Factors predicting mortality after tips for refractory ascites: a single center experience

Introduction: Transjugular intrahepatic porto-systemic shunt (TIPS) is an accepted indication for treating refractory ascites. Different models have been proposed for the prediction of survival after TIPS; aim of present study was to evaluate the factors associated with mortality after TIPS for refractory ascites. Methods: Seventy-three consecutive patients undergoing a TIPS for refractory ascites in our centre between 2003 and 2008, were prospectively recorded in a database ad were the subject of the study. Mean follow-up was 17±2 months. Forty patients were awaiting liver transplantation (LT) and 12 (16.4%) underwent LT during follow-up. Results: Mean MELD at the moment of TIPS was 15.7±5.3. Overall mortality was 23.3% (n=17) with a mean survival after TIPS of 17±14 months. MELD score (B=0.161, p=0.042), AST (B= 0.020, p=0.090) and pre-TIPS HVPG (B=0.016, p=0.093) were independent predictors of overall mortality. On multivariate analysis MELD (B=0.419, p=0.018) and pre-TIPS HVPG (B=0.223, p=0.060) independently predicted 1 year survival. Patients were stratified into categories of death risk, using ROC curves for the variables MELD and HVPG. Patients with MELD<10 had a low probability of death after TIPS (n=6, 16% mortality); patients with HVPG <16 mmHg (n=6) had no mortality. Maximum risk of death was found in patients with MELD score 19 (n=16, 31% mortality) and in those with HVPG 25 mmHg (n=27, 26% mortality). Conclusions: TIPS increases overall survival in patients with refractory ascites. Liver function (assessed by MELD), necroinflammation (AST) and portal hypertension (HVPG) are independent predictors of survival; patients with MELD>19 and HVPG>25 mmHg are at highest risk of death after TIPS

Identificazione e dosaggio di marcatori molecolari dell'endometriosi nel sangue periferico

Purpose: to quantify the mRNA levels of MMP-3, MMP-9, VEGF and Survivin in peripheral blood and the serum levels of CA-125, Ca19-9 in women with and without endometriosis and to investigate the performance of these markers to differentiate between deep and ovarian endometriosis. Methods: a case controls study enrolled a series of 60 patients. Twenty controls have been matched with 20 cases of ovarian and 20 cases of deep endometriosis. Univariable and multivariable performance of serum CA125 and CA19-9, mRNA for Survivin, MMP9, MMP3 and VEGF genes have been evaluated by means of ROC curves and logistic regression respectively. Results: No difference in markers concentration were detected between ovarian and deep endometriosis. In comparison with controls serum CA19 and CA125 yielded the better sensitivity followed by mRNA for Survivin gene (81.5%, 51.9% and 7.5% at 10% false positive rate respectively). Multivariable estimated odds of endometriosis yielded a sensitivity of 87% at the same false positive rate. Conclusions: A combination of serum and molecular markers could allow a better diagnosis of endometriosis.

Il monitoraggio della qualità di vita e dei bisogni di pazienti oncologici e caregiver: il caso ANT

La Fondazione ANT rappresenta una delle più ampie esperienze al mondo di assistenza socio-sanitaria gratuita a domicilio ai malati di tumore, tramite équipe di specialisti costituite da medici, psicologi e infermieri. La patologia oncologica ha un enorme impatto sul benessere dei pazienti. Un modo per raggruppare i diversi sintomi di disagio psicologico è utilizzare il concetto di distress, che sarebbe importante monitorare in modo semplice e veloce. Primo studio: 66 pazienti oncologici (40% uomini; età media 54 anni) in cure palliative domiciliari. Il 79% dei pazienti ha mostrato livelli clinicamente significativi di distress. Il 55% dei partecipanti allo studio ha riportato alti livelli di ansia, e l'81% dei pazienti ha riportato alti livelli di depressione. Dall'analisi delle curve ROC il singolo item del Distress Thermometer, con un cut-off maggiore o uguale a 4, è stato in grado di rilevare il 97% dei soggetti con punteggi clinici di ansia e depressione, quindi può essere utilizzato anche come uno strumento di screening precoce rapido ed affidabile per i disturbi dell'umore. I familiari sono la prima risorsa dei malati di tumore, e l'identificazione dei loro bisogni è utile per individuare chi ha maggiore necessità di aiuto ed in quali aree. Secondo studio: 115 caregiver di pazienti oncologici (37% uomini; età media 52 anni). Di seguito i bisogni più frequenti. Salute psicofisica: “preoccupazioni circa il/la paziente” (72%), ansia (53%) e rabbia (52%). Informazioni: “come prendersi cura del paziente” (64%), “terapie alternative e/o complementari” (64%) e “come gestire lo stress” (57%). Servizi e strutture sanitarie: “un operatore di riferimento”, (65%), “cure infermieristiche a domicilio” (62%), “indicazioni su servizi ospedalieri” (57%), ed “assistenza per caregiver, ad esempio consulenza psicologica” (55%). Il monitoraggio dei bisogni consentirebbe un'ottimizzazione dell'assistenza, prevenendo situazioni che potrebbero compromettere il benessere della famiglia e la qualità dell'assistenza fornita al paziente.

Landslide susceptibility in the Belt and Road Initiative

The Belt and Road Initiative (BRI) is a project launched by the Chinese Government whose main goal is to connect more than 65 countries in Asia, Europe, Africa and Oceania developing infrastructures and facilities. To support the prevention or mitigation of landslide hazards, which may affect the mainland infrastructures of BRI, a landslide susceptibility analysis in the countries involved has been carried out. Due to the large study area, the analysis has been carried out using a multi-scale approach which consists of mapping susceptibility firstly at continental scale, and then at national scale. The study area selected for the continental assessment is the south-Asia, where a pixel-based landslide susceptibility map has been carried out using the Weight of Evidence method and validated by Receiving Operating Characteristic (ROC) curves. Then, we selected the regions of west Tajikistan and north-east India to be investigated at national scale. Data scarcity is a common condition for many countries involved into the Initiative. Therefore in addition to the landslide susceptibility assessment of west Tajikistan, which has been conducted using a Generalized Additive Model and validated by ROC curves, we have examined, in the same study area, the effect of incomplete landslide dataset on the prediction capacity of statistical models. The entire PhD research activity has been conducted using only open data and open-source software. In this context, to support the analysis of the last years an open-source plugin for QGIS has been implemented. The SZ-tool allows the user to make susceptibility assessments from the data preprocessing, susceptibility mapping, to the final classification. All the output data of the analysis conducted are freely available and downloadable. This text describes the research activity of the last three years. Each chapter reports the text of the articles published in international scientific journal during the PhD.

The XENON1T experiment: Monte Carlo background estimation and sensitivity curves study

Despite the scientific achievement of the last decades in the astrophysical and cosmological fields, the majority of the Universe energy content is still unknown. A potential solution to the “missing mass problem” is the existence of dark matter in the form of WIMPs. Due to the very small cross section for WIMP-nuleon interactions, the number of expected events is very limited (about 1 ev/tonne/year), thus requiring detectors with large target mass and low background level. The aim of the XENON1T experiment, the first tonne-scale LXe based detector, is to be sensitive to WIMP-nucleon cross section as low as 10^-47 cm^2. To investigate the possibility of such a detector to reach its goal, Monte Carlo simulations are mandatory to estimate the background. To this aim, the GEANT4 toolkit has been used to implement the detector geometry and to simulate the decays from the various background sources: electromagnetic and nuclear. From the analysis of the simulations, the level of background has been found totally acceptable for the experiment purposes: about 1 background event in a 2 tonne-years exposure. Indeed, using the Maximum Gap method, the XENON1T sensitivity has been evaluated and the minimum for the WIMP-nucleon cross sections has been found at 1.87 x 10^-47 cm^2, at 90% CL, for a WIMP mass of 45 GeV/c^2. The results have been independently cross checked by using the Likelihood Ratio method that confirmed such results with an agreement within less than a factor two. Such a result is completely acceptable considering the intrinsic differences between the two statistical methods. Thus, in the PhD thesis it has been proven that the XENON1T detector will be able to reach the designed sensitivity, thus lowering the limits on the WIMP-nucleon cross section by about 2 orders of magnitude with respect to the current experiments.

The Hitchin map for one-nodal base curves of compact type

Studying moduli spaces of semistable Higgs bundles (E, \phi) of rank n on a smooth curve C, a key role is played by the spectral curve X (Hitchin), because an important result by Beauville-Narasimhan-Ramanan allows us to study isomorphism classes of such Higgs bundles in terms of isomorphism classes of rank-1 torsion-free sheaves on X. This way, the generic fibre of the Hitchin map, which associates to any semistable Higgs bundle the coefficients of the characteristic polynomial of \phi, is isomorphic to the Jacobian of X. Focusing on rank-2 Higgs data, this construction was extended by Barik to the case in which the curve C is reducible, one-nodal, having two smooth components. Such curve is called of compact type because its Picard group is compact. In this work, we describe and clarify the main points of the construction by Barik and we give examples, especially concerning generic fibres of the Hitchin map. Referring to Hausel-Pauly, we consider the case of SL(2,C)-Higgs bundles on a smooth base curve, which are such that the generic fibre of the Hitchin map is a subvariety of the Jacobian of X, the Prym variety. We recall the description of special loci, called endoscopic loci, such that the associated Prym variety is not connected. Then, letting G be an affine reductive group having underlying Lie algebra so(4,C), we consider G-Higgs bundles on a smooth base curve. Starting from the construction by Bradlow-Schaposnik, we discuss the associated endoscopic loci. By adapting these studies to a one-nodal base curve of compact type, we describe the fibre of the SL(2,C)-Hitchin map and of the G-Hitchin map, together with endoscopic loci. In the Appendix, we give an interpretation of generic spectral curves in terms of families of double covers.