ANTITUMOR EFFECT OF COMBINED TREATMENT WITH THYMOSIN ALPHA-1 AND INTERLEUKIN-2 AFTER 5-FLUOROURACIL IN LIVER METASTASES FROM COLORECTAL-CANCER IN RATS

We studied the effect of combined chemo-immunotherapy, 5-FU followed by thymosin alpha I (T alpha I) and interleukin-2 (IL-2) at low doses, on liver metastases from colorectal cancer, induced by splenic injection of DHD/K12 cells (1,2-dimethylhydrazine-inducedd colon adenocarcinoma) in syngeneic BDIX rats. The presence of liver metastases was checked by laparotomy 14 days after tumor-cell injection. Evaluable rats were assigned randomly to 5 experimental groups designated as control, 5-FU, IL-2, 5-FU/IL-2 and 5-FU/T alpha I/IL-2. 5-FU was administered i.v. as a continuous infusion for 7 days by an osmotic device implanted surgically. T alpha I and IL-2 were administered for 4 days and repeated after 11 days. Combined chemo-immunotherapy was shown both the significantly reduce the growth of liver metastases and to prevent extra-hepatic spread. 5-FU/T alpha I/IL-2 also improved survival rate. Combined immunotherapy after 5-FU restored NK activity of the peripheral-blood-mononuclear-cell (PBMC) in tumor and/or 5-FU immunodepressed rats and enhanced PBMC cytotoxic activity against the DHD/K12 autologous cell line. This model was devised to mimic the clinical situation of unresectable liver metastases. (C) 1994 Wiley-Liss, Inc

DEISCENZE ANASTOMOTICHE NELLE RESEZIONI ANTERIORI DEL RETTO CON ESCISSIONE TOTALE DEL MESORETTO

Anterior rectal resection with total mesorectal excision is currently regarded as the operation of choice in patients with neoplasms of the extraperitoneal rectum. This operation is associated with a significant incidence of anastomotic dehiscence. Some authors, therefore, advise the execution of a protective stoma. From 1987 to 2000, 241 patients with rectal neoplasma were submitted to radical surgery: 183 to anterior rectal resection (extraperitoneal neoplasms in 129 cases and intraperitoneal neoplasms in 54) and 58 to a Miles operation. The total incidence of anastomotic complications was 8.1% (15 patients). In 12 cases (6.5%) a clinical dehiscence was observed, while in 3 patients (1.6%) an asymptomatic fistula was present. In the patients with symptomatic dehiscence a colostomy was performed in 5 cases (42%), while in 7 cases (58%) a conservative approach was adopted (total parenteral nutrition and antibiotic therapy), with complete healing of the fistula. The incidence of anastomotic complications was 9.3% in extraperitoneal neoplasms and 5.6% in intraperitoneal localizations. In relation to the anastomotic technique adopted, the incidence of dehiscences was 25% after 8 Knight-Griffen anastomoses, 16% after 12 manual anastomoses and 7.3% after 163 end-to-end mechanical anastomoses (P = NS). The percentage of anastomotic complications was greater in the period from 1995 to 1997, compared to the period from 1987 to 1994 (12.6% vs 3.8%, P = NS), due to the routine execution of rectal resection in conjunction with total mesorectal excision, particularly at the beginning of the experience, in 1995. In the last 36 cases from 1998 on the incidence of anastomotic complications was reduced to 8.3%, after the learning phase. No related mortality was observed. On the basis of our experience and the evidence reported in the international literature we do not think the execution of a protective stoma is justified after low and ultra-low colorectal anastomosis, except in selected cases

[Endoscopic retrograde transparietojejunal approach in hepatico-jejunostomy. An experimental model using fibrin glue].

The Authors describe an experimental model that makes feasible to endoscopically approach a Roux-en Y hepatico-jejunostomy through a percutaneous transjejunal route. Potentials for its clinical application are briefly discussed

Città Metropolitane e Smart Governance Iniziative di successo e nodi critici verso la Smart City

The volume contains the results of the research project "Governance Analysis Project (GAP) for the Smart Energy City. The actualization of Smart Cities in the Metropolitan Areas of Europe and Italy” conducted within the PON “Smart Energy Master for the energy management of the territory” at the University Federico II of Naples (TeMA Lab of the Department of Civil, Architectural and Environmental Engineering). Smart Cities have gained increasing relevance in the scientific debate and in the national and international operational practice, emerging as one of the opportunities to rethink cities and, more generally, the life of urban communities. First reflections, researches and projects on the issue seem to converge towards the idea that a “smart” urban development should not only be a result of the yet necessary and unavoidable infrastructural endowment (physical capital) and of its continuing innovation, but also of the quality of human, social and environmental capital, conceived as strategic factors for development. A “smart” city is, primarily, a city able to effectively satisfy the needs of its citizens respecting the rules imposed by the environmental context. It is in such a debate that the project GAP fits with the aim to address Smart Cities in light of the administrative reorganization of Italian large cities as a consequence of the Law 56/2014. With a scientific approach, the volume provides a comprehensive and updated framework of how Italian and European Metropolitan cities are declining the Smart City issue and this thanks to the collection of a wide-ranging screening represented by more than 1.000 initiatives including researches, projects, interventions, technologies, etc. Furthermore, one original element of this research is that after an analysis conducted through indirect sources, a phase of dialogue with “stakeholders” was carried out (and of this there is a wide picture in the volume in which, by the way, are reported long excerpts of the interviews). This has enabled to give a clearer framework of what is now experimenting in Italian and European cities, avoiding being totally naïve for interventions and projects labelled as “smart”, but often lacking of innovative methods and contents

Alert Microorganisms Procedure: Surveillance, Monitoring And Prevention Of Health Care Associated Infections

Health care-associated infections (HCAIs) are infections developed in a hospital or other health care facility, that first appear 48 hours or more after hospital admission, or within 30 days after having received health care. It’s estimated that among all hospitalized patients, about 7% for highincome countries and about 15% for low-middle income countries contract a HCAI. Among the main causes of HCAIs there are the so-called Alert Microorganisms, intended as different species with a high probability of diffusion in hospital settings, often combined with a problematic therapeutic approach or antibiotic resistance. The objective of our study was to describe the protocol applied in the setting of AOU “San Giovanni di Dio e Ruggi D’Aragona” of Salerno in order to evaluate its efficiency in reducing cases of infections. Methods: Protocol “Alert Microorganisms Procedure: Surveillance, Monitoring And Prevention Of Health Care Associated Infections”, applied in AOU “San Giovanni di Dio e Ruggi D’Aaragona” of Salerno; Alert Microorganisms detection form, filled by the doctor and/or the head nurse of the interested Department; HCAI Surveillance evaluation form, filled by the HCAI-supervising doctor, in order to evaluate the progression and/or new cases of contamination/infection. Results: Gram-negative and fungi were the most common identified pathogens. Patiens have been isolated in a single room and treated with personal-use devices and specific therapy. When single room was not avaiable, patients’ bed were placed 1,5m away from other patients, even with screens or dividers Conclusion: The Surveillance of Alert Microorganisms allowed us to define protocols to manage and monitor HCAIs and identify areas that need to be improved. The continuous and correct application of the protocol may lead in the future to a significant reduction of the risk for patients to contract HCAI