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Using a mixed-method research design involving interviews and a survey, we examined how union officials in Quebec perceive social movement unionism (SMU). We show that union officials view SMU as a multifaceted phenomenon with ideal and pragmatic dimensions. They are torn between strong support for the ideals of SMU and a practical reluctance to use members’ dues to provide services to non-members. Experience with civil society organisations mitigates this tension, encouraging union officials to defend the interests of everyone not only as an ideal, but also as a strategy that allows unions to protect members and unrepresented workers. 1. WITHIN AND BEYOND UNIONS: INTRODUCTION 2. ROOTS AND RAMIFICATIONS OF SMU: THEORETICAL FRAMEWORK 3. A MIXED-METHOD APPROACH APPLIED TO THE CASE OF QUEBEC TUs 4. SMU AS A MULTIDIMENSIONAL CONSTRUCT: AN EXPLORATIVE QUANTITATIVE ANALYSIS 5. IDEALLY INCLINED, PRAGMATICALLY RELUCTANT: DISCUSSION 6. IDEAL VERSUS PRAGMATIC TENSION IN SMU: DELVING DEEPER AND WIDER ACKNOWLEDGEMENTS Supporting Information REFERENCES

Introduction At birth, the gastrointestinal (GI) tract is colonized by a complex community of microorganisms, forming the basis of the gut microbiome. The gut microbiome plays a fundamental role in host health, disorders of which can lead to an array of GI diseases, both short and long-term. Pediatric GI diseases are responsible for significant morbidity and mortality, but many remain poorly understood. The recent advancement of high-throughput technologies has enabled deeper profiling of GI morbidities. Technologies such as metagenomics, transcriptomics, proteomics and metabolomics, have already been used to identify associations with specific pathologies, and highlight an exciting area of research. However, since these diseases are often complex and multifactorial by nature, reliance on a single experimental approach may not capture the true biological complexity. Therefore, multi-omics aims to integrate singular omic data to further enhance our understanding of disease. Areas covered This review will discuss and provide an overview of the main omic technologies that are used to study complex GI pathologies in early life. Expert opinion Multi-omic technologies can help to unravel the complexities of several diseases during early life, aiding in biomarker discovery and enabling the development of novel therapeutics and augment predictive models.

ObjectiveNecrotising enterocolitis (NEC) is a devastating intestinal disease primarily affecting preterm infants. The underlying mechanisms are poorly understood: mother’s own breast milk (MOM) is protective, possibly relating to human milk oligosaccharide (HMO) and infant gut microbiome interplay. We investigated the interaction between HMO profiles and infant gut microbiome development and its association with NEC.DesignWe performed HMO profiling of MOM in a large cohort of infants with NEC (n=33) with matched controls (n=37). In a subset of 48 infants (14 with NEC), we also performed longitudinal metagenomic sequencing of infant stool (n=644).ResultsConcentration of a single HMO, disialyllacto-N-tetraose (DSLNT), was significantly lower in MOM received by infants with NEC compared with controls. A MOM threshold level of 241 nmol/mL had a sensitivity and specificity of 0.9 for NEC. Metagenomic sequencing before NEC onset showed significantly lower relative abundance of Bifidobacterium longum and higher relative abundance of Enterobacter cloacae in infants with NEC. Longitudinal development of the microbiome was also impacted by low MOM DSLNT associated with reduced transition into preterm gut community types dominated by Bifidobacterium spp and typically observed in older infants. Random forest analysis combining HMO and metagenome data before disease accurately classified 87.5% of infants as healthy or having NEC.ConclusionThese results demonstrate the importance of HMOs and gut microbiome in preterm infant health and disease. The findings offer potential targets for biomarker development, disease risk stratification and novel avenues for supplements that may prevent life-threatening disease.

ImportanceThe effect of using an exclusive human milk diet compared with one that uses bovine products in preterm infants is uncertain, but some studies demonstrate lower rates of key neonatal morbidities. A potential mediating pathway is the gut microbiome.ObjectiveTo determine the effect of an exclusive human milk diet on gut bacterial richness, diversity, and proportions of specific taxa in preterm infants from enrollment to 34 weeks’ postmenstrual age.Design, Setting, and ParticipantsIn this randomized clinical trial conducted at 4 neonatal intensive care units in the United Kingdom from 2017 to 2020, microbiome analyses were blind to group. Infants less than 30 weeks’ gestation who had only received own mother’s milk were recruited before 72 hours of age. Statistical analysis was performed from July 2019 to September 2021.InterventionsExclusive human milk diet using pasteurized human milk for any shortfall in mother’s own milk supply and human milk–derived fortifiers (intervention) compared with bovine formula and bovine-derived fortifier (control) until 34 weeks’ postmenstrual age. Fortifier commenced less than 48 hours of tolerating 150 mL/kg per day.Main Outcomes and MeasuresGut microbiome profile including alpha and beta diversity, and presence of specific bacterial taxa.ResultsOf 126 preterm infants enrolled in the study, 63 were randomized to control (median [IQR] gestation: 27.0 weeks [26.0-28.1 weeks]; median [IQR] birthweight: 910 g [704-1054 g]; 32 [51%] male) and 63 were randomized to intervention (median [IQR] gestation: 27.1 weeks [25.7-28.1 weeks]; median [IQR] birthweight: 930 g [733-1095 g]; 38 [60%] male); 472 stool samples from 116 infants were analyzed. There were no differences in bacterial richness or Shannon diversity over time, or at 34 weeks between trial groups. The exclusive human milk diet group had reduced relative abundance of Lactobacillus after adjustment for confounders (coefficient estimate, 0.056; P = .03), but not after false discovery rate adjustment. There were no differences in time to full feeds, necrotizing enterocolitis, or other key neonatal morbidities.Conclusions and RelevanceIn this randomized clinical trial in preterm infants using human milk–derived formula and/or fortifier to enable an exclusive human milk diet, there were no effects on overall measures of gut bacterial diversity but there were effects on specific bacterial taxa previously associated with human milk receipt. These findings suggest that the clinical impact of human milk–derived products is not modulated via microbiomic mechanisms.Trial RegistrationISRCTN trial registry identifier: ISRCTN16799022

Summary The developing gut microbiome in infancy plays a key role in shaping the host immune system and metabolic state, and human milk is the main factor influencing its composition. Human milk does not only serve to feed the baby, but also to help the new-born adapt to its new environment and microbial exposures. Human milk protects the infant by providing multiple bioactive molecules, including human milk oligosaccharides (HMOs), which are the third most abundant solid component after lipids and lactose. The infant is unable to digest HMOs, so they reach the small and large intestines intact where they have many roles, including acting as prebiotics. Bifidobacterium spp. are the main, but not the only, commensals equipped with genes for HMO degradation. In this review we will outline the HMOs structures and functions, list the genes needed for their digestion, and describe the main strategies adopted by bacteria for their utilization., Graphical abstract, Nutrition; Microbiology; Microbiome

The development of the gut microbiome from birth plays important roles in short- and long-term health, but factors influencing preterm gut microbiome development are poorly understood. In the present study, we use metagenomic sequencing to analyse 1,431 longitudinal stool samples from 123 very preterm infants (Bifidobacterium bifidum and Lactobacillus acidophilus) or Labinic (B. bifidum, B. longum subsp. infantis and L. acidophilus). Mothers’ own milk, breast milk fortifier, antibiotics and probiotics were significantly associated with the gut microbiome, with probiotics being the most significant factor. Probiotics drove microbiome transition into different preterm gut community types (PGCTs), each enriched in a different Bifidobacterium sp. and significantly associated with increased postnatal age. Functional analyses identified stool metabolites associated with PGCTs and, in preterm-derived organoids, sterile faecal supernatants impacted intestinal, organoid monolayer, gene expression in a PGCT-specific manner. The present study identifies specific influencers of gut microbiome development in very preterm infants, some of which overlap with those impacting term infants. The results highlight the importance of strain-specific differences in probiotic products and their impact on host interactions in the preterm gut.

Power resources are embedded in societal ties. Using qualitative network analysis, our fieldwork in Quebec (Canada), based on 30 interviews and three focus groups, explored union-societal ties, their resource properties and the extent to which unions weave them into a network. We identified five different types of union-societal ties: instrumental, civil society organizations, identity-based, satellite and fishing line. These ties were mostly unwoven. Analysis of networking provides insights into how unions frame issues, identify grassroots leaders and leverage societal power resources in broad-based movements.

Objectives Intraductal papillary mucinous neoplasms (IPMNs) are pancreatic cysts that can progress to invasive pancreatic cancer. Associations between oncogenesis and oral microbiome alterations have been reported. This study aims to investigate a potential intracystic pancreatic microbiome in a pancreatic cystic neoplasm (PCN) surgery patient cohort. Design Paired cyst fluid and plasma were collected at pancreatic surgery from patients with suspected PCN (n=105). Quantitative and qualitative assessment of bacterial DNA by qPCR, PacBio sequencing (n=35), and interleukin (IL)-1β quantification was performed. The data were correlated to diagnosis, lesion severity and clinical and laboratory profile, including proton-pump inhibitor (PPI) usage and history of invasive endoscopy procedures. Results Intracystic bacterial 16S DNA copy number and IL-1β protein quantity were significantly higher in IPMN with high-grade dysplasia and IPMN with cancer compared with non-IPMN PCNs. Despite high interpersonal variation of intracystic microbiota composition, bacterial network and linear discriminant analysis effect size analyses demonstrated co-occurrence and enrichment of oral bacterial taxa including Fusobacterium nucleatum and Granulicatella adiacens in cyst fluid from IPMN with high-grade dysplasia. The elevated intracystic bacterial DNA is associated with, but not limited to, prior exposure to invasive endoscopic procedures, and is independent from use of PPI and antibiotics. Conclusions Collectively, these findings warrant further investigation into the role of oral bacteria in cystic precursors to pancreatic cancer and have added values on the aetiopathology as well as the management of pancreatic cysts.

We read with great interest the article by Gudra et al 1 reporting a faecal immunochemical test (FIT; OC-Sensor, Eiken Chemical) commonly used in colonic neoplasia screening as a reliable sampling device for microbiome profiling when compared with immediately frozen samples from whole stool. The potential to use the FIT routinely completed by approximately 3 million participants annually as part of the English Bowel Cancer Screening Programme2 to understand the role of gut microbiome in colorectal neoplasia holds great promise, not least because of the convenience to individuals, cost-savings associated with use of routinely collected samples, and methodological advantages of samples collected before microbiome-altering procedures (eg, bowel cleansing).3 We aimed to validate and expand on the finding of Gudra et al 1 by investigating performance of the Bowel Cancer Screening Programme (BCSP) FIT, analysing more subjects, testing longer-term storage, investigating different methods of concentration and comparing with OMNIgene.GUT (OG; DNA Genotek), a widely used research device for stool DNA preservation at ambient temperature.4 We considered bacterial profile stability over time, mimicking real-world research scenarios with storage of FIT samples for up to 20 days prior to DNA extraction. We …

Primary malignant brain tumors (BT) are the most common and aggressive malignant brain tumor. Treatment of BTs is a daunting task with median survival just at 21 months. Methods of localized delivery have achieved success in treating BT by circumventing the blood brain barrier and achieving high concentrations of therapeutic within the tumor. The capabilities of localized delivery can be enhanced by utilizing mirco-electro-mechanical systems (MEMS) technology to deliver drugs with precise temporal control over release kinetics. An intracranial MEMS based device was developed to deliver the clinically utilized chemotherapeutic temozolomide (TMZ) in a rodent glioma model. The device is a liquid crystalline polymer reservoir, capped by a MEMS microchip. The microchip contains three nitride membranes that can be independently ruptured at any point during or after implantation. The kinetics of TMZ release were validated and quantified in vitro. The safety of implanting the device intracranially was confirmed with preliminary in vivo studies. The impact of TMZ release kinetics was investigated by conducting in vivo studies that compared the effects of drug release rates and timing on animal survival. TMZ delivered from the device was effective at prolonging animal survival in a 9L rodent glioma model. Immunohistological analysis confirmed that TMZ was released in a viable, cytotoxic form. The results from the in vivo efficacy studies indicate that early, rapid delivery of TMZ from the device results in the most prolonged animal survival. The ability to actively control the rate and timing of drug(s) release holds tremendous potential for the treatment of BTs and related diseases.

Antecedents of Censuses from Medieval to Nation States: How Societies and States CountRebecca Jean Emigh, Dylan Riley, and Patricia AhmedNew York: Palgrave Macmillan, 2016. ISBN 978-1-137-48502-1 (also available in E-PUB)DOI: 10.1057/9781137485038Hardcover $US110, 266 pp. +Changes in Censuses from Imperialist to Welfare States: How Societies and States CountRebecca Jean Emigh, Dylan Riley, and Patricia AhmedNew York: Palgrave Macmillan, 2016ISBN 978-1-137-48505-2 (also available in E-PUB)DOI: 10.1057/9781137485069Hardcover $US110, 267 pp. +

This paper outlines McGill University’s responses to the challenges of teaching and learning with information systems and technologies; it also gives a description of the underlying philosophy that is guiding these actions. The context at McGill is briefly outlined, with a discussion of the importance of planning and the relevance of these issues for a campus‐based institution. A five‐pronged approach is described that involves: the use of a university‐wide course management system; providing support, training and help for faculty and students; the provision of appropriate hardware installations; incentives for teaching staff; and encouragement for students.

Metastases represent the most common brain tumors in adults. Surgical resection alone results in 45% recurrence and is usually accompanied by radiation and chemotherapy. Adequate chemotherapy delivery to the CNS is hindered by the blood–brain barrier. Efforts at delivering chemotherapy locally to gliomas have shown modest increases in survival, likely limited by the infiltrative nature of the tumor. Temozolomide (TMZ) is first-line treatment for gliomas and recurrent brain metastases. Doxorubicin (DOX) is used in treating many types of breast cancer, although its use is limited by severe cardiac toxicity. Intracranially implanted DOX and TMZ microcapsules are compared with systemic administration of the same treatments in a rodent model of breast adenocarcinoma brain metastases. Outcomes were animal survival, quantified drug exposure, and distribution of cleaved caspase 3. Intracranial delivery of TMZ and systemic DOX administration prolong survival more than intracranial DOX or systemic TMZ. Intracranial TMZ generates the more robust induction of apoptotic pathways. We postulate that these differences may be explained by distribution profiles of each drug when administered intracranially: TMZ displays a broader distribution profile than DOX. These microcapsule devices provide a safe, reliable vehicle for intracranial chemotherapy delivery and have the capacity to be efficacious and superior to systemic delivery of chemotherapy. Future work should include strategies to improve the distribution profile. These findings also have broader implications in localized drug delivery to all tissue, because the efficacy of a drug will always be limited by its ability to diffuse into surrounding tissue past its delivery source.

There are three broad explanations for why workers adapt, or fail to adapt, to technological change in the workplace. The adversarial perspective holds that employment security produces resistant workers, and conversely that insecurity assures efficiency in adapting a workforce to technological and organizational changes. Institutionalists argue the opposite, emphasizing that secure workers have little to fear from change. Finally, a neo-corporatist variant sees managers and powerful trade-union leaders as capable of successfully negotiating industrial changes, independently of rank and file preferences. In this paper we explore these explanations via interview data collected from managers and trade unionists (or labour representatives) from Canada and Sweden. Our focus is on three industries - pulp and paper, steel and telecommunications equipment. Analyses deal with specific questions associated with the introduction of new equipment and technology, attempts to introduce organizational restructuring, and experiences with layoffs. We further examine respondents' comments on obstacles encountered during the change process, including the reactions, conflicts and grievances of the rank and file workers at their plants, mills and factories. On the whole, the results of our interviews with respondents at seventy-three plants in our three-industry two-country comparison seem to contradict the strict adversarial theory. While our data provide some evidence in favour of the institutionalist perspective, the neo-corporatist arguments found the most support. Swedish trade union leaders were viewed by managers, and viewed themselves, as more positively disposed to change than either their Canadian counterparts or workers in either country

This article provides an empirical assessment of the social psychological underpinnings of arguments that link labor market security to wage flexibility. We employ data from two surveys of blue-collar manufacturing workers, one from Canada and the other from Sweden, that were conducted by the respective national statistics agencies. The dependent variable is a dichotomy tapping respondents' willingness to take a wage cut to save their jobs. Independent variables index a variety of objective and subjective labor market conditions and experiences. We test two hypotheses. The first, that Canadians should be more willing than Swedes to accept a pay cut, is amply supported. The second, that observed differences between Swedes and Canadians should be due to higher levels of anxiety about labor market prospects among the latter, found no support whatsoever in our logistic regression analyses. We conclude with speculative alternative explanations and suggestions for additional comparative research.

A short, efficient and high-yielding approach for the diastereoselective syntheses of the four (5′S)- and (5′R)-5′,8-cyclopurine lesions and their phosphoramidites has been developed. The intermediates prepared by these synthetic pathways provide an easy access to those modified nucleosides that constitute an important molecular library for recognition of DNA damage. With respect to previous synthesis, the key methodologies for cyclization steps and phosphoramidite synthesis were ameliorated. © the Partner Organisations 2014.

There is wide agreement that one of the major problems in the estimation of wage equations, and in testing theories of wages, is the quality of the data available. In particular, the data used in almost all studies involve indirect or unsatisfactory measures of a variety of relevant factors, including working conditions. In this paper we exploit an unusual data set that includes measures of characteristics of jobs generated by observation (rather than self report, or through inference from the Dictionary of Occupational Titles). With these data we estimate a wage equation in which compensating differentials play a significant role in wage determination and, once working conditions and other characteristics are effectively controlled, all but one measure of previous labour market experience had no effect on the wage rate.

Background. A simple, accurate, reproducible and noninvasive method of body iron overload assessment would be of great clinical use.Objective. The purpose of the study was the implementation of a 0.5-T MRI method for liver iron overload measurement.Materials and methods. Thirty patients with thalassemia major took part in the study. Liver and paraspinal muscle signal intensity (SI) measurements were performed on T1-weighted images and normalized on a standard phantom, and a subjective hemochromatosis grading scale was made on both T1- and T2-weighted images. Serum ferritin levels and tissue iron from liver biopsy specimens were determined for comparison.Results. A close correlation was found between bioptic liver iron and both the liver-to-phantom SI ratio (r = −0.88) and the subjective grading scale (rho = 0.89). Serum ferritin correlated poorly with liver iron deposition, whether assessed by biopsy (r = 0.62) or MRI (r = -0.69).Conclusions. Both the subjective and the quantitative MRI methods proposed here are clinically valuable, with the former being adequate for a gross, the latter for an accurate estimation of tissue iron overload.

There is a substantial body of writing that identifies efficiency advantages from the provision of employment security, both within individual plants and at the level of the national economy. However, the business cycle persists in capitalist economies, so the question arises: how do managements deal with the fluctuations in the demand for labour which are associated with it? That is to say, what are management policies with respect to external flexibility? In North America, segmenting jobs into stable and unstable ones is thought to have provided a solution; in Scandinavia, until recently, full employment policies were thought to have eliminated the problem. In this paper, we compare the policies with respect to employment security adopted in a sample of plants in three industries in Canada and Sweden. Our evidence suggests that policies with respect to external flexibility are influenced by the character of demand for what is being produced, by the technology of production, and by the institutional structure within which firms operate. Our evidence also indicates to what degree employment security is, itself, insecure.

Controlled-release drug delivery systems are capable of treating debilitating diseases, including cancer. Brain cancer, in particular glioblastoma multiforme (GBM), is an extremely invasive cancer with a dismal prognosis. The use of drugs capable of crossing the blood-brain barrier has shown modest prolongation in patient survival, but not without unsatisfactory systemic, dose-limiting toxicity. Among the reasons for this improvement include a better understanding of the challenges of delivery of effective agents directly to the brain tumor site. The combination of carmustine delivered by biodegradable polyanhydride wafers (Gliadel(®)), with the systemic alkylating agent, temozolomide, allows much higher effective doses of the drug while minimizing the systemic toxicity. We have previously shown that locally delivering these two drugs leads to further improvement in survival in experimental models. We postulated that microcapsule devices capable of releasing temozolomide would increase the therapeutic capability of this approach. A biocompatible drug delivery microcapsule device for the intracranial delivery of temozolomide is described. Drug release profiles from these microcapsules can be modulated based on the physical chemistry of the drug and the dimensions of the release orifices in these devices. The drug released from the microcapsules in these experiments was the clinically utilized chemotherapeutic agent, temozolomide. In vitro studies were performed in order to test the function, reliability, and drug release kinetics of the devices. The efficacy of the temozolomide-filled microcapsules was tested in an intracranial experimental rodent gliosarcoma model. Immunohistochemical analysis of tissue for evidence of DNA strand breaks via terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) assay was performed. The experimental release curves showed mass flow rates of 36 μg/h for single-orifice devices and an 88 μg/h mass flow rate for multiple-orifice devices loaded with temozolomide. In vivo efficacy results showed that localized intracranial delivery of temozolomide from microcapsule devices was capable of prolonging animal survival and may offer a novel form of treatment for brain tumors.

A new electro-thermally induced structural failure actuator (ETISFA) is introduced as an activation mechanism for on demand controlled drug delivery from a Micro-Electro-Mechanical-System (MEMS). The device architecture is based on a reservoir that is sealed by a silicon nitride membrane. The release mechanism consists of an electrical fuse constructed on the membrane. Activation causes thermal shock of the suspended membrane allowing the drugs inside of the reservoir to diffuse out into the region of interest. The effects of fuse width and thickness were explored by observing the extent to which the membrane was ruptured and the required energy input. Device design and optimization simulations of the opening mechanism are presented, as well as experimental data showing optimal energy consumption per fuse geometry. In vitro release experiments demonstrated repeatable release curves of mannitol-C(14) that precisely follow ideal first order release kinetics. Thermally induced structural failure was demonstrated as a feasible activation mechanism that holds great promise for controlled release in biomedical microdevices.

Advances in microelectromechanical systems (MEMS) and miniaturization technologies have enabled the creation of biomedical microdevices intended for use in the treatment of various chronic and acute illnesses. The ability to create very precisely defined micrometer and nanometer features allows for the production of a new generation of biomedical devices that can be implanted using minimally invasive procedures to provide controlled therapeutic drug delivery. We believe that there is a wide variety of pharmacological therapies in which these novel drug-delivery systems could be implemented, including treatments for cancer and trauma. Clinical Pharmacology & Therapeutics (2009); 85, 5, 544–547 doi:10.1038/clpt.2009.4

The next generation of implantable biomedical devices based on micro- and nano-electro-mechanical systems (MEMS and NEMS) technology is presented for diagnostics and treatment of chronic and non-chronic illnesses. These passive and active implantable devices allow for early diagnostics as well as timely and precisely controlled therapeutic drug delivery. The implantable devices are also applicable to a number of medical applications, including the next generation of early cancer diagnostics and treatments.

As presented at IASSIST 2007 conference

The authors report the case of a female patient suffering from colic neoplasm and a vast peristomal laparocele, the long-term outcome of a rectal amputation that the patient underwent at a young age. After colic resection, a vast area of surgical mesh in dacron was modelled and positioned in a retromuscular scat, thus allowing the hernia pathology to be resolved relatively simply, owing to its particular location-in correspondence with a preternatural anus-until not long ago this would have represented an absolute contraindication to the use of prosthetic materials. A precise surgical approach, marked by a scrupulous respect for aseptic conditions, is essential in these circumstances owing to the persistent risk of septic complications.

Deferiprone (L1) is a largely studied oral chelator in clinical setting, however, no definite conclusions concerning efficacy and toxicity still could be drawn. In an ongoing prospective trial with L1, we evaluated the efficacy and tolerance-toxicity in patients with thalassemia major previously treated by desferrioxamine (DFO); the specific aim of the study is to demonstrate that L1 could be an alternative to DFO in some patients with an acceptable toxicity.Sixty-nine patients over 13 years of age with poor compliance to DFO were considered for the study. The design included a liver biopsy before starting L1 in all patients in order to define liver siderosis either by histologic grading or by hepatic iron concentration (HIC); only patients with a minimum HIC of 4 mg/g dry weight entered the study. A repetition of the liver biopsy after one year of L1 was planned; further evaluations included serum ferritin, plasma iron, transferrin TIBC and iron urine excretion. L1 was given at 70 mg/kg/day in three divided doses. Toxicity was monitored either clinically or by controlling liver, kidney and marrow function by specific tests. Concerning clinical characteristics 52 patients showed hypogonadism (78%), 39 growth retardation (58%), 6 diabetes (9%), 4 cardiomyopathy (6%), 9 hypothyroidism (12%); 45 patients had chronic liver damage (65%).We focus this report on data collected in a group of 29 patients with a minimum follow-up of one year (14-33 months). The mean ferritin value was 3748 ng/mL (range: 200-10,000) and 2550 ng/mL (range: 80-14,500), before and while on L1 therapy, respectively (p = 0.001); the mean sideruria changed from 17.25 mg/dL (range: 5.4-50) to 20.98 mg/dL (range: 10-40), on DFO and L1, respectively (p = 0.078); the ratio between plasma iron (sideremia) and transferrin TIBC changed from 0.96 with DFO to 0.86 with L1 (0.014). A correlation with grade of liver siderosis and serum ferritin (p = 0.069) and iron urine excretion (p = 0.008) was recorded. The judgement of efficacy showed that L1 was effective (EF) in 9 patients, no assessable (UN) in 11 patients, not effective (NE) in 2 patients and with no advantages with respect to DFO in 7 patients. Liver biopsy was repeated in 20 patients showing a reduction of grade of liver siderosis and iron content in 7 patients. Clinical toxic effects of L1 were gastric intolerance (one patient), joint pain (three patients) and mild and temporary neutropenia (one patient).This preliminary experience shows that L1 is effective in several patients with thalassemia with poor compliance to DFO and to improve iron burden and iron excretion with generally minor side effects. L1 could be an alternative to DFO in some patients, however the recognition of neutropenia warrants a careful evaluation of patients and efforts finalized to early recognition of those to be addressed with this new and still experimental therapy.

Iron overload in patients with thalassemia is a common feature which requires continuous chelation therapy and monitoring. Serum ferritin determination is widely accepted as a simple method for following iron load in patients with primary hemochromatosis; however, several reports on thalassemic patients emphasize that ferritinemia is not accurate and that other methods such as direct measurement of iron in the liver (HIC) and magnetic resonance imaging (MRI) are more precise.In order to contribute to the general understanding of iron load in thalassemia we used liver MRI to study 33 thalassemic patients, most of whom were also evaluated for iron content by liver biopsy. The data were then compared with serum ferritin levels.Ferritin levels ranged between 276 and 8031 ng/mL, and liver iron content ranged from 1.6 to 31.0 mg/g dry weight; grade III or IV liver siderosis was recorded in 23/33 patients, just as 23/33 patients were found to have severe or very severe siderosis at MRI. Significant correlations with ferritin levels were recorded between grade IV and grades III, II and I (p0.01, p = 0.02, and p = 0.03, respectively). Ferritinemia also showed significant linearity with liver iron content (r = 0.603, p = 0.001). No significant differences of levels were recorded, however, between patients found to have severe and those with mild iron load at MRI (p = 0.073).Our study shows that serum ferritin levels exhibit a tendency to be significantly correlated with the true status of hemochromatosis in thalassemic patients; however, the discrepancies recorded in several patients and the scarce or total lack of correlation with MRI suggest exploring other approaches to this problem in order to make proper decisions about therapy.

The authors speak about their experience on the giant incisional hernias. The surgical treatment of these lesions in not always easy, especially when exist some conditions such as the loss of parietal substance and the loss of residence right. In these cases the use of prosthetic meshes and the Goni Moreno's pneumoperitoneum are very helpful. The Authors point out how important is, for a successful treatment, as well as a correct surgical procedure and opportune pre and post operative management.