A Mineral Dressing and Economic Study of a Complex Arsenical Ore

The factors that influence the choice of a method for treat­ment of an ore comprise the technical and economic limitations and advantages, derived in detail and balanced according to the exigencies of the particular situation.

Combined alpha-methylacyl coenzyme A racemase/p53 analysis to identify dysplasia in inflammatory bowel disease

Identification of dysplasia in inflammatory bowel disease represents a major challenge for both clinicians and pathologists. Clear diagnosis of dysplasia in inflammatory bowel disease is sometimes not possible with biopsies remaining "indefinite for dysplasia." Recent studies have identified molecular alterations in colitis-associated cancers, including increased protein levels of alpha-methylacyl coenzyme A racemase, p53, p16 and bcl-2. In order to analyze the potential diagnostic use of these parameters in biopsies from inflammatory bowel disease, a tissue microarray was manufactured from colons of 54 patients with inflammatory bowel disease composed of 622 samples with normal mucosa, 78 samples with inflammatory activity, 6 samples with low-grade dysplasia, 12 samples with high-grade dysplasia, and 66 samples with carcinoma. In addition, 69 colonoscopic biopsies from 36 patients with inflammatory bowel disease (28 low-grade dysplasia, 8 high-grade dysplasia, and 33 indefinite for dysplasia) were included in this study. Immunohistochemistry for alpha-methylacyl coenzyme A racemase, p53, p16 and bcl-2 was performed on both tissue microarray and biopsies. p53 and alpha-methylacyl coenzyme A racemase showed the most discriminating results, being positive in most cancers (77.3% and 80.3%) and dysplasias (94.4% and 94.4%) but only rarely in nonneoplastic epithelium (1.6% and 9.4%; P < .001). Through combining the best discriminators, p53 and alpha-methylacyl coenzyme A racemase, a stronger distinction between neoplastic tissues was possible. Of all neoplastic lesions, 75.8% showed a coexpression of alpha-methylacyl coenzyme A racemase and p53, whereas this was found in only 4 of 700 nonneoplastic samples (0.6%). alpha-methylacyl coenzyme A racemase/p53 coexpression was also found in 10 of 33 indefinite for dysplasia biopsies (30.3 %), suggesting a possible neoplastic transformation in these cases. Progression to dysplasia or carcinoma was observed in 3 of 10 p53/alpha-methylacyl coenzyme A racemase-positive, indefinite-for-dysplasia cases, including 1 of 7 cases without and 2 of 3 cases with p53 mutation. It is concluded that combined alpha-methylacyl coenzyme A racemase/p53 analysis may represent a helpful tool to confirm dysplasia in inflammatory bowel disease.

Changes in pre-pregnancy weight and weight gain during pregnancy: retrospective comparison between 1986 and 2004

QUESTIONS UNDER STUDY: To compare the incidence of pre-pregnancy overweight, obesity, and difference in weight gain during pregnancy in the years 1986 and 2004, in women delivered at the maternity unit of our hospital. METHODS: Retrospective study. Maternity records of patients delivered in the years 1986 and 2004 were compared. Data extraction included booking weight, height, weight gain, birth weight as well as information on mode of delivery and gestational age at delivery. RESULTS: During the year 1986 and 2004 a total of 690 and 668 patients respectively were included in the analysis. The pre-pregnancy BMI > or =25 doubled over the 18-year period (from 15.9 to 30.1%). In 1986 only 2.6% of all pregnant women gained more than 20 kg, while in 2004 14.2% (p <0.0001) did so. The caesarean section rate was significantly higher in 2004 than 18 years earlier (28.3 and 9.3%, p <0.0001). CONCLUSIONS: We found a significant increase in all parameters between these two groups. Pregnant women are today heavier at the booking visit, are more overweight, and gain more weight during pregnancy. A similar trend is seen in the newborn babies, who have a higher birth weight than those born 18 years ago.

Gene therapy for immunodeficiency due to adenosine deaminase deficiency

BACKGROUND: We investigated the long-term outcome of gene therapy for severe combined immunodeficiency (SCID) due to the lack of adenosine deaminase (ADA), a fatal disorder of purine metabolism and immunodeficiency. METHODS: We infused autologous CD34+ bone marrow cells transduced with a retroviral vector containing the ADA gene into 10 children with SCID due to ADA deficiency who lacked an HLA-identical sibling donor, after nonmyeloablative conditioning with busulfan. Enzyme-replacement therapy was not given after infusion of the cells. RESULTS: All patients are alive after a median follow-up of 4.0 years (range, 1.8 to 8.0). Transduced hematopoietic stem cells have stably engrafted and differentiated into myeloid cells containing ADA (mean range at 1 year in bone marrow lineages, 3.5 to 8.9%) and lymphoid cells (mean range in peripheral blood, 52.4 to 88.0%). Eight patients do not require enzyme-replacement therapy, their blood cells continue to express ADA, and they have no signs of defective detoxification of purine metabolites. Nine patients had immune reconstitution with increases in T-cell counts (median count at 3 years, 1.07x10(9) per liter) and normalization of T-cell function. In the five patients in whom intravenous immune globulin replacement was discontinued, antigen-specific antibody responses were elicited after exposure to vaccines or viral antigens. Effective protection against infections and improvement in physical development made a normal lifestyle possible. Serious adverse events included prolonged neutropenia (in two patients), hypertension (in one), central-venous-catheter-related infections (in two), Epstein-Barr virus reactivation (in one), and autoimmune hepatitis (in one). CONCLUSIONS: Gene therapy, combined with reduced-intensity conditioning, is a safe and effective treatment for SCID in patients with ADA deficiency. (ClinicalTrials.gov numbers, NCT00598481 and NCT00599781.)

Verhalten der Gewichtsdifferenz von selektiv wachstumsretardierten, monochorialen Zwillingen

Problemstellung: Monochoriale Zwillinge (MZ) machen nur ca. 1/3 aller Mehrlinge aus. Im Vergleich zu dichorialen weisen sie jedoch eine höhere Morbidität und Mortalität auf bedingt durch das Transfusionssyndrom, mehr Fehlbildungen und Frühgeburten. In letzter Zeit kristallisiert sich eine weitere Entität heraus, die selektive intrauterine Wachstumsretardierung (sIUWR). Ziel der Studie war es, das Verhalten dieses diskordanten Wachstums im Verlaufe der Schwangerschaft zu untersuchen. Patienten und Methode: Die Diagnose einer monochorialen Situation basiert auf der Darstellung nur einer Plazenta, dem T-Sign sowie gleichgeschlechtiger Feten. Es wurden nur biamniote MZ eingeschlossen. Von einer sIUWR spricht man, wenn folgende Kriterien erfüllt sind: 1) ein Fetus wachstumsretardiert (Abdomenumfang <5. Perzentile) und 2) Gewichtsdifferenz beider Feten >20%. Letztere berechnet sich aus der Differenz der geschätzten fetalen Gewichte dividiert durch das Gewicht des Größeren in% (Delta%). Es wurden die Delta%-Werte bei Diagnosestellung und die letzten Werte vor Geburt verglichen. Ergebnisse: Retrospektiv wurden 23 Fälle mit sIUWR eingeschlossen, davon wurden 13 Fälle longitudinal beurteilt. Das mediane Gestationsalter bei Geburt lag bei 31,4 (16,7–38,6) Wochen. Die Frühgeburtsrate betrug 85,7%, die perinatale Mortalität 11,9%. Der initiale Delta%-Wert lag bei 28±10% und stieg signifikant auf 36,4±9,9%. In allen Fällen nahm der Delta%-Wert zu. Von den Co-Zwillingen waren postnatal 20% auch small for gestational age. Schlussfolgerungen: Bei MZ mit sIUWR ist nach unseren Erfahrungen damit zu rechnen, dass die Gewichtsdifferenz mit zunehmendem Gestationsalter steigt. Diese Zunahme erklärt sich durch eine progressive Verlangsamung der Wachstumsgeschwindigkeit des kleineren Feten. Leider lässt sich anhand der kleinen Fallzahl nicht eruieren, ob dieser D%-Wert und der Grad des Anstieges eine prognostische Bedeutung aufweist.

The umbilical cord in Cantrell: Pentalogy or Hexalogy?

Objective: Pentalogy of Cantrell (PC) is a rare congenital defect associated with five midline anomalies. The type of cardiac malformation and the size of the abdominal wall defect is often responsible for the high mortality. Of interest, the embryonic period in which PC develops is similar to that of the umbilical cord’s (UC) formation. The aim of the following study was to investigate the relationship between UC anomalies and PC. Methods: Charts of four cases with PC from 2002–08 were retrospectively reviewed for associated UC anomalies. UC anomalies were defined as single umbilical artery (SUA), short cord (during 1st trimester less than CRL or less than 30cm at term) or atypical UC coiling pattern. Results: We identified four cases: 3 singletons and one monochorionic diamniotic twin pregnancy with TRAP sequence. All cases showed a normal karyotype. All but one demonstrated the classical pulsatile omphalocele with ectopia cordis and all others anomalies of PC. One case was characterized by a major cranial omphalocele without ectopia cordis and no UC anomaly. This fetus was delivered by Cesarean at term and successfully operated on d1. In all other cases the parents requested ToP. Among the three cases with ectopia cordis, two had a short UC with SUA and one a short three-vessel cord; all these three UC were markedly uncoiled. Conclusions: Our data suggest a strong association between Cantrell and the development of the UC, in particular in cases with ectopia cordis. One might speculate that hemodynamic alterations of the feto-placental blood flow because of the cardiac malformation or structural changes at the umbilical ring (omphalocele) influence the development of the UC. More observations are needed to decide if Cantrell is a ‘‘hexalogy’’ instead of pentalogy.

Pre- and postnatal therapy of lower urinary tract obstruction - an experience of 18 years

With prenatal detection of hydronephrosis and technological advances in surgical equipment, the management of lower urinary tract obstruction has evolved to include prenatal surgical intervention. Surgical intervention, was based upon the rationale that restoring amniotic fluid to normal levels by shunting fetal urine from the obstructed urinary system to the amniotic space would prevent lung hypoplasia and, thus, improve neonatal survival. Inaddition, relief of the obstruction would also reduce back pressure and reduce injury to the developing nephron, thus improving long-term renal function postnatally. However, this remains investigational, and the vast majority of affected infants are treated soon after birth. We have experience since 1991 with prenatal treatment of megacystis. In 23 cases of 50 detected megacystis with oligohydramnion in male and without other abnormalities a prenatal intervention by bladderpunction and in 12 cases additional vesicoamniotic shunt placement was performed. The prognosis of megacystis with oligohydramnion is stated with a survival rate of 10-30%. In our group 54% (13 children) survived. Also we want present 56 cases of urethral valves with a postnatal transurethral intervention. With a follow up time from 8.6 (3 to 15) years we attend 34 children (60%) with normal renal function, 21% (12) with mild or moderate renal insufficiency and there was a kidney transplantation in 6 cases necessary. With our multidisciplinary presentation we want to discuss the indication, interdisciplinary aspects,risks and the follow up of pre- and postnatal intervention in such cases.

Gravity-based Local Clock Synchronization in Wireless Sensor Networks

Contention-based MAC protocols follow periodic listen/sleep cycles. These protocols face the problem of virtual clustering if different unsynchronized listen/sleep schedules occur in the network, which has been shown to happen in wireless sensor networks. To interconnect these virtual clusters, border nodes maintaining all respective listen/sleep schedules are required. However, this is a waste of energy, if locally a common schedule can be determined. We propose to achieve local synchronization with a mechanism that is similar to gravitation. Clusters represent the mass, whereas synchronization messages sent by each cluster represent the gravitation force of the according cluster. Due to the mutual attraction caused by the clusters, all clusters merge finally. The exchange of synchronization messages itself is not altered by LACAS. Accordingly, LACAS introduces no overhead. Only a not yet used property of synchronization mechanisms is exploited.

Die Erziehung zu einer aktiven Bürgerschaft

Trying to give a definition of Citizenship Education is a challenging operation: it is characterized by a variety of meanings flowing from Civic Education (related to knowledge and practice about the system of laws, rules, conventions referring to a particular civil community) to Socio-political education (related to the awareness of being part of the system of cultural elements, values, traditions historically produced by the community itself). It would be not be correct identifying Citizenship Education only with elements of Civic Education, as it would restrict its range to formal level of rules and laws, rights and duties. Otherwise, limiting its understanding only on elements of Sociopolitical Education, would offer the risk of investing in cultural similarities, common roots, values homogeneity, that are strong in giving hold on identity, membership, participation, but so exposed to acts of fanaticism, exclusion of diversity, hostility towards minorities. Therefore, it is necessary to assume that Citizenship Education has to be established on problematic integration of the two presented perspectives, thus founding knowledge and practice about the rules of civil society on the system of values and cultural aspects that every single micro-community (and every single individual) recognizes to be source of the rules: a complex system of various elements made of homogeneity and inhomogeneity, similarities and differences in constant modification an dynamic intercommunication.

Bassano – Venedig – Rom: "Il dolce intaglio di Volpato"

L'incisore Giovanni Volpato (1735 ca.-1803), allievo di Francesco Bartolozzi a Venezia e trasferitosi nel 1770 a Roma era un incisore che serviva due campi tra di loro molto diversi – da una parte era un'abile e fertile incisore di un genere di stampe che attingeva al genere popolare e al paesaggio di gusto veneziano ma la sua attività maggiormente notata si riferiva al repertorio classico di tradizione romano – riproducendo le opere di Raffaello, Michelangelo, degli Carracci e della loro scuola. La maggior fama del Volpato deriva soprattutto dalle 46 tavole che trasse dalle Logge di Raffaello pubblicate tra 1776 e 1777 delle quali esistono anche esemplari colorati a mano e che hanno profondamente influenzato il gusto della decorazione degli interni in tutta l'Europa oltre il 1800. Alessandro Verri nel 1776 scrisse a suo fratello Pietro a proposito di questa pubblicazione: "Dopo che si sono stampate in Roma le Loggie del Vaticano tutto ha cambiato di gusto. Le carrozze, i muri, gli intagli, le argenterie hanno preso gli ornamenti di quel fonte perenne di ogni varietà." La collaborazione con Gavin Hamilton per la Scholae Italia Picturae e le riproduzioni della Galleria Farnese e della Cappella Sistina come anche del Museo Pio Clementino e delle statue antiche in un repertorio per artisti rivelano il suo interesse per la formazione artistica. In un certo senso si può dire che Volpato era la contropparte di Piranesi e che ambedue effettuavano una precisa e ben meditata divisione dei compiti e di generi e interessi che comunque era al servizio del pubblico turistico che in numero crescente prendeva Roma come meta di viaggi e d'istruzione culturale e si serviva delle incisioni di facile portata di mano. L'importanza delle incisioni come merce di facile trasporto e diffusione è stata per la prima volta riconosciuta da Luigi Lanzi quando definì il Settecento "secolo di rame".

IDH/MGMT-driven molecular classification of low-grade glioma is a strong predictor for long-term survival

BACKGROUND Low-grade gliomas (LGGs) are rare brain neoplasms, with survival spanning up to a few decades. Thus, accurate evaluations on how biomarkers impact survival among patients with LGG require long-term studies on samples prospectively collected over a long period. METHODS The 210 adult LGGs collected in our databank were screened for IDH1 and IDH2 mutations (IDHmut), MGMT gene promoter methylation (MGMTmet), 1p/19q loss of heterozygosity (1p19qloh), and nuclear TP53 immunopositivity (TP53pos). Multivariate survival analyses with multiple imputation of missing data were performed using either histopathology or molecular markers. Both models were compared using Akaike's information criterion (AIC). The molecular model was reduced by stepwise model selection to filter out the most critical predictors. A third model was generated to assess for various marker combinations. RESULTS Molecular parameters were better survival predictors than histology (ΔAIC = 12.5, P< .001). Forty-five percent of studied patients died. MGMTmet was positively associated with IDHmut (P< .001). In the molecular model with marker combinations, IDHmut/MGMTmet combined status had a favorable impact on overall survival, compared with IDHwt (hazard ratio [HR] = 0.33, P< .01), and even more so the triple combination, IDHmut/MGMTmet/1p19qloh (HR = 0.18, P< .001). Furthermore, IDHmut/MGMTmet/TP53pos triple combination was a significant risk factor for malignant transformation (HR = 2.75, P< .05). CONCLUSION By integrating networks of activated molecular glioma pathways, the model based on genotype better predicts prognosis than histology and, therefore, provides a more reliable tool for standardizing future treatment strategies.