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Autoimmune rheumatic diseases are characterised by an abnormal immune system response, complement activation, cytokines dysregulation and inflammation. In last years, despite many progresses in managing these patients, it has been shown that clinical remission is reached in less than 50% of patients and a personalised and tailored therapeutic approach is still lacking resulting in a significant gap between guidelines and real-world practice. In this context, the need for biomarkers facilitating early diagnosis and profiling those individuals at the highest risk for a poor outcome has become of crucial interest. A biomarker generally refers to a measured characteristic which may be used as an indicator of some biological state or condition. Three different types of medical biomarkers has been suggested: i. mechanistic markers; ii. clinical disease markers; iii. therapeutic markers. A combination of biomarkers from these different groups could be used for an ideal more accurate diagnosis and treatment. However, although a growing body of evidence is focused on improving biomarkers, a significant amount of this information is not integrated on standard clinical care. The overarching aim of this work was to clarify the meaning of specific biomarkers during autoimmune diseases; their possible role in confirming diagnosis, predicting outcome and suggesting specific treatments. © 2018

Inguino-scrotal herniation of the ureter is a rare and difficult situation for a surgeon, especially if only recognized during inguinal hernia repair. An 83-year-old gentleman, with a previous history of radiation treatment for squamous anal cancer, presented with a large left inguinoscrotal hernia causing occasional pain at the base of the scrotum. Follow-up, post-radiation therapy CT scan showed a hernia sac containing the bladder and large bowel. Calcifications in the sac were interpreted as bladder stones, in keeping with the history of left renal calculi. During hernia repair careful dissection revealed a herniated portion of the left ureter located alongside a large hernia sac, complicated by ureteral calculi. Following stones extraction and ureteral repair, hernia repair with mesh was successfully accomplished. Pathogenesis of ureteric herniation is reviewed. A herniated ureter is potentially a source of serious renal or ureteral complications. When discovered, ureteric hernias should be surgically repaired. If preoperative detection of a ureter herniation alongside an inguinal hernia is missed, awareness of the existence of this condition may help avoid iatrogenic ureteral damage injury during a complex hernioplasty. Documentation of unexplained, sizeable and distinct calcifications in an inguino-scrotal hernia sac, particularly in a patient with a history of urolithiasis, may suggest the presence of a herniated, calculus-filled ureter. In such cases, retrograde pyelograms may be considered for a definitive diagnosis prior to surgery.

Conventional sintering techniques for zirconia-based materials, which are commonly used in dental reconstruction, may not provide uniform heating, with the consequent generation of microstructural flaws in the final component. A sintering system using microwave heating may represent a viable alternative. The purpose of this study was to compare the dimensional variation and physical and microstructural characteristics of commercial zirconia (Y-TZP), used as a dental restoration material, sintered in conventional and microwave furnaces. A physical-mineralogical-microstructural characterisation was carried out to evaluate the level of densification and the presence of flaws in the sintered specimens. Use of the microwave systems allowed the length of the sintering cycle to be reduced to a few minutes, compared with the several hours necessary with a ‘traditional’ heating system. Additionally, the maximum temperature used to reach the required density decreased from 1450–1480 °C with the electric furnace to 1200 °C in the microwave furnace. An important clinical implication is that the reduced sintering time could allow the introduction of zirconia in chair-side treatments, if used as a monolithic material.

in the present work, scrap packaging glass coming from urban separted collection (post consumer waste) and industrial ceramic waste (pre-consumer waste) were used as secondary raw materials to prepare protoypes of ceramic tiles 100% green. Opportunely balances mixes of wastes are able ti sinergically interact during the thermal cycle, giving rise to innovative materials able to sinter about 200 C lower than a traditional ceramic tile mix, maintain good performances in terms of flexural strength, Young's modulus and Weibull's modulus

Historically, colo-anal pull-through (P-T) has been the first surgical procedure adopted to facilitate a handmade lower anastomosis. Very popular around mid twentieth century, P-T has had poor diffusion, mainly as a consequence of the technical simplifications brought by staplers. Recent literature seems poor on this specific topic, despite description of P-T appears in published series during the reconstructive phase of total laparoscopic protectomies. A comeback of P-T has also been observed as an option with deferred anastomosis, to allow and protect a colo-anal anastomosis in situations at greater risk of dehiscence, avoiding a temporary faecal diversion. After reviewing the most significant aspects of classic techniques of P-T, we report our experience with transanal laparoscopic P-T for distal rectal cancer, presenting a new, modified P-T with deferred anastomosis aimed at improving defecatory compliance.Between January 2008 and June 2011 we operated in 258 rectal cancers (0-14 cm from the anal verge), 62.79% of which by laparoscopic access (VL), with 218 restorative procedures (84.49%). The colo-anal anastomoses (CAA) were globally 68 (26.35%), of which 48 in VL procedures (70.58%). In 27 of these CAAs we utilised the P-T procedure, with immediate CAA (I-CAA) in 11 cases (all VL) and delayed CAA (D-CAA) in 16 (2 VL), by selective indications. All CAAs were manually fashioned; 6 D-CAA had the addition of a transverse coloplasty. Site of tumor was the lower rectum in 24 patients, with 21 patients receiving preoperative chemoradiation.There was no operative mortality. Early morbidity: DCAA: 3 pelvic abscesses with stoma formation.1 intraoperative re-resection and colo-anal anastomosis with stoma formation for defective distal vascular supply. Late morbidity: anastomotic stenosis in 5/12 I-CAA and 4/14 D-CAA controlled by mechanical dilation. Function: 4/7 D-CAA and 4/6 I-CAA nearly complete functional recovery (Kirwan's 1 or 2).There are selective indications to P-T, when resection and anastomosis is not feasible in one step, or also as a primary restorative option in elective cases when a covering stoma is refused or dangerous.

Large cross-section reaction channels were measured in the systems 6Li( 7Li) + 208Pb with high statistical accuracy at 5(3) energies around the Coulomb barrier from 29 to 39 MeV. These channels were assigned (mainly) to the breakup of 6Li, very loosely bound, into α + d and to the breakup of 5Li, produced by n-transfer to the target, into α + p and to similar processes with 7Li beam. The cross-sections with 6Li, Sα = 1.475 MeV, are systematically larger than the 7Li ones. This reflects, most likely, the higher binding energy of 7Li, Sα = 2.468 MeV. Theoretical predictions for the 6Li + 208Pb system which include for 6Li breakup to continuum states within a continuum discretized coupled-channels approach (CDCC) and resonant breakup plus n-transfer with DWBA reproduce the angular distribution shapes but still underestimate the cross-sections by a factor ∼ 3.

SummaryA total of 101 patients with advanced colorectal cancer in two consecutive Southern Italian Oncology Groups (GOIM) studies (8501 and 8801- arm A) were treated with a sequential combination of high dose methotrexate (HDMTX) and fluorouracil (FU). Of the 92 eligible patients, 2 achieved complete response (2%) and 27 partial response (30%), with a median duration of 7 months. When classified according to the time interval between administration of the two drugs, retrospective analysis showed significant improvement (p = 0.04) in overall survival in the shorter time interval group (6 hours). The observed toxicities were generally mild and transient. Our data confirm the efficacy of the synergism between the two chemotherapeutic agents, in particular when administered with a 6-hour interval. Further studies are necessary to establish the possibility of enhancing the efficacy of sequential treatment with the modulation of FU with high-dose folinic acid.

Superdeformed (SD) bands in152Dy,151Dy and151Tb have been populated via the 5n, 6n and 5np evaporation channels, respectively, with the33S+124Sn reaction at 160 and 170 MeV bombarding energies. Population intensities are in good agreement with existing data for SD bands in151, 152Dy and SD yrast band in151Tb. The excited “twin” SD band in151Tb with the sameγ-transitions as the band in152Dy is populated about 5 times more strongly than by the 6n evaporation channel. This might be explained in terms of competition between proton andγ emission out of an intermediate, excited superdeformed configuration of152Dy.

The silicon pixel detector (SPD) of the ALICE experiment in preparation at the Large Hadron Collider (LHC) at CERN is designed to provide the precise vertex reconstruction needed for measuring heavy flavor production in heavy ion collisions at very high energies and high multiplicity. The SPD forms the innermost part of the Inner Tracking System (ITS) which also includes silicon drift and silicon strip detectors. Single assembly prototypes of the ALICE SPD have been tested at the CERN SPS using high energy proton/pion beams in 2002 and 2003. We report on the experimental determination of the spatial precision. We also report on the first combined beam test with prototypes of the other ITS silicon detector technologies at the CERN SPS in November 2004. The issue of SPD simulation is briefly discussed., Comment: 4 pages, 5 figures, prepared for proceedings of 7th International Position Sensitive Detectors Conference, Liverpool, Sept. 2005

The surgical treatment of low rectal cancer has yet to be standardised. The aims of the study were to define the curative role of intersphincteric resection and to evaluate its indications and functional results through a retrospective clinical experience. From 1988 to 2000, out of 783 operations for primary rectal cancers (resectability rate 96%; restorative resections 83% and APR 10%) an intersphincteric resection was performed in 48 patients (31 male, 17 female, average age 62) for tumours located at a mean distance of 4.5 cm from the anal verge. Clinical stage: 27 T3 (56.3%), 12 T2, 5 T4 and 4 T1. All the operations were rated R0. TME with N-S, endo-anal distal transection and manual colo-anal anastomosis with a protective stoma were systematically performed. The mean follow-up was 46 months (range: 12-80). Functional results were evaluated with a prospective standardised questionnaire. There was no hospital mortality (30 days). The total morbidity rate was 22% with anastomotic leakage (clinical or X-ray evidence) in 12.5%. Four anal stenoses needed dilatation. Only one local recurrence six years after operation (2.1%). Nine patients died of systemic metastases within 3 years of surgery; the others are still alive and disease-free. Minor faecal incontinence with frequency and urgency occurred in 68.7% of cases at 3 months after protective stoma closure and in 37.5% after 6 months. After one year continence was good in 85.4% of survivors. Only one case required a permanent stoma for poststenotic total incontinence. The best functional results were achieved by colonic pouch reconstruction. For selected low rectal cancers (T2/T3) without voluntary sphincter infiltration, intersphincteric resection is safe and effective for oncological and functional purposes. The procedure requires accuracy in dissecting the anorectal junction. Preoperative radiotherapy may increase the indications for intersphincteric resection as well as the availability of a disease-free margin. A manual colo-anal anastomosis with colonic pouch interposition is strongly recommended.

The efficacy of colon-J-pouch anal anastomosis (CPAA) in reducing defecatory frequency and urgency and the incidence of anastomotic fistulas has been proved by several studies but only as compared to straight colo-anal anastomosis (CAA) of the end-to-end type. We investigated the role played by the colon pouch in the strict sense, without the influence of a different CAA model, in a randomised prospective study comparing CPAA and straight side-to-end CAA. Over the period from 1994 to 1998 we selected 66 of 118 patients operated on for rectal cancer: a CPAA was constructed in 35 (group P) and a direct side-to-end CAA in 31 (group D). The two groups were well matched for surgeon, type of patient, stage of disease and incidence of radiotherapy and presented no differences in operative mortality, general and anastomotic morbidity, or need for reoperation. Functional results: after 3, 12 and 36 months, defecatory frequencyor = 4 movements/day was observed in 93.4, 67.7 and 41.6% of cases, respectively, in group D as against 25.7, 14.2 and 13%, respectively, in group P (P0.05), while defecatory urgency was recorded in 77.4, 35.4 and 27.9% of cases, respectively, in group D as against 34.2, 17.1 and 9%, respectively, in group P (p0.05). In the long term, incontinence was also significantly lower in group P. The colon pouch improves sphincter rehabilitation after anal recanalization compared to straight side-to-end CAA. It does not affect anastomotic morbidity but affords a protective effect on function in irradiated patients. CPAA proves to be the optimal reconstruction option after excision of the rectum.

The role of surgery in the therapeutic balance of locally advanced rectal neoplasms needs to be redefined in the light of recent reports on the efficacy of radio- and chemotherapy in neoadjuvant treatment.For this purpose, the authors analysed the results of 104 locally advanced rectal neoplasms during the decade 1987-1996 all of whom had undergone priority surgery (100% operability) using a decidedly radical approach. Of this continuous series, 70 were T4 M0 (Group A) and 34 T4 M1 (Group B). Resectability in Group A was 97.1% (87% R0 excisions) with sphincteric recovery in 72.8%. Resectability was 73.5% in Group B (20% R0 excisions) with sphincteric recovery in 60%.Total operative mortality was 4.7% (2.9% for R0 operations, 10.2% for R2), morbidity was 24%. No survivor died during the follow-up: there were 6 local recidivations for 68 R0 operations (8.8%), half of which were only local. The mean survival for the entire series was 34 months: 4-5 months for R0 operations; for R1-R2 operations: 18 months for M0, 8 months for M1. None of the patients with local residual disease undergoing postoperative radiochemotherapy were recovered during surgery.A comparative evaluation of the results obtained with those reported in the literature involving single or multicentre series pretreated with radio- or chemotherapy is relatively difficult and non-indicative owing to the numerous disparate aspects that have been the subject of debate and comment, ranging from the definition of locally advanced rectal cancer to the grounds for selecting patients and the comparative groups treated with out-of-date surgical standards.

To evaluate retrospectively in 64 gastric non-Hodgkin lymphoma (G-NHL) patients the role of some prognostic factors in the therapeutic strategy of this disease.Sixty-four primary G-NHL patients (39 males and 25 females; median age: 57 years) were retrospectively evaluated. Treatment consisted of surgery alone (S) in 7 patients, chemotherapy alone (CT) in 15, CT + radiotherapy (RT) in 2, S + RT in 2, S + CT in 19, S + CT + RT in 16. Three patients had no treatment. Forty-four patients received sub-total gastrectomy (21) or total gastrectomy (23), and 20 were not submitted to surgery.After a median follow-up of 106 months (range 48-201), the four-year disease free survival (DFS) was 56% and overall survival (OS) was 59%. In the univariate analysis, tumor invasion depth (p = 0.007), stage (IIE1 vs IIE2: p = 0.007; I-IIE1 vs IIE2-IV: p = 0.0000009) and treatment (in stage IE-IIE1: p = n.s.; in stage IIE2-IV: p = 0.002) were significantly different. In the multivariate Cox regression model, stage was the only significant variable negatively influencing survival.Our study confirms the prognostic value of both the depth of invasion and the disease stage. In patients with early disease stages and disease localized to the gastric wall, a conservative approach can be recommended. No difference was found between the sub-total and total gastrectomy but surgery retains its fundamental role for G-NHL, even in advanced disease. Prospective trials are needed to confirm these results.

Total mesorectal excision (TME), well established in the modern curative surgery of rectal cancer, needs further investigation, especially with regards to the preservation technic of the autonomous abdominopelvic innervation currently used to prevent or reduce the urogenital sequelae. The Authors offer a perspective study over the recovery of sexual activity in a homogeneous group of 32 male patients submitted, because of cancer, to restorative proctectomy, with anatomical preparation of the hypogastric and sacral plexus. The criteria for eligibility were the followings: male under 70 years of age, excision of the primary rectal cancer with coloanal or colo-rectal anastomosis performed at less than 5 cm from the anal verge, staging not more than T3N2M0, without previous RT or other pelvic operations and without protective enterostomy, nor local or systemic recurrences during the follow up period. The functional results obtained on the basis of a questionnaire, filled in quarterly by the patients as well as their partners for at least a year, three months after the operation were: lack of sexual disorders in 37.5%, reduction of the sexual activity (partial erection, lack of ejaculation, anorgasmy) in the 34.4%, and no sexual activity in 28.1% of the patients. After 6 months the total lack of sexual activity was observed in only 15.6% of the patients, whereas after a year 65.6% of the patients showed a normal level of sexual activity. The Authors explain the preparatory technic to approach the mesorectum sparing the autonomous nerves and discuss the two fundamental surgical-anatomical aspects of the nerve-sparing technic still not sufficiently clarified as far as the behaviour of the pelvic visceral fascia and the course of the medial-rectal artery are concerned. The results obtained even considering the limitation in the evaluation and standardization of the genito-sexual disorders, show the need to extend and deepen the study relative to the nerve-sparing technics in rectal cancer surgery.

A study of mitochondrial oxidative phosphorylation in biopsies from human hepatocellular carcinoma is presented. Tumour mitochondria as compared to control liver mitochondria, besides a reduced activity of complex IV (cytochrome c oxidase) of the respiratory chain, show a decreased phosphorylative capacity. This appears to be mainly related to a defective F o F(1) ATP synthase complex. Use of an antibody against the F(1) portion of the complex demonstrate a definite decrease for the beta subunit of F(1) in tumour mitochondria.

On the basis of their experience acquired in the field of thyroid surgery the authors examine the problems related to extracapsular lobectomy from a tactical and technical point of view, starting with its principal indications: benign monolobar thyroid disease in a single or multiple nodular form. The validity of extemporary histological tests is also assessed on the basis of their experience of rare false negatives and the relative successive totalization programme. Lastly, the paper underlines the fundamental identification of the recurrent nerve as the central point of the operation, before which the authors emphasize that nothing should be cut or ligated apart from the superior vascular peduncle and vena media.

In the search for parameters that can indicate changes in the behaviour of liver tissue from normal to chronic to neoplastic disease, DNA content by FCM (ploidy and percent of 4N cells) and morphobiological characteristics were investigated in fresh liver specimens of 16 patients with normal liver, 21 with persistent hepatitis (CPH), 23 with chronic active hepatitis (CAH), 17 with cirrhosis, and 13 with hepatocellular carcinoma (HCC). Aneuploidy was mostly found in HCC specimens (54%), whereas the percentage of 4N peak decreased in chronic hepatitis and cirrhosis patients but increased to 11.09% in HCC samples (r = -0.02; p = 0.05). Finally, the binuclearity rate decreased gradually from normal to flogistic to HCC specimens. The 4N peak and the binuclearity rate were closely correlated in non-HCC (p = 0.0006, by T-test) but not in HCC samples. Only DNA ploidy and the binuclearity rate have been confirmed as being significantly and independently related to the histology of liver tissue by multivariate regression analysis.

To compare the efficacy of two biochemical modulations of 5-Fluorouracil in advanced colorectal cancer, 104 patients were randomized to receive high dose methotrexate followed by 5-Fluorouracil and leucovorin rescue on day 1 (Arm A) or folinic acid and 5-Fluorouracil on day 1 to 5 (Arm B). Both treatments were repeated every 3 weeks. In the 92 evaluable patients, objective responses were observed in 34% in Arm A and 31% in Arm B, with a median duration of 7.5 and 8.5 months, respectively. Median overall survival was similar in both groups (12 versus 13 months, respectively). A statistically significant difference was found only between responders and non responders of group B (p = 0.004). Toxicity was mild. In conclusion, no difference in therapeutic activity was seen between the two treatments and additional biochemical modulation must be evaluated.

The Authors report their initial experience with the construction of a J-pouch as restorative surgery following total gastrectomy (TG) for malignant neoplasms. In the last 10 months of the 1990 upon 52 interventions for gastric cancer 31 TG were performed, and in 13 cases a J-pouch on the proximal end of the jejunal segment was constructed. No mortality or specific morbidity was registered using the totally stapled technique. Within one month 3/4 of the patients had normal meals as far as quantity and quality; also the foamy regurgitation seemed to be minimal. The ease of the reconstructive technique and the short term results obtained encourage the use of such approach.

The Authors describe a new reconstructive model after total proctectomy: the S-E colo-anal anastomosis (S-E CAA). The technical requisites of this variant are discussed and compared with more traditional reconstruction models. At a first evaluation of the results, the S-E CAA seems to be able to sensibly ameliorate the course and the outcome of the anastomosis and to hasten the recovery of the normal sphincteric function.

1. Injection of carrageenin into the liver of rats provoked a focal necrotic-hemorrhagic lesion that evolved through acute inflammation, accumulation of macrophages and fibroblasts and the formation of a relatively large amount of fibrous tissue that underwent resorption. The entire lesion disappeared within 15-18 days of the beginning of inoculation. 2. Ultrastructural analysis revealed that carrageenin granules were taken up by macrophages, fibroblasts and myofibroblasts and that signs of formation and degradation of collagen were constant features, the former predominating early and the latter being evident toward the second half of the evolution of the lesion. 3. The presence of fibronectin was prominent during the first days and Type I and Type III collagens were present in the extracellular matrix soon after induction of the carrageenin lesion. Both collagen isotypes subsequently underwent progressive and simultaneous resorption. 4. The rapid formation and degradation of both collagen isotypes during the evolution of carrageenin granuloma indicates that collagen stability is not fundamentally dependent on genetic isotype.

systemhave beendeduced. Comparisonoftheexperimentaldatawithtwodifferenttheoretical approaches strongly supports the direct breakup process description.1. INTRODUCTIONThe growing interest and effort of the nuclear physicists community for experimentsperformed with Radioactive Nuclear Beams (RIBs), has triggered several experimentsthat can be performed using stable beams and could give a first taste of what kind ofdifficulties and results we will face once RIBs will be available. In this perspective, it’snatural to choose stable beams that have characteristics very close to those of the RIBs.For example, if one considers the binding energy of the nuclei, it’s immediately clear thatsome stable light nuclei are weakly bound, like many light RIBs

The excitation energy above the breakup threshold of the $\alpha + d/^6$ Li system, after the interaction of 6Li nuclei with a 208Pb target, was deduced from the invariant mass of the $\alpha + d$ system. Data were collected with a large-solid-angle detector set-up at four beam energies around the Coulomb barrier. The excitation of the 6Li nucleus above the breakup threshold (1.47 MeV) has a quite similar behavior at each measured beam energy and angle; it is peaked at $\sim 1$ MeV above the threshold and shows an exponential decay on the high energy side, which is a clear signature of a direct breakup process. The experimental excitation energies are reproduced both in shape and absolute value by 1) fully quantum-mechanical Coupled-Channel calculations with coupling to discretized-continuum 6Li excitations, 2) semi-classical Coupled-Channel approach, where the relative motion is treated along a classical trajectory.

This study is concerned with the search for entrance channels suitable to synthesize elements with Z > 118. Mass-energy distributions as well as capture cross-sections of fission-like fragments have been measured for the reactions 64Ni + 238U → 302120 and 48Ca + 238U → 286112 at energies near the Coulomb barrier. Compound nucleus fission cross-sections were estimated from the analysis of mass and total kinetic energy distributions. The cross-section drops three orders of magnitude for the formation of the compound nucleus with Z = 120 obtained in the reaction 64Ni + 238U compared to the formation of the compound nucleus with Z = 112 obtained in the reaction 48Ca + 238U at an excitation energy of the compound nucleus of about 45 MeV. From our analysis it turns out that the reaction 64Ni + 238U is not suitable for the synthesis of element Z = 120. © 2010., SCOPUS: ar.j, info:eu-repo/semantics/published