Prospective validation of the CLIP score: a new prognostic system for patient with cirrhosis and hepatocellular carcinoma

Prognosis of patients with cirrhosis and hepatocellular carcinoma (HCC) depends on both residual liver function and tumor extension. The CLIP score includes Child-Pugh stage, tumor morphology and extension, serum alfa-fetoprotein (AFP) levels, and portal vein thrombosis. We externally validated the CLIP score and compared its discriminatory ability and predictive power with that of the Okuda staging system in 196 patients with cirrhosis and HCC prospectively enrolled in a randomized trial. No significant associations were found between the CLIP score and the age, sex, and pattern of viral infection. There was a strong correlation between the CLIP score and the Okuda stage, As of June 1999, 150 patients (76.5%) had died. Median survival time was 11 months, overall, and it was 36, 22, 9, 7, and 3 months for CLIP categories 0, 1, 2, 3, and 4 to 6, respectively. In multivariate analysis, the CLIP score had additional explanatory power above that of the Okuda stage. This was true for both patients treated with locoregional therapy or not. A quantitative estimation of 2-year survival predictive power showed that the CLIP score explained 37% of survival variability, compared with 21% explained by Okuda stage. In conclusion, the CLIP score, compared with the Okuda staging system, gives more accurate prognostic information, is statistically more efficient, and has a greater survival predictive power. It could be useful in treatment planning by improving baseline prognostic evaluation of patients with RCC, and could be used in prospective therapeutic trials as a stratification variable, reducing the variability of results owing to patient selection

Strumenti normativi e modelli organizzativi di prevenzione della corruzione nella legalità costituzionale.

Il lavoro muove dalla spinta regolamentare-normativa all’adozione di strumenti di gestione e controllo per assicurare scelte di policies di gestione improntate all’etica e alla legalità, nonché alla prevenzione della corruzione e/o fenomeni illeciti in genere, che riguardano il mondo dell’imprenditoria, della Pubblica Amministrazione e le relazioni tra questi due ambiti di interesse. Quanto appena evidenziato, unito all’attuale complessità delle organizzazioni aziendali, per le stesse rappresenta o può rappresentare un vincolo decisionale o - ancor più grave - un «rischio», data la concreta possibilità di assumere decisioni non conformi alle norme vigenti. Ancora più recentemente è intervenuto il quadro regolatorio UE che, insieme agli obiettivi dell'Agenda 2030 delle Nazioni Unite, ha aumentato notevolmente gli obblighi in materia di compliance in generale con grande accento a sostenibilità, ESG e green economy. Obiettivo generale della ricerca è stato il riscontro «sul campo», l’implementazione dei modelli di prevenzione e/o controllo previsti dalle norme indicate, nonché l'obbligo - possibile - per le imprese di sistemi di compliance e di responsabilità sociale d’impresa, unitamente a temi di prevenzione della corruzione, quali strumenti per l’attuazione della legalità costituzionale, intesa come effettiva attuazione dei principi di pari dignità sociale e di uguaglianza dei cittadini davanti alla legge. Va in questa direzione la scelta di adottare tali modelli - finalizzati ad evitare la commissione dei reati necessari, e a prevenire la corruzione - o comunque l’adozione di strumenti attuativi di responsabilità sociale d’impresa, rappresentanti per le aziende non un costo, ma un investimento per una migliore gestione. In tal senso, allora, certamente, la diffusione di tali strumenti di controllo costituisce per i cittadini un passo avanti per l’attuazione concreta e diffusa di principi di legalità costituzionale1 , quali l'uguaglianza davanti alla legge e la pari dignità sociale. Con questa idea di partenza, si è strutturato il lavoro in quattro capitoli nei quali il filo rosso della trattazione è rappresentato, innanzitutto, al primo dall’analisi del contesto normativo, nazionale ed internazionale, che ha rappresentato la spinta evolutiva dei modelli di prevenzione. Nel successivo, si è esaminata l’incidenza che tale massiva regolamentazione ha sulla governance delle imprese, tanto relativa alla struttura organizzativa e ai sistemi di controllo che le stesse sono portate a scegliere per obblighi o opportunità di conformità, quanto per l’influenza che ciò ha sulla scelta degli amministratori e dei dirigenti. Nel terzo è stato approfondito il tema del ritorno sociale dell’adozione dei modelli di gestione e controllo, nonché di prevenzione della corruzione. L’impatto sulla comunità, o in senso più ampio sulla società, può essere importante. D’altra parte, come affrontato nel quarto – ed ultimo capitolo – tali strumenti possono determinare un più corretto funzionamento del mercato. «In definitiva, per combattere la corruzione è necessario riporre fiducia soprattutto nelle politiche di prevenzione e promuovere, per il tramite della trasparenza, quel controllo sociale diffuso, che si è dimostrato, specialmente nelle più virtuose esperienze europee, lo strumento più valido allo scardinamento del malaffare» 2 . Pertanto, tali modelli sono un utile strumento di attuazione della legalità costituzionale, che presuppongono un’attività fondamentale da parte dell’interprete. Dell’attività di quest’ultimo si sono indagati i principi, costituzionalmente riconosciuti, posti a fondamento di quelle scala di valori che l’interprete, appunto, deve sempre tenere a mente nella corretta valutazione del caso concreto, operando quel bilanciamento di interessi necessario alla realizzazione e tutela della persona in un ordinamento che consenta, riconoscendolo e tutelandoli, l’attuazione fattuale del sistema assiologico in tutta la sua complessità e capillarità presente nell’ordinamento

Single trocar transanal endoscopy in a child.

Single trocar transanal endoscopic surgery (STTE) is a well-known technique for evaluation and management of rectal le-sions in adults. We used an 11mm balloon trocar with a 10mm operative optic, introduced into the anal canal to excise a rectal lesion along with multiple rectal biopsies in a child. Rectal visibility was good with an ease to maintain the rectum in-sufflated

Laparoscopy-assisted jejunostomy in neurological patients with chronic malnutrition and GERD. Technical considerations and analysis of the results.

BACKGROUND: Feeding difficulties and gastroesophageal reflux (GER) are major problems in severely neurologically impaired children. Many patients are managed with a simple gastrostomy, with or without fundoplication. Unfortunately, fundoplication and gastrostomy are not devoid of complications, indicating the need for other options in the management of these patients. METHODS: Between January 2002 and June 2010, ten patients (age range, 18 months-14 years) have been treated by creating a jejunostomy with the laparoscopic-assisted procedure. The procedure was performed using 2-3 trocars. The technique consists of identifying the first jeujnal loop, grasping it 20-30 cm away from the Treitz ligament, and exteriorizing it to the trocar orifice under visual guide. The jejunostomy was created outside the abdominal cavity during open surgery. At the end of the jejunostomy, the correct position of the intestinal loops was evaluated via laparoscopy. RESULTS: Surgery lasted 40 min on average, the laparoscopic portion about 10 min. Hospital stay was 3 or 7 days for all patients. At the longest follow-up (8 years), all patients had experienced a significant weight gain. One patient died 1 year after the procedure of unknown causes. As for the other complications: 4/10 patients experienced peristomal heritema, 2/10 device's dislocation and 1 patient a peristomal granuloma. CONCLUSIONS: Laparoscopic-assisted jejunostomy is a safe and effective procedure to adopt in neurologically impaired children with feeding problems and GER. We advocate the use of this procedure in neurologically impaired patients with feeding problems and reflux due to its overall practicability and because there is minimal surgical trauma. The improvement in the quality of life of these children after the jejunostomy seems to be the major advantage of this procedure. However the management of jejunostomy can be difficult for parents above all in the first postoperative months

Laparoscopic Assisted Jejunostomy:an effective procedure for the treatment of neurologically impaired children with feeding problems and GER

BACKGROUND: Feeding difficulties and gastroesophageal reflux (GER) are major problems in severely neurologically impaired children. Many patients are managed with a simple gastrostomy, with or without fundoplication. Unfortunately, fundoplication and gastrostomy are not devoid of complications, indicating the need for other options in the management of these patients. METHODS: Since January 2002, seven patients (age range, 5-14 years) have been treated by creating a jejunostomy with the laparoscopic-assisted procedure. The procedure was performed using two 10-mm trocars. The technique consists of identifying the first jejunal loop, grasping it 20-30 cm away from the Treitz ligament with fenestrated atraumatic forceps, and exteriorizing it to the trocar orifice under visual guide. The jejunostomy was created outside the abdominal cavity during open surgery. At the end of the jejunostomy, the correct positions of the intestinal loop and feeding tube were evaluated via laparoscopy. RESULTS: Surgery lasted 40 min on average, the laparoscopic portion only 5 min. There were no perioperative complications; hospital stay was 3 or 4 days for all patients. At the longest follow-up (18 months), all patients had experienced a significant weight gain, with a high level of parental satisfaction. One patient died 1 year after the procedure of unknown causes. All the others are well, without complications or problems, and their parents are extremely satisfied with the improved quality of life of their children. CONCLUSIONS: Laparoscopic-assisted jejunostomy is a safe and effective procedure to adopt in neurologically impaired children with feeding problems and GER. This procedure solves these patients' feeding problems even if the reflux is not completely eliminated. We advocate the use of this procedure in neurologically impaired patients with feeding problems and reflux due to its overall practicability and because there is minimal surgical trauma. This technique is extremely safe because the surgeon is able to verify, at the end of procedure, the status of the jejunostomy from outside and inside the abdominal cavity. The improvement in the quality of life of these children after the jejunostomy seems to be the major advantage of this procedure

One-Trocar Ileo-Colic Resection in a Newborn Infant with a Cystic Lymphangioma of the Small-Bowel Mesentery

We report a case of a newborn with a cystic lymphangioma of the small-bowel mesentery discovered antenatally at ultrasound and confirmed postnatally at computed tomography scan. The lesion together with the caecum and the last centimeters of ileum were resected by using only one trocar positioned lateroumbilically. In this paper, we describe the advantages of MIS to treat newborn with abdominal masses

Strengthening of RC structures with SRP/SRG systems: bond tests - Rinforzo di strutture in c.a. con sistemi SRP/SRG: test di delaminazione

Steel reinforced polymer (SRP) and steel reinforced grout (SRG) systems have recently been introduced in civil engineering for the external strengthening of RC members. Despite the unquestionable advantages deriving from the use of these systems, in terms of both performance and costs, the scientific papers available in literature are still limited, and there are several aspects related to their behaviour that need a better examination. Among them, the SRP/SRG-concrete bond is highlighted and this paper provides a contribute in this sense by presenting some results of 142 bond tests carried out at the University of Salerno. Particularly, tests have allowed for performing the first considerations on the SRP/SRG-concrete bond in terms of failure mode, debonding loads and effective bond lengths by varying the following parameters: concrete strength; bonded length; ratio between width of the adhesive strip and width of the reinforcement; steel tape density, and quality of the surface preparation