Renal papillary carcinoma developed in a kidney transplant recipient with late IgA-nephropathy

With improvements in immunosuppressive therapy, patient and graft survival in renal transplant recipients have been prolonged. Increasing donor age and patient survival rates have been related to an increase in the number of de novo tumors. Posttransplant malignancy in these patients is an important cause of graft loss and death in these patients. Among cancers occurring after a kidney transplant, renal cell carcinoma is the fifth most common malignancy after lymphoproliferative disorders, and skin, gastrointestinal, and lung cancers. When nonmelanoma skin cancers and in situ carcinoma of the cervix are excluded from malignancies, renal cell carcinoma accounts for 2% of all cancers in the general population, which increases to 5% in solid-organ recipients. The majority of renal cell carcinomas found in transplant recipients develop in the recipient 's native kidneys, but only 9% of tumors develop in the allograft itself. Tumors transmitted by donors represent only 0.02% to 0.2% of cases. Most de novo allograft renal cell carcinomas are single tumors. The mechanisms of development of renal cell carcinoma in renal grafts are not completely understood

Transplantation activity in the Organizzazione Centro-Sud Trapianti: A retrospective study from 1999 to March 2004

Background. The Organizzazione Centro-Sud Trapianti (OCST) was set up in 1998 to coordinate the organ procurement and transplantation activity of 9 Italian regions (Abruzzo, Basilicata, Calabria, Campania, Lazio, Molise, Sardinia, Sicily, and Umbria), each referring to a local Regional Transplant Center. The aim of the present study was to estimate organ donation and transplantation rates in the OCST from 1999 to March 2004. Materials and Methods. A retrospective study of organ donors and transplantation activity in the OCST during the study period was performed, pointing out donor epidemiological data, such as age and sex ratio, causes of death, reasons for discarding, and transplantation rate. Donors reported to the OCST were divided into 6 groups: A (October 1998-December 1999), B (2000), C (2001), D (2002), E (2003), and F (January-March 2004). Results. From 1999 to March 2004, 2272 potential donors were reported to the OCST. The nonharvested donors rate increased up to 52% (Group F), which was lower than the previous period (Group E, 64%), but higher than in 1999 (Group A, 43%). The major contributing factor was family opposition, which was 38% in 2002 and 41% in 2003. Conclusions. The introduction of the OCST into the field of organ transplantation has yielded an increase in organ donation and transplantation activity within the regions that set it up from 1999-2003. This trend is a consequence of the growth of reported donors from the intensive care unit, which grew 12.7% from 2002 to 2003. From the data analysis of the first months of 2004, we expect confirmation of this trend

The organizational model of the Interregional Transplant Agency Organizzazione Centro-Sud Trapianti

In Italy, all donation and transplant activities were officially disciplined in 1999 by the law 91 of April 1, 1999. This law enacted a coordinator-based model of transplantation, instituted the National Center for Transplantation (Centro Nazionale Trapianti-CNT), and endorsed the existing interregional transplant agencies (ITA), such as the Nord Italia Transplant program (NITp), the Associazione InterRegionale Trapianti (AIRT), and the Organizzazione Centro-Sud Trapianti (OCST). Within its borders each ITA has adopted its own organizational model; there is no overt centralized control exerted by the CNT according to the law 91/1999. The aim of the current work is to report on the organizational model adopted by OCST, the ITA gathering the Italian regions of Abruzzo, Basilicata, Calabria, Campania, Latium, Molise, Sardinia, Sicily, and Umbria

Diagnostic value of presepsin for bacterial infection in cirrhosis: a pilot study

Introduction: Presepsin (or sCD14) has been identified as a protein whose levels increase specifically in the blood of patients with bacterial infections. In this study, we evaluated the clinical performance of sCD14 and its usefulness in the early diagnosis of bacterial infection in decompensated cirrhotic patients. Materials: Seventy patients were enrolled in this study. The mean age of patients was 49.5 years, and 21 were women and 49 men. The heparinized whole blood for the PATHFAST test was used in the evaluation of bacterial infection (T0). The test was repeated after 48 hours (T1); at 96 hours (T2); at 144 hours (T3); then at 15 days (T4) to monitor the clinical responses to therapeutic interventions. Results: Forty-nine patients tested positive for sCD14. The mean sCD14 level was 1854 ± 1744 pg/mL. Microbiological findings confirmed the presence of bacterial infections within 84 ± 4.8 h from enrollment in all 49 positive patients. Thirty-eight patients were considered responders to empirical antibiotic therapy with a decrease of presepsin at the different time points, while an increased level of sCD14 was highlighted in 11 patients. When the test was performed, 45% of the patients showed no signs or symptoms of bacterial infection. At 30 days of follow-up 43 patients survived, and 6 patients died from septic shock. Conclusions: The PATHFAST test highlighted the presence of infection in a very short time (15 minutes), and the presepsin could be considered an early biomarker in patients with cirrhosis. A greater number of patients are necessary to confirm these data

SP854EVALUATION OF SUITABILITY OF KIDNEY FOR TRANSPLANT. HISTOMORPHOMETRIC ANALYSIS

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Anti-lock braking control design using a Nonlinear Model Predictive approach and wheel information

Over the past century, cars have become a fundamental part of our society. With the increasingly larger number of vehicles on the road, safety is, now more than ever, a topic of paramount importance. It is estimated that every year 26,000 people are killed on European roads, corresponding to a social cost of 100 billion euros. In the last two decades, awareness about this issue has however increased substantially, and great effort is now put into improving these numbers.The introduction of driver assistance systems in recent years has led to a significant decrease in fatal accidents. One of the first implemented ones was Anti-lock Braking System (ABS), introduced on the market in 1978. ABS is an active safety system nowadays mandated on every new car sold in Europe. By preventing wheel lock during emergency braking, the system allows for shorter braking distances and steering ability retention. Despite the fact that forty years went by since ABS introduction, the control strategy behind it has changed very little, still retaining a rule-based approach. Extensive review of literature of the subject, highlighted the possibility that significant improvements could be achieved if the control strategy was to be redesigned in a way that takes advantage of the many technological improvements achieved in the last decade.The aim in this thesis is to verify this statement and quantify any potential improvement in Anti-lock Braking System. In order to achieve the research objective, a novel ABS algorithm was designed. The controller, based on state-of-the-art hardware, uses a model predictive control approach and potentially available wheel force information as the pillars of its design.A supervisory activation logic is also developed to replicate full ABS functionalities and keep the driver in the loop. The controller is then tested on Toyota’s high-end vehicle simulator and benchmarked against the current industrial state of the art.The vehicle simulator has its core in a multibody model augmented with kinematics and compliance measurements, and it is largely validated against experiments. A complex multi-physics model of the brake system, together with the short wavelength rigid ring tire model, complete the setup.A comprehensive set of manoeuvres, including friction jumps and rough road braking scenarios, is developed to assess performance and robustness of the proposed controller. Additionally, a list of aspect-specific performance metrics is drafted and deployed to accurately investigate the simulations results and identify relative gains with respect to the benchmark in different instances of the braking manoeuvre. The analysis showed substantial reduction of the braking distance and improved steering ability in each of the simulated scenarios. Furthermore, robustness of the controller against external factors, such as high frequency noise generated by road irregularities or friction transitions, is demonstrated to be comparable to that of industrial state of the art controllers. Based on the now verified potential of the proposed controller, and a list of the future engineering steps mapping the way until an eventual controller deployment on the market is identified.<br/