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Liver and heart are anatomically and patho-physiologically related. In heart failure (HF) the increased right atrial pressure and volume overload cause histological changes in hepatocytes, leading to a condition known as “congestive hepatopathy” (CH), with consequent variations in liver functioning and ultrasound (US) findings. CH has specifical US findings especially regarding venous vessels aspect, easily detecting by gray-scale study, but many others can be distinguished by Doppler analysis. Usually, hepatic veins look enlarged and hypocollassing, together with signs of portal hypertension (hepatomegaly, ascites, splenomegaly, porto-systemic collaterals). Typically, in CH Doppler findings regard alterations in venous vessel flow and arterial resistance (venous system hyperpulsatility, reduced velocity flow, high resistance index in hepatic arterial Doppler spectrum). Sometimes CH and other primary hepatopathy can coexist, and therefore some of the expected variations may not manifest: it allows suspecting an unknown underlying liver disease. At last, US technologies of more recent applications, even if not routinely used, allow investigating additional aspects such as elastography that detects changes in liver elasticity or contrastographic US, able to show differences in hepatic venous opacification. However, most of these US signs are not pathognomonic, and therefore a multidisciplinary clinical reasoning must not be lacking. The aim of the present review is to easily provide US signs of liver alterations in HF, in particular right heart failure with volume overload, suggesting including liver US in instrumental diagnosis and therapeutic monitoring of HF.

Seawater and bilge water samples were used to isolate hydrocarbon-degrading bacteria to be screened for biosurfactant production in the presence of different carbon sources, namely tetradecane, d -glucose and sunflower oil. The panel of tested isolates, affiliated to Alcanivorax, Acinetobacter, Pseudomonas, Halomonas and Marinobacter genera, showed promising results both in terms of emulsifying activity and surface tension reduction. The selected strains Marinobacter sp. BIC3M3, Alcanivorax sp. BIC1A5 and Halomonas sp. BIC1H44 achieved total raw biosurfactant amount of 3.148, 2.922 and 2.596 g/L, respectively. The sunflower oil, here proposed as low-cost carbon source, was successfully used by all strains as substrate for biosurfactant production, with the only exception of Halomonas sp. BIC1H44, while different efficiency levels were detected during incubation in the presence of glucose and tetradecane. Among all strains, Marinobacter spp. strains from bilge waters were proven to be very competitive, although this genus has been poorly reported for biosurfactant production. The high efficiency exhibited by some strains (especially Alcanivorax sp. BIC1A5, Acinetobacter sp. BIC1AC, and Marinobacter sp. BIC3M3) during growth with tetradecane and sunflower oil suggested a promising potential for application in bioremediation purposes and hydrocarbon-enriched wastewater treatment.

Background An unexpected increased HCC recurrence and occurrence rate among HCV patients treated with direct acting antivirals combination has been reported. Aim of the study was the evaluation of early HCC occurrence rate and its risk factors in a HCV infected population, treated with direct-acting-antivirals. Methods According to the Italian ministerial guidelines for direct-acting-antivirals treatment, 1022 consecutive HCV patients treated with direct-acting-antivirals were enrolled. Patients either with active HCC at imaging or history of previous treated HCC, HBV or HIV co-infection, or liver transplant recipients were excluded. The SVR, defined as the persistent absence of detectable serum HCV-RNA 12 weeks after the end of treatment (SVR12), was assessed for all enrolled patients. Abdominal ultrasound was performed before starting antiviral therapy, and repeated every 6 months. HCC was diagnosed according to the international guidelines. Patients showing either nodular patterns suggestive of HCC or with uncertain dynamic vascular behaviour were excluded from a further follow-up. Results Nine hundred and eighty-five patients completed the 48 weeks follow-up after the end of treatment. A Sofosbuvir-based regimen was administered in the 74.9% of patients, among whom, the 71.6% underwent a simultaneous Ribavirin administration. A sustained virological response at 12 weeks off treatment was documented in 966 patients (98.2%). During the post treatment follow-up HCC was detected in 35 patients, with a cumulative incidence rate of the 3.55%. At multivariate analysis, four variables resulted independently associated with HCC development, both in a cirrhosis based and a class B Child based model, respectively: cirrhosis/class B Child, therapeutic schedule including Sofosbuvir without Ribavirin, liver stiffness values, male gender and presence of diabetes. A multivariate analysis performed on Child A cirrhotic patients, showed that Sofosbuvir based therapeutic treatment without Ribavirin had a HCC occurrence 5.7 higher than Ribavirin-based schedules with or without Sofosbuvir (p

Purpose: To analyse safety and efficacy of treatment based on ombitasvir/paritaprevir/ritonavir/dasabuvir plus ribavirin in the sub-group of GT1 patients older than 65years. Methods: We collected data extracted from the ABACUS compassionate-use nationwide Italian programme, in patients with cirrhosis due to hepatitis C virus (HCV) Genotype-1 (GT1) or 4 and at high risk of decompensation. GT1-HCV-infected patients received once-daily ombitasvir/paritaprevir, with the pharmacokinetic enhancer ritonavir (25/150/100mg) and twice-daily dasabuvir (250mg) plus Ribavirin (RBV) (OBV/PTV/r + DSV + RBV) for 12 (GT1b) or 24 (GT1a) weeks. Endpoints were to evaluate safety and efficacy, the latter defined as HCV RNA negative 12weeks after the end of treatment (SVR12). Results: Patients who suffered any adverse event (AE) were 74/240 (30.8%); 13/240 (5.4%) discontinued the treatment. A multivariate analysis found albumin < 3.5g/dL (OR 2.04: 95% CI 1.0–4.2, p < 0.05) and hypertension (OR 4.6: 95% CI 2.3–9.2, p < 0.001) as variables independently associated with AE occurrence. The SVR12 was 95% (228/240). Multivariate analysis identified baseline bilirubin < 2mg/dL (OR 4.9: 95% CI 1.17–20.71, p = 0.029) as the only variable independently associated with SVR12. Conclusion: Our findings suggest that OBV/PTV/r + DSV + RBV is safe and effective in real-life use in patients with compensated cirrhosis, HCV-GT1 infection, and age over 65.

The opening of the submillimeter sky with the Herschel Space Observatory has led to the detection of new interstellar molecular ions, H2O(+), H2Cl(+), and HCl(+), which are important intermediates in the synthesis of water vapor and hydrogen chloride. In this paper, we report new observations of H2O(+) and H2Cl(+) performed with both Herschel and ground-based telescopes, to determine the abundances of their ortho and para forms separately and derive the ortho-to-para ratio. At the achieved signal-to-noise ratio, the observations are consistent with an ortho-to-para ratios of 3 for both H2O(+) and H2Cl(+), in all velocity components detected along the lines-of-sight to the massive star-forming regions W31C and W49N. We discuss the mechanisms that contribute to establishing the observed ortho-to-para ratio and point to the need for a better understanding of chemical reactions, which are important for establishing the H2O(+) and H2Cl(+) ortho-to-para ratios.

OBJECTIVES: The occurrence of decompensation marks a crucial turning point in the course of cirrhosis. The purpose of this study was to assess the risk of mortality according to the clinical characteristics of first decompensation, considering also the impact of acute-on-chronic liver failure (AoCLF). METHODS: We conducted a prospective nationwide inception cohort study in Italy. Decompensation was defined by the presence of ascites, either overt or detected by ultrasonography (UD), gastroesophageal variceal bleeding (GEVB), and hepatic encephalopathy (HE). AoCLF was defined according to the Asian Pacific Association for the Study of the Liver criteria. Multivariable Cox proportional hazards regression was used to analyze the risk of failure (death or orthotopic liver transplantation (OLT)). RESULTS: A total of 490 consecutive cirrhotic patients (314 males, mean age 60.9±12.6 years) fulfilled the study criteria. AoCLF was identified in 59 patients (12.0%). Among the remaining 431 patients, ascites were found in 330 patients (76.6%): in 257 (77.8%) as overt ascites and in 73 (22.2%) as UD ascites. GEVB was observed in 77 patients (17.9%) and HE in 30 patients (7.0%). After a median follow-up of 33 months, 24 patients underwent OLT and 125 died. The cumulative incidence of failure (death or OLT) after 1, 2, and 3 years was, respectively, 28, 53, and 62% in patients with AoCLF; 10, 18, and 25% in patients with UD ascites; 17, 31, and 41% in patients with overt ascites; and 8, 12, and 24% in patients with GEVB (P

Apical extrusion of infected debris to the periradicular tissues is one of the principal causes of postoperative pain and discomfort. Recent researches have shown that reciprocating instrumentation techniques seem to significantly increase the amount of debris extruded beyond the apex and, consequently, the risk of postoperative pain. The goal of the present study was to evaluate and compare postoperative pain using three different nickel-titanium instrumentation techniques: a rotary crown-down technique using TF instruments (SybronEndo, Orange, Ca), a reciprocating single-file technique using WaveOne instruments (Maillefer DEntsply, Baillagues, CH), and a novel instrumentation technique (TF Adaptive, SybronEndo, Orange, Ca), using a unique, proprietary movement, combining reciprocation and continuous rotation.Ninety patients requiring endodontic treatment on permanent premolar and molar teeth with non vital pulps preoperatively were included in the study. The patients were assigned into three groups of 30 patients each, trying to make the groups very similar, concerning the number of root canals, presence of initial pain and periapical lesions. The teeth in group 1 (n = 30) were instrumented with a crown-down technique using TF instruments, whilst those in group 2 (n = 30) were instrumented with a single-file technique using Waveone 08 25. The third group (n = 30) used the 3-file Tf Adaprtive sequence. All techniques were performed following manufacturers' instructions and all canals were shaped, cleaned and obturated in a single-visit by the same operator. The assessment of postoperative pain was carried out at 3 days by using a visual analogue scale. VAS pain scores were compared using one-way ANOVA post hoc Tukey test. A value of p0.05 was required for statistical significance.Results for VAS pain scores showed a statistically significant difference was found between the WaveOne (p=0,021) technique and the other two techniques. No statistical significant differences were found between TF and TF Adaptive (p= 0,087). When evaluating patient experiencing sever pain the incidence of symptoms was significantly higher with the WaveOne technique.Since the incidence of preoperative pain, the type of tooth and the pulp and periodontal pathology were quite similar between the three tested groups, and all the other variables (operator, irrigation, obturation) were identical, we may conclude that the difference in postoperative pain can be mainly related to the different instrumentation techniques.

Using the Herschel Space Observatory's Heterodyne Instrument for the Far-Infrared (HIFI), we have observed para-chloronium (H2Cl+) toward six sources in the Galaxy. We detected interstellar chloronium absorption in foreground molecular clouds along the sight-lines to the bright submillimeter continuum sources Sgr A (+50 km/s cloud) and W31C. Both the para-H2-35Cl+ and para-H2-37Cl+ isotopologues were detected, through observations of their 1(11)-0(00) transitions at rest frequencies of 485.42 and 484.23 GHz, respectively. For an assumed ortho-to-para ratio of 3, the observed optical depths imply that chloronium accounts for ~ 4 - 12% of chlorine nuclei in the gas phase. We detected interstellar chloronium emission from two sources in the Orion Molecular Cloud 1: the Orion Bar photodissociation region and the Orion South condensation. For an assumed ortho-to-para ratio of 3 for chloronium, the observed emission line fluxes imply total beam-averaged column densities of ~ 2.0E+13 cm-2 and ~ 1.2E+13 cm-2, respectively, for chloronium in these two sources. We obtained upper limits on the para-H2-35Cl+ line strengths toward H2 Peak 1 in the Orion Molecular cloud and toward the massive young star AFGL 2591. The chloronium abundances inferred in this study are typically at least a factor ~10 larger than the predictions of steady-state theoretical models for the chemistry of interstellar molecules containing chlorine. Several explanations for this discrepancy were investigated, but none has proven satisfactory, and thus the large observed abundances of chloronium remain puzzling., Accepted for publication in the Astrophysical Journal

We present a 3-mm and 1.3-cm spectral line survey conducted with the Mopra 22-m and Parkes 64-m radio telescopes of a sample of 40 cold dust cores, previously observed with BLAST, including both starless and proto-stellar sources. 20 objects were also mapped using molecular tracers of dense gas. To trace the dense gas we used the molecular species NH3, N2H+, HNC, HCO+, H13CO+, HCN and H13CN, where some of them trace the more quiescent gas, while others are sensitive to more dynamical processes. The selected cores have a wide variety of morphological types and also show physical and chemical variations, which may be associated to different evolutionary phases. We find evidence of systematic motions in both starless and proto-stellar cores and we detect line wings in many of the proto-stellar cores. Our observations probe linear distances in the sources >~0.1pc, and are thus sensitive mainly to molecular gas in the envelope of the cores. In this region we do find that, for example, the radial profile of the N2H+(1-0) emission falls off more quickly than that of C-bearing molecules such as HNC(1-0), HCO+(1-0) and HCN(1-0). We also analyze the correlation between several physical and chemical parameters and the dynamics of the cores. Depending on the assumptions made to estimate the virial mass, we find that many starless cores have masses below the self-gravitating threshold, whereas most of the proto-stellar cores have masses which are near or above the self-gravitating critical value. An analysis of the median properties of the starless and proto-stellar cores suggests that the transition from the pre- to the proto-stellar phase is relatively fast, leaving the core envelopes with almost unchanged physical parameters., Submitted for publication to Astronomy & Astrophysics on January 18th, 2012

Optimal cardiac filling is essential for maintaining an adequate cardiac output and organ perfusion in patients with cardiogenic shock (CS) after STEMI). Passive leg raising (PLR) represents a “self-volume challenge” that could predict fluid response; the transient hemodynamic effect of

International audience; We report observations of three rotational transitions of molecular oxygen (O2) in emission from the H2 Peak 1 position of vibrationally excited molecular hydrogen in Orion. We observed the 487 GHz, 774 GHz, and 1121 GHz lines using the Heterodyne Instrument for the Far Infrared on the Herschel Space Observatory, having velocities of 11 km s-1 to 12 km s-1 and widths of 3 km s-1. The beam-averaged column density is N(O2) = 6.5 × 1016 cm-2, and assuming that the source has an equal beam-filling factor for all transitions (beam widths 44, 28, and 19''), the relative line intensities imply a kinetic temperature between 65 K and 120 K. The fractional abundance of O2 relative to H2 is (0.3-7.3) × 10-6. The unusual velocity suggests an association with a ~5'' diameter source, denoted Peak A, the Western Clump, or MF4. The mass of this source is ~10 M sun and the dust temperature is >=150 K. Our preferred explanation of the enhanced O2 abundance is that dust grains in this region are sufficiently warm (T >= 100 K) to desorb water ice and thus keep a significant fraction of elemental oxygen in the gas phase, with a significant fraction as O2. For this small source, the line ratios require a temperature >=180 K. The inferred O2 column density sime5 × 1018 cm-2 can be produced in Peak A, having N(H2) ~= 4 × 1024 cm-2. An alternative mechanism is a low-velocity (10-15 km s-1) C-shock, which can produce N(O2) up to 1017 cm-2. Herschel is an ESA space observatory with science instruments provided by European-led Principal Investigator consortia and with important participation from NASA.

Computer-aided diagnosis (CAD) systems using dynamic contrast enhanced magnetic resonance imaging (DCE-MRI) data may be developed to help localize prostate cancer and guide biopsy, avoiding random sampling of the whole gland. The purpose of this study is to present a DCE-MRI CAD system, which calculates the likelihood of malignancy in a given area of the prostate by combining model-based and model-free parameters. The dataset includes 10 patients with prostate cancer, with a total of 13 foci of adenocarcinoma. The post-processing is based on the following steps: testing of registration quality, noise filtering, and extracting the proposed features needed to the CAD. Parameters with the best performance in discriminating between normal and cancer regions are selected by computing the area under the ROC curve, and by evaluating the correlation between pairs of features. A 6-dimensional parameters vector is generated for each pixel and fed into a Bayesian classifier, in which the output is the probability of malignancy. The classification performance is estimated using the leave-one-out method. The resulting area under the ROC curve is 0.899 (95%CI:0.893-0.905); sensitivity and specificity are 82.4% and 82.1% respectively at the best cut-off point (0.352). Preliminary results show that the system is accurate in detecting areas of the gland that are involved by tumor. Further studies will be necessary to confirm these promising preliminary results.

The Vela-D region, according to the nomenclature given by Murphy & May (1991), of the star forming complex known as the Vela Molecular Ridge (VMR), has been recently analyzed in details by Olmi et al. (2009), who studied the physical properties of 141 pre- and proto-stellar cold dust cores, detected by the ``Balloon-borne Large-Aperture Submillimeter Telescope'' (BLAST) during a much larger (55 sq. degree) Galactic Plane survey encompassing the whole VMR. This survey's primary goal was to identify the coldest, dense dust cores possibly associated with the earliest phases of star formation. In this work, the dynamical state of the Vela-D cores is analyzed. Comparison to dynamical masses of a sub-sample of the Vela-D cores estimated from the 13CO survey of Elia et al. (2007), is complicated by the fact that the 13CO linewidths are likely to trace the lower density intercore material, in addition to the dense gas associated with the compact cores observed by BLAST. In fact, the total internal pressure of these cores, if estimated using the 13CO linewidths, appears to be higher than the cloud ambient pressure. If this were the case, then self-gravity and surface pressure would be insufficient to bind these cores and an additional source of external confinement (e.g., magnetic field pressure) would be required. However, if one attempts to scale down the 13CO linewidths, according to the observations of high-density tracers in a small sample of sources, then most proto-stellar cores would result effectively gravitationally bound., This paper has 12 pages and 6 figures. Accepted for publication by the Astrophysical Journal on July 19, 2010

The goal of the study is to evaluate if the use of rotary nickel-titanium (RNT) instruments, as Hedstroem files, is safe. Twelve twisted files (TF) RNT instruments size 06-25 were selected and randomly divided in 2 groups of 6 instruments each. Group A (new instruments) were used as control. Group B (test) instruments were clinically used only as Hedstroem files in a canal that had been previously instrumented to the working length with other 06-25 RNT instruments. Group B instruments were used only in the straight portion of the canal (1 minute at 1000 rpm). A cyclic fatigue test was performed for each instrument of groups. Data were statistically analyzed (Student's t-test). Results showed no significant difference (P > 0.05) between groups A and B. Data confirmed that the use of TF instruments as Hedstroem files is a safe procedure. Cross section images and volumes of the same instrument, before and after cyclic fatigue testing, have been obtained by means of microtomographic analysis to evaluate possible microstructure alterations.

A new manufacturing method to produce more flexible and resistant NiTi endodontic instruments has been recently developed. The purpose of the study was to determine whether this new manufacturing method produces NiTi instruments (TF) of superior flexibility.Ten .06 size 25 prototype (TF) instruments (Sybron Endo) and ten 06.25 ProFile instruments (Dentsply-Maillefer) were evaluated for stiffness on bending. Test procedures strictly followed ANSI/ADA Specification No.28. Bending moment was measured when the instrument attained a 45 degrees bend. All data obtained were recorded and statistically analyzed using an ANOVA test.Statistical analysis of data showed that bending moments were significantly greater (P.05) for ProFile instruments (mean value 59.06 g/cm), compared to the prototype instruments (mean value 35.60 g/cm), thereby confirming the increased flexibility of TF instruments.Results of the present study demonstrate the ability of the new manufacturing process to produce more flexible NiTi rotary instruments.

Background: Histamine is thought to play a pivotal role in the modulation of peripheral and central pain. The administration of increasing doses of histamine may lead to desensitization of receptors of histamine types 1 and 2, causing meningeal vasodilation, and to depletion of neuropeptides in the trigeminal ganglion, thus inhibiting the initiation of migraine. Objective: In this study, the efficacy and tolerability of increasing doses of IV histamine in migraine prophylaxis were investigated. Methods: This single-center, open-label, retrospective, controlled study was conducted at the Headache Center (Department of Internal Medicine, University of Florence, Villa Monna Tessa, Italy). Patients included in the study had 3 to 6 migraines without aura per month that were refractory to common symptomatic and prophylactic agents in the 6 months preceding the study. Patients were treated with IV histamine hydrochloride for 21 days starting with a dosage of 0.5 mg/d and increasing to 4.0 mg/d. To assess the efficacy of the treatment, these patients were matched for age; sex; and frequency, duration, and severity of attacks with untreated migraineurs. Clinical benefit was defined as ⩽ 1 migraine of mild intensity per month. Tolerability was assessed during the hospitalization period, and patients were instructed to contact the Headache Center to report any adverse effects after hospital discharge. Results: The histamine group comprised 47 patients (40 women, 7 men; mean [SD] age, 42.0 [8.6] years) and the control group comprised 23 patients (20 women, 3 men; mean [SD] age, 38.8 [8.4] years). The histamine-treated patients showed a clinical benefit lasting for a mean of 10.4 (4.2) months, while the patients in the control group showed a clinical benefit of 3.8 (1.9) months. The difference in the duration of the clinical benefit between the 2 groups was 6.6 months (95% CI, 5.15-7.99). Adverse effects consisted of flushing, heat sensation during infusion, headache, and palpitations. Conclusions: In this study, histamine showed lasting prophylactic efficacy in migraineurs. If further research confirms this preliminary finding, histamine could be considered when established prophylactic drugs, such as betablockers, calcium antagonists, antidepressants, and antiepileptics, have not been effective.