Epidemiological changes of hepatocellular carcinoma at the beginning of the twenty-first century: from the emerging role of metabolic diseases as etiological factors to the need of a revision of the staging system

Introduzione e scopo: la rapida diffusione delle malattie dismetaboliche sta modificando l’epidemiologia dell’epatocarcinoma (HCC). Scopo della tesi è, attraverso quattro studi, analizzare l’impatto di questi cambiamenti nella gestione clinica del paziente affetto da HCC. Materiali e metodi: quattro studi di coorte, condotti con analisi retrospettiva del database ITA.LI.CA. Studio 1:3658 pazienti arruolati tra il 01-01-2001 ed il 31-12-2012 suddivisi in base alla data di diagnosi:2001-2004 (954 pazienti), 2005-2008 (1122 pazienti), 2009-2012 (1582 pazienti). Studio 2:analisi comparativa tra 756 pazienti con HCC-NAFLD e 611 pazienti con HCC-HCV. Studio 3:proposta di quattro modelli alternativi al BCLC originale con validazione di una proposta di sottostadiazione dell’intermedio, considerando 2606 pazienti arruolati tra il 01-01-2000 e il 31-12-2012 e riallocati secondo gradi diversi di perfomance status (PS). Studio 4:analisi di 696 pazienti con HCC in stadio intermedio diagnosticato dopo il 1999 stratificati per trattamento. Risultati: studio 1:progressivo aumento dell’età alla diagnosi e delle eziologie dismetaboliche; più frequente esordio dell’HCC in stadio precoce e con funzione epatica più conservata; aumento della sopravvivenza dopo il 2008. Studio 2:i pazienti con HCC-NAFLD mostrano più frequentemente un tumore infiltrativo diagnosticato fuori dai programmi di sorveglianza, con prognosi peggiore rispetto ai pazienti HCC-HCV. Questa differenza di sopravvivenza si elimina rimuovendo i fattori di confondimento attraverso propensity analysis. Studio 3:il PS1 non è un predittore indipendente di sopravvivenza. Il modello 4 (considerando PS1=PS0 e con la sottostadiazione proposta), ha la migliore capacità discriminativa. Studio 4:i trattamenti curativi riducono la mortalità più della TACE, anche dopo propensity analysis. Conclusioni: l’aumento delle patologie dismetaboliche comporterà diagnosi di malattia ad uno stadio più avanzato, quando sintomatica, rendendo necessario stabilire un programma di sorveglianza. Inoltre per una migliore stratificazione e gestione dei pazienti, bisogna riconsiderare il ruolo del PS ed offrire un ventaglio di opzioni terapeutiche anche per il pazienti in stadio intermedio.Background and aim: the rapid spread of metabolic diseases is changing the epidemiology of hepatocellular carcinoma (HCC). Aim of the present thesis is, through four studies, to analyze the impact of these changes in the clinical management of patients with HCC. Materials and methods: four cohort studies, conducted with retrospective analysis of the ITA.LI.CA database. Study 1:3658 patients enrolled between 01-01-2001 and 31-12-2012 and divided by date of diagnosis: 2001 to 2004 (954 patients), 2005-2008 (1122 patients), 2009-2012 (1582 patients ). Study 2: comparative analysis of 756 patients with HCC-NAFLD and 611 patients with HCC-HCV. Study 3: proposal of four alternative models to original BCLC and validation of a proposed intermediate substaging, considering 2606 patients enrolled between 01-01-2000 and 31-12-2012 and reallocated according to different degrees of performance status (PS ). Study 4: analysis of 696 patients with HCC in intermediate stage diagnosed after 1999 and stratified by treatment. Results: Study 1: increasing of age at diagnosis and metabolic etiologies; more frequent onset of HCC in early stage and with more preserved liver function; increased survival after 2008. Study 2: patients with NAFLD-HCC show most frequently infiltrative tumour, diagnosed out of surveillance, with worse prognosis than patients HCC-HCV. This survival difference is eliminated by removing confounding factors through propensity analysis. Study 3: PS1 is not an independent predictor of survival. Model 4 (which considers PS0=PS1 and the proposed of substaging), has the best discriminative capacity. Studt 4: curative treatments reduce mortality more than TACE, even after propensity analysis. Conclusions: The widespread of metabolic diseases will involve an HCC diagnosis in a more advanced stage, when symptomatic, making it necessary to establish a screening program. T better stratify and manage patients, we must reconsider the role of PS and offer a range of treatment options for patients in the intermediate stage

Leben mit einem Parkinsonkranken – Eine Gratwanderung zwischen Überfürsorglichkeit und Überforderung : «Welche Faktoren gibt es, die Einfluss auf die Lebensqualität pflegender Angehörigen von Parkinson-PatientInnen haben?»

Thema: Der Grossteil von Parkinson-PatientInnen werden Zuhause durch Angehörige gepflegt. Diese Betreuung rund um die Uhr braucht viel Zeit und Energie auf Seiten der Angehörigen. In den vorhandenen Studien wird das Wohlergehen sowie gezielte Unterstützung der pflegenden Angehörigen oftmals vernachlässigt. Diese Lücke versucht die vorliegende Arbeit zu schliessen. Ziel: Das Ziel ist es, Hauptfaktoren zu eruieren, welche negativen Einfluss auf die Lebensqualität pflegender Angehöriger haben können. Methode: Mittels Literaturrecherchen wurden Studien gesucht, die Einflussfaktoren auf die Lebensqualität pflegender Angehöriger aufzeigen. Die Studienbeurteilung wurde anhand des Formulars für kritische Besprechung quantitativer Studien von Law et al. (1998) durchgeführt. Mit einem Fallbeispiel wurde untersucht, ob durch einfache Hilfestellungen mittels Hilfsmittelinstruktion und gezielter Beratung bezüglich Umgang mit den PatientInnen Einfluss auf die Lebensqualität pflegender Angehöriger genommen werden kann. Ergebnisse: Es zeigt sich, dass viele pflegende Angehörige mit ihrer Aufgabe überfordert sind. Depression, Funktionseinschränkungen, Stürze, Krankheitsdauer und fortgeschrittene mentale Symptome tragen dazu bei, dass die Belastung pflegender Angehöriger messbar erhöht ist. Schlussfolgerung: Den Autorinnen zufolge liegt es in der Verantwortung der Ärzte, Therapeuten und anderen Professionen, die pflegenden Angehörigen in ihrer Aufgabe aufzuklären und zu unterstützen

Dynamic investigation on the Mirandola bell tower in post-earthquake scenarios

After the seismic events of the 20th and 29th of May 2012 in Emilia (Italy), most of the monumental and historic buildings of the area were severely damaged. In a few structures, partial collapse mechanisms were observed (e.g. façade tilting, out-of-plane overturning of panels…). This paper presents the case-study of the bell tower of the Santa Maria Maggiore cathedral, located in Mirandola (Italy). The dynamic response of the structure was evaluated through operational modal analysis using ambient vibrations, a consolidated non-destructive procedure that estimates the dynamic parameters of the bell-tower. The dynamic tests were carried out in pre-intervention and post-intervention conditions in order to understand the sensitivity of dynamic measurements to safety interventions. Furthermore, a comparative study is made with similar cases of undamaged masonry towers up to the 6th mode. Finally, an investigation on the state of connections and of the building itself is carried out via FE model updating

Sensitivity analysis of damaged monumental structures: the example of S. Maria del Suffragio in L'Aquila

In Italy, which accounts for an impressive number of architectural heritage sites, a large part of the territory is subject to seismic risk. Nonetheless, also the two recent examples of the 2009 L'Aquila earthquake and 2012 Emilia earthquake confirmed and highlighted the vulnerability of cultural heritage structures to these types of events. In this paper the church of Santa Maria del Suffragio (Anime Sante) in L'Aquila is used as a benchmark for the experimental validation of a finite element model on the basis of the data gathered by the permanent structural health monitoring system installed on the building by IUAV in 2009. Structural health monitoring techniques have been largely applied to cultural Heritage buildings in recent times, mostly because of their non-destructive nature, and they have proven to be a valid tool in assessing the damage evolution and in characterising the global dynamic behaviour of the structure. In particular, a global sensitivity analysis technique has been applied to a finite element model. The model underwent a model updating procedure on the parameters chosen in the sensitivity analysis. The calibrated model is an invaluable tool in assessing the dynamic behaviour of the structure and may serve for several purpose

Mezclas de cemento u otros ligantes aplicables a materiales y técnicas constructivas utilizando EPS molido y cascotes reciclados provenientes de residuos de construcción y demolición.

Desde el CEP desarrollamos materiales de construcción alternativos a los tradicionales para minimizar el impacto medioambiental generado por los residuos de construcción y demolición (RCD). El hormigón es el material de construcción más empleado en el mundo gracias a sus excelentes propiedades: durabilidad, resistencia y adaptación a moldes. Su uso produce grandes costos medioambientales: enorme cantidad de energía consumida para extracción, acarreo, fabricación y traslado de componentes. Esta investigación desarrolla distintas fórmulas utilizando EPS molido y cascotes fraccionados mezclados con ligantes apropiados para fabricar Materiales Constructivos durables, económicos, de bajo peso y con buena aislación térmica, reduciendo el impacto ambiental que produce la fabricación tradicional de bloques, ladrillos y revestimientos. El EPS es uno de los RCD de restos y de embalajes más perjudiciales al medio ambiente tanto por su volumen como por su prolongado tiempo de degradación, mientras que los cascotes son el principal RCD en nuestra área de trabajo. Estas mezclas pueden ser utilizadas para autoconstrucción y planes de vivienda contribuyendo a generar empleo, creando nuevos conocimientos y expandiendo la conciencia del cuidado Medioambiental. Los profesionales del Centro trabajamos junto con alumnos en programas de pasantías de investigación con crédito académico. Para la obtención de las citadas materias primas se han generado acuerdos con empresas generadoras, con planes logísticos para optimizar recorridos reduciendo consumo de combustible. De esta forma se evita que un considerable volumen de RCD llegue a vertederos y centros de enterramiento habituales y se reduce la potencialidad de su voladura tapando desagues pluviales. Se desarrollan por un lado mezclas aislantes en densidades de 500 a 600 kg/m3 que utilizadas en espesores habituales de construcción cumplen con las normas actuales de transmisión térmica. Estas mezclas incluyen cemento, residuos de EPS molidos pasantes por tamiz de 6mm y aditivios. Por otro lado se desarrollan mezclas en densidades de 900 a 1100 kg/m3 que utilizadas en espesores habituales cumplen con resistencia equivalente a la de ladrillos comunes. Estas mezclas incluyen cemento, residuos de EPS molidos pasantes por tamiz de 6mm, restos de cascotes molidos pasantes por tamiz de 20mm, arena y aditivos. Los moldes requeridos son fabricados a su vez con materiales reciclados de EPS

Site‐specific factors for cancer of the corpus uteri from SEER registries: Collaborative stage data collection system, version 1 and version 2

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/109623/1/cncr29054.pd

Regendering Urban Space? Transfeminist Streetscapes in Milan, Italy.

Informed by critical feminist theory, this essay examines performative practic-es designed to re-territorialize the urban fabric of Milan by claiming the right to the city from a gender perspective. A further aim of the research presented here was to fill a gap in critical toponymy, because – to date – little has been written about gender and street names. Odonomastic guerrilla warfare, albeit a recent development, is not confined to the city of Milan, but rather, in light of ongoing initiatives by women’s associations and transfeminist collectives in other Italian and European cities, is also driving change in other settings, via counter-narratives that go beyond the binary male/female dimension to rethink both our history and our contemporary life spaces

La Croce Processiva di Pietro Vannini

Nowadays, Pietro Vannini is considered one of the most skilled 15th- century Italian goldsmiths. He was able to harmonize stylistic features of the late Gothic tradition with the new elements typical of the Renaissance art. Indeed, he realised various monstrances, crosses and reliquaries that are still displayed in important museums and churches. Yet, this article focuses on one of his less famous creations, a processional cross displayed at the Diocesan Museum of Osimo. The artefact has not been adequately documented in the past, despite its relevance, and this has caused confusion on its origin and iconography. Various are the hypothesis on the date of its origin, among them the one from scholar Clerici assigns the cross to the late fifteenth century. Moreover, complex is the analysis and identification of the figures that decorate the cross from the iconographical point of view. Therefore, the aim of this paper is to clarify the story of the cross and to underline its relevance. The article starts from the origin of the cross along with a stylistic and iconographic in-depth analysis, where scholars such as Gori, Fanciulli and Montevecchi (one of the best scholars of Vannini) express their views. Then proceeds to a focus on the several restorations the piece has undergone, from those mandated by bishop Spada and bishop Compagnoni, to the campaignsthat have not been documented, yet can be inferred from the changes they brought to the artefact and its various descriptions throughout different periods in history.NowadaysPietro Vannini is considered one of the most skilled 15th- century Italian goldsmiths. He was able to harmonize stylistic features of the late Gothic tradition with the new elements typical of the Renaissance art. Indeed, he realised various monstrances, crosses and reliquaries that are still displayed in important museums and churches. Yet, this article focuses on one of his less famous creations, a processional cross displayed at the Diocesan Museum of Osimo. The artefact has not been adequately documented in the past, despite its relevance, and this has caused confusion on its origin and iconography. Various are the hypothesis on the date of its origin, among them the one from scholar Clerici assigns the cross to the late fifteenth century. Moreover, complex is the analysis and identification of the figures that decorate the cross from the iconographical point of view. Therefore, the aim of this paper is to clarify the story of the cross and to underline its relevance. The article starts from the origin of the cross along with a stylistic and iconographic in-depth analysis, where scholars such as Gori, Fanciulli and Montevecchi (one of the best scholars of Vannini) express their views. Then proceeds to a focus on the several restorations the piece has undergone, from those mandated by bishop Spada and bishop Compagnoni, to the campaignsthat have not been documented, yet can be inferred from the changes they brought to the artefact and its various descriptions throughout different periods in history.    Al giorno d’oggi Pietro Vannini è considerato uno dei più grandi orafi italiani del XV secolo. Egli è stato in grado di equilibrare caratteristiche tradizionali del gusto tardo-gotico con i nuovi elementi tipici dell’arte Rinascimentale; ha infatti realizzato vari ostensori, croci e reliquiari che sono ancora oggi visibili in musei e chiese di notevole importanza. Tuttavia, questo articolo si focalizza su una delle sue creazioni meno famose, una croce processionale esposta presso il Museo Diocesano di Osimo. Questo manufatto non è stato documentato in maniera adeguata in passato, nonostante la sua importanza, e ciò ha causato disorientamento su questioni riguardanti la sua origine e iconografia. Molte sono le ipotesi sulla sua data di manifattura, tra queste si distingue lo studioso Clerici che colloca la realizzazione della croce verso la fine del XV secolo. È inoltre complessa sia l’analisi che l’identificazione dal punto di vista iconografico delle figure che adornano la croce. Lo scopo di questo articolo è quello di chiarire le vicende legate alla croce e di evidenziare la sua importanza. L’articolo si propone di analizzare le origini della croce e di delineare una approfondita analisi stilistica e iconografica che muove dagli studiosi Gori, Fanciulli e Montevecchi (una dei più grandi studiosi di Vannini); infine, si analizzano i vari restauri effettuati sull’opera, alcuni commissionati dal cardinale Spada e dal cardinale Compagnoni, e altri che non sono stati documentati, ma che possono essere dedotti dai cambiamenti che hanno portato al manufatto e dalle numerose descrizioni effettuate in vari periodi storici

Analyzing a Creditor’s Ability to Exercise its Shareholder Rights to Prevent a Bankruptcy Filing by a Company

(Excerpt) Title 11 of the United States Code (the “Bankruptcy Code”) operates as a tool allowing an honest, struggling debtor to gain a fresh start absent of their burdensome debts. Generally, when a company is about to enter bankruptcy, shareholders and creditors of the insolvent company play two distinct roles. Shareholders, those with an ownership stake in the company, have voting rights enumerated in their shareholder agreement, allowing them to vote on certain actions, including the company’s bankruptcy filing. On the other hand, creditors generally have a claim (i.e., a right to payment) against the company, which typically has arisen from receiving inadequate value in return for the value the creditor gave to the debtor. Thus, while a shareholder may have input into a company’s decision to file for bankruptcy, a creditor typically will not. However, in certain circumstances, a party may serve dual roles—it may be both a shareholder and a creditor. Ultimately, in such a circumstance, conflict arises as a creditor is now afforded the ability to exercise shareholder voting rights and prevent a company from filing for bankruptcy. Courts have recognized two central ways in which a creditor/shareholder attempts to block a company from filing for bankruptcy: (1) a golden share, and (2) blocking provisions. A golden share is a “share that controls more than half of the corporation voting rights and gives the shareholder veto power over changes to the company charter.” The term blocking provision “is a catch-all to refer to various contractual provisions through which a creditor reserves a right to prevent a debtor from filing for bankruptcy.” Ultimately, both golden shares and blocking provisions give a creditor/shareholder the ability to prevent a company with which they do business from entering into bankruptcy, eliminating the possibility of having their claims discharged. Part I of this memorandum discusses whether a creditor/shareholder may use its shareholder voting power to prevent a company from entering bankruptcy, while analyzing the difficulty courts have with uniformly deciding the issue. Part II of this memorandum examines the conclusion of many courts, that from a policy standpoint, when a party is both a shareholder and creditor, it should not have the ability to prevent a company from filing for bankruptcy