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

Molluscs of the marine protected area "Secche di Tor Paterno"

The thesis describes the molluscan biodiversity of the infralittoral off-shore reefs in the "Secche di Tor Paterno" marine protected area lying in the Central Tyrrhenian Sea off the coasts of Lazio south of Roma. Data originate from underwater sampling activities carried out by SCUBA diving in four biocoenoses: Posidonia oceanica leaves and rhizomes, coralligenous concretions and detritic pools. The representativeness of molluscs as descriptors of biocoenoses is evaluated by preliminary comparisons with data about Polychaeta, Pleocyemata (Crustacea) and Brachiopoda obtained in the same survey. The malacocoenoses of the four biocoenoses are treated in detail. Then data are compared with other data sets to assess differences and similarities with other communities. The agreement between death and living assemblages in the reefs is evaluated for the Posidonia oceanica and the coralligenous biocoenosis and was carried out by a set of standard metrics and some benthic ecology methods. Molluscs perform very well as descriptors of biocoenoses, better than the other phyla. The molluscan assemblages of the reefs are very rich in species despite richness is mainly concentrated in the coralligenous and in the rhizomes of Posidonia oceanica. The leaves of Posidonia oceanica host a rather poor assemblage. Detritic pools host a poor but peculiar species assemblage. The dead-live agreement showed that death assemblages are highly representative of sediments of nearby biocoenoses as a result of low bottom transport. Fidelity metrics suggest a good agreement between the living and death assemblages when species richness and taxonomic composition are considered. The study suggests that fidelity is lower when considering the species dominance. These differences could be associated to the trophism of species and possibly to the species life span.

Civil Liability as an Enforcement Tool of Securities Underwriter Gatekeeping Duty

This book is dedicated to the Law and Economics analysis of civil liability of securities underwriters for the damage caused by material misstatements of corporate information by securities issuers. It seeks to answer a series of important questions. Who the are underwriters and what is their main role in the securities offering? Why there is a need for legal intervention in the underwriting market? What is so special about civil liability as an enforcement tool? How is civil liability used in a real world and does it really reach its goals? Finally, is there a need for a change and, if so, by what means?