A multiorgan donor cancer screening protocol: The Italian Emilia-Romagna region experience

Background. We describe the Emilia-Romagna screening protocol for all multiorgan donors within this region of Italy and report on the first 2 years of implementation. Setting. Setting is a 24-hour multidisciplinary call service covering the 16 intensive care units in Emilia-Romagna (3,969,000 inhabitants) and a centralised pathology center, directed by a transplant coordination center. Study Population and Period. All 271 effective donor candidates presenting in Emilia-Romagna in 2001-2002. Protocol. Anamnesis, external examination, and thorough laboratory and instrumental screening is followed by sampling of internal effusions and evaluation of all internal organs. All suspect findings are then investigated by extemporary pathologic evaluation. To fit national legal requirements, candidates are classified as standard risk (no transmissible risk); nonstandard risk (low-risk of transmission, eligibility restricted to certified clinical emergencies pending informed consent); and unacceptable risk (unconditional exclusion because of high-risk pathologies). Results. The protocol was successfully implemented for all 271 candidates. In addition to 14 independent exclusions, clinical suspicion of cancer was raised for 61 donors presenting with 82 lesions or effusions. Along with one case of lymph-node tuberculosis (unacceptable risk), histocytologic screening revealed eight cases of malignancy (5 prostate, 1 papillary-thyroid, 1 follicular-thyroid, and 1 renal cell, all nonstandard risk); the remainder were benign (standard risk). Protocol implementation led to exclusion of 8 (3.0%) candidates (1 nonstandard risk transplantation was performed). Conclusions. This stringent protocol-now adopted with some modifications at a national level-provides an initial example of a feasible intervention aimed at maximising donation safety while rationalizing use of marginal donors

MODAL IDENTIFICATION AND MODEL UPDATING OF AN INNOVATIVE AUTOMATIC SELF-SUPPORTING TIMBER WAREHOUSE: THE CASE STUDY OF ROTHOBLAAS HEADQUARTERS EXPANSION

Automatic Self-Supporting Timber Warehouse (ASSTW) is an innovative and sustainable structural system with a modal response strongly influenced by both the actual mechanical behaviour of structural elements and the load conditions. The structural analysis of ASSTW is typically carried out using numerical models calibrated referring to codified materials and connection properties. The reliability of the numerical simulations, used in the design phase, can be verified through modal identification on-site tests that also allow for a subsequent model update. This paper reports the main results of the modal identification on-site campaign, conducted by CIRI-EC laboratory of University of Bologna, of the new Rotho Blaas S.r.l. ASSTW in two different load conditions: unloaded warehouse with only the mass of the structural elements and partially loaded warehouse with eccentric mass. The subsequent model update phase is presented carrying out the most significant mechanical parameters to grasp the actual modal response of the structure

Trapianto renale e neoplasie maligne: esperienza a lungo termine (25 anni) di un singolo centro = Renal transplantation and malignancies: A single-centre experience (25 years)

BACKGROUND: The prevalence of post-transplant malignancies, in renal transplant recipients, is higher than that expected in age and sex-matched controls from the general population, and there is a markedly increased incidence of certain cancers. METHODS: In 1137 renal transplant recipients (1020 from cadaveric and 117 from living donors, M/F 771/366) performed at the S.Orsola Renal Transplantation Centre since 10/1976 to 9/2001, we studied the post-transplant cancer prevalence, the correlation between cancer prevalence and population characteristics, the risk factors (smoke, cancer history, positive HBsAg and antiHCV infection) and the immunosuppressive therapy. RESULTS AND CONCLUSIONS: The prevalence of malignancies was 3.86% (52 malignancies in 44 patients). The period between transplant and diagnosis of malignant disease was 59 +/- 85 months. Skin cancer was the most common (n=16; 30.7%), followed by lymphoproliferative disorders (n=8; 15.4%), Kaposi s sarcoma (n=6; 11.5%), uterine cancer (n=6; 11.5%), renal carcinoma of native kidney (n=5; 9.6%), cancer of breast/stomach/pancreas and urinary bladder (n=2; 3.8%) and other cancers (n=5; 9.6%). The mean duration of dialysis before transplantation was longer in cancer patients (41+/- 32.1 vs. 33.5 +/- 32.4 months). We found a correlation between types of malignancies and viral infection in NH-lymphoma (EBV positive 4/4) and skin cancer (HZV positive 13/16). We also detected a correlation between Aza and skin cancer (16/22) and CyA and lymphoproliferative disorders (7/8)