Prognostic role of FDG PET-derived parameters in preoperative staging of endometrial cancer. / Función pronóstica de los parámetros derivados de FDG PET en la estadificación preoperatoria del cáncer de endometrio.

PURPOSE: To investigate the preoperative prognostic role of 18F-FDG PET/CT in patients with endometrial carcinoma (EC). METHODS: 18F-FDG PET/CT was performed in 57 patients for EC preoperative staging. Maximum and mean standardized uptake values (SUVmax, mean), metabolic tumor volume (MTV) and total lesion glycolysis (TLG) of primary tumors, at different thresholds of 40%, 50%, 60% (40-50-60), were evaluated and compared with anatomopathological features. The diagnostic performance of PET-parameters (categorized by ROC analysis) in discriminating low-intermediate and high-risk disease and the prognostic role on survival (overall survival -OS; disease free survival - DFS) was evaluated. RESULTS: The categorized TLG40-50-60 were the only parameters related to FIGO stage I versus II-III-IV (p = 0.0035 for all). The cut-off values for risk stratification were 83.69, 61.81 and 41.32, respectively (sensitivity: 60.00%; specificity; 71.43% for all parameters). Pathological stage 1 (pT1) of the primary tumor was predicted by MTV60 and TLG40-50 (p = 0.0328, 0.0240, 0.0147, respectively). The optimal thresholds were 7.795, 99.55 and 77.58, respectively (sensitivity: 38.46%, 53.85% and 53.85%, respectively; specificity: 88.64%, 79.55% and 81.82%, respectively). SUVmax and SUVmean40-50-60 were the only parameters discriminating endometrioid from non-endometrioid subtype. The corresponding sensitivity was 64.86% and 62.16% for SUVmax and SUVmean 50-60 and 62.16% for SUVmean40; specificity was 70.00% for all parameters. The mean (SD) OS was 79.77% (3.34%) and the mean DFS was 77.89% (3.73%). The tumor type was the only variable significantly associated with OS (p = 0.0486). TLG50 > 77.58 cm3 was the only variable associated with a higher risk of relapse (p = 0.0472). CONCLUSION: TLG40-50-60 and MTV60 of primary EC have prognostic value in discriminating FIGO and pathological staging. These results suggest a possible role of these parameters in predicting EC aggressiveness, thus improving the preoperative characterization of endometrial cancer.

Tantalum in type IV and V Paprosky periprosthetic acetabular fractures surgery in Paprosky type IV and V periprosthetic acetabular fractures surgery.

PURPOSE: Periprosthetic acetabular fractures represent a growing and serious complication of total hip arthroplasty (THA). The purpose of the study is to report our experience in the use of tantalum for the treatment of Paprosky type IV and V periprosthetic acetabular fractures. METHOD: We analyzed 24 patients with type IV and V periprosthetic acetabular fractures. Patients were treated with a revision surgery using tantalum components, in some cases in association with posterior plating. Outcomes were evaluated using VAS, Harris hip score and considering the average time of integration of the acetabulum and the number of complications. The endpoint evaluation was established at 24 months. RESULT: Results show that the average time of integration of the neoacetabulum in tantalum was 12.3 months (range 6-18 months). The average VAS pain is 8.7/10 cm at time 0 and gradually returns to basic pre-injury values in the following months. The average value of HHS at time 0 is 13.5 points. This value tends to increase progressively until reaching a mean score of 89.3 points at 24 months, higher than the average pre-trauma value of 84.3 points. CONCLUSION: Periprosthetic fractures of the acetabulum with bone loss are a rare but potentially disastrous complication of total hip prostheses. Their management and therapeutic choice will test the ability of the orthopedic surgeon. It is important to determine the type of fracture and characteristics in order to pursue an adequate therapeutic strategy. The modern biomaterials, such as porous tantalum, offer a greater potential in replacing bone loss, promoting bone regrowth and obtaining a stable implant.

Leisure and occupational physical activity at different ages and risk of endometriosis.

OBJECTIVE: Cohort and case-control studies have suggested that adult physical activity (PA) may lower endometriosis risk and improve symptoms, but evidence is still controversial. To add information on leisure and occupational PA impact, if any, on endometriosis risk, we have analyzed data from a small case-control study conducted in Milan (Italy). STUDY DESIGN: Ninety cases and 90 controls (median age 35 years, range 18-76) were compared. Endometriosis was laparoscopically diagnosed within the year before interview. Information on demographic variables, menstrual and reproductive history, occupational and recreational physical activity was collected. RESULTS: A consistent protective effect emerged between leisure PA and endometriosis risk. For <2-4 and ≥5h/week (reference no PA), the estimated odds ratios (ORs) were, respectively: 0.36 (95% CI 0.18-0.74) and 0.83 (95% CI 0.27-2.53) as regards PA in early adolescence; 0.31 (95% CI 0.15-0.63) and 0.78 (95% CI 0.25-2.38) as regards PA in teenage years; 0.34 (95% CI 0.12-0.94) and 0.33 (95% CI 0.08-1.28) for PA in adulthood. However, no significant trend was seen according to hours spent in leisure PA. Occupational PA did not show statistical significant differences among different types or across age classes. CONCLUSIONS: These results suggest that leisure PA in early adolescence, teenage years and adulthood may, to some extent, decrease the risk of endometriosis. In the interpretation of these results, however, the role of potential biases cannot be totally ruled out.

Soluble salt removal from MSWI fly ash and its stabilization for safer disposal and recovery as road basement material.

Fly ash from municipal solid waste incinerators (MSWI) is classified as hazardous in the European Waste Catalogue. Proper stabilization processes should be required before any management option is put into practice. Due to the inorganic nature of MSWI fly ash, cementitious stabilization processes are worthy of consideration. However, the effectiveness of such processes can be severely compromised by the high content of soluble chlorides and sulphates. In this paper, a preliminary washing treatment has been optimized to remove as much as possible soluble salts by employing as little as possible water. Two different operating conditions (single-step and two-step) have been developed to this scope. Furthermore, it has been demonstrated that stabilized systems containing 20% of binder are suitable for safer disposal as well as for material recovery in the field of road basement (cement bound granular material layer). Three commercially available cements (pozzolanic, limestone and slag) have been employed as binders.

Treatment and recycling of asbestos-cement containing waste.

The remediation of industrial buildings covered with asbestos-cement roofs is one of the most important issues in asbestos risk management. The relevant Italian Directives call for the above waste to be treated prior to disposal on landfill. Processes able to eliminate the hazard of these wastes are very attractive because the treated products can be recycled as mineral components in building materials. In this work, asbestos-cement waste is milled by means of a high energy ring mill for up to 4h. The very fine powders obtained at all milling times are characterized to check the mineralogical and morphological transformation of the asbestos phases. Specifically, after 120 min of milling, the disappearance of the chrysotile OH stretching modes at 3690 cm(-1), of the main crystalline chrysotile peaks and of the fibrous phase are detected by means of infrared spectroscopy and X-ray diffraction and scanning electron microscopy analyses, respectively. The hydraulic behavior of the milled powders in presence of lime is also tested at different times. The results of thermal analyses show that the endothermic effects associated to the neo-formed binding phases significantly increase with curing time. Furthermore, the technological efficacy of the recycling process is evaluated by preparing and testing hydraulic lime and milled powder-based mortars. The complete test set gives good results in terms of the hydration kinetics and mechanical properties of the building materials studied. In fact, values of reacted lime around 40% and values of compressive strength in the range of 2.17 and 2.29 MPa, are measured.

Manufacture of artificial aggregate using MSWI bottom ash.

This paper reports the results of an investigation on material recovery by stabilization/solidification of bottom ash coming from a municipal solid waste incineration plant. Stabilization/solidification was carried out to produce artificial aggregate in a rotary plate granulator by adding hydraulic binders based on cement, lime and coal fly ash. Different mixes were tested in which the bottom ash content ranged between 60% and 90%. To avoid undesirable swelling in hardened products, the ash was previously milled and then granulated at room temperature. The granules were tested to assess their suitability to be used as artificial aggregate through the measurement of the following properties: density, water absorption capacity, compressive strength and heavy metals release upon leaching. It was demonstrated that the granules can be classified as lightweight aggregate with mechanical strength strongly dependent on the type of binder. Concrete mixes were prepared with the granulated artificial aggregate and tested for in-service performance, proving to be suitable for the manufacture of standard concrete blocks in all the cases investigated.

[Theoric hints on the quality perception in health care services concept]. / Cenni teorici sul concetto di qualità percepita in sanità.

topic in healthcare services management. In this article we try to summarize the most relevant theoretical approaches, providing a general definition of "quality" and trying a possible generic relationship between the concepts of "perceived quality" and "client satisfaction". Finally, we examine some methodological problems, concerning surveys on quality perception in healthcare services. Through the analysis of some examples, we will compare two methodologies, coming from the University of Siena (Italy) and from the Picker Institute Europe in Oxford (United Kingdom).

Coal fly ash as raw material for the manufacture of geopolymer-based products.

In this work coal fly ash has been employed for the synthesis of geopolymers. Two different systems with silica/alumina ratios stoichiometric for the formation of polysialatesiloxo (PSS, SiO2/Al2O3=4) and polysialatedisiloxo (PSDS, SiO2/Al2O3=6) have been prepared. The alkali metal hydroxide (NaOH or KOH) necessary to start polycondensation has been added in the right amount as concentrated aqueous solution to each of the two systems. The concentration of each alkali metal solution has been adjusted in order to have the right liquid volume to ensure constant workability. The systems have been cured at four different temperatures (25, 40, 60, and 85 degrees C) for several different times depending on the temperature (16-672 h at 25 degrees C; 72-336 h at 40 degrees C; 16-120 h at 60 degrees C and 1-6h at 85 degrees C). The products obtained in the different experimental conditions have been submitted to the quantitative determination of the extent of polycondensation through mass increase and loss on ignition, as well as to qualitative characterization by means of FT-IR spectroscopy. Furthermore, physico-structural and mechanical characterization has been carried out through microscopic observations and the determination of unconfined compressive strength, elasticity modulus, apparent density, porosity and specific surface area. The results have indicated that the systems under investigation are suited for the manufacture of pre-formed building blocks at room temperature.

Efficacy of the combination of cisplatin with either gemcitabine and vinorelbine or gemcitabine and paclitaxel in the treatment of locally advanced or metastatic non-small-cell lung cancer: a phase III randomised trial of the Southern Italy Cooperative Oncology Group (SICOG 0101).

BACKGROUND: Triplet regimens were occasionally reported to produce a higher response rate (RR) than doublets in locally advanced or metastatic non-small-cell lung cancer (NSCLC). This trial was conducted to assess (i) whether the addition of cisplatin (CDDP) to either gemcitabine (GEM) and vinorelbine (VNR) or GEM and paclitaxel (PTX) significantly prolongs overall survival (OS) and (ii) to compare the toxicity of PTX-containing and VNR-containing combinations. PATIENTS AND METHODS: Stage III or IV NSCLC patients were randomly assigned to (i) GEM 1000 mg/m(2) and VNR 25 mg/m(2) on days 1 and 8 (GV arm); (ii) GEM 1000 mg/m(2) and PTX 125 mg/m(2) on days 1 and 8 (GT arm); (iii) GV plus CDDP 50 mg/m(2) on days 1 and 8 (PGV arm); and (iv) GT plus CDDP 50 mg/m(2) on days 1 and 8 (PGT arm). Treatments were repeated every 3 weeks for a maximum of six cycles. RESULTS: A total of 433 (stage III, 160; stage IV, 273) patients were randomly allocated to the study. RR was 48% [95% confidence interval (CI), 42% to 54%] for triplets and 35% (95% CI, 32% to 38%) for doublets (P = 0.004). Median progression-free survival (6.1 versus 5.5 months, P = 0.706) and median OS (10.7 versus 10.5 months, P = 0.379) were similar. CDDP significantly increased the occurrence of severe neutropenia (35% versus 13%), thrombocytopenia (14% versus 4%), anaemia (9% versus 3%), vomiting (6% versus 0.5%), and diarrhoea (6% versus 2%). Conversely, frequency of severe neutropenia (30% versus 17%) and thrombocytopenia (11% versus 6%) was significantly higher with VNR-containing regimens. CONCLUSIONS: Adding CDDP to GV or GT significantly increased RR, but did not prolong the OS of patients. Among doublets, the GT regimen should be preferred in view of its better safety profile.

[Questionnaire of perceived quality (QQP): a study on the differences of gender]. / Questionario di qualità percepita (QQP): uno studio sulle differenze di genere.

In the present paper we analyze the psychometric properties of an Italian questionnaire measuring the perceived quality of health services (Questionnaire of Perceived Quality; Coluccia, Ferretti, Lorini, Calamai, 2002). Subjects answered 14 questions subdivided into four factors (i.e. Satisfaction regarding Medical Doctors, Nurses, Auxiliary Staff, and Hospital Structure). We administered the questionnaire to 1,600 patients in the "Le Scotte" Hospital of Siena. According to structural equation modeling, we studied the dimensionality of the questionnaire using confirmatory factor analysis and, successively, we studied differences in gender using Multi-sample analysis. Results show significant gender differences for two dimensions (i.e. Satisfaction regarding Nurses and Satisfaction regarding Hospital Structures). Females, compared to males, express more negative evaluations in these two factors.

Potential application of coal-fuel oil ash for the manufacture of building materials.

In this paper coal-fuel oil ash has been characterized in terms of leaching behaviour and reactivity against lime and gypsum in hydratory systems for the manufacture of building materials. Its behaviour was also compared to that of coal ash. Metal release was measured in a dynamic leaching test with duration up to 16 days. The results have shown that coal-fuel oil ash behaves very similarly to coal ash. The reactivity of coal-fuel oil ash against lime and gypsum was measured in mixtures containing only lime and in mixtures containing both lime and gypsum. These systems were hydrated at 25 and 40 degrees C under 100% R.H. The results have shown that the main hydration products are the same as those that are usually formed in similar coal ash-based systems. That is, calcium silicate hydrate in coal-fuel oil ash/lime systems and calcium silicate hydrate plus calcium trisulphoaluminate hydrate in coal-fuel oil ash/lime/gypsum systems. From the quantitative point of view, hydration runs showed that the amounts of both chemically combined water and reacted lime measured in the case under investigation are very similar to those found in similar coal ash-based systems. Finally, the measurement of unconfined compressive strength proved that the systems have potentiality for the manufacture of pre-formed building blocks.

Gemcitabine with either paclitaxel or vinorelbine vs paclitaxel or gemcitabine alone for elderly or unfit advanced non-small-cell lung cancer patients.

The aim of this study was to assess whether a combination of gemcitabine (GEM) with either paclitaxel (PTX) or vinorelbine (VNR) could be more effective than GEM or PTX alone in elderly or unfit advanced non-small-cell lung cancer (NSCLC) patients. A total of 264 NSCLC patients aged >70 years with ECOG performance status (PS)< or =2, or younger with PS=2, were randomly treated with: GEM 1200 mg m(-2) on days 1, 8 and 15 every 28 days; PTX 100 mg m(-2) on days 1, 8 and 15 every 28 days; GEM 1000 mg m(-2) plus PTX 80 mg m(-2) (GT) on days 1 and 8 every 21 days; GEM 1000 mg m(-2) plus VNR 25 mg m(-2) (GV) on days 1 and 8 every 21 days. In all arms, an intra-patients dose escalation was applied over the first three courses, provided that no toxicity of WHO grade > or =2 had previously occurred. At present time, 217 (82%) patients had died. The median (months) and 1-year survival probability were 5.1 and 29% for GEM, 6.4 and 25% for PTX, 9.2 and 44% for GT, and 9.7 and 32% for GV. Multivariate analysis showed that PS< or =1 (hazard ratio (HR)=0.67; 95% CI 0.51-0.90), and doublet treatments (HR=0.76; 95% CI 0.59-0.99) were significantly associated with longer survival. Doublets produced no more toxicity than single agents. GT should be considered a reference regimen for elderly NSCLC patients with PS< or =1.

Heavy metal stabilization by means of innovative alumino-silicate matrix.

Powdered tuff mixed with NaOH solution has been hydrothermally cured at temperatures ranging from 90 to 150 degrees C. Hardening takes place due to the formation of an amorphous binding phase. At the lowest temperature tested a non-autoclaved process can be carried out. Values of unconfined compressive strength were found to vary from 15.5 MPa to 28.9 MPa depending on reaction conditions. The matrix was tested as a binder for the stabilization of model systems containing cadmium, chromium and lead and for a real system containing a secondary lead smelter slag. The stabilization process was tested from both the environmental and technological points of view by means of leahcing tests and compressive strength measurement. Basic characterization leaching tests carried out with the model systems showed that metal release from hardened paste is below 1%. Compliance leaching test carried out with the real system showed that lead release is below the limit set by law. From the technological pont of view, it was found that unconfined compressive strength is always higher for the real system. Specifically, this system showed compressive strength increasing with slag content to values exceeding 86.5 MPa.

Communicating with culturally and linguistically diverse patients in an acute care setting: nurses' experiences.

Communication with culturally and linguistically diverse (CLD) patients has been shown to be difficult. This study describes nurses' experiences of communicating with CLD patients in an acute care setting. A purposive sample of registered nurses and certified midwives (n=23) were interviewed. Main findings were: interpreters, bilingual health workers and combinations of different strategies were used to communicate with CLD patients; some nurses showed empathy, respect and a willingness to make an effort in the communication process with others showing an ethnocentric orientation. Main recommendations were: prioritising access to appropriate linguistic services, providing nurses with support from health care workers, e.g., bilingual health care workers who are able to provide more in-depth information, increasing nurses' understanding of legal issues within patient encounters, supporting nurses to translate their awareness of cultural diversity into acceptance of, appreciation for and commitment to CLD patients and their families.

Cement stabilization of tannery sludge using quaternary ammonium salt exchanged bentonite as pre-solidification adsorbent.

In this paper a cement-based cementitious system is studied for the stabilization of tannery sludge. Two binders were used as stabilizing matrices: pozzolanic cement alone and a 3:7 cement/blast furnace slag mixture. Due to the high organic content of the sludge, organophilic bentonite was added to the stabilization system; the modified bentonite was obtained by ionic exchange with benzyldimethyloctadecylammonium chloride and proved to be an effective sorbent of the organic components of the sludge. The different process steps were arranged to minimize the water requirement. The process was evaluated from three different points of view: chemicaL environmental and technological. From the chemical point of view, it was found that the binder hydration products are unaffected by the presence of sludge, although the hydration process is retarded. From the environmental and technological points of view, it was found that the presence of organophilic bentonite strongly enhances process performance. In fact, th e release of both organic carbon and chromium is greatly reduced and the unconfined compressive strength of the stabilized products is increased. According to Italian standards, the stabilized products are suitable for the manufacture of pre-formed building blocks.

Environmental and technological effectiveness of a process for the stabilization of a galvanic sludge.

A binding matrix containing calcium silicate beta-2CaO.SiO(2) and sulphoaluminate 4CaO.3Al(2)O(3).SO(3), and CaSO(4) that gives calcium silicate and trisulphoaluminate hydrates upon hydration has been used for the stabilization of a solid waste from a galvanic treatment process. The waste is to be disposed of in a hazardous wastes landfill to prevent the risk of cadmium, chromium and nickel release. Anhydrous calcium silicate and sulphoaluminate of the binder have been synthesized using a mixture containing powdered tuff in addition to bauxite and calcium carbonate and sulphate. Powdered tuff is quarry dust and is, as such, a true residue. Experiments have been carried out with mixtures containing up to 60% waste and have been addressed towards the environmental and technological assessment of the effectiveness of the stabilization process. Specifically, the study has been carried out taking into account requirements from three different points of view, that is the influence of the waste on the hydration process and on the technological properties of the stabilized products, the leaching behavior under some selected conditions and the effect of the leaching medium on the binding matrix in the stabilized system.

Stabilization of chloro-organics using organophilic bentonite in a cement-blast furnace slag matrix.

The application of cement-based stabilisation/solidification treatment to organic-containing wastes is made difficult by the adverse effect of organics on cement hydration. The use of organophilic clays as pre-solidification adsorbents of the organic compounds can reduce this problem because of the high adsorption power of these clays and their compatibility with the cementitious matrix. This work presents an investigation of the effect on hydration kinetics, physico-mechanical properties and leaching behaviour of cement-based solidified waste forms containing 2-chlorophenol and 1-chloronapthalene adsorbed on organophilic bentonites. These were prepared by cation exchange with benzyldimethyloctadecylammonium chloride and trimethyloctadecylammonium chloride. The binder was a 30% pozzolanic cement, 70% granulated blast furnace slag mixture. Several binder-to-bentonite ratios and different concentrations of the organics on the bentonite were used. Kinetics of hydration were studied by measurement of chemically bound water and by means of thermal and calorimetric analyses. Microstructure and other physico-mechanical properties of the solidified forms were studied by means of mercury intrusion porosimetry, scanning electron microscopy and unconfined compressive strength measurement. Leaching was checked by two different leaching tests: one dynamic, on monolithic samples, and the other static, on powdered samples. This study indicates that the incorporation of the organic-loaded bentonite in the binder matrix causes modifications in the hardened samples by altering cement hydration. The effects of the two organic contaminants are differentiated.

Adsorption of the organic fraction of a tannery sludge by means of organophilic bentonite.

Two different organophilic bentonites obtained by cationic exchange with benzyldimethyloctadecylammonium chloride and trimethyloctadecylammonium chloride have been used to adsorb the organic fraction of a tannery sludge. The exchange process was carried out to different extents to obtain bentonite samples with different organophilicities and different interlayer spacings. Before adsorption, the organic matter was extracted by contacting the sludge with a Ca(OH)2 saturated solution. The adsorption capacity was found to increase with the amount of ammonium salt exchanged for both bentonites, but the one exchanged with benzyldimethyloctadecylammonium chloride proved to be more active: up to about 80% TOC could be removed from the contacting solution. The adsorption of the organic matter caused a further increase of the bentonite interlayer spacing. In both cases, the adsorption isotherms were found to be of cooperative type, due to weak adsorbent-adsorbate interactions at low loading followed by increasing adsorbate-adsorbate interactions at increasing loading. The results may be applied to tannery sludge stabilization by cementitious systems.

Carboplatin plus paclitaxel in extensive small cell lung cancer: a multicentre phase 2 study.

A multicentre phase 2 trial (single-stage design) was undertaken to test the efficacy and toxicity of carboplatin (AUC 6 according to Calvert) plus paclitaxel (175 mg/m(2)3-h infusion) every 4 weeks in the first line treatment of patients affected by extensive small cell lung cancer. The primary end-point of the trial was the objective response rate. 31 objective responses among 50 patients were considered necessary to proceed to a phase 3 trial. 48 patients were enrolled (median age 59 years). Treatment was very well tolerated. 3 patients (6.2%) had a complete response and 23 (47.9%) a partial response, for an overall response rate of 54.2% (95% CI: 39.2-68.6). Median time to progression was 5.7 months (95% CI: 5.2-6.2). Median survival was 9.6 months (95% CI: 7.2-14.6), with a median follow-up time of alive patients of 12 months. At 1 year, the probability of being progression-free or alive was 0.16 and 0.43, respectively. In conclusion, carboplatin plus paclitaxel as given in the present study is very well tolerated but not sufficiently active to warrant phase 3 comparison with standard chemotherapy regimens.