Artificial Intelligence and Machine Learning tools for improving Early Warning systems of volcanic eruptions: the case of Stromboli

Explosive volcanic blasts can occur suddenly and without any clear precursors. Many volcanoes have erupted in the last years with no evident change in the eruptive parameters and with dramatic consequences for the population living nearby the volcano and the tourists visiting the active areas. In recent years, a big effort has been made to develop Early Warning systems to issue timely alerts to the population. At Stromboli volcano, the development of sensitive instruments to measure the deformation (tilt) of the ground has revealed that the volcano edifice is inflating tens of minutes before the explosion following a recurrent exponential ramp-like pattern. This scale-invariant of ground deformation has allowed the development of a quasi-deterministic Early Warning system which is operative since 2019. In this article we show how Artificial Intelligence and Machine Learning can be successfully applied to improve the efficiency and the sensitivity of Early Warning systems, provided the availability of a comprehensive experimental data set on past explosive events. The approach presented here for the Stromboli case demonstrates promising results also in forecasting the intensity of explosive events, offering valuable insights and new perspectives into the potential risks associated with volcanic activities.

Shedding light on PRAME expression in dysplastic nevi: a cohort study

Dysplastic nevi represent one of the least agreed-upon entities in dermatopathology despite the existence of established criteria. This study explores preferentially expressed antigen in melanoma (PRAME) in dysplastic nevi, an uncharted area. We examined 22 common melanocytic nevi (CMN), 20 cutaneous melanomas (CM), 48 low-grade dysplastic nevi (LG-DN), and 40 high-grade dysplastic nevi (HG-DN). PRAME was immunohistochemically assessed using a five-tiered system (0 to 4 +). Among CMN, 59% scored 0, 32% scored 1 + , and 9% scored 2 + . CM had score 2 + and 4 + in 11% and 89% of cases, respectively. Among LG-DN, 38% presented score 0, 31% score 1 + , 17% score 2 + , 8% score 3 + , and 6% score 4 + . Thirty per cent of HG-DN demonstrated a score 0, 30% with score 1 + , 15% score 2 + , 10% score 3 + , and 15% score 4 + . Compared to CMN and CM, LG-DN and HG-DN showed heterogeneous expression profiles of PRAME. PRAME positivity effectively distinguished HG-DN from CM with 85% specificity and 80% sensitivity (p < 0.0001). Predictive values were 87% (negative) and 76% (positive). Furthermore, a trend of increased PRAME expression from LG-DN to HG-DN was observed. However, the applicability of PRAME in the differential diagnosis of dysplastic lesions remains unclear as can yield conflicting results with morphology, which remains the primary diagnostic tool for melanocytic lesions.

Investigations on microplastic infiltration within natural riverbed sediments

Several studies focused on the role of rivers as vectors of microplastics (MPs) towards the sea. It is well known that during their path through the fluvial environment, MPs interact with riverbed sediments; however, the main factors impacting the mobility of MPs within the upper part of the hyporheic zone are not clear yet. The present work investigates the role of different sediment size layers in affecting the mobility of the most common MP (Polyethylene terephthalate - PET - spheres, PET 3D-ellipsoids, polystyrene - PS - fragments and polyamide - PA - fibers) within sediment porous media under different hydraulic loads (HL) and time scales (t) conditions. Results indicated the relationship between the characteristic MP diameter and that of the grains as the main parameter for the MP infiltration into the sediment layer. The maximum infiltration depth was found to not depend on HL and t. However, HL was able to influence the percentage of MPs penetrating the superficial layer and their distribution within the first 10-15 cm of the sediment layer. None of the MPs were found at depths >20-25 cm, where only PET spheres were detected. Starting from the suffusion theory, a model able to predict the MP maximum infiltration depth in the range of parameter values was provided. The outcome indicates the importance of considering geometrical and hydrodynamic aspects of the riverbed sediment layer to better characterize the spatial and temporal scales of MP transport in freshwater environments.

Respiratory Rate Estimation during Walking and Running Using Breathing Sounds Recorded with a Microphone

Emerging evidence suggests that respiratory frequency (f_R) is a valid marker of physical effort. This has stimulated interest in developing devices that allow athletes and exercise practitioners to monitor this vital sign. The numerous technical challenges posed by breathing monitoring in sporting scenarios (e.g., motion artifacts) require careful consideration of the variety of sensors potentially suitable for this purpose. Despite being less prone to motion artifacts than other sensors (e.g., strain sensors), microphone sensors have received limited attention so far. This paper proposes the use of a microphone embedded in a facemask for estimating f_R from breath sounds during walking and running. f_R was estimated in the time domain as the time elapsed between consecutive exhalation events retrieved from breathing sounds every 30 s. Data were collected from ten healthy subjects (both males and females) at rest and during walking (at 3 km/h and 6 km/h) and running (at 9 km/h and 12 km/h) activities. The reference respiratory signal was recorded with an orifice flowmeter. The mean absolute error (MAE), the mean of differences (MOD), and the limits of agreements (LOAs) were computed separately for each condition. Relatively good agreement was found between the proposed system and the reference system, with MAE and MOD values increasing with the increase in exercise intensity and ambient noise up to a maximum of 3.8 bpm (breaths per minute) and -2.0 bpm, respectively, during running at 12 km/h. When considering all the conditions together, we found an MAE of 1.7 bpm and an MOD ± LOAs of -0.24 ± 5.07 bpm. These findings suggest that microphone sensors can be considered among the suitable options for estimating f_R during exercise.

Design and Testing of a Smart Facemask for Respiratory Monitoring during Cycling Exercise

Given the importance of respiratory frequency (f_R) as a valid marker of physical effort, there is a growing interest in developing wearable devices measuring f_R in applied exercise settings. Biosensors measuring chest wall movements are attracting attention as they can be integrated into textiles, but their susceptibility to motion artefacts may limit their use in some sporting activities. Hence, there is a need to exploit sensors with signals minimally affected by motion artefacts. We present the design and testing of a smart facemask embedding a temperature biosensor for f_R monitoring during cycling exercise. After laboratory bench tests, the proposed solution was tested on cyclists during a ramp incremental frequency test (RIFT) and high-intensity interval training (HIIT), both indoors and outdoors. A reference flowmeter was used to validate the f_R extracted from the temperature respiratory signal. The smart facemask showed good performance, both at a breath-by-breath level (MAPE = 2.56% and 1.64% during RIFT and HIIT, respectively) and on 30 s average f_R values (MAPE = 0.37% and 0.23% during RIFT and HIIT, respectively). Both accuracy and precision (MOD ± LOAs) were generally superior to those of other devices validated during exercise. These findings have important implications for exercise testing and management in different populations.

The Prognostic Impact of Gender, Therapeutic Strategies, Molecular Background, and Tumor-Infiltrating Lymphocytes in Glioblastoma: A Still Unsolved Jigsaw

Despite the adoption of novel therapeutical approaches, the outcomes for glioblastoma (GBM) patients remain poor. In the present study, we investigated the prognostic impact of several clinico-pathological and molecular features as well as the role of the cellular immune response in a series of 59 GBM. CD4+ and CD8+ tumor-infiltrating lymphocytes (TILs) were digitally assessed on tissue microarray cores and their prognostic role was investigated. Moreover, the impact of other clinico-pathological features was evaluated. The number of CD4+ and CD8+ is higher in GBM tissue compared to normal brain tissue (p < 0.0001 and p = 0.0005 respectively). A positive correlation between CD4+ and CD8+ in GBM is present (rs = 0.417-p = 0.001). CD4+ TILs are inversely related to overall survival (OS) (HR = 1.79, 95% CI 1.1-3.1, p = 0.035). The presence of low CD4+ TILs combined with low CD8+ TILs is an independent predictor of longer OS (HR 0.38, 95% CI 0.18-0.79, p = 0.014). Female sex is independently related to longer OS (HR 0.42, 95% CI 0.22-0.77, p = 0.006). Adjuvant treatment, methylguanine methyltransferase (MGMT) promoter methylation, and age remain important prognostic factors but are influenced by other features. Adaptive cell-mediated immunity can affect the outcomes of GBM patients. Further studies are needed to elucidate the commitment of the CD4+ cells and the effects of different TILs subpopulations in GBM.

Intraductal oncocytic papillary neoplasm (IOPN): two case reports and review of the literature

Background

Intraductal oncocytic papillary neoplasms (IOPNs) place at the oncocytic extreme of the intraductal pancreatic neoplasm spectrum and display typical morphological features. Their identification in 1996 by Adsay et al. has been followed by a growing number of cases, paving the way for a deeper understanding of this underestimated entity. Contrarily to intraductal papillary mucinous neoplasms (IPMNs), most IOPNs run an indolent course and surgery is usually curative. Pancreatic IOPNs tend to develop from the main pancreatic duct (MPD) and their diagnosis is either incidental or subsequent to mass-related symptoms. Up to 30% of cases show concomitant areas of minimal stromal invasion and loco-regional or systemic spread are confined to a minority of cases. Biological hallmarks of IOPNs are being identified, including recurrent kinase gene rearrangements. Morphological and biological traits of IOPNs seem to overlap with those of other malignancies. A deeper understanding of these entities is needed in order to shed light upon the nature of pancreato-biliary oncocytic neoplasms. This case report describes two patients with a diagnosis of IOPN-one of them accounting for the largest IOPN ever described-and provides a brief review of recent discoveries on the subject.

Case Description

We describe two cases of IOPN occurring in adult male patients, respectively in their 60s and 70s. Both patients had unremarkable clinical history. In case 1 the diagnosis was coincidental to a right renal colic; case 2 complained a right lumbar pain radiating to the homolateral groin. In both cases imaging analyses revealed a voluminous pancreatic mass, posing the indication to laparoscopic pancreatectomy. Gross and histological features were consistent with the diagnosis of IOPN. Surgical margin were free from disease and the patient did not undergo further treatment. After a 10- and 7-month follow-up respectively, patients did not experience relapse.

Conclusions

Recent immunohistochemical (IHC) and molecular data reveal unique characteristics of IOPNs, highlighting the substantial differences from IPMNs. Further research is needed in order to identify novel prognostic and predictive markers applicable to oncocytic neoplasms of the pancreato-biliary tract.

Volcanic CO2 tracks the incubation period of basaltic paroxysms

The ordinarily benign activity of basaltic volcanoes is periodically interrupted by violent paroxysmal explosions ranging in size from Hawaiian to Plinian in the most extreme examples. These paroxysms often occur suddenly and with limited or no precursors, leaving their causal mechanisms still incompletely understood. Two such events took place in summer 2019 at Stromboli, a volcano otherwise known for its persistent mild open-vent activity, resulting in one fatality and damage to infrastructure. Here, we use a post hoc analysis and reinterpretation of volcanic gas compositions and fluxes acquired at Stromboli to show that the two paroxysms were preceded by detectable escalations in volcanic plume CO₂ degassing weeks to months beforehand. Our results demonstrate that volcanic gas CO₂ is a key driver of explosions and that the preparatory periods ahead of explosions in basaltic systems can be captured by precursory CO₂ leakage from deeply stored mafic magma.

Initial validation of the Italian version of the Volition in Exercise Questionnaire (VEQ-I)

The purpose of this study was to validate the Volition in Exercise Questionnaire in Italian language (VEQ-I). The translation and cultural adaptation of the VEQ-I was conducted using the forward-backward translation method. VEQ-I eighteen items correspond to the six-factors structure of the original version. The construct validity was verified by the confirmatory factor analysis (CFA) (CFI = 0.960; TLI = 0.943; RMSEA = 0.039; and SRMR = 0.040). The eighteen items were well distributed in six subscales and the six-factors structure of the questionnaire was supported. Internal Consistency value of the questionnaire was investigated for each subscale of the VEQ-I. Cronbach’s alpha and Omega values of the Reasons, Postponing Training, Unrelated Thoughts, Self-Confidence, Approval from Others and Coping with Failure subscales were 0.76 (α) and 0.76 (ω), 0.76 (α) and 0.76 (ω), 0.87 (α) and 0.88 (ω), 0.85 (α) and 0.85 (ω), 0.70 (α) and 0.72 (ω) and 0.74 (α) and 0.74 (ω), respectively. They were acceptable in all the six subscales. The concurrent validity was assessed using the correlation among the subscales of VEQ-I measures and those contained in two questionnaires: Psychobiosocial States in Physical Education (PBS-SPE) and Exercise Motivations Inventory (EMI-2).

New insights in the expression of stromal caveolin 1 in breast cancer spread to axillary lymph nodes

Recent evidence suggests that a loss of expression of caveolin in the stromal compartment (sCav-1) of human invasive breast carcinoma (IBC) may be a predictor of disease recurrence, metastasis and poor outcome. At present, there is little knowledge regarding the expression of sCav-1 at the metastatic sites. We therefore studied sCav-1 expression in IBCs and in their axillary lymph nodes to seek a correlation with cancer metastasis. 189 consecutive invasive IBCs (53 with axillary lymph node metastases and 136 without) were studied by immunohistochemistry, using a rabbit polyclonal anti-Cav-1 antibody. In IBCs sCav-1 was evaluated in fibroblasts scattered in the tumor stroma whereas in lymph nodes sCav-1 was assessed in fibroblast-like stromal cells. For the first time, we observed a statistically significant progressive loss of sCav-1 from normal/reactive axillary lymph nodes of tumors limited to the breast to metastatic axillary lymph nodes, through normal/reactive axillary lymph nodes of tumors with axillary metastatic spread. These data indicate that Cav-1 expressed by the stromal compartment of lymph nodes, somehow, may possibly contribute to metastatic spread in IBC.

Androgen receptor expression inversely correlates with histological grade and N stage in ER+/PgRlow male breast cancer

PURPOSE

Androgen Receptor (AR) positivity is often displayed in breast cancer and especially in Male Breast Cancer (MBC), where it appears to be a heterogeneous feature, with its expression ranging between 38 and 81% of cases. Given the fact that circulating androgens represent the most important sex hormones in males and that breast carcinogenesis is characteristically subjected to hormonal mechanisms, our purpose was to investigate the clinicopathological significance of AR in MBC assessing if its expression could be associated with parameters of tumor aggressiveness.

METHODS

Clinical and pathological data were retrospectively reviewed for male patients with a diagnosis of invasive breast cancer. AR status was detected by immunohistochemistry on formalin-fixed, paraffin-embedded tumoral tissue sections. Correlations between AR expression and histopathological features were assessed using univariate and multiple comparisons where appropriate, assuming P values < 0.05 as statistically significant.

RESULTS

The study included 44 consecutive male patients. AR expression ranged between 10 and 98% and the majority of cases presented a moderate to high expression of this receptor. Adopting a 20% PgR cut-off, statistical analyses highlighted a different behavior of AR: in ER⁺/PgR^high group, it positively correlated with the other steroid receptors pointing out the importance of hormonal cross-talk: in ER⁺/PgR^low group, AR status inversely correlated with histological grade and lymph node status.

CONCLUSION

Hormonal factors reveal to play a crucial role in MBC carcinogenesis and progression. Intriguingly, in ER⁺/PgR^low tumors AR expression significantly correlates with lymph node status, hinting at a favorable biological role of AR in this tumor subgroup.

Recurrence quantification analysis of heart rate variability during continuous incremental exercise test in obese subjects

The present paper concerns a new description of changing in metabolism during incremental exercises test that permit an individually tailored program of exercises for obese subjects. We analyzed heart rate variability from RR interval time series (tachogram) with an alternative approach, the recurrence quantification analysis, that allows a description of a time series in terms of its dynamic structure and is able to identify the phase transitions. A transition in cardiac signal dynamics was detected and it perfectly reflects the aerobic threshold, as identified by gas exchange during an incremental exercise test, revealing the coupling from the respiratory system toward the heart. Moreover, our analysis shows that, in the recurrence plot of RR interval, it is possible to identify a specific pattern that allows to identify phase transitions between different dynamic regimes. The perfect match of the occurrence of the phase transitions with changes observed in the VO₂ consumption, the gold standard approach to estimate thresholds, strongly supports the possibility of using our analysis of RR interval to detect metabolic threshold. In conclusion, we propose a novel nonlinear data analysis method that allows for an easy and personalized detection of thresholds both from professional and even from low-cost wearable devices, without the need of expensive gas analyzers.

Two-Color Radiation Generated in a Seeded Free-Electron Laser with Two Electron Beams

We present the experimental evidence of the generation of coherent and statistically stable two-color free-electron laser radiation obtained by seeding an electron beam double peaked in energy with a laser pulse single spiked in frequency. The radiation presents two neat spectral lines, with time delay, frequency separation, and relative intensity that can be accurately controlled. The analysis of the emitted radiation shows a temporal coherence and a shot-to-shot regularity in frequency significantly enhanced with respect to the self-amplified spontaneous emission.

Semi-dry thermophilic anaerobic digestion of the organic fraction of municipal solid waste: focusing on the start-up phase

The paper concerns the results of a pilot-scale study of the simulation of the start-up phase of the thermophilic semi-dry anaerobic digestion of the organic fraction of municipal solid wastes. The aim of the study was to aid and shorten the start-up phase of the full-scale plant (500 t/d) in Verona--Ca' del Bue, where the semi-dry anaerobic digestion process is being used. The substrate used in the experimentation was the mechanically sorted organic fraction of municipal solid waste (MS-OFMSW) enriched with the putrescent fraction from the source sorted OFMSW in order to simulate the substrate which is dealt with in the Verona plant. The results of the pilot scale study agreed with literature data and previous work of the authors: it showed a specific gas production of 0.23 m3/kg TVSfeed and a gas production rate of 2.1 m3/m3 d when operating at a specific organic loading rate of 0.135 kgTVSfeed/kgTVSreacter d. No problems regarding process stability were encountered in the gradual acclimation of the biomass. The design organic loading rate of 9 kg TVSfeed/m3reactor d was reached in about 30 days, during which the total solids content in the feedwas increased. Only a partial comparison with the full scale start-up, which is now in progress, is possible: this shows an initial general concordance with the results found in previous work.

Biological nutrient removal wastewater treatments and sewage sludge anaerobic mesophilic digestion performances

The paper deals with the performances of the mesophilic anaerobic digestion treatment of sewage sludge from a full scale BNR process without primary settling (nominally 300,000 PE). A relation between the activated sludge observed yields, Y(obs), and the anaerobic digester performance was preliminarily found: for values of Y(obs) of 0.25 kgVSS/kgCOD the anaerobic digester specific gas production showed the best performances (0.22 m3/kgVS(fad)). This has to be confirmed with wider future studies. It was also shown the level of sludge pre-thickening to be reached for the self-sustaining warming of the digester also in wintertime. According to the energetic balance and to a comparison with an aerobic stabilisation process, it was pointed out as when a co-generation unit for heat and energy production was introduced about 3.4 kWh/PE y of energy were produced in the anaerobic digestion process. On the other hand, 4.3 kWh/PE y were spent if an aerobic stabilisation process was applied. The economic assessment, carried out on the basis of the energy balances, showed that the anaerobic digestion is always economically advantageous if compared to aerobic stabilisation processes, also for small WWTPs. According to the energetic evaluations an environmental balance was assessed, in terms of CO2 emissions. The difference between anaerobic and aerobic processes was about 5.3 kgCO2/PE y in favour of anaerobic processes application.

Acidogenic fermentation of source separated mixtures of vegetables and fruits wasted from supermarkets

A pilot scale mesophilic anaerobic acidogenic fermenter was fed with mixtures of vegetables and fruits shredded by a hammer mill and mixed in a stock tank, in order to produce a liquid phase suitable as RBCOD source in denitrification and EBPR processes. Different operative conditions were studied working with a HRT in the range 1-12 days. The effluent coming from the fermenter was screw pressed, and the solid phase was recycled adopting different ratios to the fermenter, in order to define its effect on the final liquid phase composition. The variations of the VFA, lactate, methyl and ethyl alcohol concentrations, TCOD, SCOD and pH during more than one year were analysed and discussed both with reference to the fresh feed, and to the content of the fermenter. It was found that almost all the organic matter in the liquid phase inside the fermenter was represented by VFA (mainly acetate), lactate (in particular) and methyl and ethyl alcohols when HRT was longer than 6 days.

Denitrification potential enhancement by addition of anaerobic fermentation products from the organic fraction of municipal solid waste

The aim of this study is to demonstrate the denitrification potential enhancement determined by the addition of the anaerobic fermentation products from the organic fraction of municipal solid waste in BNR wastewater treatment plants. The denitrification potential rose from 6 to 17 mgNO3-N/l thanks to the good performances showed by the fermentation products in the denitrification step: a typical maximum denitrification rate of about 5 mgN/gVSS d was observed. This value is similar to those obtained by using pure organic substrates. The denitrification capacity increase is determined by a significant increase of S8 and Xs availability in the influent due to the anaerobic fermentation products addition which leads to an influent COD increase equal to 68% of the total load: this value is significantly higher than the one obtained by fermentation of primary and/or waste activated sludge (3-5%).

Integument ultrastructure of Oestrus ovis (L.) (Diptera:Oestridae) larvae: host immune response to various cuticular components

The nasal bot fly, Oestrus ovis, was investigated to establish which specific cuticular component is most immunogenic to infested sheep and how larval cuticle attains a protective role, if any, against the host immune system. To accomplish these goals, larval cuticle was extracted by a variety of agents and tested against immune sera from infested sheep and experimentally immunized rabbits. The cuticle substructure remaining after extraction was examined to localize various immunogenic components. O. ovis larval integument comprises an inner cellular layer, the epidermis, and an overlying cuticle layer. In 3rd instar larvae, the cuticle comprises 2 additional layers: the procuticle with numerous pore canals and the epicuticle which includes the wax canals. Three additional layers, altogether comprising the cuticulin layer, are present external to the epicuticle. The epicuticle is completed by apposition of an amorphous electrondense material extending for up to 1 micron in thickness. When fixed with ruthenium red, cuticle becomes heavily stained all along the epicuticular surface in larvae of all developmental stages. However, in 3rd instar larvae, ruthenium red deposits are restricted to the cuticulin layer alone. By gel electrophoresis, 3rd instar larval cuticle is shown to contain a number of polypeptides ranging in molecular weight from 180 to 4.5 kDa. The number and relative concentration of low molecular weight polypeptides was shown to vary in relation to the extraction media employed. Cuticular fragments examined after extraction exhibit an altered ultrastructure. When tested by immunoblotting, the cuticular polypeptides most reactive against sheep antisera are in the range of 180-56 kDa. A similar reaction was also detected with sera from rabbits infested experimentally with O. ovis larvae. Results are interpreted in relation to differential polypeptide distribution within the larval cuticle and to accessibility of the host immune system.

Larval salivary gland proteins of the sheep nasal bot fly, (Oestrus ovis L.), are major immunogens in infested sheep

Tissue extracts from larval instars of the sheep nasal bot, Oestrus ovis, were resolved by gel electrophoresis under both native and denaturing conditions. Polypeptides resolved under these conditions were tested by immunoblotting against sera of infested sheep. Of all tissues examined in this study, salivary glands proved to be major immunogens in infested sheep. Salivary gland polypeptides were also detected in the washing solution as larval secretory products (LSP). To a minor extent, a few polypeptides from the larval cuticle were also found to be immunogenic, but they did not contribute to LSP. These results were further corroborated by nasal infestation of rabbits that also developed specific antibodies against larval salivary gland polypeptides from Oestrus ovis.

[Urologic laparoscopy: preliminary experience]

Laparoscopy is a safe and reliable procedure for treatment of cryptorchid testicle, varix ligation, staging of lymph nodes in prostatic and in bladder cancer. Recently this procedure is adopted in management of renal cysts. From 2/92 to 7/92, we performed laparoscopic assessment in 31 patients: in 15 cases for varicocelectomy, in 9 for renal cysts, in 2 for lymph nodes dissection, in 3 for preoperatory evaluation, in 1 for unpalpable testicle and in 1 case for ileal perforation in orthotopic neobladder. In 1 case the procedure was unsuccessful because of damage of the spleen. All the patients were mobilized within 1 day postoperative treatment and discharged within 3 days. There are many present and potential application of laparoscopic surgery in urologic pathology, but we think that this technique must be carefully applied in order to avoid complications.

[Conservative elective surgery in kidney neoplasms]

After the good results of "necessary" conservative surgery in the treatment of kidney neoplasms (bilateral neoplasms, congenital, acquired or functional solitary kidney), conservative surgery itself has been employed as elective treatment in selected cases presenting without the overmentioned problems. The authors report two cases of elective conservative surgery in kidney neoplasm with good results after 18 and 24 months.

[Comparative study of 24-hour continuous gastric pH-measurements in healthy people and in patients with pancreatic neoplasms treated with duodeno-pancreatic head resection]

The Authors compare pH measurements taken over a 24-h period to monitor, using an original method, a sample group of 11 healthy subject and a series of patients suffering from gastroenteropancreatic diseases. The data obtained confirm the utility of the functional study of gastrointestinal secretion.

[Interpretation of experimental data in the presence of accidental perturbations: characterization of the bladder]

Some tests are subject to the influence of a special kind of "irreducible" effects which do not satisfy the Central Limit Theorem of statistics, even though they show no systematic character or tendency. These effects especially present when physiological experiments are concerned "in vivo". In such the lack of specific methods to reduce these effects brings about the necessity of special case in minimizing the loss of information. Contained in the experimental data as well as the accumulation of useless information. Recent work has suggested the extensive use of several indexes derived from combination of available variables and their respective mathematic correlation. The information obtained by following this methodology has the character of "working hypothesis" so it needs many favorable confirmation to assess its reliability. It is convenient to analyze a large number of relations in order to emphasize the concordant effects and discord the others. In order to obtain some preliminary indication of the reliability of this procedure we have analyzed some CMG curves in prostatic and non-prostatic subject. The final slope of the curves (urge point) t = dP/dVr has been adapted as an index of the "elasticity" of the bladder; it was compared with the filling volume, the muscular volume and their ratio, i.e. with a geometric index of the bladder shape. The correlation show that the index t can, to some extent significantly represent the mechanical behaviour of the bladder in its physiological condition or when there is a partial obstruction of urine deflection.(ABSTRACT TRUNCATED AT 250 WORDS)

Modified M-VAC regimen in advanced bladder cancer

Between June 1989 and May 1991, 11 patients with locally advanced and metastatic bladder cancer were treated by modified M-VAC regimen. After four or more courses of neo-adjuvant chemotherapy, the responders underwent to enlarged cystectomy. Patient's age ranged from 37 to 63 years (average 54 years). Four patients had T3NOMO disease, four had T3-4N1–2MO stage and three distant metastases. M-VAC regimen was modified according to the following schedule: MTX 30 mg/M2 on days 1 and 15, Vinblastin 3 mg/M2 on days 2 and 15, Doxorubicin 30 mg/M2 and Cisplatin 80 mg/M2 on day 2. Cisplatin infusion was preceded and followed by 2 liters of hydration fluid. Antiemetic regime with Ondansetron and Dexamethasone was instituted. All patients were evaluated for toxicity and response and six underwent 6–18 months of follow-up. 1 patient had significant increase of serum creatinine and, another had acute anemia. We observed 7 PR (65%) and 4 stable disease. In 2 cases of lung and liver localization metastases regressed completely. In 6 cases radical cystectomy was performed only and in 4 cases external beam radiation and cystectomy were performed after the chemotherapy. At 6, 7, 12, 16 months of follow-up 4 patients had no evidence of disease.

Combined approach (chemotherapy plus surgery) in advanced testis tumours

Eight consecutive patients with stage III or bulky stage II germ cell tumors were treated with 4 cycles of cisplatin, etoposide and bleomycin combination chemotherapy (PEB). 3 patients were in complete remission (CR) after surgery of residual masses. 5 patients received 2–4 additional courses of P.V.I. (cisplatin, vinblastine and iphosphamide) chemotherapy and had complete remission (3 cases after surgery of residual masses). No residual tumor was found in 2 cases at surgery (25%). In the present series 3 patients had extrapulmonary disease, 2 retroperitoneal lymphnodes larger than 10 cm. and pulmonary disease. 1 patient had previous incomplete RPND. After a median follow-up period of 30 months (15–37) all the patients are disease-free with normal levels of AFP and beta HCG. In conclusion we repeat that intensive combination chemotherapy is the key for successful surgery of residual malignancy in patients with disseminated testicular cancer. Second-line of chemotherapy is more favourable than early surgery, in our opinion, for treatment of far-advanced disease.

Intraoperative autotransfusion during radical prostatectomy

Intraoperative autotransfusion is the ideal method for restoring blood loss during surgical procedures. In the last few years the confirmation of damage due to transfusion of stored blood, plus risingcosts, led to a revaluation of this procedure. From March 1990 to December 1991, 18 patients underwent intraoperative autotransfusion during radical prostatectomy for carcinoma stage B, utilizing a Dideco Autotrans BT 795 processor. Recovered blood was washed by physiological solution, centrifuged and filtered for air bubble and aggregate elimination, then reinfused. Average recovered blood rate was 853 ml (640-1087), the retransfused rate was 557 ml (410-727). Preoperative Ht rate was between 38.6% and 42.7% (average 40.8%); in the immediate post operative period (4–6 hours after procedure) Ht rate was between 34.3% and 38.6% (average 36.8%). No stored blood was required. We propose a wider utilization of this procedure for safety and lower cost.

[Continuous 24-hour intragastric pH monitoring. A new model of interpretation]

Using the study as a basis for a novel interpretation of the pH-metric curve, the paper reports the results of a study carried out in a sample group of 11 normo-secretory subjects (students from the Faculty of Medicine and Surgery). The pH-metric curve was assessed over 24 hours using a portable pH measuring device.

[Pyeloureteral junction syndrome caused by "anomalous vessel"]

In presenting and describing the pathogenesis of the pyeloureteral junction syndrome, the Authors report their recent experience with four cases due to an "abnormal vessel". Symptoms, diagnosis, and surgical techniques are discussed.