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Mesenchymal stromal cells (MSC) have emerged as a promising therapy to minimize the immunosuppressive regimen or induce tolerance in solid organ transplantation. In this randomized open-label phase Ib/IIa clinical trial, 20 liver transplant patients were randomly allocated (1:1) to receive a single pre-transplant intravenous infusion of third-party bone marrow-derived MSC or standard of care alone. The primary end-point was the safety profile of MSC administration during the one-year follow-up. Nineteen patients completed the study, and none of those who received MSC experienced infusion-related complications. The incidence of serious and non-serious adverse events was similar in the two groups. Circulating Treg/memory Treg and tolerant NK subset of CD56bright NK cells increased slightly over baseline, albeit not to a statistically significant extent, in MSC-treated patients but not in the control group. Graft function and survival, as well as histologic parameters and intragraft expression of tolerance-associated transcripts in 1-year protocol biopsies were similar in the two groups. In conclusion, pre-transplant MSC infusion in liver transplant recipients was safe and induced mild positive changes in immunoregulatory T and NK cells in the peripheral blood. This study opens the way for a trial on possible tolerogenic efficacy of MSC in liver transplantation. ClinicalTrials.gov identifier: NCT02260375.

BACKGROUND The Yerdel classification is widely used for describing the severity of portal vein thrombosis (PVT) in liver transplant (LT) candidates, but might not accurately predict transplant outcome. METHODS We retrospectively analyzed data regarding 97 adult patients with PVT who underwent LT, investigating whether the complexity of portal reconstruction could better correlate with transplant outcome than the site and extent of the thrombosis. RESULTS 79/97 (80%) patients underwent thrombectomy and anatomical anastomosis (TAA), 18/97 (20%) patients underwent non-anatomical physiological reconstructions (non-TAA). PVT Yerdel grade was 1-2 in 72/97 (74%) patients, and 3-4 in 25/97 (26%) patients. Univariate analysis revealed higher 30-day mortality, 90-day mortality, 1-year mortality, and a higher rate of severe early complications in the non-TAA group than in the TAA group (p = .018, .001, .014, .009, respectively). In the model adjusted for PVT Yerdel grade, non-TAA remained independently associated with higher 30-day, 90-day, and 1-year mortality (p = .021, .007, and .015, respectively). The portal vein re-thrombosis and overall patient and graft survival rates were similar. DISCUSSION In our experience, the complexity of portal reconstruction better correlated with transplant outcome than the Yerdel classification, which did not even appear to be a reliable predictor of the surgical complexity and technique.

BACKGROUND AND AIMS: Despite concerns that liver transplant (LT) recipients may be at increased risk of unfavorable outcomes from COVID-19 due the high prevalence of co-morbidities, immunosuppression and ageing, a detailed analysis of their effects in large studies is lacking. METHODS: Data from adult LT recipients with laboratory confirmed SARS-CoV2 infection were collected across Europe. All consecutive patients with symptoms were included in the analysis. RESULTS: Between March 1 and June 27, 2020, data from 243 adult symptomatic cases from 36 centers and 9 countries were collected. Thirty-nine (16%) were managed as outpatients while 204 (84%) required hospitalization including admission to the ICU (39 of 204, 19.1%). Forty-nine (20.2%) patients died after a median of 13.5 (10-23) days, respiratory failure was the major cause. After multivariable Cox regression analysis, age >70 (HR, 4.16; 95% CI, 1.78-9.73) had a negative effect and tacrolimus (TAC) use (HR, 0.55; 95% CI, 0.31-0.99) had a positive independent effect on survival. The role of co-morbidities was strongly influenced by the dominant effect of age where comorbidities increased with the increasing age of the recipients. In a second model excluding age, both diabetes (HR, 1.95; 95% CI, 1.06-3.58) and chronic kidney disease (HR, 1.97; 95% CI, 1.05-3.67) emerged as associated with death CONCLUSIONS: Twenty-five percent of patients requiring hospitalization for COVID-19 died, the risk being higher in patients older than 70 and with medical co-morbidities, such as impaired renal function and diabetes. Conversely, the use of TAC was associated with a better survival thus encouraging clinicians to keep TAC at the usual dose. ispartof: GASTROENTEROLOGY vol:160 issue:4 pages:1151-+ ispartof: location:United States status: published

MAJIS is an imaging spectrometer operating in the visible and IR range which is part of the payload of the JUICE mission of ESA, dedicated to the study of the icy moons of Jupiter, Jupiter and the Jupiter environment, to be launched in June 2022. MAJIS implements two channels, one for the visible-near IR range (0.5 – 2.35 μm) and one for the IR range (2.25 – 5.52 μm). Each channel collects photons with a H1RG detector1,2. The trajectory of the JUICE spacecraft in the Jupiter system crosses the radiation belts, in particular during flybys of Europa and Ganymede as well as during the orbiting phase around Ganymede (280 days). The Jupiter radiation belts are the most intense in the solar system, hence a combination of shielding and on-board processing has been implemented for handling the impact rate of high energy electrons, each generating large numbers of electrons (“spikes”) when impacting detector pixels. The de-spiking approach consists in splitting each acquisition into N = 2 to 8 sub-integrations, then sorting the resulting N values for each pixel, averaging a subset of the lowest values. This selective averaging approach effectively sort outs subintegrations impacted by a spike so as to meet a target of less than 1% corrupted pixels for each frame. This can be achieved by adjusting the sorting strategy to the local high energy electron flux, which strongly depends on the distance from Jupiter and on the latitude. Specific selective averaging strategies can also be implemented for mitigating possible instrumental artefacts.

Background Liver transplantation (LT) is considered the best treatment option for HCC patients with cirrhosis. However, the scarce availability of liver donors and the risk of dropout from the waiting list due to the tumor progression severely limit LT for HCC. In this study, we evaluate the survival and recurrence in a cohort of patients undergoing LT for HCC fulfilling “Milan Criteria” (MC) pre-LT. In this study, we propose the development of a new prognostic score which could improve the accuracy in predicting recurrence post-LT. Methods Between 1997 and 2011, out of 1010 LT performed in our unit, 131 patients had T2 staged HCC (inside MC). The prognostic model predicting HCC recurrence post-LT was derived from Cox regression analysis. The performance of this model was validated in an external cohort of 198 HCC patients transplanted at another center. Results Overall survival at 1–3–5 years was 87%, 74.4%, 68.2%, whereas recurrence-free survival was 94.1%, 81.4%, 77.6%, respectively. Predictive factors for recurrence-free survival included high tumor grading (HR 5.01; p = 0.006) and tumor diameter (HR 1.46; p = 0.045). According to this model, the estimated relative risk of HCC recurrence after LT is given by this formula: 0.382 × (Tumor size [cm]) + 1.613 × (if Grading 3–4). The ROC curve was 0.878 (p < 0.001) in predicting HCC recurrence. Conclusion In conclusion, our study showed that the use of this new prognostic score, taking into account maximal tumor diameter and tumor differentiation, improves the accuracy of Milan criteria in predicting HCC recurrence.

The optical design of the Moons And Jupiter Imaging Spectrometer (MAJIS), is discussed. MAJIS is a compact visible and near-infrared imaging spectrometer covering the spectral range from 0.5 to 5.54 μm (split into two channels), designed for the Jupiter Icy moons Explorer (JUICE) mission. The MAJIS optical layout is constituted by a TMA telescope shared between the two channels, as well as the slit and a collimator, a dichroic filter that splits the light between the channels (VIS-NIR and IR), each one endowed with its own grating, objective and detector. A flat mirror mounted in a Scan Unit before the telescope allows scanning the line of sight in a direction perpendicular to the slit. The collimator has a Schmidt off-axis configuration, with a specular correcting plate for each channel (the dichroic is inserted between the collimator primary mirror and the correcting plate). With the same conceptual layout in both channels, the collimated light is reflected by a flat ruled grating and crosses a completely dioptric objective. The objectives have the same focal length of the collimator, so both spectrometers have unitary magnification. A linear variable order rejection filter is placed in front of the detector so to reject the higher orders dispersed by the grating. A calibration unit allows radiometric and spectral calibration of both channels, with an incandescent lamp and a black body illuminating a common diffuser. Calibration is realized thanks to an extra-rotation of the Scan Unit. The developed design is optimized to work at cryogenic temperatures, with a good optical quality along the whole FOV and a good correction for transverse chromatic aberration and distortions.

The Optical Head design of the Moons And Jupiter Imaging Spectrometer (MAJIS), is presented. MAJIS is a compact visible and near-infrared imaging spectrometer covering the spectral range from 0.5 to 5.54 µm split into two channels, designed for the JUpiter ICy moons Explorer (JUICE) mission [1], that will conduct an in-depth study of the Jupiter system, with particular emphasis on Jupiter, Ganymede, Callisto and Europa. The MAJIS optical layout is constituted by a fore optics, slit and collimator shared between the two channels (VIS-NIR from 0.5 to 2.35 µm and IR from 2.25 to 5.54 µm), followed by a dichroic filter that splits the light between the channels, each one endowed with its own grating, objective and detector. The two focal plane arrays have a matrix of 400×508 (pixel×spectel), 36 µm pitch. A flat mirror mounted in a SU (Scan Unit) before the telescope allows scanning the line of sight in a direction perpendicular to the slit, so to achieve either imaging of a fixed target or motion compensation to increase the dwell time when in close approach periods (e.g. during flybys). In addition, a calibration unit is realized to allow both radiometric and spectral calibration of the two channels, using two different light sources (an incandescent lamp and a black body) that illuminate a common diffuser. Mechanical design is based on a single optical bench which is populated on both sides for volume optimization. The bench implements a network of internal ribs plus a continuous peripheral rib to maximize the stiffness/mass ratio. Three bipods in composite material constitutes the interface with the S/C bench. Bipods design is the result of an accurate trade between thermal insulation from the spacecraft and structural stiffness, still minimizing stresses induced on the bench due to the temperature gradient between the Optical Head and the S/C bench. Low Optical Head operative temperature (

Context: Liver transplantation (LT) is considered the ideal therapy for patients with hepatocellular carcinoma (HCC) having cirrhosis but the shortage of liver donors and the risk of dropout from the wait list due to tumor progression severely limit transplantation. A new prognostic score, the HCC-model for end-stage liver disease (HCC-MELD), was developed by combining α-fetoprotein (AFP), MELD, and tumor size, to improve risk stratification of dropout in patients with HCC. Objectives: In this study, we investigated the ability of the HCC-MELD score in predicting the posttransplant for patients fulfilling Milan criteria (MC). Design: Two hundred patients with stage II tumor were retrospectively reviewed from a total of 1290 transplants performed at our institution from October 1997 through April 2015. Cox regression analysis was performed to identify the prognostic factors impacting the posttransplant survival. Results: Overall survival at 1, 5, and 10 years was 89.3%, 71.1%, and 67.2%, whereas disease-free survival was 86.4%, 66.5%, and 52.4%, respectively. Multivariate analysis showed HCC-MELD score (hazard ratio [HR] 39.6, P < .001) and microvascular invasion (HR 2.41, P = .002) to be independent risk factors for recurrence, whereas HCC diameter (HR 1.15, P = .041), HCC-MELD (HR 15.611, P = .006), and grading (HR 2.17, P = .03) proved to be predictive factors of poor overall survival. Conclusion: Our study showed the validity of the HCC-MELD equation in the evaluation of patients undergoing LT for HCC. This score offers a reliable method to assess the risk of waiting list dropout and predict posttransplantation outcomes.

JIRAM is an imager/spectrometer on board the Juno spacecraft bound for a polar orbit around Jupiter. JIRAM is composed of IR imager and spectrometer channels. Its scientific goals are to explore the Jovian aurorae and the planet's atmospheric structure, dynamics and composition. This paper explains the characteristics and functionalities of the instrument and reports on the results of ground calibrations. It discusses the main subsystems to the extent needed to understand how the instrument is sequenced and used, the purpose of the calibrations necessary to determine instrument performance, the process for generating the commanding sequences, the main elements of the observational strategy, and the format of the scientific data that JIRAM will produce.

Summary Neonatal haemochromatosis is a rare alloimmune gestational disease with a high mortality. The hallmark of neonatal haemochromatosis is severe neonatal liver failure associated with extrahepatic siderosis. Thus far, no pituitary dysfunction has been reported to result from the tissue damage associated with extrahepatic siderosis. The present report describes a neonate with neonatal haemochromatosis and secondary hypothyroidism associated with pituitary iron deposition. Both the conditions were successfully treated by ABO-incompatible liver transplantation. Pituitary gland dysfunction is another possible extrahepatic manifestation of neonatal haemochromatosis, and it is reversible after liver transplantation.

Intraoperative transfusions seem associated with patient death and graft failure after PLTx. A retrospective analysis of recipients' and donors' characteristics and transplantation data in a cohort of patients undergoing PLTx from 2002 to 2009 at the Bergamo General Hospital was performed. A two-stage hierarchical Cox proportional hazard regression with forward stepwise selection was used to identify the main risk factors for major complications. In addition, propensity score analysis was used to adjust risk estimates for possible selection biases in the use of blood products. Over the 12-year period, 232 pediatric cirrhotic patients underwent PLTx. One-year patient and graft survival rates were 92.3% and 83.7%, respectively. The Kaplan-Meier shows that the main decrease in both graft and patient survival occurs during the first months post-transplantation. At the same time, it appears that most of the complications occur during the first month post-transplantation. One-month and 1-year patient complication-free survival rates were 24.8% and 12.1%, respectively. Our study shows that intraoperative red blood cells and platelet transfusions are independent risk factors for developing one or more major complications in the first year after PLTx. Decreasing major complications will improve the health status and overall long-term patient survival after pediatric PLTx.

Full-right-full-left split liver transplantation divides a donor liver into two grafts to be transplanted in adult-size patients. Major technical and organizational difficulties have limited its application to few single center series. We retrospectively analyzed the long-term results of the first multicenter series of this procedure with graft sharing. Between November 1998 and January 2005, 43 transplants were performed by five centers from 23 full-right-full-left in situ split liver procedures; 65% of the grafts were shared. A total of 31 (72%) patients had complications above grade II; 3 (6.9%) were retransplanted. Hospital mortality was 23% with sepsis as the main cause. Six patients died in the long term, two of them for a road accident. A total of 27 patients are alive after a median follow-up of 3200 days (2035-4256). Actuarial survival at 1 and 10 years were 72.1%, 62.6% and 65.1%, 57.9%, respectively for patients and grafts. These figures are similar to those reported for adult living donor liver transplantation by the European Registry over a similar period. Multicenter collaboration in sharing of these grafts is feasible and can help facing the organizational limits, thus increasing diffusion of full-right-full-left split liver transplantation. Full right and full left grafts from split liver procedures can be shared among different centers of the same area in the context of a collaborative activity, being safely and effectively transplanted in adult patients, thus optimizing the use of deceased donor livers. © Copyright 2012 The American Society of Transplantation and the American Society of Transplant Surgeons

OBJECTIVES To measure the diffusion of topical preparations of moxifloxacin, amphotericin B (AmB), and polyhexamethylene biguanide (PHMB) through silicone hydrogel (SH) contact lenses (CLs) in vitro. METHODS Using an in vitro model, the diffusion of three antimicrobials through SH CLs was measured. Diffused compounds were measured using a spectrophotometer at set time points over a period of 4 hr. The amount of each diffused antimicrobial was determined by comparing the experimental value with a standard curve. A biological assay was performed to validate the CL diffusion assay by testing antimicrobial activity of diffused material against lawns of susceptible bacteria (Staphylococcus epidermidis) and yeast (Saccharomyces cerevisiae). Experiments were repeated at least two times with a total of at least four independent replicates. RESULTS Our data show detectable moxifloxacin and PHMB diffusion through SH CLs at 30 min, whereas AmB diffusion remained below the limit of detection within the 4-hr experimental period. In the biological assay, diffused moxifloxacin demonstrated microbial killing starting at 20 min on bacterial lawns, whereas PHMB and AmB failed to demonstrate killing on microbial lawns over the course of the 60-min experiment. CONCLUSIONS In vitro diffusion assays demonstrate limited penetration of certain anti-infective agents through SH CLs. Further studies regarding the clinical benefit of using these agents along with bandage CL for corneal pathologic condition are warranted.

The relationship between optical properties and local structure has been studied in a niobium tellurite glass of molar composition 4.0Nb2O5–87.0TeO2–8.5Al2O3–0.5Eu2O3 using both broadband and laser-induced fluorescence line narrowing techniques. From the broad band excitation and emission spectra information about the local symmetry and the main lanthanide–ligand vibrational modes of the Eu3+ ions in this matrix was obtained. Under laser selective excitation in the 7F0 → 5D0 inhomogeneous band the site-dependent luminescence of the Eu3+ ions allow us to analyze the distribution of local environments for the lanthanide ion in the niobium tellurite glass. Moreover, the energies of the Stark components of the 7F1 and 7F2 multiplets were obtained as a function of the excitation energy and a crystal field analysis was carried out assuming a C2v site symmetry. From the calculated crystal field parameters Bkq the ratios B22/B20 and B44/B40 for each excitation energy were obtained and compared with the values calculated using the geometric model proposed by Brecher and Riseberg.

Intense upconversion luminescence is reported for the first time in a Ho3+-doped nanocrystalline material. Anti-Stokes blue and green luminescence was noted in nanocrystalline Gd3Ga5O12:Ho3+ after excitation into the 5F5 level with 647 nm radiation. Excitation at 756 nm into the 5I4 level resulted in green and red anti-Stokes emission. In both cases, an excited state adsorption mechanism is thought responsible for the observed upconversion luminescence. The temporal dependence of the upconverted luminescence for the two excitation wavelengths revealed that the 5I7 level was the intermediate level in both two-photon processes.

In diesem Beitrag werden niederfrequente Magnetfelder, die von vagabundierenden Stromen verursacht werden, sowie deren Storeinflusse dargestellt und Masnahmen zur Reduktion erortert. In vermaschten elektrischen Versorgungsnetzen, die als TN-System betrieben werden, konnen vagabundierende Strome durch Spannungsdifferenzen zwischen Erdungsanlagen entstehen, welche galvanisch mit leitfahigen Gebaudeteilen verbunden sind. Parallel zum PEN-Leiter teilt sich der Ausgleichsstrom (Ruckstrom zum Transformatorsternpunkt) uber galvanische Verbindungen den Impedanzverhaltnissen entsprechend auf die elektrische leitfahigen Pfade auf. Charakteristische Beispiele aus der Praxis, analysiert durch Messung und Berechnung, beschreiben diese Effekte.

Introduction Use of extended criteria donors is one of the strategies to face the scarcity of donors for lung transplantation. Methods Between November 2002 and May 2009, we performed 52 LTs in 50 recipients, 10 of whom (group A) received lungs from donors aged 55 years or older (median, 58.5; range, 56–66 years) for comparison with 28 patients (group B) transplanted with lungs from donors younger than 55 years (median, 25.5; range, 15–54 years). We excluded 9 children and 3 recipients of combined liver plus lung transplantations from the study. Results Recipient age, gender, and indications for transplantation did not differ significantly between the 2 groups. Neither were there significant differences in PaO2/FiO2 ratios before lung retrieval, or length of the ischemic time The first PaO2/FiO2 on arrival to the intensive care unit (ICU) and the median length of ICU stay were similar. All patients, except 2 who died in the operating theatre, were extubated between 3 and 216 hours after the transplantation. Hospital mortality was similar in both groups: 3 patients in group A and 2 in group B (P = .1). The median portions of the predicted 1-second forced expiratory volume (FEV1) at 6 months after transplantation did not differ in the 2 groups: 62.4% in group A versus 70% in group B (P = .85). Conclusion Lung grafts from donors older than 55 years can be effectively used for transplantation, thus increasing the total organ pool.

New Al 2 O 3 -Nb 2 O 5 -TeO 2 glasses doped with Er 3+ , Nd 3+ and Tm 3+ were prepared by conventional melt quenching. The absorption spectra were measured and the Judd-Ofelt parameters were extracted. Luminescence spectra in the near infrared region were measured and the values of the stimulated cross sections σ p were evaluated for selected laser transitions. The relatively high values of σ p suggest that these materials can be considered as interesting candidates for optical applications. The spectroscopic behaviour of the lanthanide ions appears to be influenced by the amount of Nb 2 O 5 and Al 2 O 3 in the glass hosts.

Twenty-eight patients with complete T3-12 traumatic paraplegia were fitted with hip guidance orthosis (HGO, four cases), reciprocating gait orthosis (RGO, 13 cases) or advanced reciprocating gait orthosis (ARGO, 11 cases). Patients were enrolled for 2 months-6 years (median 5 months) in six Italian rehabilitation centres engaged in a common prospective protocol, including a 6 month follow up. After 12-84 (median 20) rehabilitation sessions over a 3-16 week (median 7) period of specific training all of the patients could perform don-doff manoeuvres autonomously in 2.5-15 min (median 6.4), and could walk at least 30 m with a walker (15 cases) or forearm crutches (13 cases) at 10-50 cm/s (median 16.6). HGO patients tended to walk more slowly than the others. None of them could walk upstairs, while three out of 13 RGO patients and seven out of 11 ARGO patients could. Six months later, 21 patients still used the orthosis for 0.5-3 h daily (median 2). Only four patients used the orthosis to walk outdoors. As a median they could still attain the speed recorded at discharge. Six patients had decided to abandon the device, while one was wheelchair bound due to a recent spinal intervention. Neither clinical, demographic or locomotor variables, nor centre and type of orthosis appeared to be predictive of abandonment of the device. During either the training or the follow up periods, six out of 13 RGO and seven out of 11 ARGO had to be repaired by the orthotist 1-10 times (median 3). Thus, in our sample of paraplegics, walking with these orthoses appeared to be a promising form of exercise rather than an alternative to wheelchair locomotion.

This is a theoretical estimation and experimental study of the positron camera detector design using quadrant sharing of phototubes and optically cross-coupled BGO scintillation crystals. This study estimates the maximum number of BGO crystals which can be coupled to a photomultiplier and be decoded with this design, based on the number of photoelectrons generated and the optical efficiency of the crystal-phototube combination. From photoelectron statistics, a 10/spl times/10 BGO array can be coupled to a single square phototube (Hamamatsu R-2497) and have each crystal clearly decoded. Simulation of 1-dimensional and 2-dimensional statistical photoelectron distribution verifies the estimations. The simulation also yields the optimal distribution of light to the decoding phototubes. This theoretically optimal light distribution is used to guide the development of an 8/spl times/8 array of 3.2/spl times/3.2 mm BGO crystals (10 mm deep) using Hamamatsu R-2497 phototubes. All 64 crystals in the array can be clearly identified. The reconstructed image resolution is further estimated for the 8/spl times/8 and 10/spl times/10 arrays. These resolution results are also compared to discrete detectors which do not use analog decoding. The comparison shows that the analog decoding process degrades the image resolution by 7 to 9%. >

Patients with end-stage isolated polycystic liver disease (PCLD) suffer from incapacitating symptoms because of very large liver volumes. Liver transplantation (LT) is the only curative option. This study assesses the feasibility of LT in PCLD. We used the European Liver Transplant Registry (ELTR) database to extract demographics and outcomes of 58 PCLD patients. We used Kaplan-Meier survival analysis for survival rates. Severe abdominal pain (75%) was the most prominent symptom, while portal hypertension (35%) was the most common complication in PCLD. The explantation of the polycystic liver was extremely difficult in 38% of patients, because of presence of adhesions from prior therapy (17%). Karnofsky score following LT was 90%. The 1- and 5-year graft survival rate was 94.3% and 87.5%, while patient survival rate was 94.8% and 92.3%, respectively. Survival rates after LT for PCLD are good.

The preliminary experience of the first Italian program of pediatric intestinal transplantation is presented herein. A multidisciplinary group with broad experience in pediatric solid organ transplantation started the program. Nine children with complications of chronic intestinal failure were listed for transplantation. One child died on the waiting list; one received an isolated liver transplantation; three isolated intestinal; three multivisceral; and one, a combined liver/intestine transplantation. There was no in-hospital mortality, and all children were weaned from parenteral nutrition. The recipient of the multivisceral graft died after 14 months for unknown causes. All other recipients are alive after a median follow-up of 13 months. Patient and graft actuarial survivals for recipients of intestinal grafts were 100% at 1 year and 75% at 2 years.

Some findings suggest that needle catheter jejunostomy (NCJ) is associated with a significant rate of potentially dangerous complications. The purpose of this study was to prospectively evaluate the rate and type of early and late complications associated with NCJ in patients with surgical treatment of upper gastrointestinal malignancy. Eighty patients underwent NCJ implant at the end of their scheduled surgical procedure. Enteral nutrition programme was started on postoperative day 1 in the surgical ICU. NCJ was always removed in the outpatient clinic after hospital discharge. One case of tube blockage has been observed as single short-term complication in this series. No long-term complications have been detected after a mean follow-up of 12 months. Routine use of NCJ in malnourished patients undergoing major surgical procedures on upper gastrointestinal tract is safe and effective.

We studied by cytochemical means the distribution of 5' nucleotidase (5' NT), a purine degradative enzyme, in the circulating lymphocytes of 24 healthy donors and 41 cases of chronic lymphoid leukemias, classified according to morphological and immunological criteria. About half the normal circulating lymphocytes were 5'NT positive and exhibited variable degrees of enzyme activity. Among chronic B lymphocytic leukemias we found high percentages of positive cells only in the phenotypically more mature cases. Moreover all cases of hairy cell, follicular cell, lymphoplasmacytic, and plasma cell leukemia showed moderate or weak 5' NT reactivity. Also one case of chronic T lymphocytic leukemia, CD8 positive, was moderately positive, while another, with large granular lymphocyte morphology, was completely negative. Electron microscopy revealed a discontinuous, granular plasma membrane reaction pattern, varying in intensity from case to case. In conclusion, our results confirm the usefulness of the 5' NT cytochemical reaction for identification of lymphoid populations at different stages of maturation in chronic B cell disorders.

This report is a short review of the work done in Italy on the electron irradiation of power semiconductor devices. Electron irradiation for carrier lifetime control has been investigated using a 12 MeV linear accelerator. These studies includes: modeling of electrical semiconductor component parameters, specific adjustment of carrier lifetime, DLTS measurements to identify and characterize the radiation-induced defects. The optimum conditions for radiation processing of various types of power diodes and thyristors have been determined. Equipment and methods for series production have been developed and tested with pilot production quantities, then put into operation for mass production.

The high-frequency operation of GTO's (gate turn-off thyristors) in parallel inverters with resonant load for induction heating is investigated. The load-forced turn-off process of devices with reverse-blocking capability is analyzed on the basis of experimental results. The behavior of anode and gate voltages and currents during turn-off and during reapplication of forward voltage is analyzed considering various operating parameters (rate of decrease of anode current, rate of rise of anode voltage, reverse-bias amplitude and duration), and in particular gate-command timing. Appreciable benefits in terms of commutation losses, turn-off time, and snubber reduction are obtained as compared with the usual performance with chopper operation. Indications for an optimal gate-control strategy are also given. >

The Visible and Infrared Thermal Imaging Spectrometer (VIRTIS) on board the ESA/Venus Express mission has technical specifications well suited for many science objectives of Venus exploration. VIRTIS will both comprehensively explore a plethora of atmospheric properties and processes and map optical properties of the surface through its three channels, VIRTIS-M-vis (imaging spectrometer in the 0.3-1 μm range), VIRTIS-M-IR (imaging spectrometer in the 1-5 μm range) and VIRTIS-H (aperture high-resolution spectrometer in the 2-5 μm range). The atmospheric composition below the clouds will be repeatedly measured in the night side infrared windows over a wide range of latitudes and longitudes, thereby providing information on Venus's chemical cycles. In particular, CO, H2O, OCS and SO2 can be studied. The cloud structure will be repeatedly mapped from the brightness contrasts in the near-infrared night side windows, providing new insights into Venusian meteorology. The global circulation and local dynamics of Venus will be extensively studied from infrared and visible spectral images. The thermal structure above the clouds will be retrieved in the night side using the 4.3 μm fundamental band of CO2. The surface of Venus is detectable in the short-wave infrared windows on the night side at 1.01, 1.10 and 1.18 μm, providing constraints on surface properties and the extent of active volcanism. Many more tentative studies are also possible, such as lightning detection, the composition of volcanic emissions, and mesospheric wave propagation. © 2007 Elsevier Ltd. All rights reserved.

Background and Purpose In percutaneous placement of central venous catheters an inadvertent, direct lesion of the lung parenchyma can occur. This is a cause of iatrogenic pneumothorax, whose incidence is approximately 1 to 4%, largely dependent on the experience of the operator, the site of venipuncture and probably the technique employed. Initial treatment currently ranges from observation alone to formal tube-thoracostomy. In an attempt to define the best initial treatment, if any, we reviewed our personal series and contributions from the literature. As a result we have produced a flow-chart proposing a rational treatment of this frequent complication. Patients and Methods One thousand four hundred twenty-one ports were placed in patients at the Department of Surgery of the European Institute of Oncology in Milan through an infraclavicular standardized percutaneous subclavian approach. They were placed during the 60-month period from January 1, 1996 to December 31, 2000 for long-term chemotherapy treatment of solid tumours. Chest upright X-rays were obtained post-operatively in all cases to check the correct position of the catheter tip and the presence of pneumothorax. Results Twenty-two patients out of 1421 (1.54%) experienced a radiologically-proven pneumothorax, ranging from 5 to 70% of the affected pleural space. Sixteen patients out of 22 (72.7%) with minor portions of affected pleural space received simple observation. In these patients the most common finding was an uncomplicated tachycardia (more than 100 beats/min); 8 of them did not complain of any symptoms. Six patients (27.2%) underwent an additional procedure (3 tube-thoracostomies and 3 aspirations of the pleural space), claiming symptoms of chest pain and various degrees of dyspnea. Tube thoracostomy was mainly adopted at the beginning of our experience, and in patients with a severe degree of pleural involvement (55 to 70% of the pleural space). Aspiration, instead, was used more recently and in patients with varying degrees of pleural space involved, ranging from 40 to 60%. Conclusions Looking at our own series and literature data, patients with iatrogenic pneumothorax following central venous cannulation who do not have a severe underlying pulmonary disease can be reassured, at the time of diagnosis, that surgery is usually unnecessary and tube thoracostomy is rarely needed. Simple aspiration of the pleural air by means of a central venous catheter inserted percutaneously into the pleural space under local anesthesia should be considered, even if the amount of affected pleural space is more than 50%, before opting for a formal tube-thoracostomy using small-bore tubes.

Today log traces are widely used to identify and prevent violations of corporate information systems. The most recent logging trend is to manage most level 3 ISO/OSI traffic via pcap-compatible output. But use of syslog is still very widespread, as are the security issues it entails, especially in its 'pure' version. This paper outlines the basic syslog problems as foreseen in the RFCs, examines the 'secure' alternatives to the protocol (and relative implementations) and proposes a transmission approach based on covert channels which, applied on the LINUX platform, might answer some of the intrinsic reliability problems which undermine its effectiveness as a digital forensic tool.

Alagille syndrome (AS) is a dominantly inherited, multisystem disorder involving the liver, heart, eyes, face, and skeleton. From October 1997 through July 2004, 260 pediatric orthotopic liver transplantations (OLTx) were performed in 231 patients. This report describes 21 patients of median age 1.95 years (range, 0.7-16.7) who had alagille syndrome. We present the technical features of the OLTx, incidence and type of complications, medical conditions related to the syndrome, need for retransplantation, as well as patient and graft survival rates. A split liver technique was used in 16 patients (76%) who received a left lateral segment (LLS) graft whereas 7 patients (33%) received a whole liver. Only cadaveric donors were used. The major surgical complications requiring reintervention in 11 patients (52%) included biliary problems (19%) and vascular complications (17%). One case of hepatic artery thrombosis required retransplantation. Three recipients (14%) died. All other patients are alive with an actuarial survival rate of 90% at 1 year and 80% at 5 years. The actuarial graft survival rate is 85% at 1 year and 75% at 5 years. Patients with AS, despite the associated cardiovascular anomalies, can be treated successfully by a combined approach between cardiologist, radiologist, cardiothoracic, and liver transplant surgeons. With careful planning and operative management, the results are comparable with those obtained with other more common cholestatic diseases.

In this study we analyzed the features of 12 patients who underwent liver transplantation for progressive familial intrahepatic cholestasis (Byler's disease [BD]) in view of the technical features of the OLTx, incidence and type of complications, need for retransplantation, as well as patient and graft survivals. BD was the indication in 12 patients of median age 1.32 years and median weight 10 kg. Median follow-up was 670 days. Major surgical complications requiring reintervention occurred in three patients. No thrombosis of the hepatic artery was observed. Infections with positive blood cultures were diagnosed in four patients. One patient had a biliary anastomotic stenosis successfully treated by percutaneous techniques. Four patients had episodes of acute rejection treated with steroids. Two patients were retransplanted, both of whom died in the early postoperative period due to hepatic vein thrombosis and venoenteric fistula. The actuarial patient and graft survival was 83% at 1 year and 83% at 5 years. Split-liver grafts represent an excellent organ supply for these patients, achieving good results with no mortality on the waiting list.

INTRODUCTION: We report our experience of in situ split-liver transplantation (SLT) for adult patients and compare the results with those achieved with whole-liver transplantation (WLT). METHOD: From November 1997 to December 2003, 109 liver transplantation were performed in 104 adult patients including 90 WLT (83%) and 19 SLT (17%) grafts. Fifteen extended right grafts (ERG, segments I + IV to VIII) were obtained with in situ split-liver procedures, generating also left lateral segment grafts, which were transplanted at our institution or elsewhere. Four left lobe (LL, segments I to IV) and right lobe (segments V to VIII) grafts were obtained by a modified in situ procedure for adult recipients. UNOS status, percentage of primary or secondary transplantation, and underlying liver disease were similar among patients receiving whole versus split grafts. Donors were older in whole than ERG cohorts (53 vs 26 years, P < .001). Procurement parameters and intraoperative profiles of transplant procedure were comparable among the groups. RESULTS: Median follow-up was 18 months (range: 1 to 73). Four patients with whole (4%) and no patient with ERG underwent retransplantation (P = NS). One- and 3-year patient survivals were 86% and 79% with WLT versus 93% and 93% with ERG (P = NS). One- and 3-year graft survivals were 84% and 75% with WLT versus 93%, and 93% with ERG (P = NS). Incidence of vascular complications was 8% with WLT, 13% with ERG (P = NS). The incidence of biliary complications was 13% in WLT, 27% in ERG (P = NS). CONCLUSIONS: The use of ERG from in situ split livers for adult transplantation allowed us to obtain results comparable or even better than those obtained with WLT. Split-liver transplantation is an effective, safe mechanism to expand the cadaveric donor pool.

Early portal vein thrombosis (PVT) represents a serious complication after liver transplantation (OLTx). From October 1997 through July 2004, 260 OLTx were performed in 231 children, including 189 of left lateral segments (LLS). We retrospectively analyzed the incidence and the outcome of early PVT in this group. A daily doppler US scan was performed during the first week after transplantation. Early PVT occurred in 14 patients (8%), 10 males and four females of median age 0.77 years. The main indication for primary transplantation was biliary atresia (10), followed by Byler's disease (2), acute liver failure on cryptogenetic cirrhosis (1), and Alagille syndrome (1). Four children underwent retransplantation; three cases of thrombectomy and revision of the anastomosis, two children were treated with beta blockers, one of whom had a later failed attempt at percutaneous revascularization and eventually a meso-caval shunt. Five patients were followed with observation and no treatment. Among the four patients who died, three were in the retransplantation group and one in the thrombectomy and revision of the anastomosis group; the overall mortality was 28%. With a median follow up of 399 days, 10 patients are alive with an actuarial survival at 1 and 5 years of 72%, and graft survival rates at 1 and 5 years of 64%. PVT represents a serious complication after pediatric OLTx with LLS grafts. Prompt detection and aggressive surgical treatment in selected cases are required to reduce the mortality and graft loss.

We reviewed the clinical data of 30 children-hospitalized for acute liver failure in the last 6 years. Ten patients were not listed for liver transplantation OLTX. Their clinical conditions gradually improved and they are all alive without deficit. Among 20 patients listed, 15 underwent urgent OLTX. Two children died on the waiting list and three were suspended from waiting list after few days because of improvement. Survival according to age class was analyzed dividing the patients into two groups: A, age 1 year or less versus B, age between 1 and 16 years. The patient survival was 86% at 6 months and 61% both at 1 and 2 years. Survival at 6 months and 1 and 2 years was 88%, 67%, and 45% for the patients in group A and 83%, 83%, and 83% for the patients in group B (P = NS). Observing graft-to-recipient weight ratio and donor-to-recipient weight ratio most patients received an optimal sized graft. The split-liver technique is considered the preferred method of liver transplantation even in the pediatric patients with acute liver failure; especially in the setting of a cooperative system in which all livers that are suitable for split-liver transplantation are shared between centers. In order to have the best chance for survival, children with acute liver failure should be referred as soon as possible to an highly specialized pediatric liver transplantation center that can offer all the treatment modalities that are currently available.

We report the luminescence and upconversion spectra of nanocrystalline YAlO3 doped with trivalent erbium at concentrations of 5.0, 1.0 and 0.1 mol.%. The powder samples were prepared using a solution combustion reaction method, and the resulting YAlO3 nanocrystals show, under wide-angle X-ray diffraction, a size in the range 20–40 nm. Efficient green and red emissions are observed at room temperature under continuous-wave pumping at 980 nm. A weak emission can also be detected in the blue at 410 nm. The upconversion dynamics were studied measuring the decay times and the pump-power dependence of the transitions to the 4 I 15/2 ground state starting from the 2 H 11/2 , 4 S 3/2 and 4 F 9/2 excited states. Excited-state absorption (ESA) is found to be responsible for the higher energy ( 2 H 11/2 , 4 S 3/2 → 4 I 15/2 ) green transitions. On the other hand, for the 4 F 9/2 → 4 I 15/2 red transition a competing energy-transfer upconversion (ETU) mechanism is found, which accounts for the more than 100-fold increase in intensity of the red emission on passing from the lowest (0.1 mol.%) to the highest (5 mol.%) erbium concentration.

The optical properties for single doped Cr3+ and co-doped Cr3+–Nd3+ aluminum tantalum tellurite glasses have been studied as a function of temperature. For the single doped glass, the existence of two bands in the emission spectra at low temperature indicates the presence of two different sites for the Cr3+ ions, labelled as usual as low- and high-field sites. The broad band centred in the Near Infrared region, corresponds to low-field sites transition 4 T 2 → 4 A 2 , and the narrow band centred at approximately 715 nm to the high-field sites transition 2 E → 4 A 2 . The emission intensity for both high- and low-field sites shows a strong decrease with increasing temperature, with the emission for the former sites vanishing at RT. In both cases the quenching observed with the increase of temperature can be ascribed to the presence of non-radiative relaxation mechanisms. Experimental observations for the co-doped glass show that both radiative and non-radiative energy transfer processes from Cr3+ to Nd3+ are present.

Lanthanide doped tellurite glasses containing heavy metals were prepared by the melt/quench technique. The absorption spectra in the visible and in the near infrared were measured and the behavior of the electric dipole oscillator strengths of the lanthanide 4f→4f transitions with the amount of modifier oxide in the glass matrix are discussed. The luminescence spectra in the visible and in the near infrared of the dopants were measured. The stimulated emission cross sections were reported and compared with the ones obtained for oxide glasses of relevant technological applications.

This paper presents a study of plethysmographic changes induced by methacholine (a derivative of acetylcholine) administered via iontophoresis in a population of 41 young women with apparently primary Raynaud's disease. All patients presented with a very clear statistically significant sphygmic increment, obviously connected with the vasodilatation caused by methacholine. Moreover, in nearly half of the 23 cases whose reaction to passive postural variations was successively examined by plethysmography, the district circulatory response was characterised by persistent neurogenous vasoconstriction due to methacholine or by inadequate vasomotor EDRF mediated modulation. The authors believe that their findings serve as further evidence of the pathogenetic mechanisms of Raynaud's disease. This is because they highlight the role played by "balance of vessel motility" which would guarantee district circulatory homeostasis. Concrete proof thus corroborates well known indirect evidence that a pathological vasospasm can be triggered and persist when two fundamental conditions are met: a) intense vasoconstriction initially of neurological origin and successively reinforced by biohumoural synergic stimuli; b) the breakdown of the capacity for EDRF mediated intrinsic vasomotor modulation. It is suggested that the prevalence of one or the other factor would lead to a variety of clinical pictures denoting vascular acrosyndromes of this type. The ability to single out such clinical pictures by adding the iontophoresis test with methacholine to routine screening procedures for the presence of Raynaud's disease, would allow physicians to make more accurate diagnosis and improve therapy.

A homogeneous group of 34 subjects exposed to occupational vibratory stress were studied to determine their vasodilatory response to methacoline. The methacoline was administered by iontophoresis. Methacoline is an acetylcholine derivate with the same pharmacological properties of acetylcholine. The 34 study subjects were divided into 3 groups according to their plethysmographic response to a preliminary cold test: group 1, had a typical Raynaud's response; group 2 had normal response to cold, and group 3 had an "intermediate" response. The subjects in group 1 did not respond to methacoline with vasodilation, suggesting endothelial damage at the arterial and arteriolar level, those in group 2 responded with clear vasodilation, and those in group 3 had an intermediate plethysmographic response to methacoline--modest, slowed vasodilation. Based on the results obtained, the authors believe that the true pathogenetic mechanism is an alteration in the vasomotor stability. This change in circulatory homeostasis occur after a vasoconstrictive stimulus, due to vascular endothelium disfunction, in its turn damaged by vibratory microtrauma. This would be the basis for diminished autonomic vascular regulation, mediated by EDRF at the arterial and arteriolar level. It is also probable that the pathogenesis of Raynaud's syndrome in workers exposed to physical or chemical stress has a similar mechanism.

Non-heart beating donor (NHBD) represent a considerable source of kidneys for transplantation. In the beginning of our activity NHBD were the only kind of cadaver donors. Later beating-heart donors became the most important donors. The great shortage of kidneys for transplantation obliges us to find new sources of kidneys. NHBD seem actually the most realistic.