TOPMELT 1.0: a topography-based distribution function approach to snowmelt simulation for hydrological modelling at basin scale

Abstract. Enhanced temperature-index distributed models for snowpack simulation, incorporating air temperature and a term for clear sky potential solar radiation, are increasingly used to simulate the spatial variability of the snow water equivalent. This paper presents a new snowpack model (termed TOPMELT) which integrates an enhanced temperature-index model into the ICHYMOD semi-distributed basin-scale hydrological model by exploiting a statistical representation of the distribution of clear sky potential solar radiation. This is obtained by discretizing the full spatial distribution of clear sky potential solar radiation into a number of radiation classes. The computation required to generate a spatially distributed water equivalent reduces to a single calculation for each radiation class. This turns into a potentially significant advantage when parameter sensitivity and uncertainty estimation procedures are carried out. The radiation index may be also averaged in time over given time periods. Thus, the model resembles a classical temperature-index model when only one radiation class for each elevation band and a temporal aggregation of 1 year is used, whereas it approximates a fully distributed model by increasing the number of the radiation classes and decreasing the temporal aggregation. TOPMELT is integrated within the semi-distributed ICHYMOD model and is applied at an hourly time step over the Aurino Basin (also known as the Ahr River) at San Giorgio (San Giorgio Aurino), a 614 km2 catchment in the Upper Adige River basin (eastern Alps, Italy) to examine the sensitivity of the snowpack and runoff model results to the spatial and temporal aggregation of the radiation fluxes. It is shown that the spatial simulation of the snow water equivalent is strongly affected by the aggregation scales. However, limited degradation of the snow simulations is achieved when using 10 radiation classes and 4 weeks as spatial and temporal aggregation scales respectively. Results highlight that the effects of space–time aggregation of the solar radiation patterns on the runoff response are scale dependent. They are minimal at the scale of the whole Aurino Basin, while considerable impact is seen at a basin scale of 5 km2

Natural killer cell functional dichotomy in chronic hepatitis B and chronic hepatitis C virus infections

Background & Aims: The phenotypic and functional characteristics of natural killer (NK) cells in chronic hepatitis B virus (HBV) and hepatitis C virus (HCV) infections are incompletely defined and largely controversial. Methods: We studied NK cell receptor expression, cytotoxic activity, and cytokine production in peripheral blood mononuclear cells from 35 patients with chronic hepatitis C, 22 with chronic hepatitis B, and 30 healthy controls. Results: Patients with chronic HBV infection had an increased proportion of NKG2C+ NK cells with normal inhibitory receptor expression and a lower proportion of activated NK cells compared with HCV+ patients, which was associated with normal or reduced cytolytic activity and markedly dysfunctional tumor necrosis factor-\u3b1 and interferon-\u3b3 production. Patients with chronic HCV infection showed a predominantly activating phenotype, featuring a decreased percentage of cells expressing the inhibitory receptor KIR3DL1 and a concomitant increase in the proportion of NKG2D+ NK cells. Expression of the CD69 early activation antigen on NK cells positively correlated with serum alanine aminotransferase and HCV RNA values, suggesting participation of virus-induced effector NK cells in liver necroinflammation. Phenotypic changes in HCV+ patients were associated with enhanced cytokine-induced cytolytic activity and increased usage of natural cytotoxicity and NKG2D receptor pathways, accompanied by defective cytokine production, although to a lesser extent than patients with chronic HBV infection. Conclusions: These findings provide evidence for a functional dichotomy in patients with chronic HBV and HCV infections, featuring conserved or enhanced cytolytic activity and dysfunctional cytokine production, which may contribute to virus persistence

Erratum to : Open versus robotic-assisted partial nephrectomy: a multicenter comparison study of perioperative results and complications

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ANALYSIS OF CLINICAL PREDICTIVE FACTORS OF THE TRIFECTA OUTCOME AFTER PARTIAL NEPHRECTOMY. AN AGILE STUDY

Scopo del lavoro The trifecta is an accepted index of the excellent surgical outcome after partial nephrectomy. Aim of this study was to assess which clinical variables may be an independent predictors of the trifecta outcome in patients candidates to partial nephrectomy. Materiali e metodi The data of 440 patients treated with open partial nephrectomy for T1 RCC were reviewed in our multicenter prospectively maintained database. Warm ischemia time (WIT)>25 min, complications, and postoperative acute kidney dysfunction (AKD), separately. The perioperative clinical variables associated with the Trifecta outcome, defined as warm ischemia time (WIT) Risultati The trifecta outcome was achieved in 315 (71.6%) patients; 7.5% of patients had WIT 65 25 min, 3.5% had PSM and 21.2% had perioperative complications. Reoperation rate for Clavien 653 complication was 6.7%. On univariate analysis the trifecta was significantly associated with patients gender (p Discussione In our analysis the clarity of the surgical field, associated to the containment of intraoperative bleeding and a favorable tumor nephrometry, resulted of critical importance for the achievement of the excellent surgical outcome. Conclusioni I P 128 NEPHRON SPARING SURGERY DOES NOT ALWAYS DECREASE OTHER-CAUSES MORTALITY RELATIVE TO RADICAL NEPHRECTOMY IN PATIENTS WITH NORMAL PREOPERATIVE RENAL FUNCTION U. Capitanio, C. Terrone, A. Antonelli, A. Minervini, A. Volpe, C. Fiori, F. Porpiglia, M. Furlan, R. Matloob, F. Regis, E. Di Trapani, P. De Angeli, S. Serni, R. Colombo, M. Carini, C. Simeone, F. Montorsi, R. Bertini (Milano) Scopo del lavoro Some reports suggested that nephron sparing surgery (NSS) may better protect against other-cause mortality (OCM) when compared with radical nephrectomy (RN) in patients with small renal masses. However, the majority of those studies could not adjust their results for potential selection bias secondary to clinical baseline characteristics of patients. In the current study, we aimed to test the effect of treatment type (NSS vs. RN) after accounting for clinical characteristics, comorbidities and individual cardiovascular risk. Materiali e metodi A multi-institutional collaboration among four European Tertiary Care Centers allowed collecting 2685 patients with a clinical T1a-T1b N0 M0 renal mass. Patients underwent RN (n=1059, 39.4%) or NSS (n=1626, 60.6%) and showed normal estimated glomerular filtration rates (eGFR) before surgery (defined as a pre-operative eGFR 6560 milliliters per minute per 1.73 m2). Descriptive, univariable and multivariable Cox regression analyses were used to predict the risk of OCM. To adjust for inherent baseline differences among patients, we included as covariates: age, clinical tumor size, gender, presence of hypertension at diagnosis, baseline Charlson comorbidity index (CCI), body mass index and smoker status. Risultati Mean follow up period was 76 months (median 61). Mean patient age resulted 60 years (median 62). Mean body mass index resulted 25 kg/m2. Overall, 37.2% and 9.4% of the patients had hypertension or diabetes, respectively. CCI resulted 0-1 in 73.2% of the patients. The 5- and 10-yr OCM rates after nephrectomy were 5.2% and 13.2% for NSS versus 7.4% and 15.1% for RN, respectively (p=0.3). At multivariable analyses, patients who underwent PN showed similar risk to die for OCM compared with their RN-treated counterparts (hazard ratio [HR]: 0.77; 95% confidence interval, 0.48-1.25; p=0.3). Increasing age (HR: 1.12

Surgical activity in the COVID-19 era. Trend of slowdown from a multicentre observational study

COVID-19 outbreak represented an unprecedented event that led to a redefinition of health care systems worldwide. The impact of the emergency required a deviation of the care toward the assistance to COVID-19 patients, with reduction of resources for elective activities, including surgery. We aim to report the decrease of urological surgical activity during the first weeks from the beginning of the pandemic, aiming to highlight the prioritization we applied to select patients for surgery