Improvement in hemorrhoidal disease surgery outcomes using a new anatomical/clinical-therapeutic classification (a/ctc)

Introduction  The introduction and diffusion of new techniques for hemorrhoidal surgery have made it clear how much Goligher classification is inadequate in the modern times, lacking in any correlation between anatomical and clinical features to a surgical procedure. The aim of the study was to evaluate if the application of a new classification of hemorrhoidal diseases might lead to an improvement in the postoperative surgical outcomes. Methods  From January 2014 to December 2015, all patients undergoing surgery for hemorrhoidal disease were enrolled. The procedures performed were based upon a new anatomical/clinical-therapeutic classification (A/CTC) considering these items: anatomical presentation, symptom types and frequency, associated diseases, and available surgical treatments and their related contraindications. The new classification identified four groups: A (outpatient), B, C, and D (surgical approaches). The overall outcomes were assessed and then stratified by surgical groups. These data were then analyzed in comparison with the published data about all the surgical procedures performed. Results  A total of 381 patients underwent surgery and they were stratified as follows: Group B (39), C (202), and D (140). Group B underwent Doppler-guided dearterialization with mucopexies or tissue selective therapy, Group C stapled procedures, and Group D hemorrhoidectomy. The mean follow-up was 30 months. The overall outcomes were: success rate 92.4%, recurrences 7.6%, postoperative complications 4.8%, long-term complications 5.4%, and reoperation rate 2.7%. The success rates stratified by groups were: B, 85%); C, 91.4%; and D, 95.7%. Conclusion  The A/CTC proved to be useful in stratifying the patients and choosing the proper treatment for each case. This classification seems to improve the outcome of different surgical procedures if compared with those already published

Triggering-runout modelling of rainfall-triggered debris flows: A case study in the Campania region, Italy

Debris flows are unpredictable phenomena, listed among the hugest natural hazards, since they can cause important damages to humans and structures. Rainfall can trigger this type of movements, as it provokes the pore water pressure increasing, and so the soil strength reduction. The phenomenon modelling is a key aspect to predict and prevent damages. This article shows an approach for triggering and runout analysis: triggering is studied through an infinite slope stability model of rainfall-triggered shallow landslides, while runout is modelled using a depth-averaged numerical method, which replace the real heterogeneous flow with an equivalent homogeneous fluid. The work focuses the attention to events characterized by multiple triggering zones and releases converging on the same area, whose complexity is represented by the time- and space-distribution of the different flows. The proposed approach is applied to an event that hit part of the Campania region, Italy, in 1998, causing several damages. Two rheological laws are considered and compared for the analysis. The back-analysis allows the calibration of the rheological parameters and validation of the method. Results are discussed to identify the most suitable rheology for the benchmark event

Molecular and Functional Characterization of NKG2D, NKp80, and NKG2C Triggering NK Cell Receptors in Rhesus and Cynomolgus Macaques: Monitoring of NK Cell Function during Simian HIV Infection

Abstract An involvement of innate immunity and of NK cells during the priming of adaptive immune responses has been recently suggested in normal and disease conditions such as HIV infection and acute myelogenous leukemia. The analysis of NK cell-triggering receptor expression has been so far restricted to only NKp46 and NKp30 in Macaca fascicularis. In this study, we extended the molecular and functional characterization to the various NK cell-triggering receptors using PBMC and to the in vitro-derived NK cell populations by cytofluorometry and by cytolytic activity assays. In addition, RT-PCR strategy, cDNA cloning/sequencing, and transient transfections were used to identify and characterize NKp80, NKG2D, CD94/NKG2C, and CD94/NKG2A in M. fascicularis and Macaca mulatta as well as in the signal transducing polypeptide DNAX-activating protein DAP-10. Both M. fascicularis and M. mulatta NK cells express NKp80, NKG2D, and NKG2C molecules, which displayed a high degree of sequence homology with their human counterpart. Analysis of NK cells in simian HIV-infected M. fascicularis revealed reduced surface expression of selected NK cell-triggering receptors associated with a decreased NK cell function only in some animals. Overall surface density of NK cell-triggering receptors on peripheral blood cells and their triggering function on NK cell populations derived in vitro was not decreased compared with uninfected animals. Thus, triggering NK cell receptor monitoring on macaque NK cells is possible and could provide a valuable tool for assessing NK cell function during experimental infections and for exploring possible differences in immune correlates of protection in humans compared with cynomolgus and rhesus macaques undergoing different vaccination strategies

HIV-1 Tat protein modulates the generation of cytotoxic T cell epitopes by modifying proteasome composition and enzymatic activity

Tat, the trans activation protein of HIV, is produced early upon infection to promote and expand HIV replication and transmission. However, Tat appears to also have effects on target cells, which may affect Ag recognition both during infection and after vaccination. In particular, Tat targets dendritic cells and induces their maturation and Ag-presenting functions, increasing Th1 T cell responses. We show in this work that Tat modifies the catalytic subunit composition of immunoproteasomes in B and T cells either expressing Tat or treated with exogenous biological active Tat protein. In particular, Tat up-regulates latent membrane protein 7 and multicatalytic endopeptidase complex like-1 subunits and down-modulates the latent membrane protein 2 subunit. These changes correlate with the increase of all three major proteolytic activities of the proteasome and result in a more efficient generation and presentation of subdominant MHC-I-binding CTL epitopes of heterologous Ags. Thus, Tat modifies the Ag processing and modulates the generation of CTL epitopes. This may have an impact on both the control of virally infected cells during HIV-1 infection and the use of Tat for vaccination strategies

life threatening acute myocardial infarction due to left main dissection during radiofrequency transcatheter ablation of atrial tachycardia

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Test and simulation of plastic scintillator strips readout by silicon photomultipliers

We studied the light collection in plastic scintillator strips, optimized for the detection of Minimum Ionizing Particles (MIPs). The light is collected by Wave Length Shifter (WLS) fibers and detected by Silicon Photo Multipliers (SiPMs). The study is based on prototypes developed for the muon detector of SuperB experiment. In parallel to measurement made on various type of geometries, a complete simulation suite, based on FLUKA, was developed. The simulation parameters were tuned by comparison with real data. In this way, we were able to study the effects of geometries and assembling procedures on light collection and provide a useful simulation tool for the design of future prototypes

CMS physics technical design report : Addendum on high density QCD with heavy ions

Peer reviewe

Il sistema aziendale e le sue evoluzioni. Orientamenti strategici, di governance e modalità di funding

Orientamenti strategici, governance di azienda e modalità di reperimento di risorse vengono analizzati in un lavoro articolato, inter-disciplinare e permeabile a suggestioni diversificate.A complex work, dealing with over-crossing perspectives about corporations' governance and strategies