La présente étude conduit les traditions fragmentées de la culture littéraire de Trieste vers les préoccupations contemporaines de la littérature mondiale à l’époque actuelle où la mondialisation est largement perçue comme le paradigme historique prédominant de la modernité. Ce que j’appelle la « littérature globalisée » renvoie à la refonte de la Weltliteratur – envisagée par Goethe et traduite comme « world literature » ou la « littérature universelle » – par des discours sur la culture mondiale et le post-nationalisme. Cependant, lorsque les études littéraires posent les questions de la « littérature globalisée », elles sont confrontées à un problème : le passage de l’idée universelle inhérente au paradigme de Goethe entre le Scylla d’un internationalisme relativiste et occidental, et le Charybde d’un mondialisme atopique et déshumanisé. Les spécialistes de la littérature mondiale qui tendent vers la première position acquièrent un fondement institutionnel en travaillant avec l’hypothèse implicite selon laquelle les nations sont fondées sur les langues nationales, ce qui souscrit à la relation entre la littérature mondiale et les littératures nationales. L’universalité de cette hypothèse implicite est réfutée par l’écriture triestine. Dans cette étude, je soutiens que l’écriture triestine du début du XXe siècle agit comme un précurseur de la réflexion sur la culture littéraire globalisée du XXIe siècle. Elle dispose de sa propre économie de sens, de sorte qu’elle n’entre pas dans les nationalismes littéraires, mais elle ne tombe pas non plus dans le mondialisme atopique. Elle n’est pas catégoriquement opposée à la littérature nationale; mais elle ne permet pas aux traditions nationales de prendre racine. Les écrivains de Triestine exprimaient le désir d’un sentiment d’unité et d’appartenance, ainsi que celui d’une conscience critique qui dissout ce désir. Ils résistaient à l’idéalisation de ces particularismes et n’ont jamais réussi à réaliser la coalescence de ses écrits dans une tradition littéraire unifiée. Par conséquent, Trieste a souvent été considérée comme un non-lieu et sa littérature comme une anti-littérature. En contournant les impératifs territoriaux de la tradition nationale italienne – comme il est illustré par le cas de Italo Svevo – l’écriture triestine a été ultérieurement incluse dans les paramètres littéraires et culturels de la Mitteleuropa, où son expression a été imaginée comme un microcosme de la pluralité supranationale de l’ancien Empire des Habsbourg. Toutefois, le macrocosme projeté de Trieste n’est pas une image unifiée, comme le serait un globe; mais il est plutôt une nébuleuse planétaire – selon l’image de Svevo – où aucune idéalisation universalisante ne peut se réaliser. Cette étude interroge l’image de la ville comme un microcosme et comme un non-lieu, comme cela se rapporte au macrocosme des atopies de la mondialisation, afin de démontrer que l’écriture de Trieste est la littérature globalisée avant la lettre. La dialectique non résolue entre faire et défaire la langue littéraire et l’identité à travers l’écriture anime la culture littéraire de Trieste, et son dynamisme contribue aux débats sur la mondialisation et les questions de la culture en découlant. Cette étude de l’écriture triestine offre des perspectives critiques sur l’état des littératures canoniques dans un monde où les frontières disparaissent et les non-lieux se multiplient. L’image de la nébuleuse planétaire devient possiblement celle d’un archétype pour le monde globalisé d’aujourd’hui. / The present study brings the fragmented traditions of Triestine literary culture to bear on contemporary preoccupations with world literature at a time when globalization is widely perceived as the predominant historical paradigm that informs modernity. What I am calling “global literature” refers to the refashioning of Weltliteratur – envisioned by Goethe and translated as “world literature” or “littérature universelle” – by discourses on global culture and post-nationalism. However, when literary studies take on questions of global literature they are faced with a problem, navigating the universal idea of Goethe’s paradigm between the Scylla of a relativist, occidental internationalism and the Charybdis of a dehumanized, atopian globalism. Proponents of world literature who lean towards the former position gain an institutional foothold by working with the implicit hypothesis that nations are based in language, which underwrites the relationship between world literature and national literatures. The universality of this implicit hypothesis is what Triestine writing disproves. In this study, I argue that Triestine writing in the first decades of the twentieth century acts as a precursor to thinking about global literary culture for the twenty-first century. It has its own economy of sense, whereby it doesn’t fit into literary nationalisms, but it doesn’t fall into atopian globalism either. It is not emphatically opposed to national literature; rather it does not admit national traditions to take root. Triestine writers expressed a desire for a sense of unity and belonging, as well as a critical conscience that undoes that desire. It resists the idealization of its particularities, and never successfully coalesces into a unified literary tradition. Consequently, Trieste has often been thought of as a non-place and its literature as antiliterature. In bypassing the territorial imperatives of the Italian national tradition – as the case of Italo Svevo illustrates – Triestine writing was later caught up in the literary-cultural parameters of Mitteleuropa, where its literary expression was imagined as a microcosm of the former Habsburg Empire’s supranational plurality. However, the projected macrocosm of Trieste is not a unified image, like a globe; but instead it is a nebula – as Svevo had imagined it – where no universal idealizations could gain a foothold. This study interrogates the image of the city as a microcosm and as a nowhere and how that relates to the macrocosm of the atopias of globalization, in order to demonstrate that Triestine writing is global literature ante litteram. The unresolved dialectics of doing and undoing literary language and identity through the act of writing that animates Triestine literary culture plays out in globalization debates and the questions of culture that arise from it. Triestine writing offers critical perspectives on the status of canonic literatures in a world of disappearing borders and placeless places, where the nebula is a master image for today’s world.

Introdução: O estudo dos fatores clínicos associados ao prognóstico da rinossinusite crônica (rsc), seja associada à polipose nasossinusal (RSCcPN) ou não (RSCsPN), ainda é pouco abordado a longo prazo. Objetivo: Avaliar pacientes submetidos à ESS (cirurgia endoscópica nasal, do inglês endoscopic sinus surgery) para o tratamento de RSC no Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo, entre 1996 e 2006, e correlacionar a recidiva em longo prazo com parâmetros como a extensão da doença, atopia, tabagismo, asma, eosinofilia e doença respiratória exacerbada pela aspirina (DREA). Métodos: Duzentos e um pacientes foram seguidos por um período médio de 12 anos. Os dados clínicos foram levantados, assim como exames de endoscopia nasal, Tomografia Computadorizada (TC), exames séricos, prick test e prova de função pulmonar. O tempo de seguimento pós-operatório foi analisado, sendo considerado fator de mau prognóstico a indicação de novo procedimento cirúrgico. Foi realizada comparação entre os fatores pela curva de Kaplan-Meyer, e pós-teste de Log-rank. Resultados e Discussão: Pacientes com RSCcPN tiveram chance de nova cirurgia três vezes maior do que aqueles sem pólipos nasais, no período seguido. Entre os pacientes com RSCsPN, apenas a asma foi um fator de pior prognóstico significativo, levando à chance de cirurgia 5,5 vezes maior do que os não-asmáticos. Já entre os pacientes com RSCcPN, aqueles com recidiva apresentaram maior extensão da doença à TC antes da primeira cirurgia. Foram ainda considerados fatores significativamente de pior prognóstico nos pacientes com RSCcPN: asma (odds ratio [OR] de 3,2); atopia a fungos (OR de 1,9); eosinofilia periférica (considerada como >500/µL, levando a OR de 1,9); e intolerância ao Ácido Acetil Salicílico (AAS) (DREA, apresentando OR de 2,5). Conclusões: Concluiu-se que a presença de pólipos per se é fator de pior prognóstico, aumentando em três vezes a chance de recorrência cirúrgica. Entre os pacientes com RSCsPN, apenas a asma influenciou o prognóstico. Já naqueles com RSCcPN, a asma, eosinofilia periférica, atopia a fungos e DREA aumentaram significativamente a probabilidade de nova intervenção cirúrgica. / Introduction: The analysis of prognostic factors associated with the recurrence of chronic rhinosinusitis (CRS), either with nasal polyps (CRSwNP) or without (CRSsNP), is still poorly discussed in the literature. Objective: To evaluate the patients that underwent endoscopic sinus surgery (ESS) due to CRS in Clinics Hospital of Ribeirão Preto Medical School, University of São Paulo, between 1996 and 2006, and to correlate the long-term recurrence to clinical factors, such as extensiveness of the disease, atopy, smoking habits, eosinophilia, and Aspirinexacerbated respiratory disease (AERD). Methods: We collected data of 201 patients, who were followed during an average period of 12 years. Clinical data collected were: extensiveness of the disease at endoscopy and at CT scans, prick test, blood exams, and pulmonary function. The follow-up period after surgery was assessed, and the indication of a new surgical procedure was considered as a poor prognostic factor. Comparison between factors was performed by Kaplan-Meyer curve, with Log-rank post-test. Results and discussion: CRSwNP patients were 3 times more likely to need a revisional surgery than CRSsNP during the follow-up period. Only asthma was a significant prognostic factor in patients with CRSsNP, leading to 5.5 times higher chance of recurrence than non-asthmatic patients. Among patients with CRSwNP, patients with recurrence presented, prior to surgery, higher CT scan extension of the disease. Other factors that influenced the prognosis on CRSwNP were: asthma (odds ratio [OR]: 3.2); atopy for fungi (OR: 1.9); peripheral eosinophilia (considered as >500/?L, leading to an OR: 1.9); and ASA intolerance (AERD; OR: 2.5). Conclusions: The presence of polyps were related to poor prognosis per se, leading to a higher chance of surgical recurrence. Among patients with CRSsNP, only asthma influenced the prognosis. Among the patients with CRSwNP, asthma, peripheral eosinophilia, fungi atopy, and AERD significantly increased the likelihood of further surgical intervention.

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Abstract Advances in perinatal treatment practices—such as antenatal corticosteroids, surfactant replacement therapy, and gentler ventilator modalities—have improved the survival of infants born preterm. Consequently, later morbidity and pulmonary outcome for survivors has attracted increasing interest. The incidence of bronchopulmonary dysplasia (BPD) remains high and the condition is manifesting in infants born at earlier gestational weeks than before. This so-called new BPD results from the arrest of alveolar development and is associated with less structural airway injury and interstitial fibrosis than previously. Long-term follow-up data on lung function, lung structure and respiratory morbidity of children treated with modern methods is insufficiently known. We performed a follow-up study of 88 preterm-born children and 88 matched term-born controls at school age. Children born preterm had lower values in lung function measurements than term-born peers. Reductions were most marked in those with a history of BPD. In accordance with the foetal origins hypothesis, children with intrauterine growth restriction (IUGR) had lower lung function than gestation-controls. This indicates that poor growth in utero is an additional burden on pulmonary health. Both IUGR and BPD predicted lower lung function independently. High-resolution computed tomography of the lung was obtained from 21 children with a history of BPD. Structural abnormalities were common, children with severe BPD being most affected. Preterm children were hospitalised more often than controls, mainly because of wheezing disorders. However, BPD did not influence the hospitalisations. According to the meta-analysis of the contemporary data available, the respiratory outcome of children who had only mild BPD may have improved in comparison to old follow-up data, whereas the results for those without BPD or moderate-to-severe BPD have remained remarkably stable despite progress in treatment practices during early life. In conclusion, preterm children had subtle impairments in lung function at school age. Although they were fairly asymptomatic, concern about the possible long-term effects of preterm birth on pulmonary health is justified. It has been proposed that BPD may predispose individuals to an early COPD-like disorder. Preterm children must be protected from any additional burden on respiratory health and should be monitored appropriately for early detection of lung disease. / Tiivistelmä Keskosten tehohoito on kehittynyt viime vuosikymmeninä merkittävästi, ja yhä epäkypsempänä syntyvät keskoset selviävät hengissä syntymän jälkeen. Keskosten pitkäaikainen keuhkosairaus, bronkopulmonaalinen dysplasia (BPD), on perinteisesti johtunut hengityskonehoidon ja happikaasun aiheuttamasta keuhkovauriosta ja johtanut keuhkokudoksen arpeutumiseen. Aiempaa ennenaikaisemmilla keskosilla esiintyy kuitenkin nykyään niin sanottua uutta BPD:tä, jonka ajatellaan johtuvan enemmän keuhkorakkuloiden kehityshäiriöstä kuin hoitojen aiheuttamasta keuhkovauriosta. Selvitimme, miten nykyaikaisilla menetelmillä hoidettujen keskosten keuhkojen rakenne ja toiminta kehittyvät kouluikään mennessä. Seurantatutkimukseemme osallistui 88 ennenaikaisena syntynyttä, kouluikään ehtinyttä lasta ja 88 täysiaikaisena syntynyttä, kaltaistettua verrokkia. Keskosena syntyneiden lasten keuhkofunktio oli kouluiässä huonompi kuin täysiaikaisena syntyneiden verrokkien. Alhaisin keuhkofunktio oli niillä keskosena syntyneillä lapsilla, jotka olivat sairastaneet vastasyntyneenä BPD:n. Myös kohdunsisäiseen kasvuhäiriöön (intrauterine growth restriction, IUGR) liittyi alentunut keuhkofunktio. BPD ja IUGR ennustivat alentunutta keuhkofunktiota toisistaan riippumatta. Tutkimuksessa tehtiin myös keuhkojen ohutleiketietokonekuvaus 21 keskoselle, jotka olivat sairastaneet BPD:n. Lähes kaikilla havaittiin poikkeavia löydöksiä – eniten niillä, joilla oli ollut vastasyntyneenä BPD:n vaikea tautimuoto. Keskosina syntyneet joutuivat kahden ensimmäisen vuoden aikana verrokkeja useammin sairaalahoitoon. Yleisimpiä syitä olivat hengityksen vinkumista aiheuttavat taudit kuten ilmatiehyttulehdus, ahtauttava keuhkoputkitulehdus tai akuutti astmakohtaus. Vastasyntyneenä sairastettu BPD ei kuitenkaan lisännyt todennäköisyyttä joutua sairaalahoitoon. Tutkimuksessa tehtiin myös meta-analyysi nykyaikaisilla menetelmillä hoidettujen keskosten keuhkofunktiosta: lievää BPD:tä sairastavien tulokset näyttävät parantuneen, kun taas keskivaikeaa tai vaikeaa tautimuotoa sairastavien ja ilman BPD:tä selvinneiden keuhkofunktio ei ole muuttunut uusien hoitojen myötä. Yhteenvetona voidaan todeta, että keskosten keuhkojen toimintakyky on jonkin verran alentunut täysiaikaisiin verrattuna. Lievästi alentunut keuhkofunktio ei kuitenkaan yleensä aiheuttanut koululaisille oireita. Keskosena syntyneiden lasten hengityselinten toimintaa on syytä seurata, sillä niin sanotun uuden BPD:n pitkäaikaisesta ennusteesta ei ole vielä tietoa.