Preoperative sarcopenia predicts survival after hepatectomy for colorectal metastases: a prospective observational study.

OBJECTIVE: The surgical approach to colorectal liver metastases has highly improved the survival rates in metastatic colorectal cancer patients. Since sarcopenia estimates the physiologic reserve of an individual patient, it is considered a surrogate marker of patient frailty, and the selection of appropriate candidates for LR could be crucial to maximize the benefits derived from surgery. The present study investigated the impact of sarcopenia as a prognostic factor after LR from CRLM. PATIENTS AND METHODS: The study retrospectively analyzed 74 patients. Skeletal Muscle Mass at the third lumbar vertebra in the inferior direction was quantified using enhanced computed tomography scans. The patients were divided into two subgroups, with and without sarcopenia, based on median Skeletal Muscle Index. RESULTS: The study included 48 Sarcopenic patients and 26 Non Sarcopenic patients. The median follow-up considered for the patients was 32 months. Median SMI was 39.3 and 52.7 cm2/m2, respectively. The OS rate was significantly different between the two groups. Preoperative sarcopenia resulted in worse OS up to 48 months. CONCLUSIONS: Sarcopenia represents a negative prognostic factor as it is associated with poor postoperative OS. Future programs focused on remediating to the preoperative sarcopenic status of colorectal liver metastatic patients should be implemented.

Fractal-like structures in colloid science.

The present work aims at reviewing our current understanding of fractal structures in the frame of colloid aggregation as well as the possibility they offer to produce novel structured materials. In particular, the existing techniques to measure and compute the fractal dimension df are critically discussed based on the cases of organic/inorganic particles and proteins. Then the aggregation conditions affecting df are thoroughly analyzed, pointing out the most recent literature findings and the limitations of our current understanding. Finally, the importance of the fractal dimension in applications is discussed along with possible directions for the production of new structured materials.

Association between funding, risk of bias, and outcome of randomised controlled trials in oral and maxillofacial surgery.

The influence of funding on the main outcome of a random control trial (RCT) is important, as it could potentially lead to bias towards industry, and results that are too optimistic. We investigated the association between funding, the published outcome, and the risk of bias in trials in oral and maxillofacial surgery (OMFS) published from January 2000 to May 2013 listed in PubMed. The methods used were scored using the risk of bias items given in a Delphi List. Sources of funding were recorded and categorised five ways: not funded, funded by industry, not funded by industry, supported by industry, and source of funds not clear. A total of 390 RCT met the inclusion criteria, and there was a correlation between funding and favourable main outcomes, although this was not significant. There was no correlation between the risk of bias and favourable results of the main outcome of a trial, or between the risk of bias and the reported source of funding in post-hoc analysis. We were unable to show a significant correlation between funding and a higher likelihood of a favourable result for the primary outcome in RCT in OMFS. We also failed to show a significant correlation between the risk of bias of a trial and its main outcome. In contrast, the source of funding proved to affect the risk of bias of a trial significantly, although not in post-hoc analysis. Funded trials were better organised, and so had a lower risk of bias.

Interplay between Aggregation and Coalescence of Polymeric Particles: Experimental and Modeling Insights.

In the present work, the aggregation behavior of polymeric particles possessing different glass transition temperatures (i.e., different "softnesses") has been studied to shed light on the interplay between aggregation and coalescence. In particular, the time evolution of the clusters hydrodynamic and gyration radii as well as of their structure factor has been monitored. With the help of an ad hoc developed deterministic model, based on population balance equations, it was possible to establish a link between the experimentally obtained light scattering data and the predicted particle size distribution. The simplicity of the model, involving one single adjustable parameter based on the coalescence characteristic time, allowed us to obtain a good accordance between simulations and experimental results with little computational effort.

Feeding behavior of two exotic aphid species on their original hosts in a new invaded area.

Greenidea ficicola Takahashi and Greenidea psidii van der Goot (Aphididae: Greenideinae) are Asian aphid species newly introduced in Brazil associated with Moraceae and Myrtaceae. The feeding behavior of G. ficicola and G. psidii was investigated on their respective host plants, Ficus benjamina (Moraceae) and Psidium guajava (Myrtaceae), using the Electrical Penetration Graph (EPG). Fifteen females of each aphid species were monitored during 24h using a DC-EPG GIGA-4 monitor. The time spent in phloem phase (waveforms E1 and E2) was 13.6% of the total recording time for G. ficicola and 0.8% for G. psidii. The average time in the pathway phase (waveforms C and pd) represented 50% of the total time for both species. Aphids spent more time in non-penetration and stylet pathway activities than in the phloem phase or actual feeding. The principal component analysis (PCA) showed that the two species formed different groups in relation to EPG parameters, despite some overlapping. The probing patterns with multiple penetrations of short duration in the sieve elements for both species may indicate apparent unsuitability for sustained feeding on their respective host plants. These results suggest that these two exotic species are in the process of adaptation to their host plants in their new environment and/or the plants may present either chemical or physical barriers against these insects.

Respiratory muscle oxygenation kinetics: relationships with breathing pattern during exercise.

This work aimed to investigate accessory respiratory muscle oxygenation (RMO(2)) during exercise, using near-infrared spectroscopy, and to study relationships between RMO(2) kinetics and breathing parameters. Nineteen young males (19.3 +/- 1.5 years) performed a maximal incremental test on a cycle ergometer. Changes in breathing pattern were characterized by accelerated rise in the breathing frequency (f (Racc)), plateau of tidal volume (V (Tplateau)) and inflection point in the V. (E)/V (T) relationship (V. (E)/V (T inflection)). First and second ventilatory thresholds (VT1 and VT2) were also determined. RMO (2) kinetics were monitored by NIRS on the serratus anterior. During exercise, all subjects showed reduced RMO (2) (deoxygenation) with a breakdown (B-RMO(2)) at submaximal workload (86 % .VO(2max)). .VO(2) corresponding to B-RMO (2) and to f (Racc), V (Tplateau), .V(E)/V(T inflection), or VT2 were not different. Relationships were found between the .VO(2) at B-RMO(2) and the .VO(2) at f (Racc) (r = 0.88, p < 0.001), V (Tplateau) (r = 0.84, p < 0.001), V. (E)/V (T inflection) (r = 0.58, p < 0.05) or VT2 (r = 0.79, p < 0.001). The amplitude of RMO(2) at maximal workload was weakly related to .VO(2max) (r = 0.58, p < 0.05). B-RMO (2) seems to be due to the change in breathing pattern and especially to the important rise in breathing frequency at the VT2 exercise level. Moreover, subjects who exhibit higher .VO(2max) also exhibit a higher decrease in respiratory muscle oxygenation during exercise.

Hg(II)-coordination by sugar-acids: role of the hydroxy groups.

A solution study on the ability of some derivatised sugars [glucuronic acid (GluA), galacturonic acid (GalA) and glucosaminic acid (GlNA)] to complex the Hg(II) ion is reported. The stability constants of the complex species were determined by potentiometric measurements while (1)H NMR experiments allow to define the coordination sites of sugar molecules. GluA coordinates the metal ion through the carboxylic oxygen and the O-4 hydroxyl group and is found to form more stable complexes with respect to GalA in which metal ligation is from the carboxylic oxygen and the O-5 ring oxygen. GlNA forms stable complexes chelating Hg(II) ion through carboxylic oxygen and the alpha-amino group. The ternary 2,2'-bipyridine containing systems were also investigated by means of potentiometric studies. The ML(2) complexes were also isolated in the solid state and characterised by IR spectroscopy.

Epidemiological analysis of the quality of HIV sero-surveillance in the world: how well do we track the epidemic?

OBJECTIVE: The objective of this paper was to analyse the quality of HIV/AIDS sentinel surveillance systems in countries and the resulting quality of the data used to make estimates of HIV/AIDS prevalence and mortality. METHODS: Available data on sero-surveillance of HIV/AIDS in countries were compiled in the process of making the end of 1999 estimates of HIV/AIDS. These data came primarily from the HIV/AIDS Surveillance Database developed by the United States Census Bureau, from a database maintained by the European Centre for the Epidemiological Monitoring of AIDS and all country reports on sentinel surveillance that had been provided to World Health Organization or UNAIDS. Procedures were developed to score quality of surveillance systems based on four dimensions of quality: timeliness and frequency; appropriateness of groups; consistency of sites over time; and coverage provided by the system. In total, the surveillance systems from 167 countries were analysed. RESULTS: Forty-seven of the 167 countries whose surveillance systems were rated were judged to have fully implemented sentinel surveillance systems; 51 were judged to have systems that had some or most aspects of a good HIV surveillance system in place and 69 were rated as having poorly functioning or non-existent surveillance systems. CONCLUSION: This analysis suggests that the quality of HIV surveillance varies considerably. The majority of countries most affected by HIV/AIDS have systems that are providing sufficient sero-prevalence data for tracking the epidemic and making reasonable estimates of HIV prevalence. However, many countries have poor systems and strengthening these is an urgent priority.

Quality control of 99Mo/99Tcm generators: results of a survey of the Radiopharmacy Working Group of the Italian Association of Nuclear Medicine (AIMN).

A multicentre survey of the quality control of 99Tcm generators has been completed: 245 generators from seven different commercial sources were tested over a period of 2 years. The results indicate that the mean pH of the eluates was 5.8 +/- 0.6; the aluminium contents were typically < 10 ppm; the radiochemical purity was 99.8 +/- 0.4% and the median 99Mo content was 3.8 x 10(-4) percent. The elution profiles gave a volume of 1.9 ml to obtain 50% of the total eluted activity and of 4.9 ml to obtain 95%. Other radionuclide impurities and heavy metal breakthrough were evaluated by graphite furnace absorption spectrometry and inductively coupled plasma mass spectrometry. National guidelines for the standardization of radiopharmacy procedures are currently being compiled.

Loco-regional radioimmunotherapy of high-grade malignant gliomas using specific monoclonal antibodies labeled with 90Y: a phase I study.

A Phase I radioimmunotherapy trial was conducted in which radioconjugated monoclonal antibody (MAb) was directly infused into the tumor or postoperative tumoral bed in patients with high-grade malignant glioma. BC-4, a murine MAb that recognizes tenascin, was used in these studies. The MAb was labeled with 90Y, a pure beta emitter with maximum energy of 2.284 MeV, which can penetrate into tissue up to 0.5-0.7 cm. Stable 90Y-labeled MAb conjugates were prepared using the chelator p-isothiocyanatobenzyl derivative of diethylenetriaminepentaacetic acid (ITC-Bz-DTPA), obtaining >95% labeling efficiency and conserving the antibodies' immunoreactivity (>85%). Twenty patients, 2 with anaplastic astrocytoma and 18 with glioblastoma, were included in the study. All of the patients had been treated previously with conventional therapies (surgery, external radiotherapy, and chemotherapy) and presented with progressive disease not amenable to further treatment. A dose-escalation study was performed using doses ranging from 5-30 mCi (185-1110 MBq) of 90Y-labeled MAb BC-4. The protein dose of MAb was always 1 mg. Three patients were treated at the 5, 10, 15, and 20 mCi levels, and the 25- and 30-mCi doses were each administered to 4 patients. Systemic toxicity was completely absent in all of the patients. The maximum tolerated dose to the brain was 25 mCi (925 MBq). The average dose to the tumor was 3200 cGy/mCi. Doses to the liver, bone marrow, and kidneys were below 10 cGy/mCi in all of the cases. Biodistribution studies demonstrated that the 90Y-labeled MAb accreted exclusively in the neoplastic area without any diffusion into the normal brain or other normal organs. No clinical responses were recorded because of the very advanced stage of disease at the time of radioimmunotherapy.

[Neonatal endocarditis: report of a case]. / Endocardite neonatale: descrizione di un caso.

Neonatal endocarditis (NE) is a rare and usually fatal disease. The diagnosis is difficult because the criteria that have been suggested and used in adults are not readily applicable to neonates. The cause of the neonatal endocarditis can be bacterial (BE) or nobacterial (NBE). The main risk factors predisposing to NE are: congenital heart disease, the use of central venous catheters and severe asphixia. The signs and the symptoms of NE are nonspecific and cannot be distinguished from those of sepsis or congenital heart disease (CHD). In the present paper we report on a case sheltered in our neonatal intensive care unit (NICU).

[Hydrops fetalis correlated with voluminous chorioangioma of the placenta]. / Idrope fetale correlata ad un voluminoso corionangioma della placenta.

Hidrops is a term used to describe generalized subcutaneous edema in the fetus or neonate. It is usually accompanied by ascites and often by pleural or pericardial effusion (or both). The etiology is varied. Chorionangioma, one of the most frequent placental tumors, is often associated with an important hidrops fetails. In the present paper we propose an our case.

Manuo-ocular coordination in target tracking. I. A model simulating human performance.

During eye tracking of a self-moved target, human subjects' performance differs from eye-alone tracking of an external target. Typical latency between target and eye motion onsets is shorter, ocular smooth pursuit (SP) saturation velocity increases and the maximum target motion frequency at which the SP system functions correctly is higher. Based on a previous qualitative model, a quantitative model of the coordination control between the arm motor system and the SP system is presented and evaluated here. The model structure maintains a high level of parallelism with the physiological system. It contains three main parts: the eye motor control (containing a SP branch and a saccadic branch), the arm motor control and the coordination control. The coordination control is achieved via an exchange of information between the arm and the eye sensorimotor systems, mediated by sensory signals (vision, proprioception) and motor command copy. This cross-talk results in improved SP system performance. The model has been computer simulated and the results have been compared with human subjects' behavior observed during previous experiments. The model performance is seen to quantitatively fit data on human subjects.

Manuo-ocular coordination in target tracking. II. Comparing the model with human behavior.

Several studies have shown that humans track a moving visual target with their eyes better if the movement of this target is directly controlled by the observer's hand. The improvement in performance has been attributed to coordination control between the arm motor system and the smooth pursuit (SP) system. In such a task, the SP system shows characteristics that differ from those observed during eye-alone tracking: latency (between the target-arm and the eye motion onsets) is shorter, maximum SP velocity is higher and the maximum target motion frequency at which the SP can function effectively is also higher. The aim of this article is to qualitatively evaluate the behavior of a dynamical model simulating the oculomotor system and the arm motor system when both are involved in tracking visual targets. The evaluation is essentially based on a comparison of the behavior of the model with the behavior of human subjects tracking visual targets under different conditions. The model has been introduced and quantitatively evaluated in a companion paper. The model is based on an exchange of internal information between the two sensorimotor systems, mediated by sensory signals (vision, arm muscle proprioception) and motor signals (arm motor command copy). The exchange is achieved by a specialized structure of the central nervous system, previously identified as a part of the cerebellum. Computer simulation of the model yielded results that fit the behavior of human subjects observed during previously reported experiments, both qualitatively and quantitatively. The parallelism between physiology and human behavior on the one hand, and structure and simulation of the model on the other hand, is discussed.

Three-dimensional imaging based on Gray-code light projection: characterization of the measuring algorithm and development of a measuring system for industrial applications.

A three-dimensional (3-D) imaging system based on Gray-code projection is described; it is thought to be used as an integration to the already developed profilometer based on the projection of multifrequency gratings. The Gray-code method allows us to evaluate the 3-D profile of objects that present even marked discontinuities of the surface, thus increasing the flexibility of the measuring system as to the topology of the objects that can be measured. The basic aspects of Gray-code projection for 3-D imaging and profiling are discussed, with particular emphasis devoted to the study of the resolution of the method and to the analysis of the systematic errors. The results of this study allow us to determine the optimal setting of the parameters of the measurement and to develop a suitable calibration procedure. The procedures for implementing the Gray-code method are presented, and some interesting experimental results are reported. Calibration of the system reveals an accuracy of 0.2 mm, corresponding to 0.1% of the field of view.

[Crenotherapy in sports medicine: the state of the art]. / La crenoterapia nella medicina sportiva: lo stato dell'arte.

The existing relationship linking thermal and sport medicine has developed with time. This is shown by the established beneficial effects of thermal treatments (mineral waters, mud baths, balneotherapy, aerosol applications) in a wide range of sport and non-sport related injuries. The muscle fatigue syndrome is a condition particularly worrisome for sports practising individuals. This condition impairs the cardiovascular system, as well as hematologic, renal and gastrointestinal functions, acting via biochemical and metabolic modifications of the organism, which have effects also on the psyche of the subject. The treatment of this syndrome includes the use of specific mineral waters, which underscores that the correct hydration of the organisms is a precondition to achieve high performance levels. Traumas involving muscles and skeletal segments, and precocious arthrosis occur with higher frequency in sportsmen after continuous and intense stresses. Within the scope of rheumatology, mud-baths and balneotherapy have curative and rehabilitative potentials leading to a reduction, and often a disappearance, of pain with a faster recovery of the locomotory system. The gastrointestinal system is a target of psychic as well as physical stresses displaying symptoms or diseases which may be favourably addressed with the aid of mineral waters. This treatment has proved effective in secretory and motility dysfunctions of the biliary tree allowing a rapid functional recovery. Mineral water treatments are successfully employed in the treatment of urologic disturbance and ORL and dermatological pathologies, where local applications such as mud baths, balneotherapy, showers and aerosols, play a critical role.

[Motility of the gastric antrum and the gallbladder following oral administration of sulfate-bicarbonate]. / Motilità dell'antro gastrico e della colecisti dopo somministrazione orale di un'acqua minerale solfato-bicarbonata.

The authors evaluate the influence of a sulphate-bicarbonate mineral water on gastric emptying and cholecystic motility. Nine healthy volunteers drunk at settled intervals and with same procedures equal doses of mineral water and tap water on alternate days. Ultrasonographic evaluation of the gastric emptying and cholecystic volumes was performed before and after mineral water and top water drinks at settled intervals. The mean values of the gastric and the cholecystic volumes were calculated and compared at the single times. The results showed a significant colecystocinetic effect of the mineral water compared with tap water. No difference was observed in the gastric emptying with the mineral and tap water. Our work contributes to the knowledge of the pharmacodynamic effects of the mineral water employed and confirms its usefulness in the syndromes based on alterations in bile secretion and bile excretion in duodenum.

Comparison of 12-lead repolarization parameters during follow-up study in middle-aged sportsmen and in patients during acute myocardial infarction.

Consecutive electrocardiographic (ECG) analysis is very useful in acute coronary ischemia, but it is known that ECG patterns can be misleading in subjects with left ventricular hypertrophy, mainly during the repolarization phase. An automated system was developed to collect, store, and follow-up all heterogeneous data concerning a cohort of 1,898 subjects (1,039 men), 45-65 years old, 50% of whom were physically active. The reliability of several ECG markers of ischemia was tested during chronic follow-up study (1993-1995) in 23 healthy sedentary men without hypertension (group 1) recorded in our database, as well as in 9 subjects performing regular sporting activity (SA) (group 2). The same parameters were evaluated in the intensive care unit in nine patients affected by coronary artery disease, during either successful or unsuccessful thrombolytic therapy of acute myocardial infarction (AMI) (group 3). Twelve-lead ECGs were recorded, analyzed by the Hannover ECG system program, compressed, and stored according to the Standard Communication Protocol in each of the three groups. The changes in ST amplitude 20, 60, and 80 ms alter the J point were very small in each subject of groups 1 and 2, while upsloping from 1 to 10 mm in several leads was observed slowly, rapidly, or intermittently in group 3 patients during ischemia. The ST slope and the concordance of the T wave and ST amplitude were helpful in differentiating normal and SA subjects from AMI patients. These results, obtained in resting conditions, underline that the difference among ST-T abnormalities in subjects with left ventricular hypertrophy due to SA are consistently different from those observed in patients with AMI. The serial digital ECG can be helpful to underline these differences.