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In this work we have studied the emissions from luminescent polymeric blends, aiming to obtain a white emission. Two of the materials, a polyfluorene derivative matrix poly(9,9-dihexyl-2,7-fluorene) (LaPPS 10, labeled as L10) and a polyvinylene-derivative guest (poly[(9,9-dihexyl-9H-fluorene-2,7-diyl)-1,2-ethenediyl-1,4-phenylene-1,2-ethenediyl] (LaPPS 16—L16), have not been extensively studied. The L10 was used as a matrix (host) and the L16 as a dopant (guest). A commercial polyvinylene (MDMO-PPV) was also used as a dopant. In order to achieve the white emission, it is necessary to control the energy transfer among the components of the blend. The emissions of solutions were analyzed, varying the concentration of the materials. From that, solutions of polymeric blends of L10:L16 (at different ratios) were spincoated, forming solid state films. The emission of these binary blend films were monitored as a function of the guest concentration. Therefore, in order to cover the red region of the visible spectrum, MDMO-PPV was added to the initial blend, forming a ternary blend (L10:L16:MDMO-PPV). The emissions of these blend films were studied, varying the concentration of the MDMO-PPV. Using the optimal results for the material ratios of these ternary blends, aiming for the white emission, electroluminescent devices were produced and the electroluminescence was studied. A whitish emission was obtained with the 97.5:0.5:2.0 blend, leading to the CIE coordinates 0.31:0.36.

Introdução: A síndrome de Bernard-Soulier (SBS) é uma doença hematológica e hereditária rara que possui uma prevalência estimada em 1:1.000.000. Suas anormalidades são decorrentes da expressão defeituosa do complexo glicoproteico GPIb/IX/V- receptor plaquetário que é crucial para o estabelecimento da hemostasia primária. Objetivo: Relatar um caso raro de cisto ovariano roto em portador da Síndrome de Bernard-Soulier. Metodologia: estudo descritivo, transversal, que consiste na elaboração de um relato de caso, elaborado a partir de uma análise do prontuário de um paciente portador da Síndrome de Bernard-Soulier que evoluiu com cisto ovariano roto. Para embasamento teórico foram utilizados artigos indexados em português e inglês na base de dados PubMed. Foram considerados os seguintes descritores: Ovarian Cysts, Bernard-Soulier Syndrome, e Abdomen Acute. Conclusão: Considerando a frequência e a gravidade dos eventos hemorrágicos como aspectos muito variáveis entre os pacientes portadores de SBS é necessário que o cirurgião sempre tenha em mente distúrbios hematológicos subjacentes ao se deparar com um possível abdome agudo hemorrágico.

A systematic study of luminescence from blends made of poly (9, 9-dioctylfluorene-2, 7-diyl) (PFO) and poly (3-octylthiophene-2, 5-diyl) (P3OT), and its photophysics was carried out. Acceptor concentration influence and sample preparation conditions was analyzed, particularly regarding the solvent, in order to control emission through the entire visible spectrum, and to understand the physical processes involved. An additional emission band observed in PFO:P3OT films with low concentration of P3OT was studied through confocal luminescence microscopy and was attributed to a decrease of energy transfer between P3OT molecules leading to an emission through chains with smaller conjugation length. The extra emission was also separated from the others by Time Resolved Emission Spectroscopy due to the fact that its lifetime is longer than those of the other emissions. Balance control of the emission through PFO (blue), low conjugation chains of P3OT (green) and P3OT aggregates (red) was possible changing the solvent and the way to prepare samples, that causes a greater or lesser amount of β phase in PFO. The study of the energy processes involved was also performed.

The optical properties of nanocrystal (NC) colloidal quantum dots (QDs) largely depend on their size and shape. These properties can be easily tuned by temperature and the concentration of ligands during their synthesis to generate QD particles with different optical features. However, the enormous complexity of these QD systems limits the understanding of the critical impact of passivating ligands and surface defects on their optical properties. In the present study, we systematically investigated the effect of different strategies on the optical properties of alloyed CdSe/CdSexCdS1−x/CdS core shell (CS) QDs capped with several ligands, including trioctylphosphine (TOP) and hexadecylamine (HDA). The CdSe covered with TOP ligands were produced using the hot injection method, whereas CdSe covered with HDA ligands were produced by the exchange reaction method from as-synthesized samples. The CdSe/CdSexCdS1−x/CdS QDs samples were prepared from a simple chemical route that involved an increasing concentration of thioglycerol to grow the CdS shell on the top of the as-precipitated CdSe core with different ligands in a controlled manner. Two emission peaks (at approximately 595 and 635 nm) were observed for three different surface coverages beyond the exciton recombination. These emissions were mainly attributed to the surface localized state in all samples and the charge carrier transfer between the exciton and surface states. Our findings revealed an increase in the photoluminescence (PL) intensity with increasing temperature for the alloyed CdSe/CdSexCdS1−x/CdS CS QDs. The findings also revealed a continuous red-shift in the optical absorption peak, as a function of ligand concentration. This suggests a strong electronic coupling between the surface localized states and delocalized excitonic alloyed CdSe/CdSexCdS1−x/CdS CS QDs. However, such colloidal nanocrystals (NCs) need to be further investigated to gain an in-depth understanding of their nanoscale behavior as well as explore their huge potential for several emerging technological applications.

The research of materials and structures for the manufacture of organic diodes emitting white light WOLEDS has been very intense nowadays mainly due to the possibilities of its use in obtaining low-energy light consuming. The energy transfer between polymer materials has proven to be a great allied to search organic devices with emitting white light. Polymers such as PFO-DMP (donor) and P3HT (acceptor) are candidates for this application. In this work, P3HT, PFO-DMP and blends (PFO-DMP:P3HT (5%)) films were deposited by spin-coating on digital textile printing substrates. The optical properties of the digital textile printing, polymers and blend were studied by UV-VIS, steady-state photoluminescence (PL), PL quantum yield (PLQY) and Raman (all at 298 K) spectroscopy techniques. The digital textile printing were acquired from Isoliner, a Brazilian company specialized in this kind of textile. In the blend a strongly energy transfer from PFO-DMP to P3HT was observed. The PL spectrum of the PFO-DMP:P3HT (5%) covers the 430–730 nm range. From integrated PL spectra in the range of 13–643 K, it was obtained the temperature at which the phosphor loses 50% of its initial emission intensity, T1/2 = 430 K. Gaussian fits were performed, and the peaks were identified. Raman measurements were performed on substrates with and without polymers deposited and the results are in agreement with those found in the literature. Vibrational modes of textile increase the full width half maximum (FWHM), due to electron-phonons interaction. Results obtained through the coordinate calculation CIE from blend emission for various types of textile digital printing tested, showed the more appropriate combinations (substrate/blend) for emission in white.

Resumen Introduccion El diagnostico de la enfermedad de Parkinson (EP) se basa en criterios clinicos, siendo comun observar que el curso evolutivo de la misma varia entre los pacientes. Objetivo Analizar la progresion clinica de 100 pacientes con EP (EPp) asistidos en un consultorio especializado en trastornos del movimiento. Materiales y metodos Se revisaron 100 historias clinicas de sujetos con EP y al menos 5 anos de seguimiento en la institucion. Se analizaron las caracteristicas demograficas, la edad media al diagnostico, el tiempo de progresion entre los estadios de Hoehn y Yahr (HY el tiempo de evolucion al inicio de las alucinaciones, las caidas, el deterioro cognitivo y la necesidad de asistencia para las actividades de la vida diaria (AVD), considerados como hitos de enfermedad avanzada. Resultados Los intervalos entre los diferentes estadios de H&Y fueron similares. Los EPp mayores de 50 anos al diagnostico mostraron menor tiempo de latencia para la aparicion de deterioro cognitivo y necesidad de cuidado en las AVD (p Conclusiones La progresion de la EP, asi como la severidad de los signos y sintomas parkinsonianos, difieren ampliamente entre los pacientes. Las caidas, las alucinaciones y el fallo cognitivo son marcadores de enfermedad avanzada e implican un mayor riesgo de necesidad de asistencia en las AVD.

During the last few years, great interest has been given to research in organic solar cells. Apart from the low cost techniques needed for the production of the active layers, the plasticity of these types of materials offers an additional benefit compared to traditional silicon-based solar cells. However, the commercialization of organic photovoltaic technologies is limited by rapid degradation and low efficiency. Recently, the use of luminescent down-shifting (LDS) films has been explored as a tool for increasing the external quantum efficiency of organic-based devices. A previously observed superposition in the emission–absorption spectra of Kremer blue (Kb) and Coumarin 7 (C7) dyes suggests that an energy transfer process can take place among these molecules. Decay time photoluminescence measurements in K b 100 − x C 7 x samples were carried out to confirm a Foster resonance energy transfer process. An optimization process following the design of experiments methodology was carried out to adjust the optical properties of K b 100 − x C 7 x films for applications in the P 3 H T: P C 61 B M organic photovoltaic device. An increment of 18.6% in the short circuit current density ( J s c) of P 3 H T: P C 61 B M devices coated with a K b 92.5 C 7 7.5 LDS film was observed. A degradation test shows a rapid drop in the electric current density of devices without the LDS film, which we attribute to the so-called burn-in, widely reported in the literature. For devices coated with the K b 92.5 C 7 7.5 LDS film, no rapid drop in the electric current density was observed, suggesting that the use of the luminescent layer mitigates the photoinduced burn-in loss.

The optical properties of electrochemically synthesized P3HT films were studied. After the synthesis, the samples were divided into two groups: as prepared (P3HT-E) and the chemically reduced (dedoped) in a basic medium (P3HT-D). These films were characterized by photoluminescence (PL), Raman and photoluminescence time decay techniques. Comparing the PL spectra of the films, it is noted that P3HT-D has a higher PL intensity. The films were exposed to a continuously incident 405 laser and the PL spectra were monitored every 10 min. For both samples, the photoluminescence intensity along the photo-irradiation showed an increase, although the P3HT-E sample presented a greater increase. Regarding the Raman spectra before and after the photo-irradiation, it was noticed that for P3HT-D there were no changes, whereas P3HT-E showed significant changes. The Raman spectrum of P3HT-E sample at the photo-irradiated point was very similar to the Raman spectrum of P3HT-D. Thus, it was proposed that laser irradiation induces a reduction process similar to chemical reduction. Although both processes lead to an increase in the PL intensity, there is a difference in the position of the emission bands. Unlike chemical doping, the photoreduction does not remove the charge transfer complexes of the polymer matrix, but only breaks their bond with the backbone chain. From the data of PL decay, it was observed that in the film P3HT-E, there was a predominance of longer times, evidencing the presence of barriers for the energy transfer, while, for the P3HT-D, the contribution of shorter decay times predominates, evidencing a greater energy transfer between the chains.

Endometrial carcinoma is the most common neoplasia of female genital tract. The prognosis of early stage disease (FIGO I and FIGO II) is excellent: recurrence after surgery is less than 15%, most of which are reported within 3 years after primary treatment. Herein we report a case of late rectal recurrence from FIGO Ib endometrial adenocarcinoma. Patient had also familiar and personal history of colonic adenocarcinoma and previous findings of microsatellite instability (MSI); molecular analysis evidenced heterozygotic somatic mutation in MLH1 gene. Twenty-eight years after hysterectomy and bilateral salpingoovariectomy, a rectal wall mass was detected during routine colonoscopy. Patients underwent CT scan, pelvic MRI, and rectal EUS with FNA: histopathological and immunohistochemical analysis revealed differentiated carcinoma cells of endometrial origin. No neoadjuvant treatment was planned and low rectal anterior resection with protective colostomy was performed; histology confirmed rectal lesion as metastasis from endometrial carcinoma. Recurrence of early stage endometrial carcinoma after a long period from primary surgery is possible. It is important to keep in mind this possibility in order to set a correct diagnostic and therapeutic algorithm, including preoperative immunohistochemical staining, and to plan a prolonged follow-up program.

Regio- and conformational isomerization are fundamental in chemistry, with profound effects upon physical properties, however their role in excited state properties is less developed. Here two regioisomers of bis(10H-phenothiazin-10-yl)dibenzo[b,d]thiophene-S,S-dioxide, a donor–acceptor–donor (D–A–D) thermally-activated delayed fluorescence (TADF) emitter, are studied. 2,8-bis(10H-phenothiazin-10-yl)dibenzo[b,d]thiophene-S,S-dioxide exhibits only one quasi-equatorial conformer on both donor sites, with charge-transfer (CT) emission close to the local triplet state leading to efficient TADF via spin-vibronic coupling. However, 3,7-bis(10H-phenothiazin-10-yl)dibenzo[b,d]thiophene-S,S-dioxide displays both a quasi-equatorial CT state and a higher-energy quasi-axial CT state. No TADF is observed in the quasi-axial CT emission. These two CT states link directly to the two folded conformers of phenothiazine. The presence of the low-lying local triplet state of the axial conformer also means that this quasi-axial CT is an effective loss pathway both photophysically and in devices. Importantly, donors or acceptors with more than one conformer have negative repercussions for TADF in organic light-emitting diodes., The search for brighter emitting materials is essential to the development of OLED devices. Etherington et al. show how the presence of two regioisomers of a donor-acceptor-donor thermally-activated delayed fluorescence molecule affects the device efficiency, with one acting as a triplet quencher.

Optical properties of self-assembled quantum dots (SAQDs) samples were investigated through photoluminescence (PL) with variation of temperature and excitation density. Two types of InAs SAQDs were studied: dots grown directly on GaAs, and dots grown inside an InGaAs quantum well, heterostructure known as dot-in-a-well (DWELL). The QDs structures were produced through conventional growth (with several deposition rates) as well as through pulsed growth mode, which consists in deposition cycles with growth interruption intervals. In the samples of QDs grown on GaAs, two PL peaks were identified and their behavior as a function of temperature can be explained by taking into account a bimodal distribution of dot sizes. For the DWELL sample only one PL peak was identified, which was assigned to the emission of the ground state of QDs belonging to a larger Gaussian distribution of dot sizes. SAQDs samples showed an anomalous behavior of the peak energy, integrated intensity and linewidth (FWHM) of the PL signal, as a function of temperature. To explain the observed results, a model was proposed that takes into account the size distribution of dots and the excited state emission of the family of larger dots. The QDs can be distributed in a bimodal size distribution, and the emission from the excited state can be observed, or not, depending on the growth conditions and on the potential profile of the dot. Such aspects can be combined to explain several peculiarities of the PL spectra observed in this and other published papers on SAQDs optical properties.

Background: The purpose of this study was to evaluate safety and efficacy of a new esophagojejunal anastomosis (EJA) technique allowing the insertion of the anvil of a common circular stapler without hand-sewn securing. Methods: From August 2014 to May 2015, 20 consecutive patients with esophagogastric junction adenocarcinoma underwent surgery. EJA was performed using a new technique; the free margins of the esophageal stump were suspended and the anvil of a circular stapler on a new dedicated and registered support bar (characterized by a push-rod making possible to hook-unhook the anvil of the circular stapler) was inserted into the lumen. Subsequently, the linear suturing stapler was closed over the bar and fired to suture the distal stump of the esophagus; the bar was retracted and the push-rod of the anvil was pulled out through the linear suture. Finally, the anastomosis was performed using a circular stapler. Results: There were no intraoperative complications, and R0 resection was achieved in all cases. Postoperative course has been uneventful for 18 patients (90%). Only 1 patient (5%) developed fistula, conservatively treated. Conclusions: Our preliminary clinical experience suggested that this technique was safe and efficient (for all online suppl. material, see www.karger.com/doi/10.1159/000446856).

With the idea that a small diameter stapler should cause less sphincter trauma, we began to use the 25mm circular stapler to perform ileo-pouch-anal anastomosis (IPAA) and we report our experience.A retrospective study using a bowel function questionnaire and a quality of life questionnaire has been conducted on a group of patients who underwent IPAA using a 25mm staplerWe performed IPAA using a 25mm circular stapler in 37 patients. Postoperative mortality was nil and morbidity was 27%. One anastomotic stenosis occurred. Long term follow-up information was available on 28 patients. Mean follow-up was 70 months (range 8-177). Mean number of bowel movements was 4.5 (range 2-10, median 4.5) during the day and 0.9 (range 0-10, median 0) at night. Out of 28 patients, 19 (68%) were fully continent and 32% had occasional soiling, no one reported incontinence. All patients except one were able to withold their stool for more than 15 minutes. Daytime pad use was: never 86%, occasionally 3%, frequently 11%; nightime pas use was never 86%, occasionally 7% and frequently 7%. Bowel regulating drugs use was never 82%, occasionally 14%, regularly 4%. Evacuation difficulties were: never 75%, occasionally 21%, frequently 4%.Our results compare favourably with the literature, which reports median bowel frequency 6-7.6/24h, 9.4- 33% urgency, 17-44% daytime soiling and 32-61% nighttime soiling.Our results must be considered preliminary but we found the 25-mm stapler safe and adequate to perform IPAA.IPAA, Ulcerative Colitis, Stapler, Function.Il diametro più appropriato per la suturatrice circolare usata per confezionare l’anastomosi ileo-pouch-anale, durante la proctocolectomia conservativa per colite ulcerosa, non è mai stato stabilito con sicurezza. Poiché uno dei problemi della proctocolectomia conservativa è l’incontinenza, l’uso di una suturatrice da 25mm, quindi di piccolo diametro, ha un forte razionale, perché essa traumatizza meno lo sfintere anale; inoltre i pazienti evacuano materiale fecale liquido o semiformato e non feci solide, pertanto un minore diametro dell’anastomosi potrebbe essere vantaggioso. Abbiamo quindi deciso di valutare i risultati clinici e funzionali di una serie di pazienti affetti da Colite Ulcerosa e sottoposti a proctocolectomia conservativa utilizzando una suturatrice circolare da 25mm PAZIENTI E METODI: Si tratta di uno studio retrospettivo osservazionale. Da giugno 1999 a ottobre 2013 globalmente 37 pazienti affetti da Colite Ulcerosa sono stati sottoposti a proctocolectomia conservativa con con pouch a J, utilizzando una suturatrice circolare da 25mm per l’anastomosi ileo-anale. Una ileostomia di protezione è stata confezionata in tutti i casi e chiusa, previa ileo-pouch-grafia e defecografia con mezzo di contrasto idrosolubile, dopo almeno 3 mesi. I pazienti sono stati regolarmente seguiti in ambulatorio ed una esplorazione digitale dell’anastomosi è stata eseguita almeno una volta al mese. Le caratteristiche dei pazienti e i dati di morbilità sono stati ricavati da un database chirurgico gestito prospetticamente. A tutti i pazienti, con pouch funzionante e raggiungibili telefonicamente è stato somministrato un questionario di 9 domande: numero medio di evacuazioni diurne, numero medio di evacuazioni notturne, frequenza di episodi di incontinenza, uso di un pannolino di giorno, uso di un pannolino di notte, uso di farmaci antidiarroici, eventuali difficoltà ad evacuare, capacità di posporre la defecazione di 15 minuti ed infine se la funzione intestinale interferiva con le attività quotidiane. È stato poi anche somministrato il questionario sulla qualità di vita Cleveland Global Quality of Life (CGQL): a tre domande su qualità della vita, qualità della salute e livello di energia il paziente doveva dare un voto da 0 a 10 (essendo 10 il meglio) e la somma dei voti divisa 30 dava il punteggio CGQL, compreso tra 0 e 1.In totale 37 pazienti sono stati sottoposti a proctocolectomia conservativa utilizzando una suturatrice circolare da 25mm. Non vi è stata mortalità operatoria. Si sono verificate 10 complicanze postoperatorie a 30 giorni (morbilità 27%): 5 complicanze settiche perianastomotiche, 3 risolte in modo conservativo, una con il reintervento mentre nel quinto caso è stata necessaria l’excisione della pouch, e 5 episodi di emorragia dalla pouch, risolti con terapia conservativa e trasfusioni. Alla ileografia-defecografia di controllo sono state diagnosticate due fistole anastomotiche asintomatiche, che si sono definitivamente risolte con terapia conservativa, permettendo la chiusura dell’ileostomia. Abbiamo avuto un solo caso di stenosi anastomotica, in un paziente che non si era presentato agli appuntamenti ambulatoriali, che si è definitivamente risolto con una sola dilatazione in anestesia spinale. Nel lungo termine tre altre pouch sono state rimosse, due per pouchite refrattaria e una per displasia di alto grado, una paziente è deceduta per colangiocarcinoma, tre pazienti sono stati persi al follow-up e una è stata esclusa perché la stomia era stata chiusa da meno di un mese. Pertanto informazioni dai questionari sulla funzione anale e sulla qualità di vita hanno potuto essere raccolte su 28 pazienti. Il follow-up mediano è stato di 70 mesi (8- 117). Il numero medio di evacuazioni era 4,5 (range 2- 10, mediana 4,5) di giorno e 0,9 (0-10, mediana 0) di notte. Sui 18 pazienti, 19 (68%) erano completamente continenti e 9 (32%) avevano perdite fecali occasionali, nessun paziente era incontinente. Tutti i pazienti tranne uno erano in grado di ritardare la defecazione di almeno 15 minuti. Per l’uso di pannolino di giorno le risposte sono state: mai 86%, occasionalmente 3%, frequentemente 11%; per l’uso di pannolino di notte; mai 86%, occasionalmente 7%, frequentemente 7%. Farmaci antidiarroici non erano mai usati dall’82%, occasionalmente dal 14% e regolarmente dal 4%. Difficoltà nell’evacuazione non era mai sperimentata dal 75% dei pazienti, occasionalmente dal 21% e frequentemente dal 4%. Il punteggio di qualità di vita CQLS è risultato 0,76 (0.47 – 1, mediana 0,77). COMMENTI E CONCLUSIONE. È probabile che la funzione anale della proctocolectomia conservativa per Colite Ulcerosa sia migliore se l’anastomosi ileo-anale è eseguita con la suturatrice meccanica circolare, ma quale diametro di suturatrice convenga usare, tra i vari disponibili (25mm, 28mm, 29mm, 31mm, 33mm) non è chiaro e anche in letteratura vi sono solo tre studi comparativi, su pochi pazienti e con risultati contradditori. L’uso della suturatrice da 25mm è supportato da un forte razionale. Innanzitutto in un intervento dove uno dei rischi principali è l’incontinenza, minore è il diametro della suturatrice, minore è il trauma sullo sfintere durante la sua introduzione transanale ed è molto discutibile che il diametro di una anastomosi colo-anale, attraversata da feci solide, debba essere uguale a quello di un’anastomosi ileo-anale, attraversata da materiale liquido o al massimo semi-formato. Vantaggi addizionali di una suturatrice di minor diametro, almeno in linea teorica, sono un minor trauma sull’estremità della pouch e soprattutto un minor rischio di intrappolare la parete vaginale durante la chiusura dello strumento. Inoltre se l’anastomosi è veramente sul canale anale, come sempre dovrebbe essere, usando la tecnica del “double-stapling”, è molto facile che la suturatrice circolare introdotta dall’ano, spesso da un giovane membro dell’équipe operatoria, sfondi la sutura lineare che chiude l’apice del canale anale: con una suturatrice piccola, il rischio è minore. Il maggior rischio teorico di stenosi, suggerito da alcuni ma negato da altri, nel nostro caso si è rivelato basso, purché i pazienti siano visitati regolarmente nel postoperatorio. La nostra casistica è ridotta e non siamo in grado di presentare una serie comparativa di pazienti operati con una suturatrice di diverso diametro, ma i risultati funzionali, confrontati con la letteratura, sono buoni e siamo convinti che l’uso di una suturatrice meno traumatizzante abbia contribuito a conservare una buona funzione sfinterica.

Pancreaticoduodenectomy is still associated to high morbility, especially due to pancreatic surgery related and infectious complications: many risk factors have already been advocated. Aim of this study is to evaluate the role of preoperative oral immunonutrition in well nourished patients scheduled for pancreaticoduodenectomy.From February 2014 to June 2015, 54 well nourished patients undergoing pancreaticoduodenectomy were enrolled for 5 days preoperative oral immunonutrition. A series of consecutive patients submitted to the same intervention in the same department, with preoperative standard oral diet, was matched 1:1. For analysis demographic, pathological and surgical variables were considered. Mortality rate, overall postoperative morbility, pancreatic fistula, post pancreatectomy haemorrhage, delayed gastric emptying, infectious complications and length of hospital stay were described for each groups. Chi squared test, Fisher's Exact test and Student's T test were used for comparison. Differences were considered statistically significant at p 0.05. Statistics was performed using a freeware Microsoft Excel (®) based program and SPSS v 10.00.No statistical differences in term of mortality (2.1% in each groups) and overall morbility rate (41.6% vs 47.9%) occurred between the groups as well as for pancreatic surgery related complications. Conversely, statistical differences were found for infectious complications (22.9% vs 43.7%, p = 0.034) and length of hospital stay (18.3 ± 6.8 days vs 21.7 ± 8.3, p = 0.035) in immunonutrition group.Preoperative oral immunonutrition is effective for well nourished patients scheduled for pancreaticoduodenectomy; it helps to reduce the risk of postoperative infectious complications and length of hospital stays.

This work analyses the potential consequences of two tsunami scenarios and their impacts on an oil refinery located in Sicily. Two credible tsunamis originating in the Tyrrhenian Sea were selected based on historical data. The potential for damage and hazardous materials releases resulting from the tsunami impacts to a refinery was assessed. The results obtained by the JRC tsunami propagation and inundation code HyFlux2 indicate that in both scenarios there would be eighteen storage tanks (of 43 located within 400 m from the shoreline) at the refinery subject to flooding. Water flow velocities were found to be generally low

Pyogenic abscesses in grafts after liver transplantation (LT) are observed in 0.5% to 1% of patients, with mortality rates up to 45%. Predisposing factors are hepatic artery thrombosis, presence of hepaticojejunostomy, biliary obstruction, ascendant cholangitis, bacteremia, and percutaneous procedures (liver biopsy and biliary drainage). Therapeutic options include antibiotics, immunosuppression withdrawal, percutaneous or surgical drainage, liver resection, and retransplantation. However, in extreme situations, treatments can fail and retransplantation can be contraindicated because of sepsis, a complex surgical history, or both. In this setting, a salvage approach to abscesses located in the right hepatic area was devised, inspired by the open window thoracostomy described by Clagett in 1963 for postpneumonectomy empyema. Similar to the Clagett procedure, the so-called open window hepatostomy (OWH) is based on transthoracic surgical drainage of the septic cavity and secondary wound healing. With over 1820 consecutive LT procedures performed from 1990 to 2008, the technique was applied in only 3 cases (0.2%), always resulting in control of infection and preservation of life. Repeated dressings and further interventions were needed without exception because an external biliary fistula invariably appeared. Complete skin closure was obtained in 2 cases in 12 years and 7 months, respectively. The most recent patient, whose case is illustrated here, is now at an advanced stage of the healing process. CASE REPORT

Remedial biliary surgery most often entails a Roux-en-Y hepaticojejunostomy. Sometimes the duct wall at the porta hepatis has been so damaged by inflammatory changes that the postoperative external drainage of bile away from a biliodigestive suture at risk of dehiscence is advisable. A technique of intraoperative placement of transparietohepatic biliary drainage was devised. The maneuver implies retrograde cannulation of a major intrahepatic duct with a vascular irrigation needle that is pushed to create the transhepatic path. Of 220 remedial hepaticojejunostomies performed in 211 patients (including 151 liver transplant recipients), the technique was applied in 49 (22%) of the most difficult cases in which the preoperative radiologic approach to the biliary tree had failed, was unsafe, or was unfeasible. The only major complication was a parenchymal tear needing perihepatic packing when the maneuver was performed too early after liver transplantation. Postoperative biliary fistula occurred in 2 patients (4%) and access to the biliary tract for percutaneous bilioplasty was provided in the short-term follow-up evaluation of 14 patients (29%).

Distal pancreatectomies (DP) are associated with high risk of postoperative complications, and in many series higher morbidity rate than duodenopancreatectomies has been reported. To evaluate the role of a collagen sponge with human fibrinogen and thrombin film (TachoSil®) in limiting the incidence of complications after DP.From 1996 to 2013, 221 patients have been submitted to distal pancreatectomy (± splenectomy) in our Division. A retrospective analysis has been conducted in a group of 36 consecutive and prospectively collected DP treated with intraoperative placement of TachoSil® on pancreatic stump from 2010 to 2013 (group 1). A control series of 36 consecutive patients (group 2) was matched 1:1 from hystorical database. The variables considered in the analysis were: age, gender, ASA score, pancreatic texture (hard vs. soft), histology, operative time, postoperative mortality, morbility (postoperative pancreatic fistula - POPF, postoperative hemorrage - PPH, delayed gastric emptying - DGE) and hospital stay. Differences between POPF, PPH, DGE and hospital stays between grops were investigated with χ² and t-Student test. Univariate analysis was conducted to determine factors related to POPF development. Statistical analysis was performed using freeware Microsoft Excel based program.Post operative mortality was 0% in both groups. POPF were registered in 36.1% (13/36) and 41.6 % (15/36) in groups 1 and 2, respectively (P=n.s.); in group 1 we didn't observe grade C POPF, while 4 patients in control group developed grade C POPF (P0,05). No differences were found between two groups in terms of incidence of PPH and DGE. The median duration of postoperative hospital stay in group 1 was 21.8 (7-189) days compared with 31.13 (9-249) days in group 2 (P0.001).The use of TachoSil® seems to be associated with lower incidence of grade C POPF but larger controlled trials are needed to surely assess the usefulness of TachoSil® in pancreatic surgery in order to reduce pancreatic specific complications and their severity.

Donor intra-islet endothelial cells contribute to neovascularization after transplantation. Several factors may interfere with this process and ultimately influence islet engraftment. Rapamycin, a central immunosuppressant in islet transplantation, is an mTOR inhibitor that has been shown to inhibit cancer angiogenesis. The aim of this study was to evaluate the effects of rapamycin on islet endothelium. Rapamycin inhibited the outgrowth of endothelial cells from freshly purified human islets and the formation of capillary-like structures in vitro and in vivo after subcutaneous injection within Matrigel plugs into SCID mice. Rapamycin decreased migration, proliferation and angiogenic properties of human and mouse islet-derived endothelial cell lines with appearance of apoptosis. The expression of angiogenesis-related factors VEGF, alphaVbeta3 integrin and thrombospondin-1 on islet endothelium was altered in the presence of rapamycin. On the other hand, rapamycin decreased the surface expression of molecules involved in immune processes such as ICAM-1 and CD40 and reduced the adhesion of T cells to islet endothelium. Our results suggest that rapamycin exerts dual effects on islet endothelium inducing a simultaneous inhibition of angiogenesis and a down-regulation of receptors involved in lymphocyte adhesion and activation.

This paper summarizes the cumulative work undertaken in the frame of the EU shared-cost action “ASTAR Project”—the current status and future perspectives in the field of advanced numerical simulation of three-dimensional two-phase flow processes. This 3-year running project, which started in September 2000, involves seven partner institutes from around Europe. Specific emphasis is given to the further development of characteristic-based upwind differencing (also called “hyperbolic”) numerical methods and their application to transient two-phase flow. The paper summarizes the common basis adopted for the physical and mathematical modelling of two-phase flow in the form of a single-pressure “two-fluid” model and the various numerical solution techniques developed by the partners. Several benchmark exercises are presented which have been used as verification and assessment procedures for comparing the different modelling and numerical approaches. Comments on the suitability, accuracy, numerical stability, algorithmic robustness and computational efficiency serve as indicators for the possible extension of these methods to future code development activities. Two further tasks of the ASTAR project dealt with the production of high quality experimental field data in the LINX facility of PSI, for the validation of CFD models for two-phase bubbly flow, and the coupling of a two-phase CFD module with a system code. Details of these tasks have been published separately, and will not be recalled in this paper.

The scarcity of liver donors requires consideration of grafts from sources not previously used. Allografts from hepatitis B surface antigen (HBsAg)-carriers without a significant liver disease have been proposed for liver transplant recipients with hepatitis B virus (HBV)-related cirrhosis and hepatocellular carcinoma (HCC). Combination prophylaxis schemes against HBV post-liver transplantation (LT) recurrence are currently available; the efficacy of those schemes in HBV-related cirrhosis and HCC must be assessed. This report describes the allocation of HBsAg-positive grafts in three HBsAg-positive recipients, with HBV-related cirrhosis and evolving HCC lesions, two of them with hepatitis Delta virus (HDV) coinfection. Patients were administered anti-hepatitis B immunoglobulins (HBIGs) and lamivudine in order to prevent HBV recurrence. In spite of anti-HBV prophylaxis, HBV infection did persist after LT in all patients (no serum clearance of HBsAg). HBV replication assessed by serum HBV deoxyribonucleic acid (DNA) presence was detected in the first month after LT in the 3 recipients. A prompt HDV reinfection with a clinical and histological pattern of hepatitis was observed in the 2 HBV / HDV coinfected recipients. In 1 of them, an evolving chronic hepatitis required a second LT. The non-HDV-infected patient showed an uneventful follow-up, but the lack of the neutralizing effect of HBIGs and the high risk of escape mutants forced the addition of adefovir-dipivoxil to lamivudine, in order to prevent viral variants and hepatitis recurrence. In conclusion, allografts from HBsAg-positive donors in HBsAg-positive recipients are associated with the persistence of the HBsAg after LT due to the failure of HBIG prophylaxis, even if lamivudine does inhibit virion production. This condition favors HDV replication and HDV hepatitis recurrence in coinfected patients. The allocation of HBsAg-positive grafts in HBsAg-positive recipients could be justified only in recipients without HDV coinfection and a combined prophylaxis with lamivudine and adefovir-dipivoxil is currently the best way to manage escape mutants in these recipients.

The combination of lamivudine and hepatitis B immunoglobulin (HBIG) reduces the risk of hepatitis B virus (HBV) recurrence after liver transplantation (LT). However, the efficacy of this strategy and the need for combined therapy with adefovir dipivoxil (ADV) in patients who select lamivudine-resistant strains (YMDD) before surgery is still unknown. Twenty-two patients treated with lamivudine (LAM) who underwent LT after YMDD-mutant selection were studied. In 13 patients, YMDD mutants were associated with an HBV DNA breakthrough greater than 5 log10 (group A: phenotypic resistance), and 11 were treated with ADV to decrease viral load before LT. In the remaining 9 patients who did not experience the viral breakthrough, YMDD mutants were detected only retrospectively in sera stored at the time of LT (group B: genotypic resistance). During 35 months of post-LT follow-up, none of the 11 patients of group A treated with ADV before and after surgery (in addition to HBIG and LAM) had HBV recurrence, and neither did any of the 7 subjects of group B treated with LAM before and after transplantation (in addition to HBIG). HBV recurred in 2 patients of group A (untreated with ADV before surgery and transplanted with an HBV DNA exceeding 5 log10) and in 2 subjects of group B (who spontaneously stopped HBIG after surgery). In carriers of YMDD mutants, the risk of post-LT HBV recurrence is low, provided that preemptive and prophylactic ADV (in addition to LAM and HBIG) treatment is used in highly viremic patients and prophylactic LAM (or ADV) and HBIG therapy is continued in low viremic patients.

Occult Hepatitis B virus (o-HBV) infection has been reported in HB surface antigen (HBsAg)-negative liver donors whose risk of transmitting HBV justifies a specific prophylaxis in liver recipients. The clinical significance of o-HBV infection in HBsAg-negative recipients and their need for prophylaxis is unknown. Liver samples collected during surgery from 23 HBsAg-negative patients (9 liver donors and 14 recipients) and 20 HBsAg-positive recipients (controls) were studied by polymerase chain reaction with an independent set of primers mapping the core and surface HBV genes. Intrahepatic HBV DNA was detected as core and surface genes in all the HBsAg-positive recipients, in none of the HBsAg-negative donors and in 9/14 (64%) of the HBsAg-negative recipients (2 HCV negative, 7 HCV positive). The intrahepatic amount of HBV was significantly lower in HBsAg-negative than in HBsAg-positive livers (median values 1.36 Log10/μg DNA vs. 3.66 Logs, p

Highlights • Diagnostic algorithm for pancreatic head mass. • Differential diagnosis between pancreatic cancer and mass forming autoimmune pancreatitis. • Diagnosis and treatment of IgG4-related systemic disease., INTRODUCTION Autoimmune pancreatitis (AIP) is a rare pancreatic disorder among chronic pancreatitis that can mimick pancreatic cancer (PC). Patients with type 1 AIP usually present obstructive jaundice associated with high level of IgG4 in serum and a pancreatic mass at radiological imaging; these disorders may be associated with other organs lesions presenting the same histopathological features, and in these cases AIP should be considered a pancreatic localization of an IgG4-related systemic disease. PRESENTATION OF CASE We report the case of a young man with initial suspect of PC to be treated with surgery, and final diagnosis of AIP in the context of an IgG4-related systemic disease. DISCUSSION Because of its similar features, several algorithms have been proposed for AIP diagnosis, based on combination of clinical/serological and radiological criteria. However, histology represents the only way to obtain definitive diagnosis, even if sometimes it is difficult to obtain biological samples. CONCLUSION IgG4-related systemic disease must be taken into account among differential diagnosis during the workup for PC, in order to avoid unnecessary surgery.

The influence of steatosis and of other donor and recipient characteristics in affecting liver performance post-orthotopic liver transplantation (OLT) was evaluated in 311 consecutive liver transplantations made in 278 patients. Donor variables considered were age, sex, blood group, cause of death, intensive care unit (ICU) days, need for vasopressors, hepatic enzymes and bilirubin, total and warm ischemia time, and macro- and microvescicular steatosis. Recipient variables considered were age, sex, blood group, biliary output, and post-OLT peak levels of hepatic enzymes. Patient and graft survival were the main outcome indicators. In the multivariate analysis, macrovescicular steatosis involving 25% or more of the hepatocytes was the only variable independently associated with shorter patient survival (p < 0.05). Five (62.5%) of the eight livers with macrovescicular steatosis involving 25% or more of the hepatocytes incurred in a delayed non-function (DNF) and one (12.5%) in a primary non-function (PRNF). The incidence of DNF and PRNF in the group with macrovescicular steatosis involving less than 25% of the liver cells was 1.6% (p < 0.001) and 2.3%, respectively. Microvescicular steatosis of any degree was not associated with a worse prognosis. Macrovescicular steatosis involving 25% or more of the hepatocytes identifies marginal livers, the use of which significantly increases the risk of graft non-function post-OLT.

The aim of this preliminary study was to determine specific proteins, related to inflammation process and nutritional status as well as to total antioxidant capacity, in children suffering from cystic fibrosis (CF). The study was performed on 17 nonhospitalized children (12 boys and 5 girls) with CF aged 3 months to 10 years, who were assisted at the Nutrition Service from Pedro de Elizalde Hospital. Transferrin, transthyretin, ceruloplasmin (Cp), haptoglobin, C-reactive protein (CRP) and fibrinogen were measured by single radial immunodiffusion techniques. Total antioxidant capacity (TAC) was determined by a decolorization assay. Statistical analyses were performed by the Student's t test. Transferrin and transthyretin values were lower in CF patients in comparison with data obtained from healthy children (reference group, RG). The decreased transferrin concentration and the tendency towards low plasma transthyretin values suggested an abnormal nutritional status. However, higher Cp and haptoglobin levels were shown in patients than in RG. The fact that 23 and 50% of patients exceeded the desirable values for fibrinogen (M; Trolox equivalents) was shown to be lower in the CF group than in RG. The diminished TAC concomitant with an increased plasma Cp concentration would exacerbate the inflammatory status and could explain the depression of the immune system. These preliminary results could explain the need to include biochemical and functional parameters in the early nutritional status evaluation in CF patients in order to use appropriate nutritional and pharmacological therapies and consequently to improve their survival and quality of life.

HLA-G is an effective ligand of natural killer (NK) inhibitory receptors, HLA-G transcripts have been detected in several human tumors, and cytokines like gamma interferon (IFN) enable HLA-G molecules to be expressed. These findings are particularly upsetting in case of melanomas: IFN treatment is frequently included in melanoma therapeutic protocols, and downregulation of classical class I molecules occurs in nearly half of these tumors. Therefore, a melanoma cell downregulating classical class I and de novo expressing HLA-G, either constitutively or upon IFN treatment, is probably a stealthy target for the immune system, having inhibited both the cytotoxic T lymphocyte (CTL) and the NK activity. To elucidate this point we have investigated the expression of HLA-G molecules in 45 melanoma cell lines before and after gammaIFN treatment. Analysis was performed by immunofluorescence and flow cytometry, using the anti-HLA-G MoAbs 87G and G233, by Western blot, using the anti-HLA-G MEM/G1 MoAb and PAG1 antiserum, and by RT-PCR analysis. In addition, 8 melanoma tissues from patients free from therapy and 6 nevi were studied by immunohistochemistry using the 87G MoAb. No evidence was gathered of HLA-G expression, neither constitutive nor, in cell lines, after gammaIFN treatment. We therefore conclude that HLA-G expression is an uncommon event in melanomas, and that a therapy including IFNs cannot harm the patient by inducing the de novo expression of HLA-G molecules at least in its G1 isoform.

In the last years several numerical codes have been developed to analyse tsunami waves. Most of these codes use a finite difference numerical approach giving good results for tsunami wave propagation, but with limitations in modelling inundation processes. The HyFlux2 model has been developed to simulate inundation scenario due to dam break, flash flood and tsunami-wave run-up. The model solves the conservative form of the two-dimensional shallow water equations using a finite volume method. The implementation of a shoreline-tracking method provides reliable results. HyFlux2 robustness has been tested using several tsunami events. The main aim of this study is code validation by means of comparing different code results with available measurements. Another objective of the study is to evaluate how the different fault models could generate different results that should be considered for coastal planning. Several simulations have been performed to compare HyFlux2 code with SWAN-JRC code and the TUNAMI-N2. HyFlux2 has been validated taking advantage of the extensive seismic, geodetic measurements and post-tsunami field surveys performed after the Nias March 28th tsunami. Although more detailed shallow bathymetry is needed to assess the inundation, diverse results in the wave heights have been revealed when comparing the different fault mechanism. Many challenges still exist for tsunami researchers especially when concern to early warning systems as shown in this Nias March 28th tsunami.

Aim of the study was to consider the diagnostic accuracy of galectine-3 (GAL3) in the pre-operative cytological evaluation of follicular lesions. Materials and methods: We retrospectively evaluated 100 patients suffering from thyroid nodular disease submitted to thyroidectomy from 2006 to 2007 in our Institution. Before surgery all patients underwent fine needle aspiration biopsy. The immunocytochemical analysis was performed on fine needle aspiration specimens using species-specific monoclonal antibodies and a biotin-free detection system. Based on preoperative cytological reports, 40 patients had pre-operative malignant results, and 60 patients (46 females and 14 males) showed follicular lesions. The sensitivity, specificity, positive and negative predictive values, and diagnostic accuracy of GAL3 was evaluated. Statistical analysis: Chisquare test was used to compare frequencies of GAL3 expression between the different hystopathological groups. Results: GAL3 proved to have 55% sensitivity, 100% specificity, 70% negative predictive value, and 78% diagnostic accuracy. The GAL3 expression in neoplastic and benign lesions was significantly different (GAL3+ in 16 out of 29 neoplastic lesions, GAL3+ 0 out of 31 benign lesions, p

The HyFlux2 model has been developed to simulate severe inundation scenario due to dam break, flash flood and tsunami-wave run-up. The model solves the conservative form of the two-dimensional shallow water equations using the finite volume method. The interface flux is computed by a Flux Vector Splitting method for shallow water equations based on a Godunov-type approach. A second-order scheme is applied to the water surface level and velocity, providing results with high accuracy and assuring the balance between fluxes and sources also for complex bathymetry and topography. Physical models are included to deal with bottom steps and shorelines. The second-order scheme together with the shoreline-tracking method and the implicit source term treatment makes the model well balanced in respect to mass and momentum conservation laws, providing reliable and robust results. The developed model is validated in this paper with a 2D numerical test case and with the Okushiri tsunami run up problem. It is shown that the HyFlux2 model is able to model inundation problems, with a satisfactory prediction of the major flow characteristics such as water depth, water velocity, flood extent, and flood-wave arrival time. The results provided by the model are of great importance for the risk assessment and management. Copyright © 2009 John Wiley & Sons, Ltd.

Performances of the new automatic system COBAS AmpliPrep/COBAS TaqMan 48 (CAP/CTM) (Roche, Branchburg, NJ) for HBV DNA extraction and real-time PCR quantification were assessed and compared with the endpoint PCR COBAS AMPLICOR HBV Monitor (CAHBM, Roche). Analytical evaluation with proficiency panels from UK National External Quality Assessment Scheme (UK NEQAS) over a 1-year period of distribution showed that CAP/CTM correctly measured HBV DNA levels with a close correlation between expected and observed values (r=0.995). Clinical evaluation as tested with samples from 11 HBsAg-positive patients undergoing antiviral therapy (71 serial specimens of plasma), demonstrated excellent correlation with CAHBM (r=0.958, mean difference in quantitation: 0.14 log, IU/ml), but CAP/CTM detected longer period of residual viremia. HBV DNA reduction was much higher in the combination schedule (Lamivudine+Adefovir), than in Adefovir monotherapy (5.1 vs. 3.5 logs). In conclusion, CAP/CTM allows for an accurate and standardized quantification of HBV DNA in high through-put laboratories. Due to it high sensitivity, it may further improve the detection of emerging drug resistance strains and the assessment of antiviral therapy.

Success of antiviral therapy for chronic hepatitis B is supported by highly sensitive PCR-based assays for Hepatitis B virus (HBV) DNA. Nucleic acid extraction from biologic specimens is technically demanding and reliable PCR results depend it. Performances of the fully automatic system COBAS AmpliPrep™/COBAS TaqMan™ 48 (CAP/CTM) (Roche, Branchburg, NJ) for HBV DNA extraction and real -time PCR quantification were assessed and compared with the end-point PCR COBAS AMPLICOR HBV Monitor (CAHBM, Roche). Analytical evaluation with a proficiency panel showed that CAP/CTM quantitated HBV DNA levels in one single run over a wide dynamic range (7 logs) with a close correlation between expected and observed values (r=0.976, interassay variability below 5%). Clinical evaluation as tested with samples from 92 HBsAg-positive patients, demonstrated excellent correlation with CAHBM (r=0.966, mean difference in quantitation: 0.36 log10 IU/ml). CAP/CTM detected 10% more viremic patients and longer period of residual viremia in those on therapy. In lamivudine (LAM)-resistant patients, reduction of HBV DNA after 12 months of Adefovir (ADF) was higher in the combination (LAM+ADF) schedule than in ADF monotherapy (5.1 vs. 3.5 logs) suggesting a benefit in continuing LAM. In conclusion,CAP/CTM can improve the management of HBV infection, the assessment of antiviral therapy and drug resistance, supporting further insights in the emerging area of drug resistance.

Successful pre-emptive anti-cytomegalovirus (CMV) therapy relies on sensitive, specific and reproducible tests for CMV detection. Real-time polymerase chain reaction (PCR) for CMV-DNA provides a superior reproducibility and sensitivity than pp65-antigenemia. Evaluation of a novel commercial real-time PCR for CMV-DNA associated with a fully automated DNA extraction from whole blood (WB) was performed, studying the correlation with pp65-antigenemia in guiding pre-emptive therapy. Analytical evaluation showed that PCR correctly quantitated CMV from 500 to 500,000copies/ml with a close correlation with expected values (r=0.999). Clinical evaluation on 375 consecutive WB samples from 48 infected patients (18 pre-emptively treated for pp65 values >/=50 positive cells) showed that according to pp65-antigenemia of 0, 1-10, 11-49 and >/=50 positive cells, median DNA levels were 3.7, 3.9, 4.6 and 5.6 log(10)copies/ml, respectively. According to existing pre-emptive treatment criteria based on pp65-antigenemia, receiver-operating curve analysis indicated 5.3log/ml (200,000genomes/ml) as the best CMV-DNA level to discriminate between patients requiring pre-emptive therapy and those who did not (positive predictive value: 91%; negative predictive value: 74%; sensitivity and specificity: 68 and 93%). In conclusion, real-time PCR provides reliable results for monitoring the developing of CMV infection, allowing for the definition of CMV-DNA thresholds associated with infection progress.

The polymerase chain reaction (PCR) for cytomegalovirus (CMV) DNA quantitation provides sensitive and specific data for detecting CMV as well as monitoring the infection and determining the appropriate antiviral strategy. A recently introduced real-time PCR assay for CMV DNA quantitation was applied on 158 peripheral blood leukocytes (PBLs) from 32 liver-transplanted patients with CMV asymptomatic infection and correlated with a commercial quantitative end-point PCR (COBAS AMPLICOR CMV Monitor) and CMV pp65 antigenemia. A good correlation was found between real-time PCR and pp65 antigen test (r2 = 0.691) and the two PCR assays (r2 = 0.761). Real-time PCR data were higher in pre-emptive treated patients (>20 pp65 + positive cells, median CMV DNA value: 3.8 log10 copies/500,000 PBLs) than in not-treated ones (2.9 logs). According to pp65 levels of 0, 1–10, 11–20, 21–50, 51–100, and >100 positive cells/200,000 PBLs, median CMV DNA by real-time PCR was 2.6, 3.0, 3.6, 4.0, 4.2, and 4.8 logs, respectively, (CMV DNA levels by COBAS AMPLICOR: 2.8, 2.9, 3.8, 3.7, 3.9, and 4.0 logs). For samples with >20 pp65 + cells, real-time PCR gave significantly higher values than in groups with

ERA-40 stands for ECMWF Re Analysis and refers to the rerun of the European Centre of Medium Range Weather Forecast (ECMWF) Numerical Weather Prediction (NWP) model for the period September 1957- August 2002 utilizing all state-of-the-art information and satellite data input presently available. From this dataset the top layer volumetric soil water is extracted and evaluated against surface moisture retrievals derived from the SMMR instrument on board the Nimbus-7 satellite for the European window. The evaluation of NWP model output with observed data is relevant to the initialization of land surface conditions in these models, which is important for accurate short term to long range meteorological and hydrological prediction. Because land surface parameters are highly integrated states, errors in land surface forcing, model physics and parameterization tend to accumulate in the land surface stores, such as soil moisture, of these models This has a direct effect on the model's water and energy balance calculations, and will eventually result in inaccurate weather predictions. It is expected that improved accuracy in defining initial conditions for NWPs along with continuous internal bias corrections for baseline data generated by uncoupled Land Surface Models (LSM), will lead to highly improved shortterm to long-range weather forecasting capability. Preliminary analysis presented here reveals the off set between the two data sets, although distinct, is relatively constant, which suggests a potential for improved initialization and bias correction by an optimized accuracy and spatial representation of the soil moisture data fields.

Aim Our goal was to evaluate the outcome of HCV(+) recipients after liver transplantation (LT) using HCV(+) donors and the interaction between donor and recipient viral strain. Methods We performed a retrospective analysis of 21 LT performed between 1998 and 2004 using livers from HCV(+) donors in HCV(+) recipients. Two hundred thirty-seven patients with HCV cirrhosis who underwent LT with livers from HCV(−) donors were the control group. Ishak score (IS) was evaluated for all HCV(+) grafts. The considered variables included donor age, hepatic enzymes, intensive care unit stay, HCV genotype, ischemia time, recipient age, UNOS status, Child score, HCV genotype (before and 6 months after LT) and IS (after LT). We analyzed patient, graft, and disease-free survival. Results HCV(+) donors were significantly older than HCV(−) donors. The cumulative 5-year patient and graft survivals and disease free intervals were not different between groups. IS grading was more than 2/18 in two cases; the only graft with a staging score over 2/6 was retransplanted for early nonfunction. In two cases, different HCV genotypes were matched and donor strain took over the recipient strain. In one patient, donor genotyping 2a-2c took over recipient genotyping 1b and 9 months after LT recurrent hepatitis was documented, but antiviral therapy cleared HCV. Conclusions Livers from HCV(+) donors can safely be used in HCV(+) recipients. Hepatic biopsy must always be performed; livers with bridging fibrosis should not be used. The takeover of one strain by another may change the prognosis of the patient if the predominant strain is more sensitive to antiviral therapy.

Aim. Calcineurin inhibitors (CI) are associated with significant morbidity in transplant recipients. The aim of this study was to evaluate the effectiveness and safety of mycophenolate mofetil (MMF) monotherapy in liver transplantation (LT). Methods. We analysed 32 patients (24 males, 8 female, of mean age 55.7 years) who underwent LT between 1994 and 2003. In 29 patients immunosuppressive therapy was cyclosporine; in three patients it was tacrolimus. Eleven patients were submitted for LT due to hepatitis B cirrhosis; eight for hepatitis C cirrhosis, six for alcoholic cirrhosis, and seven for other diseases. In these patients, MMF was added gradually, simultaneously reducing the dosage of CI up to complete withdrawal. We considered the efficacy (decrease in serum creatinine) and the incidence of complications (acute and chronic rejection, leukopenia, diarrhea). Results. Patients were converted to MMF after a median of 50 months after LT. MMF monotherapy was started after a median of 9 months in association with CI. Indications for switch to MMF monotherapy were adverse effects of CI (renal disfunction in 30 patients) and de novo tumoral evidence after LT in two patients. Median dosage of MMF was 750 mg twice daily (500-1500 mg). There was a statistically significant decrease in serum creatinine levels (2.02-1.7 mg/dL; P = .0001). Side effects were: leukopenia in five of 32 patients (15.6%), diarrhea in four of 32 patients (12.5%), and one acute rejection. Conclusion. MMF monotherapy improved renal function and was not associated with a significant risk of allograft rejection. Side effects were mild with dose regimens up to 750 mg twice daily.

Hepatitis B virus (HBV) recurrence after liver transplantation is significantly reduced by prophylaxis with hepatitis B immune globulins (HBIG) or antiviral drugs in nonreplicating patients and by the combination of both drugs in replicating patients. However, the load of HBV DNA, which defines replicating status in patients undergoing liver transplantation, remains unclear. This study analyzes the correlation between the viral load, tested with a single amplified assay, at the time of liver transplantation, and the risk of hepatitis B recurrence in 177 HBV carriers who underwent transplantation in a single center from 1990 to 2002. Overall, HBV relapsed after surgery in 15 patients (8.5%) with a 5- and 8-year actuarial rate of recurrence of 8% and 21%, respectively. After liver transplantation hepatitis B recurred in 9% of 98 selected subjects treated only with immune globulins and in 8% of 79 viremic patients who received immune globulins and lamivudine (P = NS). A linear correlation was observed between recurrence and viral load at the time of surgery. In transplant patients with HBV DNA higher than 100,000 copies/mL, 200-99,999 copies/mL, and DNA undetectable by amplified assay, hepatitis B recurred in 50%, 7.5%, and 0% of patients, respectively. Overall, a viral load higher than 100,000 copies/mL at the time of liver transplantation was significantly associated with hepatitis B recurrence (P = .0003). In conclusion, spontaneous or antiviral-induced HBV DNA viral load at the time of surgery classifies the risk of HBV recurrence after liver transplantation and indicates the best prophylaxis strategy.

ERA-40 stands for ECMWF Re Analysis and refers to the rerun of the European Centre of Medium Range Weather Forecast (ECMWF) Global Circulation model for the period September 1957- August 2002 utilizing all state-of-the-art information and satellite data input presently available. Here, a selection of the ERA-40 atmospheric output data at the surface is used to force the catchment hydrological model LISFLOOD to simulate historic river flows for the whole of Europe on a 5km grid resolution. Once evaluated against observed rainfall and point flow data, the output constitutes an extensive and coherent 40+ year database of pan-European calibrated river flow time series, providing a wealth of information and potential for a range of evaluation purposes. For example, statistical analyses could serve to detect flooding and/or drying frequency trends. Alternatively, the output dataset could be used to assess flood alert levels in a consistent and uniform manner at any point for any river in Europe. The set would also be extremely useful as a basis for scenario studies, investigating the impact of policy and decision making such as de/aforestation and water reservoir management on flow regimes. Further, in the context of the general scientific consensus of an expected increasing trend in extreme events, the database may serve as a resource of information for extrapolated future scenarios.

The ECMWF Re Analysis (ERA-40) refers to the rerun of the European Centre of Medium Range Weather Forecast (ECMWF) Numerical Weather Prediction (NWP) model for the period September 1957- August 2002 employing all state-of-the-art information and satellite data input presently available. A selection of the reanalysis atmospheric output data can potentially be used to run a hydrological model to simulate historic river flows for the whole of Europe. Once evaluated against observed time series of rainfall and river flow, the output would constitute an extensive and coherent 40+ year database of pan-European calibrated river flow time series, providing a wealth of information and allowing a range of evaluation possibilities. Here, in order to separate the meteorological model performance from the hydrological model performance, the ERA-40 near-surface rainfall aggregates, which come as a by-product of the ECMWF NWP system, are evaluated against interpolated fields of observed surface precipitation. The ERA-40 rainfall fields consist of forecast data with a 36 hr lead time at midday and midnight and a 6 hr lead time at 6:00 and 18:00 UTC, allowing different combinations of lead and base times to compute daily rainfall aggregates. The evaluation of these aggregated precipitation fields against observed totals is relevant to the spin-up time of the ECMWF NWP system and the forecast reliability with increasing lead time. Interpolated fields of observed daily rainfall totals are provided by the Monitoring Agriculture with Remote Sensing (MARS) database (1990-2001) based at the European Commission Joint Research Centre (JRC).

Occult Hepatitis B virus (o-HBV) infection has been reported in HB surface antigen (HBsAg)-negative liver donors whose risk of transmitting HBV justifies a specific prophylaxis in liver recipients. The clinical significance of o-HBV infection in HBsAg-negative recipients and their need for prophylaxis is unknown. Liver samples collected during surgery from 23 HBsAg-negative patients (9 liver donors and 14 recipients) and 20 HBsAg-positive recipients (controls) were studied by polymerase chain reaction with an independent set of primers mapping the core and surface HBV genes. Intrahepatic HBV DNA was detected as core and surface genes in all the HBsAg-positive recipients, in none of the HBsAg-negative donors and in 9/14 (64%) of the HBsAg-negative recipients (2 HCV negative, 7 HCV positive). The intrahepatic amount of HBV was significantly lower in HBsAg-negative than in HBsAg-positive livers (median values 1.36 Log(10)/microg DNA vs. 3.66 Logs, p0.0001, core gene, and 1.13 vs. 6.21 Logs p0.0001, surface gene). No HBV DNA was detected in plasma from o-HBV recipients; one of them tested positive in lymphocytes. No correlation was found between o-HBV and serologic markers of previous HBV exposure, response to vaccination, acute rejection, hepatitis D and G virus-infections. None of o-HBV carriers experienced a de novo hepatitis B after transplantation (median follow-up: 477 days). Occult HBV is frequent in HBsAg-negative liver recipients. It is not associated with increased episodes of acute rejection, coinfection with hepatotropic viruses, different responses to HBV vaccination, or the development of de-novo hepatitis B. In o-HBV infection a particular virus-host interaction can explain the low intrahepatic HBV content and the lack of extrahepatic HBV replication, thus justifying the low risk of hepatitis B reactivation, in absence of specific prophylaxis, once the recipient liver is removed.

Studies of the immunologic function in adult obese humans and experimental models indicate that excess adiposity is associated with impairments in host defense mechanisms. The aim of this work was to analyze the secretory and humoral immune system in obese children (n = 105, 55 boys, 50 girls ), between 6 and 13 years of age. Samples of non-stimulated saliva and whole blood were collected from fasting patients. Total salivary IgA (IgAsal), serum C3 complement (C3c) and Immunoglobulin A (IgA) were determined by quantitative radial immunodifussion on agar gel layers ( Diffu-plate, Biocienti;fica SA ). Results, expressed as mg/dl, were compared to laboratory reference values from healthy children of either sex in the same range of age that belong to the same socioeconomic class (n = 60). Data (Mean +/- 1 SD) of the whole population were: IgAsal: 11.4 +/- 4.8 vs 14.8 +/- 6.9; C3c: 190.7 +/- 53.1 vs 126.3 +/- 45.5; IgA: 194.5 +/- 101.5 vs 157.2 +/- 19.9. Data distribution showed higher frecuencies near the zone of the highest reference values for serum C3c; when results of IgA and IgAsal were expressed as percentage of the mean reference value, 51% and 48.6% of the whole studied population presented data lower than 100% and 75% respectively. These results show a compromised secretory immune system without incidence of clinical symptoms and infections, whereas humoral immunity might not be profoundly affected.

DURING ORTHOTOPIC human liver transplantation (OLT), postreperfusion tissue damage is associated with a significant increase in markers of cytolysis and cholestasis. In the early phases of reperfusion an increase in the steady-state levels of reactive oxygen species (ROS) was observed to correlate with the presence of cytolysis; nevertheless, the role of oxidative stress in causing and/or amplifying postreperfusion damage to human liver grafts has not as yet been conclusively defined. The topology and chronology of the damage in the transplanted liver may be described as an endothelial cell injury that appears in the late stage of cold ischemia, followed immediately after reperfusion by involvement of the whole liver vasculature with concomittant activation of Kupffer cells, which, together with endothelial cells, attract and trigger polymorphonuclear cells (PMNs), the major source of ROS. While oxidative stress occurring in the hepatic vasculature appears to be a primary cause of the reperfusion injury, the role of oxidative reactions in phagocyte recruitment and activation is not yet clear. Hence, patients scheduled for OLT in two different transplantation units were randomly divided into two groups: one group received an intravenous dose of an antioxidant supplement during surgery. During the first 2 hours of reperfusion, we monitored blood indices of oxidative stress and neutrophil activation. RECRUITMENT OF PATIENTS AND METHODS

Background. The risk of hepatic artery thrombosis after orthotopic liver transplantation is higher in cases of poor hepatic arterial inflow, small or anomalous recipient hepatic arteries, unsafe native hepatic arteries. Aims. To assess the use of arterial conduits as alternative technique for graft revascularization. Patients. At the Liver Transplant Center of the “sGiovanni Battista” Hospital in Torino, a review has been made of 600 consecutive orthotopic liver transplantations in 545 adult patients from 1990 to 1999. Methods. In 95 orthotopic liver transplantations (15.8%) in 88 patients, the graft was supplied by infrarenal conduit, while in 505 orthotopic liver transplantations (84.2%) in 457 patients, a direct anastomosis was used. Results and conclusions. The overall incidence of hepatic artery thrombosis in our series was 3.5% ( 21 600 ): 5.3% ( 5 91 ) for conduits and 3.2% ( 16 505 ) for standard technique (p=ns, χ test). The actuarial 5-year graft survival was 67.7% for conduits and 68.6% for the standard technique; p (log rank): ns. The iliac prosthesis torsion was the only complication related to the use of infrarenal iliac conduit. The arterial conduit, performed with donor iliac artery, is an effective and safe revascularization technique in patients at high risk of arterial thrombosis.

The influence of steatosis and of other donor and recipient characteristics in affecting liver performance post-orthotopic liver transplantation (OLT) was evaluated in 311 consecutive liver transplantations made in 278 patients. Donor variables considered were age, sex, blood group, cause of death, intensive care unit (ICU) days, need for vasopressors, hepatic enzymes and bilirubin, total and warm ischemia time, and macro- and microvescicular steatosis. Recipient variables considered were age, sex, blood group, biliary output, and post-OLT peak levels of hepatic enzymes. Patient and graft survival were the main outcome indicators. In the multivariate analysis, macrovescicular steatosis involving 25% or more of the hepatocytes was the only variable independently associated with shorter patient survival (p0.05). Five (62.5%) of the eight livers with macrovescicular steatosis involving 25% or more of the hepatocytes incurred in a delayed non-function (DNF) and one (12.5%) in a primary non-function (PRNF). The incidence of DNF and PRNF in the group with macrovescicular steatosis involving less than 25% of the liver cells was 1.6% (p0.001) and 2.3%, respectively. Microvescicular steatosis of any degree was not associated with a worse prognosis. Macrovescicular steatosis involving 25% or more of the hepatocytes identifies marginal livers, the use of which significantly increases the risk of graft non-function post-OLT.