry by latter international authors; in our view, the question is whether it is sufficient
that casuistry, as model of ethical and clinical reasoning, has simply the value of method,
as it seems considering Jonsen, whose use is therefore always possible, beyond and
regardless of the adopted content reference system.
Therefore, the following question is if it makes sense and it is possible a neutral
method for ethical analysis applied to such a delicate dimension as the clinical one, or if by
choosing this method however involves the endorsement of a certain theoretical
background.
Consequently, we try to propose an alternative to this essential critical element
identified in the perspective of Jonsen, though maintaining and supporting the value of
certain methodological issues identified by Jonsen himself as positive, such as attention to
the concreteness and the completeness in the analysis of clinical and ethical real situation,
which outlines the features of a theoretical reference system based on anthropology and
ultimately on metaphysics personalist Catholic reference.
The appropriately revisited and supported casuistic method, therefore, can be
defined synthetic because it appears effective to legitimate the fragile and flexible link
between the contributions given by individual disciplines and practical case, offering the
chance to build a "proportionate reading" of the assets at stake within the situation
determined by the concrete case, allowing a proper evaluation aimed to outline a high
profile healthcare, which is not only desirable, but possible