Both Low Anterior Resection (LAR) and Abdominoperineal Resection (APR) procedures are utilized to treat rectal tumors. There may be occasions when methods or devices may be utilized that could preserve communication to the anus and avoid conversion of an LAR to APR. We seek to compare the costs of LAR and APR procedures in comparable patient populations. The Premier Perspective™ Database (PPD) was used to estimate the incidence and costs of LAR versus APR in the United States. PPD is the largest hospital-based, database in the USA providing detailed resource utilization and cost data categorized under a patients' principal and secondary diagnosis procedure codes. Patients with procedure code for LAR or APR procedures between January 1, 2009 to June 30, 2010 were selected. A total of 7999 patients with a procedure code for either LAR or APR were identified between January 1, 2009 and June 30, 2010. APR was used in 1991 (25%) patients and LAR in 6008 (75%) patients. Propensity score methodology was used to match LAR patients to APR patients based on patient's demographics and hospital characteristics. Mean cost per discharge was significantly higher in APR procedures compared to LAR procedures, $24,922 versus $21,709, respectively, p=0.0004. OR time was approximately 54 minutes shorter for patients undergoing LAR compared to patients with APR procedures, 250 minutes vs. 304 minutes, respectively, (p<0.001). Patients undergoing LAR procedures had a significantly shorter hospital length of stay, compared to patients who underwent APR procedures, 9 days versus 10.4 days, respectively, p<0.001. LAR procedures were associated with shorter hospital lengths of stay, lower OR time and lower mean costs when compared to a matched set of patients undergoing APR procedures. These observations highlight the potential cost advantages of further developing methods or instrumentation that would preserve anal function and avoid an APR.

Bariatric surgical procedure volumes have increased as more hospitals offer the service. Strictures following bariatric surgery using circular staplers are a common complication. The objective was to assess the cost of gastrointestinal strictures following laparoscopic bariatric surgery that employed circular surgical staplers in the index procedure. Laparoscopic bariatric surgery inpatient discharges (ICD-9-CM:44.31, 44.39) with mention of circular staplers were identified in the Premier Perspective® Database for CY2008 and CY2009. Esophageal balloon dilation procedure codes (CPT:43235, 43245; ICD-9-CM:44.22) for inpatient and outpatient discharges were used to identify single or multiple strictures within 6 months following bariatric surgery. Groups were propensity score matched (1:1) on age, gender, race, region, hospital teaching status and APR-DRG severity. The initial bariatric surgery costs, hospital length of stay (LOS) and operating room (OR) time between the stricture and no-stricture groups were compared between the matched groups. The cost of strictures was assessed for patients in the stricture group. A total of 4,731 laparoscopic bariatric surgery discharges utilizing circular staplers were identified. 201(4.3%) of these had a mention of at least one balloon dilation procedure within 6 months of the index procedure. 170 (84.6%) and 31(15.4%) were performed in outpatient and inpatient settings, respectively. 200 patients were propensity matched between the stricture and no-stricture groups. There were no significant differences in initial bariatric surgery costs, LOS and OR time between groups .For the outpatient setting; mean total costs of 1st (N=169), 2nd (N=29), 3rd (N=7) and the 4th stricture (N=3) were $1251, $1025, $1603 and $1610 respectively. One patient had more than 4 strictures. For the inpatient setting, mean total cost was $7110 for the 1st (N=31) stricture. Post surgical strictures can increase treatment costs for laparoscopic bariatric surgery patients utilizing circular staplers.

The current needs of the industrial market, such as the increasing production capacity, the conservation of the plant property, the reduction of the probability of plant shutdown, strongly lead to the discipline of Maintenance Engineering. As part of the pressure equipment, such as pressure vessels, piping, and tanks, the maintenance processes must be managed with a risk management logic. Through, Fitness For Service (FFS) method, pressure equipment presenting a structural degradation can be maintained in operation, with close monitoring. This study illustrates the application of the design code for FFS according to API RP 579 and BS 7910 in the case of a longitudinal defect (crack-like flaw) on a pipe in pressure conditions. The comparison is carried using both codes in order to assess the stability of the defect. The calculation shows that the defect is stable, if the pipe is stressed with a steady load equal to the maximum admissible load in operation. The most conservative result has been obtained from BS 7910.

The diagnosis and therapy of allergic disorders are usually performed with crude extracts which are a heterogeneous mixture of proteins with different allergenic potency. The knowledge of the allergenic composition is a key step for diagnostic and therapeutic options. Parietaria judaica pollen represents one of the main sources of allergens in the Mediterranean area and its major allergens have already been identified (Par j 1 and Par j 2). In addition, inhibition studies performed using a calcium-binding protein (CBP) from grass pollen (Phl p 7) showed the presence of a homologue of this cross-reactive allergen in the Parietaria extract. Screening of a cDNA library allowed us to isolate a 480bp cDNA containing the information for an 87 AA long protein with high level of homology to calcium-binding proteins from other allergenic sources. It was expressed as a recombinant allergen in Escherichia coli and purified by affinity chromatography. Its expression allowed us to study the prevalence of this allergen in a population of allergic patients in southern Europe. Immunoblotting and inhibition studies showed that this allergen shares a pattern of IgE epitopes in common with other 2-EF-hand calcium-binding proteins from botanically non-related species. The immunological properties of the Pj CBP were investigated by CD63 activation assay and CFDA-SE staining. In conclusion, DNA recombinant technology allowed the isolation, expression and immunological characterization of a cross-reactive calcium-binding protein allergen from Parietaria judaica pollen.

For many decades, industrialized countries have carried out various programmes and actions to prevent work accidents and occupational diseases. Consequently, the numbers of accidents and occupational diseases have decreased continuously. It should be borne in mind that, on the one hand, technological advances were rapid and, on the other hand, the population as well as the number of immigrant workers have increased. It is therefore of vital importance to transfer technical as well as practical knowledge, best practices and strategies consolidated from industrialized countries to developing countries. Health and safety is a global theme which requires all the countries of the world to cooperate and share in assuming joint responsibility. Risk is a part of everyday experience and everyone has his/her own idea about it. In fact, it is related to various aspects of common situations. Risk can be evaluated from different points of view, such as psychology, industrial engineering, sociology, decision making, as well as politics.

L'art. 30 del Decreto Legislativo 81/08 attribuisce all'effettiva attuazione dei Sistemi di Gestione della Sicurezza sul Lavoro (SGSL) una efficacia esimente della responsabilità amministrativa prevista dal D. Lgs. 231/01. Le caratteristiche dei modelli di organizzazione e gestione della sicurezza idonei ad avere questa efficacia esimente sono ricondotte alle Linee Guida UNI INAIL o alle norme BS OHSAS 18001. Il sistema di gestione della sicurezza e salute sul lavoro (SGSL) ha validità generale e la sua applicazione va modulata tenendo conto delle caratteristiche complessive dell'impresa/organizzazione (dimensioni, tipologie produttive, cicli tecnologici, struttura dell'organizzazione, ecc.) che intende adottarlo. Il SGSL permette: • di integrare obiettivi e politiche per la salute e sicurezza nella progettazione e conduzione di produzione di beni o servizi; • di definire ed individuare, all'interno della struttura organizzativa aziendale, le responsabilità, le procedure, i processi e le risorse per la realizzazione della politica aziendale di prevenzione, nel rispetto delle norme di salute e sicurezza vigenti; • il raggiungimento degli obiettivi di salute e sicurezza che l'impresa/organizzazione si è data in un'efficace prospettiva costi/benefici. Tale sistema, infatti, si propone di: • ridurre progressivamente i costi complessivi della salute e sicurezza sul lavoro compresi quelli derivanti da incidenti, infortuni e malattie correlate al lavoro, minimizzando i rischi cui possono essere esposti i dipendenti o i terzi (clienti, fornitori, visitatori, ecc.); • aumentare l'efficienza e le prestazioni dell'impresa; • contribuire a migliorare i livelli di salute e sicurezza sul lavoro; • migliorare l'immagine interna ed esterna dell'impresa/organizzazione.

Allergoids of grassand treepollen-allergens have been used successfully for allergen specific immunotherapy for many years. Earlier investigations proved that although the allergenicity of allergoids is substantially reduced they induce allergen-specific IgG-antibodies of comparable titer as the allergens. The synthesis of IgG and IgE are t-cell controlled processes. In order to investigate the reactivity of human T-cells with allergens and allergoids we established Phl p 5 specific T-cell-lines and -clones from grasspollen allergic patients. These show a strong reactivity with the purified allergen and also with a 6-grass-extract, in which Phl p 5 is only one of many allergenic components. Using these cell populations it could be demonstrated that the allergoids possess pronounced t-cell-reactivity. The spectrum of proliferative responses to allergoids from a panel of t-cell-lines ranges from “better” to “similar” to “strongly reduced as compared with the allergen. The activation-thresholds of several t-cell clones from one patient differ, multiple amino acid substitutions between the different isoallergens. A panel of Bet v I-specific T cell clones with known epitope-specificities was tested for reactivity with the purified recombinant isoallergens. Some of the amino acid substitutions were permissive, but the substitution of aspartic acid to glycine in position 25 (located in the second a-helix of Bet v 1) abrogated the reactivity of T cell clones that react with 19-33, indicating that this position is essential for the integrity of the T-cell epitope. Interestingly, the HLA class II restriction of the T cell clones that react with 19-33 was very diverse, suggesting that aspartic acid interacts with a framework determinant of HLA or the TCR. These results strongly suggest that isoallergenic variation may be very important in shaping the allergen-specific T-cell repertoire, and has to be taken into account when immunotherapy with synthetic peptides or recombinant allergens is considered.

Background: Allergy is an immunological disorder affecting about 25% of the population living in the industrialized countries. Specific immunotherapy is the only treatment with a long-lasting relief of allergic symptoms and able to reduce the risk of developing new allergic sensitizations and inhibiting the development of clinical asthma in children treated for allergic rhinitis. Methods: By means of DNA recombinant technology, we were able to design a head to tail dimer expressing disulphide bond variants of the major allergen of the Parietaria pollen. IgE binding activity was studied by Western blot, ELISA inhibition assays and the skin prick test. T cell recognition was studied by peripheral blood mononuclear cell proliferation. The immunogenicity of the hybrid was studied in a mouse model of sensitization. Results: In vitro and in vivo analysis showed that the disruption of specific cysteine residues in both allergens caused a strong reduction in IgE binding activity of the PjEDcys hybrid. In addition,we were able to show that a reduction in the IgE epitope content profoundly reduced the anaphylactic activity of the hybrid (from 100 to 1,000 times less than wild-type allergens) without interfering with the T cell recognition. Sera from BALB/c mice immunized with the hybrid were able to bind the natural Parietaria allergens and to inhibit the binding of human IgE to wild-type Par j 1 and Par j 2 allergens up to 90%. Conclusion: Our results demonstrate that hybrid-expressing disulphide bond variants of the major allergens of the Parietaria pollen displayed reduced allergenicity and maintained T cell reactivity for induction of protective antibodies.

Parietaria pollen is one of the most important outdoor allergenic sources in all the Mediterranean countries, with a large number of subjects showing a positive skin prick test to both P. judaica and P. officinalis pollen extracts. A cross-reactivity between the two species has been already reported although few data are known at the molecular level. Twenty-five consecutive patients with Parietaria pollen allergy were selected on the basis of their clinical history. Skin prick test to P. judaica and officinalis extracts was performed. In vitro IgE measurement to both allergenic sources was performed by using a quantitative assay. ELISA inhibition experiments were made by using the rParj1 and rParj2 allergens. All the patients showed a positive skin prick test to both Parietaria species. Quantitative IgE measurement showed similar antibody concentration for P. judaica and P. officinalis extracts. ELISA inhibition experiments demonstrated that the cross-reactivity between the two species was due to the presence of the Parj1 and Parj2 allergens in the extracts with a high conserved IgE epitopes content. We conclude that P. judaica and P. officinalis pollens contain highly cross-reactive species-specific major allergens useful for the diagnosis and therapy of both allergenic sources.

BACKGROUND:The weed Parietaria judaica is one of the most important pollen allergen sources in the Mediterranean area.OBJECTIVE:We sought to identify P judaica pollen allergen, which might be used to serologically distinguish genuine Parietaria sensitization and cross-reactivity to allergens from other weed species (eg, mugwort and ragweed).METHODS:The allergen profile of P judaica IgE-reactive sera from weed pollen-sensitized allergic individuals from the Mediterranean region (n = 36) with high Parietaria pollen exposure and from weed pollen-allergic patients with little or no Parietaria exposure (Austria, n = 42; Scandinavia, n = 8; United States, n = 19) was established by CAP FEIA measurements and by IgE immunoblot inhibition experiments with recombinant allergens.RESULTS:The majority (83%) of the Mediterranean weed pollen-allergic patients mounted high IgE antibody levels (mean specific IgE, 20.89 kUA/L) against recombinant (r) Par j 2, whereas only 7% of the non-Mediterranean weed-allergic patients showed low IgE reactivity to rPar j 2 (mean specific IgE, 1.03 kUA/L). The cytoskeletal protein profilin and a 2-EF-hand calcium-binding allergen were identified as cross-reactive Parietaria allergens, which were recognized preferentially by Parietaria -positive, non-Mediterranean weed pollen-allergic patients.CONCLUSION:rPar j 2 might be used as a diagnostic marker allergen to identify weed pollen-allergic patients who are genuinely sensitized against Parietaria pollen and thus would be particularly suited for specific immunotherapy with Parietaria pollen extract.

Parietaria is a genus of dicotyledonous weeds of the Urticaceae family including several species and its pollen grain is one of the most important allergenic sources in the Mediterranean area. Species belonging to this genus induce IgE responses in approximately 10 million people. Identification of allergens by means of independent strategies suggest that the allergens of the two more common species, Parietaria judaica and Parietaria officinalis, show molecular weights ranging between 10 and 14 kD and that the allergens of the two extracts are highly cross-reactive. Biochemical analysis and molecular cloning allowed the isolation and immunological characterization of the two major allergens of the P. judaica pollen, Par j 1 and Par j 2. Sequence comparison suggests that the P j major allergens of P. judaica belong to the nonspecific lipid transfer protein family, and three-dimensional modeling by homology has revealed that both proteins present a very conserved structural motif composed of four α-helices. Immunological analysis has shown that Par j 1 and Par j 2 are able to bind most of the P. judaica-specific IgE and some of their IgE determinants have been mapped. Recombinant Par j 1 and Par j 2 allergens have been shown to possess immunological properties equivalent to their natural counterpart and their availability represents a fundamental tool for the diagnosis and therapy of Parietaria pollen allergy.

Par j 2.0101, a major allergen of the Parietaria judaica pollen, was expressed in E. coli, purified to homogeneity and fully characterised both at the structural and the functional level. The recombinant rPar j 2.0101 protein showed an allergenic activity in histamine release, skin prick tests and capacity to bind IgE, almost identical to that of the native allergens purified from aqueous pollen extract. The complete pattern of SS bridges of rPar j 2.0101 was determined by enzymatic digestion with endoproteinase LysC followed by mass spectrometric analysis of the resulting peptide mixtures. The eight cysteines occurring in the allergenic protein were found to be paired into the following four disulphides: Cys35-Cys83, Cys45- Cys60, Cys61-Cys106 and Cys81-Cys121. This structural information probes Par j 2.0101 to attain a 3-D fold consistent with that of the nonspecific lipid transfer protein (nsLTP) family and it represents an effective molecular basis to develop modified antigens by selective sitedirected mutagenesis for immunotherapy.