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Brewer's Spent Grain (BSG) is the most abundant by-product generated during the first steps of the brewing process and represents about 85% of the total waste. It is usually disposed of due to its complex composition and the high level of moisture, which makes it difficult to store and transport. Up to now, its main exploitation is the use as animal feed. From an economic point of view, the handling or disposal of BSG often represents a cost in the brewery balance, especially when the waste production exceeds the farmers demand and it is necessary to pay specialized disposal companies for transportation and treatment. One of the major challenges in biomass valorization is the efficient biomass fractionation because the complex structure of the plant cell wall and the high crystallinity of cellulose make the feedstock recalcitrant to separation into its components. In the present work, BSG was recovered from a local brewery and processed with a new approach in order to obtain the most complete valorization. In particular, the whole process has been divided in two main parts. A first pretreatment with hot water in autoclave allowed the separation of a solution containing the soluble proteins and sugars which accounted for 25 % of the total starting biomass. This first step permitted the preparation of a valuable growing medium which was successfully employed for different microbial fermentations leading to valuable fungal biomass as well as triglycerides with a high content of linear or branched fatty acids, depending on the microorganism used. The water-insoluble residue was then submitted to a lignocellulose deep-eutectic-solvent-mediated fractionation which allowed the recovery of two main fractions: BSGT Cellulose and BSGT Lignin. The latter was tested as potential precursor for the development of cement water reducers with encouraging results. This combined multistep strategy for the treatment of the waste biomass appears to be a promising sustainable strategy for the development of a full exploitation of BSG from a circular economy perspective.

Research on resource partitioning in plant-pollinator mutualistic systems is mainly concentrated at the levels of species and communities, whereas differences between males and females are typically ignored. Nevertheless, pollinators often show large sexual differences in behaviour and morphology, which may lead to sex-specific patterns of resource use with the potential to differentially affect plant reproduction and diversification. We investigated variation in behavioural and morphological traits between sexes of hummingbird species as potential mechanisms underlying sex-specific flower resource use in ecological communities. To do so, we compiled a dataset of plant-hummingbird interactions based on pollen loads for 31 hummingbird species from 13 localities across the Americas, complemented by data on territorial behaviour (territorial or non-territorial) and morphological traits (bill length, bill curvature, wing length and body mass). We assessed the extent of intersexual differences in niche breadth and niche overlap in floral resource use across hummingbird species. Then, we tested whether floral niche breadth and overlap between sexes are associated with sexual dimorphism in behavioural or morphological traits of hummingbird species while accounting for evolutionary relatedness among the species. We found striking differences in patterns of floral resource use between sex. Females had a broader floral niche breadth and were more dissimilar in the plant species visited with respect to males of the same species, resulting in a high level of resource partitioning between sexes. We found that both territoriality and morphological traits were related to sex-specific resource use by hummingbird species. Notably, niche overlap between sexes was greater for territorial than non-territorial species, and moreover, niche overlap was negatively associated with sexual dimorphism in bill curvature across hummingbird species. These results reveal the importance of behavioural and morphological traits of hummingbird species in sex-specific resource use and that resource partitioning by sex is likely to be an important mechanism to reduce intersexual competition in hummingbirds. These findings highlight the need for better understanding the putative role of intersexual variation in shaping patterns of interactions and plant reproduction in ecological communities.La investigación sobre la partición de recursos en los sistemas mutualistas planta-polinizador se concentra principalmente en los niveles de especies y comunidades, mientras que las diferencias entre machos y hembras suelen ser ignoradas. Sin embargo, los polinizadores suelen mostrar grandes diferencias sexuales en su comportamiento y morfología, lo que puede dar lugar a patrones específicos de uso de recursos para cada sexo con el potencial de afectar de forma diferencial la reproducción y la diversificación de las plantas. Se estudió la variación en los rasgos de comportamiento y morfológicos entre sexos de las especies de colibríes como posibles mecanismos que explican el uso de recursos florales específicos para cada sexo en las comunidades ecológicas. Para ello, se recopiló un conjunto de datos de interacciones planta-colibrí con base en las cargas de polen de 31 especies de colibríes de 13 localidades en las Américas, además de datos sobre su comportamiento territorial (territorial o no territorial) y rasgos morfológicos (longitud y curvatura del pico, longitud del ala y masa corporal). Se evaluaron las diferencias intersexuales en la amplitud y el solapamiento del nicho en el uso de los recursos florales para las distintas especies de colibríes. Posteriormente, se comprobó si la amplitud del nicho floral y el solapamiento entre sexos están asociados con el dimorfismo sexual en los rasgos de comportamiento o morfológicos de las especies de colibríes, teniendo en cuenta el parentesco evolutivo entre las especies. Se encontraron diferencias notables en los patrones de uso de los recursos florales entre sexos. Las hembras presentaron una mayor amplitud de nicho floral y fueron más disímiles en las especies de plantas visitadas con respecto a los machos de la misma especie, lo que resultó en un alto nivel de partición de recursos entre los sexos. Se encontró que tanto la territorialidad como los rasgos morfológicos están relacionados con el uso de recursos específicos por sexo en las especies de colibríes. En particular, el solapamiento de nicho entre sexos fue mayor para las especies territoriales que para las no territoriales y, además, el solapamiento de nicho se asoció negativamente con el dimorfismo sexual en la curvatura del pico en las especies de colibríes. Estos resultados revelan la importancia de los rasgos conductuales y morfológicos de las especies de colibríes en el uso de recursos según el sexo y que la partición de recursos entre sexos es probablemente un mecanismo importante para reducir la competencia intersexual en los colibríes. Estos resultados ponen de manifiesto la necesidad de comprender mejor el rol que tiene la variación intersexual en los patrones de interacción y en la reproducción de las plantas en las comunidades ecológicas.

Introduction Patients with lung cancer who harbor multiple pulmonary sites of disease have been challenging to classify; a subcommittee of the International Association for the Study of Lung Cancer Staging and Prognostic Factors Committee was charged with developing proposals for the eighth edition of the tumor, node, and metastasis (TNM) classification to address this issue. Methods A systematic literature review and analysis of the International Association for the Study of Lung Cancer database was performed to develop proposals for revision in an iterative process involving multispecialty international input and review. Results Details of the evidence base are summarized in other articles. Four patterns of disease are recognized; the clinical presentation, pathologic correlates, and biologic behavior of these suggest specific applications of the TNM classification rules. First, it is proposed that second primary lung cancers be designated with a T, N, and M category for each tumor. Second, tumors with a separate tumor nodule of the same histologic type (either suspected or proved) should be classified according to the location of the separate nodule relative to the index tumor—T3 for a same-lobe, T4 for a same-side (different lobe), and M1a for an other-side location—with a single N and M category. Third, multiple tumors with prominent ground glass (imaging) or lepidic (histologic) features should be designated by the T category of the highest T lesion, the number or m in parentheses (#/m) to indicate the multiplicity, and a collective N and M category for all. Finally, it is proposed that diffuse pneumonic-type lung cancers be designated by size (or T3) if in one lobe, T4 if involving multiple same-side lobes, and M1a if involving both lungs with a single N and M category for all areas of involvement. Conclusion We propose to tailor TNM classification of multiple pulmonary sites of lung cancer to reflect the unique aspects of four different patterns of presentation. We hope that this will lead to more consistent classification and clarity in communication and facilitate further research in the nature and optimal treatment of these entities.

Raoultella ornithinolytica is a Gram-negative, non-motile, encapsulated, aerobic bacillus belonging to the Enterobacteriaceae family. R. ornithinolytica is a not very common, but emergent causal agent of human infection, and its expression of beta-lactamase provides resistance to commonly used antibiotics. The pathogenetic potential of R. ornithinolytica isolates in human disease has become increasingly important. Several cases of hospital-acquired infection, mostly associated with invasive procedures, or in patients with co-morbidity caused by R. ornithinolytica, have been previously reported in the adult population. In pediatric population, two cases in immunocompromised children, one case in an infant with visceral heterotaxy and one case of catheter-related bacteraemia are described. Here, we present the first case of febrile urinary tract infection due to R. ornithinolytica in an 8-month-old infant, recovered from a previous febrile UTI caused by E. coli and without co-morbidity. The empiric therapy with ceftriaxone, followed by cefpodoxime proxetil, resolved symptoms: the clinical condition of the infant improved rapidly and the treatment eradicated urine from the R. ornithinolytica infection. Since other pathogens rather than R. ornithinolytica are usually identified in children with urinary tract infections, including Escherichia coli, Proteus, Klebsiella and Pseudomonas, the identification of this microorganism in our patient’s urine was also unexpected.

INTRODUCTION: Revisions to the TNM stage classifications for lung cancer, informed by the international database (N = 94,708) of the International Association for the Study of Lung Cancer (IASLC) Staging and Prognostic Factors Committee, need external validation. The objective was to externally validate the revisions by using the National Cancer Data Base (NCDB) of the American College of Surgeons.METHODS: Cases presenting from 2000 through 2012 were drawn from the NCDB and reclassified according to the eighth edition stage classification. Clinically and pathologically staged subsets of NSCLC were analyzed separately. The T, N, and overall TNM classifications were evaluated according to clinical, pathologic, and "best" stage (N = 780,294). Multivariate analyses were carried out to adjust for various confounding factors. A combined analysis of the NSCLC cases from both databases was performed to explore differences in overall survival prognosis between the two databases.RESULTS: The databases differed in terms of key factors related to data source. Survival was greater in the IASLC database for all stage categories. However, the eighth edition TNM stage classification system demonstrated consistent ability to discriminate TNM categories and stage groups for clinical and pathologic stage.CONCLUSIONS: The IASLC revisions made for the eighth edition of lung cancer staging are validated by this analysis of the NCDB database by the ordering, statistical differences, and homogeneity within stage groups and by the consistency within analyses of specific cohorts.

Introduction: The M component and TNM stage groupings for malignant pleural mesothelioma (MPM) have been empirical. The International Association for the Study of Lung Cancer developed a multinational database to propose evidence-based revisions for the eighth edition of the TNM classification of MPM. Methods: Data from 29 centers were submitted either electronically or by transfer of existing institutional databases. The M component as it currently stands was validated by confirming sufficient discrimination (by Kaplan-Meier analysis) with respect to overall survival (OS) between the clinical MO (cM0) and cM1 categories. Candidate stage groups were developed by using a recursive partitioning and amalgamation algorithm applied to all cM0 cases. Results: Of 3519 submitted cases, 2414 were analyzable and 84 were cM1 cases. Median OS for cM1 cases was 9.7 months versus 13.4 months (p = 0.0013) for the locally advanced (T4 or N3) cM0 cases, supporting inclusion of only cM1 in the stage IV group. Exploratory analyses suggest a possible difference in OS for single- versus multiple-site cM1 cases. A recursive partitioning and amalgamation generated survival tree on the OS outcomes restricted to cM0 cases with the newly proposed (eighth edition) T and N components indicates that optimal stage groupings for the eighth edition will be as follows: stage IA (T1N0), stage IB (T2-3N0), stage II (T1-2N1), stage IIIA (T3N1), stage IIIB (T1-3N2 or any T4), and stage IV (any M1). Conclusions: This first evidence-based revision of the TNM classification for MPM leads to substantial changes in the T and N components and the stage groupings. (C) 2016 International Association for the Study of Lung Cancer. Published by Elsevier Inc. All rights reserved.

Introduction Stage classification provides a consistent language to describe the anatomic extent of disease and is therefore a critical tool in caring for patients. The Staging and Prognostic Factors Committee of the International Association for the Study of Lung Cancer developed proposals for revision of the classification of lung cancer for the eighth edition of the tumor, node, and metastasis (TNM) classification, which takes effect in 2017. Methods An international database of 94,708 patients with lung cancer diagnosed in 1999–2010 was assembled. This article describes the process and statistical methods used to refine the lung cancer stage classification. Results Extensive analysis allowed definition of tumor, node, and metastasis categories and stage groupings that demonstrated consistent discrimination overall and within multiple different patient cohorts (e.g., clinical or pathologic stage, R0 or R-any resection status, geographic region). Additional analyses provided evidence of applicability over time, across a spectrum of geographic regions, histologic types, evaluative approaches, and follow-up intervals. Conclusions An extensive analysis has produced stage classification proposals for lung cancer with a robust degree of discriminatory consistency and general applicability. Nevertheless, external validation is encouraged to identify areas of strength and weakness; a sound validation should have discriminatory ability and be based on an independent data set of adequate size and sufficient follow-up with enough patients for each subgroup.

The IASLC Staging and Prognostic Factors Committee has collected a new database of 94,708 cases donated from 35 sources in 16 countries around the globe. This has now been analysed by our statistical partners at Cancer Research And Biostatistics and, in close collaboration with the members of the committee proposals have been developed for the T, N, and M categories of the 8th edition of the TNM Classification for lung cancer due to be published late 2016. In this publication we describe the methods used to evaluate the resultant Stage groupings and the proposals put forward for the 8th edition.

For nearly 40 years, there was no generally accepted staging system for malignant pleural mesothelioma. In 1994, members of the International Mesothelioma Interest Group, in collaboration with the International Association for the Study of Lung Cancer, proposed a TNM staging system based on analyses of outcomes in retrospective surgical series and small clinical trials. Subsequently accepted by the American Joint Commission on Cancer and the Union for International Cancer Control for the sixth editions of their staging manuals, this system has since been the international staging standard. However, it has significant limitations, particularly with respect to clinical staging and to the categories for lymph node staging. Here we provide an overview of the development of the International Association for the Study of Lung Cancer malignant pleural mesothelioma staging database, which was designed to address these limitations through the development of a large international data set. Analyses of this database, described in papers linked to this overview, are being used to inform revisions in the eighth editions of the American Joint Commission on Cancer and Union for International Cancer Control staging systems. ispartof: Journal of Thoracic Oncology vol:11 issue:12 pages:2082-2088 ispartof: location:United States status: published

Introduction: The current T component for malignant pleural mesothelioma (MPM) has been predominantly informed by surgical data sets and consensus. The International Association for the Study of Lung Cancer undertook revision of the seventh edition of the staging system for MPM with the goal of developing recommendations for the eighth edition. Methods: Data elements including detailed T descriptors were developed by consensus. Tumor thickness at three pleural levels was also recorded. An electronic data capture system was established to facilitate data submission. Results: A total of 3519 cases were submitted to the database. Of those eligible for T-component analysis, 509 cases had only clinical staging, 836 cases had only surgical staging, and 642 cases had both available. Survival was examined for T categories according to the current seventh edition staging system. There was clear separation between all clinically staged categories except T1a versus T1b (hazard ratio = 0.99, p = 0.95) and T3 versus T4 (hazard ratio = 1.22, p = 0.09), although the numbers of T4 cases were small. Pathological staging failed to demonstrate a survival difference between adjacent categories with the exception of T3 versus T4. Performance improved with collapse of T1a and T1b into a single T1 category; no current descriptors were shifted or eliminated. Tumor thickness and nodular or rindlike morphology were significantly associated with survival. Conclusions: A recommendation to collapse both clinical and pathological T1a and T1b into a T1 classification will be made for the eighth edition staging system. Simple measurement of pleural thickness has prognostic significance and should be examined further with a view to incorporation into future staging. (C) 2016 International Association for the Study of Lung Cancer. Published by Elsevier Inc. All rights reserved.

Introduction Separate tumor nodules with the same histologic appearance occur in the lungs in a small proportion of patients with primary lung cancer. This article addresses how such tumors can be classified to inform the eighth edition of the anatomic classification of lung cancer. Separate tumor nodules should be distinguished from second primary lung cancer, multifocal ground glass/lepidic tumors, and pneumonic-type lung cancer, which are addressed in separate analyses. Methods Survival of patients with separate tumor nodules in the International Association for the Study of Lung Cancer database were analyzed. This was compared with a systematic literature review. Results Survival of clinically staged patients decreased according to the location of the separate tumor nodule relative to the index tumor (same lobe > same side > other side) in N0 and N-any cohorts (all M0 except possible other-side nodules). However, there was also a decrease in the proportion of patients resected; among only surgically resected or among nonresected patients no survival differences were noted. There were no survival differences between patients with same-lobe nodules and those with other T3 tumors, between patients with same-side nodules and those with T4 tumors, and patients with other-side nodules and those with other M1a tumors. The data correlated with those identified in a literature review. Conclusions Tumors with same-lobe separate tumor nodules (with the same histologic appearance) are recommended to be classified as T3, same-side nodules as T4, and other-side nodules as M1a. Thus, there is no recommended change between the seventh and eighth edition of the TNM classification of lung cancer.

Objective: The significance of microscopic invasion of blood vessels (Microscopic Vascular Invasion, MVI) in patients with non-small cell lung carcinoma (NSCLC) remains controversial. The aim of this study was to evaluate prevalence, correlations and the prognostic significance of MVI in patients following complete resection of Stage I NSCLC. Methods: From 1/1998 to 10/2008 1521 patients received resection for NSCLC at our Institution, of whom 737 were at pathological Stage I after surgery. There were 323 adenocarcinomas (ADK) (44%), 322 squamous cell carcinomas (SCC) (44%), 53 bronchioloalveolar carcinomas (BAC) (7%), 29 large cell anaplastic carcinomas (LCC) (4%). Histologic grading was: 114 G1 (15%), 279 G2 (38%) and 344 G3 (47%). Mean tumour dimension was 36 mm. MVI was ascertained using routine histopathological workup. Immunohistochemical staining with antibody anti-CD34 was done to evaluate blood vessels on a selective basis. Prevalence differences, logistic regression and survival analysis were used for analysis. Results: MVI was observed in 228 patients (31%). Prevalence was significantly higher in ADK (131/323, 41%) than in SCC (80/322, 25%, p0.002). A significant correlation was found between the presence of MVI and ADK (OR 0.8, 95% CI 0.7-0.9) and increased tumour dimension (OR 1.1, 95% CI 1.01-1.24). Univariate survival analysis indicates that the presence of MVI was associated with a significantly reduced 5-year survival overall (65% vs. 52%, p0.0003) and in ADK (68% vs. 54%, p0.0002) but not in SCC (58% vs. 49%, p0.25). In a multivariate survival analysis, the presence of MVI was a significant indicator of poor survival overall (HR 1.61, 95% CI 1.30 –2.15) and in ADK (HR 2.02, 95% CI 1.36 –3-02). Conclusions: The finding of MVI in completely resected Stage I NSCLC is not infrequent. MVI is strongly correlated with adenocarcinoma histotype and increased tumour dimensions. The presence of MVI is an independent negative prognostic factor, which is particularly significant in adenocarcinomas. The use of adjuvant chemotherapy might be taken into consideration in these patients.

Backgrounds: Optimal therapy in patients with Malignant Pleural Mesothelioma (MPM) is a matter of debate. Many authors questioned the role of major surgery in the treatment of MPM. We reviewed our recent experience among different treatment options in patients with MPM to assess their prognostic impact. Materials and Methods: From 10/97 to 10/08 326 patients were admitted to our Hospital with a diagnosis of MPM (223 men, 103 women, mean age 64 years, range 32−94). Management options included pleural drainage with/without pleurodesis (24 patients), Video-Assisted Thoracic Surgery (VATS) with/without pleurodesis (195), partial pleurectomy (PL) (27), total PL (8), Extrapleural Pneumonectomy (EPP, 72). The last two treatments were intended as maximal debulking procedures before chemotherapy. Chemotherapy and radiotherapy were used when indicated in exclusive or multimodality protocols. Patients receiving total PL and EPP were compared with those receiving palliative procedures (drainage, VATS or partial PL). Survival analysis was performed using univariate and multivariate (Cox regression) models. Results: Patients receiving PL (partial or total) and EPP were significantly younger than those receiving pleural drainage or VATS (56 vs. 68 years, p = 0.002). Median survival (years) in the different management groups were: pleural drainage (0.97), VATS (0.82), partial PL (1.35), total PL (2.01), EPP (1.73) (p = 0.00001). Two-year survival rates among the groups were: pleural drainage 22%, VATS 18%, partial PL 20%, total PL 50%, EPP 32% (p = 0.00001). A significant survival advantage was observed in patients receiving EPP or total PL vs. those receiving palliative procedures (32% vs.18%, p = 0.0002). In multivariate survival analysis, advanced age was a significant negative prognostic factor (HR 1.02, 95% CI 1.00−1.03, p = 0.007), while EPP or total PL were a significant positive prognostic factor (HR 0.59, 95% CI 0.35−0.99, p = 0.04). Conclusions: In patients with MPM, different treatment options may be offered with either palliative or maximal cytoreductive intent. Patients receiving major surgery are a selected subset of patients younger than those receiving pleural drainage or VATS. A significant survival advantage was observed in patients after total PL or EPP. Our results indicate that surgery with maximal debulking intent offers a significant survival advantage over palliative procedures and should therefore be considered a valuable option in selected patients with MPM.

Lung abscess is a very rare infectious condition in children and is most commonly encountered as a complication of bacterial pneumonia. We present a case of a lung abscess in a child 6-year-old admitted with a history of right hemithorax pain lasting for 15 days and the onset of mild fever in the last two days. Etiological research showed positivity of IgM antibodies to Mycoplasma pneumoniae after seven days of admission. The child has been successfully treated with antibiotic therapy, without the use of macrolides, for a duration of 4 weeks. Our study suggests that the Mycoplasma pneumoniae infection may predispose to severe infections, such as lung abscess, caused by typical respiratory pathogens. The reported case of lung abscess is one of the few reported in the literature in the modern antibiotic era and is the first preceded by Mycoplasma pneumoniae infection.

En dos áreas con bosque de Nothofagus del Parque Nacional Nahuel Huapi (Puerto Blest y Quetrihué) el Picaflor Rubí Sephanoides sephaniodes, la única especie local de su familia, visitó flores de 11'y tres especies de plantas, respectivamente. En el pico y cabeza de 48 picaflores se encontró polen de 12 especies de plantas; siete plantas nativas con flores ornitófilas estaban representadas en cantidades abundantes. Estas siete plantas, en los géneros Embothrium, Tristerix, Fuchsia, Campsidium, Desfontainia, Mitraria y Asteranthera, tienen flores ornitófilas con néctares de alta concentración de azúcar (entre 23,02 y 37,97° Brix). Existe una correlación positiva entre la abundancia de picaflores y la de estas flores. En Quetrihué una de estas plantas, Tristerix (Lorantáceas), tiene floración invernal, lo que permite la presencia permanente de algunos picaflores. Por su morfología Sephanoides se asemeja a otros picaflores territoriales, pero los datos de campo sugieren un comportamiento variable.

The adrenal hemorrhage is a relatively rare event in newborns but must be considered in the presence of a persistent unexplained jaundice, especially in presence of predisposing factors. Serial ultrasonography is the modality of choice for initial diagnosis and follow-up of neonatal adrenal hemorrhage. We report two cases of neonatal adrenal hemorrhage presenting with persistent jaundice. The causes of the neonatal adrenal hemorrhages were a difficult vaginal delivery in macrosomic infant and a neonatal infection.

By means of the jet-bundle formalism, the Second Noether Theorem is formulated for a general first-order Lagrangian field theory with infinitesimal local symmetries. These symmetries are implemented by a linear differential operator acting between the sections of a vector bundle and vector fields on the configuration bundle. The problem of the degeneration of the Lagrangian system is examined from a covariant and an instantaneous (i.e. space+time split) viewpoint. It is shown that in the instantaneous approach the presence of infinitesimal local symmetries leads to degeneration of the theory. Vertical local symmetries are shown to imply degeneration also in the covariant formalism. These results can be extended to higher-order Lagrangians as well.

The effectiveness of carbocysteine lysine salt monohydrate (SCMC-Lys) and ambroxol hydrochloride (ABX) in the management of respiratory impairment was compared in a single-blind, randomized study of 26 cystic fibrosis patients with similar baseline characteristics. Adults received either SCMC-Lys 900 mg or ABX 33 mg three times a day and children under 14 years of age either SCMC-Lys 270 mg three times a day or ABX 10 mg four times a day. All treatments were given orally for 80 days and at the end of this control period both groups showed significant improvement in chest sound score but improvement in cough score was observed only in those receiving SCMC-Lys. Expectorate viscosity and elasticity decreased significantly in both groups. In SCMC-Lys-treated patients paCO2 decreased and paO2 and Hb O2 saturation increased while only paO2 increased significantly in those treated with ABX. An increase in tidal volume, peak expiratory flow values and forced expiratory volume were evident in those receiving SCMC-Lys while significant increases in forced expiratory flow were recorded in those receiving ABX. SCMC-Lys patients' Shwachmann index improved significantly and conversely to the ABX patients. No adverse events were recorded in either treatment group. The study concluded that SCMC-Lys is at least as effective as ABX in improving respiratory function in patients with cystic fibrosis.

Fetomaternal hemorrhage (FMH) refers to the entry of fetal blood into the maternal bloodstream before or during delivery. FMH of more than 30 mL occurs with the frequency of about 1/300. Fetal outcomes may be compromised by still births, hydrops fetalis, cardiac complications, and increased rates of postpartum infant death. In most cases, the cause is not identified. Clinical manifestations of FMH depend on the volume of blood lost and the rate that it occurred. We report a case of chronic massive FMH in a newborn of an immigrant mother with a favorable outcome. Medical visits and tests during pregnancy, including ultrasound scans, were not performed. The baby was hemodynamically stable after birth, manifesting only pallor. The complete blood count revealed severe hypochromic anemia (hemoglobin 3,8 g/dl, hematocrit 14,4%) and reticulocytosis (reticulocyte 25,2%). There was no ABO blood type incompatibility and the result of direct Coomb’s test was negative. The Kleihauer-Betke test revealed 5 % of fetal erythrocytes in the maternal bloodstream equivalent to 180 mL. The fact that FMH can occur without prior risk factors, and the diagnosis is often postnatal, underscores the importance of heightened of medical suspicion particularly in infants born to immigrants where there is often the lack of prenatal visits.

We report a rare case of intraperitoneal hepatic hydatid cyst perforation in a 7 years-old boy. Diagnosis was performed by ultrasounds, computerized tomography scan, and serology. Surgical treatment was followed by pharmacologic treatment with the aim of avoiding a relapse. A brief review of the diagnostic and therapeutic management of the disease is provided.

Kluyvera species are described infrequently in association with clinically significant infections, and infections caused by these gram negative rods are rare in children. The spectrum of disease due to Kluyvera infection in children includes urinary tract infections, enteritis, soft tissue infections, sepsis, central venous catheter infections and peritonitis. The authors report a case of Kluyvera ascorbata urinary tract infection in a 3-month-old female baby, and they review the literature on Kluyvera infections in children.

There are various method of reconstruction when chest wall resection is performed for the treatment of tumors of the chest wall. In this case a chest wall resection and reconstruction was performed using an omolateral latissimus dorsi flap, together with Gore-Tex mesh. A 42-year-old woman was diagnosed as having a huge low grade chondrosarcoma and underwent surgical resection which interested the anterior chest wall from the level of the IV to X rib and the right hemidiaphragm. Gore-Tex mesh was fixed to the residual chest wall and an ipsilateral pedicled latissimus dorsi muscle flap was placed on the alloplastic mesh. The patient was discharged from the hospital 17 days postoperatively. The postoperative course was uneventful and the wound was fine.

BACKGROUND This study examined the metabolic effects of lung transplantation in patients with end-stage respiratory failure on low dose of steroids for immunosuppressive therapy. METHODS We examined 6 patients, including 2 women and 4 men of overall mean age 53 +/- 15 years and age at transplantation 34 +/- 12 months, receiving cyclosporine 5.73 +/- 1.43 mg/kg/d or tacrolimus (FK 506) 4.67 +/- 0.58 mg/d, azathioprine 0.47 +/- 0.29 mg/kg/d, and prednisone 8.25 mg/d for comparison with 6 healthy subjects, who were selected to be comparable to the recipients in terms of anthropometric features and age. A euglycemic hyperinsulinemic clamp (1 mU/kg/min) associated with infusion of glucose and leucine isotopes was performed with indirect calorimetry. RESULTS Lung transplanted patients showed postabsorptive leucine and free fatty acid metabolism similar to controls. In contrast, there was peripheral insulin resistance with respect to glucose metabolism namely, higher values of glucose and insulin vs controls (P < .03 and P < .02, respectively). During the clamp the metabolic picture was characterized by a relative insulin resistance with respect to glucose metabolism (P = .07). Lipid and protein metabolism in the basal and insulin-stimulated conditions were similar to the control group. CONCLUSIONS In the basal condition insulin resistance is evident with respect to glucose metabolism. The metabolic picture in lung transplanted patients on low-dose steroid therapy was characterized by normal insulin-stimulated glucose, leucine, and free fatty acid metabolism. The minimal metabolic alterations in these patients were not due to transplantation itself but probably mainly attributable to immunosuppressive therapy.

To evaluate the prevalence and clinico/prognostic significance of the presence of pre-invasive lesions in patients resected for primary lung neoplasm.From 1993 to 2002, 1090 patients received resection for primary lung carcinomas. Of these, 73 presented an associated pre-invasive lesion in the surgical specimen distant from the primary tumour. Classification of pre-invasive lesions included Atypical Adenomatous Hyperplasia (AAH); Carcinoma In Situ (CIS) either diffuse or at the bronchial resection margin; Diffuse Idiopathic Pulmonary Neuroendocrine Cell Hyperplasia (DIPNECH). Correlation between the presence of pre-invasive lesion and the following variables were calculated by logistic regression analysis: sex, age, median tumour size, histology, histologic differentiation, histologic evidence of invasiveness (vascular and perineural invasion), peritumoural lymphocytic infiltrate, pTNM, lobe location, history of previous malignancy. Survival rates were computed using Kaplan-Meier method and survival differences with the total patient population of resected lung carcinomas were tested using the log-rank method.There were 28 AAH, 42 CIS (5 at the bronchial resection margin) and 3 DIPNECH. Histology of the primary tumor included bronchioloalveolar carcinoma (9 patients), adenocarcinoma (19), squamous cell carcinoma (39), typical carcinoid tumour (3) and adenosquamous carcinoma (3). Overall prevalence of pre-invasive lesion was 6.7%. A strong correlation was found between the presence of AAH and the co-existence of either adenocarcinoma, bronchioloalveolar carcinoma or mixed adenocarcinoma-containing tumours (P = 0.00002) between CIS and squamous cell carcinoma (P = 0.009) and between DIPNECH and carcinoid tumours (P = 0.001). No significant correlation was found between the presence of any type of pre-invasive lesion and sex, age, median tumour size, histologic differentiation, histologic evidence of invasiveness, pTNM, lobe location and history of previous malignancy or the probability to develop a second primary lung carcinoma in the remaining lobe(s) after resection. Survival rates in the patients with AAH and CIS were not significantly different from those of patients without pre-invasive lesion (P = 0.3 and P = 0.1).Associated pre-invasive lesions in patients resected for primary lung neoplasms are not infrequent. AAH is associated with adenocarcinoma, CIS with squamous cell carcinoma, DIPNECH with typical carcinoid tumours. Our experience indicates that in these patients histology, stage distribution and survival do not differ from the total population of resected patients with lung tumors.

The project concerns the design, optimization, construction, assembling, start-up and extensive monitoring of an experimental plant consisting of a full-titanium desalinator coupled with a small solar pond. The operational tests took place at the site of the solar pond of the University of Ancona (Italy). Data collected during the start-up and operation of the plant under various conditions are being utilized for improving expertise on heat recovery with highly corrosive fluids, on co-generation plants aimed at producing electricity and fresh water, and on desalination fed by solar energy. Some preliminary economic evaluations are discussed.

To review the patients treated at our Institute over the past 22 years and to evaluate the behaviour of 14 atypical carcinoids on the basis of Capella's classification (1994), defining the most suitable surgical approach.A total of 118 patients undergoing surgery for lung neuroendocrine tumours were reanalyzed on the basis of their anatomic and pathological characteristics, surgical treatment and survival.The 5-year survival rate was 96.5% for typical forms and 74.5% for atypical forms; the 10-year survival rate was 92.4% for typical forms and 49.8% for atypical forms (p0.001). Lymph node metastatic involvement was also an important contributing factor for survival (p0.05). A review of the series of 19 patients treated over the past 6 years, diagnosed with so-called atypical carcinoid based on Capella's anatomic and pathological classification, showed that 5 were well differentiated neuroendocrine tumours (WDNT), 8 well differentiated neuroendocrine carcinomas (WDNC) and 1 small-cell lung neuroendocrine carcinoma (SLCL). From a surgical point of view, 10 cases underwent demolitive surgery and 9 conservative surgery. The overall actuarial survival rate in this series was 78% at 5 years, 100% for WDNT and 75% for WDNC. The only case of SCLC died after a few months.The authors conclude that the 5 and 10-year probability of survival are closely linked to the histological type of the lung neuroendocrine tumour and the presence of lymph node metastasis. Capella's new anatomic and pathological classification helps to establish a more precise prognosis for so-called atypical carcinoids. Lastly, given the malignant potential of these tumours, preference should be given to radical exeresis.

After the liver, the lungs represent the most frequent site of metastasis from primary tumours. Surgical treatment of lung secondary neoplasms leads to a significant improvement in survival.Between 1960-1997, 178 patients with lung metastases underwent surgery at the Thoracic Surgery Department of Turin University in a total of 193 operations. A retrospective study was made in order to identify the prognostic factors which influenced final survival in this population.Overall survival was 47% after 2 years and 20% after five years. Prognosis was not influenced by the size of metastases, the type of surgery, adjuvant therapy and the number of operations on the same patient. On the other hand, useful prognostic factors were found to be the histological type of the primary tumour, the original site of the neoplasm, the number of metastases and, above all, the disease-free interval (DFI).Lung metastasectomy is an important therapeutic aid in selected patients, whereas the preoperative evaluation of the above prognostic factors enables a reasonably precise prognosis to be made in most patients.

A double blind study was made on a group of 35 children, 8 of whom were allergic to Grass and 27 allergic to Pteronyssinus and Farinae Dermatophagoides. We verified the efficacy and tolerability of a new immunotherapy called E.P.D. (Enzyme Potentiated Desensitization). This particular immunotherapy consists in an intradermal injection of a mix made up of an allergic solution at extremely low doses and an enzyme, beta-glucuronidase. The vaccine is administered once a year, two weeks before pollen peaks for children with seasonal allergies and two times a year, in February and November, for children with non-seasonal allergies (Dermatophagoides). The results, statistically analyzed on the basis of a symptoms score, showed good clinical efficacy in patients affected by both seasonal and non-seasonal allergies. Due to the clinical effectiveness, easy administration and excellent tolerability of the immunotherapy, E.P.D. is particularly suited for treating or reducing allergic symptoms in allergic children.

A case of hemangioma of the left twelfth rib is presented. clinical presentation, radiologic appearance and differential diagnosis with other vascular tumors of the bone are discussed, along with a review of the literature.

The activity of pidotimod ((R)-3-[(S)-(5-oxo-2-pyrrolidinyl) carbonyl]-thiazolidine-4-carboxylic acid, PGT/1A, CAS 121808-62-6) was studied vs. placebo in a double-blind, randomized, multicentre trial, involving 60 pediatric patients with recurrent urinary tract infections. Recovery from acute events was quicker with pidotimod than with placebo (9.6 vs. 12.3 days). In treated patients antibiotic therapy was shorter (6.9 vs. 8.3 days) and main symptomatic parameters (body temperature, vesical tenesmus, stranguria, pollakiuria, total number of symptoms, total symptomatic intensity, rate of asymptomatic patients, haematuria, leukocyturia, positive urinary culture) receded quickly. In patients receiving the drug as well as in patients treated with placebo changes in laboratory parameters were observed, indicating recovery from the acute infectious disease. A significant trend to normalization of the immune response, expressed by chemotaxis and index of leukocyte phagocytosis, was found only in patients treated with pidotimod. After the acute episode a significant decrease of risk of relapses (69%) was observed in these patients. If a relapse occurs, the response of treated patients is quicker (duration of fever, total time of relapses) than for control patients. These findings allow to correlate the individual immune response activation to the resistance to recurrent infections and also to a better response to therapy if the disease occurs and becomes clinically relevant. No side effects were observed. Mild reactions (4 nausea/vomiting, 1 erythema) occurred only in 5 patients (2 pidotimod, 3 placebo) but were attributed to concomitant antibiotic therapy. No alterations of main laboratory parameters were found. These findings confirm the tolerability of the drug also in long-term treatment.(ABSTRACT TRUNCATED AT 250 WORDS)

The authors report 4 cases of patients with benign fibrous mesothelioma of the pleura, an extremely rare pathology (not more than 500 cases reported to date in the literature), and discuss biological behaviour, diagnosis and surgical treatment. Benign fibrous mesothelioma is generally diagnosed by chance during chest x-ray given that it is paucisymptomatic; diagnostic procedures include thoracic CT (which may be supplemented by transthoracic needle biopsy) and bronchoscopy. Treatment is surgical and consists of exeresis of the neoplasia; prognosis is excellent and cases are reported in the literature of 24-year follow-up without recurrence. Lastly, the authors underline the importance of modern immunohistochemical techniques which help the surgeon to formulate a precise diagnosis and to differentiate benign fibrous mesothelioma.

Successful closure of a iatrogenic tracheoesophageal fistula by means of bronchoscopic application of fibrin glue in a 77-year old patient is reported. The fistula was completely obliterated after a single application of the glue, with resolution of the clinical and radiological signs. The procedure may be suggested as an alternative to surgery or as first attempt before surgery in very selected patients with TEF.