Prognostic factors for survival in patients with colorectal liver metastases: experience of a single brazilian cancer center

CONTEXT: Liver metastases are a common event in the clinical outcome of patients with colorectal cancer and account for 2/3 of deaths from this disease. There is considerable controversy among the data in the literature regarding the results of surgical treatment and prognostic factors of survival, and no analysis have been done in a large cohort of patients in Brazil. OBJECTIVES: To characterize the results of surgical treatment of patients with colorectal liver metastases, and to establish prognostic factors of survival in a Brazilian population. METHOD: This was a retrospective study of patients undergoing liver resection for colorectal metastases in a tertiary cancer hospital from 1998 to 2009. We analyzed epidemiologic variables and the clinical characteristics of primary tumors, metastatic disease and its treatment, surgical procedures and follow-up, and survival results. Survival analyzes were done by the Kaplan-Meier method and the log-rank test was applied to determine the influence of variables on overall and disease-free survival. All variables associated with survival with P<0.20 in univariate analysis, were included in multivariate analysis using a Cox proportional hazard regression model. RESULTS: During the period analyzed, 209 procedures were performed on 170 patients. Postope-rative mortality in 90 days was 2.9% and 5-year overall survival was 64.9%. Its independent prognostic factors were the presence of extrahepatic disease at diagnosis of liver metastases, bilateral nodules and the occurrence of major complications after liver surgery. The estimated 5-year disease-free survival was 39.1% and its prognostic factors included R1 resection, extrahepatic disease, bilateral nodules, lymph node involvement in the primary tumor and primary tumors located in the rectum. CONCLUSION: Liver resection for colorectal metastases is safe and effective and the analysis of prognostic factors of survival in a large cohort of Brazilian patients showed similar results to those pointed in international series. The occurrence of major postoperative complications appears to be able to compromise overall survival and further investigation in needed in this topic.

Nitrogen fertilizer (15N) leaching in a central pivot fertigated coffee crop

Nitrogen has a complex dynamics in the soil-plant-atmosphere system. N fertilizers are subject to chemical and microbial transformations in soils that can result in significant losses. Considering the cost of fertilizers, the adoption of good management practices like fertigation could improve the N use efficiency by crops. Water balances (WB) were applied to evaluate fertilizer N leaching using 15N labeled urea in west Bahia, Brazil. Three scenarios (2008/2009) were established: i) rainfall + irrigation the full year, ii) rainfall only; and iii) rainfall + irrigation only in the dry season. The water excess was considered equal to the deep drainage for the very flat area (runoff = 0) with a water table located several meters below soil surface (capillary rise = 0). The control volume for water balance calculations was the 0 - 1 m soil layer, considering that it involves the active root system. The water drained below 1 m was used to estimate fertilizer N leaching losses. WB calculations used the mathematic model of Penman-Monteith for evapotranspiration, considering the crop coefficient equal to unity. The high N application rate associated to the high rainfall plus irrigation was found to be the main cause for leaching, which values were 14.7 and 104.5 kg ha-1 for the rates 400 and 800 kg ha-1 of N, corresponding to 3.7 and 13.1 % of the applied fertilizer, respectively.

Standard surgical treatment for benign prostatic hyperplasia is safe for patients over 75 years: analysis of 100 cases from a high-volume urologic center

OBJECTIVES: In this study, we aimed to determine the complications of standard surgical treatments among patients over 75 years in a high-volume urologic center. METHODS: We analyzed 100 consecutive patients older than 75 years who had undergone transurethral prostatic resection of the prostate or open prostatectomy for treatment of benign prostatic hyperplasia from January 2008 to March 2010. We analyzed patient age, prostate volume, prostate-specific antigen level, international prostatic symptom score, quality of life score, urinary retention, co-morbidities, surgical technique and satisfaction with treatment. RESULTS: Median age was 79 years. Forty-eight patients had undergone transurethral prostatic resection of the prostate, and 52 had undergone open prostatectomy. The median International Prostatic Symptom Score was 20, the median prostate volume was 83 g, 51% were using an indwelling bladder catheter, and the median prostatespecific antigen level was 5.0 ng/ml. The most common comorbidities were hypertension, diabetes and coronary disease. After a median follow-up period of 17 months, most patients were satisfied. Complications were present in 20% of cases. The most common urological complication was urethral stenosis, followed by bladder neck sclerosis, urinary fistula, late macroscopic hematuria and persistent urinary incontinence. The most common clinical complication was myocardial infarction, followed by acute renal failure requiring dialysis. Incidental carcinoma of the prostate was present in 6% of cases. One case had urothelial bladder cancer. CONCLUSIONS: Standard surgical treatments for benign prostatic hyperplasia are safe and satisfactory among the elderly. Complications are infrequent, and urethral stenosis is the most common. No clinical variable is associated with the occurrence of complications.

Total parathyroidectomy in a large cohort of cases with hyperparathyroidism associated with multiple endocrine neoplasia type 1: experience from a single academic center

Most cases of sporadic primary hyperparathyroidism present disturbances in a single parathyroid gland and the surgery of choice is adenomectomy. Conversely, hyperparathyroidism associated with multiple endocrine neoplasia type 1 (hyperparathyroidism/multiple endocrine neoplasia type 1) is an asynchronic, asymmetrical multiglandular disease and it is surgically approached by either subtotal parathyroidectomy or total parathyroidectomy followed by parathyroid auto-implant to the forearm. In skilful hands, the efficacy of both approaches is similar and both should be complemented by prophylactic thymectomy. In a single academic center, 83 cases of hyperparathyroidism/ multiple endocrine neoplasia type 1 were operated on from 1987 to 2010 and our first surgical choice was total parathyroidectomy followed by parathyroid auto-implant to the non-dominant forearm and, since 1997, associated transcervical thymectomy to prevent thymic carcinoid. Overall, 40% of patients were given calcium replacement (mean intake 1.6 g/day) during the first months after surgery, and this fell to 28% in patients with longer follow-up. These findings indicate that several months may be needed in order to achieve a proper secretion by the parathyroid auto-implant. Hyperparathyroidism recurrence was observed in up to 15% of cases several years after the initial surgery. Thus, long-term follow-up is recommended for such cases. We conclude that, despite a tendency to subtotal parathyroidectomy worldwide, total parathyroidectomy followed by parathyroid auto-implant is a valid surgical option to treat hyperparathyroidism/multiple endocrine neoplasia type 1. Larger comparative systematic studies are needed to define the best surgical approach to hyperparathyroidism/multiple endocrine neoplasia type 1.

The photosynthetic bacterial reaction center in native and artificial envirnoments: effects on light-induced electron transfer

In this thesis we focussed on the characterization of the reaction center (RC) protein purified from the photosynthetic bacterium Rhodobacter sphaeroides. In particular, we discussed the effects of native and artificial environment on the light-induced electron transfer processes. The native environment consist of the inner antenna LH1 complex that copurifies with the RC forming the so called core complex, and the lipid phase tightly associated with it. In parallel, we analyzed the role of saccharidic glassy matrices on the interplay between electron transfer processes and internal protein dynamics. As a different artificial matrix, we incorporated the RC protein in a layer-by-layer structure with a twofold aim: to check the behaviour of the protein in such an unusual environment and to test the response of the system to herbicides. By examining the RC in its native environment, we found that the light-induced charge separated state P+QB - is markedly stabilized (by about 40 meV) in the core complex as compared to the RC-only system over a physiological pH range. We also verified that, as compared to the average composition of the membrane, the core complex copurifies with a tightly bound lipid complement of about 90 phospholipid molecules per RC, which is strongly enriched in cardiolipin. In parallel, a large ubiquinone pool was found in association with the core complex, giving rise to a quinone concentration about ten times larger than the average one in the membrane. Moreover, this quinone pool is fully functional, i.e. it is promptly available at the QB site during multiple turnover excitation of the RC. The latter two observations suggest important heterogeneities and anisotropies in the native membranes which can in principle account for the stabilization of the charge separated state in the core complex. The thermodynamic and kinetic parameters obtained in the RC-LH1 complex are very close to those measured in intact membranes, indicating that the electron transfer properties of the RC in vivo are essentially determined by its local environment. The studies performed by incorporating the RC into saccharidic matrices evidenced the relevance of solvent-protein interactions and dynamical coupling in determining the kinetics of electron transfer processes. The usual approach when studying the interplay between internal motions and protein function consists in freezing the degrees of freedom of the protein at cryogenic temperature. We proved that the “trehalose approach” offers distinct advantages with respect to this traditional methodology. We showed, in fact, that the RC conformational dynamics, coupled to specific electron transfer processes, can be modulated by varying the hydration level of the trehalose matrix at room temperature, thus allowing to disentangle solvent from temperature effects. The comparison between different saccharidic matrices has revealed that the structural and dynamical protein-matrix coupling depends strongly upon the sugar. The analyses performed in RCs embedded in polyelectrolyte multilayers (PEM) structures have shown that the electron transfer from QA - to QB, a conformationally gated process extremely sensitive to the RC environment, can be strongly modulated by the hydration level of the matrix, confirming analogous results obtained for this electron transfer reaction in sugar matrices. We found that PEM-RCs are a very stable system, particularly suitable to study the thermodynamics and kinetics of herbicide binding to the QB site. These features make PEM-RC structures quite promising in the development of herbicide biosensors. The studies discussed in the present thesis have shown that, although the effects on electron transfer induced by the native and artificial environments tested are markedly different, they can be described on the basis of a common kinetic model which takes into account the static conformational heterogeneity of the RC and the interconversion between conformational substates. Interestingly, the same distribution of rate constants (i.e. a Gamma distribution function) can describe charge recombination processes in solutions of purified RC, in RC-LH1 complexes, in wet and dry RC-PEM structures and in glassy saccharidic matrices over a wide range of hydration levels. In conclusion, the results obtained for RCs in different physico-chemical environments emphasize the relevance of the structure/dynamics solvent/protein coupling in determining the energetics and the kinetics of electron transfer processes in a membrane protein complex.

Liver transplantation for transthyretin amyloidosis: experience of a single center in Italy

Liver transplantation is the only definitive treatment for transthyretin amyloidosis, with an excellent 5-year survival in endemic countries where the Met30 mutation is predominant. We report our experience of liver transplantation for transthyretin amyloidosis. We reviewed the clinical records of 17 transplanted patients (11 males, 6 females; age at liver transplant: 45.7±11.7 years). We had a wide spectrum of non-Met30 mutations (52.9%), with a predominance of Gln89 (23.5%). Five-year survival after transplantation was 43.8%; at multivariate analysis, both non-Met30 mutations (HR 17.3, 95% CI 1.03-291.7) and modified BMI (HR 0.50, 95% CI 0.29-0.87) showed significant and independent prognostic roles (P=0.048 and P=0.015, respectively). Five out of the 9 non-Met30 carriers received combined heart transplantation because of severe cardiomyopathy; they showed a trend towards a better prognosis vs. the 4 patients who did not receive combined heart transplantation (although not statistically significant; P=0.095). At follow-up, no significant improvement of transthyretin amyloidosis manifestations was observed. The results of liver transplantation for transthyretin amyloidosis in our population are poorer than those reported in the literature probably because of the high prevalence of non-Met30 mutations.

Il problema del risparmio energetico nei data center

Con la crescente diffusione del web e dei servizi informatici offerti via internet, è aumentato in questi anni l’utilizzo dei data center e conseguentemente, il consumo di energia elettrica degli stessi. Il problema ambientale che comporta l’alto fabbisogno energetico, porta gli operatori di data center ad utilizzare tecniche a basso consumo e sistemi efficienti. Organizzazioni ambientali hanno rilevato che nel 2011 i consumi derivanti dai data center raggiungeranno i 100 milioni di kWh, con un costo complessivo di 7,4 milioni di dollari nei soli Stati Uniti, con una proiezione simile anche a livello globale. La seguente tesi intende valutare le tecniche in uso per diminuire il consumo energetico nei data center, e quali tecniche vengono maggiormente utilizzate per questo scopo. Innanzitutto si comincerà da una panoramica sui data center, per capire il loro funzionamento e per mostrare quali sono i componenti fondamentali che lo costituiscono; successivamente si mostrerà quali sono le parti che incidono maggiormente nei consumi, e come si devono effettuare le misurazioni per avere dei valori affidabili attraverso la rilevazione del PUE, unità di misura che valuta l’efficienza di un data center. Dal terzo capitolo si elencheranno le varie tecniche esistenti e in uso per risolvere il problema dell’efficienza energetica, mostrando alla fine una breve analisi sui metodi che hanno utilizzato le maggiori imprese del settore per risolvere il problema dei consumi nei loro data center. Lo scopo di questo elaborato è quello di capire quali sono le tecniche e le strategie per poter ridurre i consumi e aumentare l’efficienza energetica dei data center.

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

Sviluppo di un simulatore per la propagazione del calore nei data center

Questa tesi tratta lo sviluppo di un software in grado di simulare le dinamiche tra fluidi e oggetti considerando la propagazione del calore in vista di possibili applicazioni rivolte ad ambienti in cui lo stato termico del sistema e' critico (data center).

Differenze nella prestazione tecnico-tattica tra diverse categorie di atleti nel tennistavolo di alto livello

Nell’ambito della ricerca scientifica nel campo dello sport, la Performance Analysis si sta ritagliando un crescente spazio di interesse. Per Performance Analysis si intende l’analisi della prestazione agonistica sia dal punto di vista biomeccanico che dal punto di vista dell’analisi notazionale. In questa tesi è stata analizzata la prestazione agonistica nel tennistavolo attraverso lo strumento dell’analisi notazionale, partendo dallo studio degli indicatori di prestazione più importanti dal punto di vista tecnico-tattico e dalla loro selezione attraverso uno studio sull’attendibilità nella raccolta dati. L’attenzione è stata posta quindi su un aspetto tecnico originale, il collegamento spostamenti e colpi, ricordando che una buona tecnica di spostamento permette di muoversi rapidamente nella direzione della pallina per effettuare il colpo migliore. Infine, l’obbiettivo principale della tesi è stato quello di confrontare le tre categorie di atleti selezionate: alto livello mondiale maschile (M), alto livello junior europeo (J) ed alto livello mondiale femminile (F). La maggior parte delle azioni cominciano con un servizio corto al centro del tavolo, proseguono con una risposta in push (M) o in flik di rovescio (J). Il colpo che segue è principalmente il top spin di dritto dopo un passo pivot o un top di rovescio senza spostamento. Gli alteti M e J contrattaccano maggiormente con top c. top di dritto e le atlete F prediligono colpi meno spregiudicati, bloccando di rovescio e proseguendo con drive di rovescio. Attraverso lo studio della prestazione di atleti di categorie e generi diversi è possibile migliorare le scelte strategiche prima e durante gli incontri. Le analisi statistiche multivariate (modelli log-lineari) hanno permesso di validare con metodo scientifico sia le procedure già utilizzate in letteratura che quelle innovative messe a punto per la prima volta in occasione di questo studio.

Spektroelektrochemische Untersuchungen mittels oberflächenverstärkter Infrarotabsorptionsspektroskopie (SEIRAS) an Multi-Redox-Center-Proteinen in einer biomimetischen Membranumgebung

Die optische Eigenschaften sowie der Oberflächenverstärkungseffekt von rauen Metalloberflächen sowie Nanopartikeln wurden intensiv für den infraroten Bereich des Spektrums in der Literatur diskutiert. Für die Präparation solcher Oberflächen gibt es prinzipiell zwei verschiedene Strategien, zum einen können die Nanopartikel zuerst ex-situ synthetisiert werden, der zweite Ansatz beruht darauf, dass die Nanopartikel in-situ hergestellt und aufgewachsen werden. Hierbei wurden beide Ansätze ausgetestet, dabei stellte sich heraus, dass man nur mittels der in-situ Synthese der Goldnanopartikel in der Lage ist nanostrukturierte Oberflächen zu erhalten, welche elektronisch leitfähig sind, nicht zu rau sind, um eine Membranbildung zu ermöglichen und gleichzeitig einen optimalen Oberflächenverstärkungseffekt zeigen. Obwohl keine ideale Form der Nanopartikel mittels der in-situ Synthese erhalten werden können, verhalten sich diese dennoch entsprechend der Theorie des Oberflächenverstärkungseffekts. Optimierungen der Form und Grösse der Nanopartikel führten in dieser Arbeit zu einer Optimierung des Verstärkungseffekts. Solche optimierten Oberflächen konnten einfach reproduziert werden und zeichnen sich durch eine hohe Stabilität aus. Der so erhaltene Oberflächenverstärkungseffekt beträgt absolut 128 verglichen mit dem belegten ATR-Kristall ohne Nanopartikel oder etwa 6 mal, verglichen mit der Oberfläche, die bis jetzt auch in unserer Gruppe verwendet wurde. Daher können nun Spektren erhalten werden, welche ein deutlich besseres Signal zu Rauschverhältnis (SNR) aufweisen, was die Auswertung und Bearbeitung der erhaltenen Spektren deutlich vereinfacht und verkürzt.rnNach der Optimierung der verwendeten Metalloberfläche und der verwendeten Messparameter am Beispiel von Cytochrom C wurde nun an der Oberflächenbelegung der deutlich größeren Cytochrom c Oxidase gearbeitet. Hierfür wurde der DTNTA-Linker ex-situ synthetisiert. Anschließend wurden gemischte Monolagen (self assembeld monolayers) aus DTNTA und DTP hergestellt. Die NTA-Funktionalität ist für die Anbindung der CcO mit der his-tag Technologie verantwortlich. Die Kriterien für eine optimale Linkerkonzentration waren die elektrischen Parameter der Schicht vor und nach Rekonstitution in eine Lipidmembran, sowie Elektronentransferraten bestimmt durch elektrochemische Messungen. Erst mit diesem optimierten System, welches zuverlässig und reproduzierbar funktioniert, konnten weitere Messungen an der CcO begonnen werden. Aus elektrochemischen Messungen war bekannt, dass die CcO durch direkten Elektronentransfer unter Sauerstoffsättigung in einen aktivierten Zustand überführt werden kann. Dieser aktivierte Zustand zeichnet sich durch eine Verschiebung der Redoxpotentiale um etwa 400mV gegenüber dem aus Gleichgewichts-Titrationen bekannten Redoxpotential aus. Durch SEIRAS konnte festgestellt werden, dass die Reduktion bzw. Oxidation aller Redoxzentren tatsächlich bei den in der Cyclovoltammetrie gemessenen Potentialen erfolgt. Außerdem ergaben die SEIRA-Spektren, dass durch direkten Elektronentransfer gravierende Konformationsänderungen innerhalb des Proteins stattfinden. rnBisher war man davon ausgegangen, aufgrund des Elektronentransfers mittels Mediatoren, dass nur minimale Konformationsänderungen beteiligt sind. Vor allem konnte erstmaligrnder aktivierte und nicht aktivierte Zustand der Cytochrom c Oxidase spektroskopisch nachweisen werden.rn

Riorganizzazione di un distribution center mediante le tecniche di lean production: il caso Gambro Dasco spa

La Lean Production è un tema di estrema attualità per tutte le aziende che abbiano compreso l’importanza di produrre di più, con le risorse che si hanno a disposizione, eliminando sistematicamente tutte le attività che non creano valore aggiunto. La Produzione Snella è diventato un metodo per incrementare la competitività, riducendo l’incertezza e aumentando il servizio fornito al cliente. Nella realtà attuale vi è ancora una scarsa diffusione dei concetti Lean. Le cause di questo problema sono imputabili soprattutto alla cultura del management aziendale, alla mancanza di efficaci strumenti tecnologici a supporto, e in alcuni casi, la scarsa disponibilità delle imprese ad abbracciare la filosofica “snella”. La presente tesi, dopo una panoramica introduttiva su l’origine e l’evoluzione del Pensiero Snello e l’analisi di tutti i tools disponibili per combattere lo spreco; si propone di analizzare l’applicazione degli stessi in Gambro Dasco, multinazionale biomedicale leader nella vendita delle sue apparecchiature per dialisi.

Traduttori specializzati e business center nel processo di internazionalizzazione d'impresa: Studio esplorativo e prospettive future

This exploratory study aims at investigating the professional opportunities available to a specialised translator within the process of international business development. Firstly, the analysis focuses on a review of the theoretical principles affirming the need of a fine-tuned language strategy, especially in the process of internationalization, managed by professionals with translation, language and cultural skills. Against this background, the focus is on the role played by a specialised translator within this process. With the aim of exploring the translator’s role within this process, the analysis focuses on business centers in Italy, which bring together demand and supply of language services and services for company internationalisation. According to the results that shows the opportunities available to a specialised translator with extra skills, the analysis focuses on the placement of this professional within the process. A specialised translator can be a language and cultural consultant for the internationalised company, as well as a Project Manager working for its international development. The conclusions describe the role which a specialised translator with economic or international marketing skills might play within this framework, and pave the way for future developments of this analysis.

Controllo generalizzato via software di dispositivi per l'interconnessione flessibile di data center

La tesi riguarda le gestione via software di dispositivi che interconnettono componenti hardware di forwarding in una rete.