Normal weight obese (NWO) women: an evaluation of a candidate new syndrome.

BACKGROUND AND AIMS: Obesity, an independent risk factor for cardiovascular disease (CVD), has been associated with the early development of coronary atherosclerosis in adolescents and young men. A subset of metabolically obese but normal weight individuals was identified, with potentially increased risks for development of the metabolic syndrome despite their normal body mass index. We determined the relationship among body fat distribution and selected CVD risk factors to distinguish normal weight obese from controls with normal metabolic profiles. METHODS AND RESULTS: We analysed anthropometric variables, body composition by DXA, RMR by indirect calorimetry and bioumoral variables of 74 clinically healthy Caucasian Italian women. Significant differences were observed in the biochemical HDL-chol values between NWO and controls and pre-obese-obese. Significant correlations were found among cardiovascular risk indexes, LEAN of the right part of the trunk and TC/HDL (R=-0.69, p<0.001) and LDL/HDL (R=-0.72, p<0.001), and LEAN and RMR (R=0.44, p=0.022) of NWO women. CONCLUSIONS: In normal weight obese women the cardiovascular risk indexes are related to metabolic variables and to body fat mass distribution. NWO individuals showed a relationship between the decrease in LEAN of the left leg and an increase in CVD risk factors. We suggest that LEAN distribution seems to be a potential predictor of CVD.

Value of the CD25+ CD16+ cell determination in defining the prognosis of operable breast cancer patients.

The immunologic status of 40 breast cancer patients with operable disease and 50 healthy women was studied at the Division of Medical Oncology of the 2nd Medical School in Naples. Skin tests and lymphocyte subpopulation determination were performed. The same tests were repeated after surgery in the cancer patients. At the same time, the immunologic modifications during chemotherapy (CMF) were studied in a further 25 premenopausal breast cancer patients. The cancer patients did not show significantly different reactivity to recall antigens, nor did surgery or chemotherapy modify this parameter. The breast cancer patients showed a significantly higher CD4+/CD8+ ratio (2.07 +/- 1.06 vs. 1.56 +/- 0.58; p < 0.05) and a higher percentage of CD16+ cells (15.7 +/- 7 vs. 9.1 +/- 6; p < 0.001), than controls. Patients without axillary lymph node involvement showed higher CD4+/CD8+ ratio, CD16+ and CD25+ percentage than the N+ patients. The percentage of CD25+ cells (expressing functional IL-2 receptor) and CD16+ cells proved to be predictive of early relapse: in 14 patients who had relapsed at a 37 month median follow-up, mean CD25+ and CD16+ cell values at diagnosis were significantly lower than those in the remaining 26 (CD25+: 0.87 +/- 0.7 vs. 2.44 +/- 2.19, p < 0.01; CD16+: 9.4 +/- 6 vs. 17.3 +/- 5, p < 0.001). These data suggest that a functional activation may occur in operable breast cancer patients except those with axillary node metastatization (especially when more than 3 axillary lymph nodes are involved).(ABSTRACT TRUNCATED AT 250 WORDS)

[Strategic planning: integration of training and quality. Experience at the Umberto I Polyclinic of Rome]. / Pianificazione strategica: integrazione fra formazione e qualità, l'esperienza dell'azienda policlinico umberto I di Roma.

This work shows how personnel involvement is one change strategy used in a complex organization making use of education and quality as main reorganization factors in a hospital system based on old management that didn't consider personnel as a strategy resource within a reorganizational change.

Patients on liver transplantation waiting list with Model for End-Stage Liver Disease score ≥ 30: experience in the Organizzazione Centro Sud Trapianti macro area.

INTRODUCTION: From 2011 a program was developed for liver transplant recipients with Model for End-Stage Liver Disease (MELD) score ≥30. We examined its effectiveness and impact on the other subjects on the waiting list. MATERIALS AND METHODS: We analyzed requests received between January 2011 and May 2012 for the primary pathology, the outcome, the average waiting time, and the origin of the organ. We examined the ordinary waiting list for mortality rates and numbers of transplantations over this period (group A) versus a comparable preceding period (group B). RESULTS: There were 38 requests for 33 patients. Their primary pathologies were cirrhosis associated with viral infection (n = 15), delayed graft failure (DGF; n = 5), biliary cirrhosis (n = 4), hepatocellular carcinoma (HCC; n = 3 including 2 with cirrhosis), cryptogenic cirrhosis (n = 3), postalcoholic cirrhosis (n = 2), metabolic disease (n = 2), and iatrogenic disease (n = 1). Of the requests, 25 were successfully dealt with, whereas 5 requests were temporarily suspended and 2 were permanently suspended because of better or worse patient conditions. There were 6 deceased patients. Transplanted organs came from the inter-regional area in 64% of cases. The average waiting time was 5.9 days. Within group A were a 311 transplantations among 723 waiting list patients on with a 13.7% mortality rate. Within group B were 305 transplantations among 871 wait-listed patients with a 14% mortality rate. DISCUSSION: The liver transplantation program for recipients with MELD scores ≥ 30 allowed recipients in critical condition to receive grafts without altering substantially the opportunities for recipients on the elective waiting list.

Research for optimization in organ donation in a macro-area after federal reform of the Italian health system.

Law number 91, dated April 1, 1999, established an organizational model for the activities of donation, retrieval, and transplantation of organs consisting of 4 levels: national, interregional, regional, and local. After 12 years this organizational project, called the "National Transplant Network," has reached an excellent level of effectiveness and efficiency. Since 2001 regional administrative districts have been entrusted increasingly with responsibilities concerning health. In 2008 health federalism was approved and in 2010 the federal health fiscal system entered in force. In a country with a federal organization, where regional districts are completely autonomous, is there a reason to still have a national transplant center and 3 interregional transplantation centers? We have developed a hypothesis on the function of Interregional Transplant Centers (CIR). The risk of federalism is the fragmentation of the National Healthcare System. To adequately meet the needs of citizens, smaller regions should sign agreements with larger regions regarding transplantation programs that require a large pool of donors whereas they could retain management of patients during the presurgery and postsurgery phases. The CIR should be committed to increase organ donation, to establish shared protocols and procedures, to disseminate knowledge, and to ensure equal access to health care. In conclusion, the adoption of health and fiscal federalism provides an opportunity to build healthcare systems to optimize resources. The network model should be kept but it is necessary to overcome localism and create positive federalism.

Italy-Greece cooperation for transplantation of medically urgent Greek patients: is it an effective, efficient model?

INTRODUCTION: In 2005 the Italian National Transplant Centre (CNT) signed a cooperation agreement with the Hellenic Transplant Organization (HTO) fostering the transfer and transplantation of urgent Greek liver patients at Italian transplantation centers. So as to not reduce access to transplantation for Italian patients, the agreement provided compensation for organs allocated to Greek transplant recipients. The aim of this study was to analyze the flow of patients from Greece to Italy and the number of received livers to consider the possibility to extend this kind of agreement to other countries, so that this should not penalize Italian recipients. MATERIALS AND METHODS: The agreement provides the possibility for Greek patients affected by acute disease to be transferred to Italian transplantation centers participating in the agreement. Until 2008 livers transplanted into Greek recipients were returned through a preferential offer of surplus Greek organs, whereas from 2009 an obligation of payback was introduced. RESULTS: During the reviewed period requests for transfer, transferred patients, and number of patients who later underwent transplantation in Italy were 56, 26, and 23, respectively. Livers offered by the Greek organization that were accepted, transferred, and transplanted in Italy have been 82, 50, and 44, respectively. DISCUSSION AND CONCLUSIONS: According to our analysis, the cooperation has had as positive impact for both Greece, which has difficulties transplanting urgent recipient because of the low number of donors, and for Italy, which is not penalized by the use of an organ in a Greek recipients, but is also rewarded for helpfulness.