Comparison of a modified Sugiura procedure with portal systemic shunt for prevention of recurrent variceal bleeding in cirrhosis

BACKGROUND: There is no agreement on the management of patients with cirrhosis and recurrent variceal bleeding after failure of medical or endoscopic treatments or both. Portal systemic shunts are highly effective in preventing rebleeding but are associated with a high incidence of chronic encephalopathy. This study compared the results of a slightly modified Sugiura procedure (esophageal transection plus esophagogastric devascularization plus splenectomy) with those of nonselective portal systemic shunts in patients with previous variceal bleeding. METHODS: Fifty-four patients were included in this randomized controlled study between January 1984 and April 1989. The major end point was chronic encephalopathy. Secondary end points were recurrent variceal bleeding, survival, ascites, and hepatocellular carcinoma. RESULTS: Twenty-seven patients were assigned to each group. The rate of chronic encephalopathy was significantly (p = 0.002) lower after modified Sugiura procedure than after portal systemic shunt. Recurrent variceal bleeding was more frequent after modified Sugiura procedure than after portal systemic shunt, but the difference is not significant. One-, two-, and three-year survival rates were 93%, 81%, and 67%, respectively, in the modified Sugiura group and 78%, 66%, and 39%, respectively, in the portal systemic shunt group (p = 0.044). CONCLUSIONS: These results suggest that the modified Sugiura procedure is better overall than the nonselective portal systemic shunt in the management of patients with cirrhosis and recurrent variceal bleeding. Although the rebleeding rate is higher after the modified Sugiura procedure, this does not seem to affect mortality in these patients.     

Sequential intraluminal endoscopic and laparoscopic treatment for bile duct stones associated with gallstones

BACKGROUND: On the basis of a flowchart including prior or current jaundice or pancreatitis, abnormal liver function, ultrasound or IV cholangiography, bile duct (BD) stones were suspected in 71/593 patients referred for gallstones. METHODS: When endoscopic retrograde cholangiography detected BD stones, endoscopic sphincterotomy (ES) and endoscopic BD clearance were attempted, followed by laparoscopic cholecystectomy (LC). BD stones were found in 44/71 patients. The sensitivity values of preoperative conditions were: 92% for IV cholangiography, 88% for abnormal liver function, 50% for ultrasound, and 37% for jaundice at admission. RESULTS: Endoscopic clearance succeeded in 37 patients and LC was completed in 33 patients. Conversion to open surgery (9%) was comparable with the rate in patients without BD stones. The median hospital stay for the sequential endoscopic and laparoscopic treatments was 13 days (range 4-54) or 22 days if open surgery was used. CONCLUSIONS: In conclusion, BD stones can be endoscopically cleared preoperatively in most patients without interfering with LC.     

Transmission electron microscopy study of extended defect evolution and amorphization in SiC under Si ion irradiation

The damage induced in 3C-SiC epilayers on a silicon wafer by 2.3-MeV Si ion irradiation for fluences of 10¹⁴, 10¹⁵, and 10¹⁶ cm⁻², was studied by conventional and high-resolution transmission electron microscopy (TEM/HRTEM). The evolution of extended defects and lattice disorder is followed in both the 3C-SiC film and Si substrate as a function of ion fluence, with reference to previous FTIR spectroscopy data. The likelihood of athermal unfaulting of native stacking faults by point defect migration to the native stacking faults is discussed in relation to damage recovery. Threshold energy densities and irradiation doses for dislocation loop formation and amorphous phase transformation are deduced from the damage depth profile by nuclear collisions. The role of electronic excitations on the damage recovery at high fluence is also addressed for both SiC and Si.     

Quasi-Lagrangian Neural Network for Convex Quadratic Optimization

A new neural network for convex quadratic optimization is presented in this brief. The proposed network can handle both equality and inequality constraints, as well as bound constraints on the optimization variables. It is based on the Lagrangian approach, but exploits a partial dual method in order to keep the number of variables at minimum. The dynamic evolution is globally convergent and the steady-state solutions satisfy the necessary and sufficient conditions of optimality. The circuit implementation is simpler with respect to existing solutions for the same class of problems. The validity of the proposed approach is verified through some simulation examples.     

DALICA: Agent-Based Ambient Intelligence for Cultural-Heritage Scenarios

Villa Adriana is an enormous archaeological area where ancient artifacts and modern technology have found an unexpected equilibrium. The old artifacts are huge stone monuments; the modern technology includes PDAs and signals from the Galileo satellite combined with intelligent software agents. As part of the European CUSPIS project (Cultural Heritage Space Identification System, www. cuspis-project.info), we exploited intelligent agents for two ambient-intelligence scenarios applicable to Villa Adriana. One scenario involves cultural assets fruition-the possibility of accessing and enjoying cultural assets. This scenario concerns the dissemination of information about cultural assets; for example, users can visit a museum or archaeological site and receive on their mobile devices appropriate, personalized information about that place. The other scenario involves cultural assets monitoring, which concerns securely transporting cultural assets from the owner organization to a renter organization and back.     

The proton iron-sulfur cluster environment of the [FeFe]-hydrogenase maturation protein HydF from Thermotoga neapolitana

[FeFe]-hydrogenases contain a complex [4Fe–4S]-2Fe cluster (H-cluster) and are able to efficiently reduce protons to H₂. Due to their potential exploitation for renewable energy production biotechnologies, significant efforts have been put into understanding the mechanisms driving the H-cluster assembly, which involves three conserved proteins. Among them, HydF works as scaffold upon which the H-cluster precursor is synthesized and carrier to deliver it to the hydrogenase, resulting in its activation. A FeS cluster binding sequence (CxHx₄₆-₅₃HCxxC) is conserved in all HydF proteins and should in principle provide four ligands to coordinate the Fe atom. However, we found that alternative metal coordination may exist in different HydF proteins and that only the three cysteines are strictly required, whereas the fourth ligand may vary and is, in any case, readily exchangeable. In this work we analyzed by EPR/HYSCORE the FeS cluster proton environment of HydF from Thermotoga neapolitana to determine the possible role of surrounding residues in the non-cysteinyl iron ligation of the protein.     

Evaluation of Cell Migration and Cytokines Expression Changes under the Radiofrequency Electromagnetic Field on Wound Healing In Vitro Model

Wound healing (WH) proceeds through four distinct phases: hemostasis, inflammation, proliferation, and remodeling. Impaired WH may be the consequence of the alteration of one of these phases and represents a significant health and economic burden to millions of individuals. Thus, new therapeutic strategies are the topics of intense research worldwide. Although radiofrequency electromagnetic field (RF-EMF) has many medical applications in rehabilitation, pain associated with musculoskeletal disorders, and degenerative joint disorders, its impact on WH is not fully understood. The process of WH begins just after injury and continues during the inflammatory and proliferative phases. A thorough understanding of the mechanisms by which RF-EMF can improve WH is required before it can be used as a non-invasive, inexpensive, and easily self-applicable therapeutic strategy. Thus, the aim of this study is to explore the therapeutic potential of different exposure setups of RF-EMF to drive faster healing, evaluating the keratinocytes migration, cytokines, and matrix metalloproteinases (MMPs) expression. The results showed that RF-EMF treatment promotes keratinocytes’ migration and regulates the expression of genes involved in healing, such as MMPs, tissue inhibitors of metalloproteinases, and pro/anti-inflammatory cytokines, to improve WH.     

Ground-Hypotheses for Beta Distribution as Bayesian Prior

The paper discusses the problem of a reasonable basis for choosing a prior distribution for a probability. The beta distribution is derived on the basis of some ground-hypotheses. The limitations of the proposed approach and a simple application are discussed with reference to Reliability.     

Thermal evolution of Fe62.5Co6Ni7.5Zr6Nb2Cu1B15 metallic glass

Thermal evolution of Fe_62.5Co₆Ni_7.5Zr₆Nb₂Cu₁B₁₅ amorphous alloy prepared by one-roll melt-spinning technique was studied by XRD and DTA. The crystallisation process, occurring in several steps, can be summarised as follows: a a + -Fe a + -Fe + -Fe -Fe + -Fe + ZrB₁₂, where a and a are amorphous phases, and a can be indexed as a -Fe (fcc) structure, with a crystalline order on an average distance of 8 Å. The metallic glass demixed on quenching, but component phases tended to mix by exchanging Fe atoms in a temperature range overlapped with the first crystallisation, which yields -Fe nanocrystals (27 Å). Higher temperature exo-peaks correspond mainly to a recrystallisation of the phases formed at lower temperature. It was found that this alloy has nanocrystalline structure also after heating at a well higher temperature than first crystallization. Even after the last exo-peak, the average crystallite size (D) was considerably smaller than that found in the literature for analogous metallic glasses; D values for our alloy were comparable to those of nanocrystalline phases of other systems heat treated below the temperature of exothermal DTA peaks. Extensive oxidation above 600°C, even at a low oxygen content (c _{o 2} 2 ppm), led to a marked modification of the surface layer: two zirconia polymorphs were identified on the surface of the ribbons, and the ratio of -Fe to -Fe content increased with respect to the bulk. Differences in thermal evolution between outer layer and bulk are attributed to a different phase composition and non-uniform distribution since the as-quenched stage.     

Reading the footprints of strained islands

We report on recent advances in the understanding of surface processes occurring during growth and post-growth annealing of strained islands which may find application as self-assembled quantum dots. We investigate the model system SiGe/Si(0 0 1) by a new approach based on “reading the footprints” which islands leave on the substrate during their growth and evolution. Such footprints consist of trenches carved in the Si substrate. We distinguish between surface footprints and footprints buried below the islands. The former allow us to discriminate islands which are in the process of growing from those which are shrinking. Islands with steep morphologies grow at the expense of smaller and shallower islands, consistent with the kinetics of anomalous coarsening. While shrinking, islands change their shape according to thermodynamic predictions. Buried footprints are investigated by removing the SiGe epilayer by means of selective wet chemical etching. Their reading shows that: (i) during post-growth annealing islands move laterally because of surface-mediated Si–Ge intermixing; (ii) a tree-ring structure of trenches is created by dislocated islands during their “cyclic” growth. This allows us to distinguish coherent from dislocated islands and to establish whether the latter are the result of island coalescence.